You have failed as a parent. Give up.
Helicopter Mom: "Hi, I'd like to fill my son's prescription."
RJS: "OK, sure. [what's the number/process it/etc.] Hmm… looks like it's about two weeks too soon."
HM: "I know, but he's leaving for college in Florida tomorrow, and he needs it."
RJS: "Umm… okay. You might be able to get a vacation override or something, but they only allow that usually once per year."
HM: "Yeah, that won't help."
*RJS is totally baffled at this point* "You know there are other pharmacies in Florida, right? And that it's trivial to transfer it?"
HM: "Yes, I know. But my son is really ADD, and he'll never remember to fill it himself. Maybe it would be better to just wait until the insurance lets me fill it here and then mail it to him. I think I'll do that, so he doesn't forget."
RJS: "Er… okay?"
HM: "Thanks anyway! Bye!"
"Tastes like happy!"
Remember candy cigarettes? Those sticks of gum done up to look like smokes with a red tip, and the puff of some sort of powder when you blew through it once?
Man those used to make me want to smoke so badly when I was a kid. No joking, either. I couldn't wait to be old enough to puff on a "real" smoke like all the kids that I thought were cool.
Then the candy cigarettes all but disappeared — I stopped seeing them in stores, and I assumed that they were outlawed as part of the ongoing war against cigarette advertising. But I guess I was just looking in the wrong places. This past weekend I went to an ice cream shop done up in 1950s style with some friends. Lo and behold! Candy cigarettes! "WTF?" I said. "I thought these things were taken off the market!" I haven't been this excited about candy since my Valium necklace.
(They also had some big-league chew, which I've not seen in a while, either. Big league chew never got me interested in dip, for what that's worth.)
Unfortunately, I didn't have any cash on me, so I couldn't buy 'em, but I did open the pack, and they looked decidedly less appetizing than they used to. Amazing what time and experience will do…
For nostalgia's sake, you can still get candy cigarettes pretty easily. Amazon will happily sell you a wide variety, for example, and they've also got Big League Chew. (Actually, I think the only things Amazon doesn't sell are cars and houses, but that's what eBay is for.)
Somewhat off-topic: this page is an interesting run-down of the various candy cigarettes over the years and in various parts of the world. I think the type I used to chew as a kid were mostly Mustangs — since re-branded to "Stallions" because RJ Reynolds was too short-sighted to recognize that another company was doing their marketing for them.
In any case, my mom used to be deathly afraid of me getting candy cigarettes for fear that it would lead me to smoking. So I used to have to do it discreetly. I think that added to the allure of both candy cigarettes and smoking in general.
The title of this blog post comes from Family Guy, Season 3, Episode 3 from Baby Smokes a Lot: "Hehe! Tastes like happy!" — which I would upload to share because it's hilarious and oh so wrong… if only I could find an easy way to export Ogg Media Video files to a more web-friendly format. Argh!
[tags]Candy cigarettes, big league chew, nostalgia[/tags]
Off on a sudden road trip
I don't normally update you all on the comings and goings of my personal life, but an unprecedented opportunity to take off on a week-long road trip has presented itself, and I am (naturally) going to take it. I'll be shooting from Massachusetts down to South Carolina for one quick stop, and then off to Orlando, FL, where we will be staying with a friend of a friend. (An ER doc, coincidentally enough).
This is actually the first time I've ever done a spur-of-the-moment road trip. How sad is that? I'm practically jumping out of my skin with excitement…
Hey look, we're at the top of the IQ totem pole!
Hehe, I don't put much stock in IQ tests for obvious reasons, but I couldn't resist posting this:
Stolen gratuitously from here. Hooray for dick-measuring contests!
What does "2 qd" actually mean?
Last night I had a prescription that said "2 qd" — it was a phoned-in prescription. I filled it, thinking nothing of it, and low and behold I see it has been edited to some different directions. "WTF?" I say to myself, pulling out the hard copy. Nope, it definitely says "Π qd" (That's as close to a Unicode approximation to the symbol for 2 that I can come up with.)
"Um, so why did you change this?" I ask, handing the QA pharmacist the hard copy and the edited label.
"Because it was wrong," she says.
"No, it wasn't," I say, handing over the script written by her hand. "2 qd means '2 tablets once daily'."
"You don't know that," she says. "What if the doctor means take 1 tablet in the morning and 1 tablet 4 hours later, or 1 tablet twice a day?"
"Well then the doctor should write that."
"Sometimes they don't."
"I see. *pause* I was always taught that 2 qd means '2 tablets once daily' and if the doctor wants twice daily dosing, the script should say 'BID' otherwise the doctor — not the pharmacist — has made a mistake. And that 2 qd absolutely means 2 tablets/capsules/whatever once daily, with no ambiguity."
"Well, I like to put 'Take 2 tablets every day as directed.'"
We argued a bit after that, but the trouble with sticking "as directed" on there is a nifty way of a pharmacist doing a little CYA, which isn't necessarily a bad thing. The script technically doesn't say it, and generally speaking, the patient hasn't been "directed" in how to do anything, so it's actually not correct to do that. What if the script is for meloxicam or nabumetone?
To aid in the discussion, here's a brief Latin recap for those that have forgotten it, or never learned what the abbreviations actually meant in the first place. Unfortunately, they're not much help, either:
- q: quaque: "every"
- qd: quaque die: "every day" which is generally understood to be "once a day" or "once daily"
- qX°: every X hours
- po: per os: "by mouth"
- od/os/ou: oculus dexter ("right eye"); oculus sinister ("left eye"); oculus uterque ("both eyes")
And so on.
For me, I will continue to write "Take 2 tablets once daily" when I see "2 qd". But to others, that means something different, and I think it's important that prescribers know that that it means something different to each pharmacist. I mentioned this phenomenon in my Chantix prescribing tutorial, and it applies here as well. There is indeed ambiguity, where there should ideally be none.
And it so happens that this presents the perfect opportunity to test out my new polling toy. So I've included 2(!) polls for finer-grained results. We'll pretend we're dealing with tablets for the sake of simplicity. If you are not in the medical field, please vote "Other medical personnel". The poll will open a new window for each poll which is annoying, but there doesn't seem to be a way around this. And feel free to elaborate in the comments — I really had no idea until yesterday that this was something not everyone agreed on.
Alcohol and Flagyl = disulfiram rxn? Where're the data, dood?!
I think probably the first "real" counseling point any pharmacy student learns is "Don't drink alcohol with Flagyl!" If it's not the first thing, it's easily the second or third. In fact, I've seen this hand-written on prescription labels for added emphasis, even though the auxiliary labels that print out already say it. You don't often see "Take with food" hand-written, even though it would probably provide more real-world benefit to the patient than the standard "Don't drink alcohol" mantra.
"Heresy!" you shout. Well, hear me out…
You see, there's almost no data to support the assertion that alcohol and metronidazole combine to create a disulfiram-like reaction. It's crazy, I know. How could this age-old advice be wrong? The reason this is drilled into pharmacy and med students' heads is because the conventional wisdom is old. It got here because "everyone knows" that ethanol + metronidazole = A Bad Time. Even though there's no meaningful evidence to support this conclusion.
Regular readers know my distaste (hah!) for metronidazole. In fact, I missed out on my best friend's 21st birthday drunkfestcelebration because of it. As it turns out, I missed out for naught. Alas.
Exhibit A is a meta-analysis of published anecdotes, "Do Ethanol and Metronidazole Interact to Produce a Disulfiram-Like Reaction" published in The Annals of Pharmacotherapy. Exhibit B is a double-blind, placebo-controlled study out of Finland, also published in TAOP entitled "Lack of Disulfiram-Like Reaction with Metronidazole and Ethanol" which is a bit more science-y and a little less meta-analysis-y.
This is a long entry, so here's a ToC.
If abortion were illegal, what should the penalty for having one be?
There's an interesting home-made (I think?) documentary filmed at an anti-abortion protest. The basic question is "If abortion were illegal, what should the penalty be for having one?"
I can't embed it because it's restricted, so here's a link to it instead. (YouTube)
Some of the responses are:
- "We shouldn't put them in jail. We should pray for them."
- "I don't have an answer for that."
- "That's hard to say. [...] Depends on the state of mind of the woman."
Most of the respondents twist themselves into rhetorical knots to avoid answering the question. In the final analysis, all of them believe that it's "murder," but none of them think it should be punished like a regular murder. (Whatever you consider that to be.)
It's an interesting thought exercise. For something to be illegal, there must needs be a penalty for committing the illegal act, otherwise the law is meaningless. Perhaps they should read this Reason article, "Is Heaven Populated Chiefly by the Souls of Embryos?". It, too, is a thought-provoker for those on both sides of the abortion debate.
As a rule I am not anti-abortion. But I'm certainly not a fan of the practice, either. I think if abortion were ever outlawed again — which I don't think would ever happen — the penalty would fall on the doctors performing the abortions rather than the women actually having them. That's the way these things have historically worked, anyway. Society has no problem punishing doctors, but it seems to have a problem with throwing women in jail. One is more comfortable than the other, I suspect. But I ask, then, if the doctor is the real murderer, then shouldn't the mother also be punished as an accessory to the crime?
What're your thoughts?
[Late edit: It didn't escape me that any answers that were any more substantial may have been edited out to make a point. But I suspect that they weren't.]
[tags]abortion, law[/tags]