Swallowing Forum

We had to prepare (what felt like) a half-gallon of amoxicillin suspension the other day. It was a prescription for a teenager. Yes, Mom said, she "can't swallow pills."

Come on now. Sometimes I have a hard time --er--- swallowing that story. I am just somewhat disbelieving of these teens and adults who claim the total inability to swallow a tablet or capsule. I'm not talking about people who are handicapped or developmentally disabled or have some anatomical defect or injury. I'm talking about the normal folks who, somewhere in their past, gagged on a dry tablet or had something go down the wrong way and are now totally convinced it's beyond their capability. Sometimes they don't tell you until the prescription is all ready -- they look at you wide-eyed and say, "oh, I can't swallow THOSE !!" Well, what the heck did you think you were going to get after coming in for a doctor's appointment, receiving a prescription and waiting for it at the pharmacy --- a smoothie, a Big Gulp, what? They act kind of outraged that you would even present them with this daunting task.

The suggestions I give for this problem --- wetting the tablet or capsule and using a straw to drink the liquid needed to swallow it --- are sometimes accepted and sometimes not. Sometimes you can crush the tablet or open the capsule, but not always. But if a person has convinced themselves they can't swallow a tablet or capsule at the age of 15 it will be a difficult pharmaceutical road ahead, for sure.

Anyone have any favorite tips for our non-swallowers? I need some.

This Week's Snapshots, Pharmacy Style

1. Flu Paranoia?--- Naaahhh.....

I'm standing in line at the bank and it's pretty busy. A woman is sitting off to the side in one of the chairs waiting for someone, and starts coughing loudly. The place goes quiet and EVERYONE standing in line turns to look at her. She smiles, laughs, and announces "Don't worry, it's just smoker's cough!" Well, thank goodness.

2. Things that make me go WHAT THE.....????

A woman calls the pharmacy to check on whether one of her meds is safe in pregnancy.

Not because she is pregnant, but just in case. She tells me, "ya know, I don't use birth control but I AM sexually active. " Well, that's what we like to hear.

3. Just plain aggravating...

A guy who's out of refills on his glyburide and who hasn't filled it since JULY is annoyed because we won't 'spot' him a few tablets. I mean, if you haven't been too concerned about your blood sugar for the past 3 months, what's the big emergency all of a sudden?

4. When in doubt, dispense a placebo....

A woman calls and says the new generic brand of acyclovir we gave her does NOT work.

She says she wants the other ones, and implies we have given her some sort of bogus fake acyclovir. I don't even try to argue because there are some battles you're just not going to win. We give her the last few tablets we have of the old brand and wish her happy shopping to find any more. I wish I knew of a better way to deal with this type of thing.

5. Laugh to keep from crying.....

Working with a very slow and kind of unpleasant technician this week who's been given every chance to get up to speed. Waiting for her to crank out a simple Vicodin script that the other techs would have done in about 30 seconds. The other (dryly humorous) pharmacist I'm working with mutters, "What the hell is she doing, harvesting the opium poppies or something?"

A Bit O' the Ugly

We have a customer who comes in every few weeks -- nice squeaky-voiced little elderly lady, early 80's, who seems really sweet. She refills a prescription which is used for possible Alzheimer's symptoms or at least early signs of confusion/dementia, but she comes in unassisted and neatly writes a big fat check for this medication.

The other day I heard her asking the technician about some lab results she had been mailed from her doctor's office. I went over to see if I could help with the question and looked at the letter she had in her hand. There was a serum creatinine result and also an estimated GFR, so these were obviously kidney function tests. There were two results for the GFR, however, and one was labelled "Afr-Amer" or something like that. I don't deal with this a whole lot, but I told her I thought it was because a correction factor is applied if the person is African-American -- there's a different 'normal' range, and the lab printouts show this as a matter of routine so the correct result can be applied. These printouts can be confusing for anyone to read, no doubt, and I figured she just didn't know what the heck any of it meant.

Well, I quickly realized it wasn't the numbers that she was questioning, it was the "Afr-Amer" part. This little mouse of a lady, always pleasant small talk, usually in and out in a minute or two, got kind of upset. She got this hard edge to her voice I never heard before, and said "Why is THAT on there? Are those even my results? I just don't think THAT should be on there!" and repeated these comments several times. We finally offered to call the lab and have them explain it to her. "YES, I would like to do that," she said firmly.

Wow. After she left we all looked at each other, kind of taken aback. One of the techs ventured a comment about "people from a certain era and age group" . It was just weird to see this little bit of ugliness coming out of this (presumed) nice little old lady.

Just another interesting observation from another day at the pharmacy.

My Love Affair with Canadian pharmacies

I have some ties to Canada (specifically, Ontario) and just got back from a trip across the border. Why do I enjoy my occasional visits so much? Is it the unfailing politeness and intangible feeling of civility I encounter there? The lower prescription prices? The health care system that is equally accessible to both the minimum wage-earners and the CEOs? The notices smartly posted in the banks and other public buildings about protecting yourself from the flu?

Yes, all those things, but as a pharmacist I really enjoy snooping around in the Canadian pharmacies.

First of all, there are a number of items that are over-the-counter in Canada that we still need a prescription for in the U.S. -- things like Allegra, Clarinex (although it's called something else) & scopolamine patches, to name a few. I stock up on those for my allergies and airplane flights. Sudafed products are still out on the shelves in Canada. They even have "extra strength" Advil (400 mg per tablet -- sweet!) I don't know what the meth situation is in Canada, although the pharmacy I visited did have two large signs in the front window stating that "narcotics such as Oxycontin are available by special order only." I wouldn't have a problem with that at all.

Then I proceed to the checkout where the candy is, and this is the part I really like.

The uniquely Canadian candy bars like Coffee Crisp, Aero (the bubbly chocolate), Smarties (cousin to M & M's), and the tooth-rottingly delicious Crunchie Bar (sponge toffee coated in chocolate). The clerk must have thought I was loading up for the trick-or-treaters but no, it's all for me to take home and hoard.

Instead of "Dancing with the Stars" they have "Battle of the Blades". It's a show where skating pairs compete, and the male half is an ex-NHL hockey player! You gotta love it.

Oh, and the ubiquitous Tim Horton's coffee and donut shops ---- heaven.

I know I should be thinking about larger issues than these, but not today. I'll take a large coffee and a honey-glazed, and all's right with the world in the arms of our neighbor to the north.