Rhythm of Life

We can feel rhythm in just about everything we do.  Driving on the freeway we feel the rhythm of the wheels and the road under our seat.  Sitting in a restaurant we feel the rhythm of people coming and going.  Standing on your porch outside late at night with your eyes closed you can feel and hear the rhythm of the night.  Walking on the beach or next to a river you can hear and feel the constant rhythm of the water.  All of these have a regular rhythm, a regular beat that continues to move.

You know when something changes, when the rhythm or the constant beat is interrupted somehow.  It is clear that if you are sitting in the back seat of the car with your eyes closed driving on the freeway; the car comes into a traffic jam and the rhythm of the drive is interrupted.  We do not always notice the rhythm when it is beating and flowing so smoothly; however, invariably we will become acutely aware of it when it became irregular.

Similarly, our heart has a rhythm that beats relatively constant from the moment life begins.  This rhythm provides a smooth circulation to our body which helps sustain life.  Our steady heart rhythm is interrupted when the electrical impulses that coordinate the rhythm is disrupted somehow, causing our heart to beat too slowly, too fast, or irregularly.   When our heart beats out of normal rhythm, we call it arrhythmic.

Quite often, heart arrhythmias are harmless.  Occasionally, people will have an irregular heartbeat that causes a bit of fluttering or temporary racing heartbeat.  On the other hand, arrhythmias have the potential of causing significant and life threating complications.   An irregular heartbeat is one of the conditions that predispose an individual to developing a blood clot which may get stuck in the legs, lungs, heart or brain.  As we know, blood clots may be life threatening. 

Some irregular heart rhythms can be managed by adopting a Heart Healthy Lifestyle, while other situations will definitely require medication management.  Quite often, a combination of the two will provide the best results; however, this is a decision made between you and your physician.

Anti-arrhythmic medications work by slowing the transmission of the chemicals the heart uses for electrical conduction of the heart rhythm.  This process prolongs the conduction time of the contraction in all areas of the heart which significantly decreases the chances for irregular heartbeats.  This category of medication helps maintain a regular and steady heartbeat.

Please be aware, each medication in this category comes with various Black Box Warnings that are important to understand before taking the medication.   One common warning is the following:

In the Cardiac Arrhythmia Suppression Trial it was shown that patients who have had a heart attack within the last 2 years who were treated for a specific type of non-life-threatening arrhythmia did not benefit and may have been harmed by attempts to suppress the arrhythmia.  These patients showed an increased chance of death during treatment.   Please discuss the risks vs. benefits of this category of medications with your physician before beginning therapy.

Medication Specific Counseling SessionsTM  for the following anti-arrhythmic medications has been added at www.AudibleRx.com.   Please register to become a member, and then have full access to all of the available counseling sessions.

  • Amiodarone (Cordarone-TM, Pacerone-TM)
  • Disopyramide CR (Norpace CR-TM)
  • Dronedarone (Multaq-TM)
  • Flecanide (Tambacor-TM)
  • Propafenone (Rythmol-TM)
  • Propafenone (Rythmol SR-TM)

Please remember…These recordings are meant to supplement your knowledge and understanding of your medications and are not a replacement for counseling with your pharmacist or doctor. AudibleRxTM maintains no liability for your medication education, understanding or usage.  This information does not allow you to take a prescription medication that was not prescribed for you. Talk with your pharmacist or doctor if you have questions about your medication.


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Breathe Easy...Through Your Nose

Before I get lost in the story behind this particular blog, let me tell you, oxymetazoline nasal spray is one of the most incredibly effective products ever developed to clear a stuffy nose.  That said, this particular over-the-counter medication may also be arguably one of the most frustrating products ever developed. 

This medication works incredibly well to clear a stuffy nose; however, if it is used for more than 2-3 days in a row, your body may become dependent on it and you may get a rebound stuffiness that is worse than the original congestion when you try to stop using it.

Three weeks ago I had septoplasty surgery.   For the past 3-4 years I have been dealing with this breathing issue in my nasal passage.  After a few medication therapy trials, my ENT Doctor said he could fix the issue with this simple surgery.  He described to me that he would simply peel back the mucous membrane that covers my nasal septum.  He would then use his scissors and cut out a little of the protruding bone and clean out a little of the septal area.  Next, he would replace the mucous membrane, put in a few stitches and it would be finished.  Sounds painless, right?

The surgery went beautifully.  I was home from the surgery center by 11am, resting in my chair.  Yes, there was a little swelling and I could definitely feel that someone had been cutting on the inside of my nose; however, the incisional pain was really not that bad. 

Later that evening, I began to get a little tickle in the back of my sinus.  I woke the next morning with a fever and my nose was beginning to get a little stuffy.  By the time I made it into my follow-up appointment that afternoon I had a fever of 101.5F and my nose was so plugged up I couldn’t breathe out of it.  Here is the catch; I was told I could not blow my nose for at least a week because of the recent septoplasty surgery.

While I was at my appointment my Doctor asked me if I would like a little blast of oxymetazoline.  He has this special little nasal blaster he uses to squirt the medication back into the sinus.  I asked if he thought it might help my congestion and his reply was, “well, let’s see”.  So, he blasted two squirts of this medication up each nasal passage and within five minutes I was able to inhale through both nostrils like a wind tunnel.

This was both fantastic and scarry at the same time.  I have been a pharmacist for many years, yet rarely do I get to see a medication work so quickly and efficiently.  My nose is telling me, “YAHOO!!”; however, my pharmacist brain is telling me to be careful.  I was hesitant to use a dose the next day because of such great concern for the rebound effect.  Over the next  four days I used two more doses of this medication.  Each time, my sinus passage cleared out almost immediately and allowed for a beautiful nasal inhalation of oxygen.

Again, this medication works very well for SHORT TERM treatment of nasal congestion.  If you use this medication more than twice daily for more than three days, you will have a very difficult time tapering off of the medication without experiencing some extreme rebound congestion.


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Count, Pour, Lick & Stick...We're Talking Productivity Here

Over the past few years I have read quite a bit about the measuring of pharmacist’s productivity.  Some of the Chain Pharmacies have over 20 metrics that they use to measure all aspects of how long it takes to get a prescription ready for a patient, get paid, get the patient out the door, and on to the next prescription.

I have yet to come across any metrics that are used to measure how well a pharmacist counsels their patient.  A metric that looks at how well the patient understands what they are going to do with their medications and measures their outcome of therapy based upon the results of the counseling interaction they had with their community pharmacist.

Where I work, we have one metric that we are measured with; the number of prescriptions we fill each day.  This is by no means a perfect metric; however, the accountants need a number to gauge our productivity.  On any given day, we usually meet our metric.  I am taking a moment to discuss this because for some reason the question has come up a few times recently, “What is it you do in the pharmacy anyway?” 

The other day I took a few moments to try and document the activities of a normal day in the pharmacy. 

·         24 times I met patients at the pharmacy counseling station to discuss their new medication with them, assuring that it did not interact inappropriately with their current medication profile and that they understood all the appropriate information about their new medications.
·         5 times doctors called to consult about medication regimens, 3 were for antibiotic therapy regimens and 2 were for pain medication regimens.
·         3 times I called doctors to discuss a potential drug interaction on a new medication order. 
·         1 time I called a doctor back to clarify the dosing on a prescription written for injectable blood thinner medication.  The dose was not appropriate for the patients’ weight.
·         3 times I called doctors to clarify prescriptions because the dose that came through on the electronic prescription was different than the dose we had filled last time for the patient.
·         1 time I called a doctor in the Neonatal Intensive Care Unit to clarify the dose that he wanted us to compound for a newborn being discharged from the hospital.
·         I participated in helping discharge 3 patients from the Behavior Health Unit, each of which had at least 5 prescription orders, and one of which had 13 prescription orders.
·         I worked with a Social Worker at the Hospital to help discharge a patient that had no funds.  We helped them receive 48 hours supply of discharge medications to hold them over until they are able to get to the county/state resource available to them to complete their prescription order.
·         I participated in helping fill a Hospice Admission order which includes 9 emergency medications and then counsel the family member on the use of these medications.
·         I worked with my partner in the store helping to implement a new “real time” computer narcotic inventory system.
·         14 times I consulted with patients on over the counter concerns relating to cough, congestion, diarrhea, constipation, itchy eyes, dry mouth and various other situations.
·         Participated in helping to compound 3 different medications for pediatric patients.

I participated as a member of a team of 2 technicians, 1 pharmacist and 1 pharmacist manager.  Together we exceeded our metric of how ever many prescriptions we needed to fill that day to stay positively productive.   More than that, we worked as a team to assure that our patients received the best possible pharmacy care we could give them. 

Community Pharmacists do fill prescriptions; however, they also know who you are, know your medication profiles, and work behind the scene all day looking out for your best pharmaceutical interest.  Until the point comes that we are able to measure the effectiveness of how a pharmacist participates in your pharmaceutical care, we will continue to count how many prescriptions we fill each day.

You may also be interested in reading:
Mail order pharmacy
Modern Day Snake Oil (Dietary Supplements)
Medications from Canada


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Unfair Playing Field

Yesterday at work, I had one of my nice Medicare D patients come into the store with a stack of papers in her hand.  She looked my way and asked if she could speak to me for a few minutes.  She proceeded to lay out a series of papers discussing her Medicare D options during this year’s enrollment window, which closes in three more days.  Based on the information that she had, she was being told that next year our pharmacy is still in her network and she would still be able to use our pharmacy; however, it would be at an increased out of pocket expense.  She was being directed to one of the local Chain Store Pharmacies who has a preferred contract with this particular insurance company. 

We have been serving this customer for over 15 years.  We know her profile, her doctors, and she has developed a relationship with both of the full time community pharmacists who work here at the store.  She is now being told that if she transfers her prescriptions to this Chain Store pharmacy, she has the potential of saving over $400 per year in co payment costs.  This is an unfair playing field.

Of course, we discussed service.  We talked about how we are available for consultation and any time we are open she is able to call us and get a pharmacist on the phone and discuss whatever medical related question she has.  She totally agreed with me about our service; however, $400/year comes to more than $30/month and she is on a tight budget.  This is a significant savings in cash flow for this particular customer.

Selling our service is a reasonable argument to maintain business when we are going up against a mail order pharmacy.  To many people, it is perfectly reasonable to maintain prescriptions at a community pharmacy and pay a little extra for their refills so they have access to a community pharmacist  who is familiar with their medication profile.  This argument is not so strong when the patient is being told they can use any pharmacy in the network; however, they will receive a substantial discount if they use this particular chain store preferred pharmacy.

In the past, we have had many situations where patients have transferred their prescriptions somewhere else for convenience, then, after 2-3 months they have transferred their prescriptions back to our pharmacy because of the service.  They appreciate the relationship they had developed with us and are willing to drive a little further or work our hours into their schedule to utilize our service.   I don’t know if this will be the same situation for a Medicare D patient on a limited budget. 

I find the whole scenario very frustrating that a Medicare D patient is being told they need to transfer their prescriptions from a pharmacy that they have used for over 15 years in order to save $30+ dollars per month.

Here is what could have been done differently.  When the open enrollment time comes around, look for more than just the best cost.  Look for the best cost at the pharmacy that you want to use.  There are many different Medicare D programs available and they all want to have your business.  Different Medicare D programs are affiliated or aligned with different and specific Chain Store entities.  If you are linked into one of these programs, you will be directed to that pharmacy.  Look for a program that allows you to pick the pharmacy that you want to use.

Follow this link to the Medicare D prescription plan finder tool.  This will help you find the plan that is best for you.


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