Angry vs. the Angriest...

Ok, just want to post something I noticed here.  Angry Pharmacist was here first, right?  Why is there an Angriest Pharmacist?  How about another name Angriest or Angry?  Do the right thing in this case, I implore you to change your name.  It seems like to me you lose a lot of cred hanging in the same circles as someone you are copying.  Is this even true? Or maybe my true theory is correct.  You are one and the same -- you just have so much anger, you want to be angry and angriest!  Where in the hell is angrier then?  We need an Angrier Pharmacist! 

Paternity Testing Available More Discreetly

Friday , February 29, 2008

By Marrecca Fiore

Who needs Maury Povich when paternity tests are now available at Rite Aid, Meijer and other pharmacies for just $29.99?

The Identigene DNA Paternity Test Collection Kit was first rolled out in Washington State, Oregon and California in November last year, according to Rite Aid spokeswoman Ashley Flower. The company continues to evaluate whether it should expand the kits to other states, she said.

According to the Identigene's Web site, the tests compare genetic information obtained from cheek swabs collected from both the child and the father. The swabs are then sent to the company's laboratory along with a $119 lab fee. The results are mailed within five business days.

While the tests are believed to be accurate (the company's Web site says they're 99 percent accurate), there are some reasons why women and couples may want to consult a professional laboratory for paternity tests, said Brad Imler, president of the American Pregnancy Association.

"There's no risk of harm from a medical standpoint," he said. "Although they're not admissible in court. And, from an emotional standpoint, it's a good idea to see a professional. It doesn't have to be a doctor, but someone who is prepared to discuss the result with you if it comes back in a way you were not expecting."

Imler said some people, especially married couples, may find the results of paternity tests traumatic.

"Whatever the circumstances are that bring someone to the point of needing a paternity test, that's irrelevant," he said. "The professionals associated with the laboratories are trained to present the results in a way that doesn't cause panic or in a way that reduces panic."

Both Rite Aid and Identigene representatives say the tests have brought no more controversy than at-home home pregnancy, blood pressure, cholesterol and drug tests did when they were first introduced.

"There was a lot of concern when the home pregnancy test first came out," said Douglas Fogg, chief operating officer for Identigene. "Would people use it correctly? Would people be able to handle the results?

"We have been providing home DNA testing since 1993 and on the rare occasion we'll have a client that has a hard time dealing with the results," he continued. "Most of our clientele are aware of what the results will be. They don't want to involve lawyers or physicians. They just want confirmation in a quick, easy and confidential way."

Fogg said the company’s Web site provides consumers with counseling information

"Some people are devastated by the result of a paternity test," he said. "A paternity test can have a life-changing result. For those that need professional help in dealing with their situation, our Web site offers references to family counseling services that can provide people with the help they need."

Fogg said 60 percent of Identigene's clients are females. Some users are looking to confirm their own paternity. Almost 30 percent of purchasers buy the test for someone other than themselves, according to the company's own surveys.

The tests are sold in 1,000 pharmacies nationwide, Fogg said. He said all pharmacies have reported sales and the company is pleased with the interest. The tests are also marketed online and through resellers.

Questions asked...

- What are the typical work hours of a hospital pharmacist? Well in my case, it kind of depends on what shift you get.  Since hospitals are open 24/7, including holidays and weekends, someone is working early day shift and others 2nd and 3rd shift.  At one hospital, we had some pharmacists working 12 hour shifts (3 - 12 hour shifts) a couple that did 3 - 13.5 hour shifts to get the 40 hour per week.  I personally worked four 10 hour days - 7am-6pm (hour lunch).  I worked every fourth weekend.  Now the weekend rotation probably depends on the particular hospital.  The holiday rotation was usually two per year for me.  Christmas/July 4th, Thanksgiving/Memorial Day, etc...

- What are the common working schedules?

Typical 1st, 2nd, and 3rd shifts as mentioned above

- Is the method of income for hospital pharmacists in anyway related to Medicare reimbursement schema? If it is, I’ll never erase this cringe on my face :[…

Never has been related.  I made a salary (not hourly).  Today, I'm hourly working from home - with 7 hospitals and has nothing to do with medicare reimbursement or any other insurance situation.  In fact, I make a dollar amount per hour and actually time + half for anything over 40 hours per week.  The other hospital job was a straight salary; however, you could make something similar to time+half to volunteer for more.

- It seems to me that all this hype about shortages of available pharmacists is only the result of retail chains opening more stores than can be staffed. How is the job availability for hospital pharmacists?

In my particular area, there are always jobs available.  It really depends upon the area I believe.  I'm in a city that has 10 or more in a 60 mile radius.

- And last but not least, if people disdain retail pharmacy so much, why do most people choose it? Correct me if I’m wrong, but most graduating pharmacists sign up for retail right?

Hmmm...  I guess they do.  The money is enticing...  also the sign on bonuses alone can erase some student loan debt.  Other pharmacists really like people interaction and retail is all they knew prior to pharmacy school.  Some students do not enjoy the hospital environment.  Please keep in mind though, hospital and retail are only TWO of the many many opportunities.

Thanks a bunch! You wouldn’t imagine how much your responses mean to me. I can hardly dig up any information via Google.

Is It That Bad?

A potential pharmacist student commented on my blog here asking me if pharmacy was really that bad... he said he was reading blogs about the medical profession and all we do is gripe and complain. Got me to thinking this early morning about that question... "Is it that bad?" For me, no way it's not that bad or I would have already gone back to school to do something else. I believe it's human nature to complain some and especially to complain anonymously. Things about pharmacy that I have loved... This is a list probably needed to be completed to tell you guys and gals the GOOD stuff.

1. If you loved science and you loved biology in high school and college then pharmacy could be the career for you. Not only did I have the opportunity to learn about chemicals, etc..., but I learned the various ways they are changed, metabolized, and excreted by the human body. Not only that, but the different ways they can be broken down by DIFFERENT human bodies - some with renal issues, some with hepatic issues, etc... Everyone can be truly different. Drugs can react differently. I found this one single point of pharmacy to be quite fascinating.

2. If you want to graduate in 6-8 years and start out making six figures (potentially) this may be the job for you. I found in 1999 when I graduated that I was making close to six figures, but a lot of the older pharmacists were really ill about the new guys on the block because they knew we were making the exact same pay. It wasn't pay based on performance but LICENSURE. For the new guy, this is great; for the old guy, it can be disheartening to think that little youngin' next to you is bringing home the same bucks. I'm almost 10 years out of pharmacy school now (unbelievable time flies!) and it STILL DOES NOT BOTHER ME. I don't get wrapped up in petty stuff, and I figure if you really want a dollar more per hour, you could have negotiated up front. BE A SHARK when you negotiate - ASK FOR THE IMPOSSIBLE. If you do not ask, you will NOT RECEIVE. Vacation... they say we'll give you 3 weeks. Tell them that you want 4 weeks. Go up on pay by at least 5-10K per year. Why not? They want you and they will negotiate just like if you are selling a house.

3. Options other than retail. When I tell people I'm a "pharmacist," the majority think retail. What is great about pharmacy is that there are MANY MANY options in different jobs. Of course coming out of school, retail is the most lucrative in pay, but over time other positions can be just as tasty. There are the hospital pharmacists (me), the home infusion pharmacists, the nuclear pharmacists, the retail pharmacists, the professors in a pharmacy school, the long-term care pharmacist, the consultant pharmacist, and the specialty pharmacists within other settings. You can do a residency, make yourself a little different than Joe PharmD next to you, and land a Critical Care Specialty Pharmacist position at a big city hospital, make rounds with a physician that actually respects you if you know your shit and drink Starbucks coffee everyday leaving for home at 5pm like the rest with bankers' hours. The CHOICES ARE ENDLESS really.

I've been out of school, like I said, for 10 years almost. I have tried retail, home infusion, long-term care, and hospital. I love little bits of all of them... but I find hospital to be the most comfortable for me.

I would never tell someone to NOT pursue pharmacy. It's a great career for anyone... BUT you will find some complaining out there... even from me.

Blogs have to be funny after all, right?

Comments about working from home pharmacy

I have received quite a few comments about this particular niche within pharmacy - working from home.  I don't really have a lot of information to share about how to find a setup like this, but to research and ask in your local area.  There are still laws to consider, crossing state lines, etc...  and other things that individual companies have to explore with their legal department(s), etc... but in my case, this started up I believe a few years ago as a pilot program.  It's still not very large and still could collapse I believe... nothing is for sure. I do know that a company that owns Acc.redo is using at home pharmacists, and I heard rumors that Walgr.eens was as well.  No confirmation from anyone on that yet.

Network network network.  It's the only way to find those specialty jobs.  They just don't fall in your lap, I can say.

What advice I would give students graduating from pharmacy school

Seems others are doing the same, so I'll put in my 2 cents. 1.  Don't assume that all of pharmacy is retail.  Yes, you will make the most bucks in retail and if you have gone the way of borrowing your way into a huge hole, then it may be your only way to make it out and then find something else.  Perhaps retail is your goal, and you love it, but personally, I found 3 years of retail to be enough pharmacy prostituting that I could do.  The bucks WERE nice, but the abuse to my body from standing 14 hours a day, lack of bathroom breaks, treatment from STORE managers who have barely any sort of education, abuse from patients, and abuse from non-caring technicians, I look back now and say RUN -- no I SCREAM RUN!  There are some great jobs out there that don't involve retail at all.

2.  If you DO choose retail know that the longer you stay IN retail, the less likely you'll ever get out.  It's like getting hooked on a drug.  You keep doing it saying you'll quit, but by the time you are ready to leave, it's almost too late, unless you are lucky and some poor sweet manager in a different realm of pharmacy sees the pain you have experienced and wants to throw you a lifeline.  I had one of those - a female pharmacist that I am forever indebted to.... thanks J!

3.  Make pharmacy a hobby somehow.  Read and read and read.  The only difference between you and the girl (since girls are taking over ;)) standing next to you is that you somehow have made yourself marketable... you are reading publications and keeping up.  You are giving a rats ass about pharmacy and all the crap going on...  You know how to find anything FAST...  you can think on your toes.  Who care what you made in Biochem.  No one cares.  But do you know the difference between using Primaxin/Fortaz vs. Tygacil in different situations?  Can you think critically?

My top advice... DO NOT GO INTO RETAIL!!!!!!!!!!!!!!!!!!!!!!!!!!!

Night Shift Pharmacists

Looks like working the night shift is carcinogenic.  Can't you hear it now?  The lawyers on TV asking, "Have you been working the graveyard shift for such-and-such years?  It's not called graveyard for nothing!  Call 555-5555 and file your claim today against your company!" Article here and here.

Brain Shivers... Brain Zaps... Brain Shocks...

I do not know if many in the medical community are aware of this term that is thrown out there for such offenders as venlafaxine (Effexor), duloxetine (Cymbalta), paroxetine (Paxil), fluoxetine (Prozac), sertraline (Zoloft), fluvoxamine (Luvox), citalopram (Celexa), and escitalopram (Lexapro), but it is a very real phenomenon. Unfortunately, though many in the medical community have not had to rely on any of these meds in their own personal lives, I had a 2-3 year stint with venlafaxine from 2002-03. Basically, I presented with the inability to sleep due to anxiety of some personal issues (which we all have from time to time), and did not want a controlled substance. I tried paroxetine first and absolutely despised the drug. I quit cold turkey. Very smart for a pharmacist, right? (You can't just stop cold turkey and expect to not endure some uncomfortable sensory disturbances.) I found venlafaxine, at 75 mg extended release, to be a very good drug for its purpose of 9 to 12 months. However, what I didn't expect was that weaning from the drug would be so uncomfortable. 75 mg in itself is not even a moderate dose, falling more into the lower dose category. I've seen higher doses much more than the lower doses.

To explain what I felt, I will do my best to try to break down into words the feelings. Initially, there was a sinking feeling in my brain. If you've ever been to the Grand Canyon or a very tall building and looked down, there is a falling feeling that your brain sometimes throws at you though you are not falling at all. That feeling would happen for very short bursts, 2-3 seconds, enough to disrupt my thoughts, my work, and my being. I would just think, "What was that?" If I tapered over the recommended taper schedule (usually a week at a time step down, but keep in mind there's only one strength lower than the 75 mg XR - the 37.5 mg XR. Then where do I go? Literally it didn't matter. The big divide between the 75 mg and the 37.5 mg was enough to cause the "shivers" in my brain - a disorientation, falling, weird, and uncomfortable feeling.

"Brain zaps" are said to defy description for whomever has not experienced them, but the most common themes are of a sudden "jolt," likened to an electric shock, apparently occurring or originating within the brain itself, with associated disorientation for a few seconds. The phenomenon is most often reported as a brief, wave-like electrical pulse that quickly travels across the surface of (or through) the brain. Some people experience these "waves" through the rest of their body, but the sensation dissipates quickly. They are sometimes accompanied by brief tinnitus and vertigo like feelings. Immediately following this shock is a light-headedness that may last for up to ten seconds. The sensation has also be described by many as a flashbulb going off inside the head or brain. Moving one's eyes from side to side quickly while open has also been known to trigger these zaps and sometimes causing them to come in rapid succession. It is thought to be a form of neuro-epileptiform activity.

As withdrawal time increases, the frequency of the shocks decreases. At their peak, brain zaps have been associated with severe headaches. They may last for a period of several weeks after the last dose and usually resolve completely within a month or two. However, anecdotal reports of "zaps" during a protracted withdrawal are known to last a year or longer.

My remedy was to open the capsule and to count the tiny beads and literally make capsules with less and less tapering over a 6 week period rather than the usual 2 - 3 weeks at this dose. It did eliminate the feeling, but it definitely helped. One could go as far as asking the physician for a 37.5 mg immediate release tablet and maybe breaking it up into pieces and tapering at the very end that way. Any way you dice it, venlafaxine was a pain and taught me right away a bigger lesson in remembering the side effects than any package insert ever could.

10/31/12 - update and fitting it is Halloween! Guess what? Add Cymbalta (duloxetine) to the list. It has been given approval for pain, both arthritic lower back and cancer. Withdrawal when you miss a dose.

I did take Vitamin B Complex, and maybe it helped.  Others have mentioned other vitamins.  Would love to hear remedies that worked if you can email me at theblondepharmacist@gmail.com

Hospice Care

When I'm entering/reviewing orders for someone with terminal cancer and the last "D/C to hospice" order.  A lump will come up in my throat and then I start thinking about life.  What will I die of?  Will someone enter my last orders someday?  Will I die of a terminal cancer or something else?  I know I shouldn't think about it, but the last few decades of life have passed rather briefly.  Will the rest of life be the same?  Quick and so fast you don't take the time to enjoy it? Anyway, that's what those orders do to me... and then I have to clear my thinking and my mind and get back to work.

I just wonder sometimes if others are affected by it in the same way.

One of the most profound rotations in my last year of pharmacy school was with a hospice nurse.  To this day I still remember each and every patient we visited at various stages of dying.  The man whose terminal wife was hours if not a day from death but yet he seemed so stoic and in denial.  That one was the worst.  They had this gorgeous custom home with all the fine details and obviously had planned retirement together in this space.

Life had other plans.

To answer a question...

A comment was left on my blog asking me what did a work at home pharmacist do?  Good question!  I'm sure that most of the world has one image when thinking of a pharmacist.  The neighborhood retail pharmacist standing behind a counter with a phone propped on one shoulder (bad ergonomic posture) while typing in a prescription into a computer where the computer does all the brain work, etc...  There are many other pharmacist jobs out there... so many more that I want to take the time to address a few.  I am sure I will leave out some, so feel free to comment and leave more examples, if you wish. 1.  Hospital Pharmacist (staff) - the staff hospital pharmacist usually reviews orders that are entered from the chart.  In some settings the hospital pharmacist enters and reviews the orders from the charts, checks for drug interactions, appropriate doses, etc...  They also check carts that are filled with drugs for stock on each of the floors.  They also enter all chemotherapy orders (finding more mistakes, usually since dosage can be calculated by body surface area, etc...), mix chemotherapy and prepare, mix and prepare total parenteral nutrition (in layman's terms "IV food") that contains dextrose, lipids, amino acids, and a variety of electrolytes and salts, etc... that even within themselves have to be a specific concentration and even mixed in a certain order to prevent precipitation.  Precipitation in the vein is a bad thing.  They also mix and check IVs ranging from the easy vancomycin in sodium chloride to IVIG.  Some hospitals have staff pharmacists performing kinetics checks to make sure that the little 90 year old woman can renally (that's with the kidneys) clear certain drugs like vancomycin, tobramycin, and levaquin. 

2.  Specialty pharmacists in a hospital setting - Here we go, these are the pharmacists that did a residency - working for half of the pay for a year or more - learning a speciality.  Critical care pharmacists, infectious disease pharmacists, coumadin pharmacists, on and on and on...  These guys don't help much with the day-to-day stuff.  They usually do a lot of speeches, have pharmacist students under them during the year, have more of a 9-5 job, etc...  It's too narrow a spectrum for me, but it's definitely a brainer side of pharmacy.

3.  Work at home pharmacist - a lot of companies are centralizing their operations and in doing so the order entry/review front end work can be done from home.  Some companies that have many hospitals are condensing all of this into one job at home.  Depending on the company, you can be checking front end orders from charts that are scanned into a computer program like Pyxis all the way to handling one or two specialty drugs. 

4.  Retail pharmacist - makes a lot of money.  A lot of headaches.  A lot of stress.  And I never ever got to take a pee.  I remember most days holding my pee for 12 hours at a time all the while listening to the public bitch about their higher copay.  The real issue is that Eckerd, Walgreens, CVS, etc...  don't give you enough help hours so there's this frenzied pace of working that leads to the horrid mistakes you hear about on the news.  There's some good retail situations, but I found them few and far between.  Perhaps I am a wuss.

5.  Long term care pharmacist - front end and fulfillment responsibilities for servicing nursing homes.  Omnicare is your biggest player with Pharmerica/Kindred right behind.  Can be a good schedule. 

6.  Consultant pharmacist - the pharmacist that travels about nursing homes and residential places checking charts required by law and destroying expired controlled medications.  Making recommendations, etc... 

7.  Drug rep - Drug expert at one or two drugs - don't have to be a pharmacist.  Learns exactly what the drug company tells you.  Carries around charts and studies to look smart.  Gives away pens, free lunches, and sponsors speeches about the drug.  My personal opinion can be attacked here, but I feel this job is a conflict of interest for the public.  Some docs don't do their homework and what their drug rep tells them is what they believe.  Even if it is false.  Even if it is misled.  There are some good drugs out there, though.  I just bet the Avandia drug rep is a little nervous right now.

8.  Drug Information Center - mans an information center to answer questions from anyone, universities, and the public about drug questions, pill identification, etc...  The ability to know how to research and find what is needed.

9.  Pharmacy professor - self explanatory.

10.  Home Infusion pharmacist - takes call for new admits going home from the hospital on some sort of IV medication whether it be TPN, desferal pump, or an IV antibiotic... it's all IVs... no tablets, etc...  but a nice little clinical niche.

 I'm sure I'm leaving some out... but I wanted to at least let the world know pharmacists are more than the retail version.