A Teachable Moment?

I have this “iffy back”… most days it works as designed.. and then their are other days :-(.. earlier this week.. it started out as not going to be a good period.. It felt like I had fallen on my right Gluteus Maximus.. and had this intermittent pain shooting down my right leg… (pain level 7-8) … I checked in the mirror .. no bruises … and don’t remember falling..  I thought to myself.. have I gotten to that age when you can’t remember if you fall .. or things just start to break down… for no apparent reason nor external forces involved…

I spend a couple of days.. with a Thermopore heating pad  if you want some serious moist heat.. this is the only way to go.. they are not cheap.. but.. worth every penny. I have been down this path before — Naproxen Sod, heating pad, rest, HCD/APAP and Methocarbamol  and things will be fine… not this time.. as long as I sat, stood, laid in one spot… without moving.. the pain down my leg did not go there… make the first move and OMG… like a cattle prod to the right leg…

Broke down and called my PCP… I have the most respect for him…. have been seeing him for about 15 years…but the six pescriber practice he is in.. is state of the art.. the only way to get to a person is to make an appt.. soooo press four .. leave message for specific doc.. and they advise/warn that the message will not be listen to by the doctor himself… first red flag… and they advise/warn you that unless you hear from them check with your pharmacy after 19:00…

I tell him/them that I have a acute bursitis, pinched nerve, tendonitis… pain shooting down right leg ( 7-8 pain scale) and I need a Medrol dosepak .. couldn’t have been much more plain…

Since I work in LTC.. I am at the mercy of retail pharmacy… like the rest of the poor public… so I go on to the website.. They don’t have the drug in inventory .. instead of a Medrol dosepak .. the order was for Dexpak… I looked up in two references.. WTF is a dexpak… come to find out it is a 13 day therapy of dexamethasone… I called the pharmacy.. keep in mind this is a six prescriber practice within a stone’s throw of  the chain pharmacy.. a product not in stock…???

I asked the female person on the phone at the chain.. was this eprescribed… YEP !!!.. my first thought.. I have been had by eprescribing… did the prescriber tell one of the ancillary staff to give me a cortisone dosepak and it typed in cortisone therapy in the eprescribing software and since Dexamethasone alphabetically is in front of Methylprednisolone.. I got a Dexpak… BTW.. it would appear that the Dexpak is 30% MORE EXPENSIVE than Methylpridnisolone dosepak… and I could have probably got the Methylpredisolone a day SOONER !   Can you say CLUSTER-F ?

Here is the teachable moment… with the female staff on the phone from the chain.. I told her that I had pain shooting down my leg – level 7-8…  her response was… prescriber’s office is already closed and  we have ordered it and it will be in at 16:00 tomorrow… I know that this chain has the right to check inventory in their other stores from their computer system.. and there are at least 6 stores of this chain  in a 15 mile radius… was this offered.. NOPE…  by this time.. I am already on figuring out  my Plan B and I didn’t ask her to check….. but quite honestly… IMO …it was not my place to ask.. how many patients knows the capabilities of the Rx software?

Another 24 hrs of putting up with this pain… I have been a victim of our new EHR  system…  leave VM.. send/get emails/texts… from a patient’s perspective.. this new efficient system.. can SUCK at times…

all the things that I had tried… were not working well…  when you are in substantial pain.. pretty much all bets are off.. in trying to get some relief…  since pain management is my specialty … I can fix this.. at least in the short time…

My wife had recently had a second knee replacement and the surgeon had given her Oxycodone for the pain.. and which I knew she had not taken all of them.. so I go on a scavenger hunt for those ” bad boys”… I had taken 10 mg of HCD… which didn’t work… so I adjusted the dose for 50% more equivalent opiate relief.. good place to start…

Anyone who questions/skeptical of a pt that says that this opiate only addresses this pain .. and other addresses a different pain…  I hate to tell you.. they are right… I have found relief… a 50% increase in opiate equivalent dosing should not have made that much difference .. but .. it did… and I still have all my wits about me and did not move up the “goofy scale”

Then I noticed.. I was starting to have a slight ITCH .. all over… DAMN.. minor allergic reaction… go on a search for a antihistamine…  I can’t tell you how I hate to treat side effects with more DRUGS…

At least the next day.. the Dexamethasone came in and I went and picked it up… Like we have told pts time and time again.. you can just take a whole day’s worth at one time.. which I had done previously with Medrol dosepak…  APPARENTLY.. the potential for gastric upset is much greater with Dexamethasone than Medrol.. when taken this way…

Another search for a antacid and Rantidine to help address the GI upset.. did I mention how much I hate taking drugs to address adverse side effects from other drugs.

Is this a good example of why patients need counseling … with FOUR+  DECADES as a Pharmacist… I consider myself smarter than the average bear .. in this regards.. How do we expect the average patient with MAYBE  a high school education and MAYBE a grade school level  understanding of what is going on with the medications that we provide them?  and we expect them to deal and be compliant and all the other issues that arises with taking medications short or long term?

We RPH’s can be  both jade and privileged about the knowledge base that we have and often don’t consider how large the gap is between what we take for granted and what the knowledge base is for a particular patient.  Is not providing at the very least the minimum of counseling… GROSS NEGLIGENCE on our part?

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