In November 1993, my husband, Bob, and I had come down with a really nasty case of the flu. Flu season was bad that year. We were supposed to go down to Kennewick, Washington for Thanksgiving to see my sister and her family. We didn’t make it.

Bob and I got over the flu. Or so I thought. Well, the good news is that at least Bob got well. But I was not so lucky. I kept getting sick.

At the time I was working as a janitor with a large janitorial firm here in Spokane. It was a union job and I was fortunate enough to have health insurance, which was with Group Health Northwest. Yes, a large HMO.

I wasn’t just having flu like symptoms. I had severe breathing difficulty. Fortunately, it wasn’t bad enough to require oxygen. There was also excess mucous from my lungs. It had gotten to the point that I’d be in the bathroom, violently heaving this stuff up from my lungs. My lungs were a little sore afterwards but I was breathing easier. What was hard for me was going to bed and waking up the next morning to find it covering my face and even some in my hair. I literally had to wash my hair daily, which wasn’t easy. You see, I had a bathtub, no shower, and thick curly black hair that was and still is shoulder length. Being sick my tail dragged all the time always fatigued. I had this feeling that I was really ill. This wasn’t going to just ‘go away quietly’. I just knew something was seriously wrong. There was an eerie uncommon feel to it.

I finally got sick and tired of being sick and tired. I made an appointment with Dr. Sayers, who was my primary care physician, after two months of the on again off again illness. I told him exactly what was going. I told him everything. After a blood test and a chest x-ray, I was informed that it was bronchitis. I never had bronchitis before so this was a first for me. He prescribed an antibiotic for me.

Well, the bronchitis continued to reoccur. And everything time it did, I would go back to Dr. Sayers, only to get the same prognosis. One occasion, Dr. Sayers informs that I have the bronchitis but my asthma was flaring up as well. He continues very rudely with “You really should have told us about that asthma thing.” Naturally, my response was “I don’t have asthma and I’ve never had asthma. Are you sure?” I was really getting scared at this point. I had been dealing with this for almost two years at this point.

Dr. Sayers lit into me about it. Some of you have probably been subjected to the song and dance routine that a small minority of doctors dish out about how they’re the doctors and had the eight year of college. “Doctor knows best.”

Needless to say, I went off on him. I lit into with both barrels blazing. My response was that I wanted a second opinion like now, if I didn’t get it I’d go over his head and he had better not talk to me in that manner ever again because I absolutely did not have any qualms about turning his butt in to the administration and escorting him out of the building via the third floor window in the exam room I just so happened to be in. Evidently he believed me because by the end of the week Dr. Noble’s nurse called me to schedule for an appointment.

Well, she (Dr. Noble) was a major improvement. She’s a doctor in internal medicine at Group Health. Really nice lady and seemed to know what she was talking about. She had reviewed my file and we had talked about what was going.

Some of the things that we had talked about included anything that might run in the family, Cystic Fibrosis, and other possibilities like Tuberculosis and Cancer. She had ordered another chest x-ray and blood work, including an A.C.E. level. The test for the A.C.E. level is to find out if it is present and how high that level is, because it’s present, from what I understand, shouldn’t be higher than 50. Dr. Noble called me with the results. Mine was over 100. She suspected a disease called sarcoidosis. That’s pronounced the way it looks. (Sar coy DOH sis.)

Dr. Noble set me up with a referral to a doctor in pulmonology at Rockwood Clinic. I met with Dr. Byrd in December of 1995 for the first time. He’s a sweet, older man who looks like someone’s grandfather as well as a doctor. I like him a lot, even though he shoved a tube down my nose. We setup a time for me to go the hospital as an outpatient for a bronchoscope. What they did was gave the medication in a nebulizer, which is one of those long blue tubes that are used for breathing treatments. This medication was to freeze up my throat. It caused me to cough badly, though. I was also given an anesthetic to put me to sleep. While I was out cold, they put a tube in my nose and put in to my lungs so they could tissue to biopsy.

The next thing that I remember is starting to wake up while the orderly was wheeling me on the gurney to the recovery area. When I fully came out of the anesthesia, I was allowed to go home. I got home via Spokane Transit Authority. I took a bus.

My next doctor’s appointment with Dr. Byrd was in January 1996. I was told at that point that I did have sarcoidosis. He started me on 40-mg prednisone daily. We’ve been gradually decreasing over the years. Currently I take 1 (10-mg) tablet daily. I am also taking other medications for asthma and high blood pressure. But I guess that other than that, I am okay. At least I am still among the living.

Quite a bit of time has passed since I was diagnosed. And a lot has happened since. I am thankful for the support I’ve had. Some people aren’t so lucky.

I keep trying to have a positive and most ofthe time it isn’t hard. But that doesn’t mean that there aren’t down moments. It is possible to live with this.

Finally, as she hangs up the phone, the pharmacist notices that one of the patients is arguing with the clerk about his insurance co-pay. Why is it $25 and not $15? The pharmacist walks past your almost-ready prescriptions to explain to the angry man the pharmacy has no idea what co-pays are for any given plan. That knowledge is the responsibility of the patient. All information is entered into the pharmacy computer, sent immediately to the insurance company and they send back the co-pay information. This is true for all insurance plans. He pays, but goes away mad, sure that the pharmacy is trying to “steal even more of his money!”

The pharmacist heads back to the counter and finally gets to check your prescriptions. There are no problems and they are ready to go. Now, just as she is ready to explain the medication to you the phone rings and as all the technicians are helping others, she must answer the phone. It is a patient calling in seven refills, all of which they would like to pick up in about an hour. Would that be possible?

At last the pharmacist is able to counsel you about your prescriptions and then turns you over to the clerk to check you out. Whew!

Unfortunately that scenario is all too common these days in the pharmacy business. It continues all day long and has become a source of great frustration for both the patients and the pharmacy staff. What was not mentioned above is that for every prescription filled in that scenario, the insurance company paid the pharmacy $4 (on average … sometimes it is less than that) over and above the cost of the medication.

Now you can see why a pharmacy must do great volumes of prescriptions to be able to repurchase the medications used, pay the staff, the bills, etc. Now you can see why, as much as all of us behind the counter try to make sure no mistakes are made, errors do occur. Now you can see why, as much as all of us behind the counter try to make your wait as short as possible, circumstances often prolong that time. Now you can see why, as much as all of us behind the counter would like to spend more time making sure you understand everything, we just don’t have the time we wish we did.

Is there anything you as a patient can do to help make your wait shorter and reduce the chances that a medication error could be made on your medicine?

There are a few things to keep in mind.

You are responsible for your insurance information.

Always carry your card with you and be aware of your co-pays. The pharmacy has no way to know what your particular plan offers and cannot reduce your co-pay if it has increased. If you have a problem or don’t understand why your co-pays went up you need to call customer service at your insurance company for the answers. If you have a new insurance plan, be sure to give the information to the staff before they even start filling your prescription. That will speed up the process considerably.

Always call in regular refill medications several days before you need it and give the pharmacy some idea of when you are going to pick them up.

This is helpful in case you are out of refills and the doctor’s office must be contacted, if the medicine is out of stock, etc. Never take the last pill and then call in the refill and expect it ready in an hour. That puts undo pressure on everyone.

If your pharmacy offers a drive-up window, please try to use it only for drop-off and pick-up.

Don’t ask the pharmacy staff to get you some aspirin. If you need to shop, come into the store. Also, don’t bring five new prescriptions to the window and then wait for them in your car. This just ties up the window, not allowing others to pick up their medications.

Whenever possible, don’t call in routine refills on Mondays.

The volume of prescriptions is always greatest on Mondays, and that always increases the risk of a medication error being made.

To make your wait shorter, try to avoid coming to the pharmacy between 11 a.m. and 1 pm and 4 p.m. and 5:30 p.m.

Many people think they will just “drop by” the pharmacy and get a refill, pick up medications, ask a question, whatever, and find that they have a long wait, which is frustrating. These are very popular times for doctor’s offices to make their daily call-ins to the pharmacy, which ties up the pharmacy staff, as well as times that many people are out running errands.

If you call the pharmacy with a question for the pharmacist and you are told he or she is busy, rather than waiting on hold, offer to leave your phone number.

The pharmacist is usually glad to call you back and talk to you when things are less hectic. This gives them a chance to give their full attention to you.

If you have called your doctor and requested a medication be called in, be patient.

They need time to talk to the doctor, call the pharmacy and we need time to get the prescription processed. Many people show up 30 minutes after talking to the doctor’s office expecting their medication to be ready. It just doesn’t work that way. And please, don’t ask the pharmacy to call the doctor’s office for you when you find out the prescription is not ready.

If the medication you received looks different than it has before, never take it without calling the pharmacy.

Chances are that if it is a generic medication the pharmacy just used a different brand, but there is always the chance that an error was made. A good pharmacist is never unwilling to double check the medication to make sure is correct.

So, now you have been behind the counter. It is a hectic world that will only grow busier as the number of prescriptions written continues to increase. Hopefully this will give you some idea of what it takes to get a prescription from the doctor’s pen to your medicine bottle as quickly and error-free as possible.

I am a pharmacist. I work in a small independent store. Although I have not worked in a large chain pharmacy, I can tell you from talking with many other pharmacists that as a profession our problems and concerns are all pretty much the same. In a small pharmacy we do have a bit more of a chance to talk to our patients than our large-chain counterparts, but not much more. Almost every pharmacist I know would like to be doing a better job under better circumstances.

The first thing many people may not understand is the function of the people behind the counter. There are usually three types of people in a pharmacy: the pharmacists, the pharmacy technicians and the clerks. The technician can answer the phone, take refills, enter prescriptions into the computer and count the medications. They will alert the pharmacist if the computer flags any potential drug interactions or other problems; in the end of the process it must be the pharmacist who checks the prescription before it is dispensed. That is the law. Technicians can also help patients find over-the-counter items; help solve insurance problems, put away drug orders etc. In any given day, they will do all of those things, often interrupting one task to do another.

Clerks are usually support staff there to run the register, stock over-the-counter medications, answer the phone and be a liaison between the patient and the pharmacy staff. They can’t answer medical questions but can refer you to the pharmacist for the answer.

The pharmacist is the person most in demand. We are required by law to be there for the store to be open. No medication can be dispensed unless a pharmacist has checked it. We are required to counsel any patient that does not refuse the counseling. We take phone-in prescriptions from doctor’s offices. We must be constantly on the lookout for fraudulent prescriptions, which is a big problem. We answer patient questions over the phone and in the store. We recommend over-the-counter remedies for all kinds of ailments. We often have to handle insurance problems: drug changes due to formularies, drugs not covered by certain plans, refills too soon, etc. When medications are unavailable due to manufacturing problems we must find suitable alternatives. (In some stores, pharmacists even run blood pressure checks, blood glucose monitoring clinics, and administer flu shots.)

All of these functions and more are routine work for the pharmacist and usually more than one thing must be done at a time to try to keep the work moving at the pace demanded by today’s patients. It is very common for a pharmacist to only get to go to the restroom once or twice in a 10-hour shift and to never get a break to eat. If we get to eat at all, it is a bite between phone calls or checking prescriptions. In smaller independent stores, this is also true for the technicians.

So, now you know a bit about the function of the people you see behind the counter. Let’s now look at filling some prescriptions that you just brought from your doctor’s office for the terrible cough and fever you have. Your doctor was running an hour behind and now you are anxious to get your prescription filled and get home to fix dinner. It’s 4:30 in the afternoon when you arrive at the pharmacy and present your prescriptions to the clerk. Several people are already milling about, obviously waiting also. You are told it will be a bit, as there are several people in front of you.

The prescriptions you have handed in are given to the technician. They are read for patient name, drug name, quantity of drug and any obvious errors. They are then entered into your profile on the computer where the drug interaction programs look for any problems between the medications you already take and the new ones just prescribed.

The computer has spotted a drug interaction, so the technician must wait for the pharmacist to evaluate the potential problem before they can continue. Work on your prescription has just stopped. The pharmacist is checking several prescriptions for a person who was waiting there before you. She will look at the computer in just a moment. In the meantime another technician has answered the phone and there is a patient on the line who wants to ask a question. They will hold until the pharmacist is available. A second line rings and it is a doctor’s office needing to phone in a prescription. They will hold until the pharmacist is available. Your prescription is still waiting on the computer. The pharmacist takes the call from the doctor’s office.

The technician has the next set of prescriptions ready for the pharmacist to check. After doing that, the pharmacist is able to glance at the computer and must make a quick judgment about the potential interaction. Deciding there won’t be a problem she tells the technician to continue filling. Finally yours is being worked on again! After getting all of your prescriptions entered into the computer and through your insurance, the technician informs the pharmacist that your prescriptions are ready to be checked. The pharmacist nods, as she is now on the phone with the person who had called with a question. She will get to yours in a moment.

..to continue see post II

Luckily, there are methods that can be used to handle problems and make it more manageable.

What Is the Origin Of This?

Weak pelvic muscles usually exist in women who have this desease. When there are weak muscles, they make the urethra, the tube that releases urine, to fall downward, which results in urine spilling out. Two issues that result in a weakened pelvic floor in females who have urinary incontinence are having a baby and being overweight. Females who have had babies have a greater risk of getting urinary stress incontinence in contrast to females who don’t have any children; plus the more children that a woman has, the greater chance she has of ending up with this problem. Being overweight also puts extra stress on the pelvic floor making it weaker.

How Is This Identified?
Typically symptoms makes it easy to diagnose. If the diagnosis is unsure, the doctor might do a bladder stress test. This is done by a fluid injection in the bladder. The women is then instructed to cough and urine dripping is looked for. It is also necessary to have an urinalysis done to make sure that a urinary tract infection is not causing the symptoms.

The pelvis should be looked at to see if an enlarged uterus or ovaries are putting extra stress on the pelvic floor.

Easy Lifestyle Modifications

Frequently, simple lifestyle modifications can be very helpful in bladder controll. If being overweight contributes to this issue, losing weight could help you. One experiment conducted revealed that women who reduced their weight by three pounds decreased their amount of leakage by 32%. The outcome was even more amazing when they lost more weight.

Total avoidance of caffeine also helps the symptoms for some females. Women can also teach themselves to urinate every hour so their bladders will remain as empty as possible.

Constipation could also be part of the problem, so a diet with more fiber is something that definitely is necessary.

More Treatments

An additional worthwhile method to handle urinary stress incontinence is to make the pelvic floor muscles stronger. This is accomplished with Kegel exercises. This includes squeezing the vaginal muscles and holding them at ten second intervals a few times daily. Directions showing how to do it can be located online. This plan can require time to see results – typically four to seven months. With bad cases of stress urinary incontinence, prescribed medications might be taken. Yuo can purchase Bladder Control Natural Supplement Pills online.

online.

To treat bacterial vaginosis, the following are recommended:

Metronidazole (Flagyl) prescription drug

Metronidazole is taken orally or applied intravaginally for a period of a week. Metronidazole 500 mg pills are ingested orally twice a day. More side effects commonly occur when taken orally than when used intravaginally. Another method is to apply it in the vagina on a daily basis. To minimize any effects on the fetus, pregnant women receive reduced doses of metronidazole. Nausea, diarrhea, and/or metallic taste in the mouth are common side effects reported when systemic metronidzole therapy is used. During the treatment and for 24 hours thereafter, patients should not consume alcoholic beverages.

Clindamycin (Cleocin) medication

Clindamycin is also known by the brand name Cleocin. Clindamycin cream is applied for a week, intravaginally, just before going to bed. Clindamycin is also available in vaginal ovules which are used for 3 days, as well as in a form to be ingested orally, and that is taken for a week. Women should not utilize topical clindamycin during the second half of their pregnancies. Latex condoms and diaphragms may be weakened for 5 days after the use of oil-based clindamycin.

If symptoms clear up, it is unnecessary to return for a follow-up visit. If the infection recurs, an alternate treatment will be administered.

While bacterial vaginosis may not be transmitted sexually, sexual activity does seem to increase the likelihood of becoming infected. The male partner should only be treated for bacterial vaginosis if the infection is resistant or recurs — and recurrence is fairly common.

You are now armed with the necessary information you will require when deciding how to treat vaginosis.