Pharmacy. Jim Plagakis. Pharmacist

With this being the situation, will be ever get back to providing traditional pharmacy services for a fair price?

A woman my age has been involved with politics in Texas for most of her adult life. She is my cousin and is now an elected official in Jefferson County. This is what she said in response to my letter. Jay Pee

Thank you for this informative discussion, which is severely lacking in political debates today. As I’ve said many times, if people could have had the experience I had in the Texas Senate, none of this would come as a surprise. The Lobbyist control the agenda, WRITE the legislation and own most of the Senators and Reps!!!! End of story.

Senators no more have any idea of what’s in a proposed bill than the Man in the Moon….they never read the legislation, they are briefed by LOBBYISTS!!! The L’s write the bills, brief the staff and Senators and pour enough money, booze, free trips and women into the “public servants” until they get the vote they want….Multiply what I observed in Texas by 10 or better and you have Washington DC….Honest men and women, who don’t get lobbyists’ money for their campaigns, cannot win and if they do they won’t last at the Capitols….that’s the way it works.

People who go to Washington or Austin with lofty idealistic public servant ideas are quickly shot down, one way or the other…either by Lobbyists or the leadership in the House and Senate…they don’t like outspoken idealists who won’t go along with the votes…they get you one way or the other.

I will not listen to any more news about healthcare etc coming out of WDC…it makes me sick. The R’s control the agenda and put all the D’s on defense…they control the talk in the nation. I am ashamed of all of them…disillusioned with Obama…and wonder where the US,,,,us….where are we headed??

We are having a low turnout in this county in the primary election and an increase in R’s voting already….the class warfare is setting in good and tight. We as a country are getting deeper and deeper into the mud and civilized, intelligent discussion of differences of opinion are no longer. There is no respect on either side of any issue. So Disgusting!!

I could tell you many stories that would make you sicker than you already are of politics. The younger generation has had it too easy. We broke so many barriers in our time. The youngsters take everything for granted. One day they will have to fight a BIG Fight!! Most of my staff of women 40-ish and below don’t even understand the party system….occasionally one will send me some rightwing email…I then stroll over to their desks and explain to them that I am a Democrat and run in the Democratic Primary, thus I do not appreciate rightwing emails, please do not send anymore to me. At which, they look at me puzzled as if I were speaking a foreign language…they have no clue about party politics….intelligent conversation around here is limited to say the least!!!

What the citizens don’t know is that Reps and Senators do not have time nor do they have the staff to draft their own legislation. It just doesn’t happen. The Lobbyist do it for them and present the papers for explanation….it is a corrupt system from top to bottom….if a young lawmaker doesn’t go along with party leadership, the leadership has many weapons to use to deal with them, including re-districting their districts so they can’t get re-elected, as happened with the Senator I worked for! They shut him up…and got the person they wanted in that seat.

This is an editorial that will appear in the Galveston County Daily News.

“Some people like to rock. Some people like to roll. Moving’ and a groovin’ gonna satisfy my soul.” Wanda Jackson singing “Let’s have a party”. How simple was it? The best steaks were 79 cents a pound. 2 dollars worth of gas and you could cruise all weekend. Washington, D.C. was where elected representatives legislated for the benefit of the people.

This idiot named Plagakis has dedicated time, effort and talent to health care reform. It is a disgrace that any American father would choose to die rather than lose the family home to pay for his medical care. I recently deleted every computer link to any site regarding this subject. I unsubscribed from medical care email services that were sending me stuff all day long. I am disgusted with our federal representatives. They’re not gonna bleed me anymore.

“Stay, Aaah, just a little bit longer. Please, please, please tell me that you’re going to Staay.”
Maurice Williams and the Zodiacs “Stay”. They sent emails asking me “Why?” and I told them to mind their own business.

Those of you who know me are expecting an uncontrolled rag on the top level Republicans. That’s coming. First, let’s do the Democrats. How is it possible to have so much favor and power and screw it up so badly? Governor Tim Kaine and the Democratic National Committee squandered the political advantage that Doctor Howard Dean created. They have been acting like teenagers with their pants down when Papa Rush comes into the room.

The USA is the only modern society that uses the insurance model for health care. America spent $8863.00 per person on medical care in 2009 (Hewitt Data). Of that, up to $1595.00 per person went to Big Insurance as profit. $491 Billon Profit! Apparently, that’s not enough. Anthem Blue Cross in California (for profit) raised 2010 premiums 30% to 39% for people who have to pay their own way. The Urban Institute’s ten year projection: Individual and family spending on health care will increase by 46% to 68%. How many of us can afford that? Don’t be so smug. Your job provides health insurance.. now! You think that is going to last? Public servants of both parties would have put a stop to that a long time ago, if they were, indeed, public servants.

Senator Sherrod Brown (Dem, Ohio) had it all right.. until he got it all wrong. In the beginning of this, no American would have to go bankrupt over medical expenses if Brown had his way. Recently, he said that the feeble Senate bill that keeps insurance executives popping corks and smoking big cigars is a good bill. “I don’t know why (The Democrats) treated me so bad. Look at all those things we could have had.” Al Green. “Take me to the river.”

The poster boys for corruption and paying back special interest donors are Senator Chuck Grassley (GOP, Iowa) and Senator Max Baucus (Dem, Montana). The burly young man who loses the family ranch to pay the expenses to save his son’s life gets a free shot at these two in a dark alley. The jailed lobbyist Jack Abramoff gave money to Grassley. Baucus got $6 million from Big Insurance and the drug industry for his 2008 election campaign. They could see the future. Grassley’s and Baucus’ Senate Finance Committee favored them. People will die. Trust me!

“Mama turned on the front porch light. Sayin’, Come here darlin’, that’s enough for tonight.” The Republicans will never help to bring America into the civilized medical care world. “Sweet nothins, Ummmm, Sweet nothins!” Brenda Lee!

Citizens who believe that the GOP will help them are delusional unless they are the CEOs of sizeable companies. If you pollute the environment with Hydrogen Sulfide, the GOP (G. W. Bush era) has effectively gutted the law and you do not have to worry about a Sierra Club lawsuit taking hold. But, heaven help you if your neighbors drop dead from a benzene leak. This is not Bhopal, India.

Just because I am getting a divorce from a cheating wife (The Democratic Party) does not mean that there is any hope for the GOP. The so-called conservative base is mostly mean, spiteful white people who count in at about 18% of all voters. The ghost of Ronald Reagan cringes when he sees what people are doing calling themselves conservatives. Barry Goldwater would identify the Tea Partyers as backward-thinking reactionaries. Jay Pee voted for both Reagan and Goldwater

“I never kissed a bear. I never kissed a goon, but I can shake a chicken in the middle of the room.” The middle! The quiet middle is going to rule. Watch and see.

The BIGGER they are, the harder they fall. That would be nice. The truth is: The BIGGER they are, the HARDER they kick your ass.

I do not believe that it is productive to be an angry “Don or Donna Quixote” in the 21^st Century.  I honestly do not believe that chain, big box or super market pharmacy middle manager want to deny pharmacists a meal or rest break.  I do not think that a work day longer than eight hours is in the strategic plans for any company other than CVS.  That is what CVS seems to do.  I don’t think any company wants to deny you an earned vacation in the summer.  There is no conspiracy to make you take your kids out of school in October.  This is the way it has been in our industry.

I have worked two days a week for almost two years for one of the major chains and I had a lunch/meal break every single work day except for perhaps a dozen instances.  Half were my choice to come in late rather than take a break. 

The others incidences when the pharmacy manager had to leave to attend a meeting and there was no overlap.

The first year, I earned 10 days of vacation, at about 3.75 hours of pay a day.  I am a part time worker.  I took my vacation when I wanted to take it, in August.  I put in for the time off and it was approved.  I never even had to talk with anyone.  The middle managers of the company I work for seem to be proud of how pharmacists are treated in south east Texas.  They are all over the place, so who knows what it is like in Montana or Minnesota.

THE BIGGER THEY ARE, THE HARDER THEY KICK YOUR ASS.

I was feeling very comfortable in my pharmacy manager position for a chain in Oak Harbor, Washington.   This was on Whidbey Island.  My commute was less than 10 minutes.  People knew me.  I was feeling very comfortable.  The company was sold 5 times.  It went from Pay ‘n Save to a Los Angeles holding company to Thrifty Drugs, to PayLess and it is now Rite-Aid.

By the time we got to the PayLess stage, there was very little loyalty for anyone for anyone else.  I had never even met the middle manager in charge of the stores.  My pharmacy district manager was the same guy, Dave N.  If you are listening, Dave, you were very good.  You tried to be loyal, but I wouldn’t let you.  Your only failure was that you didn’t take me by the shoulders, shake me, make me look you in the eyes and say something like, “You dumb sunuvabitch, stop it.  You have a good thing.  Don’t screw it up.”

I screwed it up and they kicked my ass very hard.  Dave arranged for a compromise, but I refused.  The long story was that they took away our two day a week part time pharmacist even though we were setting volume records every week.  The overlap disappeared.  The meal/rest break ended and the two pharmacists were back to one 12 hour day a week, with two successive days off only once in 14 days.  I fought.  I fought. 

To make it worse, I butted heads big time with the store manager who was a micro-manager and a controller.  We were doomed, but neither of us was smart.  In the end, I refused the compromise that Dave arranged and quit.  A little more than a year later, at my new job, I was walking with a syringe to the immunization “clinic” area and there was the store manager.   He was a “detail man” for Boehringer or some such company. 

He was knocked off balance to see me.  He said, “You got out at the right time.”

Bull shit.  There was no right time.  I gave up a 10 minute commute for a minimum of 80 minutes.  There was one night, going home after closing at 9:00 PM, when an accident didn’t get me home until after one in the morning.  They painted the Deception Pass Bridge the second summer.  It was a night time job.  My job was always the late shift.  That way I missed the traffic and rarely had to see my second wife.  They stopped traffic on the bridge except for two 5 minute windows every hour.  I had to sit and wait.

I worked every other weekend.  My shift was over at 8:00 PM on Saturday night.  I had to be back at 9:00 AM on Sunday.  I spent every other Saturday night at the Motel 6.  One Saturday night was Valentine’s Day.  A usual 5 minute wait for my room key was close to an hour and I had a reservation.   What a night.  Through the wall, just a foot from my head was an intermittent bumping noise, a rhythmic cadence and “Oh, Baby.  Oh Baby.  Keep it up.  Don’t stop!” all night long.

Be smart, you guys.  If you have a good thing, don’t try to take on the giant.  Rarely do they fall harder because they are bigger.   Do not expect your old friends to be loyal if you do something stupid.  For you will get your ass kicked. 

These items are interesting things that I have intended to write about, but haven’t because “more important” issues come up. I am crossing off everything on my list that is getting old, before I turn the page.

I had just checked a half dozen very expensive medications (Including Abilify and Seroquel) and notice that there was no insurance. I asked the technician who the patient was and she indicated a bedraggled, unshaven middle-aged man sitting in the waiting area.

I called him over to the counter. He was clearly one of the homeless men I often noticed sitting with his back to the wall of the store. I recognized him and asked, “Where is your dog?”

“He’s outside.” The dog was a black lab. “Tony’s watching him.”

I got right to it. “Sir, these are expensive medications.” He didn’t react at all. “They are ridiculously expensive.” Still, he just smiled. “They are so expensive that somebody should be dragged into an alley and had the crap beat out of his CEO ass. If you don’t have insurance, I don’t think you can afford these.”

“I have insurance.” I was expecting the Medicaid paperwork, but he pulled a shiny Part D card out of his pocket.

“You are homeless, right? I’ve seen you sitting outside.” I thought, Plagakis, why do you always have to ask questions?

“I’m homeless, but that doesn’t make me stupid.” He smiled. “My wife pays the premiums. She knows that if I don’t stay on my meds, there is no chance I’ll ever come home.”

I must have given him a look. He laughed, “I feel a little guilty because I don’t think I’ll ever go home.” The laughter was too practiced. His eyes weren’t even smiling.

“She must love you,” I said.

No smile now. I got too close. “Take my card.” His face was sternly set now. His mouth moved involuntarily and I thought possibly TD. “I want to go now.”

The technician rebilled his prescriptions. The copay for well over $2000.00 of pharmaceuticals was ZERO.

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I had enjoyed some casual conversations with this gentleman in the past so I looked him in the eyes and said, “You can have this prescription refilled until next Thanksgiving and it is probably not going to work.”

“How do you know that?”

“I just know, man. Mycostatin Oral Lozenges are a very poor choice for the fungus infection in your mouth. You have used one full course of therapy and it did not work.”

“I actually think it is worse.” He frowned and opened his mouth. “Look…”

“…No. I don’t want to look in your mouth. “ I jumped back. “Don’t buy this prescription,” I advised. “Tell you doctor to order Mycelex Troches.” I wrote it down for him.

Of course, the doctor called. I took a deep breath. Then exhaled slowly when the doctor said, “I had no idea what to prescribe. I looked it up. I didn’t even know that they made such things.”

“You found Mycostatin in a book?”

“And I had to hunt.”

After he had given me the Rx for a new order for Mycelex Troches, he asked, “Why did you do that? I didn’t know that pharmacists even cared about patients.”

“It’s my job, Doctor,” I said, “It’s just my job.”

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You will love this one. After 30 seconds of trying to counsel a woman at the drive through about a complicated dosing for an oral corticosteroid for her 18 month old, I stopped. “Maam, I do not feel comfortable counseling you from a distance on this medicine. Please come inside, so we can do this properly.”

“What? You what? You want me to come in the store?”

“Yes, maam. This is a ‘cortisone’ drug. It is very powerful. I want to make sure that your baby is going to get the right amount of this ‘cortisone’ drug at the right time.”

“I AM not coming inside. Just sell me the damned medicine.’ The rest of the sentence included the words DAMNED, A*****E and DRUGGIST.

I did my best officious act. “This is serious medicine for a serious ailment. Your baby’s doctor would not have prescribed it otherwise. You must give it properly and you aren’t getting this medicine until I am confident that you WILL administer it properly.?”

She threw the big gun at me. “You are RUDE.”

Another voice. A male voice from the passenger seat. “Tammy, shut the f**k up and get your skinny ass inside so the doctor can teach your stupid ass how to give the medicine.”

Tammy came in. She was a little huffy. Her ass was anything but skinny. Tammy had been given her marching orders. She listened patiently. She read the directions off the bottle out loud for me. I asked how many MLs would she give the next morning and she flunked, so we started all over again.

This young lady is from my past.  15 years ago, she was a star in a class on writing for publication seminar series that I put on for 8 highly gifted 4th & 5th grade students in the Oak Harbor, WA School District.  She was on an Odyssey of the Mind team that I coached for two years.  She is a precocious, scarily smart (I really mean smart) and I was delighted to be allowed to mentor her.  Recently, she found me via the Internet.  After a few letters back & forth, I realized that she is having a long trudge through the forest of pharmaceuticals.  I asked her about the drugs.  The following is most of two letters.  I deleted the personal references.  I do not have the chops for this, you guys, but it looks to me that her doctors need the assistance of a good, modern pharmacist.  If you can help my friend out, that would be good.  I have her permission to post this.  JP

As for me…I’m more medicine than girl. The official diagnoses are
bipolar I and OCD…for the last 8 years or so, my basic regimen has
been lithium (lots of it, 2700mg a day…makes life interesting),
lamotrigine, bupropion SR, propranolol (for lithium-induced tremor).
About 2 years ago the bupropion just kind of kicked the bucket, we’re
not sure why, so they started adding other things to prop it
up…fluoxetine, paroxetine, duloxetine, sertraline, fluvoxamine,
citalopram, escitalopram, venlafaxine, desvenlafaxine, mirtazapine,
nortriptyline, amitriptyline, clomipramine, doxepin, imipramine,
desipramine…the ones that weren’t ruled out by horrible side effects
(about 2/3) they tried alone, or put in 3 instead of 2 (nobody ever
stopped the bupropion…I don’t know why. Obviously it’s not working.)
or raised the dosage crazy high, or with the strangest dosing
instructions (take 3 one day, 1 the next, 2 the day after, repeat…with
one foot in a bucket of chicken’s blood while patting yourself on the
head and rubbing your tummy…*groan*) – the pharmacy doesn’t even have
to ask my name anymore, they all know me by sight. So, in early December
they put me in the hospital. I was there for about a week. Nobody ever
believes me when I relate what happens to me when I take various
medications…it’s like they don’t really believe that I’ve been on all
the things I say I’ve been on, and doctors know best *rolls eyes* – so
they put me on escitalopram, and then had to take me immediately off
because of the side effects. They replaced it with citalopram, which was
just as bad, and then he kind of closed his eyes and put his finger down
in his drug book…desvenlafaxine, again. I was so fed up at that point
that I “got better” really fast just to get the hell out of there. My
doc replaced the desvenlafaxine with venlafaxine (because man, that

stuff is EXPENSIVE) which was the most godawful experience I’ve had so
far…then I went back in the hospital 2 weeks ago. Where my experience
repeated, except with more dishonesty. He started by suggesting Geodon,
Risperdal, Zyprexa, Abilify, Seroquel, Invega (that one was new to
me)…then on to haloperidol, chlorpromazine, loxapine…getting
frustrated with me even as I’m explaining that every single
anti-psychotic I’ve ever been on…and I’ve been on most of them…has
given me severe tardive dyskinesia and made me act like a sluggish
zombie. So he goes, ok, we’ll try a stimulant and a new anti-depressant,
and wrote for Concerta and perphenazine. …now, you probably got right
off what’s wrong with that statement, but I’d never heard of
perphenazine, so I didn’t know until my face started moving on its own
that it wasn’t actually an anti-depressant. I was so angry I “got
better” again…bit stupid really, since I’m still in incredibly bad
shape and going back to the hospital is out of the question now.
 
My regular doctor decided he wanted to see how the perphenazine would
go, since I’d never had it before, and cut the dose down to 4mg…killed
the Concerta, he couldn’t even understand why the guy had decided to try
it to begin with. The TD is getting bad and the depression andOCD are
out of control, and I’ve considered just flushing the whole pile of it
and playing stupid. I asked for MAOIs…they’re the only thing I HAVEN’T
tried (other than crazy old anti-psychotics) and everyone I speak to
agrees that they’re the next logical step, but there are blocks on the
line…my doc can’t prescribe them because they’re not on the clinic’s
formulary and he’s not a permanent employee, just a contractor, and
can’t alter the stupid thing. He doesn’t seem to be willing to send me
to the chief psychiatrist who CAN, though…I was angry for a while, but
I’m mostly apathetic at this point. Mostly…it’s not all gone, as
evidenced by these two enormous paragraphs. *bangs head against wall*
 

A danger to myself…man, I wish I could tell you how uncomfortably
familiar those words are. Every doctor’s appointment, it’s “Are you
having thoughts of hurting yourself or others?” Lately the answer is
always yes, to the extent where I think I can get away with it before
they start putting through papers for involuntary commitment. Things are
pretty bad…worse than they’ve ever been, I think. Still holding on,
for now.
 
Bipolar, yes. I don’t know if I’m still myself with that much lithium,
but the alternative is much, much worse, so I keep taking it. Doctors
keep trying to take me off and put me on something “milder” like
Depakote and I have to fight like crazy against it…I’ve been on
*everything*, lithium is the only thing that’s been consistently
effective. It makes me terribly sick if I’m not extremely careful, but
taking me off lithium is a guaranteed stay in a psych hospital, no
matter how good or bad I was before. I’ve had 5 major manic episodes (
almost jumped off my apartment building once, was awake for 9 days and
drove to Canada another…none of which I remember doing) and I was off
my lithium every single time. I get mild bouts of hypomania sometimes,
but mostly if I’ve got a decent lithium level it’s depression that’s a
problem. I *need* an anti-depressant that works. I can’t believe I’m the
only one who sees this.
 
As for the OCD…it’s the O that kills me, right now. Compulsive
behaviors are present to a significant extent, of course, but obsessive
and intrusive thoughts are crippling me right now. This yahoo at the
hospital insisted the Concerta would help with that…I don’t have a
medical degree, but it seems absurd to me that anyone would think a
stimulant would CALM THAT DOWN. Which it didn’t.

 
Nobody likes the idea of MAOIs. They’re all crazy about the dietary
restrictions, primarily, although my doctor doesn’t like the idea of me
being without any anti-depressant at all for the 2 weeks I’d have to be
clean in order to start (which is a bit of good sense, I think, I’m
concerned about it, too)…but like I told him, I don’t care if it means
I have to live off cardboard sandwiches for the rest of my life, if it
makes me feel good and helps me function. They’re trying to push ECT
again and it amuses me slightly that they’re more relaxed about the idea
of inducing seizures than potential spikes in blood pressure. I’ve
refused ECT so far, and will continue to do so as long as there’s
another option…my brain is all I have, I won’t take even a tiny chance
of sacrificing it. Losing my short-term memory terrifies me like nothing
else. If I’m going to live, there has to be some quality of life.