WHAT IS THAT I HEAR, AND WHAT I READ?

Two days earlier this week, we heard a strangely familiar sound, like pitter-patter on the roof, on the porch, on the windows, everywhere. After a slight lapse in cognizance, we suddenly exclaimed, 'it's raining' and hurried to the front door to view the recently rare event; we have been in a severe drought both spring and summer with accompanying heat wave of several days strung together over 100 degrees.

Which brings to mind a song made famous by Mahalia Jackson, Didn't It Rain, performed here on You Tube by Vestal Goodman.

Raindrops on Window as Seen Through Solar Curtain
from inside Kitchen  Window Box

Some personal non-descript photos scattered in this post. The first day we got 0.03 inches and the second day 0.36 inches-a real downpour. So that is WHAT I heard...... WHAT did I READ?
Like a multitude of US senior citizens, I am a member of AARP and receive several publications as a part of my membership--actually am on my husband's membership but have my own card. One of these publications is a monthly magazine, with interesting, diverse subjects. This month one article really caught my eye on page 20, MIND YOUR MEDS, pointing out medication errors are rising, and gives patients/customers simple steps to help keep oneself safe.

Since I am a retired pharmacist, I have a little to add to that article. First of all, any dispenser of medication, be it pharmacist, doctor, nurse or aides that claim they never made a mistake is dillusional and flat-out liar. I made mistakes but was fortunate to never have injured anyone. [And I still make mistakes with my own medication!--Like taking at wrong time, or forgetting if I took it, etc.]

Raindrops Outside Window Box; Trees from across Street
Reflected Off the Solar Shade from Outside the House.

To err is human and to forgive is divine, but all of us are in this together by confluence of several circumstances; some as mundane as too many white capsules and tablets [colors are disappearing as persons are allergic to some dyes, resulting in lawsuits]. Yes, there is some near unreadable numbers on these pills, be they tablet or capsule, but what about liquids, injectables? The elderly are most susceptible as their medication usage increases with aging, and hospitalization is more frequent.

Raindrops on Water Hydrant
and Deck Rail

The article suggests you shop with the least busy pharmacy in your area. I disagree with this statement. The intent of this statement, and I agree, the pressure of business is oppressive and conducive to errors. However, why do they have the least business--prices too high, made too many mistakes, terrible personality, no credit or insurance accepted, no delivery, sparse service? I would avoid a sole proprietor who has NO help---no clerks, no techs--a one man store. Oh yes, delivery service is an added expense and getting scarce, or coverage is restricted, and, increasingly, a fee is additional.


Filling a prescriptions is a complex procedure of checking that minimum amount of information is supplied--personal information correct name of drug, and directions for use including any ancillary instructions the physician did not include. Saying 'take 1 tablet daily' may or may not be sufficient. Sometimes we find ourselves trying to read a physician's mind, but NO--we should pick up the phone and personally verify what we do not know with certainty. Cholesterol lowering drugs are more effective taken in the evening. A growing number of drugs cannot be taken together or with some foods like grapefruit including juice.

Heavy Rain on Street, Tuesday

Physicians rely on pharmacists to add these details. Both physician and pharmacist are pushed to output volume--for different reasons, but both involve professional liability insurance, profit, payroll, inventory.

A large pharmacy inventory may exceed one million dollars.

While all this being processed by the professional brain, the phone is ringing, patients/customers are impatiently drumming fingers and tapping toes while waiting in line, or a person is waiting for professional counseling in a new prescription (required by law). Do not wave off professional counseling; according to the AARP article 89% of mistakes are caught in the give-and-take between counselor and customer; thus no harm comes of the mistake. DO NOT BE AFRAID TO ASK WHAT YOU MAY THINK IS A STUPID QUESTION! YOU JUST MIGHT SAVE YOUR LIFE.

Before completing this post I had appointment at gynecologist office; a told mine (a woman) this appointment ranked on the bottom rung of my favorite physician tied with the dentist or 'least favorite.'  I proved my point when I went into a small A-Fib attack, although the heat probably did not help.

Outside her office was a tree, the trunk of which had obviously been pruned multiple times, also may have been an original graft. It was an umbrella or weeping like tree-maybe a weeping elm or several japonica weeping trees that are grafted to a weeping Katsura. The trunk appeared to be grafted as well as pruned numerous times.

I took several photos. When I parked in front of it I thought some one had hung a carved wooden unpainted trout fish jumping out of  the White River into the tree. Maybe the gynecologist causes me t0 hallicinate. What shape do you think the 'deformity' looks like?

Do you see a fish in this tree???
[SOOC-Straight Out of Camera]

And Now I Am Cooling My Dudes for the Night
[SOOC - Straight Out of the Camera]

PHOTOS: NitWit1 unless otherwise attributed.

A Tiny Dose of Poison! Part 3 My Inadequacies

She timidly walked in the pharmacy; in a quiet voice, she politely asked the clerk to speak with me when I had a minute..'no hurry.' She patiently waited in a quiet aisle, as I finished the prescription order.

A neatly dressed female senior citizen, a member of the anonymous, disappearing middle class, her countenance was sad, worried, resigned to some unknown, hopeless fate. We moved to a private counseling area.

'It's my husband," she said, as she emptied a brown bag of her husband's medications. From the many bottles I knew he had advanced heart disease.

"We can no longer afford these medications. We have no savings, no prescription coverage or other health insurance, only Social Security, Medicare and small pension checks,"she said.

The wife began a litany about substantial prescription costs they could not continue to pay. Their home and all possessions were paid, she said. They retired here to save on daily living expenses and taxes, secure their savings, stretch pensions and Social Security further, she continued, in a halting voice, trying to hold back tears.

They had had good jobs with a medium sized corporation and retired, thinking they were secure with adequate pensions, Social Security, Medicare, health and prescription insurance from their long employment with the same company. As foreign competition increased, the pressure on their company to cut costs began. As with other companies, retirement promises were broken, abruptly terminated, to present and future retirees.. Pension funds were bankrupt, sometimes due to mismanagement. Health benefits were curtailed or cut. It seemed all the dire consequences that began to occur in the 1990s steamrolled collectively into this couple's front door.

She began to cry. The physician would not change drugs, even when there were suitable, less expensive alternatives. She never complained about our prices like others. She mentioned how carefully they budgeted their household expenses and substituted store brand groceries for name brands.

She tearfully asked "What did you suggest?"

At that moment I never felt so inadequate. Every feeble suggestion I had, would be nixed by her husband's unyielding physician. One prescription was for a long-acting 'twice a day' blood pressure medication. It was available in a generic tablet to be taken four times a day, the primary disadvantage of which is patient non-compliance. [Convenience of twice-a-day medications is more costly, but patient compliance is better.]

Finally, I referred her to a service where manufacturers provide 90-day supplies to patients that meet their criteria. Every 90 days the application process has to be repeated. These services are designed for persons who 'fall through the cracks' of other services like Medicaid. She was willing to give this service a try.

She profusely thanked me for my time,; I felt I had abysmally failed.

It's been nearly 13 years and I have not forgotten this middle income, neatly attired elderly lady trying to take care of her husband. There, except for the grace of God, go I.

In the present circumstances of our health care system with current proposals I can foresee where I might be in her situation. It appears services will diminish for old people. The message, as dire as it may sound, we should get out of the way, just go ahead and die.

A pharmacist/patient relationship develops over time as the patient continues to interact with the pharmacist in the course of counseling about their prescriptions. Throughout my career the retail prescription pricing was a major topic of discussion between patient and pharmacist. An expensive prescription in 1960 was $10; today the sky seems the limit. I remember when a new antibiotic was $1 per tablet. My three COPD inhalers are over $100 ea./mo. but I have insurance.

In the early days of my career the company line was the manufacturer costs included the costs of research and development, which to me and patients some was a nebulous entity in outer space. "Research and development" became the "company line."As years fled by I no longer spouted the "company line." When percentage increases in wholesale prices regularly exceeded annual cost of living increases, I saw no justification for "research and development."

Near the end of my career the wailing over prescription costs grew exponentially with every price increase. It seemed 10% wholesale increases once or twice a year were common and even 15% increases occurred with regularity. These increases were generally passed on to the patient, as in every business that deals with a commodity.

I came to believe pharmaceutical manufacturers were disingenuous in their explanations, when they began media advertising, especially television ads which may run $100,000/per 30 sec. for small viewer audiences to $1.5 million/30 sec. for a Super Bowl ad, a national viewing audience. Further, these ads provoke patients to insist their physician give them the latest remedy, even when there is less expensive alternatives.

My employers were not rolling in excess profits. Most net profits were 3%. Their inventories, like automotive floor plans, were mortgaged at the bank. A small inventory could exceed $1 million.

A National Healthcare Plan which includes prescriptions must dissect the phases of research, developing and manufacturing medications. I do not envy those charged with this task.

I am very thankful I am retired.
-------------------------------------------------------------------------------------------------Some small suggestions for shopping:

Where super discount chains exist, their competitive pricing usually cannot be beat. Wal-Mart will tell every pharmacy in their market area, they will match or beat every price of every competitor.

Pharmacies cannot routinely meet Wal-Mart's prices or their bulk buying power, so they try to be as near the competition as possible, but above it.

At least this is my experience with them.

However, for a few cents more, other pharmacies may offer delivery, shorter wait times, friendlier service. You decide what you are willing to pay. If you have prescription insurance cards, your co-pay is the same wherever you shop.

Your pharmacist should be willing to answer questions in a reasonable period of time. PLEASE remember the pharmacist is an expert on medications, not the practice of medicine. Our degrees ae PharmD, not MD.

I love to play doctor with myself or my husband, but when people ask my opinion, I tell them I am speculating and repeat it.

[I will be in Springfield MO, M-Th for medical consults. My trusty laptop will be with me, but not sure how much time I will be spending with computer. The motel has free WI FI !!!] <:~D)

When I return, I hope to be able to review the book of poetry, Reflections of a Mississippi Magnolia.

A Bad Hair Day - Part 1

Although existing before 1992, the phrase, a bad hair day, soared into prominence in the 1992 movie, Buffy the Vampire Slayer:

Buffy (Kristy Swanson) to the one-armed vampire Amilyn (Paul Reubens):

"I'm fine but you're obviously having a bad hair day."

The idiom means (1)a day on which one's hair seems unmanageable.(2) Also extended to mean a day when everything seems to go wrong.

I own a lifetime of (1) bad hair days, but (2) fewer days gone wrong.

Mother believed that little girls - all females for that matter - should look like, well, like girls. To this end, she was determined her two female children would meet the test of looking like girls [what ever that protocol is], no tom boys allowed. OOPS, I was already in trouble as far back as I can remember.

This "look like a girl" agenda began for my sister and me when we were infants. Not that we remember, but old photographs don't lie. We wore a lot of pink, even if we looked hideous in that color, and our hair was curled by whatever means available in those days.

My sister and I were both adopted; we are not blood sisters. We both had hair that would frustrate any hairdresser. Sister's hair was fine and silky, light brown and did not hold a perm well. My hair color was brunette, and its texture was a challenge. Perms burned and frizzled my hair, despite meticulously following instructions. The texture changed from somewhat coarse with no body to wiry when wet.

I remember my first beauty shop permanent. Mother dropped me off at a friend's beauty shop.[After my visit, I'm not sure the friendship endured.] I was confronted with a roomful of gossipy, yakking women and terrifying torturous appliances from some horror movie.

All was well until it came time to perm the hair with the electric curling machine chair. I took one look at that contraption and wondered what dastardly deed I had done to deserve punishment by electrocution. I screamed and cried as I was led to my perceived execution.

Despite assurances the procedure would not hurt, I continued my loud protests. The hairdresser lied. My head got hot and the smell of burning hair permeated the air. The odor was a cross between Bakelite insulators and tires burning. If I survived, I would be bald for life.

In the ensuing years Sister and I were subjected to 'Which Twin Has the Toni?' stinky, scalp-burning permanents and many other home curling ideas including home curling irons and brushes. Mother also permed her own hair.

Mother's hair and to some extent Sister's hair always looked nice. My results looked like a freak in a horror movie. Mother was not to be deterred. She tried everything that came down the turnpike on my hair. In my teen years she once again resorted to beauty shop perms, the results of which were not much improvement over home perms.

Bad hair days continued through college, my early career days, and marriage.

Just married in 1969, we moved to Baltimore where my husband's (H) naval assignment was aboard a reserve training ship docked in the Baltimore harbor. Money was tight for a while as I embarked on a new phase in my career - relief pharmacist.

My weekly beauty appointments were temporarily suspended until our financial outlook was better. But I needed a haircut badly. An annoying persistent ad on TV featured a device called a TrimComb, 'just comb your hair for a evenly shaped haircut for pennies a day.' It was unisex, too-suitable for both men and women. I ordered one for $9.95.

With visions of saving millions and eliminating a line item in our imaginary budget, I eagerly awaited its arrival via U.S. Postal Service. When it arrived, I read the somewhat vague instructions and decided to trim my hair while watching TV. After all, you just combed your hair and it magically provided a nice haircut.

Nowhere in the directions was a warning you would have choppy patches of 1/2" hair, surrounded by longer hair, or NO hair-bald patches. When I looked in the mirror that image looking back needed an exorcism.

H was appalled; for some strange reason he favored the barber on the ship...

After a couple of days at work, with some uncomplimentary comments directed at my new 'do, I sought an hairdresser willing to tackle my hair. Finding one near home,I arrived in person with my specimen of a TrimComb hairdo. Her face was white like she had seen a ghost; I thought she might faint.

She said it would take several months of trimming and shaping to get back to normal. Fortunately she had seen other TrimComb specimens, but none so severely destructive as mine. I prefer to think it was a creative cut myself.

Little did I know, you could cut hair to grow, or slow the growth--or so she told me. Unfortunately, TrimComb cuts were the no-grow way.

My husband extracted an oath in blood from me that I'd never try to cut my own hair again. And I haven't.

[I tried to find a photo of TrimCombs on the Internet and E-Bay, but to no avail. In the early '70s the ads ran all night on TV.]

Later - Part 2 ..Same song, second verse; could be better, but it's gonna be worse!