July 07, 2007

Go ask Alice...

for, indeed, she'll know. She has neither medical nor pharmacological degree, but she seems to be the go-to person recently for dispensing information and advice about pain relief and psychoactive drugs on a regular basis.

My next-door neighbor inquired about the antidepressants her friend was taking. How long until they would show effectiveness or lack thereof? I'd taken them both, so that was easily answered.

A blogging friend was diagnosed with kidney stones, which did not "pass" in a timely manner, leaving her doped up on percoset, a pain reliever second only to demerol or morphine, for weeks. She finally had surgery, followed by another percoset script. After five weeks, she ended up going through minor-league withdrawal.

My concern for her wasn't the narcotic (because when you live with migraine, 30 years of taking narcotics as needed aren't much of an issue, and by the time anyone expressed a concern, it was 15 years ago, 15 years past Alice's due date for caring) but the Tylenol with which every painkiller is compounded.

That Tylenol is serious business. (Hospitals use it only because it isn't a blood thinner like aspirin or ibuprophen. It's not because it's great against pain.)

The warning on my current migraine drug isn't against addiction; it is against ODing on Tylenol, which, in relatively large amounts, can cause permanent liver damage. Or worse: a lethal dose of Tylenol is 2g to 4g. So 500 mg here, 500 mg there can really add up. Do the math.

Next up, my mom, who never feels pain -- she could have given birth in a field. She came down with shingles, which, in her percoset haze, she referred to as "roof tiles" one night. This disease is one where long-dormant chicken pox virus (assuming you had chicken pox) re-emerges and plays painful hell on your skin for a good three to four weeks, minimum.

Note to self: shingles vaccine just invented. Put on calendar for age 60, the age after which most people develop shingles. Do not want roof tiles redux -- there's already been enough pain in my life.

Then a call from mom's best friend: she has retired, with her boyfriend, to a small coastal town in Florida, where she believes available medical care is akin to voodoo, and her shrink wouldn't know his ass from a hole in the ground even with an anatomy chart. She can't sleep, and wants to know why her so-called sleeping pill isn't working for her.

Once again, Alice pulls out her handbook of psychiatric drugs, reads off dosages, and, playing cautious, counsels mom's friend to confirm with doctor or pharmacy.

In Alice's life, it's the pharmacy that has her back. She fills every prescription at the same independent store. Forget meds by mail, or meds from a 1,000-store chain. Alice would bet she has more pharmacy experience than some of the chain-store pill-bottle fillers. She certainly can recite all the side effect labels from memory. Her pharmacy telephones her any time there is a chance of an interaction.

(Alice is on intimate terms with the entire staff at her drug store. She knows the pharmacist and everyone else, save the delivery boy, by name, and she recognizes their voices, as they do hers, on the phone. She has the number memorized and has her own charge account. They get a fruit basket every Thanksgiving.)

Useful things to know: barbiturates of any sort will make birth control pills less effective. This information wasn't given to one of Alice's friends, whose unplanned child will be 9 next year. Antibiotics also don't mix well with many pharmaceuticals -- Alice's pharmacy told her that, although it was so many years ago that she can't remember what doesn't go with what.

For Alice's mom, a stern warning from Alice: I told you not to drink with Xanax on the airplane, and you finally admitted you did anyway. Alice is sure it made for a pleasant (and fast) flight, but her mom didn't have Alice's doctor's blessing on the mix-and-match front, and mom could have woken up way farther across the pond than she intended.

Revised warning, emphasis added: Please don't drink on percoset. It's a much stronger drug and will knock you flat on your ass for days even without a Dewars chaser. Alice knows how much she can drink (two glasses of wine, max, per the shrink) on her psychopharm cocktail, but her mother -- who equates sleeping pills with arsenic, according to mom's friend who dared to make the suggestion -- has neither Alice's metabolism nor knowledge of how you can make drugs your friends -- in judicious quantity.

So, Google may be your pal, but if you really need to know your pain relievers or your psychopharms, Alice recommends a drugstore where they know your name, and she is here if you need her.

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Anonymous MetroDad said...

I know better than to have a drink with Percocet. But what happens if you have a cocktail while on Xanax?

One more lethal combination....alcohol and Ambien. Little publicized (except for various members of the Kennedy family.) However, the combination of the two will make you go insane. Worst part? You wake up with no recollection of the previous evening's events!

9:31 AM  
Blogger scout said...

It never occurred to me that the theme from Cheers could more appropriately reference personal pharmacy relationships, but since you mention it, I'd rather my pill-filler know me by name than any old bartender! (I did once receive a botched refill, swapping one generic AD for another, so even if I weren't in the habit of looking at my pills before I put them in my mouth, a habit I'd recommend to anyone who values his or her life, damage would probably have been limited to those encountered when quitting an AD cold-turkey—though that's no walk in the park on a sunny day.)

Since I'm a ward of HMO-land, alas, I must use said HMO's pharmacies, though I really shouldn't complain since the last 'scrip I picked up carried a retail price of $737.40, of which I paid $10. Say, if my "issues" are no longer quelled adequately by generics, does that mean I've finally made it to the cutting edge?

I initially read the parenthetical in your penultimate paragraph as "two glasses of wine, max, per shrink," which caused me to imagine Alice making the rounds, toasting her myriad psychiatrists. Since I prefer that reading, I'm just going to pretend that's what you wrote.

As for sleep, nothing beats the tranquilizer-dart-like somnolent effects of my precious $737 antipsychotic, but the word psychotic is so loaded these days—lay folks reverse-engineer the name of the drug class and assume that anyone taking an antipsychotic is one missed dose away from opening fire in an Applebee's.

1:04 PM  

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