blogcutter

So a little over a year ago, just after getting my regular blood tests to monitor my rheumatoid arthritis, I got a call from the rheumatologist's office indicating that I didn't have immunity to hepatitis B. I should arrange with my family doctor to get vaccinated.

I contacted my doctor and she suggested that to be extra cautious, I might want to consider the Twinrix vaccine, which protects against both hepatitis A and B. This involves a series of 3 shots: the second shot is usually a month after the first, and the third one five months after that. It's a case of the vaccine has to be fresh and refrigerated until use.

For my first shot, which I got on March 8, 2022, I ordered the vaccine through my usual pharmacy, picked it up and brought it to the doctor's office to be injected.

My second shot should logically have been April 8, but real life intervened. On March 24, I got my biennial mammogram (which was actually about 2.5 years after my previous one, due to pandemic-induced delays) and that gave rise to some additional health issues that loomed a little larger than continuing my course of Twinrix injections.

Nonetheless, I did make an appointment for Twinrix injection #2 for May 3, 2022. I duly ordered the vaccine in advance from my friendly local Shoppers Drug Mart...

After initially telling me they would get it in within 48 hours, they then phoned me to say there was a delay. Then there was another delay. Long story short, it would not be available for my May 3 appointment. I phoned my doctor's office and learned I could buy it right at their office and get it injected then and there. That seemed like the best option, even though it was slightly more expensive than it had been through Shoppers.

So my third and final shot should have happened in October. Once again, more urgent matters intervened.

On October 6, I got a lumpectomy at the Civic. I went under the knife again on November 9, this time at the Riverside (there's quite the shortage of available operating rooms, not to mention staff, but that's another story) as my oncologist wasn't confident they had got it all the first time around. Then there were the follow-up appointments, the radiation treatments and so on.

Twinrix #3 still hasn't happened, but not for want of trying! I got quite excited when I read this recently in an e-mail from Shoppers Drug Mart:

Get your next dose of hepatitis A/B
vaccine (TWINRIX)
3 doses of TWINRIX are required for maximum protection
against hepatitis A/B. The second dose is usually
given I month after the first dose and the third dose is
usually given 5 months after the second.
Question: If it has been more than 1 month since my first (or more than 5
months since my second) dose of hepatitis A/B vaccine, is it too late to get
the second/third shot?
Answer: The second dose is usually given I month after the first dose and the
third dose is usually given 5 months after the second. However, if it has been
more than 1 month since the first dose or more than 5 months since the second,
you should get the second/third dose as soon as possible. You do not need to
restart the vaccine series'.

So I thought I'd try again. If I could get my third dose at a neighbourhood pharmacy, that would be quicker and easier than arranging something at the doctor's office, which is a fair piece away. I clicked on the "book now" button and looked for an appointment time at my usual Shoppers where I get all my prescriptions.

There weren't any times available there so I tried the location just around the corner at Merivale Mall. They had quite a few appointment times available so I chose one at 10AM on March 4. I was directed to a portal where I provided all my details: OHIP number, contact details for my family doctor, and so forth. I foolishly assumed that if they were scheduling appointments for TWINRIX vaccinations, they must have a stock of the vaccine on hand and I merely had to show my health card when I arrived.

Turns out I was wrong.

Oh, and we have this thing called weather around here too. Those of you who live in the Ottawa area will know that yesterday was a rather snowy day. In spite of that, though, we have winter tires on the car and my partner was willing to drive me the short distance to my appointment. I got there with plenty of time to spare.

That's when I found out that they didn't in fact have any Twinrix in stock. (Are you seeing echoes here of the Monty Python cheese shop that didn't have any cheese?) Moreover, they didn't have any access to my file of active prescriptions at the Shoppers just around the corner. The pharmacist was actually quite nice about it and did offer to phone them to see if they could supply the vaccine. I waited while she did this, but unfortunately they didn't have any either. So I left empty-handed and empty-armed.

Back home, I returned a message from my local Shoppers (the one I get my prescriptions from). I explained the situation as best I could and now when I log into my Shoppers account I see that the vaccine has been ordered. It also indicates that this will be my third dose, not my second. On the other hand, it's still showing one of my other prescriptions as being "Ready for pickup" even though I explained to the pharmacist that I'd already picked it up.

So we'll see. What I expect to happen is that they'll eventually tell me I can pick up the vaccine - just HOW eventually I've no idea - and then I'll go through the process all over again of booking my injection site and time.

Yes, my health care team is working for me - except that the head doesn't know what the tail is doing!

So today I finally braved the pharmacy. I'd run out of refills for most of my prescription drugs so I took in some new prescriptions. A total of five drugs: four prescribed by my rheumatologist and one by my family physician.

We got there soon after 8 AM. There was no wait to get into the store and only one person ahead of me at the pharmacy counter for drop-offs. So dropping it off went pretty smoothly. The pharmacist asked if I wanted to wait for them, come back later or have them delivered. I asked how long a wait it would be and he said "At least 30 minutes."

Well, that was OK with me. The rest of the store was not all that busy and I figured I could use the time to buy a few grocery and drugstorey items.

So off I went with my shopping basket. I bought more batteries (AAs and AAAs), a couple more tins of the chickpea soup we like, a jar of "just peanuts" peanut butter, a taco kit. As with the grocery store last week, there was absolutely NO flour to be had but I did manage to get a package of flaxseed which I figured would help stretch the flour we do still have. Towards the end of the half hour, I started shopping the more perishable items: some half-and-half, a package of mixed grated cheeses, a bag of frozen corn. Then I took all my items to the self-checkout with my Visa card and Optimum card. I still don't really like those self checkout stations but admittedly they have their uses during a pandemic. I hope we'll be able to go back to real-life cashiers and paying with real cash once the pandemic ends, though.

I went back to the pharmacy counter when the 30 minutes were up although not too surprisingly, my prescriptions weren't ready yet. They invited me to take a seat at one of the 2-metre apart chairs nearby. I had quite a pleasant chat with the man seated on the other chair. He told me about his spacious greenhouse/garden area, where he was growing tomatoes, peppers (of various kinds), squash (also a couple of different kinds), lettuce and spinach. We ended up waiting another 20 minutes or so until his name was called. Soon afterwards, it was my turn.

The rule for now is that they can only provide 30 days' worth of a medication at a time, regardless of what it says on the script, but you can still keep renewing every 30 days (or maybe it's 23 or 24 days) until you've gotten the full complement you've been prescribed. So that meant that with my osteoporosis drug, for example, I got a grand total of one (monthly) pill in a 3x5" bubble pack inside a cardboard box but I'm allowed 14 renewals (usually I get a 3-month supply with 4 renewals). Then with the methotrexate (8 pills taken together once a week), they had chopped up the little bubble-packs to give me exactly 32 pills. Apparently I'm allowed 11 renewals on that one. Seems like for all the education and training that pharmacists have, they must spend an awful lot of their day doing basic arithmetic!

Anyway, they did have all of the drugs in stock. And at least with renewals, I can do them online or over the phone so it will be less of a rigamarole.

Let's hope that by the time I need to get brand new prescriptions, the pandemic will be over!

A week or two ago, I was pleased to read that some pharmacies are establishing rules and policies about using a decent-sized font on the labels of pill vials. About time, I say! Now I have a few more suggestions for pharmacists.

First, the container itself. It's all very well to have a "child-proof" lid but please consider that it may also be elder-proof, arthritic-proof and just generally patient-proof! Pharmacists waste all this time "educating" us about the medicine itself, telling us all the information that's already on the information sheet inside the bag... and sticking pretty little sticky-labels on the bottle about not giving blood with this medication, avoiding exposure to sun with that one, not drinking or driving with yet another... but all the education in the world is pointless if you can't get the @#$%^ thing open! Some well-meaning friends and acquaintances have pointed out to me that I need only tell the pharmacist my preference. But surely the onus should be on the pharmacist to be proactive and ASK what the patient prefers? After all the dire warnings I've been reading about the perils and the slippery slope involved in selling MILK in 3-litre containers, I'm absolutely astounded that no one seems to have taken up the cause of inaccessible patient pill vials! When I was first prescribed Celebrex for my arthritis, I developed a habit of just loosely setting the lid upon the bottle between doses, which of course rather defeats the purpose of a child-proof, cat-proof lid - and to some degree of any lid, if you need to keep the bottle airtight and light-tight too. Now that the arthritis is under control, I find the push-and-turn type of lid considerably easier but if the diameter of the lid is too great (as has sometimes been the case), it doesn't fit comfortably in the palm of my (nor, I suspect many adults') hand while I do the "turn" part of the opening action.

Secondly, if you are going to offer patients the "convenience" of being able to order refills by touch-tone phone, PLEASE ensure that the pick-up date and time given by the robotic voice is in fact accurate! One time I was given a particular time to pick up my meds, went in well after that time and had to go back two more times on two different days before I actually managed to get them, over a week after they were due. And it wasn't even one of those drugs like oxycontin that I know are a bit "iffy" in terms of supply.

Thirdly, make sure that ALL the prescriptions you put in that little white bag are in fact intended for the person (or delegate of that person) to whom you hand them. That surely is so fundamental that it should should be covered in any Pharmacy 101 or Pharmacist's Assistant 101 course or whatever. In one instance I went to pick up a DMARD, Methotrexate, at the pharmacy (a major national chain) and it was considerably more expensive than I had expected. But I guess I didn't quite believe that the pharmacist had made a mistake - instead I assumed that I had probably, without thinking, submitted a prescription that had both Celebrex (a much more expensive drug) AND Methotrexate on the same script, and just handed them my credit card. Once I got home, I realized I also had a prescription for someone with a vaguely similar name. I promptly took it back and the pharmacy-person did take it back and issue a credit (which she warned might take a bit of time to appear on my credit card). Still, her reaction was certainly not what I expected. If anything, she seemed slightly annoyed at having to undo a transaction that was the pharmacy's fault in the first place. Luckily I'm still fairly healthy and able-bodied and was able to get back there without too much hassle. But can you imagine if I hadn't noticed for several weeks and poor Mr. Carter Bloggs (not his real name) had had to manage without a critical medication? Come to think of it, maybe that's what happened to MY medication in the instance I mentioned in the paragraph above! Remember that scene in "It's a Wonderful Life" where young George Bailey saves the druggist from making just such a career-limiting and lives-destroying move?

Lest you think from the above paragraphs that I'm down on pharmacists generally, let me assure you that nothing could be further from the truth. I really believe that medicare can only remain sustainable if we make full use of medical professionals other than (though obviously not to the exclusion of) doctors, especially specialists. Generally I believe that we DON'T avail ourselves enough of the skills and expertise of nurses, nurse practitioners, midwives, health care technicians and technologists of various sorts - and, of course, pharmacists. I was very impressed at how smoothly my flu shot went last fall, at a Rexall pharmacy near where I live. On the other hand, I was rather put off, many years ago, when my union endorsed an order-your-meds-through-the-mail program aimed at saving the consumer lots of money on prescription drugs. What would this do to the jobs of pharmacists, I wondered? Surely as good unionists we should be protecting jobs like this in the knowledge economy? Anyway, I never used the mail-order drug scheme and I guess a lot of others were leery of it too, because I think less than a year later, it was cancelled.

Would a national pharmacare program alleviate some of the problems I've had with the existing system or could it potentially make them worse? I'd like to think that it would improve things because at present, many people who have no coverage through their employment (and even a few who do) are literally facing crippling drug costs.