Good Old Times

to the alcoholics,

There are two signs you need to look out for if you want to know if I've reached my 'buzz point': 1) I start getting real philosophical and honest to the point of political incorrectness, and 2) I start using the F-word as a noun, verb, adjective, adverb, pronoun, and even conjunction, preposition, and interjection. It's really quite extraordinary as I try to use correct grammar as I modify all the different forms of the F-word. In high school, my peers used to ask me calculus questions after I polished off a fifth of a fifth of Patron, and yes, I could still do calculus after all that. Now that I forgot all that calculus nonsense (which is good for nothing except telling people who know or care that you 5'd the Calculus BC AP along with 7 other tests), all I can do is tell you random stuff that doesn't really matter all that much but makes you think that I kind of know a little something about something.

But since I'm still slightly inebriated, I'll be a bit honest with you: Truth is I don't really know all that much about stuff that really matters (in my opinion). And it scares me. It is a wholly unsettling feeling that I'm not the badass I pretend to be at the important sh--.

At the 'buzz point', the next alcoholic beverage will send me straight to the porcelain god or passed out with a future trip to the aforementioned god (which likely has more followers than the traditional Dude whom* people praise). I feel completely honest with myself which is sad considering it takes a foreign substance to make me face up to my most protected thoughts. It is a precariously golden moment of [false?] enlightenment.

I tell people the honest truth about how my latest job got cut, and how I kinda expected it to happen and how I kinda wished it would happen.

I tell people that my job made me feel dishonest while I smiled and told customers I wished they'd come back when I secretly deplored them for ever gracing my sight.

I tell them that I have done absolutely nothing in the past 2 weeks and how it feels absolutely amazing to not have to work, disregarding the fact that they have to cram for finals in the next couple of weeks.

I abhor and then console myself for assuming the professional pharmacist role while giving a mini-speech to pharmacy students: I mustn't tell the kids that Santa Claus and the Easter bunny aren't real--they will find out for themselves soon enough if they don't suspect already.

Because who the f-- cares! I've paid my dues in time and money and mental health. It is the time for rebirth into the new me or the old me or the better me (or worse me).
--

Sometimes I think of myself as a broken man with no purposeful intention except the innate desire toward self-preservation through food, shelter, water, and sex. And is that all life amounts to for a young adult male? Food, shelter, water, and sex, and not necessarily in that order?

It is abysmal sometimes when I go out and get to that wasted, veritable state where I look at other guys and think that if they could get with that one girl they were staring at the whole night that their life would be magically cured, that somehow the other flawed human being would make them perfect. But sadly it likely isn't true. Two wrongs don't make a right, and two imperfect persons do not make a perfect one.
--

'I had a good time tonight.'

'Yea, it was kinda like old times a couple of years back when we were in school, when I was driving you around from place to place.'

'Yea, kinda like the good old times, bro..'

With that, my friend exited the car at the University parking lot. I checked the door locks manually to make sure it was secure (can't be too careful in the ghetto), made a semicircle out of the parking lot and onto the road to the freeway..

Cruising down Gulf Freeway, I activated the cruise control at 60 mph to take the speed variance out of the equation for the Friday night copper. But the folks in the right lane were moving at an even slower pace, so I disabled the crutch and took over completely.

And I started to think about my life and how it isn't really all that bad in perspective and how I can really start digging the person I am or will be. So after all the years in between high school and now, I've arrived at the same point where I've started, just a little different, hopefully a little more grown and a little less green. And you know what? That's okay..

With that, I cranked up the pathetic speakers in my ride and faded into suspended consciousness while navigating the miles of concrete, passing the familiar food dives and sleazy strip joints, past one of the adult video stores where that priest got caught for 'public lewdness' for touching himself, to mi casa in the suburbia boonies..
--

Don't live life on autodrive; don't live life like your choices don't matter. Because

'lately I, am beginning to find that I,
should be the one behind the wheel.'

..and when you feel inspirational (through natural or chemical means), write it down, because you'll forget it the next day when you're looking at the receipts and wondering how the f-- you spent so much the night before..

..but I suppose you got to pay tuition for those life lessons..

--
*yes, that is the correct use of the word 'whom', so I think..

Juiceless

to the exhausted,

'Juice' has a variety of dirty meanings, none of which I will reference any further than this point. If the title had been related to those dirty meanings, then this post would have been more appropriately named 'Juiceless & Happy'. But as it is, it is more like 'Juiceless & Even-Keeled' or 'Juiceless & Eh..' or 'Juiceless & I-could-go-for-some-lunch,-but-I'm-not-all-that-hungry.'
--

My first memory of 'juice' being anything other than fresh-squeezed* and pulpless** was when my older brother first described to me the intricacies of sports betting. In most sporting contests, there's a favorite and an underdog. If given even odds (1:1), most people would bet on the favorite and would therefore win more than 50% of the time. Bet enough money (or cycle your cash enough times), and you wouldn't have to work.

This would, however, bankrupt sportsbooks and bookies. So somewhere down the line, someone invented the idea of a spread, where you give points to the underdog to make it fair. In theory, the number of points or 'line' should match the final score. A line (or spread) might read 'New England vs Houston, Houston +5' which would mean that if you bet on Houston, you get 5 points toward the final score: NE 20 - Hou 21(26 with spread), win; NE 20 - Hou 14(19 with spread), loss; NE 20 - Hou 17(22 with spread), WIN. In the last case NE wins, but 'did not cover the spread'. A few years back in their nearly undefeated season, NE was crushing opponents, covering all kinds of ridiculous spreads like -14 (when you bet on the favorite, points are taken away, which is the same as giving points to the underdog). In football, anything over 6 points is likely a lopsided game.

In actuality, the sportsbooks don't care what the final score is or if the line even comes close to it. What they want is a line that will induce bettors to bet both sides equally, so that in the long run, they'll break even no matter the score. But how do they get their money then? One word: juice. The odds may seem close to 1:1, but it's usually 110:100 against. In order to win $100, you have to bet $110 and the $10 difference is the juice money which makes sportsbooks profitable in the long run.

In order to get even betting on both sides, the line or spread will move to entice future bettors. So if the line was initially Houston +5, and a lot of people like Houston, then the line might decrease to Houston +4.5 and so on until the bets balance out, but at whatever line you place your bet, that's the line you're stuck with.

There was a whole movie called 'Two for the Money' devoted to sportsbooks starring Matthew McConaughey (who shirtless for a good part of the show, which may qualify it as female porn) and Al Pacino. It's a horrible movie, except if you know about sports betting and want to impress a girl while she's mesmerized by a sweaty, ripped Matt. I've never tried, but in theory it should work.

So juice is that little extra bit at the end that might make a whole venture worthwhile when the initial work seemed arduous, awkward, mostly unpleasant***.
--

In non-jargon use, 'juice' usually refers to energy or electricity and the like. And I am wholly drained of all juice at the moment. And I've been drained for the past two weeks. The R&R hasn't spiked my energy or motivation one bit. There was that one Black Friday morning where I waited about 15minutes for my gaming system, but since then it's been all Netflix and shifting around to different parts of the sofa so the ass print doesn't become permanent. All this is actually pretty great, but I am concerned that I haven't grown tired after 2 weeks which is normally the breaking point.

It is like when the non-replaceable battery in my iPod nano gets entirely drained, and I plug it into the USB port of my computer (because it doesn't come with a wall charger****) and for about 5 seconds, nothing happens. Then the white apple with the bite mark comes on (for how much it costs, can't we get a whole apple?), followed by the little flashing green battery icon to which I greet with a sigh of relief.. and shame that I'm an addict to Apple juice*****.

--
*,**,***,***** - okay, I lied about the dirty meanings thing :)
****Seriously Steve Jobs-- $160 and you can't include the wall adapter which costs another $30?

Face Down

Smartphone users,

It's hard to imagine that I've only had my Moto Droid (original) smart phone for just under a year. Before that, I was still pimping the Verizon Moto Razr which after 3 years could literally only make 2 calls or 10 text messages before the battery would alert that it was near dead (but would make a ding sound for a day before it would actually die). And just forget about accessing email or the internet on the minuscule pixelated screen, let alone pay Verizon for access to their crappy VZW Navigator program.

And I wasn't going to get into the whole phone craze (maybe just a newer, thinner clamshell), but my uncle kindly commented/insulted that my swag didn't quite match my salary. And so began this unholy tethering of myself to a 3.7 touchscreen device.

For a reasonable price of $200 for the phone and $50/month paid out to my parents on or around the first of the month (they comp my minutes, but not my data plan), I get unlimited internet and email pushed to my phone via Google's relatively seamless system. Which would be great if it hasn't turned me into a email-seeking fiend.

The Droid alerts me to my Gmail messages with a windchime-like noise (I couldn't find a decent copy of the Razr default windchime) and a fluorescent green, blinking LED light in the top right corner. The green, blinking LED light also alerts me to weather alerts, alarms, Facebook stuff, and a variety of other things. Sometimes when I don't see that green light for a few hours, I start to get depressed* and wonder why the world ignores me.

But then I just force the world to pay attention by posting random status updates and updating my blog (sorry for the long absence, but I have my reasons). Or I read Ball Don't Lie or poker articles or check stock quotes. All the while waiting for that little green light to turn on to signify that someone in the ether has initiated contact and wants to talk to me. Pretty sad, I know.

Most of the time, it's just Overstock.com or Southwest.com, but it's still nice to know you're appreciated, even if it's just for your money.

So this morning, when I woke up at 4:30AM to take care of bodily functions, I noticed my favorite green, blinking light sitting on the desk. Though I passed it up the first time, I couldn't resist the second time upon returning from the bathroom: it was nowhere in my line of sight, but the temptation of its sitting there waiting for my response was irresistible.

After two random emails and a few minutes of Facebook newsfeed, I was wide awake and lusting for more contact with the outside world even though I only had 6 hours of sleep after being awake for over 24 hours.

In the subsequent 4 hours, I set up my old DSL modem/ wireless router combo only to learn that AT&T has LoJacked their DSL service to possibly only allow their current hardware to work, saw my parents off the work and harassed them for the new hardware that was sent in the mail, set up the new modem/router device, used up a week's worth of 4-letter words when the 'easy to follow instructions' were easy to follow but just didn't work, got the easy to follow instructions to work after a cooling off period, got on the internet using WiFi instead of PDAnet, forgot my password to my email account because I don't type it anymore since I get my email through my phone, used some more 4-letter words, remembered the password, saw that there were no new messages because I had seen them all on my phone, and finally composed a long-winded blog entry.

And now I think I might go back to sleep with the rising sun, which I'm used to since I work nights. But before I do that, I think I must turn my phone face down so the green light can tempt the wooden desk, which has far more staying power than me**.

--

*Not really, because that would be sad.

**Ever so subtle double entendre :)

Wasting My Time

Procrastinators Non-Anonymous,

There's only a few people I know who aren't major procrastinators. I'm sadly not one of them. And I would bet even they are closet procrastinators and are simply good at putting up a diligent front. Or they're aliens. Yes, either they're closet procrastinators or they're aliens. There's no other logical reasoning. Book it!

However, there is one defense for procrastination: if your problem may go away by itself in the future, then it is logical to put off addressing it now. One application of this is to wait out the common cold. There's no cure anyway, and the doctor to justify a copay will just prescribe some new formulation you could get over the counter anyway (yes, this particular formulation of a decades old antihistamine and decongestant is sooooo much better than Claritin-D or Zyrtec-D). If you can't tell, I have a serious aversion to drug companies.

But for the most part, procrastination is a vice that many of us try to purge ourselves of and frequently end up unsuccessful. But we manage, either by the carrot (incentives) or the stick (punishment). The problem grows fierce when there's no carrot nor stick, as in my case now.

On my work week, I delay everything to my off week because it's direly important that I get enough sleep so I'm alert and focused so I don't make a misfill and get my pants sued off of me. On my off week, I go out carousing and making jolly, killing brain cells and spending 5-10 hours straight reading fine literature. All the while the to-do-list piles up in the corner, ignored the like red-headed step-child, who is soulless and therefore undeserving of love. And then the end of the week arrives, and the bill comes due.

And so here I am scrounging about for Form 4868 to file an income tax extension*, to do more work than is necessary if I had done it right the first time around.

Oh, I'll never change.
--

During school, there were reset switches. Let me explain: When making the most of life not studying for a test, the elapsed time until the test doesn't change. The test will still be in 2 weeks whether you like it or not. And I really don't understand why people assumed that I studied all night and day for stuff. I didn't and I don't. It's a gift to guess between A-B-C-D-E a little more than 90% of the time.

So the day before the test like every other super-studious student, I crack open my notes to page 1 of 1,000 and curse the day I was born into this world which has tests and isn't just a whole Montessori-it's-okay-just-try-your-best-you're-all-winners delusion. But my test-taking skills prevail, and the procrastination is reinforced instead of punished: if I can study just a day before a test and still make the same grade, then what is the point of studying in advance. Hate me; you know you want to.

But then the situation is reset: that test is over, and then there's the next one which you have 2 weeks to study for. It's like a 2-player Halo game: when your partner gets to the next checkpoint, you get to go along for the ride even though you hardly did any work. And at the end of the year, there's a giant reset button and you get the summer off to do whatever the hell you please.
--

When you beat the game (grade school & college), however, the resets and checkpoints mostly disappear. That same task you wrote down to clean out your notes and have a huge, purgative bonfire will remain there until you actually complete it. Your dumbbell set stares at you condemningly when you don't work out ('I worked out yesterday!' 'But you didn't work out today...FAIL'). The stuff you said you'd sell on eBay remains unsold. Etc, etc ad nauseam.

Okay, so today, I'm going to listen to some music, reconcile some receipts, and clean out my room. I predict I will complete just 1 out of 3, and that would be the listening to music task.

Queue Default's Wasting My Time.
--

*Not really--the government owes me a fat check every year since they take out 1/3 of my income, and I file my taxes as early as possible so those bastards can't get more interest off of MY money.

Pre-Filled Flu Syr

Dear new techs,

The bad part about working at a brand new store is that you can hardly find a pharmacy technician with any experience. All those AIU, Remington, ITT tech places promising thorough training and career placement have fine print saying jobs aren't guaranteed. The reason being that employers want people with real-world understanding of the job. But when you open in a brand new market, those trade school grads are the ones you can find with some exposure, however minimal.

Though you can find a truly remarkable individual once in a while who ends up being really great but didn't have any experience initially, that is the exception. Experience matters, period.

But luckily for me, the techs at my store have a good attitude towards learning, which is really the most important characteristic in my opinion.

With new techs, you do see some pretty funny situations such as a tech saying that we were out of stock of albuterol MDI ('Dude, there's ProAir, Proventil, or Ventolin...pick one') or ordering Indocin suppositories because that's all that was pulled up in the computer when they typed 'Indocin' (brand for Indomethacin, which we had 10 bottles on the shelf).

But the one that took the cake, which I could see myself doing if I had a brain fart, was this:

I came in one night and noticed that we had low-dose heparin syringes, the kind that they used to clear out or push through medicines in IV lines in hospitals. It's pretty common in hospital pharmacies which usually carry several cases of them. But not in a retail pharmacy--if you have an IV line, you should probably be in a hospital or a long-term care facility. And IV drugs are probably not going to be covered under prescription insurance anyway.

Anyway, I laughed at it, chalking it up to ordering error, which happens a lot. The syringes came in white boxes with about 50 in each. In turn, the 4 white boxes fit inside a large cardboard box, which had the label: BD Pre-Filled Flush Syringes.

My goodness, so that's the reason! BD Pre-Filled Flush Syringes. I guess one of the techs thought that the 'BD Pre-Filled Flu Syr' in the wholesaler catalog was the pre-filled flu syringes that we've been using like warmcakes*.

And we can't return it because it's 'generic', but at least it's cheap. So if you need some flush syringes, get a prescription and then holla at yo boy.
--

*Flu shots haven't exactly been flying off the shelf. Maybe 10/week if that?

The Ambien Prior Authorization

Dear new RPh's and techs,

A post for my retail pharmacy people and those insomniacs whose insurance refuses to pay for sleep pills.

Just about the middle of last year, I started to notice that refills for zolpidem, generic Ambien, was being rejected for a prior authorization. This means that the insurance company wants to talk to the doctor to make sure that the patient really, really needs the medicine. What it really means is that insurance companies are the spawn of the devil and don't want to pay for anything.

A quick note about insurance companies: their business model is to take regular premiums from their customers and find ways to NOT pay out claims. One of the sneaky ways they do this is to send out brand new cards every year so that they can expire the old ones and hopefully not pay for a refill. In doing so, they make my job sucky for a few months out of the year, even more than usual with having to deal with insurance.

Most of the time though, their prior authorizations (PA) are well founded: rejecting an ADHD med for a kid who is 4 years old (my goodness, are we going to pump 1 year-olds with Ritalin next because they cry too much? wait a minute, we do! *sad face*), rejecting Cambia(R) because it's glorified ground-up diclofenac*, and rejecting Nexium(R) because it's basically rehashed omeprazole whose patent had run out**.

To these situations, I must say to the insurance co's, 'Nicely done. If I had more time to talk to the doctors to convince them to use medicines judiciously, I'd do the same. But since I'm here to dispense drugs pursuant to a prescription, I'd really wish that you'd make my life easier and just approve the medicine for a $200 copay so I can tell the patient to take it or leave it or take it up with their insurance/doctor. Because a PA makes it look like the pharmacy is being withholding, when it is in fact, you who are the angry wife (who is withholding of the marital obligation). Thank you.'

But I just don't understand when they reject meds which are comparatively dirt cheap (in the $40 range). Branded Lamisil tablets used to be prohibitively expensive, but the generic isn't too bad. Come on, guys! Let the old dude have it for his onychomycosis! Or when they rejected generic zolpidem when they had paid for it the first couple of months.

But then I remembered the lecture I gave on sleep disorders shortly after I graduated***: Ambien is FDA-approved for 'short-term treatment of insomnia characterized by difficulties with sleep initiation. Ambien has been shown to decrease sleep latency for up to 35 days in controlled clinical studies.'

Bingo! The resident medical 'expert' at the insurance department picked up on the little bit of important information (the package insert that accompanies the drug bottle), and found a great reason to reject refills of Ambien. 'Dear Dr. so-and-so: As you can see from the package insert, Ambien (Zolpidem) is not approved for treatment lasting longer than 35 days. Thank you.'

Anyone with any bit of reason (even insurance companies) knows that Ambien doesn't simply stop working after 35 days because the drug isn't approved for long-term treatment. It simply meant that Sanofi-Aventis didn't have the money to run the trial longer or were afraid that the sleep-inducing effects would wear off after 35 days and would lead to not-so-good-looking clinical results. As such, the drug is FDA-labeled for short-term treatment and now insurance companies have a perfectly valid reason to reject a claim using a prior authorization.

They could run longer trials now, but they won't because Ambien is generic, so they couldn't re-coop their expenses.
--

So why know all of this? Because it is always better to explain to customers how it really isn't your fault. When you pass the buck to other folks, preferably drug or insurance companies, customers can get angry at them instead of at you. By the way, don't pass the blame to their doctor, because they may really like their doctor or their doctor may call and chew you out.

'Why is my insurance not paying for my medicine?'

*Smile* 'Well, sir. Ambien is not approved for long-term treatment of insomnia. Though I realize that you've been using it for years now, the original studies approving the medicine was only for short-term treatment. I think the insurance company wants to run this by with your doctor and make sure that there isn't a better way to treat your insomnia.'

Congratulations! The customer is no longer angry at you, and thinks you're pretty swell for your insurance knowledge. He shakes your hand, happily pays the ~$40 for the cash price of Ambien, and will take it up himself with his doctor/insurance.

Based on a true story.

Incidentally, you could also recommend the customer to get a prescription for Temazepam (generic Restoril) which is only about $20 per month without insurance.
--

*I wanted to tell the patient to get a prescription for diclofenac 50 mg, buy a mortar and pestle, grind the pills up herself to put in water, and save $200 for 5 friggin packets!

**Please explain this to me: Omeprazole 20 mg and Nexium 40 mg are the most commonly dispensed strengths. We are made to believe that the S-enantiomer is supposedly the more active (or only active) component of the racemic mixture, and/or that it has less side effects. Therefore, if Omeprazole 20 mg contains 10 mg of the S-enantiomer (Nexium) and 10 mg of the R-enantiomer, wouldn't the equivalent strength of Omeprazole 20 mg be Nexium 10 mg?

So why does AstraZeneca market Nexium 40 mg which would be in essence, a four-fold increase in strength vs Omeprazole 20 mg (Prilosec, which they made)? Don't give me some BS about how there are fewer side effects so you could give a higher dose--show me a person who was taken off omeprazole for side effects and I'll show you a hypochondriac.

***Excuse the not-so-subtle reference to my genius :)

Death of AIM

Dear harried folks,

The truly wonderful thing about being done with school is the freedom to do and not do whatever the hell you want. If the only thing I do besides work is to sleep all day and night on my 7 off, I could very well do that. It's not at all productive, but who cares? Sleep to me is akin to another activity that starts with 's', which is to say it's immensely pleasurable.

And being virtually stress-free, I've begun to understand the ideal of single-tasking, that you do best when you focus your entire attention on a single task at a time. It is a luxury that I daresay few people have in the workforce when most have to bring their work home. At the pharmacy, you multitask for your whole shift, but when you leave, you get to leave everything there. And thankfully your salary isn't tied into your performance (there is incentive pay, but it pales in comparison to the base salary and for the most part isn't worth stressing over*). That's one of the greatest perks of my job: when I leave, I leave.

Related to this myth of multitasking, which you can read a review of the book here by Dave Crenshaw, is that I've pretty much stopped using AIM, or AOL Instant Messenger. I found that the people I really wanted to chat with aren't on there, and the ones that I don't want to chat with would annoyingly pop in ('hey wats up?' 'nothin much, chillin' ...5 minutes pass, aZnHaVoc04** has signed off ) when I'm reading my favorite blog, Ball Don't Lie, which introduced me to my favorite NBA comic-strip blog, Garbage Time All-Stars***. I think most of the screen names I had on there were from high school when instant messaging was the rage.

The last time I signed on was probably over 6 months ago, and that was because I was helping a friend shop for something and we needed to paste links to websites. People whom I talk to on a regular basis have my phone number and they have phones which are capable of making phone calls and sending text messages. Some also have the ability to send email on their devices, which is even better. When I do get messages and calls, I know that the person on the other end really wants or needs to communicate with me and isn't simply bored and I'm 'available' because I'm signed on.

When I talk to someone now, I try to put effort to connect to what they are trying to say as much as possible (but I can't help it sometimes if I'm distracted because they're hot). Because no one really listens anymore. Not really. But everyone wants to talk.

My feeling is that all this new media has created more noise instead of more communication. We cannot decide what is important or we waste too much time parsing through all the nonsense.

It'd be cool if we were to write letters using quill pens and inkwells on unlined parchment and sealed our letters with hot, red wax using our crest and gave the mailboy a shilling or shekel to hand deliver to our closest friends and mortal enemies. And we'd wait patiently the next day and wonder ever so heartbreakingly why she hasn't responded yet to our latest sincere behest. To only receive a note two days later from the fair maiden's womanservant that 'the lady has gone out riding (horseback, not bareback) with Sir what's-his-face and won't be back for a fortnight.' To which you'd respond with, 'Ah, the tiresome wench! How she irks me so!'

I swear I haven't been watching the x-rated remake called Mr. Prejudice's Pride. These are some of the random thoughts that float through my head on a daily basis.

But the point I'm trying to make using a poor metaphor of Victorian novels is that people really cared and put thought into what they're trying to say (at least I would hope so). They had writing desks, a piece of furniture designed for just writing! They didn't use crackberries to tweet while on the john in 140 characters or less.

So along with eliminating all the empty calories in my diet (with the exception of tasty single malt scotch, which no one should define as empty simply because it is alcohol), I am eliminating the empty communication in my life.

It reminds me of one of the closing lines from a Supernatural episode: 'You're all so connected...but you've never been so alone.'

How true.
--

*Imagine if bonuses were large like those finance CEOs: there might be misfills everywhere when pharmacists are pressured to increase numbers. But corporate execs would never do that because retail pharmacist salaries are insane as it is.
**Not the actual screenname, but pretty close. Not mines of course. I'm too classy for that.
***This was when Tracy McGrady was out with 'back spasms' and Von Wafer was actually a decent stand-in.