Tonight, we invited a Chinese student for Christmas Day supper. She's not a Christian, which is not to say, of course, that she's unchristian. From her hometown across the bay from Shanghai, the occasion of the holiday is enjoyed as more of a chance to enjoy time with family and join those silly Engrish in a celebration.
I asked her what religion she professes, and she replied her heritage is Buddhism as those from many Far Eastern (or Near Western) traditional cultures. I considered for a second that some might 'accuse' her of being an atheist, or even pagan. Those words, like agnostic are used in the context and usually insulting manner by those that call themselves Christian as a 'fault' comparatively by those that aspire to call their ownselves Christian, quite unfairly to those that choose to believe in another religion.
My faith is something in my heart not in whether I take Communion as a wafer, or a piece of bread, or a Triscuit, but in my belief system a transubstantiation to the Body and Blood, not rituals but acceptance of God’s love within me and my life and can not be taken away by deliberately changing my belief as a result of someone elses' persuasive abilities.
I wonder at the evangelization goal of Christians for those that already passionately believe what they believe. It is unfortunate many Christians believe that those not of a particular religion nor choosing a Christian affiliation, might consider other cultures primitive, equating their own Christianity as the highest form and most civilized of religious belief systems. Christmas is a good time to reconsider ones' personal beliefs.
I choose to continue to believe what I've believed from my childhood upbringing, perhaps, as testament to pragmatism, or refusal to update confirmation in early adolescence. I've come to realize that the church of my childhood has many fundamental beliefs reflecting rational utilization of universal truths. And, much of the religion builds on dogma expressed in symbolic concepts and terminology which underlies an intent of speaking for all across the spectrum as a set of catholic beliefs.
I could no more deny their entirety as deny my heritage, than think that wishing is a rational way to do business. It might make things easier if we were all to believe Jesus Christ as the son of God came to lead and live with us, but that is an acceptable Western tradition, no greater or lesser than any other belief system that advocates for equality, order, respect, a time before and afterwards, and striving to live for a higher purpose.
Tonight, we had sukiyaki for supper. Not Chinese cuisine, but a pleasant alternative. From the night before, slivers of beef had been marinating in brown sugar and shoyu. Cubed tofu and konnyaku, shirataki strands, sliced bamboo shoots and mushrooms awaited the deft hand of a chef, and the hokusai (or napa) was set out for my husband to cut when he cooked the meal. I remembered the taste of gobo root other times we'd prepared the dish, so bought 6-7 stalks, but realized on the fresh smell when peeling it that we only needed a half a store-bought root cut into matchstick pieces for flavor.
While watching a movie set up on the dining table, my husband cooked a meal in the wok on the electric wire, cabbage leaves overflowing the top as the liquid of it and the other vegetables were released in a flavorful blend at the bottom the wok. Sukiyaki served in bowls over hot steamed rice and the 'soup' ladled in. It was delicious. Mango ice cream and a strawberry for dessert. Three color Jell-O of green lime, vanilla puddington, and red raspberry layer on the top. Our Chinese friend learned to cook a very simple Japanese dish, and how to make gingerbread cookies for a traditional holiday custom.
Older son showed a movie about a train trip from Shanghai to Tibet on Discovery Channel which was quite impressive because of the landscape the route traveled. It seemed as if passenger could look out their windows to see Denali within shouting range passing by on the way from south to north, or say, observe antelope and moose of northern Colorado on a train trip paralleling the Trail Road to the Snowies.
So, these pseudonyms I've used altogether might give an idea of who I am in the way of Shakespeare with his analogy to a rose; opinionated, for sure. Coming up with a false name is as creative an exercise as anything else possible for an older person who hasn't time to devote to writing poetry, nor wherewithal to retire and reinvent oneself as a composer of music. If I were to retire now, I doubt at age 65 --in 13 years, I would be anywhere close to approaching the musical genius of Felix Mendelssohn, a child prodigy who took less than 15 years to develop expertise in providing outward musical expression of his innermost inspirational muse. His sister Fanny didn't take too long, either. Of course, Wolfie took less time than F. M-Bartholdy. There's no accounting for true genius. One cannot expect that the idea of even a sniggle of genius will come into play after 50 years of 'life experience', without the fresh egotism, fortitude and invincibility of a child.
One of a favorite anonym used is Mabel LeBeau; first at age 10 or 11 years old, just to have a nom de plume for an alternate identity. Alternate identities such as virtual identities have evolved into an entirely different concept than that of my childish imagination. At the time, Mabel was an old-fashioned name that sounded grown-up and mature, and easy to roll off the tongue. Unfortunately, over the years it's evolved into a allonym not easy for me to look at without any degree of irritation at the obfuscation it engenders, entirely devoid of any hint its user attempts to hide a flibbertigibbet personality.
Perhaps, if Mabel was spelled Mable, Mabyl, Maebelle, Mabol, Mabyll, or even Maybo, the name mightd seem less plain and utilitarian. However, the alternate spellings would probably throw off a spurt of enthusiasm every time I saw it in my mind, distractingly to refocus on what a person with the name 'Mabol' could stand for. It's far easier to work with black and white persona, when trying to fit into the image of Mabel rather than Mabo, to imagine a person named Mabel wearing plain blouses or polo shirts of polyester, Tencel(R), rayon, or poplin with 3/4 length sleeves, worsted wool skirts, and cotton underwear or that the opposite, 'anti-Mabel' prefers traveling to faraway places wearing paisley silk shawls, and simple chartreuse Ponte Di Roma dresses and leather heeled mules.
LeBeau is a throwback to a French Canadian heritage. With a meaning 'the beautiful' in French, it's more a nod to the commonality of anglicized 'Bo' as a surname in cajun country, an ancestry one cannot deny even as it's never been researched or specifically developed.
Sunday, December 26, 2010
Saturday, December 25, 2010
New year, another chance to look at things differently
It's interesting to consider previous posts at this blog. They were headed with 'Cinnamon, Nutmeg, and Allspice' using the related moniker: Cinnamon. Because I do not identify myself as 'just' a pharmacist, this post was a catch-all for domestic and eclectic interests as well as a typical feminine-type of identifer. Cinnamon was chosen for several different reasons. One reason is that it is an alliteration of my initials CMN. Another possible pseudonym, Chameleon, might be appropriate but whenever I've attempted to use it usually has already been taken. Other monikers I've used include, The Pharmacist, Jade (for my favorite color), Zircon (for a word I missed in a State Spelling Bee), and LD50placebo effect (for a bit of joviality), as well as my real maiden name RPh. Once I used, 'A Concerned Pharmacist', and have used Territorial Babe to express an unpopular opinion of a woman who tried to treat the role of vice presidential candidate as a high school popularity contest in an attempt to discredit the value of having rational personal integrity outside of being a 'tool' even for her husband. My son uses his real name for his blog, but I couldn't risk possibly embarrassing my family if I expressed an opinion that seemed out of sync with the image projected as their mother or wife, or even sibling.
I found several identifiable attitudes when using Cinnamon as a pseudonym. The two women I knew as Cinnamon were quite different; one was a vivacious upperclassman in high school. She was smart, and also a member of academic, social, and sports-related activities. Her hair was brown as I recall. The other Cinnamon was in pharmacy school, again, smart and sociable, as well as a country-music singer who played gigs on the weekend as others might wait tables, or wash dishes for college funds. She might have had blond hair, not a cinnamon strand.
These women were typical of who I'd anticipate having Cinnamon as a birth name. I didn't know anyone with Cinnamon as a nickname, yet when signing myself as 'Cinnamon' several males called me in not so many words a 'whore'. I have never known any nightclub strippers, let alone one named 'Cinnamon'. I also knew as Ginger, a woman who had dark hair and was as warm and friendly as one might have as a younger sister--well, that would be my younger sister.
Ginger, the pharmacy technician, was a woman I met in a small farming town Wal-mart Pharmacy. Ginger had not a ginger bone in her body. She was sweet, quick, and empathetic, and training to be a kindergarten teacher. She had infinite patience. She was the only tech on duty working with me, the agency relief pharmacist that day. Not an employee of Wal-mart, but as a principled primarily hospital pharmacist working agency jobs for experience as well as extra income. By principled, there were certain things that once I had the hang of being in the retail setting would or should not get past me unlike previous agency workers or even the regular pharmacist.
When I first started out, as I recall the first day at a Wal-mart at a shop in a major city 60 miles away, I think I nearly frightened the two technicians to death or gave them a good scare about what might happen on their watch. The two technicians I'll give as their real names because I don't anticipated running into them anytime in the future. They are pharmacists, by now, Adrian at Philadelphia College of Pharmacy, or maybe it was St. Louis College--anyway, a big name pharmacy school, and the other guy whose name I never can remember right off the bat because it's an unusual ethnic name as he seemed to be second generation. He graduated Purdue, another big name pharmacy school, and I recognized his name right off when looking over the list of new grads.
The foibles that first day working for the agency would nearly unnerved one never to return, but I justified the adventure of it as the first day as a retail pharmacist ever. Not letting on to Adrian and the other guy that probably was a good move on my part. They probably thought I was just a ding-bat and hopefully that was it. Adrian seemed a genuinely laid-back individual. He was tremendously organized, and greatly effective in his attempts to set my anxiety index lower so that I could think straight. The other pharmacy tech tried his hardest to be everything he could be, also, tremendously smart and organized but he once or twice let his anxiety slip out and I could tell that he wished he had not signed up for this particular Saturday morning.
When taking the assignment, I was given the store phone number, but not told that I needed to extract important information from the pharmacist on duty before the assigned shift. I located the shop using MapQuest online and estimate the time of the commute and prepared for the drive. I knew it was a weekend shift with weekend hours and I was the only one assigned, so I'd have to open up and close, but it was also a national holiday which meant its share of special issues.
I started out in plenty of time, but there is only so much time one can make up when the first thing that happens is that my car quits. I don't remember the scenario, but I was able to rent another quickly and started out again only 15 minutes later than planned so I figured that if I as the one closest to being on duty, there'd be no need to cancel, and try to get someone else at the last moment. So, I just increased my highway speed a little.
Normally the store wants the pharmacist to arrive 15-30 minutes before it opens, and I arrived to the store with minutes to spare before the door should have opened, but had no codes to open doors or start the computer. Even when the floor manager was able to contact someone to get them, it was difficult to unlock a combination lock on the first try if too many attempts sets off the alarm. Most locks I've been responsible for unlock for the first time, end up requiring a call to the security company or police department to ignore the warning the place is being broken in and possibly vandalized.
Besides, this pharmacy was part of Wal-mart's remodeling project. When Wal-mart remodels, I've noticed, they make a mini-pharmacy inside a locked cage with light and pressure-sensitive security warnings all around the cage. So, I'm trying to get the pharmacy open and there are sirens blaring all around from tripping the wrong code input and tripping the electric eye. Fail too many attempts or try to get in a circuitous route and alarms go off, too. So, the other tech whose name is still not coming to me, arrived to work and first duty is to help the agency pharmacist get the shop open.
Meanwhile patients were lining up, dropping off scripts, asking questions. I try not to get noticeably panicked. Techs are not supposed to know codes for getting into the shop, and generally they do not, but students might find it in their best interest to know things to keep things running smoothly, as someday, after graduation they will be in charge.
Then, when we opened the shop, the next undertaking was to get the computer system up and running to process prescriptions. The pharmacist sign-on was required first before the store prescription could be dispense.That was another dilly. It required a call to another Wal-mart pharmacy. Eventually this hurdle was cleared and we began processing scripts waiting from the patient request queue, the 'auto-refill' program, and urgent matters of patients waiting in line.
The patients didn't seem particularly upset at first, but as time seemed to stand still for them, and they had to be other places at certain times on a Saturday morning, there were a few sharp words. When patients started calling to see if their prescriptions had been called in and showing up, again a call to another shop was necessary for the codes to listen to the voicemail message, then there were additional steps to take when patients requested they have their prescriptions transferred.
So, the day progressed. Running back and forth checking what Adrian and the other tech had filled, trying to answer questions. I recall only two incidents in which the other tech seemed visibly lose his 'cool'. One was when a patient, an older gentleman, quietly questioned the number of refills originally entered in the computer system. By this time I was familiar enough with the computer to access facsimiles of the originals, so I told the patient to stick his head over to the screen and see what it said. The presence of a customer in the pharmacy upset the tech greatly and he nearly ran from the other side of the cage to shoo him out quickly, explaining that customers were never allowed in the pharmacy. I could see the logic in it, and have never invited a patient into the pharmacy since. In my hospitals, I was never shy about inviting the physicians in to wait while I made up their Abciximab drip STAT. Some pharmacists found the presence of the doc unnerving, but it always made me work more accurately, unless of course I had to do other things distracting to the matter at hand. But, a doc's behavior is probably more predictable than a patient.
The second matter that I went over and over with the other tech, was when a patient came in with no refills on her lisinopril prescription, and the only record we had in the computer was an enalapril filled a year earlier. In the meantime she'd been enlisted in a mail-order prescription service and since the doc's office was closed until the next Tuesday, and I didn't have a 'feel' for the local physicians, I told her I needed for her to bring in her bottle. She had it in her possession but it was out refills. No matter how hard I tried to imagine a patient out of her blood pressure medication for three days, the greedy 'what if I get in trouble' gremlin showed its horns. And, I did not fill any even at no charge. Years later, I still feel bad about not filling even a few days to help her get by until the mail-order supply arrived in her mailbox.
That day was only the first of the fill-in pharmacist adventures. Since then I've worked at many different kinds of shops and with many different kinds of people. Inevitably, however, if someone forgets that the pharmacy cannot remain open without the pharmacist on duty, I'm not hesitant about taking the keys and saying the pharmacy is closed for the day. Techs do not run the shop. The pharmacy buyer doesn't run the shop. Patients do not run the shop, and neither does the store manager. I am licensed and every state I'm licensed required a licensed pharmacist on duty to perform the job of a pharmacist.
I found several identifiable attitudes when using Cinnamon as a pseudonym. The two women I knew as Cinnamon were quite different; one was a vivacious upperclassman in high school. She was smart, and also a member of academic, social, and sports-related activities. Her hair was brown as I recall. The other Cinnamon was in pharmacy school, again, smart and sociable, as well as a country-music singer who played gigs on the weekend as others might wait tables, or wash dishes for college funds. She might have had blond hair, not a cinnamon strand.
These women were typical of who I'd anticipate having Cinnamon as a birth name. I didn't know anyone with Cinnamon as a nickname, yet when signing myself as 'Cinnamon' several males called me in not so many words a 'whore'. I have never known any nightclub strippers, let alone one named 'Cinnamon'. I also knew as Ginger, a woman who had dark hair and was as warm and friendly as one might have as a younger sister--well, that would be my younger sister.
Ginger, the pharmacy technician, was a woman I met in a small farming town Wal-mart Pharmacy. Ginger had not a ginger bone in her body. She was sweet, quick, and empathetic, and training to be a kindergarten teacher. She had infinite patience. She was the only tech on duty working with me, the agency relief pharmacist that day. Not an employee of Wal-mart, but as a principled primarily hospital pharmacist working agency jobs for experience as well as extra income. By principled, there were certain things that once I had the hang of being in the retail setting would or should not get past me unlike previous agency workers or even the regular pharmacist.
When I first started out, as I recall the first day at a Wal-mart at a shop in a major city 60 miles away, I think I nearly frightened the two technicians to death or gave them a good scare about what might happen on their watch. The two technicians I'll give as their real names because I don't anticipated running into them anytime in the future. They are pharmacists, by now, Adrian at Philadelphia College of Pharmacy, or maybe it was St. Louis College--anyway, a big name pharmacy school, and the other guy whose name I never can remember right off the bat because it's an unusual ethnic name as he seemed to be second generation. He graduated Purdue, another big name pharmacy school, and I recognized his name right off when looking over the list of new grads.
The foibles that first day working for the agency would nearly unnerved one never to return, but I justified the adventure of it as the first day as a retail pharmacist ever. Not letting on to Adrian and the other guy that probably was a good move on my part. They probably thought I was just a ding-bat and hopefully that was it. Adrian seemed a genuinely laid-back individual. He was tremendously organized, and greatly effective in his attempts to set my anxiety index lower so that I could think straight. The other pharmacy tech tried his hardest to be everything he could be, also, tremendously smart and organized but he once or twice let his anxiety slip out and I could tell that he wished he had not signed up for this particular Saturday morning.
When taking the assignment, I was given the store phone number, but not told that I needed to extract important information from the pharmacist on duty before the assigned shift. I located the shop using MapQuest online and estimate the time of the commute and prepared for the drive. I knew it was a weekend shift with weekend hours and I was the only one assigned, so I'd have to open up and close, but it was also a national holiday which meant its share of special issues.
I started out in plenty of time, but there is only so much time one can make up when the first thing that happens is that my car quits. I don't remember the scenario, but I was able to rent another quickly and started out again only 15 minutes later than planned so I figured that if I as the one closest to being on duty, there'd be no need to cancel, and try to get someone else at the last moment. So, I just increased my highway speed a little.
Normally the store wants the pharmacist to arrive 15-30 minutes before it opens, and I arrived to the store with minutes to spare before the door should have opened, but had no codes to open doors or start the computer. Even when the floor manager was able to contact someone to get them, it was difficult to unlock a combination lock on the first try if too many attempts sets off the alarm. Most locks I've been responsible for unlock for the first time, end up requiring a call to the security company or police department to ignore the warning the place is being broken in and possibly vandalized.
Besides, this pharmacy was part of Wal-mart's remodeling project. When Wal-mart remodels, I've noticed, they make a mini-pharmacy inside a locked cage with light and pressure-sensitive security warnings all around the cage. So, I'm trying to get the pharmacy open and there are sirens blaring all around from tripping the wrong code input and tripping the electric eye. Fail too many attempts or try to get in a circuitous route and alarms go off, too. So, the other tech whose name is still not coming to me, arrived to work and first duty is to help the agency pharmacist get the shop open.
Meanwhile patients were lining up, dropping off scripts, asking questions. I try not to get noticeably panicked. Techs are not supposed to know codes for getting into the shop, and generally they do not, but students might find it in their best interest to know things to keep things running smoothly, as someday, after graduation they will be in charge.
Then, when we opened the shop, the next undertaking was to get the computer system up and running to process prescriptions. The pharmacist sign-on was required first before the store prescription could be dispense.That was another dilly. It required a call to another Wal-mart pharmacy. Eventually this hurdle was cleared and we began processing scripts waiting from the patient request queue, the 'auto-refill' program, and urgent matters of patients waiting in line.
The patients didn't seem particularly upset at first, but as time seemed to stand still for them, and they had to be other places at certain times on a Saturday morning, there were a few sharp words. When patients started calling to see if their prescriptions had been called in and showing up, again a call to another shop was necessary for the codes to listen to the voicemail message, then there were additional steps to take when patients requested they have their prescriptions transferred.
So, the day progressed. Running back and forth checking what Adrian and the other tech had filled, trying to answer questions. I recall only two incidents in which the other tech seemed visibly lose his 'cool'. One was when a patient, an older gentleman, quietly questioned the number of refills originally entered in the computer system. By this time I was familiar enough with the computer to access facsimiles of the originals, so I told the patient to stick his head over to the screen and see what it said. The presence of a customer in the pharmacy upset the tech greatly and he nearly ran from the other side of the cage to shoo him out quickly, explaining that customers were never allowed in the pharmacy. I could see the logic in it, and have never invited a patient into the pharmacy since. In my hospitals, I was never shy about inviting the physicians in to wait while I made up their Abciximab drip STAT. Some pharmacists found the presence of the doc unnerving, but it always made me work more accurately, unless of course I had to do other things distracting to the matter at hand. But, a doc's behavior is probably more predictable than a patient.
The second matter that I went over and over with the other tech, was when a patient came in with no refills on her lisinopril prescription, and the only record we had in the computer was an enalapril filled a year earlier. In the meantime she'd been enlisted in a mail-order prescription service and since the doc's office was closed until the next Tuesday, and I didn't have a 'feel' for the local physicians, I told her I needed for her to bring in her bottle. She had it in her possession but it was out refills. No matter how hard I tried to imagine a patient out of her blood pressure medication for three days, the greedy 'what if I get in trouble' gremlin showed its horns. And, I did not fill any even at no charge. Years later, I still feel bad about not filling even a few days to help her get by until the mail-order supply arrived in her mailbox.
That day was only the first of the fill-in pharmacist adventures. Since then I've worked at many different kinds of shops and with many different kinds of people. Inevitably, however, if someone forgets that the pharmacy cannot remain open without the pharmacist on duty, I'm not hesitant about taking the keys and saying the pharmacy is closed for the day. Techs do not run the shop. The pharmacy buyer doesn't run the shop. Patients do not run the shop, and neither does the store manager. I am licensed and every state I'm licensed required a licensed pharmacist on duty to perform the job of a pharmacist.
Sunday, December 12, 2010
Baytril, Warehouse floors, VetaMeg and Cystorelin
Cystorelin® and Fertagyl® are brands of injectable gonadorelin used for treatment of cystic ovaries in cattle. Available as prescription-only on a licensed veterinarian's orders, Cystorelin® is manufactured by the English and Welsh company Merial.
I wonder if the gonadorelin manufacturers hold T.V advertising duels touting benefits of Sister Ellen vs. Fergie Girl.
Baytril ®manufactured by Bayer of Germany is a fluoroquinolone, enrofloxacin, an antibiotic for veterinary use and its range of applications in companion animals such as dogs, cats, exotic animals and food animals such as poultry, cattle, pigs and sheep.
VetaMeg ® flunixin 50 mg/mL is a prescription-only veterinary non-steroidal, non-narcotic anti-inflammatory analgesic agent with antipyretic activity, funnily listed as more potent than 'pentazocine, meperidine, and codeine' as analgesics as demonstrated in the rat yeast paw test.
What is funny is that the drug's mechanism of action is non-narcotic yet the analgesia effects are compared to narcotics and not very effective ones at that, specifically pentazocine and codeine. Maybe, pentazocine and codeine work better in relieving inflammation in sheep, but they don't do a darn thing for human animals.
What do the three drugs above have in common? First, they are used exclusively in non-human animals, and second, they are prescription-only drugs that must be ordered by a veterinarian, and dispensed only by pharmacists, the profession legally allowed to fill prescription medications in the US.
Guess. What was I doing last week in my job as an agent pharmacist? Dispensing the drugs listed above; I found myself working for a animal health supplies warehouse filling prescriptions for herds of dairy cattle and pig farms from all over in the mid-eastern cornfields. Walking up and down concrete floors of a large warehouse in my dress shoes, climbing ladders, pulling boxes of drugs from shelves high above my head; checking product names of drugs I'd never heard of before, ripping open cardboard boxes, verifying expiration dates and lot numbers of product to send out; slapping prescription labels on bottles of cyanocobalamin, ceftiofur and dinoprost.
I dreaded the called-in prescription: 'Hello, this is Dr. Heffer calling for Ladonnabella Dairy Farm in Kalamazoo, Michigan. Please dispense Excede (ceftiofur) 200 mg/mL # 3 x 100 mL bottles. Label: For treatment of foot rot. Give to the lactating cow 1 dose of 6.6 mg/Kg or 1.5 mL per 46 Kg body weight, subcutaneously at base of ear. If no improvement after 5 days, call back.
Animals as customer are quite different than human customers. For one thing ... the quantity prescribed might be somewhat different doses seen in humans, but the amount dispensed is quite a bit larger considering drugs are dispensed to similarly aged animals in herds. Vitamin K (phytonadione) doses for human adults come in 1 mL ampules of 10 mg/mL For dairy herds, the stuff comes in 100 mL bottles. Another thing, though the injectable medications come in pint-size quantities, there is no sterile rubber stopper.
It is a sobering thought that perhaps the vet or tech administering the vaccines probably does not carefully shave and swab the site of injection with antiseptic and the rubber stopper with alcohol using aseptic technique to mass immunize the herd.
Another thing, the pharmacist dispenses drugs to human herd owners, so there is no foot-stomping (hoof-stomping?) displays of temper tantrums when the prescription is not filled in 5 minutes or the patient's health insurance plan doesn't cover the cost of the drug.
For veterinary use, amoxicillin still comes in bubblegum flavor, and sulfamethoxazole-trimethoprim is still a cherry-flavored suspension for cattle, but I have my doubts about how palatable or patient-acceptable is VetaMeg which is labeled for use in animals only.
Flunixin, a fluoroquinolone... do the same limitations exist about using the antibiotic in pregnant animals, exposure to the sun, and avoiding co-administration with multi-valent cations as humans?
There are a number of adverse reactions we pharmacists counsel our human patients about the fluoroquinolones, are a highly effective broad-spectrum antibiotics with a unique mechanism of action; interference of DNA-gyrase in replication of the bacteria. Broad-spectrum refers to a highly effective mechanism of action providing potent antibiotic effect on a broad range of different types of bacteria including both those with and without cell walls.
This broad range of efficacy provokes several public health issues; emergence of resistance crosses with highly effective ciprofloxacin considered a major agent for inclusion in disaster preparedness for anthrax and other public health menaces, and in comparison to other antibiotic classes rank amongst the highest for risk of causing colonization with methicillin-resistant Staphylococcus aureus and Clostridium difficile infections, both highly resistant to conventional treatments and difficult to treat inexpensively and completely and highly transmissible.
I have seen prescriptions for these types of drugs for urinary tract and upper and lower respiratory tract infections because it often covers the likely pathogens that might normally require administration of two antibiotics. When it first came out, it was of interest that concentration in prostate tissue approached concentrations in the blood, a viable alternative to the highly polar aminoglycosides remaining in the bloodstream, and providing a serious contender in hard-to-treat male urinary tract infections.
Dependence on a singe antimicrobial agent for serious infection pushes usage patterns to maximal public exposure. When resistance emerges, the micro-organism involved is a more formidable to recognize as well as treat.
The potent fluoroquinolones must be used judiciously. And, they are not without possible adverse reactions. They are not innocuous antibiotics. This type of drug is often classified as category C because no adequate and well-controlled studies have been conducted in pregnant women, and therefore should be used during pregnancy only if the potential benefit outweighs potential risk to the fetus, however, at one time when I dispensed the drugs I advised against use in pregnancy as well as in pediatric patients less than age 18 because of effects on birthweight and delayed calcification in rodent trials.
I recall one little old woman who'd been seen in the E.R. two days prior and prescribed levofloxacin once a day for a urinary tract infection. By the third day, she had no idea of who or where she was and was found wandering in her neighborhood; altered mental status was the reason for admission to the hospital medical unit. It took several days for the drug to be fully eliminated and the central nervous system effects to diminish.
Use of fluoroquinolones may be associated with central nervous system toxicity including peripheral neuropathy, sunlight sensitization with sunburns on exposure to light through windowpane for some fluoroquinolones, effects on heart, joints and tendons. Human children and the elderly are at greater risk. These adverse effects may show up during the course of therapy, to sometime after the drug has been discontinued. Doubt the human administrator will be so picky about adverse effects on animals. Pre-tenderized veal may be a marketing gimmick.
I thought it also interesting to note what kind of vaccines were available. One product that I dispensed quite a bit was Newport Salmonella. I went to PubMed to find something about this particular vaccine. Following is the synopsis in PubMed.
"Hermesch DR et al. Effects of a commercially available vaccine against Salmonella enterica serotype Newport on milk production etc. American Journal of Veterinary Resarch. 2008 Sep;69(9):1229-34.
Objective: to determine effects of vaccination with siderophore receptor and porin (SRP) proteins derived from Salmonella enterica serotype Newport on milk production, somatic cell count, and shedding of Salmonella organisms in 180 female dairy Holsteins.
Procedures: cattle were randomly assigned to receive Salmonella Newport SRP vaccine or control solution. Vaccine or control solution was injected 45-60 days before parturition, and cattle received a second dose 14-21 days before parturition. Milk production was monitored for the first 90 days of lactation. Feces for isolation of Salmonella and blood samples for detection of antibodies against Salmonella Newport were collected at day of first injection and at days 7-14 and 28-35 of lactation.
Results: cattle inoculated with Salmonella Newport vaccine produced significantly more milk (1.14 Kg/day), compared with cattle injected with the control solution. Cattle administered vaccine had significantly higher concentrations of circulating antibody against Salmonella Newport SRP proteins at 7-14 days and 28-35 days of lactation. Salmonella Newport was not recovered; however, Salmonella enterica serotype Agona was recovered from 31 (20.3%) cattle, but likelihood of recovery did not differ significantly between vaccinates and control cattle.
Conclusions and clinical relevance: administration of a vaccine against Salmonella Newport SRP proteins to healthy dairy cattle prior to parturition increased milk production, even in cattle without detectable shedding of Salmonella Newport or clinical signs of salmonellosis. Additional research is needed to clarify the mechanisms by which productivity was improved. PMID: 18764698 [PubMed - indexed for MEDLINE]
How the winds are laughing. They laugh with all their might. Laugh and laugh the whole day through ad half the summer's night.
Donna, donna, donna, donna, donna, donna, donna, don, donna, donna, donna, donna, donna, donna, donna, don.
"Stop complaining", said the farmer, "who told you a calf to be? Why don't you have wings to fly with like the swallow so proud and free?
How the winds are laughing, they laugh with all their might. Laugh and laugh the whole day through, and half the summer's night.
Donna, donna, donna, donna, donna, donna, donna, don, donna, donna, donna, donna, donna, donna, donna, don.
Calves are easily bound and slaughtered, never knowing the reason why, but whoever treasures freedom, like the swallow has learned to fly.
How the winds are laughing, they laugh with all their might. Laugh and laugh the whole day through, and half the summer's night.
Donna, donna, donna, donna, donna, donna, donna, don, donna, donna, donna, donna, donna, donna, donna, don.
Cystorelin® is a sterile solution containing 50 mcg/mL gonadorelin (GnRH) suitable for intramuscular or intravenous administration. Gonadorelin is the hypothalamic releasing factor responsible for release of gonadotropins (e.g., LH, FSH) from the anterior pituitary. Synthetic gonadorelin is physiologically and chemically identical to the endogenous bovine hypothalamic releasing factor.
Fertagyl® is manufactured for Intervet Schering-Plough by Intervet International GmbH of Unterschleissheim, Germany.I wonder if the gonadorelin manufacturers hold T.V advertising duels touting benefits of Sister Ellen vs. Fergie Girl.
Baytril ®manufactured by Bayer of Germany is a fluoroquinolone, enrofloxacin, an antibiotic for veterinary use and its range of applications in companion animals such as dogs, cats, exotic animals and food animals such as poultry, cattle, pigs and sheep.
VetaMeg ® flunixin 50 mg/mL is a prescription-only veterinary non-steroidal, non-narcotic anti-inflammatory analgesic agent with antipyretic activity, funnily listed as more potent than 'pentazocine, meperidine, and codeine' as analgesics as demonstrated in the rat yeast paw test.
What is funny is that the drug's mechanism of action is non-narcotic yet the analgesia effects are compared to narcotics and not very effective ones at that, specifically pentazocine and codeine. Maybe, pentazocine and codeine work better in relieving inflammation in sheep, but they don't do a darn thing for human animals.
What do the three drugs above have in common? First, they are used exclusively in non-human animals, and second, they are prescription-only drugs that must be ordered by a veterinarian, and dispensed only by pharmacists, the profession legally allowed to fill prescription medications in the US.
Guess. What was I doing last week in my job as an agent pharmacist? Dispensing the drugs listed above; I found myself working for a animal health supplies warehouse filling prescriptions for herds of dairy cattle and pig farms from all over in the mid-eastern cornfields. Walking up and down concrete floors of a large warehouse in my dress shoes, climbing ladders, pulling boxes of drugs from shelves high above my head; checking product names of drugs I'd never heard of before, ripping open cardboard boxes, verifying expiration dates and lot numbers of product to send out; slapping prescription labels on bottles of cyanocobalamin, ceftiofur and dinoprost.
I dreaded the called-in prescription: 'Hello, this is Dr. Heffer calling for Ladonnabella Dairy Farm in Kalamazoo, Michigan. Please dispense Excede (ceftiofur) 200 mg/mL # 3 x 100 mL bottles. Label: For treatment of foot rot. Give to the lactating cow 1 dose of 6.6 mg/Kg or 1.5 mL per 46 Kg body weight, subcutaneously at base of ear. If no improvement after 5 days, call back.
Animals as customer are quite different than human customers. For one thing ... the quantity prescribed might be somewhat different doses seen in humans, but the amount dispensed is quite a bit larger considering drugs are dispensed to similarly aged animals in herds. Vitamin K (phytonadione) doses for human adults come in 1 mL ampules of 10 mg/mL For dairy herds, the stuff comes in 100 mL bottles. Another thing, though the injectable medications come in pint-size quantities, there is no sterile rubber stopper.
It is a sobering thought that perhaps the vet or tech administering the vaccines probably does not carefully shave and swab the site of injection with antiseptic and the rubber stopper with alcohol using aseptic technique to mass immunize the herd.
Another thing, the pharmacist dispenses drugs to human herd owners, so there is no foot-stomping (hoof-stomping?) displays of temper tantrums when the prescription is not filled in 5 minutes or the patient's health insurance plan doesn't cover the cost of the drug.
For veterinary use, amoxicillin still comes in bubblegum flavor, and sulfamethoxazole-trimethoprim is still a cherry-flavored suspension for cattle, but I have my doubts about how palatable or patient-acceptable is VetaMeg which is labeled for use in animals only.
Flunixin, a fluoroquinolone... do the same limitations exist about using the antibiotic in pregnant animals, exposure to the sun, and avoiding co-administration with multi-valent cations as humans?
There are a number of adverse reactions we pharmacists counsel our human patients about the fluoroquinolones, are a highly effective broad-spectrum antibiotics with a unique mechanism of action; interference of DNA-gyrase in replication of the bacteria. Broad-spectrum refers to a highly effective mechanism of action providing potent antibiotic effect on a broad range of different types of bacteria including both those with and without cell walls.
This broad range of efficacy provokes several public health issues; emergence of resistance crosses with highly effective ciprofloxacin considered a major agent for inclusion in disaster preparedness for anthrax and other public health menaces, and in comparison to other antibiotic classes rank amongst the highest for risk of causing colonization with methicillin-resistant Staphylococcus aureus and Clostridium difficile infections, both highly resistant to conventional treatments and difficult to treat inexpensively and completely and highly transmissible.
I have seen prescriptions for these types of drugs for urinary tract and upper and lower respiratory tract infections because it often covers the likely pathogens that might normally require administration of two antibiotics. When it first came out, it was of interest that concentration in prostate tissue approached concentrations in the blood, a viable alternative to the highly polar aminoglycosides remaining in the bloodstream, and providing a serious contender in hard-to-treat male urinary tract infections.
Dependence on a singe antimicrobial agent for serious infection pushes usage patterns to maximal public exposure. When resistance emerges, the micro-organism involved is a more formidable to recognize as well as treat.
The potent fluoroquinolones must be used judiciously. And, they are not without possible adverse reactions. They are not innocuous antibiotics. This type of drug is often classified as category C because no adequate and well-controlled studies have been conducted in pregnant women, and therefore should be used during pregnancy only if the potential benefit outweighs potential risk to the fetus, however, at one time when I dispensed the drugs I advised against use in pregnancy as well as in pediatric patients less than age 18 because of effects on birthweight and delayed calcification in rodent trials.
I recall one little old woman who'd been seen in the E.R. two days prior and prescribed levofloxacin once a day for a urinary tract infection. By the third day, she had no idea of who or where she was and was found wandering in her neighborhood; altered mental status was the reason for admission to the hospital medical unit. It took several days for the drug to be fully eliminated and the central nervous system effects to diminish.
Use of fluoroquinolones may be associated with central nervous system toxicity including peripheral neuropathy, sunlight sensitization with sunburns on exposure to light through windowpane for some fluoroquinolones, effects on heart, joints and tendons. Human children and the elderly are at greater risk. These adverse effects may show up during the course of therapy, to sometime after the drug has been discontinued. Doubt the human administrator will be so picky about adverse effects on animals. Pre-tenderized veal may be a marketing gimmick.
I thought it also interesting to note what kind of vaccines were available. One product that I dispensed quite a bit was Newport Salmonella. I went to PubMed to find something about this particular vaccine. Following is the synopsis in PubMed.
"Hermesch DR et al. Effects of a commercially available vaccine against Salmonella enterica serotype Newport on milk production etc. American Journal of Veterinary Resarch. 2008 Sep;69(9):1229-34.
Objective: to determine effects of vaccination with siderophore receptor and porin (SRP) proteins derived from Salmonella enterica serotype Newport on milk production, somatic cell count, and shedding of Salmonella organisms in 180 female dairy Holsteins.
Procedures: cattle were randomly assigned to receive Salmonella Newport SRP vaccine or control solution. Vaccine or control solution was injected 45-60 days before parturition, and cattle received a second dose 14-21 days before parturition. Milk production was monitored for the first 90 days of lactation. Feces for isolation of Salmonella and blood samples for detection of antibodies against Salmonella Newport were collected at day of first injection and at days 7-14 and 28-35 of lactation.
Results: cattle inoculated with Salmonella Newport vaccine produced significantly more milk (1.14 Kg/day), compared with cattle injected with the control solution. Cattle administered vaccine had significantly higher concentrations of circulating antibody against Salmonella Newport SRP proteins at 7-14 days and 28-35 days of lactation. Salmonella Newport was not recovered; however, Salmonella enterica serotype Agona was recovered from 31 (20.3%) cattle, but likelihood of recovery did not differ significantly between vaccinates and control cattle.
Conclusions and clinical relevance: administration of a vaccine against Salmonella Newport SRP proteins to healthy dairy cattle prior to parturition increased milk production, even in cattle without detectable shedding of Salmonella Newport or clinical signs of salmonellosis. Additional research is needed to clarify the mechanisms by which productivity was improved. PMID: 18764698 [PubMed - indexed for MEDLINE]
DONNA, DONNA or (Secunda/Zeitlein/Secunda)
On a wagon bound for market, there's a calf with a mournful eye. High above him there's a swallow, winging swiftly through the sky.How the winds are laughing. They laugh with all their might. Laugh and laugh the whole day through ad half the summer's night.
Donna, donna, donna, donna, donna, donna, donna, don, donna, donna, donna, donna, donna, donna, donna, don.
"Stop complaining", said the farmer, "who told you a calf to be? Why don't you have wings to fly with like the swallow so proud and free?
How the winds are laughing, they laugh with all their might. Laugh and laugh the whole day through, and half the summer's night.
Donna, donna, donna, donna, donna, donna, donna, don, donna, donna, donna, donna, donna, donna, donna, don.
Calves are easily bound and slaughtered, never knowing the reason why, but whoever treasures freedom, like the swallow has learned to fly.
How the winds are laughing, they laugh with all their might. Laugh and laugh the whole day through, and half the summer's night.
Donna, donna, donna, donna, donna, donna, donna, don, donna, donna, donna, donna, donna, donna, donna, don.
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