Trang Sức Khoẻ Của Bạn và Những Câu Chuyện [Archive] - Page 5

florida80

05-23-2019, 19:03

This Story Just Drugs On And On And On

Pharmacy | TX, USA | Right | February 9, 2013

(I work at a pharmacy, both as a tech and at the till when necessary. It is a Sunday, so the pharmacy is not heavily staffed. The sole customer waiting is a man, late 20s to early 30s, wearing a pink button-up shirt.)

Me: “Hello, sir. How can I help you?”

Pink Guy: “Six for [Name].”

(I search the current container and find five prescriptions. It’s not uncommon for a prescription to be put in adjacent containers if the proper one is too full, which this one likely was. I search the other containers but don’t find anything.)

Me: “One sec, I have to check the computer.”

(I check the computer. I do verify he has six prescriptions to pick up.)

Me: “Sorry about that. Can I verify the date of birth, please?”

Pink Guy: “What is this? You want my date of birth now?”

Me: “Yes sir, to verify the prescription.”

Pink Guy: “You guys never asked for that before.”

(I am roughly two years’ tenure in the pharmacy, and that has been a part of policy since day one.)

Me: “If I could just verify the date of birth to make sure there isn’t another person with the same name?”

Pink Guy: “It’s not very likely you’d have two people with the same exact name. I suppose you want me to verify my social security number in case someone has both my name and my birthday?”

(We actually do have two people with the same name and birthday.)

Me: “Not necessarily. I would go by address or phone number first.”

Pink Guy: “I’m not comfortable giving you my date of birth.”

Me: “I already have a date of birth here. I just need you to verify at least the month and the day.”

Pink Guy: *crossing his arms* “Fine. But just know that you’ve never asked me for this before and I’ve been coming here for years. It’s [birthday].”

Me: “Thank you, sir.” *check each of the prescriptions* “Okay. And I have all six prescriptions.”

Pink Guy: “Six?”

Me: “Yes, sir, six prescriptions.”

Pink Guy: “Not seven?”

Me: “Was there more?”

Pink Guy: “There should be one more.”

Me: “Okay, let me check the computer.”

(I go back to the computer, and re-enter him just to refresh the data. I verify each prescription that I have and make sure he doesn’t have another one that he usually refilled; none pop out.)

Me: “I only have six prescriptions for you, sir.”

Pink Guy: *with an inflection implying I’m a moron* “And there aren’t any for my wife?”

Me: “Oh, I see. It’s under another name.” *without asking him, I query by address, and find his wife. I see that she does have a pending prescription, but there’s a catch* “Did you call it in today?”

Pink Guy: “Yeah, I called it in this morning. It said it’d be ready tomorrow but I figured you guys would have it ready by now.”

Me: *explaining casually* “Well, not exactly. You see, when you call it in it actually gets picked up by an outside pharmacy and they fill it and ship it to us next-day. You did it through the automated system, right?”

Pink Guy: “Well, yeah. I’ve done it before and you guys had it ready.”

Me: “Well… I’m not sure about that time, but I do know the automated system tells you when the pickup is and then asks if you want it earlier; if you select that you want it earlier it sends it to us. Maybe that just didn’t go through this time.”

Pink Guy: “No, I just assumed you’d have it ready by now.”

(Well, at least he’s honest.)

Me: “Well, I’m sorry but we don’t. But I can pull it and we can fill it here. The pharmacist is out to lunch, but when he gets back in about ten minutes he’ll fill it right away. Do you have some shopping you could do or would you like to wait in the waiting area?”

(The pharmacist is behind the counter, but I’m not going to bother him unless I absolutely have to.)

Pink Guy: “No! I don’t have time for all of this crap! If you guys aren’t ready I’ll just waste my time and gas and get it tomorrow! I’m in a hurry!”

Me: “I’m sorry about that, sir.”

(I start scanning and bagging the prescriptions. He reaches across the counter at me to tear the bag away from me.)

Me: “Excuse me, just a sec, sir. I need you to verify the information on the screen.”

Pink Guy: “I thought you already verified everything. That’s why I gave you my date of birth!”

Me: “I need you to verify everything on the screen. Make sure all of the information is correct and hit ‘next’ in the lower-right of the screen.”

(Without looking at the screen, he hits the ‘back’ button at the lower-left.)

Me: *re-initializing the verification phase* “It’s the ‘next’ button on the lower-right, sir.”

(Second time’s the charm. He still doesn’t look at the screen.)

Me: “And if you could sign to verify you’ve picked up the prescriptions.”

Pink Guy: *mutters a signing-my-life-away cliche* “There. Are we done?” *extends his hand, expectantly*

Me: “Not quite. Your total comes to $20.”

Pink Guy: “Are you kidding me!? You make me go through all that and then you expect me to fork over $20? I have insurance! It covers everything! You must not have run it through, you idiots. Go check your little computer and you’ll see. I have never had to pay anything for my meds!”

(I go to the computer and refresh his information.)

Me: “It shows here we ran it through [Insurance]. They paid [amount] toward the prescription, leaving you with a co-pay of $20. The last time you got it, on [date], they paid [amount minus $20] and therefore you had a $40 co-pay. And you’ve had a $40 co-pay the last 3 times you picked this medication up.”

Pink Guy: “This is ridiculous! Whatever.” *pulls out his checkbook* “Can I get $100 cash-back?”

Me: “No, sir, the limit is $50. And, I’m sorry, but I don’t have enough in my till.”

Pink Guy: “Well… can’t you get more?”

Me: “I could, but it’d be faster for you if you just got a bottle of water and get cash-back up at the front.”

Pink Guy: *standing up defiantly* “I’m not making two transactions. I’ll wait.”

Me: “Okay. Your total is $70, and the date is [date].”

Pink Guy: “You said it was $20 before!”

Me: “Right. $20, plus $50 cash-back is $70.”

(He proceeds to write his check.)

Pink Guy: “Can I have my cash-back?”

Me: “I need to run the check first.”

(With a great show of impatience and contempt he tears the check out and hands it to me. It’s policy to verify the check by hand before running it through the feeder. Before even turning it my direction, I see he hasn’t signed it.)

Me: “Could you please sign the check?”

(He clicks his pen and makes a very dramatic and flourish display of signing the check.)

Me: “Thank you.” *I start to validate the check, the date is wrong by a few days* “I’m going to change it to today’s date and initial it, okay?”

Pink Guy: “Fine, whatever.”

(I check everything, saving the amount for last since I know it’s cash-back and I want to verify they match properly. But… there’s a problem.

Me: “Sir, I’m afraid I’ll need you to write a new check.”

Pink Guy: “What the he-why!?”

Me: “Because. You wrote the amount for $120, but the limit for cash-back is $50, and that’s how much I asked for.”

Pink Guy: “Well here!” *takes the check from me, scribbles all over it, and writes the new amounts in as tiny as he can above the errata* “There. You need my driver’s license?”

Me: “No, sir, I need you to write a new check. This one is illegible and I can’t accept it into my till.”

Pink Guy: “Screw you! Fine, forget the cash-back. I’ll just pay with my card.”

(He pulls the card out, and swipes it. But it’s too fast, I have to hit a button first.)

Me: “Okay, your card is ready to swipe.”

Pink Guy: “I already swiped it.”

Me: “I wasn’t ready in time, sorry. I have to hit a button for it to take. It’s ready now, though.”

Pink Guy: “The machine said it was ready!”

Me: “That’s the default screen. It always says that. I know it’s irritating. I wish they’d change it.”

(He swipes his card again, and poises with his pen. I expect him to start with the card transaction, but notice he’s still standing there after a second.)

Pink Guy: “Well?”

(I look at my screen, and realize it hasn’t taken the card still. I clear it and prime it again.)

Me: “Try it again, please?”

Pink Guy: “No! You’ll charge me twice!”

Me: “It won’t charge you twice. I promise. It only charges when you approve the amount and sign.”

Pink Guy: “If it charges me twice I’ll get you fired.”

Me: “I promise. It won’t charge you twice.”

(He poises with the card and practically stares me down as if judging the worth of my soul as he slides the card through. It’s then I notice the magnet strip is in his fingers.)

Me: “May I see your card, sir?”

Pink Guy: *apparently giving up, he responds less angrily than I expected* “Take it.”

(I take the card and swipe it through the correct way, setting it on the counter. Once again he poises with the pen, waiting for the prompt, and again, I notice it’s taking him a tad longer than other people. I look at the screen just as he comments.)

Pink Guy: “It’s still not doing anything.”

(I pick up his card, and take in a breath. It’s a ditch effort, but I enter the card number manually. No dice. I hand his card back.)

Me: “I’m sorry sir, your card won’t go through. Do you have another method of payment?” (It has been rejected.)

Pink Guy: “What the h***!” *literally throws the card at me, hitting my chest, and I catch it* “That’s a new f****** card! Of course it’ll take! Your computer is stupid!”

Me: “I’m sorry, sir.”

(He leaves, and I continue the day setting any emotions aside to deal with for later. I put his credit card in with one of the scripts and make a note of it for whoever has to handle it. Later that week, the pharmacist, who had been sitting behind the counter that whole time, talks to me during a slow hour.)

Pharmacist: “Hey, [My Name], you remember Mr. [Pink Guy] from the other day?”

Me: “Yeah, what about him?”

Pharmacist: “His wife came by the next day. I did the transaction. She picked up all seven scripts. She didn’t say anything about the price. Paid with a perfect check, and got the $50 cash-back.”

Me: “So, she didn’t give you any trouble?”

Pharmacist: “No, not at all.”

Me: “Well, good. At least that whole thing happened on a slow day.”

Pharmacist: “Yeah. Anyway, here.” *takes a Barnes & Noble gift card from his smock pocket and sets it on the counter* “Consider this an apology from Mr. [Pink Guy].”

(The gift card was for $75.)

florida80

05-24-2019, 17:46

Needs To Take A Chill Pill

Pharmacy | Portland, OR, USA | Right | January 29, 2013

(I’m at a chain company pharmacy/mini-stores getting a bottle of water. As I pass by the pharmacy, I witness an exchange between a very burly, muscular customer and a short, skinny female clerk.)

Customer: “I need to refill my prescription.”

Clerk: “Well, I’m sorry, but according to our systems, you have no refills left. You’ll need to contact your doctor and get a new prescription.”

Customer: “What?! I want my pills. Give me my pills!”

(The exchange continues for a while, with the customer getting more and more agitated. The clerk appears to be frightened and close to tears. The commotion is drawing the attention of the people around.)

Customer: “You dumb b****, are you f***ing stupid? Give me my pills or there will be a problem.”

(At this point, I step between him and the clerk behind the counter.)

Me: “Look buddy, she already said that she’s not giving you pills and told you what to do. So you better just listen to her, leave, and stop making an a** of yourself.”

(For a moment he looks like he is going to hit me, then just stomps away swearing under his breath.)

Me: *to the clerk* “I’m sorry you had to deal with that.”

Clerk: “It’s alright. Thank you for that. Here, that water is on me, okay?”

florida80

05-24-2019, 17:47

Paging Charlotte On Aisle 5

Pharmacy | NJ, USA | Right | January 16, 2013

(I am at the cashier, ringing up a long line of people. I notice when customers walk in, they suddenly skirt around the theft detectors. A lady approaches the counter.)

Lady: “There is a big spider in the entrance!”

(Note: I don’t want to leave the counter because of the enormous line.)

Me: “Okay, cool.”

Lady: “You have to kill it. You work here.”

Me: “It’s not hurting anyone.”

(The lady’s husband chimes in.)

Husband: “Kill it, she’s right!”

(Everyone in the line seems to agree with the lady and her husband.)

Me: “Okay, I’ll just move it outside.”

Husband: “No, kill it!”

Me: “No, it wont do any harm out there in the parking lot.”

(I move the spider outside.)

Lady: “I can’t take it anymore!”

Me: “Can’t take what?”

(Suddenly, the lady grabs a basket made for carrying products outside and finds the spider. She starts violently smashing the red basket on the spider.)

Lady: “Why is it not dying?!”

(It turns out the basket has little legs on the bottom, preventing it from making contact with the spider. She eventually figures this out and kills it, but not before it charges her one last time and causes her to flip out!)

florida80

05-24-2019, 17:47

Paging Insecurity

Pharmacy | Oakland County, MI, USA | Right | January 16, 2013

(I am a customer in this pharmacy store late at night. As I walk up to the counter, a male customer is loudly complaining to a male cashier about ‘the gays.’ Being a lesbian, I’m gathering up the courage to say something when the following happens.)

Male Customer: “The gays keep trying to turn everyone!”

Male Cashier: “It must be rough.”

Male Customer: “How do you mean?”

Male Cashier: “I have a handful of gay friends, and no matter how much time I’ve spent with them, I’ve never wanted to have sex with other dudes. I’m just saying it must be rough to have such a tenuous hold on your sexuality that you’re always worried about being turned by the slightest contact. I feel for you.”

(It takes a moment, but the male customer realizes what the male cashier is saying.)

Male Customer: “…Hey, f*** you, buddy!”

Male Cashier: “You want to f*** me? Oh god, it’s happening now! There must be a gay in the store! Run!”

Customer: *screaming* “Go to h***!”

(The customer then runs out of the store. As I put my stuff up on the counter, the manager runs up from one of the aisles.)

Manager: “What the h*** was that?”

Cashier: “Oh, I’m probably just getting a customer complaint in the morning. Totally worth it… I’ll explain later.” *to me* “Sorry about all that. How are you tonight?”

Me: “If I was straight, I would totally be giving you my number right now.”

florida80

05-24-2019, 17:48

Antisocial Behavior Is Its Own Reward

Pharmacy | Jersey City, NJ, USA | Working | January 9, 2013

(About three months prior, we hired some new help since we were severely understaffed at our pharmacy. Two of the workers are doing very well. One, on the other hand, is not. Today, it’s a bit busier than normal, and unfortunately the not-so-good worker is the only one I have to back me up on the register. Note: In October we switched our rewards cards.)

Coworker: “Do you have [Rewards Card]?”

Customer: “Yes, it’s right here.” *pulls out our current rewards card*

Coworker: “Sorry, but we have a new one now that we switched to.”

Customer: “I was told this is the new one.”

Coworker: “Yeah, but we have a newer new card.”

Customer: “Well, what’s going to happen to my points?”

Coworker: “I can switch you, but I don’t know what’s going to happen.”

Customer: “Well, this is stupid! Why do you keep changing it up?!”

(By this point, I finish cashing out my own customer and speak up.)

Me: *to the customer* “Ma’am, I can assure you, the card you’re holding is our current rewards card. I have no idea why he’s lying to you.” *to my coworker* “For God’s sake, don’t do that.”

(My coworker shuts up for the rest of the transaction. After all the customers are cashed out and gone, I confront him.)

Me: “You cannot do that to the customers! What the h*** are you thinking?”

Coworker: “Man, I been doing that, and I’m gonna keep doing it! It’s what keeps me sane here!”

florida80

05-24-2019, 17:48

Kids Will Send Any Parent To The Funny Pharm

Pharmacy | Sacramento, CA, USA | Right | January 1, 2013

(I am taking a refill order over the phone.)

Me: “Thank you for calling [pharmacy]. How can I help you?”

Customer: “I need to refill a couple of prescriptions. This one I have the number for.”

(She proceeds to give me the number, and while I am running the prescription through her insurance I hear some kids playing in the background.)

Me: “Okay, so that one went through just fine. What is the next one?”

Customer: “I don’t have the number, but can you look it up for me? It’s my birth control.”

(I look in the customer’s file and sure enough it’s there. But while I am running it, the playing in the background has turned into a serious screaming and fighting match.)

Customer: *embarrassed* “And this is why I am refilling the birth control. Can’t you tell?”

florida80

05-24-2019, 17:49

Super-flu-ous Advice

Pharmacy | AB, Canada | Right | December 10, 2012

(It’s currently flu season, and we are offering flu shots.)

Me: “Alright, sir. We got you all set. Have you gotten your flu shot yet?”

Customer: “Ah, no. I don’t get a flu shot. I don’t get the flu, sweetie.”

Me: “Wow, you must be lucky.”

Customer: “You want to know my secret, dear?”

Me: “What’s your secret, sir?”

Customer: *leans in close* “You see now, chickens, cows, pigs: they get the flu. So, if you don’t eat them, you don’t get the flu! You remember that now!”

Me: “Um, okay, sir. I will. Have a nice day

florida80

05-24-2019, 17:50

Their Problems Will Only Multiply From Here

Pharmacy | Alabama, USA | Working | December 10, 2012

(I am training a new girl. One basic of our job involves 3rd-4th grade level math. We are both in our twenties.)

Me: “Okay. They are taking two, four times a day. How long will it last?”

New Girl: “Uh…”

Me: “What’s 2 times 4?”

New Girl: “…12?”

florida80

05-24-2019, 17:51

A Paucity Of Verbosity

Pharmacy | UK | Working | November 25, 2012

(I need to get some prescription medication, and decide to use the opportunity to get some exfoliating cream, which helps remove dead skin.)

Me: “Hi, this is a prescription I need filled. Can you also tell me where you keep the exfoliating creams?”

Cashier: “…The what?”

Me: “Exfoliating creams?”

Cashier: *slowly* “Ex-fooo-liating creams…” *turns to her manager* “What’s exfoliating creams?”

Manager: *to me* “They’re right this way.”

Cashier: “Sorry, I haven’t learnt big words yet!”

florida80

05-24-2019, 17:52

Might We Prescribe A New Job

Pharmacy | Ontario, Canada | Working | November 22, 2012

(I’ve just come from the emergency department of the hospital, with instructions to fill two prescriptions immediately. I’m obviously sick and having difficulty breathing. It’s about 9:30 PM, which is 30 minutes before closing.)

Me: “I have a severe corn allergy, so can you please double-check the ingredients on those before filling them?”

Pharmacist: “No.”

Me: “…Pardon? ”

Pharmacist: “Almost all medications are made with corn starch, you know. I don’t think I can fill them.”

Me: “My understanding is that very few prescriptions meds have corn in the them. Can you check them please?”

Pharmacist: “No. I don’t have the ingredients.”

Me: “Aren’t they on the bottle?”

Pharmacist: “No.”

Me: “Can you look them up somewhere? Online or in a compendium?”

Pharmacist: “No.”

Me: “I really need these medications immediately.”

Pharmacist: *sighs* I guess I could leave them for someone tomorrow, and they could call the company.”

Me: “I need them tonight. I’m not sure what to do.”

Pharmacist: “I’m sure you’ll be fine. There’s only a little bit of corn starch in a pill.”

My Husband: “NO! Didn’t you hear her? She’s ALLERGIC!”

Pharmacist: “Well, there’s nothing I can do tonight. I guess I can keep these until tomorrow and someone else will deal with it.” *wanders off*

(I called another pharmacy in the same chain, and they were able to check the ingredients immediately. We retrieved my prescriptions from the unhelpful pharmacist, and my husband made a complaint the next day. It turned out he was a temp and was fired.)

florida80

05-24-2019, 17:53

This Is Why We’re In A Recession, Part 16

Pharmacy, Recession | ON, Canada | Right | November 13, 2012

Customer: “Excuse me, miss? I’d like a $20 iTunes card, but there are none here.”

Me: “Oh, yes. Unfortunately we haven’t received that shipment yet. But we do have the $10 cards.”

Customer: *frustrated* “But I want a $20 card.”

Me: “Well, ma’am, you could always buy two $10 cards instead.”

Customer: *yelling* “That doesn’t equal 20 dollars!” *storms out of the store*

florida80

05-24-2019, 17:53

Discretion Is The Better Part Of Disclosure

Pharmacy | England, UK | Working | October 10, 2012

Coworker: “Hello, how may I help you?”

Customer: “I need… um…”

(The customer is clearly too embarrassed to speak, so she pulls out a piece of paper and writes what she wants down.)

Coworker: *reads the paper and looks over at me* “HEY, [my name], WHERE DO WE KEEP THE THRUSH CREAM?”

Me: *facepalm*

florida80

05-24-2019, 17:54

Contraception Misperceptions

Pharmacy | Oslo, Norway | Right | October 5, 2012

(I am a pharmacist working at 24-hour pharmacy. This takes place on a late Sunday evening.)

Female Caller: “Hello, um… I… um… you know the morning after pill?”

Me: “Yes, certainly. What would you like to know about it?”

Female Caller: “Is there an anti-morning after pill?”

Me: “Sorry? An anti-morning after pill?”

Female Caller: “Yes. You see, this guy, he came around today, and he brought some flowers and everything, so now I’m kind of regretting taking that pill. So is there an anti-morning after pill I could take?”

Me: “No, I’m sorry, there isn’t such a thing.”

Female Caller: “Oh, that is a shame. Do you think they will make one?”

Me: “No, I’m sorry, but I really don’t think they will.”

Female Caller: “Really? Oh, that is a bummer.” *hangs up*

florida80

05-24-2019, 17:55

Not Quite Registering

Pharmacy | Ontario, Canada | Working | August 25, 2012

(A customer pays with a fifty dollar bill. Spotting it, the pharmacist on duty grabs his wallet and asks the cashier to give him the fifty for two twenties and a ten.)

Coworker: “I can’t do that!”

Me: “Why not? He’s giving you $50 for $50.”

Coworker: “But my till will be wrong!”

Me: “How? You take out the fifty, and put in two twenties and the ten. The totals are still the same.”

Coworker: “But I won’t have the fifty, and the register will KNOW!”

florida80

05-24-2019, 17:56

Good Things Come In Small Dosages

Pharmacy | New York, USA | Right | August 15, 2012

(My coworker at the pharmacy has been working with a customer who seems to be having the worst day. Unfortunately, my coworker is the victim of the customer’s mood, and he has reduced the poor girl to tears. Behind this customer is a young father in his mid-20s and his three sons, aged probably six, two, and less than a year old. The young father is clearly upset with the behavior of the customer in front of him, but, probably for the sake of his children, is keeping his mouth shut. Out of nowhere, his six-year-old son speaks up.)

Six-year-old Son: “‘Scuse me, sir? I think you’ll probably get what you need easier in life if you’re nice to people. You’re making the pretty lady sad and she didn’t do anything wrong.”

Customer: *clearly shocked* “Didn’t your father here teach you to mind your own business, son?!”

(The young father is actually grinning proudly, and reaches over to high-five his son.)

Father: “Actually, I taught him not to raise his voice at good, honest people.”

Customer: *clearly embarrassed, pays and leaves quickly*

Six-year-old Son: *to my coworker* “Can I give you a hug? If anyone gives you trouble, call me!”

(My coworker was very impressed by the brave little boy’s actions, while his father proudly teared up. I doubt the family will ever have to pay at our pharmacy again, and my coworker has a new best friend!)

florida80

05-24-2019, 17:56

There’s No Business Like My Business

Pharmacy | California, USA | Right | August 9, 2012

(I work at a well-known retail pharmacy. One night while I’m still new on the job, I’m manning one of the cash registers.)

Woman: “Hi, where is your baking soda?”

Me: “Um, I can’t guarantee that we have baking soda, but if we do, it would be in Aisle 3.”

Woman: *goes off to look for it*

(15 minutes later, the customer comes through my line with her baking soda.)

Me: “Oh, I see you found it! I’m glad we carry it.”

Woman: “If you hadn’t, I would have been very frustrated, and I would never have come here again!”

(I think she’s joking and laugh a bit.)

Me: “Well, I’m certainly glad you found it!”

Woman: *completely serious* “I did that to [other retail store] when they didn’t have lettuce, and they went out of business within a week!”

Me: *pause* “Um… I’m REALLY glad you found the baking soda, then.”

florida80

05-24-2019, 17:57

A Knight In Patrolling Armor

Pharmacy | Costa Rica | Right | August 2, 2012

Me: “So, your total is going to be of 30 thousand colones (60 USD). Here you go, and have a nice day.”

Customer: “Oh, you’re so nice. Thank you, too. I was wondering if you could do something else for me?”

Me: “Sure, what is it?”

Customer: “I was told at my church that they needed more members, and I was asked to bring a few. Would you mind to come?”

Me: “Well, I apologize, but I wouldn’t like to.”

Customer: *gets defensive* “Why? Don’t tell me you think we’re all cultists that don’t care about God!”

Me: “I’m sure you’re not, but I don’t want to go.”

Customer: “Why the h*** not, then? I already told you we’re nice people, so why don’t you go?!”

Me: “Ma’am, if I offended you I apologize, however I don’t want to go. It’s not because you’re nice people or not; it’s because I’m an atheist.”

Customer: “So, you don’t believe in God, is that it? Well, f*** you! You’re going to Hell! What are you going to tell me next, that you’re a f***ing queer?”

Me: “In fact, I am a homosexual, but—”

Customer: “That’s all I needed to know! Being gay is a sin!”

Me: “Ma’am, I’m going to have to ask you to leave.”

Customer: “F*** no! You’re kicking me out because I’m a Christian! That’s illegal, and it’s bulls***!”

(At this point, a man behind her speaks up. Note that he is a police officer in full uniform.)

Officer: “No, he’s kicking you because you already paid and you’re disturbing the peace. So, I’m going to give you my recommendation: Leave now, or I’ll arrest you.”

Customer: *suddenly pales and leaves without saying a word*

Me: “Thank you very much, Officer. Now, how may I help you?”

Officer: “Actually I didn’t need anything. I was just patrolling when I heard the conflict. However, now that you mention it…” *he blushes a little* “…I need to ask, would you go out in a date with me?”

Me: “…Of course!”

(The officer and I have now dating for nearly half a year.)

florida80

05-24-2019, 17:58

Never Say No To La Novia

Pharmacy | Roselle, NJ, USA | Right | July 10, 2012

(I am watching my girlfriend’s two-year-old sister near the counter while she does her shopping. Her sister is learning to talk in Spanish, so I’m quizzing her with colors. While we’re playing, a seven-year-old girl approaches us and asks to play because she takes Spanish at school. Everything is fine until the girl’s mother comes.)

Mother: “Leona, what are you doing? You know not to bother people.”

Me: “Oh, she’s not, ma’am. She just asked to play with me and my girlfriend’s sister.”

Mother: “Girlfriend?” *thinks for a few moments* “Oh, a close friend! Sorry, I was thinking you meant a girl you were dating.”

Me: “I did. I am dating a girl. This little girl is her sister and your daughter was just playing with us. She wasn’t bothering us.”

Mother: “What?! Leona, you were playing with a homo?!? Come over here, right now!”

(In tears, the girl slowly approaches her mother, who yells at her about how she knows better than to interact with “h***-bound sinners” like me. She then chides me for “sinning” around such a small child, referring to my girlfriend’s sister. While I’m speechless, a man comes up, who I assume is the girl’s father.)

Father: *to the mother* “I got the rest of the stuff. What are you yelling about?”

Mother: *to her daughter* “Tell Daddy what you did!”

(In hysterics, the girl tells her father what happened, ending her telling by clinging to his leg and apologizing over and over. I’m feeling dreadful and very guilty and am near tears myself. But to my surprise, this happens.)

Father: *to the mother* “Are you serious?! What is wrong with you?! I don’t even know why I came out with you! Just go wait in the car! Sheesh!”

(The mother, now apparently embarrassed, exits the store. The father calms his daughter down and apologizes to her and me before leaving. Right after they leave, my girlfriend comes up, having seen the whole thing.)

My Girlfriend: “I actually know that family. The father moved in next door to me two weeks ago. That girl’s parents are divorced and her parents have joint custody of her, but today is her birthday and she wanted to be with both of them together. They said yes to make her happy, but I don’t think that’ll happen again.”

(A few weeks later, my girlfriend tells me the father got full custody of his daughter. Now, she and my girlfriend’s sister play together on a daily basis, and I occasionally help her with her Spanish homework.)

florida80

05-24-2019, 17:59

No Scan, No Scam

Pharmacy | Newton, NJ, USA | Right | July 10, 2012

(I work in a store in a small town where most of the customers are elderly and sweet. If a price doesn’t come up, I will generally trust a customer if they say they know the exact price.)

Me: “Oh, there’s no bar code on this.”

Customer: “Well, it was $39.99, but I guess that doesn’t help you.”

Me: “Well, I can enter it manually. You’re sure it was $39.99?”

Customer: “Actually, it was…$19.99.”

Me: “Sir, do you really want me to call for a price check and make you and all the people behind you wait ten minutes for someone to come up here?”

Customer: *defeated* “…It was $39.99.”

florida80

05-24-2019, 18:00

Plz Change Abbrev, Stat

Pharmacy | London, UK | Right | July 9, 2012

(If a customer gets regular medication from a pharmacy, they can have a Medicine Use Review (MUR). It’s basically talking through their meds with a pharmacist. I answer this call from a sweet elderly caller.)

Me: “Hello, pharmacy.”

Customer: “Um hello, someone just delivered my medicine. The bag has a sticker on it that says “Patient eligible for MUR.” What it is MUR?”

Me: “It stands for “Medicine Use Review,” which involves discussing your medicines with the pharmacist. However, those labels are meant for our reference, so I apologise that it’s been put on your bag by mistake. Sorry if it caused confusion.”

Customer: “Oh, that’s alright, dear. I just thought MUR might be short for murder!”

Me: “Er no, ma’am! Don’t worry, no one is going to murder you!”

Customer: “Oh, good! Thank you very much!”

florida80

05-24-2019, 18:01

Not Ever Working

Pharmacy | TN, USA | Working | July 9, 2012

(The pharmacy I work at has just lost several techs at once, so we’ve hired a few new people. One of these new coworkers isn’t working out at all.)

Pharmacist: “Hey, could you help out in the front for a minute? I think [coworker who isn’t working out] could use a hand.”

Me: “Sure. Hi, [regular customer], what can I do for you?”

Regular Customer: “Oh good, I’m trying to get a refill.”

New Coworker: *to Regular Customer* “I keep telling you, you don’t have any!”

Me: *to Regular Customer* “Let me just check on it for you.”

New Coworker: *to me* “Why? I already told him he didn’t have one.”

Me: “Actually, he has enough refills for the rest of the year. What are you looking at?”

New Coworker: “No, you’re wrong. I know what I saw!”

Regular Customer: “I knew I had some..I was starting to think I was going to have to call my doctor. Thank you so much, [my name]!”

New Coworker: *to Regular Customer* “You need to leave right now. GET OUT!”

Me: *to New Coworker* “Whoa, what do you think you’re doing? You do not have ANY authority to kick a patron out.”

New Coworker: “He’s being unruly.”

Me: “What? No, he’s not. You’re just being rude.”

New Coworker: “No, you’re just trying to make me look stupid. I know exactly what I saw.”

(I examine my new coworker’s computer screen.)

Me: “You were looking at the wrong person.”

New Coworker: “No, I wasn’t!”

Me: “Sorry, but the name on your screen is a woman’s. [Regular Customer] is a man. It happens.”

New Coworker: “You changed it!”

Regular Customer: “Are you kidding me? Listen kid, you were wrong. It’s not that big of a deal. It happens. Just man up already.”

New Coworker: “You, shut up! I’m not talking to you, old man!”

(The pharmacist has been listening to the entire conversation. He decides he’s had enough.)

Pharmacist: *to New Coworker* “Get over here, right now!”

New Coworker: *rudely* “I’m BUSY! I’m trying to work, but—”

Pharmacist: “Get your stuff. You’re fired.”

New Coworker: “You can’t fire me!”

(At this point, the store manager also comes over.)

Store Manager: “I can. Get your stuff. You are not longer employed here.”

New Coworker: “YOU CAN’T FIRE ME! I DIDN’T DO ANYTHING WRONG! YOU PEOPLE ARE JUST TRYING TO MAKE ME LOOK STUPID!”

Regular Customer: “No one has to try and make you look stupid, son. You’re doing a fine job of that all by yourself.”

(My coworker carried on and screamed obscenities. We ended up having to call the police to remove him from the store!)

florida80

05-24-2019, 18:01

Feeling Man-strual

Pharmacy | Edmonton, Alberta, Canada | Right | June 24, 2012

(I am working the prescription counter when a big, burly 6-foot or so tall man comes to the counter. Note: I am a female.)

Me: “Hello, how can I help you?”

Customer: “Um, I think…” *trails off*

Me: “I’m sorry, sir…could you say that again?”

Customer: *leans in close* “I think I got my first period.”

Me: *speechless*

Customer: “I’m bleeding down there, and I’m really hurting in my stomach.”

Me: “Sir, men don’t get those. You need to go to the hospital.”

Customer: “I knew you girls would be insensitive! I’m leaving!”

(I didn’t see him again. I still hope he got to a hospital!)

florida80

05-24-2019, 18:02

Employees Are Sharper Than You Think

Pharmacy | Salt Lake City, UT, USA | Right | June 20, 2012

(Pharmacy law in Utah says that it’s up to the pharmacist’s discretion if they want to sell insulin needles/syringes without a prescription. Our store has the policy that the patient either has to have a prescription for the syringes or for an injectable medication on file.)

Customer: “I need to get some syringes.”

Me: “Okay, I need your name so I can look up the prescription.”

Customer: “Actually, they’re not for me. They’re for my mom.”

Me: “Okay, what’s her name?”

Customer: “Well, not my mom. My best friend’s mom who’s like a mom to me.”

Me: “What’s her name?”

Customer: “Actually, it’s for her dog.”

Me: “What’s the dog’s name?”

Customer: “I…don’t know.”

Me: “Then I’m not selling you any syringes.”

Customer: *walks away in defeat*

florida80

05-24-2019, 18:03

Contextual Innuendos

Pharmacy | Salt Lake City, UT, USA | Right | June 19, 2012

(I’m at work on a Saturday with a clerk and a pharmacist. I notice the clerk speaking with an elderly woman out front but don’t think much of it. A few minutes later, the clerk comes back with a strange expression on her face and tells me I have to go help the woman.)

Me: “What can I help you with?”

Customer: “I’m looking for a vibrator.”

Me: “A…vibrator?”

Customer: “Yes. I had one, but I used it too much and it wore out.”

Me: “I don’t think we have anything like that. Where did you buy the first one?”

Customer: “At another pharmacy, but I want one with a long handle so it can reach better.”

(At this point I’m biting the inside of my cheek in an effort not to laugh.)

Me: “What kind of vibrator are you looking for, exactly?”

Customer: “You know! One of those that rub your feet!”

Me: “OH! Sorry, we don’t have anything like that.”

florida80

05-24-2019, 18:04

Not Lacking For Laxatives

Pharmacy | Long Island, NY, USA | Right | June 17, 2012

Me: “**** Pharmacy, how can I help you?”

Customer: “Yeah, I gotta question for you: I drank a whole thing of prune juice like water, and now I’m s***ing my brains out.”

Me: “Okay, and what did you need to know?”

Customer: “Is your generic of ducolax the same thing?”

Me: “Yes. Same thing.”

Customer: “Okay, good, because I’m gonna need a plug soon or something!”

florida80

05-24-2019, 18:04

Getting Burned Can Be A Pain In The Butt

Pharmacy | Salt Lake City, UT, USA | Right | June 15, 2012

(It is a very windy day during summer, and a power line has blown over in the field behind our store.)

Me: “Hello, [pharmacy] how may I help you?”

Customer: “I need to see if you have [hemorrhoid cream] in stock.”

Me: “Alright, let me check…”

(At this point, I put him on hold to check our stock when a fireman walks in. He tells us they are evacuating all the buildings in the area, and that we have 5 minutes to get out. I go back to pick up the phone so the customer isn’t on hold forever.)

Me: “Sir, we do have it in stock. However, I can’t help you right now. I’m being told to evacuate the building.”

Customer: “Does it have aloe vera in it?”

Me: “I don’t know. As I said, I need to hang up. Please call back tomorrow.”

Customer: “Can you see if you can order it for me?”

Me: “Sir, there is a field fire right behind the pharmacy and I really can’t answer your questions right now. I was told by the fire department to evacuate. Please, call back another time.”

Customer: “Well, fine then. I’ll just get it somewhere else!” *hangs up*

florida80

05-25-2019, 17:50

Out Of Brain Cells

Pharmacy | Maple Grove, MN, USA | Working | May 22, 2012

(At the pharmacy where I work, I do a lot of training of new employees. This day’s trainee is particularly slow on the uptake.)

Me: *to new employee* “Now, when the customer pays in cash and just hands you a bill, you should repeat back to them how much they gave you. For example, when a customer gives you a $20 bill, you say, ‘Out of $20,’ as you make change.”

(This is a technique to help avoid after-the-fact disputes about the denomination of the bills customers hand over.)

New Employee: “Got it.”

(The customer walks up and pays cash, handing him a $20. The new employee says nothing.)

Me: *to new employee* “What are you forgetting?”

New Employee: “Um…”

Me: “Say the amount they gave you.”

New Employee: “Oh, right…”

(The next three customers all pay cash, and as they each fork over a crisp clean $20 bill, the new employee performs flawlessly, verifying that it is indeed “Out of $20” with each transaction. I think he’s finally gotten it down until the fourth customer.)

New Employee: “That will be [price].”

Customer #4: *hands over credit card*

New Employee: “Out of $20!”

Me: *facepalm*

florida80

05-25-2019, 17:51

Time To Start Screening Customers

Pharmacy | USA | Right | May 19, 2012

(A customer slams a bottle of sunblock on the counter.)

Customer: “This is worthless! I can’t believe you sell this!”

Me: “I’m sorry to hear that, sir.” *examines the empty bottle* “But this is the highest protection factor we have.”

Customer: “Well, it’s crap! I want a refund!”

Me: “Sorry, I can’t refund an empty bottle; it’s store policy.”

Customer: “Well, what do you expect?! I have two large windows!”

florida80

05-25-2019, 17:52

A Game Of Kat And Birdie

Pharmacy | Georgia, USA | Right | April 5, 2012

(I work at a pharmacy and we are very busy, causing a few customers having to wait. The last woman in line finally steps up.)

Me: “I apologize for your wait. How can I help you?”

Customer: “Does your name tag say your name is Kat?”

Me: “Yes, ma’am, how can I help you?”

Customer: “Did you have some crazy new age parents or something? Why would they name you after an animal? That’s just dumb! You should have a good sturdy name, like mine!”

Me: “I’m sorry, ma’am, but what can I help you with?”

Customer: “I need a refill.”

Me: “Of course. Can I get your date of birth?”

Customer: *gives me her date of birth* “And the prescription is under Birdie.”

Me: “Okay, it’s put in and will be ready in 15 minutes.”

Customer: “Thank you. I’m sorry you have such a foolish name.”

Pharmacist: “Did that woman just tell you your name was foolish and complain about people with “animal” names?”

Me: “Yeah.”

Pharmacist: “But her name was Birdie…”

florida80

05-25-2019, 17:52

Less Is More, More Or Less, Part 3

Drug Store, Pharmacy | Omaha, NE, USA | Right | March 30, 2012

(Our store regularly runs a promotion on the various vitamin brands for ‘BOGO’, buy 1, get 1 free. A customer comes up to the register with a bottle of a brand on the BOGO promotion. I am also an avid couponer and I regularly take in coupons for items we carry that I won’t use so that I can give them to customers.)

Me: “Sir, I see you’re buying a [brand] item. This week we currently have this whole line at Buy One, Get One Free. If you do get another one, I also have a coupon I can give you which is good for $2 off two items. So instead of getting one for $9.99 you can get 2 for eight bucks and change.”

Customer: *quite angrily* “What the h*** is wrong with you people? I just want my vitamins. Why are you always trying to push me to buy extra stuff and give you more money!?”

Me: “I’m…sir, I apologize. I probably wasn’t clear you’ll get twice as many vitamins and spend two dollars less—”

Customer: “Oh f*** this. You’re all scam artists!” *storms off without paying*

Me: *stares in disbelief*

Next Customer:“So…can I use that coupon?”

florida80

05-25-2019, 17:53

No Pain, No Vain

Pharmacy | Winnipeg, MB, Canada | Right | March 29, 2012

(A customer comes in to return a home leg waxing kit.)

Me: “Can I ask why you are unsatisfied with this product?”

Customer: “It hurts!”

Me: “Yes, because waxing involves ripping the hair out by the roots.”

Customer: “Well, it shouldn’t hurt!”

florida80

05-25-2019, 17:53

You Better Belize It

Pharmacy | Belize | Right | March 19, 2012

(I live in Belize. A lot of tourists think they can get away with anything in my country. One day, a foreigner walks into the store.)

Customer: “Can I get some Diazepam?”

Me: “Do you have a prescription?”

Customer: *tries to look bewildered* “Do I need one?”

Me: “Yes, especially since it’s a controlled substance.”

Customer: “It is?” *scoffs* “Well I didn’t know that. Some Xanax, then.”

Me: “That is a controlled substance too. Valium, Xanax, alprazolam, lorazepam, diazepam…they’re all controlled.”

Customer: “Well, then!” *hurriedly walks out of the store*

florida80

05-25-2019, 17:54

Why You Always Bring Your Own Dinnerware

Pharmacy | Graham, NC, USA | Right | March 3, 2012

(An elderly lady approaches the counter.)

Me: “Can I help you?”

Customer: “Yes, I need some dish bags.”

(Unaware of what dish bags are, I assume she means dish rags.)

Me: “I’m not sure what that is and if we carry it. I would look in the cleaning section.”

Customer: “Well, my doctor said I could get it here.”

Me: “Okay, well I would check that aisle.”

(The customer leaves and returns after a couple minutes.)

Customer: “I didn’t find them!”

Me: “Can you tell me again what it is you need?”

Customer: “Dish bags.”

Me: “And you say your doctor told you to get them here?”

Customer: “Yes!”

Me: “Well, I’m sorry. I’ve never heard of dish bags and I don’t believe I’ve seen anything like that here.”

Customer: “Well, this is ridiculous! What am I going to do?”

Me: “I’m sorry, ma’am, would you like me to ask our pharmacist about them?”

Customer: “Yes!”

(I go get the pharmacist to assist me.)

Pharmacist: “So, what is a dish bag used for?”

Customer: “Jeeze! You clean your lady parts with it!”

florida80

05-25-2019, 17:54

Perhaps There’s Insufficient Blood To Your Brain

Pharmacy | Windsor, Ontario, Canada | Right | February 24, 2012

(We have a free self-use blood pressure machine in our pharmacy.)

Customer: “When are you going to fix your blood pressure machine?”

Pharmacist: “Excuse me?”

Customer: “Your blood pressure machine is broken. Every time I come in here, it doesn’t work! You should really take care of it. Lots of old people need to check their blood pressure, you know!”

Me: “Are you sure? I just filled the paper roll the other day. It was working fine.”

Customer: “No, it’s not! I’ve been trying to use it for days. It’s not working. You should really take care of it!”

(I take a look at the machine and try to troubleshoot the problem. I sit in the seat, roll up my sleeve, put it in the cuff, and push the big green “Start” button. The cuff inflates normally.)

Customer: “You mean you’re suppose to push that button?!”

florida80

05-25-2019, 17:55

Weekend Roundup: Don’t Mess With Employees

Fast Food, Gun Store, Pharmacy, Tech Support | Not Always Right Archives | Right | February 19, 2012

Introducing Weekend Roundups: each week, we’ll be featuring some of our favorite stories from the Not Always Right archives.

Don’t Mess With Employees! This week, we feature five stories that teach misbehaving customers the consequences of messing with employees.
1.In Real Hot Sauce Now:
A young teenage employee decides her dignity is worth more than £3.71 and dealing with a cowardly manager.

2.A Good Ol’ Fashioned A** Whoopin’:
A customer tries to rough up an employee, but ends up getting roughed up by the manager instead.

3.Hard Drugs And Harder Pharmacists:
Teenage robber, meet Doug. Doug is our new pharmacy tech. Doug is also built like a fridge.

4.Who’s Got The Power Now:
Tech support is happy to support your technology. Supporting your potty mouth, not so much.

5.Your Prank Got Spanked:
A prank caller picks the wrong, well-armed store to call.

florida80

05-25-2019, 17:55

A Dose By Any Other Name

Pharmacy | Belize | Right | February 3, 2012

Customer: “Hey, I want some Tylenol.”

Me: “For children or for adults?”

Customer: “For adults.”

Me: “At the moment, we only have the generic kind available. You know, paracetamol, also known as acetaminophen?”

Customer: “No! I don’t want any acetaminophen! Give me the other one!”

Me: “Ma’am, they are the same thing, just different names for the same ingredient.”

Customer: “Well, I just want the first one you named. Just don’t give me the other one.”

florida80

05-25-2019, 17:56

Harvested From The Great Nyquil Tree

Pharmacy | Ontario, Canada | Right | January 25, 2012

Patient: “Hi, my 6-month-old grandson has some congestion in his nose and a fever. I gave him some NyQuil yesterday and that seemed to help. Is there anything you would recommend?”

Me: “For the congestion, you can use these saline drops, they’re–”

Patient: “No! I don’t wanna use that medicated stuff.”

Me: “All right. Well, for the fever you can try this Tylenol. Do you know the wei–”

Patient: “No! I don’t want to use that! It has acetaminophen in it! That’s not safe for babies.”

Me: “Actually, acetaminophen is quite safe for infants.”

Patient: “You’re a pharmacist. You would say that!”

Me: “Well, the only other option is the Advil.”

Patient: “That has acetaminophen too!”

Me: “No, that has ibuprofen. Which is also saf–”

Patient: “No, it isn’t!”

Me: “Are you aware that NyQuil has acetaminophen in it?”

Patient: “You lie! NyQuil has NyQuil in it! Isn’t there anything more natural I can give?!”

Me: “No.”

Patient: “You’re useless!” *storms off*

florida80

05-25-2019, 17:58

It’s The Small Victories

Pharmacy | Montreal, Canada | Right | January 21, 2012

(I’ve been working for a quite a while, so my voice is scratchy. Near the end of my shift, an old man comes to the counter.)

Customer: “Hm. You’re losing your voice there, eh?”

Me: “Haha. A little bit, I suppose.”

Customer: “Well, that’s the end of the world for a woman.”

Me: “Ha ha…” *confused as to where he’s going with this*

Customer: “HAHAHA, YOU CAN’T YELL AT ME!” *does a victory dance*

florida80

05-25-2019, 17:59

The Horrors Of Mispronunciation, Part 5

Pharmacy | Maryland, USA | Right | January 2, 2012

Customer: “Do you have any fecal heart monitors?”

Me: “Uh…what?”

Customer: “You know, to hear the baby while it’s still in the womb?”

Me: “That would be a fetal heart monitor. Right this way…”

florida80

05-25-2019, 17:59

Photo-synthesise A Cure

Pharmacy | Sun Prairie, WI, USA | Related | December 17, 2011

(A mother has her sick three-year-old with her. She needs help finding medicine.)

Me: “What symptoms are you trying to treat?”

Mother: “Well, her nose…and, um, her eyes, uh…Hang on.”

(The customer digs in her purse and pulls out a photo.)

Mother: “Here’s a picture of what my daughter normally looks like, and look at her now. She’s really sick. What do you recommend?”

florida80

05-25-2019, 18:03

A Real Pain In The Rear

Pharmacy | Germany | Right | December 14, 2011

(An elderly gentleman approaches me at the counter.)

Me: “How may I help you, sir?”

Customer: “My butt hurts! I need medicine!”

Me: “All right, do you have a prescription? Or, can you tell me what exactly is wrong so that I can recommend you something that doesn’t need one?”

Customer: “I don’t know what’s wrong. But my butt hurts!”

Me: “Please go see a doctor then, sir. Without knowing what causes your pain, there’s little I can do.”

Customer: “But I don’t want to wait at the doctor’s together with all the sick people! I’ll catch a disease or something!”

Me: “That’s understandable. Maybe you could go early in the morning when fewer people are there?”

Customer: “No! I don’t want to! I want you to tell me what’s wrong! Look at my butt!”

Me: “Sorry, sir, but we don’t do that–”

(The man doesn’t listen. In front of me and three other customers, he drops his pants and underwear, turns around and sticks out his butt in my direction.)

Me: “Sir, please pull up your pants again! I can’t tell what’s wrong and you will have to leave if you don’t stop that!”

Customer: “Nonsense! If you can’t tell what’s wrong from over there, come closer and get a better look!”

(My boss then comes to look at what’s going on and ends up kicking the guy out.)

Customer: *on the way out the door* “Why will no one look at my butt?!”

florida80

05-25-2019, 18:04

A Warm And Full(filling) Night In

Pharmacy | Boston, MA, USA | Right | December 9, 2011

(A man in his mid-30’s approaches the register. I notice that he looks a little grumpy about something.)

Me: “Hello!”

Customer: “Hi.”

(It is at this point that I notice that he only has two items to ring up: a 20oz bottle of soda and an enema.)

Me: “How are you today?”

Customer: “I’m holding an enema, what do you think?!”

Me: *speechless*

(I ring him up silently. Poor guy, I hope he feels better!)

florida80

05-25-2019, 18:04

D Is For Definitely Shiny

Pharmacy | Wyckoff, NJ, USA | Right | November 16, 2011

(A customer walks to my register with a Halloween decoration in tow. It’s a cheap cardboard statue of a cartoon-looking black cat covered in a shiny plastic material.)

Customer: “So, why is this 3D?”

Me: “Excuse me?”

(I peer at the tag. It says “3D Cat”.)

Me: “Oh, that’s because it’s 3D.”

Customer: “No, I mean why is it ‘D’? Is it because it’s shiny?”

(A multitude of thoughts are racing through my head at this point. I debate the prospect of explaining to her what 3D actually means. In the end, I decide it’s easier to just agree with her.)

Me: “Exactly! It’s really sparkly and that’s why it’s called a 3D cat. Would you like to purchase it?”

Customer: “Oh, definitely!”

florida80

05-25-2019, 18:05

What’s Your Poison

Pharmacy | New Zealand | Right | November 15, 2011

(I’m a pharmacist in a rural area. A shop assistant calls me out from the dispensary to talk to a customer, who is a slightly intoxicated middle aged woman.)

Customer: “This medicine made my partner sick! Violently sick!”

Me: “Let me see. Has he had any alcohol?”

Customer: “No.”

Me: “Are you sure? Not even a little?”

Customer: “He doesn’t drink. Maybe only a little, but he wasn’t drunk.”

Me: “It clearly says on the label that you must not drink any alcohol while being treated with this medicine.”

Customer: “But he didn’t drink much at all. A beer shouldn’t matter, should it?”

Me: “It contains enough alcohol to–”

Customer: “But, like, you can even drive if you only drink a beer!”

Me: “That has nothing to do with–”

Customer: “I think he’d better not take this medicine. It made him violently sick!”

Me: “I think he should–”

Customer: “Thanks, I’ll tell him what you said. This medicine is a poison!” *turns around and walks out*

florida80

05-25-2019, 18:06

Have You Tried Dihydrogen Monoxide, Part 3

Pharmacy | Lansing, MI, USA | Right | November 9, 2011

(I am standing in line at the pharmacy counter and a man rudely cuts in front of me, stating that he has been waiting in line, just in another part of the store. He assures me he’ll be quick, but I don’t buy his excuse. The following exchange occurs between him and the pharmacist.)

Customer: “I need to speak to a pharmacist immediately.”

Pharmacist: “Do you have a question about your medication?”

Customer: “Yes, it says on the bottle to take with water. I don’t drink water. Water makes you fat.”

Pharmacist: “Um, water is essential for your body, especially with those pills.”

Customer: “What about water retention? Will I just pee it out, then?”

Pharmacist: “Yeah, your body will eventually eliminate it. You should drink water, though. Your body needs plenty of water to work well, and you really don’t want to be dehydrated while on this drug.”

Customer: “Okay, I’ll try it. Oh, and one more question. What about alcohol? Can I still have my alcohol?”

florida80

05-25-2019, 18:06

Take Two Werewolves And Call Me In The Morning

Pharmacy | New Zealand | Right | November 8, 2011

(I have just given a customer his prescription and am explaining to him the directions.)

Me: “So, just take two of these with water at night.”

Customer: “Okay, thanks. Wait, I work at night…should I take these in the day time?”

Me: “Yes, just take them before bed.”

Customer: “Okay, so they aren’t activated by the moon or anything?”

Me: “No.”

Customer: *slight disbelief

florida80

05-25-2019, 18:07

I’ll Take An Album Cover For 7000

Pharmacy | California, USA | Right | November 4, 2011

(I work in the OTC section of a well-known pharmacy chain. I’m stocking the shelves in an aisle when a customer approaches me.)

Customer: “Excuse me. I’ve looked all over here. Where are your hemorrhoid wipes?”

Me: “Oh, those are actually down on Aisle 20.”

Customer: “Really? Why are they over there and not in this aisle with the rest of the anal care?”

Me: “I’m sorry, what?”

Customer: “Anal care!” *points at the aisle’s sign*

(The sign she was pointing at? “Analgesics”.)

florida80

05-25-2019, 18:07

Like There’s No Tomorrow

Pharmacy | Goffstown, NH, USA | Right | October 24, 2011

(A customer has called to ask if we carry an over the counter soap in our store.)

Me: “Hello, ma’am? I just checked and we do carry [brand] soap. However, we are all out of stock right now, but we could order some for you and it would come in tomorrow.”

Customer: “You don’t carry [brand]?”

Me: “We do carry it. We just don’t have it in right now.”

Customer: “Well, why not?”

Me: “Because other customers have purchased it. But we can order some for tomorrow.”

Customer: “Well, how long will that take?”

Me: “It’ll come in tomorrow.”

Customer: “So, how many days will that be?”

florida80

05-25-2019, 18:08

They’re Right Next To The Abacus Tablets

Pharmacy | North Carolina, USA | Right | October 10, 2011

(I’m working behind the counter one morning when an older customer and her son approach.)

Customer: “I’ve been really itchy lately. I need something for the itch. My son used algebra tablets last time.”

Me: “Well you could use an allergy tablet, but you can’t if you have high blood pressure.”

Customer: “I have high blood pressure but this itching is terrible. Can you show me the algebra tablets?”

Me: “I can’t recommend the allergy tablets, then. It could interact with your medicine.”

Customer: “I know, but my son had algebra tablets last time and they helped with the itching.”

Me: “Yes, the allergy tablets would interact though. So I can’t recommend those.”

Customer: “Which of these algebra tablets would you recommend?”

Me: *gives up* “The pink box.”

florida80

05-25-2019, 18:09

One’s Green And The Other Makes You Green

Pharmacy | New Jersey, USA | Right | October 10, 2011

Customer: “Hi, I’m calling to see if you have cholera pills in stock.”

Me: “I beg your pardon? Cholera is a contagious disease.”

Customer: “No, it’s not! I’m looking for cholera pills!”

Me: “Um, do you mean the natural supplement Chlorella?”

Customer: “That’s what I said! Cholera! It’s spelled C-H-L-O-R-E-L-L-A. Cholera. I am looking for a large bottle if you have it.”

Me: *gives up* “Yeah, sure. We happen to have a few bottles of cholera in stock.”

Customer: “I’ll be there in five minutes!”

florida80

05-25-2019, 18:09

Run Artificial Stupidity Program

Pharmacy | Illinois, USA | Right | September 27, 2011

(Our pharmacy phone system is down, so all pharmacy calls are going through the main line, which is answered by me. These calls include people trying to reach the automated prescription line.)

Me: “Thanks for calling [store], where we offer flu shots every day. This is [name]. How may I help you?”

Customer: “You’re not a machine.”

Me: “No. If you were trying to reach the automated line, the phones are down. I can connect you to the pharmacist.”

Customer: “I want the automated system. People are dumb!”

florida80

05-25-2019, 18:10

Not So Modest Aspirations

Pharmacy | Europe | Right | August 25, 2011

(I’m speaking with a three year old girl as I serve her mother.)

Me: “Do you like the pharmacy? Do you think you will be a pharmacist when you grow up?”

Girl: “No! I will be a dancer!”

Me: “Oh, a dancer! That’s nice! Like in a dance group?”

Girl: “No! On the pole!”

florida80

05-25-2019, 18:11

Cost-Benefit Analysis

Auto Parts, Pharmacy | Dalton, GA, USA | Right | August 25, 2011

(A customer comes in to pick up his Viagra prescription. I’m trying not to be awkward and ring him up as if it’s any other order.)

Me: “Hi, how may I help you?”

Customer: “My name is [name]. I need to pick up my prescription.”

Me: “That will be just a moment.”

(I get the man’s prescription and proceed to ring him up for it.)

Me: “Your total today comes out to [price].”

Customer: “What?!”

Me: *I repeat the price*

Customer: *mumbles* “Still cheaper than a hooker, I guess.” *pays and leaves*

florida80

05-25-2019, 18:11

Sleepless Sleep Aids

Pharmacy | South West England, UK | Right | August 24, 2011

(A woman comes to the counter.)

Me: “Hello, how can I help you?”

Customer: “I see you’ve got [sleep aid]. Does it come in a non-drowsy version?”

florida80

05-25-2019, 18:12

Two Halves Make A Hole In Your Brain

Pharmacy | Massachusetts, USA | Right | August 22, 2011

Me: “Thank you for calling the pharmacy, how can I help you?”

Customer: “I’d like you to check how much my prescriptions are. My name is [name].”

Me: “You have two prescriptions waiting for you. Each one is $2.50.”

Customer: “So, how much does each one cost?”

Me: “$2.50 each.”

Customer: “So, one is $2.50. How much is the other one?”

Me: “Each of your two prescriptions is $2.50.”

Customer: “So, if I give you $5, how much will my change be?”

Me: “Nothing.”

Customer: *hangs up*

florida80

05-25-2019, 18:13

Recipe For Disaster

Pharmacy | Vancouver, WA, USA | Right | July 14, 2011

(A customer comes up to the pharmacy counter. Keep in mind, Sudafed (pseudoephedrine) is controlled in all 50 states as it is used to make methamphetamine.)

Customer: “I need some Sudafed.”

Me: “Did you want Sudafed or [store brand]?”

Customer: “What’s the difference?”

Me: “The active ingredient is the same but sometimes they change the inactive ingredients. It still works the same though. Plus, [store brand] is about 5 bucks cheaper.”

Customer: “The recipe said I need Sudafed.”

Me: “…”

Customer: *realizing what she said* “Um, s***. Never mind, I got to go.”

florida80

05-26-2019, 12:16

49 Secrets Your Pharmacist Isn’t Telling You

When you pick up your prescription, at a minimum, ask…

Female medicine doctor prescribing pills to her male patient. Healthcare, medical and pharmacy concept.

ldutko/Shutterstock

What is this drug? What does it do? Why am I taking it? What are possible side effects? and How should I take it? Not only does this help you to use the drug correctly, it’s also a good way to double-check that you’re getting the right drug. Half the prescriptions taken in the U.S. each year are used improperly, and 96 percent of patients nationwide don’t ask questions about how to use their medications. Make sure you know about these 10 super-important questions you must ask before taking prescription medications.

florida80

05-26-2019, 12:17

When you pick up your prescription, at a minimum, ask…

What is this drug? What does it do? Why am I taking it? What are possible side effects? and How should I take it? Not only does this help you to use the drug correctly, it’s also a good way to double-check that you’re getting the right drug. Half the prescriptions taken in the U.S. each year are used improperly, and 96 percent of patients nationwide don’t ask questions about how to use their medications. Make sure you know about these 10 super-important questions you must ask before taking prescription medications.

florida80

05-26-2019, 12:18

Your pharmacist has spent more time studying drugs than even your doctors

Go ahead and call me doctor; I’m just not that kind of doctor. Since mid-2004, pharmacy students must pursue a doctorate in pharmacy (Pharm.D) in order to be licensed. Pharmacists licensed before then must have at least a Bachelor of Pharmacy and pass a series of exams. This is why your pharmacist probably knows more about your health than your doctor.

florida80

05-26-2019, 12:19

All pharmacists are not created equal

A less-qualified pharmacy technician may have actually filled your prescription. Currently, there is no national standard for their training and responsibilities

florida80

05-26-2019, 12:20

People assume that if it’s over-the-counter, it’s safe

According to Daniel Zlott, a pharmacist at the National Institutes of Health, this may not always be the case for you. “I’ve seen serious complications” with over-the-counter meds, he says. Here are some over-the-counter medication mistakes you didn’t know you were making.

florida80

05-26-2019, 12:21

An over-the-counter version of your medication might do the trick

You may just need to take more pills and forgo insurance reimbursement. But always talk to your pharmacist, and do the math

florida80

05-26-2019, 12:22

We’ll save you money if we can

“A good part of a pharmacist’s time is spent dealing with patients and their incomes,” says pharmacist Cindy Coffey. Part of that is suggesting generic or OTC alternatives. Or if a doctor has prescribed a newer drug with no generic alternative available, says Zlott, “I might call the doctor to suggest an older drug that’s equally effective.” Make sure to ask these questions that could save you money on medication.

florida80

05-26-2019, 12:23

I’d think twice about using a drive-through pharmacy

Our drive-through window may be convenient, but most pharmacists don’t like them. An Ohio State study found that pharmacists believe the distractions associated with drive-through service contribute to delays, reduced efficiency and even dispensing errors. They also create the unrealistic expectation of fast-food-like service. So the next time you’re frustrated and stuck behind five cars, try to remember that getting the wrong prescription is much more dangerous than getting the wrong burger at McDonalds’s—and try to be patient.

florida80

05-26-2019, 12:24

The more I know you, the more I can help you

The better I know you as a patient—your health history, your family, and how busy your life is—the better I can tailor medications to fit your lifestyle,” says Zlott. “You may not want to take a drug three times a day, for example, and I’ll know that if I know you.”

florida80

05-26-2019, 12:25

Generics are a close match for most brand names

But I’d be careful with blood thinners and thyroid drugs, since small differences can have big effects

florida80

05-26-2019, 12:26

Don’t try to get anything past us

Prescriptions for painkillers or sleeping aids always get extra scrutiny. Here are some lies you should never tell your doctor.

florida80

05-26-2019, 12:26

When in doubt, ask

I can give you a generic refill that’s different from the one you started with. Online resources like cvs.com let you double-check your pill.

florida80

05-26-2019, 12:27

Use one pharmacy if you can

There’s not some big computer database that tracks your drugs and flags interactions for pharmacists everywhere. If you start using a new pharmacy, make sure we know what you’re taking

florida80

05-26-2019, 12:28

Here’s how to avoid lines

It gets busy Monday and Tuesday evenings, since many new prescriptions and refills come in after the weekend. Also, steer clear of pharmacies on the first few days of the month—that’s when Social Security checks arrive and recipients swamp the pharmacy. Generally, the best time to visit is in the middle of the week or during the workday (but stay away at lunch hour).

florida80

05-26-2019, 12:29

Look into the $4 generics

Chains like Target, Kroger, and Wal-Mart offer them. And it can’t hurt to ask your pharmacy if it will match the price.

florida80

05-26-2019, 12:30

Yelling at me won’t help

If I can’t reach your doctor and/or insurance company to approve a refill, there’s nothing I can do about it. “It’s frustrating,” says Zlott, “but I’d be breaking the law in some states if I gave it to you.”

florida80

05-26-2019, 12:31

Pharmacists are required by law in most states to counsel patients and answer their questions

If your pharmacist seems too busy to talk with you, take your business someplace else. Check out these other signs you need to fire your doctor.

florida80

05-26-2019, 12:32

Pharmacists are filling more prescriptions than ever

“Some pharmacies are so volume-driven that the pharmacist can’t look up all day,” says Coffey. There were a record 3.8 billion prescriptions filled in the U.S. in 2007—a 13 percent increase from 2003. If I’m grumpy, there’s a reason. In most chain stores, I have 15 minutes to fill a prescription, and I get reprimanded if I’m too slow. I may also be expected to answer the phone, counsel patients, call insurance companies, and run the cash register—all while making sure you get the right medicine at the right dosage

florida80

05-26-2019, 12:33

Sometimes we can’t read the doctor’s handwriting either

E-prescribing can help, but as of 2006, fewer than 20 percent of prescriptions were being electronically transmitted. This is the real reason doctors often have such messy handwriting

florida80

05-26-2019, 12:34

I hate your insurance company as much as you do

“Even if something’s working for you, the insurance company may insist you switch to something else,” says pharmacy owner Stuart Feldman. “I’m stuck in the middle trying to explain this to customers.” These are 18 secrets your health insurance company is keeping from you.

florida80

05-26-2019, 12:35

We can give flu shots in most states

Just ask us. Also know that when I ask, “Would you like to get a flu shot today?” I’m not just asking for your health; flu shots are so profitable that some stores give clerks a monetary bonus at certain times of the year based on how many immunizations they sell.

florida80

05-26-2019, 12:36

People take too many drugs

Two out of every three patients who visit a doctor leave with at least one prescription for medication, according to the Institute for Safe Medication Practices. “Drugs are an easy solution,” says Feldman, “but there are other solutions.” Here are things you need to know right now about taking too many medications.

florida80

05-26-2019, 12:38

Always ask to get the lowest price

When it comes to paying for prescriptions, you have to ask to get the lowest price. In a Consumer Reports study, secret shoppers who were quoted a higher price at first were often able to negotiate a discount if they just asked. So the lesson is: be pushy.

florida80

05-26-2019, 12:40

We wear white to inspire trust

Many of us require our pharmacists wear white lab coats because we know it inspires trust. In one study, three out of four respondents judged a pharmacist in a white lab coat as more competent and approachable compared to one who was just dressed professionally.

florida80

05-26-2019, 12:50

Beware this word: phenylephrine

That’s the active ingredient in most over-the-counter cold medicines, but it’s no better than a placebo. Drugmakers started using it after pseudoephedrine, a decongestant that does work, was forced behind the counter because it was being used to make meth. Watch out for these medical terms you should be sure to never confuse.

florida80

05-27-2019, 19:18

Zombies Need Lawyers Too

Pharmacy | Miami, FL, USA | Right | June 17, 2011

Me: “Ma’am, unfortunately we are waiting on your prescriber to contact the pharmacy because parts of your prescription were unclear.”

Customer: “Are you telling me my prescription is not ready?”

Me: “Yes, it is not ready.”

Customer: “Well, if I die, I’m suing you!”

florida80

05-27-2019, 19:18

The Purchase Was A Pre-Medicated Decision

Pharmacy | Joliet, IL, USA | Right | May 23, 2011

(I am closing the pharmacy curtain. A customer comes up to the counter.)

Customer: “I need to pick up my prescription for my pain medication. I’m in a lot of pain.”

Me: “Okay. Just for future reference, the pharmacy closes at 9pm.”

Customer: “I know. I was too busy getting an iPhone to get here while you were open.”

florida80

05-27-2019, 19:19

This Medicine Doesn’t Really Hit The Spot

Pharmacy | TX, USA | Right | April 10, 2011

Me: “Thank you for calling [pharmacy]. What can I help you with?

Caller: “I just bought some [acne medication]. I was wondering if you could, uh… use it on herpes?”

Me: “On herpes? [Acne medication] is a treatment for acne only.”

Caller: “So can I put it on my junk or not?”

florida80

05-27-2019, 19:19

This Customer Has Trouble Written All Over Him

Pharmacy | Baldwinsville, NY, USA | Right | April 3, 2011

Customer: “I’d like to buy some syringes.”

Me: “Can I see some ID?”

Customer: “They’re not for me, they’re for my dad. He’s a diabetic and needs them for his insulin.”

Me: “Okay. I still need to see some ID. Do you know his date of birth?”

Customer: “I’ll never forget his date of birth. I had it tattooed on my arm the day he died.”

(The customer proceeds to show everyone in the pharmacy the tattoo of his deceased father’s DOB–the same father that he is trying to buy syringes for.)

florida80

05-27-2019, 19:20

So Mummy Can Have Birds Without The Bees

Pharmacy | United Kingdom | Right | January 30, 2011

(I am a customer in line at a pharmacy. A mother and her two youngs boys is ahead of me. One of the young boys is sitting on the floor pointing at random medicines.)

Boy: “Mummy, what’s that for?”

Mother: “That’s for an itchy head.”

Boy: “Mummy, what’s that for?”

Mother: “That’s for when you can’t sleep.”

(The boy then points at the pregnancy tests.)

Boy: “Mummy, what’s that for?”

Mother: “That’s to see if you have a baby growing inside of you!”

(The boy then stands up and gets back in line with his mother.)

Mother, to me and the pharmacist: “Thank god he didn’t point at the condoms!”

florida80

05-27-2019, 19:23

Two Pillows On The Couch, Once Daily

Pharmacy | Richmond, BC, Canada | Right | January 26, 2011

(I need to make a new profile for the customer’s wife on our computer system, so the customer calls his wife.)

Customer, to wife: “Hello? What’s your card number? It’s for the prescription.”

(The customer relays the card number to me. I ask for her birthday.)

Customer, to wife: “When’s your birthday? No, of course I remember. It’s December 7th!”

(I hear his wife cry out loudly over the phone.)

Customer, to wife: “What? It’s September 22nd?!”

(The customer ends the conversation and hangs up the phone.)

Me: “Are you going to be alright when you go back?”

Customer, to me: “You should warn me next time you have to ask for her birthday.”

florida80

05-27-2019, 19:23

Identity Theft Is Childs Play

Pharmacy | Iowa City, IA, USA | Right | January 14, 2011

(I am a customer in line. There is a woman with a 4 year old finishing up their purchase.)

Me: “Here’s your change.”

4-Year-Old: “Mommy, can I do the scribbles?”

Customer: “No, honey. I paid with cash, not my credit card.”

florida80

05-27-2019, 19:24

Looking Down The Barrel Of A Smoking Gum

Pharmacy | Madison, WI, USA | Right | January 3, 2011

(I hear this conversation in my checkout line.)

Customer #1 (https://www.vietbf.com/forum/usertag.php?do=list&action=hash&hash=1) : “Oh my God, I love that nicotine gum! It makes my mouth feel all numb.”

Customer #2 (https://www.vietbf.com/forum/usertag.php?do=list&action=hash&hash=2) : “You know that stuff’s going to get you addicted to cigarettes, right?”

Customer #1 (https://www.vietbf.com/forum/usertag.php?do=list&action=hash&hash=1) : “Nah! That stuff gets you un-addicted to them and I don’t smoke. I’m fine!”

florida80

05-27-2019, 19:25

Children Get Sick Periodically

Pharmacy | New York, New York, USA | Right | November 19, 2010

(A woman walks into the store with her young daughter. Her daughter looks feverish and is sniffling.)

Customer: “Oh look honey, they have candy bars. Go get yourself one while mommy shops for her things.”

(The little girl walks up to the counter and takes a candy bar.)

Me: “Are you feeling okay, little girl?”

Daughter: “My mommy says as long as she gets her tampons, I’ll feel better.”

(The girl suddenly vomits all over the candy bars and on the counter.)

Daughter: “QUICK MOMMY! GET YOUR TAMPONS!”

florida80

05-27-2019, 19:25

Ear-Waxing Lyrical About Bad Service

Pharmacy | London, UK | Right | November 1, 2010

Customer: “I’ve come to pick up my prescription.”

Me: “Oh I’m really sorry, due to extenuating circumstances we don’t have a pharmacist at the moment so legally I can’t give out any prescriptions. But if you wait 5 minutes, a replacement pharmacist will be here and then you can take it.”

Customer: “But I need it. Give it to me!”

Me: “I understand your problem but I would be breaking the law if I gave it to you.”

Customer: “I work in the pharmaceutical industry and I know for a fact you are lying! Give it to me now!”

(The pharmacist arrives and I explain the problem.)

Pharmacist: “I’m really sorry for the inconvenience but my colleague was right, there was nothing she could do. But now that I’m here, you can take your prescription.”

Customer: “You’re colleague is a cruel, moral-less b**** with the intelligence of a moron. She has endangered my life! I shall take this to court and win!” *storms out*

Me: *to pharmacist* “What was in her prescription?”

Pharmacist: “Drops for excessive ear wax.”

florida80

05-27-2019, 19:26

Retired & Extremely Dangerous

Pharmacy | Georgia, USA | Right | October 18, 2010

Me: “Thank you for call [Pharmacy], may I help you?”

Elderly Female Customer: “I would like to get these two of my medications refilled and I want to pick them up tomorrow afternoon.”

Me: “Okay ma’am, that will be fine. Is there anything else I can do for you?”

Elderly Female Customer: “Honey, you can come to my house and do me anytime.”

Me: “I, uh, oh, uh…”

Elderly Female Customer: “I hope I didn’t offend you, but I’m old so I can say things like that!”

florida80

05-27-2019, 19:27

Discount Discounted

Pharmacy | Sherman Oaks, CA, USA | Right | September 29, 2010

Me: “And do you have a free rewards card with us, ma’am?”

Customer: “A what? I don’t know. Maybe. I don’t know.”

Me: “If you think you have one, I can look it up by your phone number?

Customer: “My what?”

Me: *louder* “Your phone number, ma’am.”

Customer: “I don’t have one of those! I don’t think I have one! I don’t have a phone number! I don’t have one!”

Me: “Okay, ma’am, that’s fine. Your total today is $26.74, and just to let you know, you could have saved $5.90 if you had the rewards card.”

Customer: “A discount? My phone number is ***-****.”

florida80

05-27-2019, 19:27

Will Power On Aisle 2

Pharmacy | Canada | Right | September 28, 2010

Teenage girl: “Do you guys sell that contraceptive abstinence?”

Me: “Abstinence?”

Teenage girl: “Yeah! Abstinence! I read that it’s the only 100% way to not get pregnant!”

Me: “That’s right. But, abstinence is to not have sex. Like abstain from.”

Teenage girl: “Well, that just sucks!”

florida80

05-27-2019, 19:28

Misunderstood ‘Total Coverage’

Pharmacy | Detroit, MI, USA | Right | September 17, 2010

Me: “Our records show you’ve never had a prescription filled here before, so I’ll need an ID and your insurance.”

Customer: “Here’s my ID. I don’t have my insurance on me, but it’s through [car insurance company].”

Me: “Sir, I think that’s your car insurance. Do you have health insurance?”

Customer: “You mean there’s more than one kind?”

florida80

05-27-2019, 19:28

Feeling Pooped

Pharmacy | Milwaukee, WI, USA | Right | September 12, 2010

(A couple approaches the counter.)

Me: “Can I help?”

Customer: “Yes, can you give me advice about his stool?”

Me: “I’m sorry, I can’t give medical advice. Perhaps you’d like to speak to our pharmacist, or consult your doctor?”

Customer: “No, I’m sure they’re very busy. I just want someone to tell me if it’s normal.”

Me: “The law says I can’t give advice. Let me get the pharmacist.”

Customer: “No, really, I have some here.” *whips out a clear bag of poo on the counter* “See, it’s all gritty. That’s not normal, is it? Do you have pills for that?”

Me: “Ma’am, you might want to take that to your doctor. We can’t accept biological waste.”

Customer: *to her husband* “See, Joe, I told you it was wrong. That’s why I save them.”

florida80

05-27-2019, 19:29

Rectify The Situation

Pharmacy | UK | Right | August 12, 2010

Customer: “Hi there, do you sell rectums?”

Me: “I’m sorry, what?”

Customer: “Rectums. I need a rectum. do you sell them?”

Me: “Why do you need it?”

Customer: “I have some tablets here and it says ‘insert via rectum’ and as I don’t have one, I thought I better buy one.”

Me: “I think I better call the pharmacist in.”

(I call the pharmacist in who explains to the man exactly what a rectum is. He leaves red faced.)

florida80

05-27-2019, 19:30

Don’t Hold Your Breath For This One

Pharmacy | Boulder, CO, USA | Right | July 16, 2010

(I am counseling a patient on using an inhaler.)

Me: “Do you know how to use an inhaler, sir?”

Patient: “Nope, never used one.”

Me: “Okay, you’ll want to begin inhaling, and then depress the inhaler as you are breathing in. Then, hold your breath for as long as possible to allow the medication to be absorbed into your lungs.”

Patient: “Oh, sort of like smoking pot…”

florida80

05-27-2019, 19:30

Hollywood, M.D.

Pharmacy | Vancouver Island, BC, Canada | Right | July 1, 2010

(A customer comes to the counter with a bleeding hand.)

Customer: “Have you got a first aid kit back there? I caught my hand and it’s bleeding.”

Me: “Of course. I’ll go get it.”

(I come back with the kit and take out some antibiotic ointment and some bandages.)

Customer: “Oh, I shouldn’t need the bandages.”

Me: “Are you sure? It’s bleeding quite a lot.”

Customer: “Well, that ointment will just fix it, won’t it?”

Me: “Pardon?”

Customer: “That stuff you’ve got in your hand, that’ll just heal it up right?”

Me: “This helps it heal faster and prevents it from getting infected, but it doesn’t heal it immediately.”

Customer: “Don’t you have the stuff that just fixes it right away?”

Me: “I don’t believe they have anything that does that, ma’am.”

Customer: “They do, I saw it before!”

Me: “Where did you see it?”

Customer: “I saw it on some movie. I don’t want that stuff there. I want the stuff I saw in the movie. Just get that stuff and fix this already, will you?”

florida80

05-27-2019, 19:31

Medication Frustration

Pharmacy | Vancouver Island, BC, Canada | Right | June 28, 2010

Customer: “I’m picking up a prescription for [name].”

Me: “Okay. Just a second.”

(I check the drawer for the prescription and can’t find it.)

Me: “When did you order it?”

Customer: “Well, I saw the doctor on Monday.”

Me: “So you came in on Monday?”

Customer: “No, I went to the doctor’s on Monday.”

Me: “Okay, so when did you drop your prescription off?”

Customer: “What do you mean? I went to the doctor.”

Me: “And did he give you a piece of paper that said what drugs you needed?”

Customer: “Yeah.”

Me: “That’s a prescription. You need to bring it here so that we know what you need.”

Customer: “But I saw the doctor on Monday! Why didn’t he do it?”

Me: “That’s not his job. That’s what pharmacists are for.”

Customer: “So what, he’s a doctor but he’s not a pharmacist? Look, I saw him on Monday so he probably just did it then. You’re just not looking hard enough. Look for the things done on Monday!”

florida80

05-27-2019, 19:31

The Truth Is A Bitter Pill To Swallow

Pharmacy | Vancouver Island, BC, Canada | Right | June 25, 2010

Customer: “Why isn’t my prescription ready yet?”

Me: “We’re trying to get in contact with your doctor because of a problem with the prescription. You’re profile says you’re allergic to penicillin. Is that correct?”

Customer: “Oh yeah, that stuff is real bad for me!”

Me: “The medication your doctor prescribed has penicillin in it, so we’re trying to get a hold of him to find out what he wants you to take.”

Customer: “Oh, well, he wants me to take the penicillin. That’s what he wrote down, right?”

Me: “Yes, but you said you were allergic to it.”

Customer: “But he’s a doctor, so he knows what’s best. If that’s what he wrote, then just give me that.”

Me: “Well, we’ll check with him first to make sure that it’s safe for you.”

Customer: “Of course it’s safe for me or the doctor wouldn’t have prescribed it! He probably just cured my allergies. Check my old prescriptions; I bet he prescribed me something to cure my allergy!”

florida80

05-28-2019, 17:33

High School Dropouts Work On The Pharm

Pharmacy | Boston, MA, USA | Right | June 12, 2010

(I work as a pharmacy tech at a chain pharmacy. I am also currently in pharmacy school and will be a pharmacist one day.)

Customer: “You should be ashamed of yourself!”

Me: “I’m sorry. Can I help you with something?”

Customer: “No! I refuse to be helped by a high school dropout! You should be ashamed of yourself for working where children can see you! You are going to make them think that it is okay to not have an education!”

Me: “Ma’am, I am not a high school dropout. I have a high school diploma and I am currently in pharmacy school working towards a Doctor of Pharmacy. I am going to be a pharmacist one day.”

Customer: “Stop lying! I have never heard of a pharmacist before. You are a high school dropout!”

Manager: “Can I help you?”

Customer: “Yes! Your employee is lying to me! She says she is going to be a pharmacist! That job doesn’t exist!”

(The manager looks at our pharmacist who is near tears from laughing so hard.)

Manager: “Ma’am, see the man over there? He’s the one who filled your prescription. He is a pharmacist.”

Customer: “No he isn’t! He just counts pills! You don’t need school for that!”

florida80

05-28-2019, 17:34

Health Care(less)

Pharmacy | Greenville, SC, USA | Right | May 19, 2010

Me: “That will be $43.78, ma’am.”

Customer: “Oh, no it won’t.”

Me: “I’m sorry, did you have insurance? You weren’t in the system. Do you have your card on you?”

Customer: “No, I don’t have insurance. Obama said health care is free.”

Me: “I don’t think that’s how it works, ma’am.”

florida80

05-28-2019, 17:35

There’s No Pills Like Home, Part 2

Pharmacy | New Jersey, USA | Right | April 19, 2010

(My phone number is 1 number off a nearby pharmacy. We get a lot of misdials. My father happens to actually be a pharmacist but he doesn’t work there.)

Me: “Hello?”

Caller: “Hello? You just say Hello? How dare you be so rude! You should say “thank you for calling”!”

Me: “Oh, you must be looking for [pharmacy]. You have the wrong number.”

Caller: “Liar! How would you know what store I’m looking for? You’re just trying not to get in trouble. Give me your manager.”

Me: “Ma’am, I don’t have a manager. You’ve called a private residence. The number for the pharmacy is close to our number, so we get a lot of wrong calls.”

Caller: “This is outrageous! Give me your manager! I will not be treated this way!”

(At this point the caller was rambling and being rude so I hung up the phone. She called back, and my father answered it.)

Father: “Hello?”

Caller: “Is this the manager? Thank god! I want to know if [drug] can be taken with food! And you should fire that girl that answered before, she was very rude to me! I want to file a complaint!”

Father: “Ma’am, this is not the grocery store pharmacy. You just told off my 14-year old daughter. I happen to be a pharmacist. That drug does not need to be taken with food. However, you should see a doctor about your ears, as you clearly can’t hear a word anyone says.”

florida80

05-28-2019, 17:35

Seriously Bad Hair Day

Pharmacy | Melbourne, Australia | Right | March 11, 2010

(It’s 10pm we are in the final motions of locking up, registers closed and lights off. I’m just locking the door.)

Customer: *runs up in a panic* “Oh no! You are closed? It’s an emergency! I really need to buy one thing!”

Me: “Sorry, we’re closed. Maybe you could come back in the morning.”

Customer: “No! I can’t wait that long-this is an emergency! Please help me!”

Me: “OK, I suppose I can help you quickly for an emergency. Do you need antibiotics or paracetamol or something?”

Customer: “I need a packet of hair pins!”

florida80

05-28-2019, 17:36

How To Seize The Moment

Pharmacy | Tallmadge, OH, USA | Right | March 8, 2010

(An elderly woman is having a seizure and obviously 911 was called to the scene.)

Customer: “Excuse me, but when can I get my prescription?”

Me: “Ma’am, this woman is having a seizure and needs medical attention right away.”

Customer: “But I was here before her!”

florida80

05-28-2019, 17:37

This One’s A No-Brainer

Pharmacy | Sydney, Australia | Right | February 13, 2010

Customer: “My mother is taking some medication and it is making her sick. Can you stop giving it to her?”

Me: “I’ll have to ask the pharmacist for you. What medication is it?”

Customer: “It’s a little white pill.”

Me: “You don’t know the name of it, sir? We do have many white pills in the pharmacy.”

Customer: “I think it’s for her heart…or her brain.”

florida80

05-28-2019, 17:37

Noah Already Had Two Customers On The Ark

Pharmacy | | Right | October 26, 2009

(Note: much of our area is suffering from massive flooding. A man walks into our chain pharmacy, completely drenched from the chest down.)

Me: “Wow, what happened to you?”

Customer: “I tried to go to your other location and it was closed!”

Me: “That location is flooded, sir. There’s about four feet of water surrounding it.”

Customer: “I know! I had to wade all the way up to the door before I found out it was closed! How do you think I got so wet?”

florida80

05-28-2019, 17:38

Not A Case Of If, But When…

Pharmacy | | Right | August 20, 2009

(While waiting in line, I overhear a conversation between a teenager and a police officer, both of whom are also waiting. The boy has red plastic cups and ping pong balls in hand.)

Officer: “Can I ask what those are for?”

Teenage customer: “No, no questions.”

Officer: “Where’s the party?”

Teenage customer: “No parties.”

(The kid checks out, and as he’s walking out the door yells “SODA PONG!” and flicks his wrist.)

Officer, to me: “Yeah, I’ll get the call in a couple hours.”

florida80

05-28-2019, 17:39

There’s No Pills Like Home

Pharmacy | | Right | July 17, 2009

(A patient called in to inquire about her medication she had just picked up.)

Me: *on the phone* “Pharmacy.”

Patient: “Hi, I just picked up this medication, and I think I may have a problem.”

Me: “Is there something incorrect with how it was filled?”

Patient: “No, it’s just that the cream here says to apply locally, and I’m going out of town tonight. I was wondering if I could still use it.”

Me: “Um…yes, yes you can.”

Patient: “Oh, OK good…. Oh…oh God. I just realized…oh my God, just forget I asked! How stupid of me!”

florida80

05-28-2019, 17:40

On The Bright Side, There Are Worse Orifices

Pharmacy | | Right | July 15, 2009

Me: “*** Pharmacy, how can I help you?”

Customer: “Yeah, your medicine is defective.”

Me: “Sir, why don’t I get your information so I can take a look at your profile.”

Customer: *gives his name and date of birth*

Me: “I see that the last prescriptions you filled were antibiotic and drops for your ear infection. Are your symptoms still bothering you?”

Customer: “Yes, and how the h*** do you expect me to fit this giant pill in my ear?”

Me: “Sir, that’s an antibiotic tablet. It’s meant to be taken orally.”

florida80

05-28-2019, 17:41

TMI Mom Tries To Help

Pharmacy | | Right | July 6, 2009

(A forty-something year old woman comes to the counter with her purchases. Amongst them is a box of condoms, which have security stickers on them. Before I scan the item, I swipe it a few times over the scanner to deactivate it.)

Customer: “Is it not scanning?”

Me: “No, I’m just deactivating the security sticker. I don’t want you to set off the alarm on the way out. Especially over condoms!”

Customer: “Oh I’m not embarrassed! They’re not for me, they’re for my son. I can’t even get an erection

florida80

05-28-2019, 17:41

Script Stupidity

Pharmacy | | Right | May 28, 2009

Customer: *holds up two bottles* “What’s the difference between these two medicines?”

Me: “The one on the left is a capsule; the one on the right is a tablet.”

Customer: “I mean, which one would be better?”

Me: “They’re exactly the same medicine, just in different forms. Most people buy whichever one is easier for them to swallow.”

Customer: “That’s just stupid! How can you swallow a bottle?”

florida80

05-28-2019, 17:42

Where There’s A Pill, There’s A Way

Pharmacy | | Right | May 21, 2009

(A customer comes in with a prescription for a narcotic pain reliever. He says that he was at the hospital with his wife and the hospital stole his pills, which is why he needs to get this prescription filled, even though his last prescription was just filled a few days ago.)

Me: “OK, sir, I talked to your doctor and he says I can fill your prescription.”

Customer: “Great, can I wait? I have no pills left and I really need it.”

Me: “It’ll be about 10 minutes.”

(10 minutes later.)

Me: “OK sir, your prescription is ready.”

Customer: “Hey, are those pills the same as this?” *holds up pill*

Me: “I thought you didn’t have any pills left, sir.”

Customer: “Well…I bought this off the street, to be honest with you.”

Me: “Oh…good.”

florida80

05-28-2019, 17:43

Super Absorbent For Those Mentally Heavy Days

Pharmacy | | Right | April 23, 2009

(An elderly man calls up to the store.)

Me: “Thank you for calling ****, this is ****, how can I help you?”

Customer: “Yes, my granddaughter came to visit me, and she bought me a birthday gift. It’s on the kitchen table, but I’m not sure what it is.”

Me: “OK, well, what can you tell me about the product?”

Customer: “Well, the box says ‘K-O-T-E-X’ – can you tell me what that is, honey? What it’s used for? I just can’t figure it out.”

Me: Well, sir…that’s a feminine hygiene product.”

Customer: “Feminine hygiene? What’s the product for? I just can’t figure it out.”

Me: “Sir…it’s for women on their period.”

Customer: “Why would my granddaughter buy me Kotex?”

Me: “I don’t know sir, maybe you should ask her that.”

Customer: “So can I still use them to stir my Kool-Aid with? Because that’s what I’ve been using them for.”

florida80

05-28-2019, 17:43

Yeah, Definitely Contraindicated

Pharmacy | | Right | April 21, 2009

(A patient walks up to the pick up window looking like he just came from the emergency room.)

Me: “Hello, sir, how can I help you?”

Customer: “I wanna drop this off…” *hands me an ER prescription*

Me: “Sir, this is the pick up window. You need to drop off the prescription at the drop off window.”

Customer: “Where’s that?”

Me: “The counter at the entrance to the room with the big sign that says “Drop Off Window’.”

Customer: “Where?”

Me: “You know, you already waited in line so I’ll just take the prescription here. Have you ever had any medication here before?”

Customer: “I don’t know, have I?”

Me: “I’ll take that as a no. Do you have any allergies to medication?”

Customer: “Well, when I mix heroin and battery acid, I get a rash.”

Me: “… I’ll make a note on that.”

florida80

05-28-2019, 17:44

Bilingual Secret Shame

Pharmacy | | Right | April 20, 2009

Customer: “Excuse me, what are diaper couches?”

Me: “I’m sorry?”

Customer: “Diaper couches.”

Me: “Ma’am, I’m not sure what you mean.”

Customer: *points to the boxes of diapers* “That box! It says ‘diaper couches’.”

Me: *suddenly understanding* “Ma’am, that box says diapers, and then it says ‘couches’. That’s the French word for diapers.”

Customer: *looks around, then whispers* “Don’t tell anyone!” *leaves*

florida80

05-28-2019, 17:45

Rip Van Winkle To The Extreme

Pharmacy | | Right | April 2, 2009

Customer: “Hi, I have a rather simple question to ask you.”

Me: “Sure thing. What can I help you with?”

Customer: “Hypothetically speaking, if I wanted to make someone sleep for a really long time, what would I use?”

Me: “Um, just how long are you talking?”

Customer: “Well, I was thinking somewhere around forever.”

Me: “…”

florida80

05-28-2019, 17:46

MacGyver Becomes a Dad

Pharmacy | | Right | March 26, 2009

(A man was picking up a prescription for his infant child.)

Customer: “How much did you say the prescription was?”

Me: “$49.99.”

Customer: “What’s the difference between this and what I can get over the counter?”

Me: “There’s no cough medicine you can give your 8 month old, sir, other than this.”

Customer: “Well, what’s in it?”

(He picks up the prescription papers and starts rustling through them.)

Customer: “If I can buy everything that’s in it over the counter, I’ll just make it myself.”

Me: “…excuse me?”

florida80

05-28-2019, 17:46

Perhaps Multiple Choice Might Be Easier

Pharmacy | | Right | February 20, 2009

Customer: “I’m after some cold and flu medication.”

Me: “Sure, do you take any other medication?”

Customer: “Um… no… I don’t thi-… wait, yes, but it’s… actually no, no, I don’t.”

Me: “Okay then, and are you allergic to anything?”

Customer: “God, this is too hard!” *storms out*

florida80

05-28-2019, 17:47

Surely, One Missed Anatomy Class Can’t Hurt…

Pharmacy | | Right | February 19, 2009

(A woman walks in with her daughter one afternoon.)

Me: “Hello, how can I help you?”

Customer: “There’s something wrong with my daughter.”

Me: “Oh?”

Customer: “Her eyes keep closing on their own!”

Me: “…ma’am, that’s called blinking.”

florida80

05-28-2019, 17:48

Insert Butt Crack Here

Great Stuff, Health & Body, Pharmacy | | Right | October 31, 2008

Customer: “Hi, I’m having a problem with my suppositories. They’re not working at all!”

Me: “Okay, let me get the pharmacist for you so he can help you.”

(The customer decides to just yell the same question over two counters to the pharmacist in front of at least 10 other people.)

Pharmacist: “Ma’am, would you like to come over to our consultation are so we can talk about this privately?”

Customer: “No, I just want to know why my suppositories aren’t working!”

Pharmacist: “Well, okay. Are they melting before you insert them?”

Customer: “No, nothing like that!”

Pharmacist: “Are they breaking up into pieces before you use them?”

Customer: “No, no, nothing like that! They’re all in one piece and the same shape and all that stuff! I know how to follow the d*** directions!”

Pharmacist: “Are parts of the foil wrapper sticking to it at all?”

Customer: “What wrapper?!”

(Note: the suppository wrappers are aluminum foil with sharp edges

florida80

05-28-2019, 17:49

After This, She’s Gonna Need An Antidepressant

Pharmacy | | Right | October 26, 2008

Customer: “Hi, can I have some of those allergy medications that are behind the counter? The 24 hour kind.”

Me: “Sure thing…”

(I grab one, because law mandates that the computers only allow me to check out one 24 hour medication for a certain period of time).

Customer: “Oh, I wanted four. Can I have four, please?”

Me: “Sorry, I can only give you one. There’s a law that makes me check your ID on the computer. It won’t let me check out more than one for you, at least not in the 24 hour dose.”

Customer: “Well, can you at least try? If you’d TRY once in a while, you never know what you can do!”

Me: “Alright then…”

(I scan one and sure enough, the second won’t go through.)

Me: “Yup, it won’t let me check out the second one. Your total’s gonna be about 20 bucks.”

Customer: “Okay, now try the third one.”

Me: “What?”

Customer: “If the second one didn’t work, maybe the third one will.”

Me: “Ma’am, all four of these are exactly the same. If the second one didn’t work, what makes you think if I rang up another box of the exact same thing would work?”

Customer: “JUST DO IT!”

Me: “Okay… yeah… it’s not working.”

Customer: “Okay, now try the fourth one.”

(Suffice it to say it doesn’t work; after she buys her one box, she comes back about fifteen minutes later.)

Customer: “HOW DARE YOU SELL ME THIS EXPIRED MEDICATION!”

Me: “Err… what? I can guarantee you it’s not. I checked it before I gave it to you.”

Customer: “Oh yeah? Then what’s this? It says FEB 10!”

Me: “Yes… February… of 2010. Not February 10th.”

Customer: “Uh… well, I’m older than you and I probably make way more than you anyway, so I’m right. I’m 42 and I make $** an hour!”

Me: “I’ll agree with you, you’re much older than I am. I’m only 26. But ma’am, you are talking to a pharmacist. I make twice that. Oh wait… I’m in overtime now… three times that. Actually, in the time it took me to help you, I just made one hour’s worth of your wage. Is there anything else I can do for you today

florida80

05-28-2019, 17:50

Even Managers Have A Stupid Quota

Pharmacy | | Right | October 8, 2008

(A young, angry-looking woman is standing at the pharmacy counter with a small pile of white sticks.)

Me: “How can I help you?”

Customer: “Yeah, these pregnancy tests are all faulty. I want a refund.”

Me: “Okay. So, what happened? Were they broken or missing pieces?”

Customer: “No, they keep saying positive. I’m not pregnant.”

Me: “Um… okay. So, if you’re not pregnant, then why get the tests?”

Customer: “Get your manager!”

Me: *gets manager*

Manager: “What’s the problem?”

(I wander off at this point, called into the vitamins section. When I come back, security is taking the woman out of the store.)

Me: “What the…?”

Manager: “Twit. She just wanted her money back. I hope she has twins that cause a LOT of pain and are ugly. REAL ugly… and poop a lot!”

florida80

05-28-2019, 17:52

Speak For Yourself

Great Stuff, Jerk, Pharmacy, USA | | Right | August 28, 2008

Customer: “Excuse me!”

Me: “How can I help you, sir?”

Customer: “My wife sent me in here to pick up some chestnut brown and I can’t find it.”

Me: “Okay, is that makeup or hair color?”

Customer: “I don’t know; she just said chestnut brown.”

Me: “Do you happen to remember the brand name?”

Customer: “No! She just said chestnut brown. Weren’t you listening?”

Me: “Well, it sounds like hair dye to me. Let’s have a look.”

(We both go to the hair coloring aisle and I start to look through every shade in every brand. The man does not help at all; it takes me ten minutes.)

Me: “Here you go, sir. This is Garnier hair color, chestnut brown.”

Customer: “Are you sure that’s it? I don’t want to go home and have to come back.”

Me: “You could call your wife and ask her.”

Customer: “She’s not at home. Oh, wait, hold on.”

(He pulls a piece of paper from his pocket and begins to read it.)

Customer: “Yep, Garnier chestnut brown. That’s it!”

Me: “Sir, no offense, but you could have saved us a lot of time by reading that note in the first place.”

Customer: “That’s the problem with this country. Nobody wants to work anymore!”

Me: “Yeah, that’s our problem.”

florida80

05-28-2019, 17:53

He Shoots, He Misses

Pharmacy | | Right | August 13, 2008

(I used to work at a drug store. From time to time, the pharmacy portion of the store wouldn’t open because there wasn’t a pharmacist to do so. A customer reads the closed sign…)

Customer: “What’s the meaning of this?!”

Me: “I’m sorry, sir. The pharmacy is closed today because we don’t have a pharmacist.”

Customer: “People are SICK! They need their MEDICATION!”

Me: “I wish there was something I could do, sir, but–”

Customer: “You know what this is? Do you?! Two words! TWO WORDS! UN-ACCEPTABLE!”

florida80

05-28-2019, 17:54

Thirteen Bucks Can Buy A Lot Of Beans

Great Stuff, Health & Body, Money, Pharmacy | | Right | August 4, 2008

Customer: “I hear there’s this stuff you can put on your food that won’t give you gas.”

Me: “Oh, yeah… it’s called Beano. Put a couple of drops on your food and the enzymes in it prevent the food from giving you gas.”

Customer: “So, you have it?”

Me: “Yep. I’ll show you.”

(We walk over to the shelf where Beano is kept. I show him the little 3 or 4 oz. bottle; a little goes a long way with that stuff.)

Me: “This is it.”

Customer: “How much?”

Me: “$12.99.”

Customer: “For THAT little bottle? S***, I’ll just fart!”

florida80

05-28-2019, 17:54

Along The Way, You’ll Meet Some Hopped-Up Munchkins

Extra Stupid, Great Stuff, Pharmacy | | Right | May 23, 2008

(I live in a town where 65% of the people are 65 years old and older. When we were redoing the design of the store, they placed a large white walkway from the front door to the pharmacy.)

Customer: “Hi, I would like to pick up my prescription.”

Me: “I’m sorry, ma’am, but this is the front of the store. Your prescription is in the back of the store, in the pharmacy.”

Customer: “How do I get there?”

Me: “Follow the white brick road.”

florida80

05-28-2019, 17:56

Teenage Boys And Smutty Mags? You Don’t Say!

Crazy Requests, Great Stuff, Parents, Pharmacy, Religion, Rude & Risque | | Right | May 19, 2008

Angry Old Woman: “Excuse me! I am very upset because you sold my young grandson pornography!”

Me: “I’m sorry, ma’am, but we don’t sell pornography.”

Angry Old Woman: “Get me the manager, now!”

Manager: “What seems to be the problem, ma’am?”

Angry Old Woman: “Your pervert cashier sold my grandson pornography!”

Manager: “Are you sure about that? We don’t sell anything like that here.”

Angry Old Woman: “Do you think I’m stupid? I saw it with my own eyes! It had naked women and he told me he bought it here with no problem!”

Manager: “Could you show me on the shelf what it was?”

(She goes over to the magazines, and points at Maxim.)

Angry Old Woman: “It was this one! See? Right here! Where any child could see!”

Manager: “Ma’am, this magazine is not pornography. Granted, the women are scantily clad in a few pictures but they aren’t naked and there is no age restriction on its sale.”

Angry Old Woman: “I know pornography when I see it, and this is very offensive. How could you sell it to young children?”

Manager: “Well, actually our store policy dictates that we won’t sell this to a young child even though it is still legal. How old is your grandson?”

Angry Old Woman: “He’s only sixteen!”

Manager: *rolls eyes* “I don’t want to offend your moral beliefs, Ma’am, but if your sixteen year old grandson wants to look at women in bikinis there is no force on earth that is going to stop it. Seriously.”

Angry Old Woman: “The power of Jesus can stop it! The power of Christ should compel you to remove this magazine from your shelves!”

Manager: “Right… Real quick, ma’am, before I get back to work, can I ask you a question? Does your grandson have Internet access?”

Angry Old Woman: “What does that have to do with anything?”

Manager: “A lot, and I think that the power of Christ should compel you to learn how to look up his browser history. Have a good day.”

florida80

05-28-2019, 17:57

How About Some Ritalin While You’re At It

Pharmacy | | Right | May 7, 2008

(Our insurance transmitter was experiencing problems, so we were unable to transmit to any insurance companies when filling prescriptions. I explained this to one customer, who decided to sit and wait for a while to see if the transmitter would come back up. Meanwhile another customer came in with a prescription.)

New Customer: “Hi, I’d like this filled please.”

Me: *explains transmitter problem*

New Customer: “Oh that’s okay, I don’t have insurance.”

Me: “No problem, we’ll have it ready in just a few minutes.”

Original Customer: “Wait! I was ahead of her! Why isn’t mine ready!?”

Me: “We are still waiting for the insurance transmitter to come back up, sir.”

Original Customer: “Well how did you fill hers!”

New Customer: “I pay cash, I don’t have prescription coverage.”

Original Customer: “Well I pay cash too!”

Me: “You want to just get it at retail price, and not use insurance?”

Original Customer: “Yes! I have cash! I’ll pay for it, just fill it now!”

(Five minutes later…)

Me: “Okay, sir, we’ve got you ready. The total comes to $35.99.”

Original Customer: “WHAT! My co-pay is only $3.00!”

Me: “Sir, you said you wanted to go ahead and pay cash price since the insurance transmitter is still down.”

Original Customer: “I do have cash! See?” *shows wallet with cash in it* “Why is it $35?! You people don’t know anything! I’m taking my business elsewhere!”

Me: *facepalm*

florida80

05-28-2019, 17:58

Back In My Day, Pills Fell Like Mana From The Heavens

Crazy Requests, Great Stuff, Health & Body, Pharmacy | | Right | March 13, 2008

(I was cashiering the closing shift on a Sunday night. The pharmacy closes earlier than the rest of the store on weekends. A customer comes in at 9:30pm.)

Customer: “Oh sh*t! The pharmacy is closed?!”

Me: “Yes, they close at 6pm on weekends. They will open again at 8am tomorrow morning.”

Customer: “But I need a prescription filled.”

Me: “I’m sorry, sir, but the pharmacist will not be here until 8am tomorrow morning.”

Customer: “Can’t you do it?”

Me: “No…”

Customer: “Why not?!”

Me: “I’m not a pharmacist.”

Customer: “Don’t be a smart a**!”

Me: “I’m sorry, sir. Only a pharmacist can fill your prescription.”

Customer: “What is this world coming to?!” *storms out*

florida80

05-29-2019, 19:10

Những Điều Ngại Hỏi Về Chuyện Đi Tiêu - BS Hồ Ngọc Minh
Đi tiêu thường được xem là chuyện tự nhiên, nhưng khi “chuyện ấy” không xảy ra tự nhiên được thì đó là một vấn đề lớn chứ không nhỏ.

Thật vậy, có rất nhiều chi tiết, dấu hiệu về tình trạng sức khỏe được biểu hiện qua chuyện đi tiêu. Một chuyện chúng ta “làm” đều đặn nhưng không ai muốn hỏi khi có chuyện, vì là chuyện riêng tư, và đây không phải là đề tài thú vị cho lắm.

Tình thật mà nói, có rất nhiều điều mà ai cũng muốn biết, muốn hỏi, nhưng lại ngại ngùng không thể nói ra. May mắn thay, có rất nhiều chuyên gia chuyên trị về vấn đề này đã trả lời cho những câu hỏi thường được nêu lên.

Trước hết là do nhai không kỹ, hoặc có vấn đề với răng miệng, như bị thưa răng, sún răng chẳng hạn. Khi chúng ta thấy những mảnh vụn trong phân, phần nhiều là do tiêu hóa không được, nhất là rau cải. Hầu hết những loại rau cải, đậu, củ, thí dụ như bắp ngô, hay nấm, được bao bọc bởi những màng cellulose mà con người không thể tiêu hóa được. Chỉ có những loại động vật như trâu, bò ngựa… mới có thể tiêu thụ được những màng cellulose này.

Thức ăn không tiêu còn tồn tại trong phân không phải là điều đáng lo ngại, chỉ trừ trường hợp có kèm theo triệu chứng bất thường. Trung bình, thức ăn tốn khoảng 8 tiếng để đi qua bao tử và xuống ruột non, sau đó, khoảng 24 đến 36 tiếng để ra ngoài. Có người có thể đi vài ba lần trong một ngày vẫn là bình thường. Trong trường hợp có triệu chứng như phân nổi lều bều, có nhiều dầu mỡ, hay đau bụng từng cơn khi đi, là do cơ thể có vấn đề hấp thụ chất bổ, hay bị dị ứng với thức ăn. Nếu hiện tượng xảy ra thường xuyên thì nên tham khảo bác sĩ.

2. Thế nào là mùi bình thường?

Phân thường thường có mùi riêng biệt, “của người nào người ấy… thơm”. Thật ra mùi có thể từ nhẹ đến… nặng tùy theo mỗi cá nhân, trừ trường hợp mùi ấy thay đổi đột ngột, và thật nặng đến độ mọi người phải di tản hay phải kêu xe chữa lửa cứu cấp, thì đó là do ăn không tiêu.

Một khi thức ăn không tiêu sẽ bị sình thối bên trong ruột. Một số bệnh khó tiêu thức ăn gồm có: Celiac disease, bệnh ký sinh trùng sán lãi, viêm sưng tuyến pancreas, không tiêu được sữa tươi, hay dị ứng với thức ăn.

Một số thuốc men có thể làm cho mùi của phân thay đổi. Phần nhiều là do chất sorbitol, được trộn trong vỏ bọc của viên thuốc. Sorbitol là một loại đa đường mà cơ thể không tiêu hóa được. Nếu mới uống thuốc mà phân bị thay đổi mùi, nên tham khảo với bác sĩ.

3. Đi tiêu ra máu có bình thường hay không?

Bác Sĩ Minh đã đề cập về vấn đề nầy trong một số bài viết trước đây. Câu trả lời ngắn gọn, tuyệt đối là không. Cho dù đa số mọi trường hợp đi tiêu ra máu là do bệnh trĩ, nhưng hiện nay càng nhiều người trẻ tuổi bị ung thư ruột già, do đó thấy máu trong phân là điều cần quan tâm và đi khám bác sĩ ngay.

4. Ngồi ở tư thế nào là tốt?

Một điều ngạc nhiên nhưng suy nghĩ cho cùng lại rất là logic, đó là, tư thế ngồi xổm là tốt nhất.
Ngày xưa, bàn cầu thiết kế theo tư thế ngồi xổm, ngày nay được cho là lạc hậu, nhưng đúng ra, ngồi trong tư thế này ruột già được kéo giãn thẳng ra, và các bắp thịt bàn tọa được kết hợp rất nhịp nhàng để tống phân ra ngoài hoàn toàn, không bị sót. Nói cho đúng, ông bà tổ tiên loài người đã ngồi trong tư thế này cả triệu năm, cũng có cái lý của nó. Vấn đề có quay trở lại kiểu ngồi xổm hay không, thì tùy theo định nghĩa của mỗi cá nhân, thế nào là thoải mái?

5. Có cần phải đi ngoài mỗi ngày hay không?

Không cần thiết cho lắm. Mỗi cá nhân có một “nhịp điệu” khác nhau. Có khi vài lần trong một ngày hay vài lần trong một tuần vẫn kể là bình thường, miễn sao đó là nhịp điệu đều đặn ít khi thay đổi. Táo bón chỉ xảy ra khi nhịp độ đi ngoài ít hơn bình thường. Hầu hết đều đi mỗi ngày một lần, và dễ nhớ, dễ theo dõi tình trạng sức khoẻ và là một thói quen có thể tập được.

6. Có nên đọc iphone, ipad khi ngồi trên “ngai” hay không?

Tôi đọc được đâu đó, giây phút thần tiên nhất là khi được “ngồi lên ngai” không khác gì “ngài lên ngôi”! Trong thời đại Internet, để kéo dài giây phút thần tiên ấy, rất nhiều người mang theo điện thoại cầm tay khi đi làm “công chuyện,” để có thể lướt mạng, đọc mạng xã hội, hay chơi game… Có người cho rằng mang theo iphone khi ngồi suy gẫm chuyện thời sự trên “ngai vàng” sẽ làm cho tâm tư thoải mái và dễ… đi hơn. Nhưng nghiên cứu cho thấy không đúng như vậy. Sử dụng điện thoại khi đi ngoài sẽ kéo dài thời gian hơn, lâu dần trở thành thói quen, dễ tăng thêm cơn ghiền. Hơn thế nữa, do ngồi lâu trên bàn cầu, máu dồn xuống hậu môn, dễ tăng nguy cơ bị bệnh trĩ.

Lần tới khi đi ngoài thì nên bỏ vài phút để nhìn xuống dưới để thấy rằng mình rất diễm phúc, vì sức khoẻ hãy còn tốt.

BS Hồ Ngọc Minh
www.nguoi-viet.com

florida80

05-29-2019, 19:12

Phương Pháp Giảm Mỡ Bụng Bất Ngờ Của Một Bác Sĩ Nhật Bản, Hóa Ra Bạn Không Cần Phải Nhịn Ăn…

Đa số nhiều người vì muốn giảm cân mà chọn cách nhịn ăn khổ sở, thậm chí bỏ một số tiền lớn đến phòng tập, chỉ vì muốn đạt được một thân hình thon gọn như hình tượng mình mong muốn.

Thế nhưng hiện nay đã có một phương pháp giảm béo vô cùng hiệu quả mà không phải khổ sở. Gần đây, bác sĩ nổi tiếng người Nhật là Masashi Kawamura đã giới thiệu “phương pháp 3 ngày đi bộ bụng nhỏ gọn”, chỉ rõ rằng chỉ cần đi bộ đúng cách thì có thể dễ dàng giảm béo! Chúng ta cùng nhau nghiên cứu xem sao nhé!

Thế nào là “phương pháp 3 ngày đi bộ bụng nhỏ gọn” thực ra rất dễ thực hiện, bạn chỉ cần khi đi bộ thì “hóp bụng”, “phình bụng”, phối hợp nhịp nhàng với nhịp thở “hít vào, thở ra” là được rồi!

Khi bước chân phải lên, bạn đếm thầm là 1, sẽ hóp bụng vào; tiếp theo bước chân trái lên, đếm thầm là 2, thả lỏng, để bụng phình ra.

Chắc cũng sẽ có nhiều bạn hoài nghi phương pháp này liệu có hiệu quả không? Tuy nhiên bác sỹ Masashi Kawamura cũng đã tự mình kiểm chứng điều đó, không những gầy đi 10kg trong vòng 3 tháng, mà vòng eo còn giảm khoảng 17cm, hơn thế nữa trong vòng 3 năm sau không hề tăng cân trở lại.

Ngoài ra, khi đi bộ bạn nhớ phải ưỡn ngực! Nếu bạn gù lưng xuống thì khi hóp bụng và phình bụng sẽ phản tác dụng, không chỉ giảm đi lượng calo cần tiêu hao mà còn tạo gánh nặng cho phần eo lưng.

Phần bụng của chúng ta thường bị tích tụ một lớp mỡ dày bao quanh là do ta chưa biết cách sử dụng và vận động phần cơ bụng đúng cách, do vậy chỉ cần sau khi học được cách vừa đi bộ vừa hóp bụng, phình bụng, rồi luyện thành thói quen thường xuyên, thì không những bạn sẽ cảm thấy vòng eo nhỏ đi mà ngay cả dáng đi cũng trở nên đẹp hơn. Thêm nữa, cách đi bộ kết hợp hít thở này rất tốt cho phần ruột do đó sẽ chữa được bệnh táo bón.

Theo Meirihaowen
Quỳnh Chi
Nguồn: dkn.tv

at 1:56 PM

florida80

05-29-2019, 19:17

Già Ơi, Chào Mi! - Nguyễn văn Sở

https://i.imgur.com/BlrCpJJ.gif

Anh em chúng ta người trước kẻ sau ai rồi cũng già. Làm sao tránh được! Đã có "sinh" là có "lão". Một giai đoạn tất yếu của cuộc sống. Nếu ngày đầu tiên mình sinh ra mà đã biết nghe, biết nói, nếu có ai bảo rằng mỗi ngày mình lớn lên là một ngày mình sẽ già đi, và tiến dần về cõi chết, chắc chắn là mình đã không tin. Tại sao lại bi quan vậy? Nói chi chuyện giả tưởng nghe như lối đặt câu với mệnh đề giả định trong một lớp học ngoại ngữ, ngay trong những giai đoạn trưởng thành từ thuở niên thiếu cho đến khi lăn lóc vào đời, có mấy ai ngừng lại vì những bận tâm liên quan đến lão suy hay lão hoá, trừ những thiền sư hay những chú tiểu trong chùa. Giòng sống cứ thế mà cuốn trôi đi, mỗi kiếp nhân sinh như một chiếc lá giữa giòng, trôi từ đầu nguồn ra sông, ra biển. Đâu có như con cá hồi (salmon) sau năm năm ở biển lại quay ngược trở về nguồn để sinh, để chết!

Trong lớp sinh lý học phổ thông, học sinh trung học đã được biết về tiến trình già-chết của các tế bào trên thân thể con người. Từng giây, từng phút. Nhưng biết để mà biết. Đó chỉ là chuyện tăng trưởng và đào thải trong thân thể con người! Hay trong lớp siêu hình học nhập môn, khi nêu lên những vấn nạn về cuộc sống như "Ta là ai?" , "Ta từ đâu tới?" hay "Ta sẽ đi về đâu?", thì cũng chỉ là để đáp ứng một nhu cầu giới hạn nhất định trong phạm vi lớp học. Rời khỏi trường rồi, còn mấy ai nhớ những buổi hăng say thảo luận về các vấn đề triết lý trừu tượng ngày xưa? Còn bao nhiêu chuyện quan trọng, bức bách hơn. Chuyện bây giờ lo đã muốn bức hơi, đa mang chi chuyện của ngày mai, chưa tới.

Nhưng cái già nó vẫn tới và tới với mình chầm chậm, từ từ. Nhiều khi nó đến rồi mà mình vẫn chưa hay. Sở dĩ như vậy là vì hình như ai cũng phải qua một giai đoạn tự phủ nhận (self-denial) trước khi chịu nhận là mình bắt đầu già. Giai đoạn này dài ngắn còn tùy ở cá tánh và hoàn cảnh của mỗi người. Thật sự ra phải nói là cũng có người tuy tuổi đời còn thấp, nhưng trong cách suy nghĩ hay ứng xử xem ra thì đã có những phản ánh tiêu biểu của người già như phản ứng chậm chạp, nói năng lẩm cẩm, xoay trở vụng về, để đâu quên đó, còn đi lại thì như là người chỉ còn nửa bầu sinh khí. Lại cũng có người tuy tuổi tác đã cao nhưng lúc nào cũng mau mắn, nhanh nhẹn, nói năng mạch lạc, lớp lang, đầu óc minh mẫn, sáng suốt, ưa thích những sinh hoạt ngoài trời như tắm biển, chơi thể thao, sẵn sàng tham gia các buổi họp mặt với bạn bè, không quá ngần ngại, đắn đo trước những chuyến đi xa, bao giờ cũng sốt sắng, vui vẻ, lạc quan, biết sống trọn vẹn với cái bây giờ thay vì bận bịu, lo toan về cái tương lai, chưa tới.

Trong phạm vi bài này tôi không muốn kể lại đây những nhận định của các nhà chuyên môn về tuổi già và người già khi họ giải thích "thế nào là già" hoặc "tại sao ta già". Tôi chỉ muốn chia xẻ một số ghi nhận của chính bản thân mình, một người cũng đã quá cái ngưỡng 60, về những biến đổi tâm sinh lý trong con người mình cũng như về những khó khăn khi đối phó với những dấu hiệu biến đổi đó trước khi chấp nhận "chung sống hòa bình" với nó. Do đó mà có cái tựa đề như trên là "Già Ơi, Chào Mi!"

Tục ngữ Anh có câu "A man is as old as he feels, and a woman as old as she looks", nghĩa là cái già của đàn ông tùy thuộc vào cảm nghĩ của chính anh ta. Nếu anh ta vẫn cảm thấy mình trẻ trung, khỏe mạnh, thì tuổi tác có quan hệ gì đâu. Cũng như đối với người đàn bà, nếu dung nhan vẫn tươi tắn, mặn mà thì già trẻ cũng thế thôi, nhắc đến làm chi. Tựu trung già hay không là tùy ở cái đầu của mình. Bởi thế tôi rất tâm đắc với câu trích dẫn (không có ghi rõ tác giả) sau đây trong tập sách "Già ơi! Chào bạn!" của BS Đỗ Hồng Ngọc mà Anh Hà Quí Phú, một bạn đồng nghiệp cũ cùng tuổi ở Đà Nẳng, vừa gởi cho: "Age is mostly a matter of the mind! If you don't mind, it doesn't matter" (Tuổi tác là chuyện cái tâm, nếu ta không thèm quan tâm, chả có vấn đề tuổi tác!)

Nếu mình ngồi lại với nhau và hỏi nhau "Bạn thấy mình già từ lúc nào?" thì chắc chắn là mỗi người sẽ trả lời một cách, không ai giống ai. Nói như một người bạn của tôi, anh Tôn Thất Khoát : "Nếu ra bãi biển Santa Monica hay Malibu mà tình cờ được xem một màn quay "Baywatch" với những nữ tài tử trẻ trung, hấp dẫn trong show này diễn xuất bằng xương bằng thịt ngay trước mắt mình, nhởn nhơ, khêu gợi, mà trong lòng vẫn thấy dửng dưng, nguội lạnh thì phải nhận là mình đã già." Tếu, nhưng không phải là hoàn toàn sai. Khi chất testosterone trong cơ thể mình đã càng ngày càng khô cạn thì phản ứng như vậy đâu có gì là khó hiểu!Thật sự ra đối với các nhà khoa học thì dấu hiệu sinh lý của tuổi già đã được nghiên cứu từ lâu. Đại loại, nếu bỏ qua các giai đoạn chuyển tiếp từ tuổi 20 đến tuổi 60 mà chỉ so sánh một người đã quá 60 với thời anh mới 20 tuổi, thì theo Curtis Pesman, tác giả cuốn "How a Man Ages," ta có thể ghi nhận những thay đổi như sau:

Da mỏng hơn và chùng xuống, độ co giản của da càng ngày càng giảm sút, và qua nhiều năm tháng biểu lộ vui, buồn, sướng, khổ, những nét nhăn trên mặt đã hằn sâu và lớn. Tóc bạc, thưa, và nhẹ hơn, đường kính của tóc chỉ còn 86 microns (1 phần triệu của 1m) so với 101 microns hồi 20 tuổi.

Hai tròng mắt bị co lại, mức độ ánh sáng vào đến võng mạc giảm đi, khó phân biệt được sự vật trong tối, do đó mà khi đọc cần phải có ánh sáng đủ.

Tai không còn nghe được tiếng động trên tầm 10,000 hertz, như tiếng hót của chim, vì chức năng chuyển thể độ rung từ tai ngoài vào tai trong đã suy thoái.

Men răng càng ngày càng mòn dần vì quá trình nhai, nghiến, trong khi đó lợi răng co rút lại, làm lộ rõ khoảng trống giữa các chân răng.

Xương mất dần calcium, trở nên xốp, dòn, dễ gãy, lớp sụn ở các đầu khớp không còn nguyên vẹn, chất nhờn giữa các khớp khô đi, sinh ra di chuyển chậm, khó khăn.

Tim không còn bơm đủ máu ra khắp châu thân, một phần do cholesterol đóng dày trên thành động mạch làm tim phải hoạt động nhiều hơn mới bơm được máu đi.

Các cơ bắp làm cho phổi hoạt động bình thường suy yếu dần, độ co giản của lồng ngực yếu đi, làm cho lượng dưỡng khí hít vào chỉ còn bằng một nửa thời 20 tuổi.

Trọng lượng của thận giảm từ 20% đến 30%, sức lọc chất thải của thận chỉ bằng nửa hồi trẻ, và sức chứa của bọng đái cũng chỉ còn chừng một nửa (8 fluid ounces, khoảng non 230cl).

Với năm tháng qua đi, khối não cũng rút nhỏ lại và giảm trọng lượng, hàng tỷ tế bào não bị mất đi, trí nhớ bị giảm sút.

Những thay đổi trên thì ít nhiều ai cũng nhìn thấy, nhất là nơi người khác. Với tôi, đèn đỏ đầu tiên báo động tiến trình lão suy đã bắt đầu là cách đây 7 năm, lúc tôi phải vào Bệnh viện Hoag ở Newport Beach để mổ tim và thay van (mitral valve). Trước khi vào phòng mổ tôi cũng đã cố tìm đủ mọi lý do để tự thuyết phục cho quyết định của mình, mà lý do nặng ký nhất vẫn là "wear and tear." Có tốt đến đâu mà dùng lâu ngày cũng phải mòn, phải rách. Cũng như chạy xe thì đến lúc cũng phải thay 4 vỏ xe. Cũng như cái máy giặt trong nhà, cái lò trong bếp, hay cái bóng đèn trên trần. Sử dụng cẩn thận đến đâu đi nữa thì đến lúc hỏng cũng phải thay. Nhưng thay van là để được sinh hoạt bình thường trở lại, đâu có nghĩ là cơ thể mình đã bắt đầu già!

Rồi 3 năm sau khi mổ, theo khuyến cáo của những người có thẩm quyền, tôi lại phải ngưng chơi tennis, một thú tiêu khiển cuối tuần mà bao nhiêu năm ròng tôi thích thú đeo đuổi với tất cả hăng say, nhiệt tình. Lý do là chứng đau nhức phần lưng dưới (lower back) cứ dai dẳng, không dứt. Bản án thứ hai: Sau khi xem hình quang tuyến chụp phần lưng dưới, bác sĩ phán là tuy chưa trầm trọng nhưng đã có dấu hiệu suy thoái giữa các khớp xương L2-L3, L3-L4, và L4-L5 là các khớp xương ở phần lưng dưới, nghĩa là chất nhờn đã khô đi, lớp sụn bao quanh các khớp đã mòn (Multilevel Degenerative Disease), khoảng cách giữa các đốt xương sống ở vùng này đã rút ngắn lại, và các ngạnh của khớp xương đã bắt đầu nhô ra (Multilevel Spondylosis). Tóm lại đây là dấu hiệu của bệnh lão suy. Nhưng nói là "bệnh" thì nghe ghê quá! Làm sao tuổi mình mà gọi là già!

Tuy nhiên với bản án khắc nghiệt đó tôi bắt đầu âm thầm tìm cách cưỡng chống lại, ít nữa là cũng để "trì hoãn chiến". Theo các bác sĩ tây y thì không có thuốc chữa. Có loại thuốc với hỗn hợp của hai chất glucosamine và chondroitin được quảng cáo ầm ĩ là có thể làm giảm đau ở các khớp thì Cơ quan Quản trị Thực và Dược Phẩm (U.S. Food & Drug Administration) lại chưa chuẩn nhận là có giá trị lâm sàng. Đồng thời nó cũng có thể có phản ứng nghịch đối với các loại thuốc làm loãng máu. Chất nhờn giúp các khớp chuyển động dễ dàng, tự nhiên, là của "trời cho", đến một tuổi nào đó sẽ khô dần đi, không có thần dược nào có thể tái tạo nó lại được. Nhưng các bác sĩ đông y lại quả quyết là được. Đau ở lưng là do gan nóng, hoặc thận suy. Nếu kiên nhẫn uống theo toa của các vị này đảm bảo sẽ lành. Thế là lại âm thầm đi bổ thuốc, nghe thầy nào hay xa đâu cũng tìm đến, thuốc sắc (ba, bốn chén còn một), thuốc tể, thuốc ngâm rượu. Thử hết, xem có kết quả gì không. Nhưng cái đau âm ĩ vẫn còn.

Cái khó đối với tôi còn ngặt nghèo hơn so với những anh em khác cùng bịnh trạng là tuy đau nhưng không thể dùng các loại thuốc giảm đau hiện có vì sợ phản ứng nghịch với loại thuốc làm loãng máu (Coumadin) mà tôi vẫn phải uống hằng ngày sau khi thay van nhân tạo bằng kim loại.

Song song với những cố gắng chữa trị bằng thuốc, tôi còn tìm cách thăm dò, luyện tập theo nhiều phương pháp khác nhau, mỗi cách đều có một mức độ công hiệu nhất định, do bằng hữu hoặc các anh chị sinh viên đã từng có thời học ngoại ngữ với tôi biết tôi đau nên đề nghị luyện tập thử. Cũng xin kể ra đây những môn tôi đã có tập qua để có anh em nào đồng bệnh cùng trao đổi kinh nghiệm cho vui:

Yoga (Hatha Yoga và Pitales Yoga) tại các trung tâm 24-Hour Fitness.

Khí công Thiếu Lâm Tự, theo cách hướng dẫn của tác giả Wong Kiew Kit trong cuốn Chi Kung for Health and Vitality.

Phương pháp thở sâu, chậm, nhẹ, và đều trong cuốn Wujishi Breathing Exercise của tác giả Men Den.

Phương pháp Đạt Ma Dịch Cân Kinh.

Phương pháp Thiền Vô Cực do Thầy Tôn Thất Hanh, nguyên giáo sư Quốc Học, Huế, giới thiệu.

Phương pháp Hồi Xuân gồm năm thế tập của các tu sĩ Tây Tạng do Peter Kelder thuật lại trong cuốn Ancient Secret of the Fountain of Youth.

Tôi đã tập qua các phương pháp được giới thiệu cũng như một số phương pháp khác do các bạn thân quen vốn là võ sư chỉ giáo mà tôi không tiện kể hết ra đây, mỗi môn tôi tập một thời gian để tìm xem phương pháp nào phù hợp cũng như thuận tiện và công hiệu với mình nhất. Mấy năm gần nay tôi cố gắng đều đặn tọa thiền mỗi buổi sáng (theo Sổ tức quán) và tập Thái Cực Quyền là chính. Và đã thấy có phần nào giảm đau, không gay gắt như những năm trước đây.

Điều đáng nói không phải là chuyện phải kiên trì tập luyện, vì đây là nhu cầu sinh tử, mà chính là mình phải trực diện với thực trạng của thân thể mình, coi lão hóa là một phần của tiến trình tất yếu, tự nhiên, không có gì phải quá lo âu, sợ hãi. Và như đã nói ở trên, biết nó làm khổ mình, nhưng vẫn phải làm lành với nó, chung sống hòa bình với nó, thực tế khắc chế nó được đến đâu hay đến đó, không nôn nóng, hối hả, không trông chờ phép lạ mà mình biết ở tuổi này khó còn có thể xảy ra.

Gần đây tôi lại tình cờ đọc được bài "Tính Tuổi Theo Lối Mới" (Calculate Your Age in Neo-Years) trên trang nhà của Giáo sư Tiến sĩ Davis Demko có liên quan đến cách suy nghĩ về tuổi già. Theo ông, 75% tiến trình lão hóa của con người có thể điều chế được do tác động của sáu yếu tố sau đây:

Khắc chế yếu tố di truyền. Dĩ nhiên yếu tố di truyền tạo cho mỗi con người một tình trạng có thể bị mắc những bệnh mà cha mẹ người đó đã từng bị, nhưng những phương pháp phòng ngừa và bảo vệ sức khỏe hiện đại, nếu áp dụng đúng mức, có thể làm giảm đi rất nhiều tính đe dọa của yếu tố này.

Tập thể dục, thể thao. Rất nhiều các chứng đau nhức phát sinh do thiếu hoạt động. Nếu luyện tập thường xuyên thì hệ thống tim mạch sẽ được bảo toàn, xương và bắp thịt sẽ rắn chắc, khỏe, và sự phối hợp chân tay sẽ nhịp nhàng, hữu hiệu.

Tinh thần luôn được kích thích. Những người tưổi cao mà vẫn có những sinh hoạt tinh thần đều đặn và đầu óc luôn luôn được kích thích, suy nghĩ, tìm tòi như đọc sách, học ngoại ngữ, chơi ô chữ, hay tham gia vào các cuộc thảo luận hứng thú sẽ giữ được tinh thần minh mẫn, tỉnh táo lâu dài.

Có tập quán dinh dưỡng tốt. Cách tốt nhất để chống lại già trước tuổi hay bệnh tật. Thức ăn là năng lượng. Phải tìm hiểu những phương cách dinh dưỡng lành mạnh, cũng như những sinh tố hay khoáng chất mà cơ thể mình cần.

Sống có ý nghĩa. Sống phải có những mục đích đáng đeo đuổi. Ý thức rõ mục đích công việc mình đang làm dễ gây cho mình cảm hứng, giúp mình tập trung, chú ý, tránh được buồn nản, bẳn gắt, và kết quả tích cực sẽ nâng cao giá trị của chính mình.

Biết phòng ngừa bệnh tật. Đây là yếu tố quan trọng có giá trị điều chế tiến trình lão hóa.

Cần khám tổng quát thường xuyên để kịp ngăn chận các bệnh hiểm nghèo. Đừng bao giờ nghĩ là các chứng đau nhức hành hạ mình chỉ là hậu quả của tuổi già.

Sau khi phân tích các yếu tố nói trên, Giáo sư Demko đề nghị một lối tính tuổi mới mà ông cho là chính xác hơn. Ông đặt tên cho công thức tính tuổi của ông là: DNA-Plus. DNA là viết tắt của Demko's Neo Age, Plus ngụ ý là già với những đặc tính tích cực. Công thức DNA-Plus tính trung bình của 4 lọai tuổi:

Tuổi thời gian, tính theo số năm đã sống.

Tuổi thể chất, tính theo tình trạng sức khỏe.

Tuổi xã hội, tính theo mức độ sinh hoạt hằng ngày trong việc làm, đời sống gia đình, giải trí, hay các công tác thiện nguyện.

Tuổi tâm lý, tính theo khả năng đối phó với khủng hoảng, mâu thuẫn, sự căng thẳng trong đời sống, hay thích ứng với mọi sự thay đổi bất ngờ.

Nếu áp dụng công thức này cho một người đã sống đến 80 năm (tuổi thời gian), có tình trạng sức khỏe của một người sống 70 năm (tuổi thể chất), có mức độ hoạt động của một người sống 60 năm (tuổi xã hội), và có khả năng ứng phó của một người mới sống 50 năm (tuổi tâm lý), thì tuổi trung bình của người này sẽ là (80+70+60+50) : 4 = 65 tuổi (Neo Years), nghĩa là tuổi chính xác của người này chỉ mới 65 chứ không phải là 80 theo cách suy nghĩ thông thường.

Bởi vậy cho nên, các Anh các Chị ơi, hãy mỉm cười như tôi mỗi buổi sáng khi thức dậy và bắt đầu ngày mới với một nụ cười: Già ơi, Chào Mi!

Vâng, đúng vậy. Tuổi già đã đến với tôi, và tôi đã làm thân với nó. Vì tò mò tôi cũng đã tính tuổi tôi theo công thức DNA-Plus của Giáo sư Demko. Bây giờ đến lượt Anh và Chị. Anh, Chị thử tính xem mình bao nhiêu tuổi?

Nguyễn Văn Sở

florida80

05-29-2019, 19:20

Sổ Mũi, Hắt Hơi, Rát Cổ, Xin Đừng Vội Dùng Kháng Sinh - BS Nguyễn Ý Đức

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Hắt hơi là chuyện thường xảy ra khi bị cảm lạnh. (Hình: stjhs.org)

Thời tiết bắt đầu chuyển động. Cho nên nhiều người đã bắt đầu than phiền khó chịu với sổ mũi, hắt hơi, cảm lạnh. Và cũng không thiếu gì người vội vàng lục lọi tìm kiếm vài chục viên kháng sinh để tiêu trừ bệnh tật. Vì sợ rằng để lâu thì bệnh nặng thêm.

Ðây là hành động đáng khen và cũng cần xét lại. Khen vì đã biết tự lo tự liệu nhưng có điều hơi “nhanh nhẩu đoảng.”

Giới chức y tế khắp nơi vẫn luôn luôn nhắc nhở rằng thủ phạm những cảm lạnh vào cuối Thu đầu Ðông của mỗi năm không phải do vi khuẩn gây ra. Ða số hung thần là những cô những chú siêu vi sinh vật virus bất trị, ngang ngược.

Kháng sinh đều bó tay trước sự hoành hành của các tiểu yêu này. Cho nên dùng kháng sinh chẳng những vô hiệu mà còn gây ra nhiều rủi ro xấu.

Sự khác biệt giữa virus và vi khuẩn

Vi khuẩn (bacteria) là những vi sinh vật đơn bào, sinh sản vô tính bằng cách phân chia nhân đôi tế bào. Vi khuẩn có khắp mọi nơi: trong nước, đất, không khí. Nhiều loại sống ký sinh ở người, súc vật và cây cối. Trong cơ thể, vi khuẩn nhởn nhơ đầy rẫy ngoại trừ máu và nước tủy sống. Không phải tất cả vi khuẩn đều có hại, vì một số giúp cơ thể trong nhiều lãnh vực khác nhau. Kháng sinh có thể khuất phục được hầu hết các bệnh do vi khuẩn gây ra.

Còn virus là những “hạt” rất nhỏ, có khả năng sinh sản nhưng chỉ tồn tại được ở trong tế bào sống. Ra không khí một thời gian ngắn là chúng hai năm mươi tiêu tùng. Kích thước của virus rất nhỏ nên không nhìn thấy qua kính hiển vi quang học.

Nhỏ vậy mà chúng đã và đang gây ra những bệnh quái đản giết hại có khi cả mấy chục triệu sinh linh, người và súc vật. Như là cảm lạnh, cúm, đa số viêm cuống phổi và cuống họng; bệnh sởi, quai bị, thủy đậu, herpes, đậu mùa, tê liệt trẻ em, bệnh dại, viêm gan.

Ðặc biệt trong những thập niên qua, các bệnh liệt kháng HIV-AIDS, cúm gia cầm đang hầm hừ đe dọa nhân loại và các quốc gia đang sát cánh với nhau dốc toàn lực phòng chống. Kháng sinh không có hiệu lực với virus nhưng một số bệnh có thể kiểm soát được bằng chủng ngừa vắc xin.

Làm gì khi sổ mũi, hắt hơi?

Sổ mũi là chuyện thường xảy ra khi bị cảm lạnh, đặc biệt ở trẻ em.
Khi vi sinh vật xâm nhập mũi, mũi phản ứng bằng cách tiết ra chất lỏng trong để loại bỏ các tác nhân này khỏi lỗ mũi và xoang mũi. Sau vài ngày, hệ thống miễn dịch của cơ thể bắt đầu hoạt động, phản công lại các cô chú virus, nước mũi trở thành mầu trắng hoặc vàng.

Kháng sinh không làm bớt ho, bớt chảy nước mũi. (Hình: mutantworkout.org)

Rồi đến khi vi sinh vật tăng sinh trong mũi, chúng sẽ làm nước mũi có màu xanh xám. Ðó là những diễn tiến bình thường. Và khi mũi bị chất tiết kích thích thì ta phải hắt hơi, để gạt bỏ những chất này. Ðôi khi chất tiết xuống cuống họng, ta ngứa cổ; xuống cuống phổi, ta ho sù sụ.

Khi thấy vậy, ta nên kiên nhẫn chờ đợi vài ngày, đừng vội vàng dùng kháng sinh. Lý do là kháng sinh KHÔNG làm bớt ho, bớt chảy nước mũi hoặc đau nhức xương thịt, mà chúng tự hết sau ít hôm.

Có nhiều thuốc trị chảy nước mũi hiệu nghiệm. Chẳng hạn nhiều người chỉ cần nhỏ mấy giọt nước pha muối, hít thở vào máy bốc hơi lại giải quyết được vấn nạn mau chóng. Kháng sinh chỉ nên dùng nếu thầy thuốc nói bị bội nhiễm vi khuẩn như viêm xoang sinusitis, sưng phổi.

Cảm lạnh, cúm có cần đến kháng sinh?

Như đã thưa ở trên, cảm lạnh và cúm là do virus gây ra.

Cảm lạnh (common cold) là bệnh cấp tính do siêu vi thuộc nhóm rhinovirus, tác hại trên mũi, xoang mặt, cuống họng, thanh quản, đôi khi xuống tới cuống phổi. Bệnh này chưa có thuốc chủng ngừa.

Còn cúm do virus Influenza A và B gây ra. Siêu vi này thay đổi cấu trúc mỗi năm do đó sự trầm trọng của bệnh cũng thay đổi. Nhưng cúm có thể ngăn chận lây lan được bằng chủng ngừa trước mùa cúm khoảng một tháng. Ðọc xong bài này, xin mời quý thân hữu đi chích ngừa ngay cho kịp. Vì ở các xứ lạnh, cúm đến vào mùa Ðông, từ Tháng Mười Một trở đi tới Tháng Hai, Tháng Ba. Còn ở xứ nóng thì cúm xảy ra hầu như quanh năm.

Kháng sinh không tiêu diệt được virus. Bị cảm lạnh, cúm mà dùng kháng sinh chẳng những vô ích tốn tiền, không chữa được bệnh, không ngăn ngừa sự lan truyền bệnh sang người khác, không làm mình cảm thấy khỏe hơn. Trái lại còn đưa tới nhiều ảnh hưởng xấu như nhờn thuốc, tốn tiền, phí phạm dược phẩm.

Thường thường cảm lạnh, cúm tự lành sau khi bệnh đã hoàn tất chu kỳ là hai ba tuần lễ. Ðiều trị bao gồm sự hỗ trợ như uống nhiều chất lỏng (nước lã tinh khiết, nước trái cây, nước súp) để tránh khô nước; hít thở trong máy phun hơi hoặc nhỏ mấy giọt nước pha muối vào mũi nhiều lần trong ngày; làm dịu đau cuống họng với ngậm vài viên nước đá cục, súc miệng với dung dịch diệt trùng.

Ho là phản ứng tự nhiên của cơ thể để đẩy nước tiết ra khỏi phổi nên cũng chẳng cần quan tâm. Nhưng nếu ho nhiều đến đau ngực, rát họng, mệt mỏi thì uống mấy thìa thuốc giảm ho. Chỉ khi nào có dấu hiệu bội nhiễm vi khuẩn như sưng phổi mới cần đến kháng sinh. Mà khi bác sĩ cho toa thì uống đủ ngày, đúng liều lượng đã ghi trong toa thuốc, chứ đừng thấy bớt là ngưng, để dành thuốc cho kỳ sau.

Riêng cúm thì bác sĩ có thể cho mấy loại thuốc như Tamiflu, Relenza, Amantadine, Rimantadine …

Rửa tay thường xuyên, tránh tiếp xúc quá gần với người bệnh là những phương thức rất hữu hiệu để ngăn ngừa sự lan truyền bệnh gây ra do virus.

Bác Sĩ Nguyễn Ý Ðức

florida80

05-29-2019, 19:24

Rủi Ro Bị Bắt Lầm Vào Viện Tâm Thần, Làm Thế Nào Để Chứng Minh Bạn Là Người Bình Thường

Tại một bệnh viện tâm thần của nước Ý, do tài xế chuyên chở bệnh nhân lơ là nhiệm vụ mà bắt nhầm ba người bình thường. Ba người đó bị nhốt trong viện ròng rã suốt 28 ngày trời, hai người trong số đó còn suýt chút nữa vì điều này mà biến thành bệnh nhân tâm thần thật sự. Và làm thế nào họ đã thoát ra được?

Grey Back, ký giả của tạp chí Toread của Mỹ đã đến nước Ý để mà tiến hành phỏng vấn ba người bất hạnh vừa mới được cứu thoát này.

Nguyên ban đầu, một tài xế phụ trách vận chuyển những người mắc bệnh tâm thần, trên đường đã để cho ba người bệnh bỏ chạy mất. Để không bị mất việc, ông ta lái xe đến một trạm xe buýt, bảo với mọi người rằng ông lái xe miễn phí. Cuối cùng, ông đã “dụ” được 3 người lên xe, rồi gắn mác “bệnh nhân tâm thần” vào những vị khách này.

Như mọi người chúng ta đều biết, một người bị bệnh tâm thần nếu muốn ra khỏi bệnh viện thì cách duy nhất chính là chứng minh bản thân mình không bị bệnh tâm thần. Ba người họ đã làm được điều đó như thế nào?

Theo báo cáo của Grey Back, hai người trong số họ đã dùng đủ mọi cách để mà chứng minh với nhân viên y tế rằng mình không phải người điên. Tuy nhiên, họ nói càng nhiều nhân viên y tế càng tin chắc rằng họ chính là người điên.

Dưới đây là cuộc phỏng vấn của anh với A

Grey: Khi ông bị nhốt vào trong bệnh viện tâm thần, ông đã nghĩ ra cách gì để mà giải cứu mình vậy?

A: Tôi nghĩ rằng, nếu muốn đi ra, trước hết cần phải chứng minh rằng bản thân mình không có bị bệnh tâm thần.

Grey: Vậy ông đã chứng minh như thế nào?

A: Tôi nói: ‘Trái đất hình cầu’, câu nói này chính là chân lý. Tôi nghĩ, người nói ra chân lý sẽ không bị xem là bệnh tâm thần.

Grey: Cuối cùng ông có thành công không?
A: Không, khi tôi nói câu này đến lần thứ 14, nhân viên y tế đã chích một mũi kim vào mông tôi.

Dưới đây là cuộc phỏng vấn với C

Grey: Ông đã ra khỏi bệnh viện tâm thần như thế nào?

C: Tôi và A được B cứu ra ngoài đấy. Anh ấy đã thành công mà ra khỏi bệnh viện tâm thần, sau đó liền đi báo cảnh sát.

Grey: Lúc đó, chẳng phải ông cũng tìm cách để ra khỏi đó?

C: Đúng vậy, tôi nói với họ rằng tôi là nhà xã hội học. Tôi nói rằng tôi biết tổng thống nhiệm kỳ trước của nước Mỹ là Clinton, thủ tướng nhiệm kỳ trước của nước Anh là Blair. Khi tôi nói đến tên các vị lãnh tụ của các đảo quốc thuộc Nam Thái Bình Dương, họ liền chích cho tôi một mũi. Tôi không còn dám nói tiếp nữa.

Grey: Vậy B đã giải cứu các ông ra ngoài như thế nào?

C: Sau khi anh ấy bị bắt vào trong đó, cái gì cũng không nói. Lúc cần ăn cơm thì ăn cơm, lúc nên ngủ thì đi ngủ, những lúc cần xem sách đọc báo thì xem sách đọc báo. Khi các nhân viên y tế cạo mặt cho anh, anh ấy sẽ nói cảm ơn. Khi đến ngày thứ 28, họ đã để anh xuất viện.

Người B sau khi thoát ra liền đi báo cảnh sát, nhờ vậy mà giải cứu được hai người bạn kia.

Thì ra là đơn giản như vậy, biện pháp tốt nhất lại chính là không cần phải chứng minh gì cả.

Grey Back đã phát biểu cảm khái như vậy trong bài viết của mình: một người bình thường muốn chứng minh sự bình thường của chính bản thân mình, đó là điều vô cùng khó khăn. Có lẽ chỉ có những ai không cố gắng để chứng minh bản thân mình, mới được xem là người bình thường vậy.

Về sau, nhiều người khác đã để lại những lời bình luận liên quan đến bài viết này trên trang mạng.

Có lời bình khá sâu sắc…..

Những người dùng đủ các loại phương thức nào đó để chứng minh rằng bản thân mình đang nắm chắc chân lý trong tay, những ai dùng đủ các phương thức để chứng mình bản thân mình tri thức vô cùng phong phú, bao gồm những người dùng các phương thức để chứng minh rằng bản thân mình rất giàu có, đều có thể bị xem là người điên, chỉ có điều là chính bản thân họ không biết mà thôi. Tỷ như những người trong lòng không chín chắn mới hết lần này đến lần khác muốn chứng minh và biểu hiện với người khác mình trông rất chín chắn, vì họ lo sợ rằng bản thân sẽ bị người khác cho là mình vẫn chưa chín chắn.

Một câu nói khác cũng khá phù hợp trong tình huống này: bạn vốn không cần phải giải thích với người khác về bản thân mình, vì đối với những người yêu mến bạn thì việc đó vốn dĩ không cần thiết, còn đối với những người không yêu mến bạn thì cho dù bạn có nói thế nào thì họ cũng sẽ không tin. Vậy nên tôi cho rằng nếu muốn chứng mình bản thân là người bình thường, thì tốt nhất là không nên làm quá nhiều thứ và nói quá nhiều lời.

Càng là người bình thường thì càng không cần phải chứng mình với người khác rằng bạn là người bình thường, còn với những tay cao thủ thì tất nhiên cũng không cần phải chứng minh với người khác rằng mình đã là cao thủ.

Núi dẫu không nói rõ độ cao của mình, thì độ cao chót vót của nó cũng không hề bị ảnh hưởng; biển không nói rõ độ sâu của mình, thì việc dung nạp trăm sông đổ dồn về nó cũng không bị ảnh hưởng; mặt đất dẫu không nói rõ độ dày của mình, thì cũng không có ai có thể thay thế nó làm chỗ dựa cho vạn vật được……

Tiểu Thiện dịch từ secretchina

at 8:48 PM

florida80

05-29-2019, 19:26

Quyền Được Chết Theo Ý Muốn Của Bệnh Nhân - Trần Bình Nam

Sống và chết, nhất là chết là một vấn đề các tôn giáo đều quan tâm. Mỗi tôn giáo có một giáo điều khác nhau. Phật giáo nói: sinh, lão, bệnh, tử, nghĩa đơn giản là đã có sinh thì có tử. Nếu không chết trẻ vì một lý do nào đó thì nói chung ai cũng sẽ già, bệnh hoạn rồi chết. Công giáo và Tin lành tin rằng Chúa đã cho cái Sống thì chỉ Chúa có quyền quyết định về cái Chết. Hàng chục thế kỷ trước sự chết cứ theo lẽ tự nhiên như thế không ai đặt điều thắc mắc, nếu bệnh kéo dài ngày gây đau đớn cho người bệnh thì con người có quyền can thiệp không bởi lẽ y khoa chưa tiến bộ, có muốn giúp đỡ người sống đau đớn thể xác và tâm thần chấm dứt đời sống cũng không có cách nào thực hiện một cách nhân đạo.

Nhưng khi y khoa tiến bộ, người ta có cách chấm dứt sự sống một cách khoa học và nhân đạo thì một câu hỏi rất tự nhiên được đặt ra. Có nên để cho người bệnh khổ đau thể xác mà trước sau cũng sẽ chết hay giúp cho người bệnh chết một cách thoải mái không?

Cho đến nay chỉ có vài nước Âu châu, như Hà Lan, Bĩ, Thụy Sĩ và 3 tiểu bang Hoa Kỳ (Oregon, Washington, Vermont) có luật cho bệnh nhân được quyền chọn cái chết cho mình bằng sự giúp đỡ của y khoa. Tuy nhiên vấn đề đang là thời thượng và hiện có 20 bang Hoa kỳ (trong đó có bang California) và nhiều nước khác trên thế giới như Canada, Đức, Úc, Tân Tây Lan, Anh đang đặt vấn đề thành luật.

Những người chống luật chọn chết cho rằng luật ấy cướp quyền của thượng đế và nguy hiểm, vì có thể bị lạm dụng bởi người còn sống vì quyền lợi và làm cho con người xuống cấp vì thái độ chạy trốn. Mặt khác luật cho phép chọn chết làm chậm đà tiến bộ y khoa trong lĩnh vực chữa bệnh và nuôi dưỡng người bệnh.

Tuy nhiên thống kê của tieu bang Oregon, có luật chọn chết từ năm 1997 cho thấy đa số người chọn chết đều có trình độ học vấn cao, có bảo hiểm tốt và có phương tiện vật chất hơn người khác để được săn sóc chu đáo nếu họ muốn. Họ chọn chết để khỏi đau đớn thể xác hay tâm thần và tránh “bệ rạc” vào cuối cuộc đời. Cho đến nay trong số 1327 bệnh nhân ở Oregon chọn chết được bác sĩ cho thuốc để tự uống kết liễu đời mình chỉ có 2/3 dùng. Một phần ba còn lại ngần ngại chấp nhận đau thể xác. Thống kê đó chứng tỏ phương pháp chọn chết theo luật “Death with Dignity Act” của Oregon rộng rãi và nhân đạo. Theo luật bác sĩ có quyền viết toa thuốc chấm dứt sự sống nếu có ít nhất hai bác sĩ khám nghiệm và đồng ý bệnh nhân chỉ sống được tối đa 6 tháng. Và quan trọng nhất là bệnh nhân quyết định muốn chết khi tâm thần còn sáng suốt. Và có một thơi gian chờ đợi 15 ngày trước khi thực hiện. Trong thời gian này, các đối tượng liên hệ là bệnh nhân và 2 bác sĩ khám nghiệm có quyền thay đổi ý kiến bất cứ lúc nào.Tuy nhiên luật “Death with Dignity Act” của Oregon có một số hạn chế và được xem là chưa tiến bộ vì không cho người đau thể xác, người có bệnh tâm thần còn có thể sống được dài ngày hay trẻ em vị thành niên quyền chọn chết.

Nói chung khuynh hướng trên thế giới về vấn đề “chọn chết” là thuận lợi. Bảng thăm dò của tờ “The Economist” kết thúc tháng 6 năm nay cho thấy: Trừ Nga và Ba Lan, đa số các nước Tây phương, vài nước Á châu và Hoa Kỳ đều chấp thuận. Và trong 2 phương cách chấm dứt đời sống bằng cách tự dùng thuốc hay để cho bác sĩ chích thì đa số đều nghiêng về giải pháp bác sĩ chích.Cuộc tranh đấu đòi “quyền được chết” tại bang California là một cuộc tranh đấu nhiều màu sắc. Nhiều nỗ lực làm luật cho phép chọn chết trước đây đều thất bại. Năm 2014 cô Brittany Maynard 29 tuổi cư dân California có một sáng kiến. Cô bị ung thư não bộ, cô quyết định dọn lên bang Oregon trước khi bị mù hay tê liệt cơ thể để được chết.

Trước khi chết, cô Maynard ghi vào CD một lời kêu gọi nghị viện California hãy mau chóng thông qua luật được quyền chọn chết. Nghị viện California đáp ứng lời kêu gọi của cô Maynard. Ngày 4 tháng 6 vừa qua Thượng viện tiểu bang thông qua luật “được quyền chọn chết” phỏng theo luật “Death with Dignity Act” của Oregon với 23-14 phiếu, và đang chờ Hạ viện bang biểu quyết và thống đốc Jerry Brown ký ban hành. Có hai trở ngại là thủ tục thành luật phải hoàn tất trước ngày 11 tháng 9 năm nay, nếu không thủ tục lập pháp phải bắt đầu lại từ đầu và cộng đồng Công giáo đang mạnh mẽ vận động hành lang tại Sacramento ngăn cản. Tuy nhiên người ta tin tưởng lời kêu gọi của cô Maynard sẽ có đủ sức mạnh vượt qua các trở lực. Thống đốc Jerry Brown sẽ ký, mặc dù ông là một tín đồ Công giáo và trước khi bước vào chính trường đã có ý định vào nhà thờ đi tu. Trước khi chết, cô Maynard đã điện thoại thuyết phục ông Brown.

Tuy khuynh hướng đòi quyền được chọn cái chết đang lên mạnh trên thế giới, con đường thành luật còn lắm trở ngại. Năm 2012 Nghị viện bang Massachusetts sít sao bác bỏ một dự án luật như vậy, và nghị viện Scotland vừa biểu quyết 82-36 chống.

Về bệnh trí óc như Alzheimer sự chọn chết bằng luật càng khó thông qua hơn vì ngoài sự mất trí nhớ bệnh nhân không có dấu hiệu đau đớn thể xác. Mới đây, năm 2011 nhà văn Terry Pratchett bị bệnh Alzheimer. Trước khi đi Thụy Sĩ để được chết ông để lại một tài liệu đầy xúc động kêu gọi thế giới thông cảm nỗi đau của những người như ông.

Thụy sĩ là nước đầu tiên từ năm 1942 đã có luật cho phép giúp người muốn chết được chết với những điều kiện rộng rãi. Ấn độ và Ireland là hai quốc gia bảo thủ nhất. Cho đến năm 2013 Ấn Độ còn luật bỏ tù người tự vận hụt, và Ireland đến năm 1993 mới bỏ luật này.

Tại Thụy Sĩ có hai lọai cơ sở giúp người muốn chết. EXIT không nhận người nước ngoài, và cơ sở Dignitas nhận. Từ ngày mở cửa (1998) đến nay Dignitas nhận 1700 người đến từ 40 quốc gia trên thế giới. Trong số này có hai trường hợp của hai người Anh đáng ghi nhận. Năm 2007 Dan James bị tai nạn tê liệt toàn thân khi chơi rugby. Năm sau bố mẹ đưa ông đến Dignitas để chết. Trở về, hai ông bà bị đưa ra tòa về tội “giúp người khác chết” nhưng được tòa tha bổng. Và mới đây ông Jefferey Spector, bị hỏng cột sống không chữa trị được đã tự đi đến Dignitas. Trước khi chết, ông nói ông quyết định tự đi trước khi cột sống thoái hóa đến độ không cho phép ông đi để thân nhân khỏi bị rắc rối với pháp luật như thân nhân của Dan James.

Khi nhận một bệnh nhân (đến để chết) cơ sở Dignitas bắt đầu giúp hướng dẫn, cung cấp thuốc men, khuyên lơn và làm những gì cần để thuyết phục bệnh nhân đổi ý và muốn sống trước. Hết phương kế thì mới giúp bệnh nhân chết một cách thoải mái. Tại Thụy Sĩ dưới 1% số người qua đời đã chết bằng sự giúp đỡ của các cơ sở như EXIT hay Dignitas. Số người chết bằng tự vận là 2%.

Luật “Death with Dignity Act” của Oregon có lẽ là luật cân đối nhất, không quá dễ dãi, cũng không quá khắt khe nên đang được các bang khác ở Hoa Kỳ và các nước trên thế giới phỏng theo. Từ năm 1997 khi luật được áp dụng cho tới nay bác sĩ cho thuốc theo luật 1,327 trường hợp, nhưng cuối cùng chỉ 2/3 thực hiện và chết, còn 1/3 do dự không uống.

Khi luật Oregon mới ban hành người ta ngại rằng những thành phần nghèo trong xã hội, không có bảo hiểm tốt, sẽ tìm con đường chết cho khỏe. Nhưng thực tế cho thấy ở Oregon đa số người tìm cách chết theo luật định đều là người khá giả, có bảo hiểm tốt, có trình độ học vấn cao, hoặc đang được các cơ sở y tế có tiêu chuẩn cao lo săn sóc những ngày cuối (hospice). Đa số nói họ chọn cái chết để tránh đau đớn thể xác và trong trường hợp bệnh không hành thì còn để tránh thân thể bệ rạc và khỏi sống một đời sống không còn thú vị gì nữa.

Có một số người tin rằng nếu có cơ sở săn sóc người cuối đời (hospicce care) tốt thì số người muốn chết sẽ giảm đi. Nhưng thống

kê tại Anh từ các trung tâm “hospice care” được xem là đầy đủ phương tiện nhất cho thấy tỉ số người muốn chết cao hơn tỉ số người muốn chết tại các bệnh viện.

Tháng 9 năm nay Quốc hội Anh sẽ thảo luận và biểu quyết luật cho phép chết phỏng theo luật bang Oregon. Luật sẽ cho người sắp chết chọn thời điểm chết nhưng không cho các bệnh nhân bị bệnh nan y hết cách chữa trị nhưng vẫn sống lây lất năm này qua năm khác được chết. Bà Debbie Purdy, người Anh, bị bệnh tê cóng bắp thịt (multiple sclerosis) có thể còn sống lâu nên (không chờ luật ban hành) bà quyết định không ăn để chết để tránh cho chồng bị luật pháp hỏi tội nếu phải đưa bà đi Thụy sĩ để chết. Bà để lại một lá thư tuyệt mệnh kêu gọi quốc hội Anh thông qua một luật rộng rãi hơn bao gồm quyền được chết của những bệnh nhân hết phương chữa trị nhưng vẫn sống được.

Luật đang thảo luận tại Canada bao gồm trường hợp như bà Purdy yêu cầu, nhưng thủ tục lập pháp phức tạp tại Canada nên còn phải chờ.

Các bộ luật cho phép được chết tại Hà Lan và Bĩ rộng rãi hơn luật Oregon. Bác sĩ có quyền chích thuốc vào mạch máu cho bệnh nhân thay vì buộc bệnh nhân tự uống thuốc. Và tại Thụy Sĩ, trẻ em trên 12 tuổi nếu được cha mẹ đồng ý cũng được hưởng quyền này. Tại Hà Lan 3% số người chết là do bác sĩ giúp, một tỉ số cao nhất thế giới. Tại Bĩ luật còn cao hơn luật Thụy Sĩ, không giới hạn tuổi đối với trẻ em.

Hà Lan và Bĩ là hai quốc gia có cơ sở săn sóc và chống đau (thể xác) và chống khổ (tâm thần) do bệnh hành rất tân tiến. Người ta cũng ghi nhận rằng tại Oregon từ khi có luật “Death with Dignity Act” các cơ sở này càng được cải tiến hơn.

Quá trình hình thành luật giúp người được chết tại Hà Lan là một kinh nghiệm cho thế giới. Năm 1971, một bác sĩ quyết định giúp Mẹ chết an lành theo sở nguyện của bà. Tòa phạt vị bác sĩ này một hình phạt tượng trưng cốt chỉ để hợp với luật. Trường hợp này gợi sáng kiến thành lập “Hội Những Người Muốn Chết Không Đau”, giúp giải quyết từng trường hợp với toà án. Qua các án lệ Hội được phép chính thức thành lập, và sau cùng quốc hội biến thành luât.

Đa số các trường hợp chọn chết ở Hà Lan là ung thư và bệnh tim. Tỉ số bệnh Alzheimer và tâm thần ít nhưng lên dần. Năm 2002 khi Hà Lan chính thức có luật không có trường hợp nào, năm 2013 có 42 trường hợp.

Tại Bĩ cũng như tại Hà Lan trong 15 năm qua bác sĩ hay dùng cách cho thuốc an thần để bệnh nhân ngủ yên thoải mái và chết dần. Tại Anh (chưa có luật) các bác sĩ cũng dùng phương thuốc này với sự mặc nhiên đồng ý của thân nhân người bệnh.

Nói chung các Tổ chức Y tế, các Hội bác sĩ ít khi công khai ủng hộ các Bộ luật cho phép chết vì sự ràng buộc bởi lời thề của Hippocrates, người Hy Lạp, cha đẻ của y khoa Tây phương viết 2500 năm trước “không viết phái thuốc độc cho ai và cũng không khuyên ai làm vậy” (Nor shall any mans entreaty prevail upon me to administer poison to anyone; neither will I counsel any man to do so) và hiện nay một số trường y khoa trên thế giới còn bó buộc sinh viên thề trước khi nhận văn bằng bác sĩ y khoa.

Trước cuộc bỏ phiếu tại Thượng viện California tháng 6 vừa qua tại California, Hội Y tế quốc gia Hoa Kỳ (American Medical Association) chọn thái độ trung lập. Và theo thăm dò của mạng điện tử Medscape năm 2014 thì lần đầu tiên mạng ghi nhận hơn 50% bác sĩ được hỏi ý kiến đồng ý; Hội Y tế Anh còn chống nhưng ý kiến của dân chúng Anh muốn Hội nên thay đổi ý kiến.

Trong cuộc tranh luận về quyền được chết có một điểm cần làm rõ. Có luật còn hơn không. Và những ai vì lý do tôn giáo không muốn tự kết liễu đời mình dù đau đớn thì đó là quyền của họ, nhưng không có lý do gì để ngăn cản những người không còn hy vọng gì và đang đau khổ (thể xác hay tâm thần) không được chết.

Một người đã hiến cả cuộc đời mình cho công cuộc nhân đạo này là bác sĩ Jack Kevorkian, chuyên về bệnh lý. Bác sĩ Kevorkian sinh năm 1928 tại bang Michigan. Ông chuyên giúp người tự vận nếu vì bệnh không còn muốn sống mà ông cho là một việc làm nhân đạo tối thượng và cao quý mà nghề bác sĩ cho phép ông làm. Ông từng giúp ít nhất 130 bệnh nhân cuối đời được chết thoải mái và ra tòa ít nhất 3 lần. Trước sau tòa tiểu bang Michigan cũng thông cảm và ông chưa bao giờ bị phạt tù cho đến năm 1998 khi ông công khai mời đài truyền hình CBS thu hình và lên chương trình “60 minutes” một khúc phim ông đang tự tay chích thuốc chấm dứt đời sống của ông Thomas Youk bị bệnh Lou Gehrig yêu cầu. Ông bị truy tố và năm 1999 tòa xử ông 25 năm tù về tội cố ý giết người. Năm 2007 ông được phóng thích vì tác phong tốt khi bị cầm tù. Ông qua đời năm 2011 tại bệnh viện Royal Oak, bang Michigan, thọ 83 tuổi./.

Trần Bình Nam

August 10, 2015

binhnam@sbcglobal.ne t

www.tranbinhnam.com

(Tài liệu tham khảo: Easing Death 20/10/2012 – Final Certainty 27/6/2015 – The Right to Die 27/6/2015 – tuần báo The Economist. London)

florida80

05-29-2019, 19:29

Nếu Có Một Ngày - Nguyễn Sỹ Thùy Ngân

Nhìn cô cháu gái đều tay thoa bóp, đôi chân đang sưng như thấy hết đau, bà thấy trong lòng dào dạt thương yêu, tận trong lòng bà thấy biết ơn, nên tỏ bày cùng cô cháu gái: "Cám ơn con, đã cho cô những ngày vui vẻ, bỏ hết bên kia cô về đây sống, muốn gần mồ mả ông bà, cũng muốn được gần con."

Cô cháu cười tươi, khoe hàm răng trắng: "Có gì đâu, cô như người mẹ, mà con lo cho mẹ là chuyện phải làm. Cô đừng bận tâm chỉ nên lo cho sức khỏe. Lần trước cô xuống lầu, không kêu con nên trợt té, cái chân đau tới bây giờ còn chưa hết, sau lần nầy cô phải cẩn thận hơn, đi tới đi lui phải có cây gậy cho an toàn. Con không có việc làm, chỉ quanh quẩn trong nhà nấu cơm rồi rửa chén, nếu cô cần sai bảo điều chi, thì cứ lớn tiếng kêu, con sẽ chạy lên ngay lập tức."

Nghe những lời chân tình từ cô cháu gái, bà cười hiền, nheo nheo đôi mắt ướt:

- Cô muốn khóc khi nghe con nói. Tuổi trẻ bây giờ có mấy đứa được như con? Gia đình ta bao nhiêu đời nhân nghĩa, nên sanh ra được cây lành giống tốt là con. Cái chân đau cô ngồi hoài một chỗ, cứ lẩn quẩn trong phòng, thấy cuống cả chân tay. Sau lần nầy con nên thu xếp lại, để cho cô ở dưới lầu đi đứng được dễ hơn.

Cô cháu gái nhìn bà mỉm cười phân giải:

- Cô ở bên kia sạch sẽ quen rồi, nên con dành phòng trên lầu cho cô yên tịnh, vừa ngăn nắp, lại vừa có không gian riêng cho cô thoải mái, chứ ở dưới kia tụi con bày bừa bộn, nấu nướng cả ngày, cô khó nghỉ ngơi.

Nghe cô cháu giải thích bà thấy ấm lòng, vì trong từng lời nói, từng cử chỉ săn sóc nó làm bà hài lòng hơn cả ước mong. Cứ thế sáng chiều ba bữa nó nấu ăn, chăm chút từng món ngon cho bà vừa miệng. Biết bà thích cá lóc, nó lựa ngay con thật bự, để dành riêng đùm trứng rất ngon, còn cho thêm nhiều hành, tiêu để bà ăn vào cho ấm bụng. Ăn uống xong bao giờ nó cũng nhắc, cô phải uống thuốc ngay, đừng chần chờ, vì nếu lỡ quên, chân hành đau sẽ làm cô nhức nhối. Hay có bữa nó bưng mâm cơm lên mà tiếng nói reo vui:

- Con nấu canh chua cá bông lau mà cô ưa thích, cô ăn nhanh còn nóng mới ngon.

Nhìn mâm cơm canh tươm tất, bà thấy rất thương, vì cảm được cái tình của cháu dành cho mình rất đậm. Bà dịu dàng căn dặn:

- Con nấu món gì cô cũng thích ăn, nhưng nhớ đừng nấu món riêng đặc biệt, cô già rồi ăn không còn nhiều được nữa, tụi con muốn ăn món nào, cô cũng thích ăn theo. Cô về đây ở luôn chứ phải đâu là khách, cứ nấu nướng bình thường đừng để cực cho con.

- Dạ, con biết rồi, cô đừng có ngại, chăm sóc người già, là phải lo cho kỹ, ăn uống sao cho bổ dưỡng mới kiện thân, tụi con còn trẻ ăn gì cũng được, chỉ cần ăn sơ sơ cũng qua xong một bữa.

Vừa ăn bà vừa thầm nghĩ: già như mình thì cũng nên... già, ở với cháu mà được nó thương, lo cho từng chút, thấy sao ấm lòng. Đã mấy mươi năm làm thân viễn xứ, nặng gánh đôi vai thay chồng đã khuất, ông đã làm tròn bổn phận với quê hương, còn tôi cũng lo xong một đời làm mẹ, dang rộng đôi tay bao bọc đàn con, nay các con đã khôn lớn nên người, thì cũng là lúc tôi muốn quay về sống lại với làng xưa, để sau nầy khi tới lúc phải ra đi, thân xác tôi sẽ được nằm kề bên ông.

Nay tôi đã được thỏa lòng, ôm mơ ước về quê dù ngơ ngác, cũng nơi đây chiếc cầu ngày xưa tôi và ông hò hẹn, nhưng bây giờ là cầu gạch bắc qua sông. Cũng không sao, đời vật đổi sao dời, huống chi chỉ có cây cầu năm xưa. Cầu có đổi thay nhưng lòng tôi không thay đổi, cũng vẫn như ngày nào thích nằm nghe tiếng gà gáy, thích nghe tiếng rao hàng thanh thoát trong sớm mai, thích nghe tiếng người cười nói lao xao bắt đầu cho một ngày mới. Chỉ ngần ấy đó thôi, những thứ rất bình thường nhưng sao thấy đậm đà sao tha thiết tình quê.

Nghĩ thế nên bà mới chọn con đường về Việt Nam sống luôn với cô cháu gái, tụi nó không có việc làm chỉ săn sóc bà thôi, thì như thế cũng rất công bằng cho cả đôi bên, bà có tiền, cô cháu có công, nên cũng vẹn toàn cho cả cô lẫn cháu. Quà cho cô cháu là xây lại căn nhà, trên nền nhà cũ của hai vợ chồng ngày họ mới cưới được vài năm. Chi phí việc chăm lo cho bà là 300 đô mỗi tháng, do các con ở bên Mỹ gởi về.

Quyết định về Việt Nam sống luôn làm mấy đứa con bà lo lắng không yên, nhưng chúng vẫn phải để mẹ đi theo con đường mẹ chọn. Riêng bản thân bà lại thấy mình... sáng suốt, tuy có nhớ con nhớ cháu, nhưng lòng thấy nhẹ nhàng vì mình không làm gánh nặng cho các con, mà lại được sống những năm cuối đời như mình mơ ước.

Ngày tiễn bà về Việt Nam ở luôn không qua nữa, đứa nào cũng bịn rịn khóc thương không muốn rời. Giấu nước mắt bà dặn dò: đừng về thăm mẹ vì đường xa con nhỏ, hãy coi như mẹ đi chơi xa một chuyến, nếu còn khỏe thì cứ vài năm mẹ sẽ về thăm...

Chỉ có cô em Út, lúc đầu là ồn ào phản đối không vui, rồi còn khuyên giải chị đừng về nơi chốn cũ, nơi mà chị em mình từng đánh đổi mạng sống để ra đi. Và đến khi thấy không còn lay chuyển được bà chị già bướng bỉnh, nó làm mặt giận hờn rồi không thèm nói nữa. Tưởng là con em Út giận luôn, ai dè giờ chót nó cũng ra tiễn bà. Nhét gói thuốc bổ cho bà, nó dặn dò đủ thứ rồi còn thì thầm: “lần nào đi đâu cũng có chị có em, chỉ có lần nầy chị muốn một mình ra đi không định ngày trở lại, chị có thể quên tất cả, nhưng phải nhớ đừng quên lời em dặn”. Nghe nói bà gật đầu cho nó được yên tâm, chứ thật ra thì bà đang nghĩ: con Út nầy lúc nào cũng lo xa, nhưng đôi khi cũng... không cần thiết lắm. Từ ngày đó đến nay con Út cũng an tâm khi nghe chị mình sống vui là có thật, nên đã bớt lo, còn hẹn năm sau nó sẽ về thăm.

Như thường lệ, sáng nay cô cháu bưng cho bà mâm cơm nóng. Hăm hở ăn bà xuýt xoa khen, rồi cao hứng vừa ăn vừa kể chuyện, cô cháu ngồi nghe cũng góp lời cho bà thêm hứng khởi, được một lúc, bà chợt thấy câu chuyện mình đang kể, cô cháu nghe hưởng ứng chỉ cầm chừng chứ không còn sôi động nữa, nên ngừng đũa bà dò hỏi:

- Có gì không con? Sao mà ngồi thừ ra đó?

Cô cháu nhìn bà, rồi nhìn xuống bàn tay, săm soi mấy cái móng, nó ngập ngừng: "Cô à, con cần... 5 ngàn."

Hơi ngạc nhiên bà hỏi lại cho rõ: "5 ngàn Việt hay 5 ngàn đô?"

Cô cháu cười phì: "5 ngàn đô, chứ 5 ngàn Việt thì con có rồi."

Bà nhìn cô cháu gái, ngần ngừ một chút rồi nói:

- Con có nhớ, cô đưa con 3 ngàn đô lần trước, là số tiền cuối cùng cô giữ để hộ thân, đưa hết cho con, vì con cần khẩn cấp, nên bây giờ cô chỉ còn có mấy trăm.

Cô cháu gái có vẻ không vui, ngồi yên không nói, một lúc sau nó ngập ngừng đề nghị:

- Hay là cô phone về bên đó, kêu gởi tiền qua để... cô xài. Con kẹt tiền nên mới nhờ cô lần nữa, chứ hỏi tiền hoài con thấy quá ngại ngùng. Cô cũng biết vật giá leo thang, cái gì cũng mắc, nếu đủ tiền rồi thì con đâu dám hỏi cô.

Thấy nó đổi giọng buồn buồn thì bà cũng thương, nhưng nó xúi xin thêm tiền thì bà thấy không vui, nhưng vẫn ôn tồn:

- Từ đầu con nói với cô, 25 ngàn đô là quá dư để cất một căn nhà, nên cô bằng lòng vì số tiền đó cô lo được, nhưng từ đó đến nay, tiền đã tăng lên gấp đôi, mà nhà cất vẫn chưa xong làm cô lo lắng, vì thật sự cô không còn tiền nữa.

Nghe tới đây, nó xụ mặt, lầm bầm trong miệng:

- Mỗi lần kêu cô đưa tiền, là mỗi lần cô nhắc chuyện... đời xưa. Cất một tầng, với cất ba tầng lầu thì giá tiền phải khác chứ!

Thấy đứa cháu mới mấy phút trước còn ngọt ngào vui vẻ, mấy phút sau đã trở giọng khi nghe không có tiền, bà thấy bực mình, nhưng vẫn giảng giải:

- Cô đã nói với con, phải “liệu cơm gắp mắm”, phải gói gọn trong số tiền mình có. Cô về đây là để dưỡng già, cốt chỉ gần mồ mả ông cha, chứ không cần nhà cao cửa rộng. Nhà cũ của con tuy đơn sơ nhưng ấm cúng gọn gàng. Cô thay nhà tranh, thành nhà tường như con mơ ước, vì muốn nhân đây làm quà tặng cho con. Dự định ban đầu là cất nhà tường, nay đã trở thành nhà lầu ba tầng, có cổng rào riêng biệt, cô cũng vui nếu con biết ngừng ở đó, còn nếu như con tiếp tục dài dài, hết đập bỏ nhà bếp xi măng vừa mới làm xong, thay vào đó là đá hoa cương cho giống nhà hàng xóm, rồi nhà tắm, giường nằm, bộ bàn ăn, con cũng muốn thay... Cô thật sự cạn kiệt không còn tiền cho con nữa.

Biết lần nầy khó lấy được tiền, nó hạ giọng, nhưng chầm dầm cái mặt:

- Thì cũng muốn cô ở cho sang, mang tiếng Việt kiều mà cất nhà tường lèo tèo dưới... nách nhà bên cạnh, nên con cũng... ráng cất cao thêm một chút, để cho thiên hạ khỏi chê cười.

Nghe con cháu có cái tánh đua đòi, bà thấy ngán ngẩm nên nói:

- Con đừng so sánh với người ta. Nhà ai nấy ở, mình nhìn người ta làm gì!?

Nghe bà nói cái kiểu... an phận đó, nó phát bực:

- Con... khổ với cô hết biết! Nói cách nào thì cô cũng không... thèm hiểu. Người ta Việt kiều, mình cũng Việt kiều, Việt kiều mình... bèo quá sẽ bị người ta khinh! Cái cổng nhà bên nó xây chồm ra phía trước, làm cho cái nhà mình coi lép vế kề bên, nên dễ gì con để nó... chơi ngông, nên tiền đợt trước con đã xây liền cái cổng. Con chỉ cần thêm 5 ngàn nầy nữa, là coi như xong hoàn tất được căn nhà.

Bà buông đũa, ngồi thừ ra, một lúc sau bà nói:

- Nói thật, cô không dám phone về xin tiền thêm lần nữa, anh chị bên kia còn nợ nhà, còn con nhỏ phải lo. Cũng đã nhiều lần cô kêu tụi nó gởi thêm tiền lần cuối, để cất cho xong căn nhà còn dang dở, nhưng bây giờ nhà đã xây xong, thì mỗi tháng con chỉ nên nhận 300 đô là đủ.

Vẻ cương quyết không đưa tiền thêm nữa lần nầy của bà làm cô cháu bất mãn. Nó thẳng thừng:

- Nhà đẹp thì cô cũng... nở mày nở mặt, chứ phải đâu chỉ một mình con? Nếu lòng cô không muốn giúp, thì thôi cứ để mặc con!

Nói xong cô cháu vùng vằng đứng dậy, tiện tay bưng luôn cái mâm, dù thấy rõ bà chưa ăn hết phần cơm trong chén. Bước ra khỏi phòng, tiện tay nó đóng ầm cánh cửa lại. Thái độ của nó làm bà chới với, bà lắc đầu ngao ngán rồi nghĩ thầm: con nhỏ nầy bình thường ngọt ngào hiếu thảo, hôm nay hỏi tiền không có, thì nó lộ ra là đứa chẳng ra gì! Bực mình quá bà cũng hết muốn ăn, nhưng thái độ đòi tiền của cô cháu gái, làm bà như nghẹt thở.

Sáng nay thức dậy sau giấc ngủ mệt nhoài. Bà ngồi yên nhìn cánh cửa, mà hôm qua cô cháu đã mạnh tay đóng ầm, bà thấy cuộc sống yên vui từ nay chắc không còn nữa... Suy nghĩ miên man cho tới khi thấy đói, bà mở cửa phòng nhìn quanh, rồi cất tiếng kêu to. Nhà không có tiếng động, im lặng như tờ. Ngồi chờ cho tới quá trưa, tay chân bắt đầu run vì đói, bà kéo mấy cái hộc tủ ở ngay đầu giường, kiếm xem có bánh kẹo gì để ăn, nhưng rồi lại nhớ ra ngày thường vì sợ kiến bu, nên đồ ăn vặt không để trong phòng bà.

Muốn từng bước xuống mấy bậc cầu thang tới nhà bếp để kiếm gì ăn, nhưng loay hoay một lúc, bà lại sợ sẽ nhào đầu xuống thang, nên đứng dựa lưng vào tường mà thở. Bụng đói cồn cào buồn nôn muốn ói... bà chợt nhớ ra trong hộp thuốc bổ có mấy cây kẹo ho, mà con em út đã nhét vội cho bà lúc tiễn đưa. Mừng quá, bà lần bước trở về phòng tìm cây kẹo. Chất kẹo the ngọt làm cho bà không còn muốn ói nữa.

Quá 3 giờ chiều, cô cháu về đem cho bà ổ bánh mì thịt, nó hấp tấp nói: "Con đi... chạy tiền, nên về không kịp, cô ăn đỡ bánh mì, khi nào trả được nợ con mới có... sức nấu nướng cho cô." Nói xong, nó bước nhanh ra cửa. Bà kêu vói theo, nó đi luôn không quay lại. Nhìn theo nó, bà muốn quăng trả lại ổ bánh mì cho đỡ tức, nhưng cùng lúc cũng dằn được cơn nóng giận. Nhìn ổ bánh mì rồi nhớ lời nó nói trước khi đi, bà thấy bất an. Bà thầm nghĩ: chẳng lẽ từ đây mỗi lần nó cần tiền là mỗi lần nó chơi cái trò bỏ đói mình?

Lần đầu tiên sau 6 tháng về đây, bà mới biết thế nào là lo lắng, vì cảm thấy cô cháu mà bà hết dạ tin yêu đã bắt đầu... trở mặt.

Mà quả đúng như bà lo sợ, đêm đó nó đi đâu mất biệt không về. Nhà cửa tối đen, mình bà ngồi im trông ngóng... Đêm đó bà tiếp tục ngậm kẹo ho cho đở đói, rồi ngủ thiếp đi cho tới khi bà giựt mình thức dậy, trời chưa sáng lắm, bà chống gậy bước ra khỏi cửa phòng rồi cất tiếng kêu vang, không có tiếng trả lời, chỉ có âm thanh dội lại trong cái không khí thanh vắng của buổi sáng không người...

Ngoài kia có tiếng người qua lại, có tiếng rao hàng của chị bán xôi, bà mở tung cửa sổ định thẩy tiền xuống mua, nhưng bà chợt nghĩ: tiền thì xuống được chứ xôi thì... Nghĩ đến đây bà hốt hoảng kêu trời, vì chợt nhớ ra, khi đi thì chắc chắn nó đã khóa cửa trước, cửa sau, khóa luôn cổng rào. Đêm qua bà ở một mình, nếu nhà bị cháy, thì coi như đã xong đời bà. Ý nghĩ nầy làm bà hoảng hốt... Nước mắt tuôn dài, lần đâu tiên bà biết sợ, và biết thế nào là thế cô một mình. Bà bắt đầu hối hận. Cả đời bà không biết tận hưởng những giây phút an vui với con cháu bên kia, mà luôn hoài niệm về quá khứ, rồi tưởng tượng ra cái tương lai mơ hồ không có thật để mong an dưỡng tuổi già, nên bà đã hân hoan ôm tiền về đây xây nhà... tù nhốt mình.

Càng nghĩ bà càng thấy sợ, tự dưng người phát lạnh, tay chân run rẩy, bà choáng váng muốn té nhào, nhưng cố gượng lại, ráng quay về giường. Muốn phone cho con Út để khóc than với nó, nhưng ngày thường con cháu của bà nó chỉ xài điện thoại di động mà thôi, cho nên nếu như nó bỏ đi luôn cả tháng không về, thì cũng sẽ không ai biết có một bà già đang... chết khô. Tới trưa cô cháu về mang cho bà gói xôi, nó nói:

- Hôm qua con biết cô ở nhà một mình, con muốn về sớm hơn nhưng kẹt đò, đành phải ngủ lại đó qua đêm.

Thấy mặt nó, bà bừng bừng nổi giận, bà nhìn nó trân trân, muốn chửi cho nó một trận mới hả lòng, nhưng bà ở trong cái thế phải ráng dằn lòng, nên nhè nhẹ hít vào rồi lại thở ra trước khi trách nhẹ nhàng:

- Con làm gì, thì cũng phải nghĩ tới cô ở nhà một mình đói khát, cách đối xử của con mấy ngày nay rất tệ. Nên dành ra một chút thời gian suy nghĩ lại đi con!

Nghe cái giọng trách hờn đó, cô cháu bực mình trả đũa ngay:

- Con chạy đôn chạy đáo kiếm tiền làm gì mà có thời gian suy nghĩ. Tại cô không muốn giúp, thì con phải tự lo thôi!

Tưởng là nó còn... nể mặt nên bà mới lên tiếng trách, nào ngờ vừa mới dứt lời thì nó... đốp lại ngay, bà không sao nín được, nên lên giọng:

- Con nói vậy mà nghe được sao? Tiền đưa cho con bao nhiêu cũng hết, lần nào cần tiền, con cũng nói là đưa thêm lần cuối, nhưng con đã lấy bao nhiêu lần cuối rồi con có nhớ không?

Cô cháu cũng không vừa: "Tiền cô đưa ra, cũng đổ vô cái nhà cho cô ở, chứ mất đi đâu mà cô kể lể!" Nói xong nó dùng dằng bỏ đi.

Bà lớn tiếng kêu to, nó vẫn không thèm nhìn lại. Còn lại một mình, bà ôm đầu nhìn lên trần nhà, bà nghĩ: thương nó như con, có bao nhiêu tiền thủ thân bà đã lần hồi... nhét hết cho nó, vậy mà khi hỏi tiền không có, nó dám bỏ bà đói để bà... lòi tiền ra. Nhìn gói xôi tự dưng bà... khóc ngất. Bà chợt nhớ con, nhớ cháu, nhớ những lời con em Út dặn dò trước khi đi... Đêm đó, nó cũng khóa cửa nhà, rồi đi đâu mất biệt. Bà biết muốn lấy tiền thì nó phải làm vậy thôi, nên lần nầy bà nằm im, ngậm kẹo ho chịu trận!

Sáng hôm sau, chưa tới 9 giờ, cô cháu mở cửa phòng bước vào, nó tươi vui như không có chuyện gì. Nhìn thấy mặt nó, bà giận dữ, muốn thét lên cho hả giận, nhưng kịp ngừng. Bà nín thinh dây mặt ra hướng khác. Cô cháu vừa cười vừa đưa cái điện thoại cho bà, nó nói:

- Cô phone về bển, nói mấy anh chị cho con mượn 5 ngàn đô, rồi từ từ con trả lại. Con đang nấu cháo gà. Nói chuyện xong là có cháo nóng ăn liền.

Nghe nó trắng trợn lấy tô cháo gà đổi lấy 5 ngàn đô, bà tức ứa gan, mặt bà đanh lại, ánh mắt long lên tia giận dữ. Cô cháu nhìn bà, thấy hết những căm hờn từ trong ánh mắt ấy, nó cũng đã chuẩn bị tinh thần để đối phó nếu cần, và tô cháo gà chỉ là phương tiện để điều khiển bà cô... cứng đầu nầy. Nó nghĩ: cháo gà thì có thể cô không ăn, nhưng 5 ngàn đô thì nhứt định nó phải lấy. Nghĩ thế, nó nghiêm sắc mặt tiến tới ấn cái điện thoại trong tay bà mà nói:

- Cô nên phone liền bây giờ, 9 giờ sáng bên nầy, khoảng 9 giờ tối bên kia, đừng để trễ quá 10 giờ, mấy anh chị bên kia còn phải ngủ. Cô nhớ: chỉ nói những chuyện cần nói, và chỉ trả lời trong phạm vi sức khỏe mà thôi.

Nhìn cái cách nó sấn tới ấn cái điện thoại vào tay bà, và nó đứng ở thế sẵn sàng đối phó nếu bà la lên cầu cứu bên kia. Thì bà biết con nhỏ nầy đã táng tận lắm rồi. Suy nghĩ thật nhanh, thay vì giận dữ, bà chuyển qua vẻ mặt chịu đựng, cho nó có cái cảm giác đã khuất phục được bà, để bà được an thân. Cầm cái điện thoại trên tay, trái tim bà đập mạnh, vì biết sau lần nầy, sẽ ít khi nào bà có dịp cầm tới. Bà bắt đầu bấm số. Phía bên kia đầu dây cô Út reo vui khi nhận ra tiếng bà, chỉ hỏi thăm sơ vài câu ngắn ngủi bà vô đề ngay, vì thấy con cháu nó đang nghiêm mặt nhìn bà không nháy mắt:

- Út à, em gởi ngay cho chị 5 ngàn.

- Ủa, sao cần nhiều tiền vậy chị?

Nghe hỏi như thế, bà bực mình nên hơi lên giọng: "A Di Đà Phật, kêu gởi thì gởi liền đi, gởi càng sớm càng tốt. A Di Đà Phật!"

Bên kia đầu dây, một thoáng yên lặng, rồi tiếng cô Út trả lời: "Hiểu rồi, chị yên tâm, em sẽ gởi ngay cho chị trong tuần nầy. Thôi chị nghỉ ngơi đi. Bye chị!"

Lấy lại cái phone, nó hỏi: "Ủa! Cô Hai vô đạo Phật hồi nào mà nói A Di Đà Phật liền miệng vậy?"

Bà nhếch môi nói: "Ừ, thì bên đó, nghe mấy người bạn nói hoài nên cũng quen miệng nói theo."

Nghe bà nói thế nó nín thinh, bỏ đi ra ngoài. Lát sau nó bưng lên cho bà tô cháo trắng với dĩa củ cải kho. Nhìn thấy tô cháo trắng thay vì tô cháo gà như lời nó nói, bà lặng im ăn không nói gì. Nhìn bà khoan thai ăn, thần sắc thư thái, nó nghĩ: Vậy cũng tốt! Mới bỏ đói có hai ngày mà đã biết... sợ rồi, ngoan ngoãn nghe lời như vậy thấy... dễ thương hơn! Sau đó, mọi thứ trở lại bình thường, ngày ba bữa nó bưng lên đầy đủ, chỉ là hai bên không có gì để nói với nhau.

Cuối tuần đó, bỗng dưng nhà có khách. Cô Út về thăm bất ngờ nầy làm cho con cháu ngỡ ngàng lo sợ, vì lát nữa đây cô Út sẽ gặp cô Hai trên lầu. Lần nầy cô Út về quê không báo trước. Bấm chuông, cửa mở, cô xông thẳng vào nhà như cơn gió lốc, mặt tươi vui cô nói cười luôn miệng, còn lăng xăng khen nhà đẹp, nhà sang, khen qua con cháu gái có nước da quá mịn, khen luôn thằng cháu rể có phước tướng, thế nào cũng phát tài, phát lộc, phát giàu sang... làm cho không khí xôn xao vui nhộn. Và khi mọi người còn chưa dứt tiếng cười vang, thì cô Út chủ động nắm tay con cháu, kéo nó cùng đi ngay lên lầu, miệng kêu ơi ới: "Chị hai ơi! Chị hai. Ra coi ai về thăm chị nè!"

Nhận ra tiếng cô Út, bà dằn lòng không khóc. Thấy hai cô cháu cùng bước vào, bà tươi cười hỏi: "Ủa, Út về mà sao không cho hay trước, để chị kêu em mua thêm vài thứ thuốc."

Cô Út cười lớn tiếng nói: "Em phải chạy về gấp, vì có người hỏi mua căn nhà của chị, em cần thêm giấy tờ để bán cho xong."

Trong lúc bà còn đang gật gù như hiểu chuyện, thì cô Út dây qua nói với cô cháu gái: "Con đi lấy toàn bộ giấy tờ của cô Hai ra đây, để cô Út coi cái nào cần xài."

Nghe thế, cô cháu thoáng liếc bà, tần ngần một chút, rồi dây qua nhìn anh chồng đang đứng xớ rớ ngoài cửa phòng, thấy thế cô Út cười lớn nói: "Bán xong căn nhà, thì có tiền cho tụi bây."

Khi cầm được cái passport trong tay, cô Út bỏ ngay vào bóp, rồi dây qua ân cần nói với bà chị: "Ngồi đây chi một mình, để em kè chị xuống nhà có đông người cho vui." Nói xong cô Út tự động ôm cánh tay chị mình, từng bước dìu xuống mấy bậc cầu thang. Khi xuống được tới dưới nhà thì cô Út dây qua nói với hai vợ chồng cô cháu gái:

- Hôm nay vui quá! Mình ra ngoài ăn mừng ngày đoàn tựu. Tài xế cô bao vẫn còn chờ ngoài kia.

Cô cháu gái nghe thế nên lên tiếng: "Cô về sao không cho hay, để tụi con đi đón đông người cho vui."

Cô Út nhìn nó cười giòn:

- Tánh cô tự lập quen rồi. Khi muốn đi thì mua vé, bay cái vèo qua đây. Bước ra một bước, thì có cả đoàn xe sắp hàng chờ, nên cô đâu muốn kêu con, để cho bất ngờ con sẽ thấy vui hơn...

Và khi xe ngừng lại trước cửa nhà hàng. Vỗ nhẹ vai chị, cô Út dịu dàng: "Cái chân đau, chị đi đứng khó khăn không thoải mái, cứ ngồi yên chờ, em sẽ mua đồ đem ra." Nói xong, cô Út dây qua nắm tay cô cháu gái kéo nhau cùng xuống xe. Chọn đại một cái bàn, vừa kéo ghế ngồi xuống, cô Út bật đứng lên, móc bóp lấy ra tờ 100 đô đưa cho cô cháu gái. "Nè, con cầm tiền nầy, hai đứa muốn ăn gì tùy thích, cô nhớ ra là có chuyện cần làm, cô đi trước, sẽ gặp tụi con sau."

Từ lúc gặp cô Út cho đến giờ, cô nói cười luôn miệng, phản ứng nhanh nhẹn, biến đổi không ngừng, làm cho hai vợ chồng cô cháu gái bị động theo từng chuyển biến của cô. Giờ cầm tờ 100 đô trên tay hai vợ chồng nó bối rối chưa biết phản ứng sao, thì cô Út đã đi nhanh ra xe, nói tài xế vọt thẳng về hướng Sài Gòn.

Nắm chặt tay cô Út, bà khóc ngất, cô Út nhẹ nhàng giải thích: "Sợ nó làm khó không trả lại giấy tờ cho chị, nên em làm bộ nói chuyện bán nhà cho nó ham mà đưa passport ra cho lẹ, rồi cũng phải tìm cách đưa chị ra khỏi chỗ đó cho nhanh. Sợ ở qua đêm, hai chị em mình sẽ bị nó... làm càng vì mưu đồ đã lộ. Nên rủ tụi nó đi ăn, để tiện bề kéo chị thoát thân."

- Chị sợ em không hiểu.

- Làm sao mà không hiểu! Cũng may là chị còn nhớ lời em căn dặn trước khi đi.

- Không nhờ câu... mật khẩu của em, thì chị sẽ chết mòn trong tay nó, và sẽ là món mồi ngon để tụi nó câu tiền... Em cũng khôn khi chọn câu: A Di Đà Phật, vì khi nói lên câu nầy, nghe như mình đang niệm Phật, tụi nó tinh ranh cỡ nào thì cũng khó mà đoán ra.

- Khi thấy chị quyết định về Việt Nam an dưỡng tuổi già, lòng em không yên, nên mới nghĩ ra câu mật khẩu nầy, để nếu có một ngày nhận được... tín hiệu nầy, em sẽ bay về... cứu chị.

Em à, chuyện như thế nầy chị có nghe nhiều người kể, nhưng không tin lắm và luôn nghĩ người bất hạnh đó sẽ không phải là mình. Bây giờ lâm cảnh nầy chị mới hiểu vì tiền thì chuyện gì cũng có thể xẩy ra, gặp những đứa bất tài mà có lòng tham thì sẽ dùng mọi thủ đoạn để kiếm tiền, mà đi lường gạt người ngoài thì không đủ sức còn lo tù tội, chi bằng kiếm tiền vừa dễ vừa nhanh mà lại an toàn đó là lợi dụng vào cốt nhục tình thâm. Người lường gạt, sang đoạt được, thì nhởn nhơ vui hưởng vì không phải lo bị truy tố, còn người mất của thì lặng im trong nỗi đau không dứt vì vừa mất tiền vừa mất cả lòng tin.

Nguyễn Sỹ Thùy Ngân

at 1:32 AM

florida80

05-29-2019, 19:34

Người Đến Tuổi Trung Niên Tối Kỵ Làm 8 Việc Này

Cổ nhân có nói: “Tứ thập bất hoặc, ngũ thập tri thiên mệnh, lục thập nhĩ thuận” (Tạm dịch: 40 tuổi thì không bị nhầm lẫn, 50 tuổi hiểu được mệnh Trời, 60 tuổi nghe điều gì cũng thấy thuận tai).

Sau khi bước vào tuổi trung niên, chỉ muốn dùng cái tâm bình thường để làm những việc bình thường. Bài viết dưới đây là một bức thư mà một người trung niên viết cho chính mình, lời nói ra chỉ là những câu chuyện bình thường trong nhà, trong cuộc sống, đơn giản nhưng hàm ý thâm sâu mà từng câu từng chữ đều thật thấm thía.

Nhất định phải đọc hết. Hãy ghi nhớ thật kỹ, đối với các bậc trung niên đều rất có ích.

1. Hãy thôi nghĩ về quá khứ

Chúng ta vào thời thanh thiếu niên chịu khổ bao nhiêu so với những người trẻ hiện nay. Cũng may, cuộc sống bây giờ càng ngày càng tốt, cũng có cho mình một ít tiền tiêu, có một chút nhàn rỗi để làm những việc mình thích.

Vậy nên, các bậc trung niên đừng nhất mực chìm đắm trong những hồi ức quá khứ, hãy lạc quan, nhìn về tương lai, dù sao chúng ta cũng đã có 20 năm hoàng kim trong cuộc đời rồi.

2. Đừng nên tức giận

Lúc còn trẻ chúng ta có bao nhiêu là cáu gắt, đặc biệt là lúc con cái không nghe lời, khó tránh khỏi quát nạt nó, thậm chí dùng cả đòn roi. Nhưng hôm nay con cái đã trưởng thành rồi, đã có cách nghĩ cho riêng mình rồi, và chúng ta cũng không giống như trước đây.

Chúng ta có thể vận dụng trí tuệ và kinh nghiệm tích lũy, cung cấp cho chúng tham khảo, đồng thời bảo trì thái độ yêu thương và hóm hỉnh của mình. Không được vì con cái không tiếp thu ý kiến mà không ngừng phàn nàn hoặc sinh tức giận để tránh hình thành căng thẳng cho hai thế hệ.

3. Hãy thôi phàn nàn, oán trách

Tục ngữ có câu: Mỗi cây mỗi hoa, mỗi nhà mỗi cảnh. Mỗi người đều có lúc có phiền não, có khi cũng muốn cùng người khác thổ lộ hết. Điều này có thể lý giải, nhưng phải chú ý không nên phàn nàn nhiều quá.

Nếu như bạn bè luôn phàn nàn với bạn về một việc, mỗi ngày mỗi ngày đều đang truyền đi những năng lượng trong lời nói, tin rằng bạn sẽ không muốn có một người bạn như vậy.

4. Đừng lãng phí thời gian

Thời gian trôi qua chỉ như một chớp mắt, giờ ta đã bước vào hàng bậc trung rồi. Thời gian không đợi người, chúng ta càng không nên lãng phí thời gian. Muốn làm cái gì thì hãy làm, muốn mua gì thì hãy mua, muốn ăn gì thì hãy ăn. Đừng nói là: “Hãy đợi sau này”, “Đợi khi có thời gian”, “Đợi qua mấy hôm nữa”.

Người có thể đợi thời gian, nhưng thời gian quyết không đợi người! Vậy nên, đừng phụ bạc chính bản thân mình.

5. Hãy thôi cô độc, cô đơn

Cho dù là ở cùng với con cái, cuối cùng thì cũng là hai vợ chồng già sống với nhau, đều muốn làm được độc lập về tinh thần và không muốn suốt ngày sinh hoạt quẩn quanh trong nhà từ sáng đến tối.

Người già phần đông muốn đi đây đi đó, nên có bằng hữu xung quanh, có một số thú vui tao nhã, như vậy cuộc sống mới thêm phần phong phú.

6. Đừng xen vào việc của người khác

Làm người lớn tuổi, có một bí quyết, chính là đối với một số việc nên nhìn cho rõ, với một số việc không nên nhìn và cũng nên bỏ qua.

Không nên bất kì điều gì cũng lấy mình làm trung tâm, nên cho con cái không gian sinh hoạt và một khoảng trời riêng, không nên can thiệp vào cuộc sống của chúng.

Về vấn đề giáo dục con cháu, hết sức không lấy “kinh nghiệm” mà cho rằng mình đúng, cũng nên hiểu bố mẹ chúng là ai, cố gắng chiểu theo quan điểm của bố mẹ chúng để dạy dỗ chúng.

7. Không nên càm ràm

Sức khoẻ, tình yêu hôn nhân và công việc là chủ đề yêu thích khi trao đổi cùng con cái lúc về già, nhưng người trẻ lại không muốn người lớn nhắc nhiều về những vấn đề đó. Vì vậy, không nên hỏi nhiều về chuyện đó, có một số việc, bọn trẻ trong tâm tinh tường, tự chúng biết phải làm gì, chúng ta cũng chớ dông dài.

8. Đừng nên tồn nhiều tiền

Những người bằng hữu tuổi trung niên, nên dừng lại việc tích trữ tiền. Tiền dù tồn thành từng xấp, bất quá chỉ là con số. Chúng ta khổ cực cả đời, thật sự muốn đối đãi với mình tốt một chút. Trong phạm vi năng lực của mình, đừng quá quan tâm một bộ y phục bao nhiêu tiền, một món ăn bao nhiêu tiền, muốn mua, muốn ăn thì cứ chi thôi!

Tiền mình tiêu đó là tiền của mình, tiền tồn trữ sau này chỉ là di sản mà thôi.

Nguồn: phunugiadinh.vn

Thời gian không đợi người, vì vậy hãy làm những gì mình muốn làm, hay mua gì muốn mua, muốn ăn gì thì hãy ăn… (Ảnh: shutterstock.com)

Cổ nhân có nói: “Tứ thập bất hoặc, ngũ thập tri thiên mệnh, lục thập nhĩ thuận” (Tạm dịch: 40 tuổi thì không bị nhầm lẫn, 50 tuổi hiểu được mệnh Trời, 60 tuổi nghe điều gì cũng thấy thuận tai).

Sau khi bước vào tuổi trung niên, chỉ muốn dùng cái tâm bình thường để làm những việc bình thường. Bài viết dưới đây là một bức thư mà một người trung niên viết cho chính mình, lời nói ra chỉ là những câu chuyện bình thường trong nhà, trong cuộc sống, đơn giản nhưng hàm ý thâm sâu mà từng câu từng chữ đều thật thấm thía.

Nhất định phải đọc hết. Hãy ghi nhớ thật kỹ, đối với các bậc trung niên đều rất có ích.

1. Hãy thôi nghĩ về quá khứ

Chúng ta vào thời thanh thiếu niên chịu khổ bao nhiêu so với những người trẻ hiện nay. Cũng may, cuộc sống bây giờ càng ngày càng tốt, cũng có cho mình một ít tiền tiêu, có một chút nhàn rỗi để làm những việc mình thích.

Vậy nên, các bậc trung niên đừng nhất mực chìm đắm trong những hồi ức quá khứ, hãy lạc quan, nhìn về tương lai, dù sao chúng ta cũng đã có 20 năm hoàng kim trong cuộc đời rồi.

2. Đừng nên tức giận

Lúc còn trẻ chúng ta có bao nhiêu là cáu gắt, đặc biệt là lúc con cái không nghe lời, khó tránh khỏi quát nạt nó, thậm chí dùng cả đòn roi. Nhưng hôm nay con cái đã trưởng thành rồi, đã có cách nghĩ cho riêng mình rồi, và chúng ta cũng không giống như trước đây.

Chúng ta có thể vận dụng trí tuệ và kinh nghiệm tích lũy, cung cấp cho chúng tham khảo, đồng thời bảo trì thái độ yêu thương và hóm hỉnh của mình. Không được vì con cái không tiếp thu ý kiến mà không ngừng phàn nàn hoặc sinh tức giận để tránh hình thành căng thẳng cho hai thế hệ.

3. Hãy thôi phàn nàn, oán trách

Tục ngữ có câu: Mỗi cây mỗi hoa, mỗi nhà mỗi cảnh. Mỗi người đều có lúc có phiền não, có khi cũng muốn cùng người khác thổ lộ hết. Điều này có thể lý giải, nhưng phải chú ý không nên phàn nàn nhiều quá.

Nếu như bạn bè luôn phàn nàn với bạn về một việc, mỗi ngày mỗi ngày đều đang truyền đi những năng lượng trong lời nói, tin rằng bạn sẽ không muốn có một người bạn như vậy.

4. Đừng lãng phí thời gian

Thời gian trôi qua chỉ như một chớp mắt, giờ ta đã bước vào hàng bậc trung rồi. Thời gian không đợi người, chúng ta càng không nên lãng phí thời gian. Muốn làm cái gì thì hãy làm, muốn mua gì thì hãy mua, muốn ăn gì thì hãy ăn. Đừng nói là: “Hãy đợi sau này”, “Đợi khi có thời gian”, “Đợi qua mấy hôm nữa”.

Người có thể đợi thời gian, nhưng thời gian quyết không đợi người! Vậy nên, đừng phụ bạc chính bản thân mình.

5. Hãy thôi cô độc, cô đơn

Cho dù là ở cùng với con cái, cuối cùng thì cũng là hai vợ chồng già sống với nhau, đều muốn làm được độc lập về tinh thần và không muốn suốt ngày sinh hoạt quẩn quanh trong nhà từ sáng đến tối.

Người già phần đông muốn đi đây đi đó, nên có bằng hữu xung quanh, có một số thú vui tao nhã, như vậy cuộc sống mới thêm phần phong phú.

6. Đừng xen vào việc của người khác

Làm người lớn tuổi, có một bí quyết, chính là đối với một số việc nên nhìn cho rõ, với một số việc không nên nhìn và cũng nên bỏ qua.

Không nên bất kì điều gì cũng lấy mình làm trung tâm, nên cho con cái không gian sinh hoạt và một khoảng trời riêng, không nên can thiệp vào cuộc sống của chúng.

Về vấn đề giáo dục con cháu, hết sức không lấy “kinh nghiệm” mà cho rằng mình đúng, cũng nên hiểu bố mẹ chúng là ai, cố gắng chiểu theo quan điểm của bố mẹ chúng để dạy dỗ chúng.

7. Không nên càm ràm

Sức khoẻ, tình yêu hôn nhân và công việc là chủ đề yêu thích khi trao đổi cùng con cái lúc về già, nhưng người trẻ lại không muốn người lớn nhắc nhiều về những vấn đề đó. Vì vậy, không nên hỏi nhiều về chuyện đó, có một số việc, bọn trẻ trong tâm tinh tường, tự chúng biết phải làm gì, chúng ta cũng chớ dông dài.

8. Đừng nên tồn nhiều tiền

Những người bằng hữu tuổi trung niên, nên dừng lại việc tích trữ tiền. Tiền dù tồn thành từng xấp, bất quá chỉ là con số. Chúng ta khổ cực cả đời, thật sự muốn đối đãi với mình tốt một chút. Trong phạm vi năng lực của mình, đừng quá quan tâm một bộ y phục bao nhiêu tiền, một món ăn bao nhiêu tiền, muốn mua, muốn ăn thì cứ chi thôi!

Tiền mình tiêu đó là tiền của mình, tiền tồn trữ sau này chỉ là di sản mà thôi.

Nguồn: phunugiadinh.vn

florida80

05-29-2019, 19:35

Những Điều Người Cao Tuổi Nên Tránh

Con người khi về già, các bộ phận trong cơ thể đều lão hóa, yếu đi. Một số điều sau đây luôn ẩn chứa những hiểm họa bất ngờ.

Con người khi về già, các bộ phận trong cơ thể đều lão hóa, yếu đi. Một số điều sau đây luôn ẩn chứa những hiểm họa bất ngờ mà người cao tuổi cần phải lưu tâm đề phòng.

1. Không nên tập luyện vào lúc sáng sớm

Ta vẫn có quan niệm cho rằng tập luyện vào buổi sáng là tốt vì không khí trong lành. Điều đó không đúng. Vì từ 4-6 giờ sáng theo quy luật của đồng hồ sinh học của người già thân nhiệt đang cao, huyết áp tăng, thận thượng tuyến tố cũng cao gấp 4 lần buổi tối, nếu vận động mạnh, chạy hoặc đi bộ nhiều gặp gió lạnh, tim dễ ngừng đập. Đã có không ít cụ đi bộ buổi sáng sớm về ra mồ hôi, tắm xong huyết áp tăng đột ngột, đứt mạch máu não, đột quỵ luôn. Tốt nhất là nên tập vào chiều tối, tuy không khí không được thanh sạch như sáng sớm nhưng an toàn hơn nhiều.

2. Đang ngủ không nên trở dậy vội vàng

Thần kinh người già thường chậm chạp. Lúc ngủ muốn dậy đi tiểu hoặc có ai gọi đang ở tư thế nằm mà trở dậy ngay, đi lại luôn dễ làm huyết áp tăng đột ngột, dễ dẫn đến đứt mạch máu não. Vì vậy, đang ngủ khi có việc cần dậy phải từ từ theo 3 bước, mỗi bước khoảng nửa phút. Bước 1 khi tỉnh giấc hãy nhắm mắt lại nằm thêm nửa phút. Bước 2, ngồi dậy tại giường nửa phút xoa tay, xoa chân. Bước 3, cho hai chân chạm đất hoặc chạm nền nhà nửa phút rồi mới đứng dậy đi.

3. Không nên ngoái đầu một cách đột ngột

Người già mạch máu thường xơ cứng, thành mạch dày hẹp và đàn hồi kém. Nếu đột nhiên quay ngoắt đầu về phía sau, mạch máu ở cổ bị chèn ép, động mạch vốn đã hẹp bị chèn ép lại càng hẹp hơn cộng thêm thần kinh giao cảm bị kích thích mạnh làm mạch máu co lại, máu lưu thông chậm làm não thiếu máu cục bộ, thiếu ôxy nên bị choáng, hoa mắt, chóng mặt, có người đã bị ngã. Vậy đang đứng hoặc đang đi có ai gọi từ phía sau, chớ có quay ngoắt đầu lại ngay mà nên quay chầm chậm. Tốt nhất là xoay cả người lại, tránh chỉ quay đầu.

4. Không nên đứng co một chân để mặc quần

Xương của người già thường bị xốp do thiếu canxi. Nếu không bị xốp thì xương cũng giòn. Khi mặc quần mà đứng co chân để xỏ từng chân vào ống quần dễ bị ngã do mất thăng bằng hoặc do vướng vào quần. Người cao tuổi đã ngã thì dễ gãy xương, dập xương. Khi mặc quần tốt nhất là nên ngồi trên ghế hoặc trên giường. Trong nhà tắm nếu không có chỗ ngồi thì phải dựa mông vào một bên tường để giữ thăng bằng cho khỏi ngã. Nhiều người bị ngã gãy xương ống chân, dập xương chậu vì đứng co chân mặc quần.

5. Không nên quá ngửa cổ về phía sau

Do gần mạch máu nơi cổ có nhiều đốt xương, bình thường giữa các đốt có chất nhờn bôi trơn nhưng về già chất bôi trơn kém đi, các đốt xương trở nên sắc cạnh. Khi ngửa cổ ra phía sau quá giới hạn cho phép, phần xương sắc cạnh đó làm tổn thương đến mạch máu, hạn chế lượng máu đưa lên não gây ra thiếu máu não làm ngất xỉu. Vì vậy, người già khi ngồi ghế tựa không nên ngửa cổ quá mức về phía sau.

6. Không nên thắt dây lưng quá chặt

Vùng bụng quanh dây lưng là nơi gần dạ dày, ruột non, ruột già, trực tràng và hậu môn. Dây lưng mà thắt chặt quá sẽ chèn ép các mạch máu bụng, cản trở máu lưu thông, đoạn trực tràng gần hậu môn có thể dễ bị lòi ra ngoài khi đi đại tiện mà ta thường gọi là lòi dom. Dây lưng thắt chặt, dạ dày, ruột non luôn ở trạng thái chịu sức ép ảnh hưởng xấu đến tiêu hóa. Vì vậy, không nên thắt chặt dây lưng và tốt nhất là dùng dây đeo quần qua vai, tiếng Pháp gọi là Bretel. Bình thường ở nhà chỉ nên mặc quần ngủ lồng chun không nên mặc quần âu cứ phải thắt dây lưng làm bụng luôn bị gò bó.

7. Khi đi đại tiện không nên rặn quá mức

Táo bón là hiện tượng thường gặp ở người già. Tâm lý khi đi đại tiện không ai muốn ở lâu trong nhà vệ sinh nên thường muốn rặn mạnh để đi cho nhanh nhưng nếu rặn quá sức, mặt mũi đỏ gay rất nguy hiểm. Các khảo nghiệm về y học đã cho biết khi rặn mạnh dễ giãn tĩnh mạch ở hậu môn gây chảy máu nhưng điều quan trọng hơn là huyết áp sẽ tăng có thể dẫn tới tai biến mạch máu não và nhồi máu cơ tim. Để đỡ phải rặn khi đi ngoài, người già cần ăn nhiều rau quả, chuối, khoai, uống nhiều nước để chống táo bón.

8. Không nên nói nhanh, nói nhiều

Một số nhà khoa học Mỹ phát hiện khi ta nói chuyện bình thường dù chỉ là chuyện vui nhẹ nhàng, các tế bào trong cơ thể vẫn chịu tác động và ảnh hưởng tới huyết áp. Thử nghiệm khoa học với 100 người mỗi người đọc 2 trang tài liệu với tốc độ nhanh chậm khác nhau. Kết quả cho thấy người đọc tốc độ vừa phải thì huyết áp, nhịp tim bình thường. Người đọc nhanh quá, đọc liến thoắng thì lập tức huyết áp tăng, nhịp tim tăng nhưng khi đọc thong thả trở lại, huyết áp, nhịp tim lại giảm xuống. Qua đó ta thấy người già nên nói ít, nói chậm thì có lợi cho sức khỏe. Những cụ nào bị bệnh tim mạch, bị huyết áp càng phải nói chậm, nói ít.

9. Không nên xúc động

Đối với người già mạch máu đã lão hóa nếu xúc động mạnh, quá giận dữ hoặc quá vui dễ bị nhồi máu cơ tim và đứt mạch máu não. Do đó, người già không nên xúc động tránh mọi sự tức giận, buồn phiền mà cần sống thanh thản, hòa nhã, vui vẻ, bỏ qua hết mọi chuyện ảnh hưởng đến tâm lý, sức khỏe.

Có một câu nói rất hay: "Đừng để chết vì thiếu hiểu biết". Vì thật ra đã có rất nhiều người chết vì thiếu hiểu biết kể cả những người còn trẻ. Qua sự hiểu biết ít ỏi của bản thân, qua kinh nghiệm cuộc sống và qua tham khảo các tài liệu y học mới nhất của nước ngoài mong rằng với bài viết ngắn này sẽ giúp các bậc cao niên sống lâu, sống khỏe, sống vui tăng thêm nhiều tuổi thọ.

Nguồn: https://tuoitre.vn

florida80

05-29-2019, 19:38

Gian Lận Thi Cử Kiểu Mỹ - Ngô Nhân Dụng

Ông Jared Kushner, con rể Tổng Thống Donald Trump, đã được vào Havard sau khi ông bố tặng $2.5 triệu cho nhà trường. Tuy nhiên, gia đình Kushner kịch liệt bác bỏ mối nghi ngờ này. (Hình minh họa: Win McNamee/Getty Images)

Ở nước Mỹ, tốt nghiệp một đại học nổi tiếng là chìa khóa tốt nhất để dễ kiếm việc làm. Hầu hết các phụ huynh người Việt đều lo cho con cái mình được vào trường lớn. Một vụ xì căng đan mới nổ có thể khiến nhiều người thấy chán, nhưng chắc không ai bỏ không thúc đẩy con cháu cứ cố gắng một cách lương thiện!

Các tài tử nổi tiếng Felicity Huffman và Lori Loughlin được nêu danh trong số các người giàu có đã bỏ tiền ra cho con mình được nhập học, nhờ gian lận. Theo FBI điều tra, họ đã chi tổng cộng $6.5 triệu! Những người này sẽ phải hầu tòa cùng nhiều viên chức đại học trong vụ tai tiếng chưa từng thấy trong nền giáo dục ở đại học Mỹ.

Người giàu ở Mỹ có thể chiếm ưu thế khi con xin vào đại học. Các trường lớn vẫn có chính sách ưu tiên nhận con cái của các cựu sinh viên. Cựu sinh viên các trường lớn thường thành công về tài chánh, có một cách nhắc nhở là đem tiền đóng góp cho trường cũ, để được chú ý hơn.

Tại Đại Học Havard, 14% sinh viên là con cháu các cựu sinh viên. Những học sinh xin vào Havard có 6% hy vọng được thâu nhận, nhưng có 34% con cháu các cựu sinh viên được vào học. Ông Jared Kushner, con rể Tổng Thống Donald Trump, đã được vào Havard sau khi ông bố tặng $2.5 triệu cho nhà trường. Gia đình Kushner kịch liệt bác bỏ mối nghi ngờ này, vì họ đã tặng dư cho rất nhiều cơ sở giáo dục. Nhưng trong cuốn “The Price of Admission” của Daniel Golden, in năm 2006 trước khi Tổng Thống Trump vào chính trị, tác giả đã phỏng vấn các người điều hành tại trường trung học cũ của Jared Kushner và họ cho biết học lực của cậu rất tầm thường.

Vụ xì căng đan mới liên quan đến nhiều đại học danh tiếng như Yale, Georgetown, Đại Học Nam California (USC), UCLA, Stanford và Đại Học Texas. Chỉ có một người chủ mưu, là William Rick Singer.

Singer, 58 tuổi, đã lập ra một cơ sở từ thiện mang tên Key Worldwide Foundation, gọi tắt là Key, ở California, quảng cáo một chương trình “kèm học” giúp các thí sinh muốn vào đại học. Nhưng sau đó đã “làm ăn lớn” khi tổ chức một mạng lưới gian lận, được trả tổng cộng $25 triệu, theo cáo trạng đọc trước tòa ngày Thứ Ba, 12 Tháng Ba, 2019.

Mánh khóe bình thường nhất của Singer là gian lận trong các kỳ thi ACT (American College Testing) và SAT (Scholastic Aptitude Test) có mục đích trắc nghiệm khả năng học hành, mà các phụ huynh vẫn cho con tới các lớp luyện thi mọc lên khắp nơi, kể cả vùng Little Saigon.

Singer thuê người đi thi SAT và ACT thay cho các học sinh ứng viên vào đại học và hối lộ những người đứng đầu cũng như giám thị cuộc thi để giữ kín. Một mánh khóe khác là bảo thí sinh bỏ trống bài thi, rồi người giám thị ăn tiền sẽ điền các câu trả lời đúng vào đó. Phụ huynh trả đến $75,000 cho một vụ gian lận như vậy.

Trước tòa, Singer thú nhận có khi còn bàn với phụ huynh để chọn một điểm số “vừa phải” đủ để được nhận vào trường nhưng không cao quá, bị chú ý. Được trả tiền rồi, Singer sẽ mướn Mark Riddell, ở Florida, đi thi hộ, hoặc tráo bài thi có câu trả lời đúng với “thân chủ” của mình. Riddell đã cộng tác với Singer từ năm 2011. Theo công tố viện ở tòa Boston cho biết thì phần lớn các sinh viên không biết cha mẹ mình đã mua cho mình chỗ ngồi trong đại học, cho tới khi vụ tai tiếng này nổ ra.

Một mánh khóe khác của Singer là hối lộ 13 huấn luyện viên thể thao các trường để họ ủng hộ các ứng viên nhập học vì thành tích trong các môn được nhà trường ưu đãi.

Các đại học Mỹ vẫn có chính sách nhận sinh viên giỏi thể thao dễ hơn; 70% sinh viên thể thao được công nhận giỏi thể thao được vô học nhưng một sinh viên thường cùng học lực chỉ được nhận với xác suất 0.0076%.

Bà Rudy Meredith, cựu huấn luyện viên bóng tròn Đại Học Yale, và ông John Vandemoer, huấn luyện đội đua thuyền buồm thuộc Stanford University, đã bị Singer mua chuộc. Bà Meredith được trả $400,000 sau khi một ứng viên được vào Đại Học Yale.

Một huấn luyện viên tennis Đại Học Georgetown đã giúp cho 12 sinh viên vào đội tuyển của trường, được trả tổng cộng $2.7 triệu. Singer đã tạo ra những bức hình giả cho các sinh viên này, cho thấy họ đang chơi môn thể thao được chọn. Nữ tài tử Loughlin và ông chồng thú nhận đã trả $500,000 để con gái được gia nhập đội thể thao USC mặc dù không làm gì hết.

Tháng Sáu này quan tòa ở Boston mới tuyên án, Singer có thể bị từ 15 đến 19 năm tù.

Vụ xì căng đan mới làm ồn ào dư luận ở Mỹ vì đây là một chuyện hiếm hoi, khi so với những vụ gian lận thi cử đã lên báo ở Việt Nam. Các trường đại học bị dính vào vụ này vẫn giữ được uy tín hàng trăm năm của họ, chính vì đây là một chuyện ít khi xảy ra.

Sau vụ tai tiếng này, các phụ huynh cũng nên nghĩ lại khi thúc giục con cái cố học nhiều hơn để được vào các trường lớn nhận. Nhiều học sinh đã bị bệnh tâm thần vì bị ám ảnh quá, chỉ lo mình không làm đúng ý nguyện cho cha mẹ. Có 15% đến 40% học sinh trung học ở Mỹ thú nhận sử dụng quá nhiều “thuốc thức” thường dùng để trị bệnh.

Chúng ta nên khuyến khích con em lo học giỏi, nhưng cũng cần đào luyện tánh khí, chơi thể thao, thưởng thức nghệ thuật, sống với thiên nhiên hòa hợp với mọi người trong xã hội. Không nên để các em chỉ nghĩ tới điểm số trong trường mà quên mình phải sống cân bằng, hạnh phúc. Tuổi trẻ đáng được sống hạnh phúc. Mà hạnh phúc không tùy thuộc vào điểm số khi đi học, hay lợi tức khi ra đời.

Trong một cuộc nghiên cứu, có tới 90% sinh viên đại học công nhận họ đã gian lận khi đi thi. Những người gian lận trong cuộc sống như vậy khó đạt được hạnh phúc đích thực.

Ngô Nhân Dụng

florida80

05-30-2019, 18:09

My Heart Palpitations Turned Out to Be Lung Cancer

Jen Babakhan

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Every five minutes an American woman is diagnosed with lung cancer. After her diagnosis, Colette Smith is on a mission to educate other women.

electrocardiogram
DimiSotirov/Shutterstock

Four years ago on a late night, Colette Smith, 53, sat alone in her living room watching TV. The rest of her family had gone to bed earlier. Suddenly, she noticed her heart-rate speeding up. It slowed, but then happened again a few minutes later; this time the rapid pulse continued for ten minutes. “I thought it was strange, and it had never happened before—it made me sit up and pay attention.” She woke up her husband, and together they guessed that she was having heart troubles. Smith wasn’t. But she was experiencing the symptoms of a deadly disease.

Her husband drove her to the ER where a doctor suggested they do a CAT scan to check for blood clots in her lungs. “I knew when the doctor came to give me the results of the CAT scan that he looked concerned. He said they found a nodule in my left lung and several in my right. He told me to follow up with my primary care doctor. I didn’t think anything of it, though.” The presence of nodules don’t always mean a cancer diagnosis—here are 13 things to know about lung nodules.

When her regular doctor thought the CAT scan results were inconclusive, and Smith put the event out of her mind. “A year later, my primary doctor called me back and said he wanted to repeat the CAT scan to see if anything had changed.” She went in, and the next day she got a call from the doctor—even though he was away on vacation. “I knew that wasn’t good. The nodules were still there, and he wanted to do a PET scan.”

Though Smith’s PET scan results were also inconclusive, her doctor wasn’t satisfied. “I asked what he would do if he were in my shoes—he said he would take it one step further.” Smith found a highly recommended cardiothoracic surgeon. “He looked at my scans and said he could tell right away it was 1A lung cancer. I wasn’t so sure, so I asked for a biopsy.” When the biopsy was inconclusive, Smith’s surgeon recommended she get surgery to find exactly what they were dealing with. “I had the surgery and he was right. It was stage 1A lung cancer. The surgeon removed the upper lobe of my left lung, along with lymph nodes that may have been affected.”

Lung cancer is the leading cause of cancer-related death among men and women; about 142,670 people will die from the disease this year alone. Though smokers are more likely to develop lung cancer, many people—like Smith—develop it with no history of smoking. Often, patients will have no obvious symptoms until the cancer has spread. If symptoms are present, they’re likely to be a chronic or worsening cough (here’s when to worry about a cough that won’t go away), coughing up blood, chest pain that worsens with deep breaths or laughter, hoarseness, loss of appetite, weight loss, shortness of breath, fatigue, chronic lung infections, and sudden onset wheezing. Shoulder pain may also be a symptom—though that’s just one of possible reasons you have pain in your shoulder.

Though her recovery was difficult, Smith is feeling much better. She credits her walking routine and regular therapy with a mental health provider. “It’s amazing how much movement helps with pain management. Finding a therapist was also helpful because I needed someone I could trust and connect with outside of my family, who could help me understand it all.”

Because her doctors caught the cancer early, Smith did not require radiation, chemotherapy, or other targeted cancer therapies. After surgery, Smith was declared cancer-free. “I was one of the lucky ones,” she says. Smith continues to get scans every six months to check for recurrence. She’s also joined up with the American Lung Association to become one of their Lung Force Heroes—survivors that help raise awareness about the disease. (You can learn more about Lung Force and fund-raising efforts here.) Smith’s words of advice to others facing a frightening diagnosis? “This is probably one of the worst things you’ll ever face, so be sure to get care that you’re comfortable with—don’t settle for less.”

florida80

05-30-2019, 18:12

Finally: Good News About Prostate Cancer That Could Save Your Life

Thanks to a much better understanding of this common cancer, men are much more likely to survive prostate cancer—especially in the United States.

In the United States, 1 out of every 9 men will be diagnosed with prostate cancer in his lifetime. Scary news, but here’s something positive: The number of deaths due to the disease has plunged an amazing 51 percent from 1993 to 2016, according to the American Cancer Society, due largely to a combination of active surveillance and improved interventions.

“That is the largest fall of any major cancer of either men or women,” says Jonathan Simons, MD, an oncologist and the president and CEO of the Prostate Cancer Foundation. While the disease remains the most common cancer among American men other than skin cancer, with an estimated 164,690 new cases diagnosed in 2018, it is largely found in men aged 65 and older, with an average of diagnosis at age 66. Check out some more myths and truths about prostate cancer.

Prostate cancer facts

The prostate is a small gland about the size of a ping-pong ball located in men deep inside the groin, between the base of the penis and the rectum. Its job is to supply the seminal fluid (which mixes with sperm from the testes) in order to help sperm travel. A collection of nerves and blood vessels, called the neurovascular bundle, sits on either side of the prostate and also helps to control erectile function—which is why difficulty with erections is one of the signs of prostate cancer men should never ignore. In addition, the urethra, a narrow tube that connects to the bladder, runs through the middle of the prostate and along the length of the penis, through which both semen and urine travel out of the body. The prostate isn’t an essential organ, but it does play an important part in reproductive function.

Prostate cancer occurs when normal prostate cells mutate and grow out of control. But not all prostate cancers are alike. Some are very slow-growing and can take years to develop; others are aggressive and likely to divide and spread to other parts of the body relatively quickly.

Know your risk

Although age plays an important role, “Between 60 and 70 percent of prostate cancer is based on genetics,” says Dr. Simons. The disease is more common among African American men, who are 76 percent more likely to develop prostate cancer compared to white men and 2.2 times more likely to die from the disease, according to the Prostate Cancer Foundation.

Knowing your family history is key: Men who have had a relative with prostate cancer are twice as likely to develop the disease; those with two or more relatives are nearly four times as likely to be diagnosed. “There are at least 17 genes that we know of that are associated with prostate cancer today, including the ‘breast cancer’ genes BRCA1 and 2,” says Dr. Simons.

Sounding the alarm

“A big part of the decline in prostate cancer deaths is due to our being able to find the disease early and treat it appropriately,” says Rich Wender, MD, chief cancer control officer for the American Cancer Society.

There are two common ways to screen for prostate cancer: The first is a digital rectal exam (DRE), which allows a doctor to physically feel for irregularities. The second is a blood test that measures levels of PSA (prostate-specific antigen), a protein produced by the prostate. If something is wrong in the prostate (such as the growth of cancer cells), more PSA is released. “It’s like a smoke detector,” explains Dr. Simons. “While PSA will naturally rise as you get older, a sudden increase can signal that there’s a fire happening—the growth of cancer cells—that needs attention.” It’s not an exact science: Normal PSA levels vary and other things can cause it to rise, but it remains one of the most effective ways to screen for prostate cancer, adds Dr. Simons. “Most of the improvement in the reduction of the death rate due to prostate cancer has been early detection through PSA tests.”

The Prostate Cancer Foundation recommends that African American men get a baseline PSA screening starting at age 45 and that non-African Americans get an annual screening between the ages of 55-69. Because of the controversy over unnecessary treatment (invasive treatment for a tumor that might not ultimately spread or be dangerous), the U.S. Preventive Services Task Force does not recommend men over age 70 be screened. Here are some more things your doctor may not have told you about prostate cancer.

Watchful waiting

“About 40 percent of the prostate cancer diagnosed in the United States looks abnormal under the microscope but won’t kill you; the other 60 percent is aggressive or invasive,” says Dr. Simons. “Just as we shouldn’t be overtreating, we also still want to catch the more aggressive form.”

That’s where the idea of watchful waiting—or active surveillance—comes in. “A significant percentage of men with a low-risk prostate cancer diagnosis will develop a more aggressive second cancer,” says Dr. Simons. With active surveillance, men are advised to simply have their PSA levels rechecked on a regular basis to see if there is any unusual activity, and in some cases may also be given MRIs. “We have gotten better at helping men figure out if they have a form of prostate cancer that may be likely to progress,” notes Dr. Wender. “Active surveillance doesn’t mean doing nothing—it’s being an active participant in your health.”

Taking charge

Whether you’ve been diagnosed with prostate cancer or want to reduce your risk, there are steps to take to improve your health. The first is to watch your weight. “There’s clear evidence that having a BMI [body mass index] over 25 by the time you are age 30 increases your risk regardless of your genetics,” says Dr. Simons. Determine your BMI here.

Eating more cruciferous vegetables like broccoli, cauliflower, and Brussels sprouts can also help. “There appears to be a protective effect against prostate cancer from these types of vegetables,” says Dr. Simons. High-fat dairy—especially milk—on the other hand, may prove problematic.

Smoking not only increases your risk of lung cancer, but it can also speed the growth of prostate cancer, according to a recent study from Johns Hopkins University. If you’re struggling to kick the habit, here are 23 tips on how to quit smoking.

It can also pay to get some sunshine. Ultraviolet light is converted to vitamin D in the body, and that nutrient appears to have a protective effect against prostate cancer, says Dr. Simons. “Vitamin D is a hormone that not only keeps your bones strong but also boosts the immune system, so there may be some correlation there,” he adds. Researchers are studying whether vitamin D supplements might reduce prostate cancer risk, but it’s too early to make definitive recommendations, says Dr. Simons.

Finally, being physically active on a regular basis—walking at least 20 minutes a day, for example, or playing sports that raise your heart rate at least three times a week—may reduce your risk of prostate cancer. “Your prostate is the most sensitive organ in the body when it comes to exercise,” says Dr. Simons. “Every form of exercise appears to have a protective effect.”

Stay up to date

Being aware of your treatment options, which can range from active surveillance to surgery, is critical if you’re diagnosed. “It’s important to understand all of the risks and potential side effects involved,” says Dr. Wegner. Getting a second opinion can also be very helpful; you’re also more likely to hear up-to-date options if you seek care in a large health-care center where clinicians see a higher volume of cases. For more information, check out the Prostate Cancer Foundation’s patient and family guide, which provides the most up-to-date information on treatment options and risk assessment. You can also learn some surprising facts about prostate cancer here.

florida80

05-30-2019, 18:14

Why People with Red Hair Have a Higher Risk of Skin Cancer

Skin cancer is the most common cancer diagnosis in the United States. One in five Americans will develop skin cancer by the age of 70—and redheads are especially at risk. Here’s why people with red hair have a higher risk of skin cancer.

What is melanin?

Melanin is a pigment that special cells produce, according to Megan Winner, MD, a surgical oncologist with expertise in melanoma skin cancer from the NYU Winthrop Hospital. The melanin pigment absorbs light hitting the skin, dissipating the ultraviolet (UV) radiation from the sun before causing damage, Dr. Winner says. So it acts as the body’s natural defense against the harmful rays of the sun. “Exposure to UV radiation can directly harm the DNA of a skin cell, resulting in changes in the cell’s behavior that ultimately lead to the transformation of a normal cell into cancer,” she says. That’s why everyone should be regularly checking for these 7 skin cancer symptoms.

Why do people with red hair have a higher risk of melanoma?

People with lighter skin tone, particularly those with red hair, have lower levels of natural melanin protection and thus higher rates of melanoma, Dr. Winner says. The amount and type of melanin in our skin actually helps determine skin color, according to Shari Lipner, MD, a dermatologist at NewYork-Presbyterian and Weill Cornell Medicine. This same pigment determines hair color, too. Pheomelanin is the dominant, lighter pigment in people with red hair, while people with darker hair make the eumelanin pigment. These pigments are essentially why some people “tan” while others “burn” after sunlight damages the skin. Although you can’t control your natural hair or skin color, you can control these 9 surprising skin cancer risks you might be ignoring.

New research could make a difference

Recent research could make a big difference in decreasing the risk of melanoma in redheads. People with red hair have variants in the melanocortin-1 receptor protein, causing their light skin color, according to Dr. Lipner. The study showed mice given a small increase in palmitoylation, enhancing the melanocortin-1 receptor protection, were less likely to get melanoma than those who did not, Dr. Lipner explains. This research uses mouse models, however, and needs more work before applying the findings to humans, Dr. Winner notes. Plus, the body’s natural melanin alone is not enough to prevent skin cancer even in darker-skinned people, Dr. Winner says. So even if this research does eventually apply to people, you should never skimp on SPF.

In fact, people of all skin and hair colors can still decrease their risk of developing skin cancer by avoiding the sun during peak hours, regularly applying sunscreen, avoiding tanning beds, wearing protective clothing, and visiting a board-certified dermatologist for any concerning or changing spots on your skin. Checking out these 50 other things dermatologists need you to know about skin cancer also helps.

florida80

05-30-2019, 18:16

10 Things That Happen to Your Body When You Stop Eating Sugar

Denise Mann, MS

Cutting out sugar isn’t easy, but the health benefits are exponential—and they kick in almost immediately after you rein in your sweet tooth. Here’s exactly what happens.

You will look younger

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Jacob Lund/Shutterstock

Sugar equals wrinkles, says Anthony Youn, MD, a plastic surgeon in Troy, Michigan, and author of The Age Fix: A Leading Plastic Surgeon Reveals How To Really Look Ten Years Younger. “Sugar causes glycation, a process by which the sugar molecules bind to and deform the collagen and elastin in our skin,” he says. Collagen and elastin are the two main proteins that give our skin its youthful, supple properties, so we want to preserve them as much as possible.”Giving up (or reducing) the amount of sugar you eat can also reduce glucose and insulin spikes in your bloodstream, reducing chronic and acute inflammation linked to aging.” You can get your glow on within 14 days of giving up sugar, Dr. Youn says. Here’s how to get started cracking a sugar addiction.

florida80

05-30-2019, 18:16

You’ll get happy

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Jacob Lund/Shutterstock

“You might think eating a cookie will make you happy, but sugar consumption has actually been linked to higher rates of depression,” says Megan Gilmore, a certified nutritionist consultant in Kansas City, Kansas, and author of No Excuses Detox: 100 Recipes to Help You Eat Healthy Every Day. “This may be due to the fact that sugar can lead to chronic inflammation, which impacts brain function.” When you cut out sugar, you might feel that fog lift, along with your mood, in just one to two weeks, she says. Research helps to back this up. Women who consumed foods that ranked high on the glycemic index, including those rich in added sugar, were more likely to be depressed than women who ate fewer of these foods. This study appears in the June 2015 issue of The American Journal of Clinical Nutrition. If you control sugar spikes, you keep your moods in check, confirms Leah Kaufman, MS, registered dietitian at NYU Langone’s Weight Management Program. “Think about a kid on Halloween. After they eat all that sugary candy, they get a sugar high and then they crash,” she says. This is what happens when adults eat sugar too. Another study also shows that men who 67 grams or more of sugar per day had a higher risk of developing depression than those who ate less than 40 grams per day.

florida80

05-30-2019, 18:17

You’ll shed pounds

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Ruslan Shramko/Shutterstock

On average, we consume 22 teaspoons of added sugar a day, which equals around 350 calories, according to the Harvard School of Public Health in Boston. “Sugar can be addicting, and when we decrease the amount that we eat, it also stops cravings, so we consume fewer calories and lose weight,” Kaufman says. “When you eat refined sugar, your body may not get the signal that you’re full, causing you to consume too many calories and gain weight,” Gilmore says, adding, “When you replace sugar with nourishing whole foods, your hormones will naturally regulate, sending signals to the brain when you’ve eaten enough.” As a result, you’ll lose weight without trying so hard—often within the first week, she says. Look out for these signs you are eating too much sugar.

florida80

05-30-2019, 18:18

You’ll catch fewer colds

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Subbotina Anna/Shutterstock

Sugar contributes to chronic inflammation, which lowers our immune system’s ability to fight off colds and flu, Gilmore says. What happens to your body when you stop eating sugar? “You’re likely to have fewer sniffles year-round, and it may also help to reduce your allergy and asthma symptoms too.” A study published in the American Journal of Clinical Nutrition found that eating 100 grams of sugar lowered white blood cells’ ability to kill bacteria by as much as 50 percent—and this effect lasted for up to 5 hours. It’s not too difficult to eat less sugar if you try these easy food swaps to reduce your sugar intake.

florida80

05-30-2019, 18:18

You’ll lower diabetes risk

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Syda Productions/Shutterstock

Quitting sugar gives your body’s natural detox systems a chance to do their job. “In the first couple of hours without sugar, your pancreas will start to produce less insulin and your liver will also start to catch up on processing stored toxins,” explains Marc Alabanza, a Certified Nutritional Counselor and program director of GroundSea Fitness, a detox retreat in the Berkshires of Massachusetts. This process will take a little longer if you are already insulin resistant (a pre-diabetes state in which your body produces the hormone insulin, but doesn’t use it properly), he adds. “The time for most of these symptoms to completely subside can run up to five weeks, at which point one will no longer be a slave to refined sugar.” Don’t miss these 7 ways to maintain healthy blood sugar

florida80

05-30-2019, 18:19

You’ll live longer

“When glucose spikes after eating sugary food, our insulin increases to compensate for it, and this activates a part of our nervous system which increases blood pressure and heart rate,” Kaufman says. High blood pressure is a major risk factor for heart disease, as is diabetes and obesity, both of which have been linked to excessive sugar consumption. Sugar also increases unhealthy blood fats called triglycerides in the blood, which up risk for heart disease and stroke. In one April 2014 study, those who ate the most added sugar were most likely to die from heart disease than their counterparts who consumed the least

florida80

05-30-2019, 18:20

You’ll improve your breath and your smile

Your sweet tooth is really anything but when it comes to the health of your smile, says Saul Pressner, DMD, a dentist in New York City. “Sugar is a major cofactor in causing cavities as it interacts with bacteria in your mouth to form the acid that causes decay,” he says. Your breath will also improve as sugar feeds the bacteria that cause bad breath. These benefits will be immediate, and will only get better with time, he says. Here are some other things sugar does to your body.

florida80

05-30-2019, 18:21

You’ll have better sex

For men, eating sugar causes an insulin spike that drives pathways that reduce sex drive and function,” explains Mark Hyman, MD, Medical Director at Cleveland Clinic’s Center for Functional Medicine in Ohio and the Founder of the UltraWellness Center in Lenox, Massachusetts. Sugar also wreaks havoc female sex hormones, says Hyman, the author of several books including the 10-Day Detox Diet. This affects more than just sex life and desire, he adds. “It can cause women to lose hair on their head, and grow it on their faces as well as develop acne and irregular periods.” Reversing these effects are among the benefits of cutting out sugar

florida80

05-30-2019, 18:22

You’ll sleep like a baby

If it’s loaded in sugar, your midnight snack may rob you of the ability to get good night’s sleep, Dr. Hyman says. “People can develop low blood sugar and get night sweats if they have a sugary snack before bed,” he says. “Eating sugar before bed can also supercharge stress hormones, which leads to trouble sleeping. What happens when you stop eating sugar? You will get higher quality z’s within two or three days of kicking the sugar habit, he says.

florida80

05-30-2019, 18:23

Stay the course

It’s not necessarily easy to give up sugar, according to Auckland, New Zealand-based doctor Sharad Paul, MD, author of The Genetics of Health: Understand Your Genes for Better Health. “Sugar is addictive and triggers withdrawal symptoms if we stop eating it,” he says. “Mood changes like anxiety and anger usually last for about two weeks, but up to a month if you have been eating a lot of sugar over a long period of time.” Even artificial sweeteners like aspartame cause withdrawal effects, so it’s best not to use them as means to reduce sugar intake,” he says. Alabanza adds that headaches and flu-like symptoms may also occur, and you can reduce them with exercise, he suggests. “A moderate to brisk paced walk or hike can help by slightly increasing circulation and metabolism, boosting the immune system and giving the person something positive to focus on.” Next, don’t miss the 25 ways sugar is making you sick.

florida80

05-30-2019, 18:27

16 Secrets Bed Bugs Don’t Want You To Know—But Are Crucial For Keeping Them At Bay

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We may be tiny buggers (about the shape and size of an apple seed), but our presence elicits a massive case of the heebie jeebies. Read on to find out what you need to know to sleep tight and be sure we don’t bite
As a recent study in the Journal of Medical Entomology showed, we really like dark red and black (so maybe don’t choose bedding in those colors) and tend to stay away from white, green, and yellow. Researchers think these colors offer good protection from predators like ants and spiders. And since we have a red exoskeleton, it’s likely that we’re drawn to this color because it suggests the presence of other bed bugs—and we generally like to stick together to stay safe

florida80

05-30-2019, 18:31

What Are the Signs of Bed Bugs?

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Bed bugs go to great lengths to stay out of sight, something they excel at thanks to their tiny size and flat shape. When they’re not sucking your blood—usually at night, but they can adjust to daytime sleepers—they prefer to hide in dark spaces where they can digest their meal, mate, and lay eggs. Even though you might not see the creatures, you can see evidence of them: These are the bed bug signs entomologists use.

Watch for bed bugs

If you’re sharp-eyed, you might spot the insect itself: They’re about the size of an apple seed. That’s why they creep up on you while you’re sleeping because they don’t want to be disturbed while feeding or when they are digesting their blood meal, mating or laying eggs in their harborage, hidden out of sight. They’re also quick and will scatter when you enter the room. Here’s where you can get a better sense of what bed bugs look like.

Watch for bed bug bites

bed bug rash
Courtesy National Pest Management Association

A clear bed bug sign is a bite—which you’ll wake up with when they’ve been feeding on you at night. If you wake up feeling itchy and have red welts or bumps in a line or in several zig-zag clusters, that’s a good indication you’re dealing with bed bugs. The bugs have a numbing agent in their saliva so you don’t feel the bite, says Brittany Campbell, PhD, an entomologist with the National Pest Management Association (NPMA). The itching that most people feel stems from a mild allergic reaction to the numbing agent. The good news, she says, is that bed bugs are unlikely to spread disease, unlike other biting insects like mosquitoes.

Bed bugs are stealthy by nature—you'll rarely see them scampering around your house. Here are the signs you have an infestation

florida80

05-30-2019, 18:31

Watch for bed bug poop

bed bug eggs
Courtesy National Pest Management Association

“Regardless of the blood source or host,” says Campbell, “once bed bugs digest their blood meal and excrete it, it appears as dark brown or black spots on a surface—very similar to what you would expect an ink stain to look-like if your pen leaked onto your clothing,” says Campbell. You might notice the spots on your sheets, mattress, box springs, or in the cracks and crevices of your headboard, nightstand, or other bedroom furniture. Other “droppings” are tiny blood spots. Sometimes bed bugs “overeat” and they excrete a few drops of blood that will appear as tiny red dots if the fabric or upholstery is a light fabric.

florida80

05-30-2019, 18:32

Watch for bed bug shells and eggs

Other bed bug signs include molted shed skins and eggs, says Campbell. “The molted skins are very thin and lighter in color but will be in the same shape as a bed bug since they are essentially the left-over skin of the bug.” You might be able to see eggs, though they are tiny—about the size of a pinhead—and whitish or translucent. Still, these are bed bug signs to look for when you check into a hotel room.

florida80

05-30-2019, 18:33

Watch for bed bug signs in other rooms

Bed bugs won’t stay in your bedroom—if you fall asleep in front of the TV on the couch or in a recliner, say, they’ll set up camp in the furniture nearby. “Bed bugs commonly infest sofas and chairs and can even hide unseen in chair legs, if the legs are hollow. The bugs will reside in any hidden crack or crevice of the sofa, including deep into the couch under the cushions, inside of the wooden structure of chairs and sofas or metal, as well as inside of screw holes and screw heads,” says Campbell. Just don’t look for the bugs in your hair—and don’t fall for these other myths about bed bugs.

florida80

05-30-2019, 18:34

Where else can I see bed bug signs

You can find bed bug signs in curtains, walls, behind baseboards, wallpaper, picture frames, books, electrical switch plates, electronics—really, just about anywhere inside your home. They can also hitch rides: “Beg bugs are also known to survive in temporary or alternative habitats, such as in backpacks and under the seats in cars, buses, and trains,” says Campbell.

florida80

05-30-2019, 18:37

12 Things You Think Are Contagious—But Aren’t

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Just because something looks bad doesn’t mean it’s contagious—and that includes these icky diseases, disorders, and infections

If you’re not sure what condition someone has and you’re not a medical professional, you probably won’t be able to tell. Visible symptoms for contagious and non-contagious diseases can seem identical, and the mode of transmission depends on the particular disease. “There is not a single relationship between the cause of an infection and its contagiousness, as there are bacterial diseases that are contagious and others that are not,” explains Amesh Adalja, MD, an infectious disease physician and Senior Scholar at the Johns Hopkins Center for Health Security, adding that the same is true for the world’s smorgasbord of viruses. And then there are the conditions caused by a malfunctioning immune system or environmental factors. The bottom line: It’s never a bad idea to take safety precautions. “Overall,” says Dr. Adalja, “being vaccinated and frequent handwashing are good practices regardless

How can you tell if something’s contagious?

florida80

05-30-2019, 18:40

Pneumonia

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Whether or not this lung infection is contagious depends on what caused it. Two types of pneumonia that can’t be spread from person to person are fungal pneumonia, which is contracted from the environment, and aspiration pneumonia, which occurs when food or liquid is inhaled into the lungs. On the other hand, bacterial and viral pneumonia—which cause most cases of pneumonia, according to the American Lung Association—are indeed contagious, though not in the way you might think. “The causative microorganism may move between people but may not automatically cause pneumonia,” says Dr. Adalja. “For example, some bacteria may just colonize the nasal passages, while influenza, which can cause pneumonia, may cause bronchitis in another individual.”

Whether or not this lung infection is contagious depends on what caused it. Two types of pneumonia that can’t be spread from person to person are fungal pneumonia, which is contracted from the environment, and aspiration pneumonia, which occurs when food or liquid is inhaled into the lungs. On the other hand, bacterial and viral pneumonia—which cause most cases of pneumonia, according to the American Lung Association—are indeed contagious, though not in the way you might think. “The causative microorganism may move between people but may not automatically cause pneumonia,” says Dr. Adalja. “For example, some bacteria may just colonize the nasal passages, while influenza, which can cause pneumonia, may cause bronchitis in another individual.”

florida80

05-30-2019, 18:43

Legionnaires’ disease

Water tap flowing in The bathroom

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An outbreak doesn’t always result from an infected person or animal. In the case of Legionnaires’ disease, a contaminated water supply is the culprit: Transmission only occurs when a person inhales mist or water droplets that contain the bacteria Legionella. According to the National Institutes for Health, exposure can come from faucets, showers, whirlpools and the ventilation systems of large buildings. While this rare form of pneumonia can be severe and deadly, not everyone who is exposed to it will contract it. People at particular risk include those over 50, especially if they have a weakened immune system or chronic illness.

florida80

05-30-2019, 18:45

Psoriasis

This skin disorder that affects around two percent of Americans has nothing to do with germs or bacteria. “Psoriasis is an autoimmune condition in which the immune system attacks the skin,” explains Dr. Adalja. “It is not caused by a microorganism that can be passed between people.” Telltale signs include red, itchy patches of skin topped by white or silvery scales that are often found on the elbows, knees, and scalp; they occur when the body creates and accumulates new skin cells too quickly. Don’t miss these 6 surprising signs of disease your skin can reveal

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florida80

05-30-2019, 18:47

Ear infections

health, people and hearing concept - close up of young african american woman ear

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The good news: You can’t catch an ear infection. The bad news: If a germ caused this painful malady instead of, say, water in your ears, you can catch that germ responsible—and the most common culprit is a cold virus. “Due to congestion caused by the cold, the inner ear fills up with fluid and can become secondarily infected by bacteria; these stay in the ear and are therefore not contagious,” explains Matthew Mintz, MD, Clinical Associate Professor of Medicine at the George Washington University School of Medicine and an internal medicine and primary care doctor in Bethesda, MD. “However, since the ear infection started with a cold, if the patient still has cold symptoms, they can still be contagious.” While ear infections can affect individuals of all ages, they more commonly hit children—they account for around 30 million trips to the pediatrician each year in the United States.

florida80

05-30-2019, 18:51

Rosacea

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vessels in the face, and sometimes small bumps filled with pus. Less commonly, rosacea can also lead to a thickening of the skin on the nose. While experts aren’t sure what causes this condition—which hits approximately 14 million Americans—they theorize that genetics, abnormal facial blood vessels, and possibly even the gut bacteria H. pylori may play a role. The National Rosacea Society explains that antibiotics used to treat rosacea may be effective because they help to combat inflammation, not because they’re killing bacteria.

florida80

05-30-2019, 18:51

florida80

05-30-2019, 18:55

Bronchitis

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Much like pneumonia, some forms of bronchitis are contagious and others are not: It depends on what’s causing the inflammation of the bronchial airways and the resulting coughing, wheezing, and general breathing difficulties. Acute bronchitis, which usually results from an upper respiratory infection that travels to the chest, is often caused by a virus and is contagious. Hundreds of viruses, as well as some bacteria, can potentially lead to bronchitis, and you can catch them when germs enter your mucous membranes through your eyes, nose, or mouth. Chronic bronchitis, however, isn’t contagious. This ongoing condition is often caused by long-term smoking or exposure to environmental pollutants.

florida80

05-30-2019, 18:57

Lyme disease

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Infected ticks are the only contagious things you need to worry about in terms of Lyme disease, according to the CDC—and only if they attach to your body and feast on your blood. That means that you can’t catch this bacteria-based disease from other people, whether it’s through casual contact, kissing, or even sex. Pets can’t infect you either, though they can carry ticks into your home. Fever, fatigue, and a distinctive bull’s eye around the infected site are among the early symptoms of Lyme disease, while later on, people may develop severe joint pain, debilitating headaches, tingling in their hands or feet, and brain and spinal cord inflammation

florida80

05-30-2019, 18:58

florida80

05-30-2019, 19:03

Poison ivy

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Just looking at a poison ivy rash may make you feel itchy, but it’s all in your head. Poison ivy cannot be transmitted to another person, even if you touch the rash or the fluid from a blister. Transmission can only happen if your skin comes in contact with the plant’s oil—called urushiol—which can happen either through direct contact with it or if it gets on your clothing or pets—and then you snuggle or pet them. Wondering if that rash is poison ivy? According to the Mayo Clinic, it will often present in a straight line, if you’ve brushed up against the plant. However, if it’s gotten onto your clothing or your beloved pup’s fur, the rash might be more haphazard and expansive.

florida80

05-31-2019, 18:39

16 Silent Symptoms of Leukemia You Shouldn’t Ignore

Jenny G. Zhang

Leukemia, or cancer of the blood cells, causes subtle and surprising symptoms throughout the body. These are clear signs you need to get checked.

What is leukemia?

Leukemia is a cancer of the blood and bone marrow, a malignancy that causes an abnormal production of certain blood cells. As the unhealthy blood cells crowd out healthy ones, blood function begins to falter and you may notice physical symptoms. The disease may get worse quickly if you have a type known as acute leukemia; the disease may progress slowly and get worse over time if you have chronic leukemia, according to the National Institute of Health. Regardless of which type you have, if you notice a collection of these subtle leukemia symptoms, see your health care provider for an evaluation.

florida80

05-31-2019, 18:39

Fatigue and weakness

Fatigue and weakness are the most common leukemia symptoms, according to Mark Levis, MD, PhD, the director of the leukemia program at the Johns Hopkins Sidney Kimmel Comprehensive Cancer Center. These signs are often caused by anemia (a deficiency of red blood cells), which only compounds the physical exhaustion. In both chronic and acute cases, you may experience a range from slight fatigue to extreme physical weakness, but in all cases, the symptoms only worsen over time. “It creeps up on people, that’s the problem,”

florida80

05-31-2019, 18:41

Shortness of breath

As patients grow weaker and more fatigued, they may also experience shortness of breath that stems from anemia or, in much rarer cases, masses in the chest. “They’re panting, they’re out of breath,” says Dr. Levis. “Walking across the room might be difficult.” Shortness of breath also makes the list of lung cancer symptoms

florida80

05-31-2019, 18:43

Excessive or spontaneous bruising

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Unexplained bruises without any physical trauma may be one of many leukemia symptoms, according to Pamela Crilley, DO, chair of the department of medical oncology at the Cancer Treatment Centers of America and chief of medical oncology at the Eastern Regional Medical Center. Unusual bruising is a result of a low platelet count or clotting issues, explains Dr. Levis. “You will bruise spontaneously, seemingly doing nothing,” he says. “It can be anywhere, but typically they’ll be on the extremities—legs and arms.”

florida80

05-31-2019, 18:45

30 Simple Ways You Can Prevent Cancer

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Similar to bruising, unusual nosebleeds or bleeding in the gums, bowels, lungs, or the head may be a sign of platelet deficiency and clotting problems, which can indicate acute forms of leukemia, says Dr. Crilley.

Cancers don’t develop overnight. These cancer-fighting foods and other lifestyle moves can significantly reduce your cancer risk. Of course, you should always check with your doctor with any concerns.

florida80

05-31-2019, 18:52

Petechiae (small red spots under the skin caused by bleeding)

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Dr. Crilley describes petechiae as “like someone painted little red dots with a pen.” The spots, which you might not notice because of their size, painlessness, and placement in the lower extremities, indicate a low platelet count and are one of the symptoms of leukemia. According to Dr. Levis, petechiae are typically found around the ankles because gravity results in the accumulation of bodily fluids in the lower legs throughout the day.

florida80

05-31-2019, 18:53

Swollen and enlarged gums

Although an increase in the size of the gums, also known as gingival hyperplasia, is usually only found in a small portion of acute leukemia patients, it’s one of the most obvious leukemia symptoms. “If you have a patient with leukemia, you always look in their mouth to see if the gingiva has gotten bigger,” says Dr. Crilley. The gum may look swollen, says Dr. Levis, and you nearly always feel a strange tightness in your mouth

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florida80

05-31-2019, 18:57

Feeling full or bloated

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One sign of chronic—and sometimes acute—types of leukemia is an enlarged spleen, which may result in a loss of appetite. You might have what’s called “early satiety,” according to Dr. Crilley. “Patients eat a little bit of food, they feel full quickly because the spleen is pushing up on the stomach,” she says

florida80

05-31-2019, 18:58

Discomfort or pain in the upper left abdomen

An enlarged spleen caused by leukemia sometimes results in abdominal discomfort or even sharp pain. “A patient that presented to me with chronic leukemia a few weeks ago, part of his spleen had died off from spleen enlargement,” says Dr. Levis. “It hurt like heck. It was a sharp pain in his abdomen.” Because the spleen is located in the upper-left quadrant of the abdomen, the discomfort usually occurs there. Don’t miss the 29 things you think cause cancer but actually don’t.

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florida80

06-01-2019, 20:58

FDA takes major step to lower insulin prices

FDA is advancing major new policies to lower insulin prices in the United States.

In a statement published on April 2, 2019, FDA announced plans to transition certain biological products—including the diabetes medication insulin—that have been historically regulated as conventional drugs (a.k.a. small-molecule drugs) under the Federal Food, Drug, and Cosmetic Act (FD&C Act) to be regulated as biologics under the Public Health Service Act (PHS Act). PHS Act typically regulates FDA approval of most biologic drugs.

FDA explained that this transition will allow biosimilar insulin products and substitutes to come to market for the first time, stimulating competition and hopefully lowering the drug’s prices.

The price of insulin has been a pressing issue in public minds, especially among patients with diabetes, pharmacists, and physicians. While the medication has been around for nearly a century, its price continues to skyrocket by double digits annually.

These soaring prices are due in part to a lack of effective competition in the market for insulin products and biosimilar substitutes. Until recently, insulin and other biologic drugs did not have an “abbreviated pathway for bringing follow-on versions to market under the PHS Act,” according to the statement. This changed with the 2010 Biologics Price Competition and Innovation Act through which Congress authorized FDA to open biologics regulated under the PHS Act to competition.

FDA will hold a public hearing on May 13, 2019, to discuss this transition and the unique challenges the introduction of competitive insulin products may bring. The agency hopes to gain feedback from stakeholders and patients alike regarding different factors it should consider as it works to build a “solid regulatory foundation for the review and approval” of these products. FDA added that the input from the hearing will also help to inform the agency on further steps it can take to make high-quality, affordable insulin options more accessible to the public.

florida80

06-01-2019, 20:59

Pharmacy pet care: Benefits for animals, their owners—and pharmacists

Kristin Wiisanen

, PharmD, FAPhA (Editor-in-Chief, Pharmacy Today)

As pharmacists, we work every day to make sure people get the right drug at the right dose at the right time. An increasing number of pharmacists are focusing their efforts on veterinary medications to help ensure the same level of care for our animal patients.

This month’s Innovations cover story (page 24) holds a special place in my own heart, as I have seen two beloved family pets pass away in the last 6 months—our 12-year-old golden retriever, who suffered from genetic pigmentary uveitis; and our 10-year-old chocolate lab, who passed away within a few days of being diagnosed with lymphoma and acute kidney failure.

Getting involved with pet care is more than simply a good business opportunity or diversification strategy for many pharmacists. It’s also an important area of specialized practice. Animals are not simply “smaller, larger, fuzzier, scalier, featherier versions of humans … extrapolating [animal doses] from human pharmacotherapy is rarely appropriate,” said Gigi Davidson, RPh, DICVP, director of clinical pharmacy services at North Carolina State’s College of Veterinary Medicine. Check out our cover story to learn more about business model opportunities, common pet care medications, and even some personal stories from veterinary pharmacists.

In this month’s Pharmacy Today, you’ll also learn the latest on newly approved drugs (page 10), updated American Heart Association guidelines for blood pressure measurement (page 19), and recent FDA warnings about deaths with febuxostat (page 22). Catch up on your continuing education with this month’s CPE article reviewing diabetes self-management technologies (page 43).

My family will always have a special place in our hearts for the pets we have lost this year. We will also be forever grateful to the pharmacists who helped us afford up to 16 doses of eye drops per day, compounded custom formulations of pet medications, and provided guidance on administering medications to our pets after surgery and in dialysis. Never underestimate the benefit to your human patients of providing excellent and compassionate care for their pets

florida80

06-01-2019, 20:59

What’s the right treatment plan for imbalances in pharmacist workforce supply and demand?

Thomas E. Menighan

, BSPharm, MBA, ScD (Hon), FAPhA (Executive Vice President and CEO, APhA)

Imbalances between workforce supply and demand are notoriously difficult to resolve. Market corrections can take decades to work themselves out, and leaving the market to self-correct doesn’t help those who are suffering today. APhA aims to tackle the problem, yet this stuff is hard! Still, our proactive efforts have opened some potential avenues to progress.

We’re making headway, but just as market and practice changes took time, so will solutions. Since June 2017, APhA’s leadership has targeted the challenges that affect the well-being and resiliency of pharmacists and pharmacy personnel, and our efforts picked up through the discussions of our 2018 House of Delegates. The complexities we’re facing include workforce changes, health care and societal economics and their associated pressures, payer policies, and provider status. It isn’t as simple as “too many schools”!

We’re still working on the profession’s “big picture issues,” including provider status and other regulatory, financial, and legislative remedies. We’re also tackling these short-term issues:
■Payment policies that harm the sustainability of pharmacy practices and their ability to safely provide services to patients.

■Pharmacy safety concerns that are very real and must be addressed.

■Workplace conditions that make many frontline pharmacists feel like they’re in an assembly line. System efficiencies, use of technology, and reductions in administrative burdens can reduce practitioner pain points and allow enhanced focus on patient care.

■Concerns about retaliation against staff who speak up. Retaliation is a violation of the most basic tenets of patient safety systems. At APhA2018 and APhA2019, the APhA House of Delegates adopted a policy officially opposing retaliation and expressing support for systems that allow pharmacists to share their patient safety concerns without fear of losing their job or facing sanctions.

■Pharmacist and pharmacy personnel well-being. Self-care and resilience are essential for any health care professional, and pharmacist well-being is at the center of a major new APhA initiative we’re getting off the ground. Our November 2018 statement on pharmacist and pharmacy personnel well-being and resilience identifies important parts of the equation, such as employer and workplace issues, payment policies, pharmacist recognition, and system issues.

We will convene a consensus conference in July 2019 to facilitate collaborative, respectful dialogue among employers and pharmacy staff, educators, regulators, and policymakers that balances their respective needs and objectives. Stay tuned to learn more about the outcomes of our July 2019 consensus conference.

florida80

06-01-2019, 21:01

23andMe releases pharmacogenomics test that doesn’t require prescription

Loren Bonner

Upwards of 20 companies and more than 70 labs offer pharmacogenomics testing through a health care practitioner, giving patients and providers insight into how patients might respond to certain medications.

As pharmacists and other practitioners are trying to get up to speed with this new science, the consumer genetics testing company 23andMe announced in late 2018 that it gained FDA approval for a first-of-its-kind pharmacogenomics test that can bypass a practitioner completely.

According to reports from FDA and 23andMe, the test examines 33 different variants for eight different genes that produce drug metabolizing enzymes. This roughly translates to providing information on how a patient metabolizes about 50 different prescription and OTC medications. While 23andMe has yet to say when the test will be available to patients and for how much, FDA issued a strong statement warning patients and health care practitioners not to use the results to make any treatment decisions.

“FDA is basically saying ‘buyer beware,’ ” said Manju T. Beier, PharmD, BCGP, FASCP, senior partner at Geriatric Consultant Resources LLC and adjunct associate professor of pharmacy at the University of Michigan in Ann Arbor.

For some time now, Beier has been advocating that more pharmacists need to be educated about pharmacogenomics. She believes the recent news from 23andMe can serve as a wake-up call.

“This is yet another tool to utilize judiciously to manage and monitor therapy,” she said.

“Pharmacists are really furthest down the path on pharmacogenomics education,” said David Kisor, PharmD, director of pharmacogenomics education at Manchester University College of Pharmacy in Indiana. “The education that pharmacists are receiving through current certification programs, [continuing education], or graduate programs is necessary to put the pharmacist in the position to discuss this with the public appropriately.”

Kisor hopes the direct-to-consumer test from 23andMe, called the Personal Genome Service Pharmacogenetic Reports test, can ignite a broad discussion with the public about pharmacogenomics testing.

“When we look at educating individuals about pharmacogenomics, we tend to work from the health care provider down to the patient level, and this is really an opportunity to work at the patient or public level,” said Kisor.

Where’s the risk?

Some confusion and even contradiction surround how the new test is supposed to work. In press statements, both 23andMe and FDA

florida80

06-01-2019, 21:01

New and emerging considerations in Parkinson’s disease

Joseph Ladd

With roughly 1.5 million Americans diagnosed and 50,000 new incurable cases each year, Parkinson’s disease (PD) has become prevalent in the United States. For some time, the cornerstone of treatment was with levodopa and carbidopa, but in our ever-aging population, medications are needed to address “off” episodes when drugs simply do not work and to treat debilitating symptoms of PD, such as tremor and gait difficulties.

“We need neuroprotective therapies that can be started much earlier than we currently start treatment,” said Jeannette Wick, MBA, RPh, FASCP, assistant director of pharmacy professional development at the University of Connecticut School of Pharmacy. “That is, right now we tend to treat the symptoms, when what we really need is to get to the root of things and have some treatments that are preventive.”

To offer patients gold standard care and prepare them for what to expect in the future, health care providers must become familiar with current and developing therapeutic options for PD.

PD now and in the future

Recently, FDA extended its goal date for review of a levodopa inhalation powder (Inbrija—Acorda Therapeutics) from October 5, 2018, to January 5, 2019.1

If the drug makes it to market, it will be the second drug approved for PD in more than 10 years, following safinamide’s (Xadago—Newron Pharmaceuticals SpA) approval in 2017. Inbrija claims to have improved bioavailability through bypassing the digestive tract with inhaled delivery.

Safinamide is an add-on treatment for patients who are taking levodopa/carbidopa (Rytary—Impax Laboratories) and can help reduce “off” episodes. Dopamine agonists like ropinirole and pramipexole may also be considered, but note the two- to threefold increase in the odds of patients experiencing impulse control disorder. Pimavanserin (Nuplazid—Acadia Pharmaceuticals) helps manage nonmotor symptoms such as depression, dementia, psychoses, and constipation, and has robust effects in patients with cognitive impairments.

“One of the most significant changes in PD has been wider use of deep brain stimulation,” said Wick. “This is an area where pharmacists frequently can be helpful to patients and clinicians, as medications need to be adjusted in the perioperative period.” In contrast to other PD surgeries, deep brain stimulation (DBS) is reversible and causes minimal damage to brain tissue. DBS also allows adjustments to be made externally on the basis of symptoms.

The glucagon-like peptide-1 receptor agonist exenatide has shown trends toward less deterioration of motor function for patients in early studies. It might also provide some improvement in nonmotor symptoms and quality of life, but further research is needed.

Medications commonly associated with drug-induced parkinsonism

High risk

Medium risk

Low risk

Dopamine D2-receptor blockers Some second- and third-generation antipsychotics Antiarrhythmics
Reserpine, alpha-methyl dopa, tetrabenazine Calcium-channel blockers with dopamine agonist activity Some antidepressants
Metoclopramide Antiepileptics (valproate) Immunosuppressants

(cyclosporine, tacrolimus)
Prochlorperazine Lithium

Amoxapine Statins, some antivirals/antifungals, and antibiotics
View Table in HTML

Note: This is not a complete or totally inclusive list.

Source: Reference 2

.

Likewise, more evidence on the use of cannabidiol (CBD) oil for PD symptoms would be helpful. While CBD oil is now used fairly often across the United States, much of the information gathered is anecdotal.

PD in practice

Pharmacists can have an integral role in educating patients with PD and helping them manage their medications safely and effectively. They can also monitor for motor and nonmotor symptoms and postsurgical complications, as they may have frequent access to patients. While assessing new prescriptions, help patients avoid drugs that could cause troubling symptoms. The table reviews some medications that risk inducing parkinsonism.

Levodopa absorption is decreased by high-protein meals, so encourage patients to take this drug 1 hour before or after food to help maintain consistent plasma concentrations.

A synergistic effect has been recognized between DBS and levodopa therapy that allows levodopa to work more effectively and helps some patients use less medication. Immediately after surgery, however, this effect may temporarily magnify levodopa-induced dyskinesias. Patients and clinicians must be prepared for this possibility.

Before DBS surgery, patients should discontinue medications for at least 12 hours. Rarely, patients can stop medications completely following DBS, but this is unrealistic; and clinicians should help patients manage expectations for goals both short term and in the future.

“Hopefully, we’ll have considerably more options to deal with our Parkinson’s patients,” Wick said. “Ideally, they will be drugs that address symptoms evenly, and will have a better selection of less toxic medications.”

florida80

06-01-2019, 21:02

Guidelines add latest evidence for managing opioid-induced constipation

Joseph Ladd

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The American Gastroenterological Association (AGA) updated its guidelines on medical management of opioid-induced constipation (OIC), which were published last October in AGA’s journal Gastroenterology.1

Considering the climbing rate of opioid use in the United States and the rate at which OIC accompanies opioid therapy, clinicians may find that reviewing this latest evidence will confer benefits to many of their patients with chronic pain.

Approximately 9 to 12 million Americans suffer from chronic pain annually, and 4% to 5% of the U.S. population uses prescription opioids regularly. OIC is estimated to affect 40% to 80% of patients on chronic opioid therapy. While rates of opioid prescribing have risen throughout several decades, a true representation of those affected by opioid-induced adverse effects and dependence is greater because of increased nonmedical or illicit use.1

As a condition specifically associated with the effects of opioids, OIC differs mechanically from other forms of constipation. For this reason, it deserves dedicated attention and an approach to treatment individualized for specific patients’ needs.

“In my palliative care practice, I have found that untreated constipation—or suboptimal treatment of constipation—can significantly impact a patient’s quality of life,” noted Leah Sera, PharmD, MA, BCPS, assistant professor of pharmacy practice and science at the University of Maryland School of Pharmacy. “We know that constipation is a predictable opioid-related adverse effect, and that patients don’t become tolerant to it. Several new drugs have been approved to treat OIC in the last few years. Guidelines help clinicians translate medical evidence into clinical practice and provide optimal care to patients.”

Recommendation review

This guideline was developed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology and best practices determined by the Institute of Medicine. Strong recommendations indicated that most individuals should receive the recommended courses of action, while conditional recommendations suggested that different choices would be appropriate for different patients and that clinicians should spend more time on these decisions. See the table for a graded summary of AGA recommendations for medical management of OIC.

Traditional laxatives were recommended as first-line agents for treatment of OIC because of their low cost, few safety concerns, and wide accessibility in generic or OTC formulations. To avoid potentially undertreating laxative-refractory OIC, the panel suggested treatment combining use of at least two types of laxatives from different classes before escalating therapy. These should also be administered in a scheduled fashion, versus “as needed” use, before considering alternative OIC therapy.

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Four peripherally acting μ-opioid receptor antagonists (PAMORAs) were reviewed, with naldemedine and naloxegol receiving strong recommendations. “Because PAMORAs all have similar mechanisms of action,” said Sera, “the authors of this guideline based their recommendation primarily on the quality of available evidence for each agent.”

Naldemedine was the only prescription drug evaluated by AGA with available long-term safety data available. The overall quality of evidence for use of naldemedine in OIC refractory to laxatives was considered high, but cost may pose limitations. Naloxegol was the first PAMORA approved by FDA, but its moderate-quality evidence for OIC management and high cost denote judicious use. Evidence supporting the use of methylnaltrexone was marked low, receiving downgrades for indirectness, inconsistency, and imprecision across outcomes. The availability of a S.C. formulation, however, may convey advantages in some clinical situations.

Limited consistent evidence exists to support a recommendation for use of lubiprostone or prucalopride for OIC treatment. In the literature, 6.4% of patients who received lubiprostone experienced adverse effects leading to treatment discontinuation, compared with 3.0% in the placebo arm. The quality of evidence for OIC treatment with prucalopride was inconsistent and marked down for suspected publication bias and imprecision.

Distinguishing OIC

OIC has variable descriptions throughout the literature. The most widely used definitions include not only a change in stool frequency, but also changes in stool consistency with or without difficulty upon defecation. On the other hand, opioid-induced bowel dysfunction more generally refers to a group of GI adverse effects associated with opioid therapy, including constipation, gastroesophageal reflux disease, nausea and vomiting, bloating, and abdominal pain.

The Rome IV definition for OIC1

, 2

is new or worsening symptoms of constipation when initiating, changing, or increasing opioid therapy that must include at least two or more of the following:
■Straining during more than one-fourth (25%) of defecations

■Lumpy or hard stools with more than one-fourth (25%) of defecations

■Sensation of incomplete evacuation with more than one-fourth (25%) of defecations

■Sensation of anorectal obstruction/blockage with more than one-fourth (25%) of defecations

■Manual maneuvers to facilitate more than one-fourth (25%) of defecations

■Fewer than three spontaneous bowel movements per week

A consensus definition of OIC, determined at a roundtable meeting by a multidisciplinary working group and published in the journal Neurogastroenterolog y & Motility, is “a change when initiating opioid therapy from baseline bowel habits that is characterized by any of the following: reduced bowel movement frequency, development or worsening of straining to pass bowel movements, a sense of incomplete rectal evacuation, or harder stool consistency.”1

, 3

Treating OIC

OIC is a common and debilitating GI effect of opioids, and some degree of constipation is near universal in patients taking opioids.1

These GI effects of opioids are mediated by κ-receptors in the stomach and small intestine and μ-receptors located in the small intestine and proximal colon. Activation of μ-receptors by opioid medications, resulting in increased tonic nonpropulsive contraction, increased colonic fluid absorption, and stool desiccation, is the primary driver of OIC. Opioids may also increase the minimum sensory threshold of the rectum and anal sphincter tone. Overall, these effects result in harder, dryer stool and less-frequent defecation.

One of the first steps to managing patients with OIC is ensuring that the indication for opioid therapy is appropriate. Patients should participate in a pain management program, ideally in conjunction with a pain specialist, and take the minimum necessary opioid dose. The guideline focuses on medical management of OIC and presumes that patients have had a prolonged requirement or dependence on opioids.

The AGA recommendations do not address the role of psychological therapy, alternative medicine approaches, surgery, or devices used to treat OIC. In addition, combination opioid agonists/antagonists are not specifically addressed, though these agents may result in less constipation than pure opioid agonists when used for management of chronic pain. “There is evidence that fixed-ratio combination prolonged-release oxycodone/naloxone may have a more favorable side effect profile with regards to constipation than other opioids,” said Sera.

Appropriate lifestyle modifications for patients with constipation include increasing fluid intake, getting regular moderate exercise as tolerated, and toileting as soon as possible in response to urges. “Opioid switching”—changing to an equianalgesic dose of an alternative, less-constipating opioid—may also be beneficial. Oral or parenteral morphine, for example, may induce more constipation than transdermal opioids like fentanyl.

The Bowel Function Index is a three-question tool that has been validated in the OIC patient population. A score of 30 or higher is consistent with clinically significant constipation, and a consensus panel recommended using this score cutoff to determine which patients would benefit from escalation of therapy after an inadequate response to two concomitant first-line laxative agents.

“Pharmacists can play a huge role in preventing OIC by counseling patients receiving new prescriptions for opioids about this predictable side effect,” said Sera. “Most patients who are taking a long-acting opioid should also be taking a traditional laxative, as described in the guidelines. Pharmacists can also help to identify exacerbating factors by taking a thorough patient history, and can triage patients who present with red-flag symptoms such as abdominal pain, vomiting, or bloody stools.”

florida80

06-01-2019, 21:03

Little adults? Big kids? Caring for adolescents and teens

Rachel Balick

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Skywalk Pharmacy staff members: Clayton Pope, CPhT; Jessica Araujo, CPhT; Colette Zlomaniec, CPhT; Kara Boghossian, PharmD; Lauryn Mattek, CPhT; Joyann McChesney, PharmD; Amy Hager, CPhT; Fabiola Zuniga, CPhT; Richard Dieringer, operations manager; Jelena Stojsavljevic, CPhT; Jennifer Garner, CPhT; Julie Gall, MBA; Amy Consolazione, PharmD; Jake Olson, PharmD; Stephanie Williams, CPhT.

Adolescence is an awkward time for everyone. There can even be awkward moments for pharmacists treating patients of that age.

“Oral contraceptives are an awkward thing to discuss with a teenager when their parents are nearby. They don’t want to ask questions. But we still have the responsibility to counsel them on appropriate use, including using extra protection for at least a week if they miss doses,” said Jake Olson, PharmD, owner of Skywalk Pharmacy, which has three locations in Children’s Hospital of Wisconsin in Milwaukee.

“That can be a difficult conversation if mom is standing right there. We need to be prepared for those real-life situations that didn’t come up when we were learning the art of consultation in pharmacy school,” Olson said.

It can get worse. “I’ve had a dad come storming in and say, ‘Is my daughter on birth control?’ ” he added.

A different world

“We are a pharmacy dedicated to working with children, and it’s a bit of a different world. Much of the medication information that’s out there is about adults and dealing with the health challenges that come when you’re older. Trying to find information on children and what they’re going through, especially in dealing with chronic pediatric illnesses, is a challenge,” Olson said.

But what did Olson do about that dad? “I looked at him and said, ‘That is a conversation you should have with your daughter, not me.’ My mind was racing to figure out what HIPAA says about discussing a minor’s medication with a parent. This is not addressed in fraud, waste, and abuse training,” he said. “I have also had parents say, ‘I’m paying for those medicines on my insurance, so you need to tell me.’ I have even had a parent in a divorced home ask for their year-end tax form to try to get information about the medications their child was filling that the other parent was picking up,” he said. “It’s really challenging to figure out how to respond without breaking confidentiality laws and maintaining the trust that the young adult has in me.”

What to say and to whom is a theme when it comes to treating teens and adolescents, Olson said. “Many times you think, ‘Should I talk to the parent, or should I talk to the child themselves? When is the appropriate time to transition from speaking with a parent about the child’s illness versus speaking to the child directly?’

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Boghossian; Gall; Maria Perez, sales associate; Carly Jones, student pharmacist; Brian Halm, PharmD.

“You want to include adolescents and teenagers in their own health care knowledge and treatment, but at the same time, you need to make sure that they’re actually taking their meds and being responsible,” he said. “We all know that ‘responsibility ’ is not the first word that comes to mind when you think about teenagers,” Olson said.

“If they have chronic illnesses—cystic fibrosis, juvenile rheumatoid arthritis, Crohn’s disease—there are very important medications that they need to take consistently. If they’re not taking their medications appropriately, then they end up getting sick,” Olson said. “But as a 13-year-old, is it supposed to be your job to remember to take your inhaler twice a day, or is that mom’s job to tell you that? And when does that start to transition to become your responsibility?”

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Boghossian and Olson.

Olson noted that, unfortunately, he’s seen kids as young as 5 who are forced to become their own primary health care provider because of issues in the home. “It’s eye-opening how young some children are who call in their own refills and receive their consultations when they pick up their medications.” But there’s another side to that coin. “We see 25-year-olds who are still waiting for mom to tell them when to take their pills.”

And then there’s that rebellious phase. “A child who’s 16 years old may start to experiment with alcohol,” Olson said. “A 60-year-old realizes that drinking too much alcohol with certain medications can have serious side effects. But teenagers sometimes have to learn that for themselves the hard way, and that can cause problems.”

Warning teens can be uncomfortable. “You need to say, ‘No driving with this medication and no drinking,’ and a helicopter mom is not letting you talk directly to the child,” Olson said. “Sometimes we ask mom, ‘Hey, mom, why don’t you go check out the candy over there in the corner,’ or ‘Why don’t you go next door for a second? I need to have a conversation with your child about some things.’ ”

Mental health

“Kids are really stressed out,” said Julie Dopheide, PharmD, professor of clinical pharmacy, psychiatry, and the behavioral sciences at University of Southern California and Keck School of Medicine. “Adults are stressed out, too, but adults have learned some coping strategies. Kids are figuring everything out all at once. They’re really anxious.”

Teens and adolescents might engage in self-injurious behavior and have suicidal thoughts and behaviors. “There are so many things that could make a youth think that suicide is their only way out. Some of it’s related to bullying, some of it’s related to anxiety, depression, not fitting in, gender identity issues,” Dopheide said. “They don’t have the futuristic thinking of, ‘Maybe when I’m 30, I’ll feel differently.’ ”

Dopheide said teens are highly reactive to their environment, with many variables that affect how they present from one day to the next. “They’ve got their friend group, they’ve got their parents, they’ve got their other extended family members. They tend to not be mature enough to think things through. They’re more impulsive,” Dopheide said. “It’s important to see them over time to get an accurate diagnosis.”

That can be a challenge for pharmacists. “Pharmacists only see the parents and the family members for a particular window in time,” Dopheide said. “I think the best thing practically for a pharmacist to do is to encourage the family not to jump to a diagnosis too quickly. Parents may want easy answers. Sometimes it’s a relief for them to know, ‘My child has this. So, I can just put them on that, or we can just get him this therapy, and then they’ll be fixed.’ But it’s not that simple.”

Pharmacists should encourage a systematic approach. “You have to look at what’s predominant in the child: is the anxiety predominant, the ADHD predominant, the depression predominant? And then you treat that first. Once that is better, you re-evaluate to see if the other conditions also need a medication,” she said.

“I’ve seen patients on five or six, even seven to nine meds. And they’re doing okay finally, so nobody wants to take anything off. That’s the fear: ‘Well, this combination’s working, so I don’t want to change anything,’ ” she said. “A child might be on clonidine and Risperdal, and they’ve got some aggression and they’ve got some ADHD, but they’re also anxious. And then they’re getting Benadryl for sleep and maybe they’ve also got melatonin, and then they’re adding Zoloft or Prozac, and then finally, they start to do well. But maybe it’s because they were depressed or anxious all along!”

Dopheide said that all pharmacists should learn certain principles of psychiatric pharmacotherapy. “The special thing about giving youth antidepressants is that they could potentially have a hyperarousal or activation type of reaction. They could get restless, jittery, more amped up or hyper. They could become more impulsive,” she said.

Pharmacists should refer patients experiencing activation syndrome to their psychiatrist. “It could be a sign that they might have an underlying bipolar disorder, or it could be a sign that they are at risk for acting on any suicidal thoughts.” She emphasized that this should not preclude antidepressants. “But we have to watch for that behavioral activation within the first month of starting the antidepressant,” she said.

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“Another premise for kids is that withdrawal symptoms are worse in youth than in adults. So, everything must be tapered off gradually,” she added.

Counseling teens on mental health

“While we might be talking to the parents the most, sometimes it is good to talk to the kids, especially if you’ve got someone who’s 14, 15, 16, 17. The medical model works well with those kids—they’ve had some biology, some biochemistry. You can talk to them about rebalancing chemicals in their brain and staying on a medicine to make sure their brain is healthy,” Dopheide said. She believes that message can destigmatize mental health conditions.

Sometimes cultural issues are at play. “A lot of cultures believe if you have a mental health condition, it’s embarrassing or a smear on the family, and maybe you’re a bad parent if your kid has some mental health condition. So, pharmacists can try to help develop a culture of anti-stigma,” she added. “It’s a very delicate area.”

Dopheide once treated a patient on the autism spectrum who was acting aggressively and hitting his mother when she tried to get him to eat. “Part of autism is you have particular food texture issues, and you don’t eat everything. But in that family’s culture, you’re supposed to eat! It’s a big deal if you’re not eating.”

She recommends pharmacists visit the National Alliance on Mental Illness (NAMI) website at www.nami.org to learn more about issues in various cultures. “And I typically recommend patients and families call their local NAMI groups, which sometimes have cultural chapters. In Santa Ana there’s a large Vietnamese community, so there’re NAMI groups that specialize in cultural issues in that area.”

Birth control

Sally Rafie, PharmD, is assistant clinical professor of health sciences at the University of California San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences. She is also the founder of birthcontrolpharmaci st.com and helped develop the California statewide protocol for self-administered hormonal contraceptives.

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Look out for adverse effects

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ADHD is one the most studied neuropsychiatric conditions in youth, and there are numerous ADHD formulations with different release forms that pharmacists should know about. “There’s now Jornay PM (Ironshore Pharmaceuticals), which is given at bedtime and takes effect in the morning. And there’s a recent meta-analysis that showed methylphenidate should be first-line in adolescents because of tolerability issues,” Dopheide said. She noted the availability of several new amphetamine compounds, variations of mixed amphetamine salts, and a triple-bead amphetamine, Mydayis (Shire). “Pharmacists need to stay on top of and help patients and families manage side effects and find the right ADHD medication for them.”

Dopheide urges pharmacists to scrutinize indications for antipsychotics to make sure that there is a valid indication, such as schizophrenia or bipolar disorder with psychotic features. They shouldn’t be used for anxiety, insomnia, or behavior control for conduct disorder for longer than a 3-month trial.

“Long-term use of antipsychotics like risperidone can lead to decreased bone density, and kids could be more at risk for fractures when they are playing sports or in general,” she said. She noted that there is evidence that this is a particular issue for kids with autism spectrum disorder.

“And then there’s the metabolic side effects of things like olanzapine and clozapine. You can develop diabetes, hyperlipidemia, and weight gain—it’s much harder to reverse if you develop these as a child or teenager than if you develop them as an adult.”

Emergency contraception

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Pharmacies typically stock Plan B emergency contraception (EC) products—the levonorgestrel-containing emergency contraceptives. A newer method, ulipristal acetate (Ella—Afaxys), is also available. “EC is extremely safe. There are essentially no contraindications for anyone of any age to be using those products,” Rafie said.

“Given all of the changes that happened in the last decade with the regulatory status of the Plan B products being prescription only, then OTC for 18 and over, and now fully OTC, it’s been really hard for pharmacies to keep up with all of that, especially because there isn’t targeted academic detailing or outreach to pharmacies. I think that is part of the reason why sometimes there’s misinformation out there,” said Rafie.

Rafie said pharmacies are the go-to source for EC. “We want to make sure pharmacists are knowledgeable about the products and are offering counseling, but not requiring it. Ideally, they are keeping the product out on the OTC shelves unlocked, because locking it just makes it more stigmatizing and intimidating. Then we should also be keeping some in the back in the pharmacy, because some patients will prefer to come straight to the pharmacist.”

For those times when you can’t help, “there are some really great resources out there. If a pharmacy is in a state where prescribing a birth control is available, but the pharmacy doesn’t provide that service, [pharmacists] can hop on BirthControlPharmaci es.com and find another pharmacy nearby to send the patient to. If the patient, for example, wants something like an IUD, something the pharmacy obviously can’t provide, [the pharmacist] can hop on Bedsider.org and find a clinic that can help them with that,” said Rafie.

Rafie encourages pharmacists to consider why their adolescent patients are pursuing hormonal contraceptives. “Sometimes, they may be seeking it for noncontraceptive reasons. So, they may not even be sexually active but may want to treat their acne, or maybe they have really heavy periods. So, while it’s not required in California that we get into the indications, it does allow for more patient-specific counseling and a better experience for the patient.”

Rafie advocates that pharmacists “think about making sure that we’re welcoming our younger population—so have literature that’s appropriate for youth, and have a confidential space to speak to young people so that it’s not in front of everyone.”

While some pharmacists may have personal biases toward teenagers having sex, “as long as they can acknowledge that and actively work around it to serve their patients’ needs, then I think they can still provide really respectful competent care to patients,” Rafie said. “Teens don’t want to have someone speak to them in a condescending fashion. So we want to make sure that we are respectful toward them and helpful and friendly. Our facial expressions, our tone—all of that makes an impact on their experience at the pharmacy.”

When dealing with sexually active adolescents, keep in mind that they “are typically at higher risk for STDs, so we should counsel them about safe-sex practices such as using condoms, as well as getting at least annual screenings for STDs,” Rafie said. Pharmacists should make sure that “our counseling is comprehensive, listening to the patient about their values and what they’re comfortable with. If they want a birth control method that they can hide from their parents, take that into consideration, and help them understand the importance of adherence for the effectiveness of the medication.

“There is one kind of additional counseling point when it comes to the Depo injection, which is the shot that’s good for 3 months. That does cause some reversible bone density loss in young people. We would just encourage them to use calcium and vitamin D supplements [and do] weight-bearing exercises, and then there’s a return of that bone density after they stop the medication,” Rafie added.

Opioids and other considerations

“Another challenge for pharmacists dealing with patients this age is when they stop getting weight-based doses and begin getting regular dosing for adults. When does that transition occur?” said Skywalk’s Olson.

“If you’ve got an 11-year-old who’s 5’11”, and you see there’s a weight-based dose for her, sometimes you have to think that through. Sometimes we get 18-year-olds with special needs who are really small, and you think, ‘Well, this is an adult, I should treat them as an adult.’ But no, they’re not big enough yet.”

Controlled substances for pain, ADHD, and other uses also pose consultation challenges at Skywalk. “We consult patients and families on postsurgical pain medications on a daily basis. We once again have to mention the risk of driving while taking opioids and the dangers associated with mixing it with alcohol,” Olson said. “We also have to say, ‘This is what you read about every day. This prescription is a gateway to potential abuse problems down the road.’ ”

He also tries to educate parents on the potential for abuse. “They need to know that it is important to dispose of unused medications promptly to make sure they don’t fall into the wrong hands,” Olson said. “We feel we can help combat the opioid problem with this initial education.”

florida80

06-01-2019, 21:04

New AHA/ACC cholesterol guideline recommends use of statins, new drugs

Loren Bonner

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The American Heart Association (AHA) and the American College of Cardiology (ACC) released a new guideline that emphasizes a more patient-centered approach to cholesterol management. The guideline, which was published in the November 2018 issue of the Journal of the American College of Cardiology, updates the 2013 AHA/ACC cholesterol guideline and incorporates all recent evidence relevant to the treatment of hypercholesterolemia .

Even though statins continue to be the cornerstone of therapy in the new guideline, health care practitioners—includ ing pharmacists—should know that just starting a statin is not sufficient, according to Joseph Saseen, PharmD, BCPS, BCACP, who was a part of the writing committee for the guideline, serving as APhA’s representative.

“Patients need to be evaluated after implementing therapy to ensure they are adherent, and to also ensure that an adequate response is achieved,” said Saseen, who is vice chair of the department of clinical pharmacy at University of Colorado Skaggs School of Pharmacy.

The updated guideline not only calls for a more personalized assessment of risk for patients, but also recommends nonstatin cholesterol lowering medications, including ezetimibe and proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors, for patients who are at the greatest risk.

Maximally tolerated statin use is recommended to reduce LDL-C levels by at least 50% in patients who have atherosclerotic cardiovascular disease (ASCVD). But when statins are not working and the patient is very high risk, the guideline endorses the use of new drugs, PCSK9 inhibitors, that have been developed since the 2013 cholesterol guideline—but after starting ezetimibe. The guideline stresses a healthy diet and exercise as the primary intervention for patients who do not fall into these categories.

APhA is listed in the AHA/ACC guideline report as an official partner organization that endorsed the new guideline.

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Individualized treatment decisions

The new guideline, like the 2013 version, still strongly recommends statin therapy for patients who are at an increased risk of ASCVD. It’s recommended that patients use a maximally tolerated statin to reduce LDL-C.

“However, there is now strong emphasis on evaluating the response to therapy by evaluating the LDL-C lowering while on therapy,” said Saseen. “It’s all about the LDL-C lowering achieved—if it’s not acceptable, then it’s recommended to intensify therapy,” he said.

If the threshold LDL-C value is not reached, the guideline recommends enhancing statin therapy and then adding ezetimibe. In some patients, then adding a PCSK9 inhibitor may also be an option.

However, it’s noted in the guideline that PCSK9 inhibitors are likely cost-prohibitive to patients, based on mid-2018 pricing. Evolocumab (Repatha—Amgen) and alirocumab (Praluent—Sanofi-Aventis) both launched in 2015 with a list price of more than $14,000 a year. One manufacturer announced a price reduction this past October to less than $6,000 a year, with the other one expected to do the same.

Karen McConnell, PharmD, FCCP, BCPS-AQ Cardiology, ASH-CHC, system director of Clinical Pharmacy Services at Catholic Health Initiatives in Colorado, found it interesting that the guideline incorporated the cost of PCSK9 inhibitors in the recommendations.

“They used cost considerations to add a value statement on high-cost therapies. I think more guidelines should incorporate this information so clinicians understand the overall cost for medications,” said McConnell, who was appointed by APhA as an expert reviewer of the guideline.

Tools for personalized assessment of risk for patients are included in the guideline. Also emphasized is the need for health care practitioners to have a clinical discussion with their patients, which they can use to guide their choice of therapy.

Assessing an individual’s other risk factors can help further determine risk and allow a patient and clinician to discuss treatment options on the basis of the patient’s specific risk factors. These include metabolic syndrome, a family history of premature ASCVD, kidney disease, chronic inflammatory conditions, HIV, race and ethnicities at a higher risk, elevated lipoprotein(a), or elevated high-sensitivity C-reactive protein.

“It is allowing for more individualized treatment decisions,” said Janelle Ruisinger, PharmD, FAPhA, clinical professor of pharmacy at the University of Kansas School of Pharmacy. She said pharmacists can aid in risk assessment and discussion with patients about treatment decisions.

“Physicians are already pushed to see more patients in less time, so this is an area where pharmacists can assist by engaging in the clinician–patient risk discussion, help patients understand their CV risk, and determine the appropriate treatment route based on the patient’s preferences,” said Ruisinger, who also served as an APhA-appointed expert reviewer of the guideline.

She said the same is true for conversations about lifestyle modifications that the guideline calls for. Pharmacists are fully equipped to educate patients about the importance of diet, exercise, and more.

Separate sections in the guideline discuss recommendations for special populations, such as older adults, and for patients with certain conditions, such as heart failure.

Pharmacists influence adherence

The guideline specifically mentions the important role of pharmacists on the health care team when treating patients with hypercholesterolemia .

“The 2018 version recognizes that pharmacists can have a positive impact on adherence, which is a constant struggle with lipid-lowering medications,” said Ruisinger.

McConnell said pharmacists in all settings can contribute. Those working in ambulatory care can make sure their chronic care patients are on appropriately dosed statins, are adherent to their medications, and have had an appropriate response to therapy. Pharmacists working in inpatient settings need to ensure patients are discharged on an appropriate secondary prevention medication, including those for lipids. In the community setting, a pharmacist can play a role in making sure patients are adherent to their medications, McConnell said, and if they are complaining about adverse reactions, pharmacists can work with their provider to find alternatives.

In addition to the AHA/ACC guideline, other guidelines exist for managing patients’ cholesterol: The National Lipid Association (NLA) Recommendations for Patient-Centered Management of Dyslipidemia; the American Association of Clinical Endocrinologists and the American College of Endocrinology Guidelines for Management of Dyslipidemia and Prevention of Cardiovascular Disease; and the U.S. Preventive Services Task Force’s statement on Statin Use for the Primary Prevention of Cardiovascular Disease in Adults: Preventive Medication.

Ruisinger said she thinks it’s important to be aware of the other guidelines. However, pharmacists should ultimately follow whatever their health care team chooses.

“Most practitioners follow the AHA/ACC guidelines, and a few follow the NLA guidelines,” said Ruisinger. “If the pharmacist is working with a primary care practitioner group that prefers to follow the NLA guidelines, that is reasonable. I think it is important that the team is on the same page and following the same guidelines or recommendations.”

The 2018 AHA/ACC guideline is based on a few key studies that were published since the 2013 guideline, including HOPE-3 (Heart Outcomes Prevention Evaluation-3); IMPROVE-IT (The Improved Reduction of Outcomes: Vytorin Efficacy International Trial); FOURIER (Further Cardiovascular Outcomes Research With PCSK9 Inhibition in Subjects With Elevated Risk); and ODYSSEY Outcomes (Evaluation of Cardiovascular Outcomes After an Acute Coronary Syndrome During Treatment With Alirocumab).

florida80

06-01-2019, 21:04

These strategies can prevent accidental daily methotrexate dosing

Institute for Safe Medication Practices

Methotrexate is a folic acid antagonist that was originally approved to treat a variety of cancers. For oncologic indications, methotrexate is administered in cyclical frequencies and in variable doses based on body surface area and the type of cancer being treated. The labeled indications for methotrexate later expanded to include treatment of nononcologic conditions, including psoriasis and rheumatoid arthritis. Methotrexate also is prescribed for other nononcologic off-label uses (e.g., Crohn’s disease, multiple sclerosis). For most nononcologic indications, a low dose of methotrexate is administered just once or twice weekly (e.g., 7.5 mg/wk when treating rheumatoid arthritis).

A high-alert medication

Relatively few medications are dosed weekly; thus, accidental daily dosing of oral methotrexate has occurred all too frequently. This type of wrong frequency error has originated in all stages of the medication use process, from prescribing to self-administration. These errors have resulted in serious overdoses that have led to vomiting, mouth sores, stomatitis, skin lesions, liver and renal failure, severe myelosuppression, GI bleeding, life-threatening pulmonary symptoms, and in some cases, death.

Since early 1996, harmful or fatal errors with daily oral methotrexate for nononcologic use have been reported to the Institute for Safe Medication Practices (ISMP). ISMP has designated oral methotrexate for nononcologic use as a high-alert medication since 2003. Although the risk of errors with oral methotrexate for nononcologic use has been known for a long time, harmful and fatal errors are still occurring today.

Fatal error

The most recent event involved an error that was caught during hospitalization but continued upon discharge when an incorrect entry for daily methotrexate on a patient’s home medication list was not corrected. An older adult with rheumatoid arthritis was admitted to a hospital with renal failure. At home, he had been taking oral methotrexate 2.5 mg twice weekly. When completing the list of the patient’s home medications, the admitting physician mistakenly documented that the patient had been taking 2.5 mg of oral methotrexate twice daily instead of twice weekly. He then made this an active order during the patient’s hospitalization.

Noticing the daily order for methotrexate, a pharmacist contacted the physician to let him know that he must prescribe daily methotrexate on a hospital-mandated chemotherapy order template. However, the pharmacist did not verify that the patient had an appropriate oncologic indication for the order. The physician then prescribed the daily methotrexate via a chemotherapy order template. Fortunately, an oncology pharmacist identified the error after talking to the patient and corrected the active order to twice weekly. However, it never occurred to the pharmacist to correct the methotrexate entry on the patient’s home medication list.

The patient received the correct dose during his hospital stay before being transferred to a skilled nursing facility. The physician reconciled the patient’s list of home medications for continuation upon discharge. In doing so, he pulled the erroneous methotrexate entry from the patient’s home medication list and prescribed oral methotrexate 2.5 mg twice daily. The patient received twice-daily methotrexate at the skilled nursing facility for more than a week before he was rehospitalized with a change in mental status, severe neutropenia, and mucositis.

Sadly, he died in the hospital about a week later.

Strategies

Most of the wrong frequency errors with methotrexate could be prevented by fully implementing long-standing risk reduction strategies, including the following:
■Defaulting to a weekly dosing schedule in prescriber and pharmacy order entry systems

■Requiring verification and entry of an appropriate oncologic indication in order entry systems for daily orders

■Educating patients and providing them with verbal and written instructions that specify the weekly dosing schedule, and emphasizing the danger with taking daily or extra doses

■Asking patients to repeat back the instructions for taking oral methotrexate to validate understanding

■Verifying the dose and frequency of all medication lists and discharge instructions

■Limiting the prescription quantity to a 30-day supply (e.g., dispensing just eight 2.5-mg tablets for a 5-mg/wk dose would reduce the risk of a serious overdose)

florida80

06-01-2019, 21:05

Pharmacists have duty to consult prescriber, court says

David B. Brushwood

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Pharmacists have a legal duty to screen prescriptions for potential problems and to consult with the prescriber when necessary to resolve problems in the patient’s best interests. An Ohio court has addressed the basis of this responsibility and the argument that prescribers either do not welcome, or will not heed, concerns expressed to them by pharmacists.

Background

The plaintiffs alleged negligence by the defendant pharmacy in dispensing lamotrigine to a 6-year-old patient. The lawsuit claimed that the dispensing pharmacist erred by not providing warnings to the patient and by failing to consult the prescriber about an excessive dose and off-label use to treat bipolar disorder.

The court said that the pharmacist testified “he knew lamotrigine was a dangerous antipsychotic drug when used for a child under 16 years of age. He knew that dosing was calculated by age and weight. He knew the prescription was ‘red flagged’ by [the pharmacy’s] computer DUR system. He failed to obtain the 6-year-old plaintiff’s weight and failed to call the minor plaintiff’s physician. He testified he could have easily done so and that he could have obtained the necessary information in 5 minutes or less. He was also aware that exceeding the dosage guidelines carried an increased dangerous risk for children. He failed to warn the plaintiffs of the dangers associated with the use of the drug at this dosage level.”

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The defendant pharmacy moved to dismiss the case, arguing that “courts across the country have ruled as a matter of public policy that a pharmacist has no duty to warn a patient of a drug’s contraindication, or to warn a patient of the consequences of taking the drug.”

Rationale

In considering the motion, the court said, “The better public policy argument for imposing a duty to warn is the pharmacist’s role as a ‘safety net.’ Pharmacists have an equal (if not greater) knowledge of the pharmacology and contraindications of drugs than many physicians. Why have any DUR policies if a pharmacist is merely the processor of the physician’s prescription and simply the pill counter? Certainly, most pharmacists would be insulted to know that physicians and courts of law view pharmacist expertise as limited to the perfunctory manual rote duty of filling prescriptions. This court fails to see the logic in not adding a duty to warn as one last layer of protection for a patient when a physician prescribes a drug that a pharmacist has reason to know has potentially disastrous side effects.”

The pharmacy contended that even if the pharmacist had consulted the prescriber, there would have been no changes in the prescription because prescribers do not accept advice provided by pharmacists. The court disagreed, noting testimony provided by a physician expert witness. That expert testified, “The pharmacist’s job is to educate the doctor when a prescription is written that is dangerous or inaccurate. I think that if a pharmacist calls you up and says that you’re giving a potentially dangerous dose of a drug and you don’t change it, you probably won’t be practicing medicine very long.”

The court concluded from this testimony that “a physician called by a pharmacist and warned of the high potential for harm for an overdosage of the drug for the child’s weight and age would likely modify the dosage or cancel the prescription.”

The pharmacy’s motion to dismiss the case was denied.

Discussion

Prescriptions that pose potential problems for patients rarely need to be processed immediately. There is ample time to consult the prescriber and resolve questions that a pharmacist may have. This is not a matter of obstinately refusing to process a prescription without consultation. Rather, it is an inability to provide medication to a patient without clarifying matters related to dosage, drug–drug interactions, or other concerns about patient safety. It is the prescriber who has caused these concerns, and it is the prescriber to whom a pharmacist must turn for resolution.

florida80

06-02-2019, 21:59

A man goes into a drugstore and asks the pharmacist if he can give him something for the hiccups. The pharmacist promptly reaches out and slaps the man's face.
"What did you do that for?" the man asks.
"Well, you don't have the hiccups anymore, do you?"
The man says, "No, but my wife out in the car still does!"

florida80

06-02-2019, 22:00

A doctor is to give a speech at the local AMA dinner. He jots down notes for his speech. Unfortunately, when he stands in front of his colleagues later that night, he finds that he can't read his notes. So he asks, "Is there a pharmacist in the house?"

florida80

06-02-2019, 22:00

A miracle drug is one that has now the same price as last year.

florida80

06-02-2019, 22:01

A new drug for Yuppies: It doesn't give a false sense of security or relaxation -- it makes you enjoy being tense.

florida80

06-02-2019, 22:01

A man goes in for an interview for a job as a TV news broadcaster. The interview went quite well but the trouble was he kept winking and stammering.
The interviewer said, "Although you have a lot of the qualities we're looking for, the fact that you keep winking and stammering disqualifies you."

"Oh, that's no problem," said the man. "If I take a couple of aspirin I stop winking and stammering for an hour."

"Show me," said the interviewer.

So the man reached into his pocket. Embarrassingly he pulled out loads of condoms of every variety - ribbed, flavoured, colored and everything before he found the packet of aspirin. He took the aspirin and soon talked perfectly and stopped winking.

The interviewer said, "That's amazing, but I don't think we could employ someone who'd be womanizing all over the country."

"Excuse me!" exclaimed the man, "I'm a happily married man, not a womanizer!"

"Well how do you explain all the condoms, then?" asked the interviewer.

The man replied, "Have you ever gone into a pharmacy, stammering and winking, and asked for a packet of aspirin?"

florida80

06-02-2019, 22:02

guy goes to a travel agent and books a two-week cruise for himself and his girlfriend. A couple days before the cruise, the travel agent calls and says the cruise has been canceled, but he can get them on a three-day cruise instead. The guy says "OK," and goes to the pharmacy to buy three Dramamine and three condoms.
Next day, the agent calls back and says he now can book a five-day cruise. The guy says he'll take it. Returns to the same pharmacy and buys two more Dramamine and two more condoms.

The following day, the travel agent calls again and says he can now book an eight-day cruise. Guy says, "OK," and goes back to the pharmacy and asks for three more Dramamine and three more condoms.

Finally, the pharmacist asks, "Look, if it makes you sick, how come you keep doing it?"

florida80

06-02-2019, 22:02

young man goes into a drugstore to buy condoms. The pharmacist says the condoms come in packs of 3, 9 or 12 and asks which the young man wants.
"Well," he said, "I've been seeing this girl for a while and she's really hot. I want the condoms because I think tonight's "the" night. We're having dinner with her parents, and then we're going out. And I've got a feeling I'm gonna get lucky after that. Once she's had me, she'll want me all the time, so you'd better give me the 12 pack." The young man makes his purchase and leaves.

Later that evening, he sits down to dinner with his girlfriend and her parents. He asks if he might give the blessing, and they agree. He begins the prayer, but continues praying for several minutes. The girl leans over and says, "You never told me that you were such a religious person." He leans over to her and whispers, "You never told me that your father is a pharmacist."

florida80

06-02-2019, 22:03

Did you hear about the new "morning after" pill for men?
It changes their blood type.

florida80

06-02-2019, 22:03

An elderly woman went into the doctor's office. When the doctor asked why she was there, she replied, "I'd like to have some birth control pills."
Taken aback, the doctor thought for a minute and then said, "Excuse me, Mrs. Smith, but you're 75 years old. What possible use could you have for birth control pills?"

The woman responded, "They help me sleep better."

The doctor thought some more and continued, "How in the world do birth control pills help you to sleep?"

The woman said, "I put them in my granddaughter's orange juice and I sleep better at night."

florida80

06-02-2019, 22:04

A pharmacist looks out the front of the store and sees a woman holding a bottle jumping up and down in the parking lot. The pharmacist walks out to the parking lot and asks the woman whats the matter. She replies " I saw it said 'Shake Well' after I took it".

florida80

06-02-2019, 22:04

Customer gets a topical cream. Direction: apply locally two times a day.
Customer says to the pharmacist: "I can't apply locally, I'm going overseas

florida80

06-02-2019, 22:07

A pharmacist is going over the directions on a prescription bottle with an elderly patient. "Be sure not to take this more often than every 4 hours," the pharmacist says. "Don't worry," replies the patient. "It takes me 4 hours to get the lid off".

florida80

06-02-2019, 22:08

A funeral procession is going up a steep hill on main street when the door of the hearst flys open and the coffin falls out then speeds down main street into a pharmacy and crashes into the counter. The lids pops open and the deceased says to the astonished pharmacist, "You got anything to stop this coffin

florida80

06-02-2019, 22:08

front end clerk in a pharmacy has just been admonished by the owner for missing too many sales. "I'm sorry" the boss says "But one more missed sale and your fired"
The next customer that comes in has a terrible cough and asks the problem clerk for help. Unable to recall where the cough remedies are, the nervous clerk points to a box of Ex-Lax and says "Here, buy this then go over to our cooler and take all of it with plenty of water".

The customer thanks him and obliges. Finishing his last glass of water, the customer exits the pharmacy. Once outside he stops, takes a few faltering steps, then hugs a telephone pole. The boss, having witnessed the entire scene, approaches the clerk and asks him what he recommended.

"Ex-Lax," says the clerk hesitantly.
"Ex-Lax !" yells the boss. "That won't help a cough!"
"Sure it does," says the clerk. "Look,.. he's afraid to cough."

florida80

06-02-2019, 22:09

Lady says to pharmacist: "Why does my prescription medication have 40 side effects?"
Pharmacist replies: "Cause that's all we've documented so far."

florida80

06-02-2019, 22:10

woman and her husband approach their pharmacist and begin to ask questions like if the pharmacy checks for medications past their expiration date and the reliability of a certain company that makes birth control pills. Finally the pharmacist asks the couple what's the matter. The wife explains, "In spite of using birth control pills I continue to get pregnant."
The pharmacist is astounded and asks the woman if she takes them every day.
The woman replies, "My husband takes them every day."
"What ?" the pharmacist croaks.
"Yep. After we read all those potential side-effects, my husband said ' Ah honey.. I don't what you taking that stuff.. it's too dangerous,.....let ME take them.' "

florida80

06-02-2019, 22:11

How many pharmacists does it take to change a light bulb?
Just one, but he has to do it ten days, three times a day.

florida80

06-02-2019, 22:11

Two young pharmacists are talking professionally at their office.

Boy Pharmacist. : What do you want this time, with coat or without coat ?
Gal Pharmacist: with coating, because I don't want to release granules earlier.
Boy Pharmacist: So, Shall I start molding?
Gal Pharmacist: No, No... first close the door and window and switch off, because this work is light sensitive.

florida80

06-02-2019, 22:12

What do you call a pharmacist working at a veterinary drug company... a FARM-ASSIST

florida80

06-02-2019, 22:12

Guy runs into a pharmacy. He dashes to the counter and exclaims, "Please, help! I've got a splinter in my finger and I don't know what to do!" The pharmacist grabs a bottle of Ichthammol Ointment and says to the man, "Here my good sir...Try this black salve." To which the man replies, "This is no time for heavy metal music!"

florida80

06-02-2019, 22:13

What do scots take for fungal groin infections?
'Sporranox!'

florida80

06-02-2019, 22:16

Doctor, please hurry. My son swallowed a razor-blade."
"Don't panic, I'm coming immediately. Have you done anything yet?"
"Yea, I shaved with the electric razor."

florida80

06-02-2019, 22:16

Doctor, doctor, You've got to help me - I just can't stop my hands shaking!"
"Do you drink a lot?"
"Not really - I spill most of it!"

florida80

06-02-2019, 22:17

Doctor, doctor, will I be able to play the violin after the operation?"
"Yes, of course..."
"Great! I never could before!"

florida80

06-02-2019, 22:17

man speaks frantically into the phone, "My wife is pregnant, and her contractions are only two minutes apart!"
"Is this her first child?" the doctor queries.
"No, you idiot!" the man shouts. "This is her husband!"

florida80

06-02-2019, 22:18

The surgeon told his patient that woke up after having been operated: "I'm afraid we're going to have to operate you again. Because, you see, I forgot my rubber gloves inside you."

"Well, if it's just because of them, I'd rather pay for them if you just leave me alone."

florida80

06-02-2019, 22:21

A doctor and his wife were having a big argument at breakfast.
"You aren't so good in bed either!" he shouted and stormed off to work.
By midmorning, he decided he'd better make amends and phoned home. After many rings, his wife picked up the phone.
"What took you so long to answer?"
"I was in bed."
"What were you doing in bed this late?"
"Getting a second opinion

florida80

06-02-2019, 22:22

Doctor: I have some bad news and some very bad news.
Patient: Well, might as well give me the bad news first.
Doctor: The lab called with your test results. They said you have 24 hours to live.
Patient: 24 HOURS! Thats terrible!! WHAT could be WORSE? What's the very bad news?
Doctor: I've been trying to reach you since yesterday.

florida80

06-02-2019, 22:23

A man goes to his doctor for a complete checkup. He hasn't been feeling well and wants to find out if he's ill. After the checkup the doctor comes out with the results of the examination.

"I'm afraid I have some bad news. You're dying and you don't have much time," the doctor says.

"Oh no, that's terrible. How long have I got?" the man asks.

"10..." says the doctor.

"10? 10 what? Months? Weeks? What?!" he asks desperately.

"10...9...8...7..."

florida80

06-02-2019, 22:24

Doctor: "I've got very bad news - you've got cancer and Alzheimer's"
Patient: "Well, at least I don't have cancer

florida80

06-02-2019, 22:24

A man walks into a doctor's office. He has a cucumber up his nose, a carrot in his left ear and a banana in his right ear.
"What's the matter with me?" he asks the doctor.
The doctor replies, "You're not eating properly."

florida80

06-02-2019, 22:25

A young woman went to her doctor complaining of pain.
"Where are you hurting?" asked the doctor.
"You have to help me, I hurt all over", said the woman.
"What do you mean, all over?" asked the doctor, "be a little more specific."

The woman touched her right knee with her index finger and yelled, "Ow, that hurts." Then she touched her left cheek and again yelled, "Ouch! That hurts, too." Then she touched her right earlobe, "Ow, even THAT hurts", she cried.

The doctor checked her thoughtfully for a moment and told her his diagnosis, "You have a broken finger."

florida80

06-02-2019, 22:26

A baseball manager who had an ulcer was in his physician office for a checkup. "Remember," the doctor said, "don't get excited, don't get mad, and forget about baseball when you're off the field." Then he added, "By the way, how come you let the pitcher bat yesterday with the tying run on second and two men out in the ninth?"

florida80

06-02-2019, 22:26

Doctor, are you sure I'm suffering from pneumonia? I've heard once about a doctor treating someone with pneumonia and finally he died of typhus."
"Don't worry, it won't happen to me. If I treat someone with pneumonia he will die of pneumonia."

florida80

06-02-2019, 22:27

A man went to see his doctor because he was suffering from a miserable cold. His doctor prescribed some pills, but they didn't help.

On his next visit the doctor gave him a shot, but that didn't do any good.

On his third visit the doctor told the man, "Go home and take a hot bath. As soon as you finish bathing throw open all the windows and stand in the draft."

"But doc," protested the patient, "if I do that, I'll get pneumonia."

"I know," said the doctor, "I can cure pneumonia."

florida80

06-02-2019, 22:28

guy walks into work, and both of his ears are all bandaged up. The boss says, "What happened to your ears?"
He says, "Yesterday I was ironing a shirt when the phone rang and shhh! I accidentally answered the iron."
The boss says, "Well, that explains one ear, but what happened to your other ear?"
He says, "Well, jeez, I had to call the doctor!"

florida80

06-02-2019, 22:28

A SHORT HISTORY OF MEDICINE: "Doctor, I have an ear ache."
2000 B.C. - "Here, eat this root."
1000 B.C. - "That root is heathen, say this prayer."
1850 A.D. - "That prayer is superstition, drink this potion."
1940 A.D. - "That potion is snake oil, swallow this pill."
1985 A.D. - "That pill is ineffective, take this antibiotic."
2000 A.D. - "That antibiotic is artificial. Here, eat this root!"

florida80

06-02-2019, 22:29

A pipe burst in a doctor's house. He called a plumber. The plumber arrived, unpacked his tools, did mysterious plumber-type things for a while, and handed the doctor a bill for $600.
The doctor exclaimed, "This is ridiculous! I don't even make that much as a doctor!."
The plumber quietly answered, "Neither did I when I was a doctor

florida80

06-02-2019, 22:30

A doctor said to his car mechanic, "Your debit is several times more per hour then we get paid for medical care."
"Yeah, but you see, doc, you have always the same model, it hasn't changed since Adam; but we have to keep up to date with new models coming every year."

florida80

06-02-2019, 22:30

The seven-year old girl told her mom, "A boy in my class asked me to play doctor."
"Oh, dear," the mother nervously sighed. "What happened, honey?"
"Nothing, he made me wait 45 minutes and then double-billed the insurance company."

florida80

06-02-2019, 22:31

The doctor said he would have me on my feet in two weeks."
"And did he?"
"Yes, I had to sell the car to pay the bill."

florida80

06-02-2019, 22:32

A fellow walked into a doctor's office and the receptionist asked him what he had.
He said, "Shingles."
So she took down his name, address, medical insurance number and told him to have a seat.

A few minutes later a nurse's aid came out and asked him what he had.
He said, "Shingles."
So she took down his height, weight, a complete medical history and told him to wait in the examining room.

Ten minutes later a nurse came in and asked him what he had.
He said, "Shingles."
So she gave him a blood test, a blood pressure test, an electrocardiogram, told him to take off all his clothes and wait for the doctor.

Fifteen minutes later the doctor came in and asked him what he had.
He said, "Shingles."
The doctor said, "Where?"
He said, "Outside in the truck. Where do you want them?"

florida80

06-02-2019, 22:32

A woman, calling Mount Sinai Hospital, said, "Hello, I want to know if a patient is getting better."

The voice on the other end of the line said, "What is the patient's name and room number?"

She said, "Yes, darling! She's Sarah Finkel, in Room 302."

He said, "Oh, yes. Mrs. Finkel is doing very well. In fact, she's had two full meals, her blood pressure is fine, she's going to be taken off the heart monitor in a couple of hours and if she continues this improvement, Dr. Cohen is going to send her home Tuesday."

The woman said, "Thank God! That's wonderful! Oh! That's fantastic! That's wonderful news!"

The man on the phone said, "From your enthusiasm, I take it you must be a close family member or a very close friend!"

She said, "I'm Sarah Finkel in 302! Cohen, my doctor, doesn't tell me a word!"

florida80

06-02-2019, 22:33

An old fellow came into the hospital truly on death's door due to an infected gallbladder. The surgeon who removed the gallbladder was adamant that his patients be up and walking in the hall the day after surgery, to help prevent blood clots forming in the leg veins. The nurses walked the patient in the hall as ordered, and after the third day the nurse told how he complained bitterly each time they did. The surgeon told them to keep walking him.

After a week, the patient was ready to go. His family came to pick him up and thanked the surgeon profusely for what he had done for their father. The surgeon was pleased and appreciated the thanks, but told them that it was really a simple operation and we had been lucky to get him in time. "But doctor, you don't understand," they said, "Dad hasn't walked in over a year!"

florida80

06-02-2019, 22:34

If it is dry - add moist; if it is moisten - add dryness. Congratulations, now you are a dermatologist

florida80

06-02-2019, 22:34

Patient to the eye doctor: "Whenever I drink coffee, I have this sharp, excruciating pain."

"Try to remember to remove the spoon from the cup before drinking."

florida80

06-02-2019, 22:35

A man goes to the eye doctor. The receptionist asks him why he is there. The man complains, "I keep seeing spots in front of my eyes."
The receptionist asks, "Have you ever seen a doctor?" and the man replies, "No, just spots."

florida80

06-02-2019, 22:36

Patient: I always see spots before my eyes.
Doctor: Didn't the new glasses help?
Patient: Sure, now I see the spots much clearer

florida80

06-02-2019, 22:36

A veterinarian was feeling ill and went to see her doctor. The doctor asked her all the usual questions, about symptoms, how long had they been occurring, etc., when she interrupted him: "Hey look, I'm a vet -- I don't need to ask my patients these kind of questions: I can tell what's wrong just by looking. Why can't you?"

The doctor nodded, looked her up and down, wrote out a prescription, and handed it to her and said, "There you are. Of course, if that doesn't work, we'll have to have you put down."

florida80

06-03-2019, 20:04

A chemist walks into a pharmacy and asks the pharmacist, "Do you have any acetylsalicylic acid?"
"You mean aspirin?" asked the pharmacist.
"That's it, I can never remember that word."

florida80

06-03-2019, 20:05

A physicist, biologist and a chemist were going to the ocean for the first time.
The physicist saw the ocean and was fascinated by the waves. He said he wanted to do some research on the fluid dynamics of the waves and walked into the ocean. Obviously he was drowned and never returned.

The biologist said he wanted to do research on the flora and fauna inside the ocean and walked inside the ocean. He too, never returned.

The chemist waited for a long time and afterwards, wrote the observation, "The physicist and the biologist are soluble in ocean water".

florida80

06-03-2019, 20:10

Researchers explore augmented ACL reconstruction procedure

Marshall University Joan C. Edwards School of Medicine

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IMAGE

IMAGE: Viewing outside the knee, the tibial passing sutures, InternalBrace passing sutures, and femoral passing sutures can all be seen docked. view more 

Credit: Chad Lavender, M.D., Marshall University

HUNTINGTON, W.Va. - An innovative procedure that explores the use of amnion, bone marrow concentrate and suture tape in anterior cruciate ligament (ACL) reconstruction may result in earlier return to play protocols for athletes, suggests a new Marshall University study published in the May 6, 2019, edition of Arthroscopy Techniques, a companion to Arthroscopy: The Journal of Arthroscopic and Related Surgery.

The ACL is one of four major ligaments that stabilize the knee. An ACL tear is one of the most common types of knee injuries, most often occurring during high-demand sports such as soccer or football. Traditional ACL reconstruction requires a graft to replace the ligament. Small tunnels are drilled into the bone above and below the knee for screws to keep the graft in place. Small buttons may also be used along the bone's edge to secure the graft.

In the Arthroscopy Techniques article, Chad D. Lavender, M.D., lead author and assistant professor of orthopaedic surgery at the Marshall University Joan C. Edwards School of Medicine, and Charles Bishop, M.D., a fifth-year orthopaedic resident at Marshall's School of Medicine, outline a new process that fills, or "fertilizes," these tunnels with a mixture of amnion, bone marrow concentrate and suture tape to speed up recovery and stabilize the knee. Amnion is used due to its potential to decrease adhesions, possibly protect ACL grafts and increase vascularization by acting as a scaffold. Bone marrow concentrate containing the patient's mesenchymal stem cells combined with Allosync has the potential to increase the speed and quality of graft bone incorporation, especially when used in the setting of a soft-tissue allograft. Using suture tape augmentation with the reconstruction has been thought to increase the early strength of the reconstruction.

"There are early advantages to fertilized ACL reconstruction such as decreased pain, and when this is combined with biologics, we may be able to accelerate rehabilitation and return to play more than previously anticipated," Lavender said.

The study builds off Lavender's previous approach using bone marrow concentrate and a suture tape, as published in the November 19, 2018, edition of Arthroscopy Techniques.

To date, Lavender has successfully completed more than 30 procedures using some form of the fertilized ACL. Patients have reported the same results as the standard ACL reconstruction with shorter recovery times, significantly less pain and no known additional risks. Future research will determine whether using this technique could shorten the return to play for athletes and reduce the use of opioids post-surgery

florida80

06-03-2019, 20:11

News Release 3-Jun-2019

Climate action urgently required to protect human health in Europe

New EASAC report 'The imperative of climate action to protect human health in Europe' highlights an alarming range of health risks due to climate change and the benefits of rapid phase out of fossil fuels

European Academies' Science Advisory Council, Leopoldina - Nationale Akademie der Wissenschaften

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EASAC is the voice of independent science advice, mobilising Europe's leading scientists from 27 national science academies to guide EU policy for the benefit of society. By considering a large body of independent studies on the effects of climate change on health, and on strategies to address the risks to health, EASAC has identified key messages and drawn important new conclusions. The evidence shows that climate change is adversely affecting human health and that health risks are projected to increase. Solutions are within reach and much can be done by acting on present knowledge, but this requires political will. With current trends in greenhouse gas emissions, a global average temperature increase of over 3°C above pre-industrial levels is projected by the end of the century. The increase will be higher over land than the oceans, exposing the world population to unprecedented rates of climate change and contributing to the burden of disease and premature mortality. Health risks will increase as climate change intensifies through a range of pathways including:

•Increased exposure to high temperatures and extreme events such as floods and droughts, air pollution and allergens;
•Weakening of food and nutrition security;
•Increased incidence and changing distribution of some infectious diseases (including mosquito-borne, food-borne and water-borne diseases);
•Growing risk of forced migration.

EASAC emphasises that the top priority is to stabilise climate and accelerate efforts to limit greenhouse gas emissions. The economic benefits of action to address the current and prospective health effects of climate change are likely to be substantial.

Working Group co-chair, Professor Sir Andy Haines (London School of Hygiene & Tropical Medicine), comments, "If urgent action is not taken to reduce emissions in order to keep temperatures below the 2°C (or less) limit enshrined in the Paris Climate Agreement, we face potentially irreversible changes that will have wide ranging impacts on many aspects of health. The scientific community has an important role in generating knowledge and countering misinformation. We hope that this comprehensive report will act as a wake-up call and draw attention to the need for action, particularly by pursuing policies to decarbonise the economy. The protection of health must have a higher profile in policies aimed at mitigating or adapting to the effects of climate change". Key messages addressed in the report include:

•Several hundred thousand premature deaths annually in the EU could be averted by a 'zero-carbon' economy through reduced air pollution
Pollution endangers planetary health, damages ecosystems and is intimately linked to global climate change. Fine particulate and ozone air pollution arise from many of the same sources as emissions of greenhouse gases and short-lived climate pollutants. For the EU overall, fossil-fuel-related emissions account for more than half of the excess mortality attributed to ambient (outdoor) air pollution. A recent estimate suggests that about 350,000 excess deaths annually in the EU can be attributed to ambient air pollution from burning fossil fuels and a total of about 500,000 from all human-related activities.

Understanding of the range of health effects of air pollution on the health of children and adults is growing. Seven million babies in Europe are living in areas where air pollution exceeds WHO recommended limits and such exposure may affect brain development and cognitive function. Action to reduce pollution through decarbonisation of the economy must be viewed as a priority to address both climate change and public health imperatives.

•Promotion of healthier, more sustainable diets with increased consumption of fruit, vegetables and legumes and reduced red meat intake will lower the burden of non-communicable diseases and reduce greenhouse gas emissions.
Promoting dietary change could have major health and environmental benefits, resulting in significant reductions of up to about 40% in greenhouse gas emissions from food systems as well as reducing water and land use demands. Such diets can also lead to major reductions on non-communicable disease burden through reduced risk of heart disease, stroke and other conditions.

If food and nutrition security declines because of climate change, the EU can probably still satisfy its requirements by importing food. But this will have increasing consequences for the rest of the world; for example, by importing fodder for livestock from arable land that has been created through deforestation. It is therefore vital to develop climate-smart food systems to ensure more resilient agricultural production and to promote food and nutrition security, for the benefit of human health.

•Climate action could avert a significant increase in the spread of infectious diseases
The spread of infectious diseases in Europe could increase through climate change. These diseases include those that are spread by vectors (particularly mosquitos) and food- and water-borne infections. There is also an increased risk to animal health across Europe from conditions such as Blue tongue virus.

Distribution of the mosquito species Aedes albopictus, known to be a vector for diseases such as dengue, is already expanding in Europe and may extend to much of Western Europe within the next decade.

Water-borne infections such as diarrhoea may increase following heavy rainfall and flooding and higher temperatures may be associated with increased antibiotic resistance for pathogens such as E. coli. In the case of Salmonella species, an increase in temperature will increase multiplication and spread in food and increase the risks of food poisoning. There could also be an increase in Norovirus infections related to heavy rainfall and flooding. Strengthening communicable disease surveillance and response systems should be a priority for improving adaptation to climate change.

•Providing evidence of the health benefits of action on climate change may be instrumental in achieving rapid reductions in greenhouse gas emissions
Although the EU is actively engaged in efforts to reduce greenhouse gas emissions and to identify suitable adaptation measures, the impacts of climate change on health have been relatively neglected in EU policy. Recognising the serious challenges that climate change poses to the global health gains made in recent decades is key to promoting public engagement.

Furthermore, the impact of climate change in other regions can have tangible consequences in Europe and the EU has responsibilities in addressing problems outside its area.

The EU must do more to ensure that health impact assessment is part of all proposed initiatives, and that climate and health policy is integrated with other policy priorities including coordinating strategies at EU and national level. It is also vital that the steps are taken to counter misinformation about the causes and consequences of climate change which threaten to undermine the political will to act.