Some Medical Work

I think I will keep the discussion below, virtual.  The actual event should probably be kept to just a short quick picture at the site.  By keeping politics, and racial discussions out of it, we can probably solve a health problem in an integrated way in the community I’m in.  I think Martin Luther King, Jr. would be honored by having the health issue solved.

A little preparation for the demonstration, in case questions are asked by the reporter.  If I were the reporter, I would first cover the demonstration, then interview the town pharmacist (at the grocery store), then interview the town doctor (brand new in town).  For the past 50 or so years, the town has not had a doctor.

For the following discussion, OTC (over the counter) means over the pharmacy counter, by discussion with the pharmacist.

A.  Diabetes medications (type II)

Some uptake inhibitors (alpha-glucosidase inhibitors) are available in both OTC (InSea2) and prescription formulations (Acarbose).  Other uptake inhibitors (alpha-amylase inhibitors) can be found in white kidney bean extracts.  Orlistat (Xenical) pancreatic and gastric lipase inhibitor) is prescription strength at 120 mg.  Alli is OTC at 60 mg.  A review of these various formulations is presented in “Life Extension“.

Type I   and   Type II

type I diabetes: Regular and NPH insulin already OTC, Lantus status should be converted to OTC as it is safer than these other ones.  There is some evidence of use regarding pregnancy and Lantus.

B.  Blood pressure medications

(One does the above exercises recognizing the subtle reinforcement of the “motivating-to-the-professional” stereotype of “patient screwed up by acting independently, and needs reeducation”.  It’s a kind of psychological warfare on people with diseases.)  I finally got a 100% on the above test.  The test is full of psychological inaccuracies “Patient knows his medicine when …”.  Still, when one distills all of that from the actual factual information, there is probably some valuable instruction.

Intro to diuretics

Pamabrom is OTC, used for premenstrual bloating.  Caffeine and Theophylline (present in tea) can also be used OTC.

Angiotensin II Receptor Blockers

ACE inhibitors

Calcium Channel Blockers

Beta Blockers

C.  Cholesterol medications


Simvastatin available OTC in England

Lovastatin and pravastatin being debated.

D. Erectile Dysfunction

Viagra (OTC in England)

Age, pregnancy factors

Kidney and/or liver complications

Organ physiology review (pancreas, heart, kidney, liver, vascular system)

Familiarization with Canadian, Mexican, and other models of pharmacy access.

Research on specific candidates that FDA might consider.

Discussion of models of possible interaction between pharmacist and individual.

Different scenarios:

1) Individual has never had a prescription for the substance.

2) Individual has evidence of symptoms immediately and locally measured by blood pressure machine, or blood glucose monitoring device.

3) Elderly individuals or underage individuals.

4) Individual has old medicine container with them.

For diabetes (which I know well), this is what I would suggest:

Individual discusses symptoms (thirst, frequent urination, nausea, fatigue).  Blood sugar testing equipment recommended.  Fasting test performed in front of pharmacist reveals high blood sugar, but individual has no experience with diabetes (no family history, etc).  Recommend medical assessment.  If less than 250, advise individual that the situation is probably not life threatening although serious and warranting proper medical diagnosis by a professional, and counseling.  If higher than 250 (even if not fasting but not just after eating), advise the individual that the situation is more serious, again warranting proper medical diagnosis by a professional, and counseling.  Give them contact information with a local diabetic support group.  If the individual insists on immediate relief, and has no experience, then they sign a release, and receive their first very small regular insulin injection (3 units purchased if 250-350, 5 units if 350-400, 6 units if >400) at the pharmacy, leaving their insulin at the pharmacy, and monitoring the blood sugar drop in the absence of food intake from its initial value to a value 2 hours later, to another value 3 hours later, to values 4 and 5 hours later.  Give them a record of their values.  Once the individual has experience with normalizing their blood sugar a few times (adjusting the above doses as needed), release the insulin vial and syringes to them.  After they tally a few days, recording amount and time injected, any reactions, and blood sugar values, suggest the possibility of a long acting insulin at a dose equal to half of their daily dose.  If they choose to try this (Lantus), recommend attempted fasting for a day while they try this the first time, monitoring blood sugar levels 5 times during the day, eating if necessary.  With these values in hand, the next day, again give the long acting (adjusting the value according to the previous day’s experience), and introduce meals with corrections of blood sugar values with short-acting Regular according to what is eaten.  Discuss injections of Regular insulin 30 minutes prior to meals to anticipate blood sugar rises.  If necessary, when the individual can fast again, readjust long acting insulin.  Give them an A1c kit, and explain how it works.  Again, suggest the need for regular follow-up with a diabetic nurse, or doctor.  If they are adult type II, advise them that losing weight and exercise may positively impact the diabetes to the point where they might be able to manage the diabetes with a blood sugar meter and oral medication, or even eventually no medicine at all.

Some final thoughts on the event preparation:

Maybe prepare a reading of Martin Luther King, Jr.’s “I Have a Dream” Speech in the hopeful event that it is an integrated event.  Maybe try to find 2 people willing to do a black and white alternating reading of parts of the “I Have a Dream” speech for the occasion.  Note its historical significance, and prepare a reading from one of Barack Obama’s  health care reform speeches.

Possibly ask for representation from local parishes to offer a prayer to commemorate the religious aspect of King’s work.

Almost all of the fliers have been distributed to the community.  I bought some broad pens, and 10 posterboards for about $10.  It would have helped to have some versions in Spanish.  Comments within the community ranged from “requests for explanations”, to discussions about whether we are “in end-of-times” and need to worry about our health, to comments that “everything is going to be solved when the new health legislation comes into play”, to “it doesn’t work that way in the military”.  Inside the churches: “I take my problems to church, not the doctor.” Wives talking about husbands.  Gambling.  Going with systems that have established legacy.  “If it ain’t broke, don’t fix it.”

I’m out of fliers (and gas) now.  So, we will see how things develop.  I’ve done my part.  I’m not looking for radical reform, just enough change or movement to help.  Maybe, it’s “I have this bottle of prescription medicines, and I’m out.  The medicine helps me to achieve this beneficial effect on cholesterol, or blood pressure, or blood glucose.  Please refill it.”  Maybe it’s more.  “I have these symptoms, and I have tried this medication and it helps.  This is my documented symptom.  Could you tell me the counterindications, and recommend/provide me with some more of the medicine?”

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