Pharmacist Foibles
A few minutes after I got off the phone with the compounding pharmacist, I called him back again.
"Hi," I said. "I talked to you a few minutes ago about the Nystatin, and we had decided it would be safest to just have you send me the plain Nystatin powder so I could mix it up myself. After I hung up it occurred to me that it would probably be a good idea to check the ingredients on the powder itself."
"It's just nystatin."
"I know, but often powders have something like silica or dextrose in them to stabilize or standardize them."
"We're a compounding pharmacy. All of our ingredients are 100% pure. There's nothing in there but nystatin. --E isn't allergic to nystatin, is she?"
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"I don't think so, but I suppose anything is possible. It would be really unusual for someone to be allergic to nystatin, wouldn't it? It's supposed to be inert in the human digestive system. But I guess it's possible she could be allergic to it.
Still, I think it's more likely she's reacting to the glycerine or something like that. I think I'll talk to her doctor about taking her off the Nystatin completely for a week or so. Then we could try putting her on the plain powder to see if she reacts to that."
"Okay. Whatever you want to do."
"But I really need to know if there's anything she might react to in the powder."
"There is nothing but nystatin in that powder."
"Please, could you just check the ingredients on the package for me?"
"We would never use anything but pure ingredients in our pharmacy! Everything we use is 100% pure! I promise you there is nothing in that powder but nystatin."
"One of your other pharmacists kept telling me earlier this week that your stevia powder was 100% pure stevia, and then when she actually looked at the box it said 90% stevia. And you all kept telling me there was nothing but water and a little bit of pure stevia in the nystatin suspension, when there were things like glycerine and xanthan gum in it. I would really feel a lot better if you'd just check the box for me. Please?"
"No! I don't need to look at the box. I know there is nothing in there but nystatin."
"Can't you just double-check?"
"No, I will not."
"Well, then please hold off on filling the prescription. I'm going to talk to my daughter's doctor before we do anything else."
"I have a note here to call you and the doctor before I fill the prescription."
" . . . By the way, what is nystatin exactly, anyway? I mean, what's it derived from? Do you happen to know?"
"It's a medicine."
"I know it's a medicine, but what kind of element is it, or what is it made of? Is it a mineral, like barium?"
"No, it's not a mineral. It's just a medicine."
"I know, but do you know what it's made from? Is it plant-derived, or a mineral, or what?"
"It's not any of that! It's a MEDICINE!"
"Do you mean it's chemically-derived?"
"Yeah, I guess you could say that. It's a medicine."
I couldn't make this stuff up if I tried. In fact, if I was making it up I'd write much better dialogue than this.
You'd think a highly-trained professional like the head pharmacist in a compounding pharmacy would be able to think of a more imaginative response. Most people aren't quite THAT limited.
It must be awful for that man to have such a crippling fear of ever under any circumstances allowing the words "I don't know" to pass his lips.
By the way, nystatin is an antifungal organic compound. It is derived from the bacteria Streptomyces noursei, which was originally discovered in dirt by two women who were trying to find an antifungal antibiotic.
S. noursei is often cultured in mediums made up of various ingredients, including soy broth, yeast extract, and glucose (glucose is generally corn-derived).
This paper says, "For nystatin production, S. noursei strains were grown for 120 h in 50 ml SAO-23 medium (g per l: glucose, 45; NH4NO3, 2·5; corn meal, 3; MgSO4 . 7H2O, 0·4; KH2PO4, 0·2; CaCO3, 5) in shake flasks at 28 °C (220 r.p.m.). Cells were then pelleted and extracted with DMSO, and extracts analysed by HPLC."
It seems the cornmeal culture is a standard method for producing nystatin.
"Hi," I said. "I talked to you a few minutes ago about the Nystatin, and we had decided it would be safest to just have you send me the plain Nystatin powder so I could mix it up myself. After I hung up it occurred to me that it would probably be a good idea to check the ingredients on the powder itself."
"It's just nystatin."
"I know, but often powders have something like silica or dextrose in them to stabilize or standardize them."
"We're a compounding pharmacy. All of our ingredients are 100% pure. There's nothing in there but nystatin. --E isn't allergic to nystatin, is she?"
################
"I don't think so, but I suppose anything is possible. It would be really unusual for someone to be allergic to nystatin, wouldn't it? It's supposed to be inert in the human digestive system. But I guess it's possible she could be allergic to it.
Still, I think it's more likely she's reacting to the glycerine or something like that. I think I'll talk to her doctor about taking her off the Nystatin completely for a week or so. Then we could try putting her on the plain powder to see if she reacts to that."
"Okay. Whatever you want to do."
"But I really need to know if there's anything she might react to in the powder."
"There is nothing but nystatin in that powder."
"Please, could you just check the ingredients on the package for me?"
"We would never use anything but pure ingredients in our pharmacy! Everything we use is 100% pure! I promise you there is nothing in that powder but nystatin."
"One of your other pharmacists kept telling me earlier this week that your stevia powder was 100% pure stevia, and then when she actually looked at the box it said 90% stevia. And you all kept telling me there was nothing but water and a little bit of pure stevia in the nystatin suspension, when there were things like glycerine and xanthan gum in it. I would really feel a lot better if you'd just check the box for me. Please?"
"No! I don't need to look at the box. I know there is nothing in there but nystatin."
"Can't you just double-check?"
"No, I will not."
"Well, then please hold off on filling the prescription. I'm going to talk to my daughter's doctor before we do anything else."
"I have a note here to call you and the doctor before I fill the prescription."
" . . . By the way, what is nystatin exactly, anyway? I mean, what's it derived from? Do you happen to know?"
"It's a medicine."
"I know it's a medicine, but what kind of element is it, or what is it made of? Is it a mineral, like barium?"
"No, it's not a mineral. It's just a medicine."
"I know, but do you know what it's made from? Is it plant-derived, or a mineral, or what?"
"It's not any of that! It's a MEDICINE!"
"Do you mean it's chemically-derived?"
"Yeah, I guess you could say that. It's a medicine."
I couldn't make this stuff up if I tried. In fact, if I was making it up I'd write much better dialogue than this.
You'd think a highly-trained professional like the head pharmacist in a compounding pharmacy would be able to think of a more imaginative response. Most people aren't quite THAT limited.
It must be awful for that man to have such a crippling fear of ever under any circumstances allowing the words "I don't know" to pass his lips.
By the way, nystatin is an antifungal organic compound. It is derived from the bacteria Streptomyces noursei, which was originally discovered in dirt by two women who were trying to find an antifungal antibiotic.
S. noursei is often cultured in mediums made up of various ingredients, including soy broth, yeast extract, and glucose (glucose is generally corn-derived).
This paper says, "For nystatin production, S. noursei strains were grown for 120 h in 50 ml SAO-23 medium (g per l: glucose, 45; NH4NO3, 2·5; corn meal, 3; MgSO4 . 7H2O, 0·4; KH2PO4, 0·2; CaCO3, 5) in shake flasks at 28 °C (220 r.p.m.). Cells were then pelleted and extracted with DMSO, and extracts analysed by HPLC."
It seems the cornmeal culture is a standard method for producing nystatin.
Copyright 2009. All rights reserved.
Posted by purple_kangaroo at 1:21 AM[Permanent link]
13 Comments:
Holy sh...amoley.
....
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I'm unable to comment without using certain key words that I don't feel are appropriate to use on a family blog.
Fireplace! Can we say that?
Truly unbelievable. You are entirely correct that the whole problem is that he refuses to say "I don't know." And he seems to think that "Let me check that" would translate as "I don't know." Which it would, but where's the shame?
By the way, I had an allergic reaction to nystatin once. It was the topical cream, when I had thrush during breastfeeding. I have no idea if it was the nystatin itself or some ingredient in the cream I reacted to, but when I called the pharmacy I got the response I think I've told you about before: "Anyone can be allergic to anything."
I just wish you had a pharmacist (and an allergist) who could say that, and follow up to help you cope with it.
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Still hunting for words.
good grief. you've got to be kidding me.
So does that mean if I take "medicine" and my neighbor takes "medicine" that they're both one in the same? Hm...maybe my neighbor's prescription is cheaper! :) --Kathy
I can't beleive he flat out refused to look at the box for you! That is crazy how hard would it be???? MY GOODNESS!
I'm with Liz.
I might suggest you look into a little plastic bubble, but I'm sure it would be made with corn. Or soy. Or something grown with them.
Oy!
Not even willing to look at the package insert (while clearly having no idea what the "medicine" contained) verges on criminally negligent in my mind.
What if Baby E's reaction was not so mild as eczema, but more of the respitory distress sort?
Oy!
.... (back with Liz)
Liz, you made me chuckle.
Madeleine, most certainly. I would think it was just male macho-ism, but I get the same response from women all the time, too.
I'm hoping our new allergist will be a little more likely to believe us. I do have better evidence now, and more complete information, than when we first started seeing the other allergist. And, I'm much less likely to dissolve into tears in the office. :)
Miraclebaby and my4kids, that's about what I wanted to say to him. "Good grief. You've got to be kidding. How hard can it be to LOOK AT THE PACKAGE INSERT?!?"
Kathy, it's all medicine, right? No real difference, of course. Medicine is medicine.
Amy, you'd be amazed at how many plastics and other materials are made out of corn and/or soy.
For instance, I just found out that the filling in the Targ*t brand down alternative pillows is made from corn. All those biodegradable plastic grocery store bags that are getting so popular are made from corn, too, and probably printed with soy-based ink.
Un-fireplacin'-believable.
What the fireplace is this person doing in a job that affects people's health? HE WON'T CHECK THE FIREPLACING INSERT?!?!?!
I wondered the same thing, genevieve. A compounding pharmacist, of all people, should not be that ignorant and uncaring. I mean, a huge part of his job is making special meds for people with allergies and checking to make sure the ingredients aren't going to make someone sick.
Still speechless. I wish that all the doctors, pharmacists, manufacturers, etc, would take the same care of Baby E that they would of their own children.
Is this Pharmacy M__'s where we got Nystatin before? Is it run by different people now?
My O My.
I guess an "I'll wait on the line until you check it" probably wouldn't have worked and even mama bear tactics sound like they would have been ignored.
Not good, Not good.
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