My top 4

Top 4 meds that Samoans will sell their souls for.

Having to constantly try to win an uphill battle with an enourmous number of patients, has left me a little flabbergasted to say the least. It seems for every 1 person I try to educate, 3 more don't have the time to listen. And so, in lack of any other brain destressing excercises to deal with this little everyday frustration, I have devised a list of top 4s. For all ye future medicine seeking bradas (and sisters) yet to experience the wrath of BMIs >35, old age, smoking and drinking too much !lol

Sitting at number 4 is- Fualaau Sela, aka- Ventolin tabs.
 I dont really know what it is with our people and this aversion to using an inhaler. A patient will happily sit in front of me and debate that -: they dont have sela (asthma) but uhm...why are they requesting ventolin tabs?? (i.e 20yrs of shortness of breadth and wheeze but they feel that if they admit to the diagnosis the inhaler is automatic) so they will sit there and describe symptoms of cough at night and shortness of breath but deny the obvious diagnosis. Then we go through the whole dilly dally of trying to dispel their beliefs that- the inhalers make it worse....trying to convice them that- the tablet and the inhaler have the same basic drug in it.... that it is better to deliver the drug straight to the diseased organ rather then your whole body... bla bla bla. Often after this whole excercise, I get some ooohhhhs and aaahhhhs and then a smile and a, "well can i try to the inhaler next time but now I will just take the tablet thanks"...like I even gave them a choice (tired much??) Not that there is any harm in giving a ventolin tab...its just in times of emergency you can give yourself multiple puffs of your inhaler whereas you can't do that with a tab...so yea, I kind of worry about those times...being so far away from the hospital...and having something on hand for those times of emergencies...anyways I can only advice thats all...

Number 3 is antibiotics...namely amoxycillin and flucloxacillin
Pneumoniaes and boils. Maybe one out of 3 times, you might have the mentioned, but many a time, people just have simple viral infections or wounds /cuts that could do with a little cleaning and care , and  do not yet need  an antibiotic. But my frequent flyer customers will often pull out all the whole dramatic fiasco of why they need antibiotic "oh my cold started this morning- and my nose just wont stop dripping!- and I know every time I take amoxy my nose turns off right away please really  this is all I ask of you, its a simple request- the pharmacist usually just gives it to me everytime I ask, even they know my nose well "
 Really ? man I want to know where you get your amoxy from because even though it has absolutely no nasal drip stopping properties, any med that can do it that quick whatever it may be should be made known to all !   I am constantly fighting  an in-my-head save the world battle with the overuse of unneccesary antibiotics.  Sure I dont want to miss anything but at the same time dont want to add to the ongoing plight of antibiotic resistance ever growing in Samoa- most people will now know the name of the antibiotic they think they need, most wont know about MRSA and other organism resistance which is brewing in Samoa ( note to readers- in Auckland they have isolated a strain of resistant bacteria known as  the "Samoa varient of  multi resistant....bla bla bla"- otherwise known as the resistant bug that came from us...hmmmm think a minute next time you offer that friend your 'leftover antibiotics in your fridge' )  When I dont perscribe antibiotics, I am often made to feel like I did not give patients their moneys worth...that being said- I always tell my patients to come back if things dont get better or get worse in a few days. Most of the time , they never come back- so I think they either got better without needing anything just as I had said , or they  just doctor shopped along to the next place that gave into what  they wanted haha:)

Number 2 is gonna be Voltaren.
Fuala'au ponaivi aka fualaau gugu. Ive spoken about this craze before. I dont know who decided and came up with the samoan terms for medications, but I wish "fualaau Gugu:" translated to a drug called Allopurinol and not Voltaren (or Naproxen for that matter). Unfortunately, for  a population of patients who learn very little about the human body and disease, Voltaern surely must 'feel' better then Allopurinol and so one goes on how they feel. Take the former and the pain goes away instantly  the latter is meant to decrease uric acid which helps improve gout slowly over the future months  after taking it religiousloy (ie it is meant to be preventative) ..unfortunatley the latter process can still be littered with episodes of excrutiating gout attacks  and so people who do not understand wholy what this drug was for, get disillusioned and give up. I am constantly being approached by people asking me if I have Voltaren at hand. Most of the time, they are not even seeing me as a patient but just asking me over the counter and out right...as if I would just dish it out if I had. What they don't realise is I have a recurring night mare of all the people I have seen with Gastric bleeds from Ulcers. Ulcers that were caused by years of Voltaren abuse (and no sign of Allopurinol anywhere!!) ....What people dont know is how difficult it is to treat an active GI bleed without having gastroscopes available in Samoa. What people dont palpitate over (like me) is the vast open sea that seperates where I live from where the main hospital and surgeons and more intense help is available. People dont realise my nightmares because they dont know any better. I wish I could given them a snippet of the movies going on in my head, rather then try to convince them about the risks of their risky pill popping behaviour. The Facts are- Voltaren increases your risk of GI bleed from 1 to 4. A Voltaren addict is 4 times more likely to develop (and maybe die) of an ulcer then your average Joe. Other interesting facts??- Brufen increases risk by 2 only (all NSAID class meds have a risk but there is a ladder) Naproxen is even worse coming in at 9.2 X more likley (!! Yikes!!) Yes folks...lets go easy on the orange and white tablets...and lets all start to befriend Allopurinol.

And to top my list at number one, its Voltarens best Friend- Dexamethasone.
I had never really heard of Dexa apart froma  few mentions in pharmacy lectures until I got back home.  Where I trained and previously worked, everyone was always so conscious about the use of steroids (Dexa is a steroid) . Steroids are a potent anti inflammatory and if you look up the uses of Dexa you will quickly find literature on it being used for "Rheumatoid Arthritis ( a life long and sometimes severely debilitating illness) Bad asthma, Crhons and cancer"...all of which some form of severe suffering warrants its use. For everything else, there are less potent steroids which should be used spppooorrraadddiicaly throught out ones life. In Samoa, Dexa is popped like candy. Seems like any little thing and its - Dexa to the rescue. So much so that patients now counsel other patients and the word in the village spreads like wildfire about this wonderful little white magic pill. People have bottles of their own supply from goodness knows where...and they all seem to have the same moon facies, humped backs and stretch marked stomachs...hmmmmmm I wonder why. The problem with this drug, is it is 26 X stronger then the naturally occuring equivalent in the human body it is meant to replicate. It is 7 x stronger then its much more friendly and smaller counterpart- Prednsione. Being stronger although will make one feel better in the short term, in the long term has terrible side effects. Such as  the most obvious being- an immunosuppressant or "suppresses your immune system" in layman's terms so- makes you more susceptible to other diseases/infections- next on the list is  osteoporosis (brittle bones) - kinda ironic given people with gouty arthritis are the ones popping these....High blood pressure, fragile skin and Cushings syndrome (which is what the whole moon faced, back humped combination describes) Unfortunately we are not really good at testing for this as we dont test for hormones in Samoa.... so alot of the side effects and bad effects just fly under the radar  and people just then end up living with all these other things. My issue really with such a strong drug is how relaxed people are with using it. Something like Dexa should only be used by a doctor for a short time and with monitoring and ongoing advice. Unfortunately my fellow Samoan has discovered and enjoyed the relieving short term effects of what I like to call - the "superman pill" that cures all ailments (with a price to pay) . For some, I guess the relief of pain is worth the side effects.  For others, they simply do not realise there are less side effect induing ways to treat their ailments- many patients would have jumped 4 or 5 rungs on the ladder to land at Dexa. My point is to know all the rungs and start from the bottom up...one step at a time.

Okidoki...so thats my little rant for today. My top 4 headaches that I have shared with you to educate yourselves your bradas and sistas , your fathers and mothers and uncles.Happy reading!