My ra raa RAHHHH for the day ;)

Why is it that-

When the sign says we close at 12  people RUSH into the carpark…at 12.02 ..ie we are sweeping the floors and closing the windows…everything has been counted balanced put away and turned off. The last available appointment is- 11.45. They then  proceed to stand in the window and frown and hold on to their sides  like they have appendicitis or are going to give birth to a baby or something.

You

Had

All

Morning.

But obviously, mines a  a job where a closing time is non existent so….my babysitter develops a headache because she wanted to leave at 12.30 to go look after her own kids but now…I'm running late. My receptionist is grumpy because not only is it the time I need now to see someone but all the closing procedures have to be repeated. Count, balance, put away, turn of. Been there, done that. ALREADY. My kids get to see LESS OF ME..and more of the TV. Because –you decided to come at 12 and not before 12. The phone even dares to ring and a sulky voice on the other side goes “eeeaaaaa….you guys close at 12?a ea?....” to which the answer is obviously YES. Then they go “mmmm…ua ke'a le sefulu lua a ea?   eaaaaaaaa….mafai ga ou laku pea loa le kaimi gei fai vave a saka kalavai?’’…..

leeeeaaaaaaaaiiiiiiiiii

Why is it that.

People do not see the hysteria and comic of their actions when they come to see me for the first time (ie their file is BLANK) and they pronounce…”FAAFOU  IFO KA FUALAAU KOKO”…and then when asked what they take the proceed to go “KAILO- e pa’epa’e lapokopoko le fualaau”- do you take Panadol for your BP?? Oh wait maybe Metformin?? Oh but septrin looks like that too…goodness grief there are a million white round tabs and you are one person whos been drinking this pill from a packet with a label for 5 years dont know what its called....even a cizzzaaa-something I can do (and I get alot too) but a kailo?? ok...I'm gonna write that on your script.

Go

Learn

Your

Tablets

Names.

Fullstop.

Why is it that.

I go on holiday for a few weeks and then come back to a hoard of angry patients. Most of the convos go like this “ia, well I ran out of my BP pills and now  I have nothing so of course my Bp is UP”- followed by a glare that  kinda looks like a ‘its all your fault’ kind of glare….then a “So I came for a repeat script and YOU WERE NOT HERE”- say it loud incase I didn’t hear or know, that I-was-not-here

Many conversations like this and I was actually saying sorry. Hold up.

Take

Charge

Of

Your

Own

Health

Ie- use another dr the hospital etc….a ou oki ga a lea??? I did have a notice up for a month before I left to which only 2 people were pro-active enough to come get future scripts.

Just a couple of white hair moments..nothing like being welcomed back to Savaii hamo style.

Why oh why ??

OMG
If another male patient takes my polite "building rapport" -ness the wrong way and decides to share with me  all the weird and quirky things they feel  and dont feel while bonking their wives/girlfriends/whoeverIdontgiveacrap.... when they intially just wanted me to check their cold out or refill their script...I might just have to shoot myself. Seriously. like WTF. Is there a sign on my head that says SEX THERAPIST....ok I know my scope of work can sometimes cover some man problems (and sometimes women too) in that department and their are some diseases and meds that can help in that arena...but old men with bedridden wives who want to describe in detail this feeling and that feeling and then BANG...honestly.... and young men who are like " then when I go faster and faster" when the convo initially started off with "my stuffy nose and sneezing wont stop"....I seriously just want to spew in my mouth....

Im trying really hard to tell myself that sometimes, people may have a legitamate problem they need help with. But more often then not, the things that get described are absofuckinglutely normal and I dont know why people feel the need to share with me. Like seriously. You are crossing a barrier. I am just uncomfortable now. The same way your daughter should feel uncomfortable if you told HER about you freakin sexual excursions....it freaks me out too.

And to add to that, I dont need to know that you think that 'cold rush' you feel at the end ...is because you walked over that grave last week and you think a spirit is floating in and out of you. Like seriously, freaky and then scarey...

I am a lover of signs. Signs tell people all the unspoken stupid things that they should be doing that I don't want to waste my breadth on like "please wait patiently until  your name is called  before entering the office" (and not just barge in on other patients  when you feel like it) and "If you would like a repeat prescription, please bring in your medications or at least write down their names"(as oppposed to "koe faafou mai ka fualaau", and then you ask what they  are taking and they say "kailo")
Im contemplating a sign for the above problem but how would one word it ?? please keep the sexual talk to a bare minimum and only if requiring treatment???

eh se kailo se...

Things you can't see

This week, I've had a rollercoaster of experiences over things you cant see. Some my own, some of other people. In my job, often I am a listener. I think its important in a job where you provide a service, to be a good listener.  So I have been listening alot to people that have been suffering, but they suffer from things you can't see. Funnily enough, Ive been experiencing this a little myself. I have found myself the unfortunate victim of a symptom called "Tinnitus" which is basically a ringing sound in your ears. Like, all the time. Its kinda really annoying when trying to appreciate the stillness of the night, the quiet, the full moon, the stretch of black water...and then this darned ringing like someone has a high pitched radio stuck on no station just going EEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEE.
 You get my drift.

So, this week Ive listened to people who have things in their eyes (blurred vision aching eyes), their heads (pulsing headaches and migraines) , some depression and even morning sickness! And its made me feel a whole lot of empathy for these people who have these things that you can't see. You look at this person and they look absolutely fine, a picture of good health really! And then, apparently, they are sick. And the most dissappointing part  about what they are feeling is that no one else understands what they are going through, and are even getting annoyed with them. Basically if you can't see something, its hard to understand the nature of whats there. Its also hard to empathise at the right time, and support people who have (ringing in their heads and nausea left right and centre) ....I can see why someone with a not so obvious symptom, could easily fall into depression. Unless you have a really caring on to it support person who ASKS you how you are ...its easy to feel ignored and left to suffer in your own silence.

I try to encourage these sorts of people to bring their support people, their other halves, or a sibling in with them. Someone who you can reiterate the nature of the problem and the severity of their ailment. That does not always happen and this is not always an ideal world. heck, even I feel like that many a time, but sometimes I think my other half is too mechanical with his way of thinking about life. You have a problem, whats the solution, right you're on that tablet huh..the end.And I don't think he is alone in this mannerism. I think alot of people (men) are like this.... and sometimes it is our job to (knock some sense into them ) tell them about whats going on and what you need from them (eh) I am also sure alot of medical people fall into the trap of everyone expecting them to 'treat' themselves as it is our profession- and that includes, nurse oneself and ask oneself how one is. (!)no need for anyone else to ?interfere.  
Not trying to go all Dr Phil on you but in a way I am so too.

Anyways, so just a word to my friends, if you know someone that has something, that isnt like a broken leg in a cast, make the effort to remember and ask- hey hows that _______(insert symptom you heard about in the past but can not see) Because I think human nature makes us look at our friends and family and partners for empathy/sympathy as a way to help get us all through any sort of suffering. And many types of suffering are unfortunately silent.

Adios people:)

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!