Friday, March 4, 2011

Lap Bands

Lap bands and gastric bypass get on my nerves. They have all kinds of complications. I am sure they work for the most part, but all my patients who come to the ER with lap bands are still huge.

Today I want to rant about taking pills and lap bands. I hate when I write a script for someone with a lap band and they ask me, "Can you prescribe it in liquid? I can't take pills because of my lap band."

It doesn't matter if it is a pain pill... antibiotic... whatever it is... they want liquid. A grown friggin adult asking for liquid medicines. And they usually have just scarfed down a burger or Cheetos. I always ask "Can you eat food?" They say yes, but they still need liquid medicine.

WELL TOO DAMN BAD. I don't give liquid meds to a grown adult unless they have some disease where they can't swallow solids. I am not going to calculate some huge amount of liquid and make the pharmacist dispense 40 ounces of meds when you can make the adjustment yourself.

If it's a pill and you want to be a puss, then grind it up. If its a capsule, open it up and put it in yogurt. (Haha like they really eat yogurt...I meant cheese fries).

ER Doc


Anonymous said...

Ha ha ha. FUCK YOU.

Sarah G said...

First of all I love your blog & until today had never been offended by any of your stories or observations. However, as a Lap-band patient (and a successful one at that) I can say that sometimes things get "stuck" in my band. Even well chewed solid food, It f*cking hurts, causes excess salivation, nausea & sometimes vomiting until the blockage passes. It can last a few minutes to a few hours.

Just something to think about the next time some puss wants liquid meds instead of some horse pill that tastes like battery acid when crushed.

Hope your next shift is uneventful!

juno said...

Your mother must be so proud of you. Off you went to med school to use your giant brain to become a doctor!!! And now look, a cynical asshole who hates on all his patients who aren't pretty or nice. Well screw you. I bet your coworkers pretend to find you funny just to stay on your good side, and behind your back they have given you a hilarious nickname. Hope to never ever cross the doorway of your ED, would rather die with dignity.

jen said...

Honest question - if random stuff gets stuck in a lap band, are pills really a particular problem?

I can understand food sometimes getting stuck. But I'm assuming you do in fact eat meals. Is that an incorrect assumption?

I just don't understand why a tablet or capsule would add to the problem or be an issue.

The fact that food gets stuck in there is pretty significant to me - means it's definitely not something I'd ever want to have done. Especially since I can't swallow pills with liquids - it takes something more solid to push them down.

Liz said...

My sister has a lap band, and if she actually followed the rules (hah), she'd probably be worried about it. I think there's a rather small list of things that can potentially happen to get stuck. I'd use pills as an example, but since she went off her meds, it's not feasible. (my sister is an idiot). Yes, they can eat. My sis mostly eats junk food but - gasp - still loses weight. Lap band does not equal healthy. Even with gastric bypass you can cheat.

@Juno - eh. I'd rather have an ER doc that is alive than having killed themselves over stress. People vent for a reason. Healthcare is stressful as hell. Possibly even more stressful. It's one place where you can literally want to off yourself every friggin day.

Unless you've worked in an ER or known someone who has, don't judge until you've walked in their shoes. (I suppose this can apply to the patients, too, but ER docs have to cope somehow. They see the crap of the crap and just...well, have to deal with it.)

/end rant.

SerenityNow said...

Anon #1...If you're going to post something so intelligent, at least leave your name so we can give you credit for it.

Liz...Finally someone who gets it! Thanks for the kind words.

I had never thought too much about this issue until my colleague posted this. But, there are 2 groups of people who ask for liquid meds. First is lap-band patients. Second are the mentally retarded (or their guardians) who ask for them because their brains aren't coordinated enough to swallow a pill. Coincidence?

-Psych Doc

Anonymous said...

I am Anonymous #1. That was my initial, unfiltered reaction to your post.

Keep in mind that lap-banders are told by their surgeons to take liquid meds. They're being compliant, at least in this small way. That should make you happy?

I have had gastric bypass surgery. I am two years out and have lost nearly 200lbs. I am still losing, slowly, I take all of my vitamins (yes, mostly in pill form now), and I still drink goddamn protein shakes because it's the only way that I can get my protein needs met. I also eat chili cheese fries occasionally, maybe four of them at a time. At this point I *could* eat more, but having GBS has helped me figure out how to eat in moderation. I am lucky and have had very few far.

Consider all of the above when you read this: I am 5'6" and still weigh about 260lbs, therefore, I am still probably "huge" in your eyes.

Am I a failure? Would my having had GBS be such a burden on you if I showed up in your ER? Is that burden not worth a 200lb weight loss?

If so, fuck you once again.

I have been to the ER once since my surgery, for falling off of some stairs onto a concrete patio and hurting my back. It turned out to be a muscle strain, but it kept spasming and hurt like hell. The ER was in the same hospital where I had the surgery, a hospital that does *a lot* of bypass surgeries. Yet, the ER staff didn't know that I couldn't take NSAIDS, in any form. They kept trying to give me an NSAID injection and acted like I was drug-seeking because I said I couldn't have one. Shouldn't they know that GBPers can't be given NSAIDS? How does this little stipulation differ from any other complication of any other condition?

Why does this happen? My cynical guess is because it's only fat people who get these surgeries. If they had any self-control, they wouldn't need the surgery. If they had any self-control, they wouldn't be bothering me with their "special needs". If this is, indeed, the conscious or unconscious reasoning, then...nice. Very very nice.

SerenityNowHospital said...


Stop being such a sensitive pansy. Did I say I hate all lap banders like I hate all fibro patients?? No. I even said I am sure most work. In fact, a friend at work (who I respect the hell out of) had a lap band done years ago, sticks to his restrictions, and looks awesome.

I said I hate it when the failed lap bands who come in and and whine about pills when they can crush them themselves. This lady was huge, was extremely annonying (prob will be written about on new nurse in the hoods site as it was her patient too) Also had fake tits to go with the lap band.

And ER docs, or other non surgeons, don't know about NSAIDs and shit with lap bands bc we don't do the damn sugeries. They don't teach us that crap in med school bc they r busy filling our heads with other worthless garbage.

ER Doc

Anonymous said...

Would it really hurt you to try and think of how it feels to be someone else for once?

Pretty insensitive post from someone who's supposed to be helping these people.

Alison said...

This actually just made me curious. What about slow-release pills? Would they be less effective on someone with a gastric bypass or lapband, because they wouldn't stay in the body long enough to release their chemicals?

Just wondering.

SerenityNowHospital said...

Yes anon I think of that stuff....just not on this blog

ER Doc

amyinbc said...

Ouch. That one had to have hurt the readers who have lap bands. The junk food comment.

But I guess even if they are no longer obese they are still fair game for discrimination?

amyinbc said...

And the comment by Psych Doc. Surely in your field of expertise you have caught up with the fact that the MENTALLY RETARDED label went out with the early 80's. The term is considered derogatory in this day and age.

I believe the most current politically correct label is developmentally delayed or mentally challenged. And, of the 100 or so inividuals with such delays I have worked with all are perfectly capable of swallowing multiple pills.

SerenityNowHospital said...

Re amy inbc:

You mentioned the politically correct term of mr. And that proves part of the mission of this not be politically correct. We have to do that at work not here.

ER Doc

SerenityNow said...


The medical term is Mentally Retarded. In my field of expertise, I am trained to memorize the DSM-IV-TR. There, you will find definitions for Mild, Moderate, Severe, and Profound Mental Retardation.

So, while it may be politically incorrect, it is 100% accurate. DSM-V will be out in a couple of years, and maybe that definition will change.

It was not meant to offend anyone. Likewise, I don't think ER Doc was trying to offend lap band people. The point is about whiney bitches asking for liquid prescriptions. It is a pain in the ass, when you only have so much space on a prescription pad, to write "Disp: 1,563,234 mL. Sig: 47 teaspoons PO TID"

-Psych Doc

Liz said...

@Anonymous #1 -

Unfortunately, you're probably in the minority of lap-band people. All my sister eats IS junk food. The reason she loses weight? She throws it all back up. All of it.

@ Anonymous who says this: " Would it really hurt you to try and think of how it feels to be someone else for once?"

This applies both ways. Unless you've (again) worked in healthcare at all, you have NO IDEA what sh$t they put up with on a daily basis - not only from their patients but often from coworkers as well. It's a coping mechanism. Look, I've worked both in LTC and I volunteer in a postpartum unit. I have a couple people I know who have worked in the ER and I've shadowed a shift or two.

These people see the lowest of the low. The druggies, the fat people who are mad at everyone because they're fat (or whatever) - they see the dregs of society in a lot of cases and have to put up with them on a daily basis and make them happy because management demands it.

It's a shitty job sometimes. Again - he's VENTING. It's a friggin coping mechanism, people. It's far improved on him killing himself, if you ask me.

This is why I rarely comment...

Sarah G said...

@jen Skipping pills when possible is a precaution in my mind. I've never had one get stuck but I can imagine that if one was not fully dissolved and tried to pass through it could get stuck. I was instructed to take pills with lots of water or in liquid/chewable form when possible.

@Psych doc I now take offense to being equated with the mentally challenged just because I have a Lap-band. Thanks for that!

@ER Doc & Psych Doc I understand needing to vent and blow off steam, truly I do! But in your own words someone is a "puss" or a "whiney bitch" for asking for their legitimate medication in a form other than what you normally would prescribe?! It takes too much of your time to make the conversion, a pain in the ass to write a little smaller, and too inconvenient for the pharmacist to fill. Sirs, this is all part of your job! Get over yourselves!

Anonymous said...

@ER Doc, You pussed out like a girl. Instead of a scribbling a screed how all GBS patients are a drain on society in resources used (time and money). That their problems could be solved by exercise and putting down the fork, you offer up some bullshit excuse that the medication CALCULATIONS are a pain in the ass for switching from solid to liquid dose form. And THAT is why your underoos are in a wad? Really? The person who probably slept thru math all through their academic career and got As, is sniveling about a calculation you probably learned in freshman chemistry? Are you ciphering these conversions out in the parking lot with chalk?

And when did ER doctors give two craps about how retail/hospital pharmacists deal with your scripts/orders? So I'm not buying the whole pharmacist love thing either.

We all got people who drive us wild on sight. It doesn't even matter if they haven't even said two words. If these patients make your skin craw, and it's a RANT, RANT for heavens sake. Don't chicken shit out.

D- for today. One of your weaker efforts. Go read anything by "The Angry Pharmacist", The Ninja Master of the Rant or Nurse K, a goddess in her own right.

amyinbc said...

Sorry, I still content the term 'Mentally Retarded' offensive.

Unfortunately our society has used the term "retarded" in all too many unflattering situations. A dig one may use to discredit another persons wisdom.. To consider them stupid. Under educated. Not worthy of opinion.

Not sure about where you practice but in BC Canada 'retarded' is considered slang for what I consider a huge insult. And pretty much socially unacceptable.

In this day and age Mentally Retarded is a hurtful label. Having spent my life working with individuals with mental/physical challenge your label hurts and is in my opinion archaic.

Brush up on that and your patients and their families will thank you for it.

Anonymous said...

@Allison, Anonymous #1 again. Yes, extended-release or enteric-coated pills do not work as well in GBS patients b/c they aren't absorbed properly.

ER you never learn anything new?

And, I will also say this. The GBS program I went through was thorough in its evaluation of people before surgery, but people know how to lie to get what they want, unless they're really impaired. Just in my program, I have run into patients who never had any intention of following post-surgical recommendations, and, as we all know, eventually they will pay the price, and will probably show up in somebody's ER. Many times. Maybe it'd be useful to learn something about these patients and the conditions they might likely show up with?

I am looking forward to seeing the data...if any accurate data manages to get published..

So, I am still curious. I am currently at a weight were some people (god help them) are just *getting* their bypass surgery. I show up at your ER but there is no medical record for me at your hospital. Do you automatically assume, since I'll tell you right off that I've had GBS, that I'm a failure and should be treated like one?

And FWIW, years ago I volunteered in the ER of the very same hospital where I had my surgery, in deepest darkest Detroit. I do have some idea of the sorts of people that ER staff deal with, and I don't envy them.

DIY Health said...

When I was a child, I used to take plenty of medicines for my vast illnesses. When I can;t swallow them anymore, she would insert it in a small banana and in it goes.
I don't have a lap band. And I don;t want to be judgmental to these people

DIY Health said...

but perhaps the banana could help?

Anonymous said...

Okey dokey, Anonymous #1 back again, probably talking into the void, but like a fat person with a cake, I apparently just can't leave it alone.

I think the offensive thing here is that you tar all "failed" lap-banders with the same brush, when in fact, it appears that what you have here is a woman with a personality disorder who is also a "failed" lap-bander.

A, then B.

I assume, maybe I'm wrong, that not all "failed" lap-banders are personality-disordered?

And, I guess another part of this, is that you didn't say anything about how you know she had "failed". Was it just her size, or did you actually have/get some history? How do you know that all she eats is crap?

Jake said...

I work in a pharmacy, and most of the liquid medications come in strengths intended for children, so an adult is going to be taking a shit ton of teaspoons of the medication, like Psych Doc mentioned. And if we got a prescription for a crazy amount of liquid medication for an adult, we would probably call the hospital and be like...seriously??? And then change it to oral pills anyway instead of ordering 100 bottles of one medicine.

thatsit said...

I hear ya. Gastric Bypass is a PITA!

The only rule I break is taking Motrin. Sorry folks, my back hurts and I get horribly cranky. After ruling out important stuff it still hurts. I told the Dr. I'll take my chances.

Oh and if it's abx, I'll take the shot please-but I'll do it at my own Dr.s office. ER's have germs and teh curazy.

So vent away, it's your blog.

Hell if we can't talk about the things that bug us on our own blog, where can we?

Another_Poster said...

I'm not going to post under my actual blogger ID... but also work in the health care field, just not in the ER.

It's not necessarily the person or the condition that requires the liquid medication, but sometimes just the way it is asked for. Or maybe the fact that it is expected. Patients don't get to dictate their care. PERIOD. That's just the way it works. Sorry. While health care is moving toward patient centered care, you still don't get to be a whiny bitch and get to pick how everything is going to go. It's amazing what being nice and explaining your situation calmly and politely can do for you.

I actually work in an orthopaedic department. We get people who want their percocet in liquid form. GIVE ME A FREAKING BREAK! Your drug addicted ass can call me begging for it, but you can't swallow a pill. Yes, some of them are Lap Band patients too, but a lot of times they don't even bother telling us that.

The point behind all of this is when you deal with it all day, it gets REALLY old. I am both a patient (with multiple chronic conditions) and I work in the health care field. If you don't want to read this stuff, then simply don't. I'm sure he was plenty nice to this patient and all his other patients. Haven't you ever thought something bad about someone???? I bet you have.

Anonymous said...

Wow TSH you really hit a nerve with this post!

ERP said...

You must have known you were going to get flammed for this one.
However, I agree about the annoyance of liquid meds. I know several people with lap bands and they have no trouble taking pills. I guess some may because the band is really tight I guess.
The worst are teenagers with NO medical problems or surgeries (or MR for that matter) who refuse to take pills and want liquid because they "can't swallow pills!". You know what. Grow a pair and take the fucking pills.

Anonymous said...

New, late to the party anonymous here. I hear you on the meds, but frankly, I have no patience for the people who've had or "need" bariatric surgery.

Ok, so it works by preventing you from eating too much and absorbing too many calories? Right....uh, here's an idea: Learn how to eat moderately BEFORE you have your innards reshaped.

Seriously, are you fucking kidding me? Bariatric surgery taught you to eat moderately? That's f'ing awesome...did you decide to get into a massive, multi-car pile-up in order to teach you to follow traffic signs?

Yeah, I'm average weight. You know why? Cuz when I started getting really fat, I stopped eating so damn much, because I didn't want to be enormous and uncomfortable and inactive my whole life. And then when I got tired of being merely large and uncomfortable and mostly inactive, I learned how to eat less and eat better and exercise more. And amazingly, did all of this without a single high-risk, expensive, debilitating surgical procedure.

And according to the very friends I once commiserated with about the unpleasantness of being fat, this makes me an evil person who doesn't REALLY get it. Anymore. Right. Because I totally forgot what fat was like, and somehow just miraculously turned into a skinny bitch.

Yeah, sorry, I'm not usually this vicious, I'm just tired of listening to people who I was fat with now whine about how it's IMPOSSIBLE for them to change. Apparently, I am IMPOSSIBLE. Or they need some reality checking.

Nurse K said...

I've read ER Doc's [March 5, 2011 3:23 PM] comment like 5 times now.

Frickin' brilliant.

Jules said...

Hey Anon#1, no one here cares that you're offended. This isn't a place where you get to show up, anonymously comment (grow a pair and use your regular screen name btw, coward), and expect some kind of retraction, apology, or ass kissing. You seem like the type of entitled bitch who has learned to use this tactic in the real world to get her way, but it won't work here.

probably talking into the void, but like a fat person with a cake, I apparently just can't leave it alone.

No, not "apparently", you just can't, period. You have a lack of self control to the extent you had to undergo major surgery to correct it.

PharmGamerKid said...

i had an adult patient who came w/ prescription for augmentin x 10 days. we gave her the pills but then she insisted that she couldn't take pills 'cause she had a lap band and wanted them in liquid. i told her that this would require her taking a gallon of augmentin. she didn't care. long story short, she used up our stock of augmentin suspension that should have gone to the kiddies. oh yeah, for some reason, her insurance paid for it too. wtf...

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