Author Archives: Jacalyn Duffin

Story 61 Hydroxychloroquine and COVID-19

An Ontario rheumatologist writes….

 

There once was a pill for malaria

But a bug came along that was scarier

They used up the rest

With barely a test

The result  H. C. Q. is now rarier.

 

  1. Several patients have called me to tell me their pharmacist cannot provide hcq. Some are already taking a reduced dose in the hope of maintaining efficacy but not running out
  2. Three patients have asked to be started on it where not indicated!
  3. Two colleagues have requested a prescription (declined).
  4. Several patients have told me they are not concerned about isolation because they are protected.

Story 60 – Acamprosate

Dr. David Goldbloom, an Ontario psychiatrist writes….

I have been on the phone trying to help a patient of mine with severe bipolar disorder who has comorbid and severe alcohol use disorder. He just came out of inpatient rehab at CAMH. Naltrexone has failed him twice as an anti-craving medication, so next up is the other first-line drug for alcohol use disorder, acamprosate.

And guess what? It has been on back order for many months, with a scheduled release April 23. However, our CAMH pharmacist told me that every month they keep extending the date of when it will be released.

Alcohol kills lots of people in Canada every year and puts many more into hospital.

Story 59 – Losartan again

A reader from northern Ontario writes:

I am also caught in the shortage of Losartan 100 mg and with previous writers, I fear for the future. I ran into the shortage issue in October 2019. Being the kind of patient who does as he/she is told and think little of the pills.

Well a day or two without the Losartan I was experiencing light headiness upon rising and walking. After 4 days of complete abandonment of the druggist and a lack of communication between parties my family doctor found a supply and I found immediate relief and a blood pressure of 120/80 (72 year old male).

So life is going to be good for 90 days ,and then my life will be in danger and no one seems to be doing anything about it. We need a made-in-Canada solution with perhaps, Government intervention in producing important drugs instead of allowing private industry to rape and pillage the Canadian public for share holders profits.

Story 58 – Losartan and other blood pressure drugs

A reader in London Ontario writes:

 

My physician had ordered a refill of Losartan which had had been controlling my blood pressure well.  It was not available.

She ordered her second choice, which was also not available.

She finally ordered a medication that the pharmacy could get for me. Now I hear that that third medication is not available at some pharmacies.

This situation presents a huge problem for people who travel, as travel insurance considers this a medication change and it puts the person in the medically unstable group at a great financial cost–if it is available at all.   This now impacts travel across provincial borders for those of us in Ontario.

Furthermore, in a country that is contemplating a pharmacare program, its implementation may be either worse or better for the consumer depending on the ability of the government to hold the drug companies to a commitment.

And for someone with high blood pressure the uncertainly exacerbates the condition!

Story 57 – Dessiccated thyroid, yet again!

A woman in Kelowna writes …

I was one of the hypothyroid people who insisted against great resistance from my doctor that I be prescribed a natural desiccated thyroid instead of the synthetic she wanted me to have for my hypothyroidism. We debated and finally I had to say to her “don’t make me go to my naturopath” before she agreed to it.

The reasons she gave were about the difficulty in trying to get the dosage correct using a natural version, and in my mind, they were a bit vague and not good enough. I got my way and felt somewhat better on this natural thyroid from Erfa and then the shortages began in Kelowna BC where I live.  I then found a compounding pharmacy who made it in a capsule with no talc or bad fillers and I felt way better on this form of natural desiccated thyroid than on the Erfa brand, which is a compressed tablet rather than a capsule.

I called [my] pharmacy today to renew my compounded medicine and they said “ “Hmm we are having a shortage even for the compounded – let me see if we have enough to give you another month’s supply.”  She came back saying they did, but it got me wondering about why on earth this shortage of natural dessiccated porcine thyroid is happening at all? Where does the raw ingredient come from? Is this some kind of weird conspiracy to get everyone taking the synthetic form only? Why was my doctor really so hesitant to prescribe it in the first place?

It’s very weird and I don’t know what to think. I do know that the compounded version of natural desiccated thyroid is unmistakably better and I have a friend who also switched to the compounded formula from the Erfa brand due to the shortage and she feels better too.  I’m not sure why, but I suspect it must be the fillers..
Any insight about any of this is appreciated!

Story 56 – Hydroxyurea

A hematologist in Ontario writes….

My current issue is how to deal with all my patients who can’t get Hydroxyurea, a compound with 1 nitrogen atom, 1 carbon atom, 2 oxygen atoms and a few hydrogen atoms. I probably could make it in my kitchen.

Story 55 – Dessicated thyroid, again!

A woman in British Columbia writes….

I’m writing you in regards to shortages of desiccated thyroid hormone that has been going on for the past few years for me.

Most pharmacies are short and won’t release any more than a month’s supply each time. Nothing else works and every month when I need a refill, I have to call around and find out who has some in stock.

A couple of years ago I was able to call the manufacturer, Erfa, and have a year’s supply sent to my pharmacy, but now all the phones are busy and mail boxes are full!

I see you can buy it on line (at a far higher price)!

What is going on?
Profit over healthcare!
What can be done?

See also Story 52

Story 54 – Verapamil — again!

A woman in North York writes….

I’m contacting you regarding a shortage of verapamil 240mg SR.  The shortage began in March 2019, I was informed by my pharmacist that the medication I’ve been taking for over 20 years was no longer available.  I was told to check with my doctor as to what alternative there was, after lots of back and forth it was decided I should take verapamil 120mg SR , just double the dose. Unfortunately verapamil 120mg SR is the only one in the verapamil family not covered by Ontario Drug Plan, which causes me financial hardship, so far I’ve had to pay for six months.
I’ve tried to follow up with the pharmaceutical company Mylan, producer of verapamil, in March I was told the restock date would be July, in July they said the date was now September, in August they admitted they don’t know when it would be restocked.

I’m 87 years old, you can imagine how frustrating this situation is.

Story 53 – Verapamil and frustration!

A reader in the British Columbia interior writes….

 

I am a 79-year-old man and have used verapamil for a number of years
to control blood pressure and a irritating PSVT. I now cannot get it,
and am one of those long term users you describe who doesn’t want to
fart around trying new stuff when there is no inherent necessity to do
so. It angers me, especially when I read of the complex and
profit-driven…excuse me, profit-OBSESSED, agencies that are the root
cause of it.

It seems that we as a nation are unaware of the profound dangers that
are entailed. “Extortion” isn’t an overstatement.

I am going to read the whole thing [this website], particularly those elements
proposing an nationalised production. It is ridiculous that a modern
1st world nation like ours has no pharmaceutical capacity to protect
the heath of the citizens- and there is, as you say, no economic
argument for not doing it, given the costs that would arise if
appropriate treatments and preventions aren’t available.

You’ve got my blood pressure up (ha ha) and I’m going to get chewing
on the material, all the while growling at the political inertia
around this.

I think it’s very important to alert people to the essentially precarious nature of pharmaceutical supplies, especially in the context of the magnitude of our reliance on them and their cost.

The problem is political and economic- and apparently no political
establishment can imagine anything more than bulk buying and
pharmacare as a solution…and even these are largely seen as too
radical.

It’s an acute case of path dependency wherein “pragmatism”
and “empiricism” are forgotten archaisms. …

What must be re-established in policy decision-making is a clear understanding of the inherent power of a modern sovereign state to meet the essential needs of its citizens. Canadian resources, human, natural and institutional are immense. The question “how can we afford it?” is rather silly. No. It’s really
silly.

Story 52 – Desiccated thyroid

A reader from Greater Toronto area writes:
I had my thyroid removed due to cancer in 2014. Originally, half of the thyroid (where the growth was) was removed and sent in for biopsy. I felt fantastic after having this removed. I felt 15 years younger. Roughly a month or so afterward, I was informed that the results came back as cancerous. I was told that I should have the other half removed as well to prevent the possibility of the cancer returning.I was told this is a simple surgery and would have to take a synthetic hormone for the rest of my life. I was told millions of people have had this done and there were little to no side effects, and that I could live a normal life afterward. I was an avid hiker and hiked about 17 km 2 days before my second surgery (with about 30 lbs of photography gear in my backpack).
After the second surgery, I felt terrible. I felt worse as time went on. The endocrinologist was unconcerned. I could not work. I could barely get off the couch to get a glass of water without my heart beat going up to 160 to 200 bpm (one of a long list of effects I was experiencing). My family doctor offered to prescribe anti-depressants, I refused (although I am positive I was experiencing severe depression, again with a host of other issues). My pharmacist told me he thought the issue was the synthroid that I was prescribed for the thyroid hormone replacement.
After trying to go for a short walks (as told by my doctor) and having to call an ambulance as my heart was pounding out of my chest and was over 200 bps for the 4th time in 10 days, I asked to see another endocrinologist, and asked my family doctor for a referral to another doctor. I should add that I was told my blood work was fine and my complaints sounded like both hypothyroid and hyperthyroid issues, which was impossible. One of the major complaints was that I could not sleep. I could go 4 or 5 days with only a couple hours of sleep. In order to keep my sanity, I only took 1/2 of my prescribed dose, which sent my blood work out of whack, but I felt that was all that I could handle without going insane.
It took a year to see another Endocrinologist. My new family doctor said they could not change my prescription because I was under the care of a specialist. Finally, I was given an alternate prescription (I forget the name, but it was T3 as opposed to the T4 Synthroid). Most of the symptoms went away within a 10 day period, except now, my feet swelled up. It was extremely  painful to walk. I was told I could get a wheelchair…
Finally, I was reading about desiccated thyroid. I mentioned it to my endocrinologist. He said it was snake oil and does not do anything. I told him to try it on me. He said no. Eventually, I stopped taking my T3 and told him unless we tried the desiccated thyroid, I would not take the T3 (we tried 2 different types of T3 ) as I would rather go into a coma and die then to continue life as it was.
Desiccated thyroid was my magic pill. My endocrinologist could not believe it worked. After 2 1/2 years, I finally have a livable life again. I have a regular job again, and although I don’t feel as good as before they removed the second half of my thyroid, I can live a decent life once more. Too much and my feet swell and get numb. Too little and I feel drowsy, can’t concentrate etc. For some reason I am very sensitive to these hormones. My perfect dose (through trial and error) is around 110mg. Doses come in 60 or 125 mg’s so I cut the pills. My blood work has always been in range and I feel pretty good.
The down side to all of this, is the pharmacy having stock outs of desiccated thyroid. Since the fall of 2016, when we found a dosage that put my blood work and my life in a decent range, I remember once when they had a decent stock of this at the pharmacy. I am either taking their last stock, or they have to phone around to find another pharmacy that has stock for me. To me, this is my lifeline. I’ve tried all the alternatives (that I am aware of, or that any doctor has mentioned to me). Too much and my feet swell and get numb. Only one manufacturer in Canada, so I am always checking a month or so early with the pharmacy to make sure they will have some when I need more.
Sorry to write a book, but the thought of drug shortages does cause a little anxiety for me…
See also Story 55