I had yet another interesting day today in #pharmacy land….

Many #prescriptions to fill and many #people to see…..

At one point, the cranky #wife of one of our registered patients pooped in to ask for a tube of #Anusol HC ointment to treat her husband’s #haemorrhoids. I remembered the #lady from a week or so ago and asked how her husband’s haemorrhoids were shaping up. She told me that despite using the hydrocortisone-based ointment, the problem was still there and that he was in a lot of pain and discomfort with the condition. She also told me that he was grumpy - still not sure if that was down to her general assessment of his character in old age or because of the piles.

On questioning, I found out that the patient was prescribed a number of opiate-based medicines for pain management (e.g. morphine). Naturally, I concluded that he was most likely constipated due to medicine side-effects and that excessive straining whilst going to the loo for a ‘number two’ caused the haemorrhoids to present.

The product license states that the ointment should not be used for more than 7 continuous days. This is because topical steroids can cause thinning of the #skin, which in turn can be irreversible. Hence, I had concerns when the wife requested a second tube of the product.

I made my concerns clear and first of all offered advice on how the #constipation may be relieved. Key aspects for the couple to consider - as a partnership - were an increase in fluid intake to soften the stools, an increase in dietary fibre (e.g. more brown bread; #Hovis) to bulk out the intestine to stimulate bowel movement and also working with the #doctor / #NHS to review the pain management strategy (i.e. decrease the reliance on the opiate-based medicines causing the problem / incorporate #laxatives to help the situation). In terms of pain management, a move down runs of the pain ladder would be important with a view to reaching the point of regular paracetamol use, if acceptable pain control was achieved.

On this occasion, I made the sale of the second tube of Anusol HC ointment due to the fact 3 days had elapsed since the end of the use of the first tube. I made it very clear to the lady that a third supply of the product would not take place from our #communitypharmacy and that steps needed to be taken to manage the root cause of the problem rather than simply smoothing over the surface. The lady understood my concerns and was extremely grateful of the advice that I provided. She told me that her husband would be happy to follow my recommendations.

Naturally, all of my experience in the real-world of pharmacy feeds directly into the www.pharmascholar.co.uk project. Get in touch today to see how we can help you develop into an effective #healthcare practitioner with the best interests of the #patient at heart (and bum)….