“It is much more important to know what sort of a patient has a disease than what sort of a disease a patient has.” - Sir William Osler






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Don't Try This At Home

If I ever write my autobiography, the first sentence will probably be "I was raised on grits and expired drugs." The grits are courtesy of my mother, a Southerner; the expired drugs are my father's contribution. He retired from family practice a few years ago, but my parents' house is still full of pharmaceutical samples labeled with expiration dates you wouldn't believe. When we, as kids, got sick we were dosed with Dimetapp from stock bottles and antibiotic samples Dad acquired from his friendly drug reps. I remember with particular resentment the buttock shots of Bicillin (I could expect at least one of these per winter since I got particularly snotty and long-lasting colds). For those of you not familiar with this Antibiotic From Hell, Bicillin is a formulation of injectable penicillin which has to be kept in the refrigerator and is the consistency of wallpaper paste. One of those in your gluteus maximus is an experience you won't forget in a hurry.

When I left home for college and medical school I did not leave without being well-stocked from my father's seemingly inexhaustible home pharmacy. Dad's infatuation with antibiotics didn't rub off on me; I try to wait out each respiratory infection despite his well-meant urgings before (usually) throwing in the towel on Day Ten or so and beginning antibiotics. The irritating thing is that they usually work, which forces me to listen to his triumphant "I told you so!" I counter with a rehash of the current warnings against overuse of antibiotics, which he waves away with scorn.

My father's been blithely ignoring drug expiration dates for years (with the exception of tetracycline and nitroglycerin, which do require strict observation of the expiration dates. Interestingly, even the warnings about tetracycline are being called into question now; it may be safe to use after its expiration, after all). I first realized he might be right in medical school, when I called him in a panic over a urinary tract infection. All I had was trimethoprim-sulfa which had expired five years previously. "Use it," he said. My symptoms were gone in less than an hour.

Several months ago the Wall Street Journal ran a pharmaceutical article which agreed with what my father's been saying for years; most drugs stay viable long after their expiration dates. Of course, a lot depends on the conditions under which they were stored - if kept in bright sunlight and warm conditions, the medication will degrade much sooner than if kept in a store cupboard at room temperature. I promptly clipped the article and sent it to him. He responded with a gift of cough syrup which he'd recently unearthed in storage. The expiration date on this stuff is November 1982. That's right, it's old enough to vote. It packs quite a punch - every 5 cc's (one teaspoon) contains 60 mg of pseudoephedrine, 5 mg of hydrocodone, and 5% alcohol. The manufacturer listed on the label no longer exists as an independent entity... Dow Pharmaceuticals merged with Merrell years ago.

It still works. I was coughing my brains out last night and it was all I had. It's scary when you realize you've picked up the very quirks that used to drive you crazy in your parents.


posted by Dr. Alice at #