And Your Stools
People are usually embarrassed about issues concerning dropping the boys off in the bathroom. I always wondered if the fragrance was that of a newly mowed lawn, would it change the air a bit concerning stool shyness. I mean regularity is just a normal part of life but it’s always such a hush-hush issue. This brings to mind a behind the scenes consultation in the Rx department. It involved something unusual that occurred in the water closet.
Patients jockey up to the prescription counter with such thought-provoking questions almost every day. This one instance, frozen forever in my memory, involves a gentleman who with a barely audible voice said, “I am having a problem”. I brought him over to the privacy area where all whispering goes on in the pharmacy department. Since he started taking a new medication (Exalgo), he noticed that the tablets were ending up in his feces. He was asking me what could be done to make the tablets dissolve in his stomach instead of ending up in the toilet. I ask how he knew they were in his stool. He said, “I saved my duty and my wife and I picked through to find three complete tablets. At that point I could no longer give him any eye contact. This was of course a serious matter for him. To maintain my composure, I ended up staring intently at his neck. I said, “How did you know to look through your bowel movement?” He tells me he happened to glance in the bowl before the flush and saw a tablet sticking out of his waste material. Then he emptied the toilet with a container and called his wife for help.
At that moment, the other pharmacist arrived for our scheduled overlap. I told my partner that I was taking our patient into a backroom for a private talk. I got the gentleman seated comfortably in a chair and just smiled at him. He said, “You think this is funny?” I politely smiled again and said, “you just experienced ghost tablets. The medication is made with a laser hole shot into a non-digestable outer coat that is filled with your drug. The fluids in your intestinal tract cause the tablet to swell, the medication than liquefies and shoots out of the laser hole. What remains when it hits the toilet is just a ghost outer tablet devoid of any medication.” We both started laughing together. I told him that his secret was safe with me. That I would tell the story but never mention his name. We parted ways as casual stool buddies and I went back to checking prescriptions.
Ghost tablets are made by a number of manufacturers. You will see Invega, K-Tab, Allerga-D, Concerta, Exalgo, Glucotrol XR among the dozens of extended release preparations that haunt the toilet bowl afterwards. Boo! Just check with your pharmacist to make sure that what you see should really be in your stool.
Abbreviations that indicate sustained released medications can not usually be broken or crushed up. You will see CD (controlled delivery), CR (controlled release), TR (timed release), LA (long acting), XL (extended release) and XR (extended release). It gets a little ridiculous, but the drug manufacturers spend millions to come up with their own innovative way to control the release of medication. Sometimes it’s not only a tablet but there are capsules and even liquids having small microscopic particles that release the medication over a long period of time.
A Poop Fact:
Do you know if you consume enough fiber in your diet your stools will float. High amounts of dietary fiber absorb a large amount of fat from the diet like a sponge. Fats will float, therefore the feces containing all that fat will do the same. So floaters in the toilet bowl are a good thing. The more fiber you consume, the more fluid you must drink to not let the system constipate.