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Should Pharmacies Limit Teen Access To Protein Supplements?

A strange thing happened to me at a CVS pharmacy two days ago. I was attempting to purchase a protein drink when the girl at the counter asked me to show her my I.D. card. I assumed she meant my CVS savings card and was sincerely confused when she rejected it, saying, “No, your picture I.D.”

I dug through my purse to find my driver’s license while the girl explained,

“You have to be 18 years old to buy this product. I need to type in your date of birth into the computer.”

I wondered if the girl was partially visually impaired – at age 39 I didn’t think anyone would confuse me for a teen (though of course, I would enjoy it if they did), but beyond the amusement of being carded for the first time in over a decade, I was taken aback by the age restriction placed on protein. “I must be really out of the loop,” I thought to myself. “How on earth are teens abusing whey protein? And how did this become so common that CVS instituted a policy against it?”

As it turns out, it’s not uncommon for teenagers (especially boys) to want to gain muscle mass. A quick Google search revealed various teen message board conversations about how to “get a chest like Usher” (or other favorite male celeb). Short of abusing anabolic steroids, teens are turning to over-the-counter performance enhancing supplements like creatine, ephedra, and steroid precursors, to improve their appearance and sports performance. Although my protein product did not include any of the above, I suppose that taken in excess it could cause the typical side effects of an excessively high protein diet: hypercalcemia, bone loss, and kidney stones.

The Mayo Clinic has an excellent review article about the most commonly abused performance-enhancing drugs, including steroids, erythropoietin, androgens, growth hormone, diuretics, creatine, and stimulants. Surveys suggest that performance-enhancing drug use among teens may be more common than we think, with between 1.6-5.4% of 8th to 12th graders using anabolic steroids alone.

Mayo also has tips for parents who suspect that their child may be abusing certain steroids, supplements or hormones. They write:

Possible red flags include:
*Behavioral, emotional or psychological changes — particularly increased aggressiveness (“roid rage”)
*Changes in body build, including muscle growth, rapid weight gain and development of the upper body
*Increased acne and facial bloating
*Needle marks in the buttocks or thighs
*Enlarged breasts in boys or smaller breasts in girls

As for my CVS experience, I suspect that the check-out girl mis-identified my protein drink as a creatine supplement (just as she mis-identified me as a youngster), though it’s possible that CVS does have a policy against allowing teens to purchase protein drinks.  If that’s the case, do you think they’ve gone too far in restricting product purchasing? If a teen can purchase acetaminophen, then what’s the harm in them purchasing protein drinks?

Insights and opinions welcome!


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3 Responses to “Should Pharmacies Limit Teen Access To Protein Supplements?”

  1. Jim says:

    Sorry Val , 39 – wow .

  2. Hrmph… What does that mean? I’m OLD? Ha ha!

  3. Jim says:

    No , a very attractive 39 – I’m a couple of years older ( 24 to be exact ) . (g)

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Richmond, VA – In an effort to simplify inpatient medical billing, one area hospitalist group has determined that “altered mental status” (ICD-9 780.97) is the most efficient code for use in any patient work up.

“When you enter a hospital, you’re bound to have some kind of mental status change,” said Dr. Fishbinder, co-partner of Area Hospitalists, PLLC. “Whether it’s confusion about where your room is located in relationship to the visitor’s parking structure, frustration with being woken up every hour or two to check your vital signs, or just plain old fatigue from being sick, you are not thinking as clearly as before you were admitted. And that’s all the justification we need to order anything from drug and toxin screens, to blood cultures, brain MRIs, tagged red blood cell nuclear scans, or cardiac Holter monitoring. There really is no limit to what we can pursue with our tests.”

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Nursing staff at Richmond Medical Hospital report that efforts to inform hospitalists about foul smelling urine have generally fallen on deaf ears. “I have tried to tell the hospitalists about cloudy or bloody urine that I see in patients who are undergoing extensive work ups for mental status changes,” reports nurse Sandy Anderson. “But they insist that ‘all urine smells bad’ and it’s really more of a red herring.”

Another nurse reports that delay in diagnosing urinary tract infections (while patients are scheduled for brain MRIs, nuclear scans, and biopsies) can lead to worsening symptoms which accelerate and expand testing. “Some of my patients are transferred to the ICU during the altered mental status work up,” states nurse Anita Misra. “The doctors seem to be very excited about the additional technology available to them in the intensive care setting. Between the central line placement, arterial blood gasses, and vast array of IV fluid and medication options, urosepsis is really an excellent entré into a whole new level of care.”

“As far as medicine-induced mental status changes are concerned,” added Dr. Fishbinder, “We’ve never seen a single case in the past 10 years. Today’s patients are incredibly resilient and can tolerate mixes of opioids, anti-depressants, anti-histamines, and benzodiazepines without any difficulty. We know this because most patients have been prescribed these cocktails and have been taking them for years.”

Patient family members have expressed gratitude for Dr. Fishbinder’s diagnostic process, and report that they are very pleased that he is doing everything in his power to “get to the bottom” of why their loved one isn’t as sharp as they used to be.

“I thought my mom was acting strange ever since she started taking stronger pain medicine for her arthritis,” says Nelly Hurtong, the daughter of one of Dr. Fishbinder’s inpatients. “But now I see that there are deeper reasons for her ‘altered mental status’ thanks to the brain MRI that showed some mild generalized atrophy.”

Hospital administrators praise Dr. Fishbinder as one of their top physicians. “He will do whatever it takes to figure out the true cause of patients’ cognitive impairments.” Says CEO, Daniel Griffiths. “And not only is that good medicine, it is great for our Press Ganey scores and our bottom line.”

As for the nursing staff, Griffiths offered a less glowing review. “It’s unfortunate that our nurses seem preoccupied with urine testing and medication reconciliation. I think it might be time for us to mandate further training to help them appreciate more of the medical nuances inherent in quality patient care.”

Dr. Fishbinder is in the process of creating a half-day seminar on ‘altered mental status in the inpatient setting,’ offering CME credits to physicians who enroll. Richmond Medical Hospital intends to sponsor Dr. Fishbinder’s course, and franchise it to other hospitals in the state, and ultimately nationally.

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