The Silliness of Japanese Medicine-Dosage Rules
Drip Drip Drip kusaridoi rain chain at the Eigenji Temple (永源寺) -- Eigenji Temple (永源寺) -- Higashiomi, Shiga, Japan -- Copyright 2016 Jeffrey Friedl, http://regex.info/blog/ -- This photo is licensed to the public under the Creative Commons Attribution-NonCommercial 4.0 International License http://creativecommons.org/licenses/by-nc/4.0/ (non-commercial use is freely allowed if proper attribution is given, including a link back to this page on http://regex.info/ when used online)
Nikon D4 + Voigtländer 125mm f/2.5 — 1/400 sec, f/2.5, ISO 1250 — map & image datanearby photos
Drip Drip Drip
kusaridoi rain chain at the Eigenji Temple (永源寺)

I'm currently on the recovering end of a very bad cold that stole a week of my life. The photo above (that actually has no dripping in it) is from a photogenic outing last fall, first seen in Anatomy of a Selfie.

Here's a less-photogenic photo from yesterday, with an actual drip in it (two, if you count the I.V.):

Getting a Gram of Antibiotic Goodness 1g of Rocephin , along with 20mg of Prednisolone for good measure -- Copyright 2017 Jeffrey Friedl, http://regex.info/blog/
iPhone 7 Plus + iPhone 7 Plus front camera 2.87mm f/2.2 at an effective 32mm — 1/30 sec, f/2.2, ISO 125 — map & image datanearby photos
Getting a Gram of Antibiotic Goodness
1g of Rocephin, along with 20mg of Prednisolone for good measure

I noticed the cold coming on when I woke up last Tuesday, and it seemed to be mild at first, so I thought it might be like a one-day cold I had a couple of weeks ago, but I still had it the next day, so after the photoshoot with Taran and Kate (where I kept my distance so as not to give it to them) I went to the doctor. He said it was bacterial and not viral, so prescribed antibiotics.

Antibiotics normally make me feel better almost immediately, almost back to 100% by the next day, but this time, the 250mg of Levofloxacin twice a day didn't seem to do a thing, and I descended into a hazy world of misery.

I would have liked to have gone back to the doc on Friday, but it was a holiday, so I went back yesterday. He said that perhaps the dosage was low for my weight. I'm 90kg (200lbs), double the weight of some of the more petite adults in Japanese society.

I'd expressed some worry about the Levofloxacin, due to reports of tendon issues among athletes, so he moved me to something else, hopefully at a dosage appropriate to my weight. He was also going to jump-start things with an I.V. of antibiotics, but since there was a short wait for that, I went and got my prescription filled first.

At the pharmacy, I asked whether the prescription, 100mg of Cefditoren thrice a day, was appropriate for my weight, and I was stunned at the deer-in-the-headlights response. They said that medicine dosage for adults was something set by law, so a patient's weight was never part of the dosage consideration, except for children.

Now, if they said that this medicine's dosage was set that way, I'd not have been surprised, as I suppose it depends on the specific medicine whether it's best dosed by weight, but it was clear that they had never even considered dosing adults based on weight.

I asked So, a ballerina and a sumo wrestler always get the same dosage?. A big sumo wrestler can easily weigh six times that of a petite adult. The look on their faces told the story, being a mix of wow, I never thought of that combined with a kid having got caught with the hand in the cookie jar. It was now clearly apparent to them how stupid the situation was, but at the same time, it had never occurred to them, nor could they do anything about it because the law was the law.

Asshole one does not walk on the delicate moss at a temple, unless you're a selfish asshole (don't mind me, I'm just being grumpy) -- Eigenji Temple (永源寺) -- Higashiomi, Shiga, Japan -- Copyright 2016 Jeffrey Friedl, http://regex.info/blog/ -- This photo is licensed to the public under the Creative Commons Attribution-NonCommercial 4.0 International License http://creativecommons.org/licenses/by-nc/4.0/ (non-commercial use is freely allowed if proper attribution is given, including a link back to this page on http://regex.info/ when used online)
Nikon D4 + Voigtländer 125mm f/2.5 — 1/400 sec, f/2.8, ISO 1400 — map & image datanearby photos
Asshole
one does not walk on the delicate moss at a temple, unless you're a selfish asshole
(don't mind me, I'm just being grumpy)

Anyway, these meds are definitely better and I finally feel the cold receding.

Happy Photo to End With Zensuiji Temple (善水寺) -- Zensuiji Temple (善水寺) -- Konan, Shiga, Japan -- Copyright 2016 Jeffrey Friedl, http://regex.info/blog/
Nikon D4 + Nikkor 24-70mm f/2.8 @ 70mm — 1/400 sec, f/2.8, ISO 4000 — map & image datanearby photos
Happy Photo to End With
Zensuiji Temple (善水寺)

All 5 comments so far, oldest first...

I was sorry to read about your medical problems. I really hope that you are feeling better by now.

— comment by Arthur Brigham on August 14th, 2017 at 12:06am JST (1 month, 6 days ago) comment permalink

Hope you recover soon and have added happiness.

— comment by Rick H. on August 14th, 2017 at 4:51am JST (1 month, 6 days ago) comment permalink

With many medications, you are not treating body mass. You are treating blood/brain and accounting for the ability of the organs to deal with the medication.

Children have an immature organ system – their livers & kidneys clear medications at a less effective rate than a healthy adult. Weight tends to be a good measure of how much to give those kids without overwhelming their organs.

On the most simplistic level, you can expect the liver/kidney of a healthy 100 lb woman to process drugs at the same rate as you would that of a 400 lb man. So despite the massive weight difference, the amount of medication that will do the job but not cause injury is often the same in both. Actually, in many cases, I would not be surprised to see the 400 lb man dosed *lower* then the 100 lb woman – because diabetes and kidney failure follow obesity, and you often give lower doses to those with impaired kidney function.

They will also start dosing lower – regardless of weight – in the elderly, as their organs are often no longer as efficient.

Now there are many, many exceptions to this, and in the hospital, many critical care intravenous medication doses *ARE* weight based. But even in that, depending on the med, it’s based on the patient’s ideal weight rather then actual weight.

Anyway, , glad you’re feeling better!

— comment by Marcina on August 15th, 2017 at 4:43am JST (1 month, 5 days ago) comment permalink

Your experince reminds me too of the differences in medical care quality there (which I can personally attest to) and here, which makes me glad we in the U.S. do not and hopefully never will have nationalized health care.

— comment by Expat in VA on August 15th, 2017 at 11:51pm JST (1 month, 4 days ago) comment permalink

Like M says, there are many medicines that don’t vary dose by weight. I have no idea if the one in question was one of them. However, the pharmacists should have been able to tell you.

Goes to support my belief that the entire profession should be abolished. I’ve never, ever seen a pharmacist do anything other than what could be accomplished by a vending machine.

— comment by ZZZ on August 25th, 2017 at 7:24pm JST (3 weeks, 5 days ago) comment permalink
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