Adding thanks rather than a view. I do not have a view worth the space.
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Access · Shortages · continued
Managing an unplanned gap in supply posts 31–60
This is a continuation of a long topic, addressed by post number rather than by page. Start at post 1.
l.salinas, post #16: Post #14 describes the usual case. This is about the unusual one. What I would want before treating managing an unplanned gap as settled: the method, the sample, and whether anyone tried to find the opposite result. Two of the three are usually missing. Go to post
I would keep managing an unplanned gap and the decision it usually gets used for separate in this thread. They are related and they are not the same question, and merging them is why the last one went badly.
cannula_notes, post #24: Nothing here is medical advice, and decisions about what to do during a supply interruption belong with a prescriber. Go to post
Picking up post #30: that is the part I would want checked first.
Device availability and compound availability are separate supply chains and the device is frequently the constraint.
Having read the whole managing an unplanned gap thread before replying: the question in the first post has not actually been answered yet, and three of us have answered a nearby one instead.
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MSaarinen, post #22: Second-hand on managing an unplanned gap, so weight it accordingly — someone whose method I trust told me this and I have not verified it myself. Go to post
Regional differences during a shortage are large, and a supply position in one country says nothing about another.
I have written this out at length because the short version keeps being misread.
Managing an unplanned gap is worth one more sentence than it usually gets, and the sentence is the one about how the number was arrived at.
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Narrowing post #38, because the general version has more than one answer.
Dose hold versus tapering: if a temporary shortage forces a gap, holding your dose and resuming when supply returns is different from gradually tapering. The two are different decisions.
Genuinely open to being wrong about this one.
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This is the first time the answer has come with its own limits attached. Appreciated.
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Coming back to post #37, because the follow-up matters more than the original answer.
Small correction to my own earlier position on managing an unplanned gap. I had the units the wrong way round, which changes the conclusion by an order of magnitude and therefore changes it entirely.
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Collapsed as off-topic by two members at trust level 3 or above
Post #41 is right about the mechanism and I think understates the practical bit.
Worth separating managing an unplanned gap as a question about the compound from managing an unplanned gap as a question about the documentation. They get answered by different people and only one of them is answerable here.
z.yildiz, post #43: Nothing here is medical advice, and decisions about what to do during a supply interruption belong with a prescriber. Go to post
Managing an unplanned gap: if a shortage causes a gap in treatment, the questions are how long the gap will be and how that affects your condition. Discussing with your clinician is prudent if the gap is weeks or longer.
That is a description of practice, not a recommendation of it.
I had written a reply contradicting post #41 and deleted it. Here is what survived.
Resuming after a gap: after a gap of days or a few weeks, most people resume at the dose they were on when they stopped. Gaps of months might require retitration discussion with a clinician.
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International supply chains: a shortage in one country does not mean shortage in another. That is why ordering from multiple suppliers before a shortage gets bad is prudent if you can.
Not the answer, but possibly the question that gets there.
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a.reyes, post #15: Adding the measurement that post #12 says would settle it. My experience of managing an unplanned gap contradicts the reply above. I am posting it as a data point rather than as a refutation, because one person's experience is exactly that. Go to post
Where I have landed on managing an unplanned gap, having got it wrong once in public: the direction is clear, the magnitude is not, and anyone quoting a precise magnitude has borrowed it from somewhere that did not measure it.
v.klausen, post #5: An honest declaration on managing an unplanned gap: I have a prior here and it is strong enough that you should weight what I say downward. Stating it rather than hiding it. Go to post
Bookmarking this. I will come back when I have something worth adding.
Communication from suppliers: a supplier having supply problems usually communicates them. If a supplier goes silent, that is itself information.
Somebody will have a better source than mine, and I hope they post it.
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Collapsed as off-topic by two members at trust level 3 or above
Reading rather than answering, but this is the post I would point somebody at.
cannula_notes, post #24: Nothing here is medical advice, and decisions about what to do during a supply interruption belong with a prescriber. Go to post
Managing an unplanned gap came up in a thread eighteen months ago and was answered well. I cannot find it, which is itself the problem, so here is the reconstruction.
Managing an unplanned gap: if a shortage causes a gap in treatment, the questions are how long the gap will be and how that affects your condition. Discussing with your clinician is prudent if the gap is weeks or longer.
I have said this before in a thread nobody could find, so it is worth repeating.
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n.szabo, post #8: Post #7 is right about the mechanism and I think understates the practical bit. Stockpiling in response to a shortage worsens it, which is true and is a poor argument to make to somebody who has run out. Not the whole picture, but the part of it I can speak to. Go to post
Post #52 is the version of this I will quote in future. One addition.
Device availability and compound availability are separate supply chains and the device is frequently the constraint.
j.bhattacharya, post #20: Noted, and I have changed what I was going to do on the strength of it. Go to post
Where I part company with post #54, and it is a narrow parting.
The arithmetic on managing an unplanned gap is the easy part and it is where the errors are, which is an uncomfortable combination. Show your working and someone will catch it.
A note on how managing an unplanned gap gets discussed rather than on managing an unplanned gap itself: the confident posts get the replies and the careful ones get ignored, and the careful ones have been right more often.
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Knowlton, post #26: The arithmetic in post #23 is right; the assumption feeding it is the part to check. Reports that a pharmacy has stock are the least durable information on the site and are still worth posting with a date. Someone should write this up properly, and it should probably not be me. Go to post
Regional differences during a shortage are large, and a supply position in one country says nothing about another.
I would hold that lightly until someone with a larger sample weighs in.
sterile_file, post #40: This is the first time the answer has come with its own limits attached. Appreciated. Go to post
That matches what I have seen, for whatever a single anecdote is worth.