Prescription for survival

Independent druggist finds niche in customized medications

(Globe Staff / Joanne Rathe) Arlington pharmacist Lawrence A. Maida, trained in the art and science of compounding medications, prepares a customized prescription.

Buckwheat the cat is the kind of affectionate feline who becomes part of the family. At 20, he predates Caroline Vitiello's relationship with her husband, Jeff Miner, and is the only pet their 11-year-old daughter has known. "We just love him to pieces," said Miner, who lives in Belmont.

But last year, Buckwheat's health deteriorated, partly due to congestive heart failure and his distaste for the commercial pills and liquids prescribed by the veterinarian. Things looked bleak for the shorthaired cat.

Enter Lawrence A. Maida, a third-generation Arlington pharmacist who specializes in mixing medicine from scratch. Maida's compounding practice and his personalized service have allowed his family-owned store to survive and even thrive at a time when many neighborhood pharmacies have disappeared. Just a generation ago, Arlington had about 15. Now, Maida Pharmacy is the only independent left.

For Buckwheat, Maida concocted a special treat: tiny cakes of enalapril maleate, for hypertension, and furosemide, a diuretic, bound with xanthan gum and flavored like chicken.

The cat is wild about it, and the results have been astounding. Buckwheat is "so healthy the veterinarian doesn't even know what to do," said Miner, a clinical psychologist, who gives Maida "absolute, total credit for saving Buckwheat's life."

Local pharmacies like Maida's, which celebrates its 75th birthday this year, can't compete with big chains financially when it comes to purchasing pharmaceuticals from drug companies or negotiating reimbursements from insurers. Instead, the ones that endure find their own niche - in this case, by making drug compounds that are not commercially produced.

"That's the key here, and that's why we've been able to sustain ourselves," said Maida, 43, who took over the practice from his father a few years ago. (Although they don't share a middle name, they are known as Larry Jr. and Sr.) "We focus on serving that patient to whatever the individual need is."

Compounding, a modern approach to the pharmacist's mortar-and-pestle tradition, allows Maida to offer alternatives to people and pets who have trouble processing prepackaged treatments, and to fill specialty prescriptions for those with conditions not addressed by commercial drug makers.

Robert H. Grossman, an Arlington dentist, sends patients who are undergoing chemotherapy to Maida for a special rinse to treat the resulting mouth sores.

"Pretty much every single case, they've worked out," Grossman said. "As a matter of fact, an oncologist from Lahey Clinic called me recently and said, 'What the heck did you give that patient? It cured him within a few days.' And I told him to call Larry."

Bob Halls, who works at a bank across Massachusetts Avenue from Maida, visited the pharmacy at the suggestion of co-workers after his newborn son developed acid reflux exacerbated by an allergy to soy and dairy in infant formula; it got so bad that the baby had to sleep inclined in a car seat or baby swing. Maida compounded a special formula, prescribed by the pediatrician, and adjusted it until the potion achieved the desired outcome. Andrew, now a year old, sleeps more peacefully.

"Larry was just wonderful," said Halls, who lives in Raynham. He described Maida Pharmacy as "old school. Everybody knows your name and asks how the baby is, and you chat for a while."

That approach also draws customers filling traditional prescriptions, such as Arlington resident Eric Segal, who said the difference between Maida's and a chain pharmacy is like "the difference between talking to a good friend and staring at the wall." Segal initially skipped Maida's for the brighter expanses of a big-name drugstore. (Maida, whose shop and sign have not been freshened in a few decades, is planning a renovation and potential expansion to include the neighboring storefront, which he also owns.)

But Segal dropped the chain after considering it absurd that he had to sign a form acknowledging he had not spoken with a pharmacist when picking up his prescription, and he's never gone back.

Maida, though, is reluctant to dismiss the competition. His wife, whom he met during his freshman year at Massachusetts College of Pharmacy and Health Sciences, works as a fill-in pharmacist at a chain to give her more time with their three children. Chains and independents fill different needs, and offer pharmacists and patients different experiences, Maida said.

Maida's grandfather, Carmelo, started the family store in Quincy in 1933 but relocated to Arlington in 1947 when he had a chance to buy a building. His was an era of custom-made ointments, solutions, and powders.

Larry Sr., a Winchester resident who still works 35 hours a week at age 67, weathered the growth of proprietary drugs, the arrival of chains, and the advent of HMOs. The son introduced compounding, a labor-intensive movement popularized in the last two decades that melds the old philosophy with today's science and precision lab equipment.

Of the 140 or so independent drugstores in the state - compared with well over 1,000 a generation ago - fewer than half offer compounding, which requires additional training, said Todd Brown, executive director of the Massachusetts Independent Pharmacists Association. Among area communities, the International Academy of Compounding Pharmacists counts nine pharmacies, including Maida's, that offer the service.

Maida said he learned compounding for a variety of needs, like making gels to ease arthritis or treat sports injuries in patrons who don't want to ingest pills. He recently spoke at a conference of the American College of Nurse-Midwives, meeting in Boston, about using bioidentical hormone-replacement therapy to manage stress in menopausal or aging women.

To see Maida at work in his compounding room is to understand why he does what he does. Moving swiftly in his white lab coat, he grins and laughs excitedly as he offers demonstrations of various concoctions, created after consulting with patients and doctors.

"Oh, what a relief, you're by your bedside and you're up all night with a sore throat," he said, picking up a spritzer. "You give yourself a spray, and you're back to sleep."

He set it down and reached for what looked like a Popsicle mold: a tray filled with special suppositories for hemorrhoid relief. "This here is the greatest thing," he said.

Clearly in his element, Maida is like a boy who dreamed of getting a beaker for Christmas but awakened to find an entire science lab.

"This room . . . allows me to do what I love to do," he said. "If a patient feels better, then that's the best feeling I can get."

Eric Moskowitz can be reached at emoskowitz@globe.com.