"You gotta know when to hold 'em, know when to fold 'em"

WELCOME TO THE FABULOUS LAS VEGAS!!! Last week, Thomas and I, along with a bunch of our classmates, went to the American Society of Health-System Pharmacists' Mid-year Clinical Meeting in Las Vegas. We were there from Sunday through Wednesday, although many of our friends went early to get a head start.

The conference was held at the Venetian, which was magnificent! (Here we are in St. Mark's Square) The convention/expo center had HUGE ballrooms and many floors of them, yet there were still too many people to go to every event. Even the student programming had "such an overwhelming turnout" that we were turned away (by the fire marshall, folks). Anywho, we spent Sunday going to different talks and lectures, learned once again that you shouldn't by a brand new BMW on graduation day, and that this continuing education thing is not going to be interesting in some cases.

Monday morning we heard from Dennis Quaid about the medical error that almost killed his twins. He's planning a documentary for next year, could be interesting, although I didn't find hime to be the best public speaker (and his analogies to plane crashes really made the flights home enjoyable). Monday afternoon and Tuesday morning we went to the Residency Showcase (think GIANORMOUS college/job fair) where we went to talk to the residency programs we're thinking of applying to. Pharmacy residencies are similar to medical residencies -- another year or two of training -- but they aren't required (yet) and aren't as long.

Tuesday afternoon we had some free time. We grabbed lunch at Paris, walked around Caesar's Palace, and played a little black jack at Bill's Gamblin' Saloon. We were up $65 when we walked away, but we went back later that night and lost $15 of that back. My father and stepmother bought us tickets to Cirque du Soleil's KA for Christmas so we made our way down The Strip to the MGM. We went up the Eiffel Tower and watched the Bellagio's water show and then went browsing around NYNY before the show.

I'm not a huge Vegas fan, but I can say I've been, and I walked away a winner. Now if only I had the money to eat at the big name restaurants while I was there! All in all, a good trip.

Rabbit Rabbit

My college roommate told me if you say "rabbit rabbit" as your first words on the first day of a new month, it would bring you good luck for the month. I never remember to do it first thing, but I usually remember later. It doesn't seem to do much for me then.

So its December and I'm back home in Charlotte. I have the month off from clerkships which is a nice break, but by no means "empty" or "free time." I've already gone back to work at Presbyterian Hospital as a technician where I've worked throughout pharmacy school. My big project for the month of December is residency applications. Pharmacists can do residencies just like doctors, only its shorter and not required by everyone (yet). Next week I'm going to Las Vegas for a few days for a HUGE national residency showcase (think monstrous college fair) and pharmacy convention. After which, I get to assemble packets of transcripts, letters of intent, and letters of reference to send in to apply for a one year ambulatory care residency. Interviews will be in late January - February and then the Match is in March (its all very much like sorority recruitment -- just on a national level).

Anywho, the last weekend in Asheville was nice and calm. Only one of the roommates and I were there. I went downtown on Saturday to watch the Holiday Parade. It was a fun, small town parade with marching bands, horses, candy for the kiddies, and floats! Oh, and Santa came at the end of course.

I got back to Charlotte just in time for Thanksgiving: complete with our own turkey and pilgrim!

November's almost over

My November rotation that is.

This month has been fast paced, challenging, and a learning experience in more ways than I thought it would be. I know I've learned things, I've certainly spent enough time every night looking up things I didn't know that I must have learned something, but if I had to list them, I couldn't.

Let's see, I'll try:
Zosyn covers Psuedomonas
Cefepime covers practically all gram (-) bacteria
Doctors think about and/or find cancer way more than ever I thought about
Communication issues can kill people
Despite your advice, the doctor's going to dose the drugs however they want to

Anywho, although I can't remember the things I've learned about medicine this month, I think I've learned more about myself. In the two mornings out of this month that I've gone on walking rounds, I have confirmed that I should be a pharmacist and not a doctor. At least not a doctor in a hospital. And maybe not even a pharmacist in a hosptial.

Our Attending physician this week was not very pharmacy friendly. Despite recommendations that "Hey, this guy's kidneys aren't working really well, can we decrease the dose of this antibiotic so it doesn't kill his kidneys, please?" or "This little old 92 year old woman got a dose of digoxin that can get toxic really fast, can we please not load her up on this heart rhythm drug that can increase the toxcity?" Nope, just do it, do it the way I want it or the way consulting physicians want it. They know better. (P.S. the consulting physicians went back and forth on the dosing of the antibiotic based on his kidney function; and the lady's digoxin level got more toxic and her kidney function got worse the next day)

I guess my biggest issue with this rotation is I just don't know how what I've done for 3 weeks really translates into a job. The morning stuff, reviewing the patients and then rounds, makes sense, but our afternoons have been time for projects or topic discussions, that I don't know what a "real" pharmacist would do for that time. I know I learned stuff and would continue to, I know sometimes we might make a difference for the patients, but overall, I don't think this is the job in pharmacy I want. Only 1.5 rotation days left, then home for Thanksgiving and Christmas :)

Traditional Rounds

An update on my November...

This month is internal medicine at Mission Hospital. I am with another pharmacy student this month and its nice to share the work. She and I arrive at the hospital around 0800 and spend a couple hours looking up patients in the computer. We check their labs, read their history, check their meds, make sure things are dosed properly, make sure their using the right antibiotics, make sure they didn't forget something the patient was on at home, etc.

At 1000 we normally go to Rounds with the Family Medicine Team. There are several first year interns and a third year senior resident plus their attending physician for the week. They each present their patients and we discuss what to do for them. As pharmacy representatives, we're there to bring up any issues we saw when we were looking up patients, and address any questions they have during their discussion. After rounds, most days we go to lunch and then maybe have a topic discussion with our preceptor. Usually though, by the end of the day we have discovered 6 more things we didn't know we didn't know about from rounds and have to go look them up. I'm living in a state of overwhelmed and stressed this month!

Anywho, this morning our attending wanted to do full team, traditional, walk rounds. So we all met at 0700, no one had looked at their patients, and we proceeded to walk all over the hospital and talk about (and examine) all 14 of our patients. 0700 - 1300 (6 HOURS!) of rounding on people. Oh it was awful. I don't think I learned anything, I didn't have a chance to look at the patients before hand so I was totally unprepared, grr. Not my favorite format, and I discovered once again why I don't want to be a doctor. No touching people for me, thank you.

The Pumpkins

Ok, I know I'm a few days late with this but this new rotation is a whirlwind (which I'll try to write about in a new post this weekend...maybe).

Anywho, throughout the month of October, I heard about this pharmacist that carved pumpkins. He took time off at the end of October and carved and carved and carved and the whole neighborhood comes to see. Well he did carve, and there were certainly more than I would ever do, but there weren't the hundreds I was thinking of. The neighborhood does come, but mostly because they close off the street to auto traffic so its a pretty safe place for kids to go running on a sugar high.

I, and a few of my fellow future pharmacists, volunteered to hand out candy. He makes this little tunnel/walled pathway with trees and vines and had people stand in cloaks in little alcoves. Most people could see me as they came through, but the girl on the other side had a suburb time reaching out and tapping adults on the shoulder when they had no idea another person was around. I got home just in time for the rain to hit and watched the UT/USC game and listened to my roommates scream at a horror movie downstairs. All in all it was a fun night, and the Vols won in their cute black and orange -- yay for halloween themed sports uniforms. Enjoy the pictures!

Oh wait, almost forgot. Part of the reason I wanted to check out the pumpkins and volunteer is because Mr. Pumkin-carver-Pharmacist takes donations all night for the Eblen Foundation. Its a charity here in Asheville that does a little of everything: helps people get healthcare, vision, dental, travel to other hosptials out of the area, communications, rehab, electricity, heating, college scholarships... really everything. OK, now enjoy pictures :)

and of course his lab...

...and then a hero comes along....

(yuck, not my favorite song).

So Thomas and I got a last minute invite to attend a fundraising event this past weekend. Every year the Charlotte Bobcats host the My Hero Gala to raise money for Presbyterian Hospital's Community Cruiser. The theme: black tie and tennis shoes! For once, fashion meets comfort...and I like it!

The event recognizes a physician and a community member or two that have gone above and beyond to help promote healthcare for kids in Charlotte. The Community Cruiser is a big RV/camper thing, painted bright orange and green, that provides healthcare to un/underinsured kids in the Charlotte areas and in the last year, the cruiser has seen almost 2300 children!! Anywho, here are some pictures from the event.

Putting on my new kicks! The whole family.

One of the Heros, in her tennis shoes

Thomas and Gerald Henderson (boo dook!) and me and Raymond Felton (GO HEELS!)

Oh yeah, when Thomas and I got off the light rail train by his studio, we decided to go to Jillian's for a couple games of skeeball! What a fun night :)

A few of my patients

I'd thought I'd let you know a little about some of the patients I've seen so far at MAP. Most of them are nice and really appreciate the counseling they get from the pharmacists at MAP. A few of them, you can tell, it just goes in one ear and out the other.


I started this past week actually leading the visits with the patients, instead of just watching and listening. By the end of the week I was charting and leading the visit at the same time (putting notes into the computer during the visit, rather than taking them on paper and putting them in later). I started off nervous, but my first patient was excellent! She totally played into me being the student pharmacist and leading the visit. She even caught herself directing a question or two to Ben, stopped, turned to face me, and started over. Great confidence builder. :)

My patients on Friday however, were not so easy. Mr. D, my first patient of the morning, is an older gentleman with diabetes, high blood pressure and cholesterol, sleep apnea, depression, and a history of two heart attacks. When he came in a few months ago his blood sugars were in the high 100s/low 200s, now they are consistently in the 300s (we want them <110).>

My next patient, Mrs. F, wasn't in much better shape. She's an older widow, lost her husband in 2006 to lung cancer, has heart failure, high blood pressure and cholesterol, and depression. She has Medicare Part D and the Low Income Subsidy which is "extra help" for your medications. She came to us because she fell into the donut hole. Matt, my pharmacist, didn't even know that was possible. It wasn't the true donut hole, because she wasn't paying cash prices for her meds, but it was something like it. All of her medications had been fully covered, until this month when she went to pick them up. Her generics were now $2.40 and her brand name drugs were $6 for a months supply (this is even better than the Wal-mart $4 list, which if $4 for generic meds). What this amounted to was an extra $15-ish a month for her prescriptions, and she was coming to us because she couldn't afford it. For her, $15 for drugs meant giving up some of her groceries. She drove to us that day on an empty tank and she has no way to heat her house (the lows are in the 30s this weekend). She's budgeted down to the wire and she thought she was covered. As a patient, she has made enormous strides in her health over the last three years; she's lost weight, she's improved her nutrition, she's taken care of her mental health, she's worked really hard to take care of herself since her husband died. Matt decided to give her as much of her medications as we could to last her until January.

Ben wasn't in the meeting with Mrs. F, and for the first time, I heard one of them question giving a patient medications. Thus far, I've been a little surprised at how freely Matt and Ben give away medications. I know its a medication assistance program, but practically everyone that has called needing a medication has received it if they have it. For once, it was questioned if we should fill all of her meds. The concern was not over whether she needed it and couldn't afford it, but over how that restricted MAP's ability to help the next patient that came along. MAP has a limited budget to buy medications with because most of their function is getting medications for free for designated persons, so giving this woman a 2 week supply of her depression medication (all that we had) would cost us $80, and maybe we could spend $80 on two or three other medications that would help two or three other people. Matt filled it because he couldn't justify turning her away without everything we had that would help. This rotation has really been a great one. I'm learning a lot about pharmacy, as well as getting to know some pharmacists I really admire. I'll be sad to leave in a couple weeks.

A MAP to free drugs...

This month my rotation is at an ambulatory care site, Mission Hospitals Medication Assistance Program (MAP). Ambulatory care is best described as a clinic that is a step between retail pharmacy (CVS, Walgreens, your local independent, etc.) and the hospital. One of the best examples is the VA system. Amb care clinics usually have doctors, pharmacists, nurses, educators, and social workers in various combinations and can either be general care or specialize in a few disease states (ie. diabetes, high blood pressure, anticoagulation) or specialize in a particular patient populations (veterans, geriatrics, low income).

MAP sees patients from three different groups: medication assistance, wellness, or Medicare Part D doughnut hole patients. Wellness patients are enrolled in an employers Wellness Program and come to meet with a pharmacist at least once every 6 months to discuss their diseases and medications and what they can do to live a healthier life. Their meetings are covered by their insurance and the goal is to prevent health problems, doctor and hospital visits, and thus spend less overall on their health care.

The Medicare Part D patients that come to the doughnut hole are actually being enrolled in a study that the pharmacy residents are doing about when patients are falling into the doughnut hole, what kind of help they need when they are there, and when they will fall into the doughnut hole next year. The doughnut hole is a coverage gap in Medicare where patients after reaching some amount of dollars spent on medications by Medicare are now responsible for paying 100% of their drug cost out of pocket. Its incredibly expensive for some folks and can mean the difference between food and medications for the month in some cases.

Doughnut hole patients and medication assistance patients are enrolled in MAP's medication assistance program if they qualify financially. For most programs that means people make less than 200% of the federal poverty level; for one person that is less that $21,660 a year and for a family of two that is less than $29,140 a year. Since these folks can't afford their medications, we apply to drug companies on their behalf to get their medications for them. There's a great website, here, to find out which meds have assistance programs. As part of the assistance program, they have to meet with a pharmacist every 1 - 6 months, depending on how well controlled their diseases are. So that's where I come in....

For the past week or so I have been sitting in with the pharmacists as they meet with patients about their diseases. I look over their charts first and ask questions about why this drug or that drug and then I tell the pharmacist what I think we should ask the patient about since the last visit. Then we meet with the patient. We talk about how they've been doing, if they're going to have enough money for the light bill or food this month, or if they have been checking their blood sugar as often as they should be, etc. If they are a new patient, then we can talk about all the community resources there are in Asheville like Ladies Night Out where they can get free mammograms and pap smears and other women's health things or the dental clinic that offers cleanings for $10 and such. After the patient leaves, the pharmacist and I chart our encounter and talk about why a particular medication or lifestyle change would be most appropriate for this patient.

So far I've done a lot of watching and a lot of learning about resources for those without health insurance. It makes me really wonder what is available in other cities. I've had to teach one patient how to use a new blood glucose (blood sugar) meter, which he thought was fantastic. Despite having diabetes for years, no one had really taught him how to use a new meter and make sure he was doing it properly. He really appreciated me talking with him which definately put my nerves at ease. This coming week I'll start taking every patient's blood pressure at our meetings and I'll give a talk to a geriatric nurse group about food and drug interactions. This Saturday I'll be at a local health fair educating people on ways to manage their high blood pressure and high cholesterol. I'm still trying to decide between this and nuclear as a career, I like them both, but I'm looking forward to getting more involved with amb care this month.

2 down, 6 to go.

I apologize for neglecting my blog. Not so much neglect really, the past two weeks just haven't been that interesting at work. I finished up observing the scans I needed to see and even went to spend a day in PET. Positron emission tomography (PET) is a different kind of radiation than general nuclear medicine. Its much stronger but it gives really cool pictures (they spin and flip and everything -- so much fun!) We had a lot of reports to write for Dr. K so I really spent most of the last couple weeks going in early to set up the pharmacy and then heading off to the library.
Two weekends ago I went to visit my little brother in Wilmington. He was in the middle of fraternity rush so we went to the Kappa Sigma Oyster Roast Friday night. Great concept, bad efficiency -- fyi: have more than one pot to cook 500 oysters. Saturday and Sunday were lazy days filled with football and movies. He seems really happy there and it makes me smile. He's changed directions in his studies and its great to see him some place he feels he really relates to people and can have fun!

Last weekend Thomas came to visit. He had a day off so we had a fun three day weekend. He planned Date Night for Friday night. It was hilarious, awesome, goofy, comfortable, tragic, and surprising all at the same time. He decided we should go roller skating! Other than a few Kappa Delta Bid Nights when we rented out the place, I haven't been skating since... middle school. It was going to be a blast.

We couldn't pick a restaurant for dinner so we googled something close to the rink. We found a Mongolian Grill with decent reviews and decided to try it. It was really pretty good. If you've never been, you grab a bowl and fill it with your choice of raw meat, veggies, a few carbs or fruits, spices and sauces and then take it over to a big grill service and the cooks cook it for you. Its fun because you can try all kinds of new things and if you don't like it you can make something else.

We headed to the skating rink ready to attempt to do the hokey pokey on skates and see who would fall first. Apparently every middle schooler and high schooler in the area had the same idea! We found ourselves surrounded by swarms of youngsters weaving in and out of everyone else skating around or making laps around the rink with no intention of skating at all. We spent the hour or two we were there laughing at each other, remembering how we used to be "that kid," watching the social interactions of teenagers and wishing for another couples skate because then most people would leave the floor. Personally, I also wanted to request some Bon Jovi or Journey but it just didn't seem like it would fit between Britney and Lil' Wayne. Anywho, after a couple of hours of fighting with the cheap and obnoxiously over-abused inline skates, we headed to the bowling alley! A pitcher of beer and a couple of games (which Thomas won) later we called it a night.




Saturday we watched a little football and got ready for a KD cookout. Unfortunately the cookout got rained out, but we met up with Jennifer, Carrie, and Matt for dinner anyways. I had Jenna, one of my KD sisters from CLT, make some cup cakes (she's starting her own side project here) for the cookout so I took them to dinner. They were Irish Car Bombs and very delicious!!

It was a great weekend to wrap up my month in Chapel Hill. October will be spent in Asheville at an outpatient medication assistance program. The program meets with patients every 1 - 6 months depending on the patients' need to monitor their chronic diseases and to help them get medications they can't afford. It should be a really great learning opportunity and really help me decide what path I want to follow in pharmacy.

Bid Day and my jersey

Last week was sorority recruitment at UNC. I went back to the house this year to help out during House Tours and after preference party. It was great to see some of the girls I have advised over the last year or so and to meet a new chapter advisor. Thursday was Bid Day. I met Eve, one of the other advisors, at the house and we walked over to the Arboretum where the potential new members were opening their bids and running to their new sisters. Unlike Queens, they don't get run to their respective houses because they would need to shut down Franklin Street to prevent traffic accidents.

The theme this year was NASCAR: Feel the Rush of Life in Victory Lane. They had old tires out front, and inner tube tires hanging from the porch, and someone loaned them a very nice Mustang to park in the front yard. Anna, the president, even put on a full firesuit and helmet to celebrate! Kristen, their chef, made a fabulous dinner with pasta, fruit, and italian salads. The Clef Hangers, an all male a capella group, stopped by to serenade the ladies and their 49 new members! Rush is SO much different in a house this size compared to Queens, and Bid Day was a fabulous party. I miss so many of my Kappa Delta sisters.

I went to Charlotte for the weekend and to the Panthers stomping (it wasn't really much of a game after the first drive). It was miserable to watch Jake throw the ball away so many times, but the highlight of the day was going to the team store to buy a jersey. I have wanted a John Kasay jersey for YEARS! Its been on the wish list and finally, finally it is mine :)! And the other bonus -- realizing the Eagles were my defense for my fantasy football team -- oh the silver lining.

Take a right at the zebra butts.

This week started clerkship #2: Nuclear Medicine. My preceptor is Dr. Kowalsky, one of the "founding fathers" of nuclear pharmacy, and my professor for my nuclear electives last school year. The objective of this clerkship is to spend time in the hospital, with the patients, and learn about the drugs from the user side. I will be making kits and hitting generators like the summer, but in much smaller numbers. Most of my time will be spent watching patient scans and writing.

Tuesday (Day 1), Dr. Kowalsky, myself, and Mike (another UNC student) met to do paperwork and get a tour. Until that day I had never set foot in UNC Hospitals -- hospitals with an "s" and HUGE! We started down hallways and turns and "remember the light at the end of the tunnel" and whatnot, and then I found my landmark -- the zebra butts. You see, radiology and nuclear medicine are in the basement of the Women and Children's hostpital, so they have fun pictures of animals on the walls to make kids smile. Anyways, its worked so far.

Our first days have been getting oriented and doing some instrumental experiments. We have to learn how to calibrate some of the machines that count the radioactivity and that could help us identify an unknown compound (I thought I was through with that sophomore year in chemistry!) This morning we went in early, did some quality control tests on the dose calibrators, eluted the generator, and made some kits. I let Mike do most of it since I did it the summer. He was nervous and Dr. K watching him wasn't making it better! I tried mostly to stay out of the way.

Once the kits were made, Dr. K took us upstairs and bought us a cup of coffee. We just sat in the lobby for an hour or so talking. I think there are going to be some real points in this rotation to just get to know Dr. K personally, and for him to get to know me, which will be a great relationship to build and help me decide if I want to go in to nuclear pharmacy.

I'm looking forward to the weekend. Panthers v. Steelers tonight, a UNC alumni basketball game between the 2005 and 2009 Championship teams Friday, and UNC football v. The Citadel on Saturday. Plus, no work on Monday!!

1 down, 7 to go...

...and then I'm a REAL Pharmacist!

My last week at Black Mountain was pretty uneventful. The week started off with cart fill as usual, switching out new medication carts for the empty ones. Tuesday and Wednesday mornings were Care Plans for the Alzheimers Units. There were several family members that came this week which meant they ran a little long (it didn't help that Dr. Kelly wanted to play airplanes with one little boy that came).

One interesting thing that I learned more about last week was ECT or electroconvulsive therapy for treatment resistant depression. Basically, in an anesthetized and controlled environment, doctors send electrical current through the brain until a small seizure occurs. The seizures act as "reset" buttons to hopefully restore the chemical imbalance that causes depression. Sadly, most people think of One Flew of the Cuckoo's Nest or the very terrible ways this procedure was done 40 or more years ago and they don't want to participate, but there really is data showing success when nothing else has worked.

We had our first seminar this week as well. Kelly and Savanna gave case presentations of patients they met on their rotation and their primary disease. They both did a good job, but boy am I nervous about doing mine. Dr. Michelets, one of our seminar coordinators is going to be a TOUGH grader, and she'll stop you in the middle of your presentation to ask questions (yay fun). A bunch of us went out to dinner to celebrate Kelly and Savanna's work.

I spent the weekend in Charlotte (mostly out on the boat :) ) before heading back to the Triangle for my next rotation. Saturday night dad grilled some chicken in his barbeque sauce and some in Antony's Caribbean sauce and we headed to the parking lot to tailgate for the Panther's game. We had a good time, but it would be nice if we could start pulling out some wins. We'll see what happens Thursday.

Now I'm in Durham, staying in a friend's house for the month. She and her husband are out in Asheville this year like I am and are nice enough to let me stay in their house for the month. Its a cute 3 bedroom/2.5 bath townhouse only a little ways away from the mall and a short drive to a park and ride lot for the bus. This month my rotation is nuclear medicine at UNC Hospitals. I will spend the month mostly with nuclear medicine technologists that are responsible for administering radiopharmaceuticals (the stuff I made this summer at Cardinal) and scanning patients for diagnostic tests. I've heard its a great way to tie together all the theory we learned in class with the practical application I learned at Cardinal this summer. The technetium shortage is still ongoing though, so who knows how much activity we will really have.

I love you the whole world...

Dr. Kelly took me to meet one of his favorite patients on Friday. He has a profound intellectual disability, but he's really a funny guy. He's a big Carolina fan and told me, "I hate Duke," and he really enjoys watching baseball too. We talked about baseball for a few minutes (his favorite team is the Dodgers), what he was watching on TV, and his favorite musicians (Pink Floyd, Johnny Cash, and Led Zeppelin). As we turned to leave, he asked me if I'd come back and visit and told me he loved me. He also told Dr. Kelly, "Dr. Kelly, I love you the whole world!" Dr. Kelly and I chuckled as we headed down the hall to the nurses station and there was my smile for the day.

Friday night Kim, Laura, Allison (and John), and I went out in downtown Asheville. We'd heard about a music festival and were off to see it. Turns out it was Asheville After 5, very similar to Live After 5 in CLT (or really any town in the summer). We didn't really know much about it so we got there just in time for the last song. We walked around Asheville a little more and stumbled upon the Drum Circle. I don't know much about it other than on Friday nights in the summer a bunch of people get together and play their drums in this little greenspace in the middle of town. Again, we showed up at the end!

We decided to find a bar and get a drink. We got a great table at College Street Pub. They had live music and were charging a cover if you went inside, but for some reason not if you sat out on the patio. The weather was nice and they had the windows open so we just sat out there -- and got service, it was great! Here we are: Laura, Allison, Kim, and myself.

Saturday, Kelly, Allison, John, and I had tickets to the Baseball and Beers Festival. It was a big beer tasting at McCormick Field where the Asheville Tourists play baseball. We walked to the stadium, got our wristbands and cups, and got to tasting. My favorites of the day: Magic Hat #9, Magic Hat Circus Boy, Allagash White by Allagash, Son of a Peach by R. J. Rockers, Apricot by Haywire, and Vanilla Creme by Thomas Creek. After the tasting we went out looking for some food. Our first choice, Wild Wings Cafe, was PACKED! So we headed up the street to ED Boudreaux's, a BBQ place on Biltmore Ave. They had the Panthers game on and we had a really great server. She even brought us an extra basket of fries (regular and sweet potato!) We all went our separate ways for the night, but we had a great time.

One more week here in Asheville at the Black Mountain Neuro-Treatment Center and then back to Chapel Hill for the month of September to do nuclear medicine with Dr. Kowalsky. Its hard to believe one month is almost over, this year is going to fly by!

Cloggers and Bloomin' Idiot

This week I got to go to one of the activities for the residents. A local clogging group came Tuesday afternoon to perform. They were a group men and women of all ages and they really looked like they were having fun. From a technical standpoint, they weren't the greatest, but they were entertaining. It was amazing to see how excited and interactive the residents were with the group. There was one man with Alzheimer's that just couldn't sit still! The recreators kept jumping up to grab ahold of him because he wanted to dance -- and not just in a corner, but out there in the middle with the cloggers! The dancers did take a break and get the residents involved. They were invited to come up and dance. Several of them jumped right up there, or wanted to be pushed in their wheelchairs. It really was pretty incredible to see the joy on their faces.

Today I was with Sandy, my preceptor, on one of the Alzheimer's units. One of the residents came to the nursing station and told me I was wearing a nice blouse. She's a sweet little lady that usually tells everyone woman they're wearing a nice blouse. I thanked her, told her she was wearing a pretty blouse as well, and she thanked me back. From reading her chart for a review the other day, I knew she had loved to garden, and her shirt was covered in flowers so I asked her if she liked flowers. She replied, "Yes, I'm a bloomin' idiot!" Sandy and I immediately laughed and I was so surprised at her response because many of the patients can't hold even the simpliest of conversations, let alone be witty. She was having a very good day for a response like that.

This week has gone by fast, but today was particularly slow. I started off grumpy because Sandy was coming in late and hadn't really given me anything to work on so I thought I could use that time to begin working on a project for my seminar that I had been putting off. I was feeling a little used this morning by the rest of the pharmacy staff because they wanted me to keep the pre-packing machine running while I researched, which isn't a hard task -- more annoying than anything, but they were all in the other room just reading the paper and joking around. Ugh, grumpy! I didn't get very far on my project, and this afternoon Sandy and I went to a Care Plan meeting and then did chart reviews. I feel I'm getting better at chart reviews, but we still aren't making very many medication recommendations so I don't know that I'm very good a suggesting the next step in therapy. Oh well, I still have time to learn.

The Beauty of a Nightlight

Our hallway is DARK! I run in to walls on the way to the bathroom in the middle of the night or the shower in the morning. So I bought a nightlight. It's wonderful. There is only one plug in the hallway, in the middle of the wall on the landing of the stairs (and by middle I'm talking vertically, its next to the window), but it's the perfect place for a nightlight. Yay for safer nights!.

Anyway, on to more important things:, an update from the last week. My rotation isn't quite as exciting as it used to be. I've settled in and gotten used to the work flow, and it's SLOW. I'm used to a fast paced hospital of hundreds of patients or a lecture hall covering 50 slides per hour, but the Black Mountain Center just doesn't work that way.

Unfortunately I am feeling like most of my week is spent in meetings. Those meeting are important for the patients, and it's important for pharmacy to be represented there, but it's not really teaching me anything -- at least not about pharmacy. My goal for this week is to try to get out of a couple of those meetings so that I can spend more time with one of the pharmacists doing drug regimen reviews. I think reviewing one patient's chart and medications at a time will better teach me about the drugs and how they are used as these diseases progress in these patients.

I went back to Charlotte this weekend for some fun. Thomas and I saw a couple movies (Transformers 2 and G. I. Joe) which we thought were not the greatest movies of all time, but entertaining and enjoyable. We tried a new-to-us sushi place in south Charlotte that sadly wasn't really anything special. We also went out to Rock Bottom in Uptown for dinner and beers with one of our pharmacy friends, Jason, who is nearby for the month of August. We had a great time until we got back to discover his car had been towed from the visitors lot and he would have to spend the night on the couch before he could get it back. Long story short: the building managers have people's cars towed if they think they are just using the lot for free parking and not actually visiting. The towers mistakenly thought Jason had just parked and walked away (despite later admiting they saw us walk towards the door of the building) and thus towed his car. They were super jerks about it both last night and this morning when we tried to get the car back. Luckily, after explaining the situtation to the building manager in the middle of the night, we got the car back this morning without having to pay for the tow. Some people are just jerks, with nasty attitudes, and its really not necessary. I can't imagine they live very happy lives.

Anywho, my goals for the week:
1. Get out of meetings and do more drug reviews to learn the drugs
2. Start working on my first project for seminar
3. Go to the gym every day
4. Find something new to do in Asheville

Things I'm looking forward to this week:
1. Panthers playing the Giants in MNF
2. Beers and Baseball Fest this Saturday
3. Burger Pie for dinner :-) -- THANKS MOM!!

The First Week

I have completed my first week as a PY4!! Monday was full of orientation with a few more bits on Wednesday and Thursday afternoons. Tuesday was my first full day at my rotation site for the month, BMNMTC.

Tuesday and Wednesday mornings I went to Care Plan meetings to talk about selected patients on the Alzheimer's units. Its really interesting to me to hear the whole team talk about the progression of the patients and then to go back to the pharmacy with the pharmacists and talk about different ways to behaviorally or pharmacologically manage the patient.

Tuesday afternoon I wrote a quick drug fact sheet about a new anti-seizure medication that was approved in June. The neurologist that consults for the Center was one of the test sites for the approval process and was coming Friday to discuss the drug with the doctors at the Center. (Interesting fact: one of my pharmacy professors actually discovered the compound for the drug.) Wednesday afternoon I had orientation at the Asheville Buncombe County Christian Ministry Clinic (ABCCM Clinic) which is a free clinic for un- and under-insured residents. We will all be volunteering at the clinic one evening a month this year.

Thursday morning I helped with cart fill at BMNMTC. Every Monday and Thursday the pharmacy switches out the med carts with a new 3 or 4 day supply of meds for the patients. They have a pre-packing machine that unit doses they medications (basically individually wraps each pill) that is very similar to the one at Presbyterian Hospital, so the staff was very impressed I already knew how to run their machine. We had our first seminar meeting Thursday afternoon. Dr. Haile, the director of the drug information center at the hospital, led a statistics review to help with our future assignments. He's a very nice guy, but NONE of us like the statistics!!

Friday was my favorite day of the week. Norm, one of the pharmacists at BMNMTC, and I did drug reviews. Each of the pharmacists has to do a medication/drug review on each patient monthly. We spent most of the day on the unit looking through charts. We looked at behavioral changes, sleep patterns, and eating patterns which can indicate response to medications, and possible depression. We looked for drug interactions, and controlled lab values, and had lots of discussions about drugs. I also got to put faces with a lot of the names I had heard in the Care Plan meetings over the week.

Fun things for the week:
Thursday night Kelly, Anna, Allison, John (Allison's fiancee), and I went to an Asheville Tourists game. The Tourists are the single A baseball team and it was a double header due to rain earlier in the week. It was also Thirsty Thursday, yay $1 drafts and pretzels, hot dogs, nachos, and all the other smells of a ballpark!
Friday night we ventured out in downtown a little bit. We met at the Thirsty Monk for a round of drinks or two. It was a cool place that wasn't very crowded or smokey with a wide selection of beers.
Saturday met Kelly and her aunt and uncle in Black Mountain for the Sourwood Festival. There were vendors everywhere trying to sell thier jewelry, pottery, cookware, artwork, bags, clothes, you name it. Again, the smell of fair/festival food filled the air and was absolutely delicious. It was fun to walk around and see things, I even got some slow churned home-made ice cream and some honey. The people that sold the honey even donate a portion of their sales to JDRF!

Sorry for the long post, its been an exciting week. Now for some reading and research!

The Sandwhich Lady Song

A couple of summers ago, a friend of mine gave me a card before my very first clerkship in pharmacy school. It was a cute little card that made me laugh and helped settle my nerves before my first big day. I thought it only appropriate to bring it along on my 4th year, a year full of clerkships and big days. It still makes me smile everytime.

Outside: I was walking to my car, and I saw this lady I recognized from the deli, the sandwhich lady, and I made up this song:
"You are the sandwhich lady! Come on, sandwhich lady! Go, go, sandwhich lady!"
So now I think maybe I'm creative.
Inside: You're creative. You tell me.

I moved to Asheville Sunday. I am living in the MAHEC House with 7, soon to be 8, other women! Its 5 bedroom, 2.5 bath, and has a small kitchen (w/ 2 refrigerators), dining room, and living room. I am sharing a room with two girls, Laura and Dana, and everyone in the house except one girl is from our pharmacy class. I haven't had roommates in a long time, and certainly never this many at a time, so it will be an adjustment!

Monday was a day full of orientation. We all got up and showered (surprisingly without any waiting) and were off to the hospital and MAHEC. We decided to walk because the house is only a couple blocks down the street. We spent the day learning about our seminar, projects for the year, policies, computer passwords, and ice cream at the end of the day! I sat across the table from a couple of the program leaders at lunch and it was great to already start building a relationship and getting advice on career plans and clerkships.

Today was my first day at my clerkship site for the month. I am at Black Mountain Neuro-Treatment Center, a long term care facility specializing in Alzheimer's and Developmentally Disabled patients. I spent the morning in a Care Plan meeting with the mult-disciplinary team that reviews each resident quarterly (and sometimes more frequently if needed). They discuss disease progression, behavioral issues, precautions, medication therapy, restorative care plans, and any other pertinant issues about the patients. While discussing one patient, I quickly came to the sad realization that he had become a more manageble patient because of his cognitive decline. He was happier to be there because he couldn't remember he didn't want to be there for long enough to get mad about it. I will definately be learning a lot this month, not only about psychotropic and neurological medications, but about overall patient care.

Good-bye little cottage

The past week has been all about moving. Yuck! After finishing my internship, I spent the week packing my little cottage and going through as much stuff as I could. Man do I have a lot of stuff! I have loved my little place in Chapel Hill. I lived there for all three years of pharmacy school and I'm sad to leave it.

Thomas, my boyfriend, is also moving, tomorrow. We have spent the week making trips to buy tape and boxes and bubble wrap and paper and trips to Good Will and then back again. Its exhausting, and a little sad. Three years is the longest either of us has left our stuff in one place since we left home after high school. For me, the last 12 months have been the first time I have spent 12 consecutive months in the same place since I left for college (8 years of bouncing back and forth!)

Our parents are wonderful helpers and have come to Chapel Hill to load trucks, drive them back to Charlotte, unload trucks, and help clean (thanks Mom!). Now that all my stuff is in Charlotte, I have a week to reorganize it and hide it in attic spaces before moving to Asheville for my last year of school. I'll be living in a house with other healthcare students (some from my class) which is paid for by a state program, so at least I won't have to move furniture again!

I hate moving, but I did get oriental lilies from Thomas, just to be nice. They are my new favorite flower this week, and they smell wonderful!! :)

My last "day"

I finished my internship with Cardinal Health Nuclear Pharmacy Services in Raleigh last week. I woke up Thursday afternoon around 4:30 pm, took a shower, and got ready for dinner. It was the third Thursday of the month so I was off to Tyler's Tap Room in Durham for dinner with my lovely Kappa Delta Sisters of the RDU Alumni Association.

I LOVE these women and was so very glad to see them one last time before I move. I have really enjoyed meeting the women of the RDU KD AA and can't thank you all enough for being my friends. You have given me new opportunities to continue my involvement in Kappa Delta and shown me how KD truly is a lifelong connection. I will miss you all very much, and I look forward to coming back to visit. AOT.

After dinner I had a really terrible headache so I went home to take a nap. I woke up again at 12:30 am and got ready for my last "day" at work. I fixed some tea, grabbed some breakfast, and headed out the door. Despite the generator shortage we've been experiencing most of the summer, my last week was a good one. We received two medium sized generators on Monday and two large ones on Thursday plus an unexpected small one as a bonus!

When I arrived Friday, Andy, the pharmacist, was busy making kits (adding radioactivity to different drugs for specific tests). I set up a work station and jumped right in with the other technicians drawing up doses and sending them out for packaging. As we finished the majority of the first run of doses, Andy noticed we had enough left over kits to draw the rest of the doses for the morning so we just finished everything up. Three hours into my shift and almost all the work for the day is completed, things are looking good!

We all grabbed a snack and then the guys took out their deliveries. There were a few clients that called in for some extra doses so we worked on those as needed. Around 7 am, a couple of big wigs came in to train the pharmacists and technicians on the new Smart Fill radioiodine machine that had been installed on Thursday. I got to observe the training and smooze with the big wig for a little while. The machine is designed to better contain the radioactivity of the iodine while capsules are being made. Iodine has a long half life (8 days) and targets the thyroid. If the pharmacist, technician, or nuclear medicine worker, inhales or absorbs too much iodine while working with it, it will kill their thyroid and they will have to be on medication for the rest of their life. Thus, installing a new machine that can accurately make the iodine capsules while containing the radiation is a big safety feature!

I was very glad to have the opportunity this summer to complete an internship with Cardinal Health. I learned a lot and finally got the chance to experience this niche of pharmacy that I have been working towards since my senior year in high school. This summer I learned how to: elute a generator to obtain technetium, tag a drug with radioactivity, tag blood cells with radioactivity, quality control test a drug kit to make sure it was properly tagged, safely draw up doses for a patient, safely package and ship doses to clients, deliver doses to clients, sleep during the day (blackout curtains or a dungeon work best), and the embodiment of customer service no matter how much work it creates for you. I have learned I still like nuclear pharmacy and could be happy doing it "when I grow up." And more than that, I met some really amazing people that really know this business and this company.

Charleston Harbor Fest

This weekend Thomas and I went to Charleston for the 2009 Charleston Harbor Fest. The mission: Pirate Ships!! Charleston was one of the stops on this year's Tall Ships Atlantic Challenge where a fleet of Tall Ships race from Spain to Ireland stopping in the Canary Islands, Bermuda, USA, and Canada along the way. Thomas's whole family is interested in Tall Ships; he, his father, and his brother have all spent at least some time working on one, and his brother met his bride-to-be on one. We were very excited.

Friday morning we got up early, loaded the car, got some fun tickets and breakfast, grabbed my new GPS (thanks Dad, I remembered it this time) and were off! We got to Patriot's Point, just across the Cooper River Bridge mid-afternoon, dropped our stuff and went looking for the ships. We headed back across the bridge to Charleston, found parking, and as soon as we started walking toward the harbor we heard drums, singing, and marching. We had stumbled on a parade of sorts of most of the crews of the ships. We followed them along to the harbor where the Class A (or big ships) were.

We exchanged our tickets for wristbands and set out to tour some ships. It was closing to time for the ship tours to end, so we only toured the US Coast Guard Eagle. Eagle is a trainging ship so most of the crew are cadets at the Coast Guard Academy. Gerin, Thomas's brother, actually helped crew Eagle over to Spain though, to begin the race, so I thought it was pretty cool to see where he had worked. Other Class A ships we saw: Kruzenshtern, the Russian Navy training vessel (she actually broke her foremast in a bad storm from Bermuda to Charleston), Captain Miranda, the Navy training vessel from Uruguay (which had the best musical selections -- those guys were having a good time!), and Mircea, the training ship for the Romanian Navy (and actually a sister ship to the USCG Eagle).

On Saturday we got up early and headed back over to the Harbor Fest. There was an airshow in the morning, complete with a Para-Commando jump from a military airplane. We spent most of the morning new the Maritime Center touring some of the smaller ships. We toured the Etoile from France, the Europa from Amsterdam, and the Schooner Virginia from Norfolk. Not all the ships were open for tours but we could see most of them in the harbor. We decided to go find some shade because it was SUPER hot, check out the souveniers and market they have in the middle of downtown, and grab some lunch.

Saturday afternoon we took a sail on the Spirit of South Carolina. It was a two hour sail and they let us help raise the sails! Thomas and I both helped and then got to enjoy the breeze as we circled the harbor. As soon as our sail was over the sky turned dark and started raining so we timed that just right. We were meeting a friend of Thomas's for dinner that evening and as we headed to the restaurant, the bottom fell out, I'm talking "frog strangler!" It was high tide already, and with all the rain, there was flooding in the streets. People at the market were starting to load their cars and were ankle deep or more in water! We changed plans and went further away from downtown for dinner, but it was crazy to see that much water!

Sunday we slept in a little before packing up and checking out of the hotel. We headed over to the Patriot's Point Naval & Maritime Museum before leaving. We toured the USS Clamagore, a Cold War submarine, and the USS Yorktown, and Essex-class WWII air craft carrier. The Yorktown also has a bunch of different kinds of military planes on board, including an F-18, an F-14 (yay TOP GUN), and a TBM Avenger, the kind of plane George H. W. Bush flew in WWII. After a stop to the gift shop to acquire a smushed penny for myself and a sword letter-opener for Thomas, we were back on the road for home. All in all it was a really great weekend!

Wake Med

Yesterday I went over to Wake Med, one of the local hospitals, to observe their nuclear medicine department. I went over a little after 6am when we delivered their morning doses and stayed until about noon.

I saw one patient get a series of scans of her GI tract. The doctor suspected a blockage in her gall bladder so after her injection she had to be scanned at several different points over a couple hours. It was neat to see the progression and her organs to "light up" at different points in time.

I also watched some patients get stress heart scans. Patients that have been experiencing chest pain and are suspected to have ischemia or dead heart tissue are given two scans: resting and stress. The patient is given a small dose and scanned at rest then the patient walks on the treadmill or is given a drug to induce stress on the heart, given a larger radionuclide dose, and imaged again to see the difference. The goal is to see if tissue that appeared dead during the resting test receives blood flow during the stress portion. If so, the tissue is damaged, but not dead, so with lifestyle modifications and drug therapy, hopefully the patient's heart function will improve.

I also got a chance to look through their files at all the kinds of scans they do and see the difference between normal scans and scans with defects. It was really helpful for me to see what the nuclear medicine technologists do and to know what happens to the doses I prepare once they leave the pharmacy.

Nuclear Pharmacy

For the past six weeks (and four more to come) I am interning at a nuclear pharmacy in Raleigh NC. Nuclear Pharmacy is like any other pharmacy in the sense that doctor's write orders/prescriptions for doses and call or fax them in. Pharmacists and technicians prepare and draw the doses in syringes or vials and then package them to be sent to the site and administered to the patient. The key difference however is that all the drugs in the nuclear pharmacy are radioactive. They are used mostly for diagnostic testing (think treadmill stress tests for heart disease or special eggs for gastric emptying), but some doses are for therapy (iodine for overactive thyroid or strontium for pain in bone cancer patients).

In my first six weeks I have learned to elute (or hit) a medical nuclear generator to obtain the radioactive isotope we use for most of our drugs. I have learned how to draw doses, package them and check to make sure they are cold (not radioactive) so they may be shipped to our clients. I have learned quality control procedures to make sure our equipment is working properly and to make sure the drug kits were properly tagged with radioactivity so the clinic will get a good scan for the patient.

The biggest challenges I've faced so far are the hours and a generator shortage. The hours are from the middle of the night to the middle of the afternoon. They have four pharmacists that rotate weekly between the 2400, 0200, 0600, and 0900 shifts (I've been flip flopping between 0200 and 0600). I knew about the hours when I signed up for this, what I didn't know was how hard it was going to be to sleep during the day when I'd rather lay outside and read a book (I slept for 12 hours Friday night to make up for it -- given I'd been awake for 29 at that point).

The generator shortage was unexpected. Apparently there are only about 5 or 6 medical nuclear reactors in the WORLD (none of which are in the US) and 3 (three!) of them went out of service at the same time. One of them had a heavy water leak and will be shutdown for 3 - 8 months (or forever, they haven't decided), and the other two went down for routine maintenance. Basically our product was cut down to about 30 - 40% of what we were used to, but none of the clinics (or at least few of them) cut down on their patient loads. It has made for long drawn out days and stressful times trying to decide who gets what doses and when exactly they can have them. We're getting an extra generator tomorrow we weren't expecting, so things are looking up.

The beginning...

So over the past several months I have started following the blogs of several of my friends and decided to create my own. I wish I could chronicle new travels, a creation/addition of a family, or a new business adventure, but I have none of those. The biggest thing going on in my life is school. Currently I am interning at a nuclear pharmacy in Raleigh and I will start my final year of pharmacy school in August, spending most of the time in the Asheville region of NC.

I don't know how good I'm going to be at keeping up with this, but I thought it would be a good way to share my pharmacy experiences (and other life ones too) with those that might just want to know. Tune in later for a recap of the nuclear internship thus far, and have a happy weekend!