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!