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.