...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.