What is next for the pharmacist-to-be?

Sorry it has been so long since my last post. These past two months have been a whirlwind for me, so I’ll start with October 1^st. I finished my September rotation at the DIC and began my General Medicine II (two month long) rotation at TMC Lakewood.

I will answer the usual question I get when it comes to rotations. What I actually do…

My projects/responsibilities these two months:

-Journal Club Presentation over insulin therapy

-Drug Presentation over Xarelto (rivaroxaban) for stroke and venous thromboembolism prevention 

-Monday Morning Meetings

-Participating in clinics: Family Medicine, Dermatology, Pulmonology, and Anticoagulation

-Worked with healthcare teams: pharmacists, medical residents, nurses, and attending physicians in order to provide care to our patients

-Perform patient assessment, medication reviews, patient counseling, and provided recommendations regarding medications.

I have thoroughly enjoyed my time on this rotation. I especially like working in the clinics with the residents. I expected to learn a lot about pharmacy, but I’ve learned even more about medicine in general. Working in outpatients clinics have been really rewarding as I see the same patients multiple times for complete medical care: initial visit, follow-up visits, establishing care with a PCP, etc.

For instance, in the anticoagulation clinic, patients who are taking warfarin (Coumadin) for stroke and clot prevention visit every 1-4 weeks to have blood work done. I then interview the patient discussing medications, side effects, problems, concerns, and of course, medication education. After each visit, I meet with their physician to recommend changes to their medications before contacting the patient with their new regimen.

As you can tell, this rotation has been very influential for my pharmacy career. Due to my rotation experiences, I’ve developed a strong interest in Ambulatory Care. I’ve also learned that I really enjoy teaching, mentoring, and precepting students. Once I determined an area of interest, the next step was figuring out what to do with that. Therefore, I have decided to pursue a PGY1 pharmacy residency after graduation. A residency? Isn’t that for doctors? Well, there are residencies available to pharmacy graduates. Their purpose is to further advance our pharmacy practice training.

PGY1: “Postgraduate year one of pharmacy residency training is an organized, directed, accredited program that builds upon knowledge, skills, attitudes, and abilities gained from an accredited professional pharmacy degree program. The first-year residency program enhances general competencies in managing medication-use systems and supports optimal medication therapy outcomes for patients with a broad range of disease states.” Read more on ASHP’s website (American Society of Health-System Pharmacists). 

Thus, I will be attending ASHP’s Midyear Conference in New Orleans this December. At the conference, there will be a “Residency Showcase”. The Showcase is an opportunity for prospective residents to meet programs' current residents and preceptors in an informal session to gain information about their programs and institutions.

So with that, I will be updating the blog after my trip to New Orleans. Until then, I would appreciate prayers from all of you as I take a step forward in my pharmacy profession.

An Office of My Own

First, I'd like to apologize for the long delay on posting. I will be adding my journal entries from my Honduras trip as soon as I get my journal back from my preceptor (who is currently grading it). And having August OFF from rotations was really nice to get in some good hours at work, train the new students, and update my professional portfolio with my work from the summer.

Secondly, I'd like to welcome you to the next month of my life as a pharmacy student on rotations - UMKC's DIC...

At the DIC (Drug Information Center), located within the pharmacy school on Hospital Hill, I have my own office which is really exciting. I'm starting to feel less like a student and more like a professional which is exactly what rotations help do - transition us students into the professional world.

So a lot of friends and family have been asking: what is it you actually do? In response, at the DIC I help provide drug information to patients, caregivers, and other professionals when they call or email us with drug related questions. We also do a lot of research in order to help recommend medications for hospitals and state agencies to include in their formulary (a list of medications used by the institution).

My projects/responsibilities this month:
-Journal Club Presentation: review pharmacy articles and present to preceptors/fellow 5th year students
-Project/Presentation: review and compare medications for a local hospital
-Call Duty: retrieve, research, and respond to any drug related questions via email or phone
-Friday Morning Meetings: discuss questions from the week, news articles, journal articles, print resources, etc

With this rotation, there are four other students from my class with me. It's definitely nice to have familiar faces with me for the month. I am also really thankful that our class is not overly competitive with each other, and we're all willing to help out a fellow student. Therefore, it's helpful to have others to turn to when you need an extra set of eyes to hunt down pharmacy articles and answers to drug questions. Even after three working days in, I'm glad to have the others with me as we've relied on each other to assist during research.

I have to honestly say I was not super interested in drug information before this rotation, but now I've found that I actually enjoy it. It's essentially a chance to "Google" things most of the day (though Google is not our preferred search engine for scholarly research...).

All in all, I'm really happy that I ended up at the DIC this month. The people that I get to work with are awesome and the work is rewarding. I'll keep posting as much as I can throughout this month to update you all on my experience with Drug Information.

Preparing for the Next Adventure

Since returning to Kansas City, I've been hard at work. Upon arriving home, my parents helped me unpack my massive amount of fish and luggage in order to turn around and start packing for Honduras. I was really thankful to have them with me when I got home. My dad fixed the fridge door and sprayed for weeds while my mom and I unpacked and did laundry. It made the transition back a lot less stressful. I went to dinner at The Blue Moose with some close friends that night. We enjoyed some good food and drinks and good company as well. Though I do have to say that after being back, I miss Alaskan beer and am currently trying to figure out how to get it to Missouri.

The past five days I've been working at Bruce Smith as usual, and I have to say I really missed the people. It's been great to see friends during this time before I leave again. It would have been nice to be able to go to church this past Sunday, but work has monopolized my time this weekend. Have to make the money to pay the bills... especially for my adventurous lifestyle this summer. But I'm thankful to have the next few days off to relax and organize everything for the two week trip. I've been experimenting some halibut recipes so far, but I'm really holding off on a lot of cooking until August. Sunday night I made beer battered halibut (minus the beer) from a box mix and it turned out pretty good. I've determined lemon is key and a good tartar sauce will pair well with the halibut. I'm also really excited to try some homemade recipes that I've received from people.

In order to prepare for Honduras, we've been watching recorded lecture videos about Global Health and then writing research reflective papers. When I completed my last one yesterday, it made me realize how close I am to leaving again. Tomorrow we have a meeting with the group to brush up on our pharmacy treatment plans  and physical exam skills that we will be using while in the clinics. We will then have our pre-departure packing party on Saturday where we will load all the medications and supplies into our extra luggage. I'm attempting to only pack a carry-on for the two weeks in order to make more space and weight available for the supplies. Don't worry, updates to follow on how that process goes since I'm a chronic over-packer.

Bitter Sweet Endings

June 29, 2011

Today was my last day of my first rotation. I’m definitely going to be sad leaving Elmendorf. I had a great overall experience. I met some truly awesome people who I’m going to try my best to stay in touch with. I had high expectations for Alaska, and it has lived beyond those expectations. Normally in life, I've become use to disappointment when I get my hopes up only to be crushed by reality. But in this case, this “dream” world has become real life. I've learned so much about myself and about people over the course of this month. Not only did this rotation grow me professionally and intellectual, but it grew me personally and emotionally.

It was harder to say bye to everyone than I thought. These next few days I’m going to be mentally preparing myself to return to Kansas City. I know it will be great to get back and see everyone, but at the same time I’m sad to be leaving this place of adventure and fun. Thus, during my last week here I plan on having as many Alaskan Adventures as I can.

Tonight Becca and I drove to Homer to stay the night before halibut/salmon fishing in the morning in Ninilchik which is 35 minutes North of Homer. I'm really growing to like that fishing town a lot as it is my third time visiting Homer.


June 30, 2011

We woke up pretty early to grab breakfast and lunch for our fishing adventure. Shortly after 8am we met up with Captain Dan and his friend Ben in Ninilchik. We then met Dan's Aunt Ann and Uncle Charlie who joined us on the boat for the day. We all hopped into Dan's truck pulling the 24-foot vessel on a trailer. This boat was a lot smaller than the 50-foot Whistler we fished off of a couple weeks before, but with only 6 of us fishing for the day, it was perfect. Because of the 27-foot tide differential (between high and low tide - 2nd highest in the world), tractors pull and push your boat on trailer into and out of the water. This was a pretty cool experience riding in a boat on a trailer on the beach.

The weather predicted strong winds and overcast weather, but Becca and I seem to bring the sunshine and calm weather, so it was a BEAUTIFUL day to be out on the water. Once we got out to our halibut spot, Dan dropped anchor and gave us detailed instructions on how/what to do to hit bottom, catch the fish, reel it in, etc. Not even 5 minutes after dropping our lines, I caught a 35 lb halibut. From then on, we joked that it was going to be a good day fishing. About 3 hours, 12 halibut, and 2 cod later, I finished up with 2 nice sized halibut. Yep, I threw back 10 halibut. The entire time fishing Ben and I had some unspoken competition about who was catching more fish. Among all the joking, we really had a good time with everyone on the boat.

Ben, Me, Becca, Ann, and Charlie with our halibut.
(Mine are to the left and right of me in the picture) 

After halibut fishing, Dan took us in to troll for King Salmon. This part of the afternoon was much slower and not as exciting and fast paced as fishing for halibut. We trolled 10-17 feet deep water and only snagged one baby King. Dan promptly tossed me the rod and told me to reel. Apparently I didn't reel fast enough or the salmon wasn't actually caught, because our one King for the day got away. As it got later in the afternoon, we called it a day and headed back to the beach to be fished out of the water by the tractor.

Dan and his dad, Bob, filleted up our fish and sent us over to Tanner's Fish Processing to get our 35 lbs worth of halibut flash frozen and vacuum sealed. We then decided to spend another night in Homer since our fish wouldn't be ready until the following morning. While in Homer we enjoyed a delicious steak and crab dinner before heading to bed as it was a very long and exhausting day. Props to the fishermen out there who do this day in and day out. It's definitely tough work.


July 1, 2011

We spent the morning in Homer as it would probably be our last time there during this trip. We went for a hike and found a waterfall. We enjoyed lunch at Sweet Berries a cute store/bakery/lunch place. We then picked up our halibut and headed back to Anchorage. Once we were back in the city, we decided to stop at Humpey's for some of their famous halibut tacos. They were delicious. By now you'd think I'm sick of halibut,  but I absolutely love it. And I better love it as our entire freezer is full of it!

Freezer full of fish. The challenge: get it all back to Missouri...

As the weekend approaches, I'm getting excited for the 4th. But it's bitter sweet as I'm definitely ready to be home and not ready to leave this place. My mind and heart are very confused at where they want to be.

A Drug with No Antidote / Uphill Battle

Wednesday June 22nd -
Today was presentation/projects day meaning at 2pm we headed to the conference room at the AFB to show our IM and SQ injection videos to the the other students and pharmacists from the base. It was hard for me to watch/hear myself on screen but they all seemed to like the videos. After the other students presented, Captain brought us cake to celebrate and our Sargent agreed to teach us a dance (apparently from some childhood show I did not watch). We have video and pictures of this floating around somewhere. Overall, it was a fun and random afternoon at work.

This evening we went to Kinley's Restaurant and Bar for a Pharmaceutical Rep dinner. Here, we were educated on Pradaxa (anticoagulant drug) which after his presentation I'm still weary of. There is no known antidote to the drug unlike Coumadin/warfarin which has Vitamin K as an antidote. Regardless of the presentation, the steak I enjoyed was delicious. We also had crab cakes and bacon wrapped dates that were also quite tasty. After dinner, Captain took us out to play foosball, billiards, and table shuffleboard. Mallory and I dominated at shuffleboard probably out of pure luck rather than actual skill. It really was a great night to spend outside of work with the other interns.


Thursday June 23rd -
Today Becca and I had the day off, so we decided to hike Mt. Baldy which was recommended to us as a fairly easy hike with some harder spots. Since our classmate Kyle has a rotation here in July, he flew in early to explore Alaska, so he also came with us on our hike. Boy, we didn't know what we were getting ourselves into. It was an uphill battle that I was not ready or in shape for. Kyle, on the other hand, had no problem traversing the side of the mountain. Last month he spent some time in Utah hiking the Blue John Canyon same place Aron Ralston, 127 Hours, was trapped and had to amputate his arm. Therefore, he was more prepared than Becca and myself. When we finally made it to the top, the view of Eagle River was beautiful! I still like when we hike further away from the developed cities where you can't see/hear the highway though, but it was still nice. We went beyond the peak some to Blacktail Rocks where we abandoned the trail to play in some snow. I pitched Kyle a couple of snowballs and he used his walking stick as a bat. After that, we decided to go back a different way than we came up the hill, so we found a downhill path that was pretty fun for trail-running. By the end of the hike, I was really ready to rest my legs while working on a paper for my Honduras trip.

Summer Solstice: 24 Hours of Daylight

Yesterday I was scheduled to spend the morning in the inpatient pharmacy which I have definitely enjoyed doing so far. Instead, I was told to go to Labor and Delivery and scrub up! I started out the morning by being introduced to the staff. They were really awesome and made me feel welcome in their unit. We worked on dosing iron sucrose for a pregnant woman with iron deficiency. Luckily, this question had come up on rounds the week before so I was able to contribute to the discussion and calculating of the dose. 

Next, we had a couple women come in to be induced into labor, so I brushed up on my oxytocin knowledge in order to weigh in on the conversation. (Sidebar: I'm realizing how much I need a phone upgrade since Epocrates was removed from Palm phones. And Lexi-Comp for phones is a tad pricey. Okay, enough with my rant. Back to the good stuff.) After they were induced, we had an odd array of patients that had fallen or weren't feeling well come in to get checked out and stay a while for monitoring. Also, a couple moms-to-be came in for tours of the L&D unit. 

One of the moms was to receive an epidural so the anesthesiologist walked me through each step describing everything in full. He then quizzed me on my ropivicaine, epinephrine, and lidocaine knowledge. Afterwards, he allowed me to ask him any questions I wanted to know the answers to. Overall, I learned a lot about epidural administration which I'm glad for. 

After the epidural, we continued to monitor the baby's heart rate along with mom's contractions until it was time to push. So I gloved up and headed into the birthing suite with the OBGYN and supportive nursing staff. Instead of watching from the head of the bed, I took a place next to the doc for a up close viewing of the live birth. Everyone’s first question to me afterwards: “You still want to have children?”

That evening I went for a walk around the lake while making a couple phone calls. So the following occurred while on the phone with my mom. Between the trail and lake, there was a dog staring at a baby moose. The owner of the dog called for it to try and get it to move away, but the dog only crept closer to the moose. Advice: if you see a baby moose, mama is not far behind. When the dog began to bark, the mother moose flew out of the trees over the ridge. At this point, eight other people and myself were stuck in a stalemate with a baby moose and its mom. Mama was definitely upset that we were so close to her baby. Looking back, we probably did not have the best reaction, but we all decided to run away in different directions weaving in and out of trees. Everyone was able to make it away safely when the moose began to charge at us.

I didn't get much sleep as it was the Summer Solstice, so basically 24 hours of daylight. Though the sun did set behind the mountains, it still managed a nice twilight glow until it rose again a couple hours later. I'm still not really use to this daylight stuff, and I'm not sure I ever will. 

A Halibut a Day Keeps the Doctor Away

We packed up the Escape and drove down Friday night after work to Homer, AK. We got in pretty late in the evening, but decided to drive the Spit for the others who hadn't been to Homer yet. I felt like a personal tour guide ha. After that we settled in at the hotel and tried to get some rest before the big fishing day.

5 am came a little too early, but we managed to get everyone ready to go for the day. We stopped by Boardwalk Bakery like last time to get cinnamon rolls for breakfast and boxed lunches for the boat ride. The half day halibut fishing trip included myself, Becca, Jenna, Paige, Hana, and Tim. We were joined by the Sherman family along with a father/son duo which made a total of 16 people fishing for the day. We boarded the Whistler, a 50 foot fishing yacht, and hit the water. 

Upon getting on the boat, Becca and I both managed to sit in huge puddles. At that point, I was really thankful for my Columbia hiking pants that dry rather quickly. It made for a funny start to the trip though. It was a BEAUTIFUL day for fishing. The weather was great and the water was perfectly calm, so no one got sea sick.

I caught my first fish fairly early after anchoring and dropping lines in, but Jenna was the first of us to catch one in a couple of minutes. It got pretty crowded and chaotic at points with how many people were fishing. The crew was running around like crazy every time someone yelled "Color" - meaning you had a fish near the surface. Once we got our limit (2), we hung out and got to know the rest of the people on the boat while the remainder of the people continued to fish. Jenna and I explored the boat some which you can see in the pictures I posted. We didn't do a great job at staying out of trouble, but those are stories for another time. 

Around 10 am, we started heading back to the harbor while the deckhands began filleting our fish. We started timing them and it took an average of 55 seconds to filet one halibut. They were crazy fast! I don’t know how they don’t cut themselves. Around 11 am we made it back to the harbor after a really nice ride back. The total fish caught between the 6 of us was 50+ lbs of halibut. We had them cut into 1 lb filets, sealed, and flash frozen in order to take back to Anchorage on Sunday.

Me and my halibut

After fishing, we headed back to our hotel to shower. After cleaning up and washing the fish/sea smell off, we headed to Bear Creek Winery for wine tasting. We sampled a variety of wines, and I was surprised how good they were. My two favorites were Blue Zin and Pomegranate. So I’m going to find a way to bring a bottle of each back home.

After wine tasting, we met up with the whole group of pharmacy students for dinner. We headed to Captain Pattie’s on the Spit. We were able to bring in some filets from Mallory’s fish (106 pounder) that she caught and have it cooked up in various ways. We had more than enough food for everyone and it was delicious! I also enjoyed a glass of Blue Zin which tasted great after fish.

The whole group with our feast from Mallory's monster catch.

After dinner, we hit up the Salty Dawg Saloon. The deadliest catch guys were still not there, and they won’t be back until August. It was definitely great to sit and relax after the long day. I also found that I really like Alaskan Brewing Company’s beer. They have a “summer” that is a wheat; I also tried their “white” and the “amber”. All of which I really enjoyed. After Salty Dawg, we headed to another place that had a live band playing and played some pool. I found out that I’m a little better at billiards than I thought, but still no professional. I think I’ll stick to pharmacy. By the end of the day, I was completely exhausted.

On Sunday, we headed to the Spit to pick up our fish from Coal Point Trading Co. I ended up with 13 one lb fillets. I'm going to be eating a lot of fish once I figure out how to get it back to Kansas City. While on the Spit, we also did some last minute souvenir shopping before grabbing some lunch and hitting the road back to Anchorage. On the way back, we stopped at Indian Valley Meats where they sell Alaska wild game meats basically anyway you want it. You can also bring them what you hunted/fished for and they will process it for you. I’m keeping that in mind for salmon fishing next week!