M.I.A.

Sorry I’ve been MIA for a while. July was a very, very busy and tiring month. I was on the Adult Internal Medicine/Therapeutic Drug Monitoring rotation at UK. Needless to say, the entire month was challenging, but worthwhile. I was seriously dreading this rotation going in, but now it is over and I can look back and say that it wasn’t all that bad afterall. The hours were the long and the workload heavy, but I definitely learned a lot and was introduced to new environment for pharmacy. Afterall, since the first two rotations were horribly slow (and boring), I was in need of a faster pace.

This month I am at the Veterans Administration hospital on the Geriatrics rotations. There are two components: Drug Regimen Review, where we basically review patients’ charts for safety and efficacy of drug therapies; and Home Based Primary Care, where clinicians actually go out to Vet’s home instead of the Vet coming to the hospital. For this portion, we have considerably more say in patients’ treatment. The environment at the VA is completely different than UK. It is totally laid back, not to mention that the veterans’ health records are entirely electronic, which is awesome since you never have to get out of your chair! We have somewhat of a heavy workload, but stress is minimal and you can pretty much work at your own pace. This rotation has been interesting, and different, and I may still consider working for the VA in the future, once I am burnt out with Community Pharmacy. I am off in September and October, so I will be working full-time at the K.

In other news, Amanda and I made an offer on the house in Franklin. Since real estate is S-L-O-W and its pretty much a buyer’s market, we decided to make a low-ball offer, just to see what happens. After several days, the Realtor finally contacted me to let me know that the seller could not accept the offer. Now we are just waiting for their counteroffer. I pretty much have a top dollar amount in my mind, and I am pretty sure that we will be able to negotiate an acceptable price. I have plenty of faith that this will work out. We made the decision to move to Franklin at the end of September regardless of what happens. I have rearranged my rotations and both of us have put in our notices with our employers. If the house deal falls through we will try to find an apartment or house to rent, and if all else fails we can stay with her family for a while.

And now a little info about this past weekend.

Friday. I was off work and had nothing to do, so I called up Jon to see if he wanted to go to the Wild Turkey Distillery. Instead, we decided to head to Red River Gorge for an overnight camping trip. The wives were terrified that we would fall off a cliff or get lost in the woods. Needless to say, we had a great time and made it home alive. Hopefully we can make another trip before we move.

Saturday. Amanda’s friends Tiffany and Jayme came to visit for the weekend. Amanda knew that Jayme was coming, but had no idea that Tiff was coming, so she had a pleasant surprise when got home from work Friday evening. Jon and Emily came to join us and we grilled some N.Y. Strips. Then we spent the rest of the evening playing the Wii and Guitar Hero on the PS2. Sounds like fun, huh?

Sunday. We did absolutely nothing. That’s right, we all just lounged around all day and did absolutely nothing.

This coming weekend Amanda and I are going to Nashville for the holiday. All of her family are getting together at the lake and renting a huge pontoon boat. Unfortunately, I have to work on Saturday, so I will have to drive Amanda to Louisville so that she can ride down with her Sister, who is coming from Indy. Then I will drive down Saturday night after work. Since we are planning on going to the lake Sunday, I will make it in time for most of the excitement. I am sure Amanda will post an entry with all the details and some pictures for your viewing pleasure.

Disappointed…

I am coming up on my last day of my most anticipated rotation and I must say that it was pretty disappointing (except for the 9-3 hours). Out of all 10 rotations, I expected this one to be the most interesting and introduce me to a totally different practice of pharmacy. Don’t get me wrong, there were some interesting projects, but overall it was rather boring. For the past month, I have been working with the Department of Corrections and a University-Affiliated organization, who shall remain unnamed. Basically, for the entire month I worked independently and contributed to chart review of inmates and data collection for a research project examining the appropriateness of care and documentation of such care in the state correctional facilities. I came across some very interesting things, most notably the Psych notes of some of the inmates, especially those on death row. Some of these inmates have some serious issues. It makes me wonder if they were crazy before they were incarcerated, or if their insanity is a product of such confinement.

I must say that the most interesting part of the whole rotation was the visit to the state medical facility. The syllabus says that we would make 4 trips to this prison–I made it once, the student before me didn’t get to go at all. This was somewhat of a disappointment; however, I am thankful for the opportunity. During the visit, I sat in on the Pharmacy & Therapeutics Formulary meeting and took a tour of the prison. We also went to the Warden’s office and meet with him for a little while. The inside of the prison was definitely interesting and definitely not what I was expecting. This was a medium-security facility, but when you walked in, everyone was pretty much free to roam. Sure, some inmates were confined, but for the most part they were free to wander around in their khaki slacks and button-up shirts. I honestly felt like I was in a mental facility rather than a prison–everyone looked a little looney. Not to mention the Psych Unit, which truly is a high security inpatient mental ward. Very interesting.

Aside from this one day of excitement, most of my time was spent at a computer reading doctor’s notes. I think there are more people in the prison for sex crimes than any other offense.

I must say, this rotation really failed to meet my expectations. Oh…did I mention that I only saw my preceptor once a week for about 2-3 hours. She is a pretty busy woman though. Next month I am at the University Hospital on the Therapeutic Drug Monitoring rotation. This will be a very clinically driven rotation, where I will get to apply all of the Pharmacokinetics that I’ve learned. I will be rounding with the doctors and pharmacists, evaluating drug levels and responses and making notes in the chart, and probably giving a couple of presentations/journal reviews. I did not choose this rotation, rather I was drafted into it. I am dreading it a little, but I know that it will keep me busy and will be very informative and challenging. I emailed the current student to see what he has been doing in the rotation. About a week later he wrote back and apologized for delay, but said that he had been too busy to respond. (That could be a really good or really bad thing…we’ll see) He said he would call me this week and fill me in–he hasn’t called yet.

Hopefully this rotation will be worthwhile–even though I’m a little intimidated–and won’t be too difficult and hopefully I won’t make a fool of myself. I will keep you posted. Leave a comment!

One Down, Nine to Go

One rotation down, nine more to go until I earn my Pharm.D. My first PY4 rotation took place at a small pharmacy located within a large clinic and adjacent to several other medical practices and a hospital. Despite this prime location, this particular pharmacy is *VERY* slow–they only fill around 30 prescriptions per day, compared to some major chains that fill over 500/day. The majority of these scripts are for trials of meds accompanied by coupons, which usually result in the patient going elsewhere in the future. I think this pharmacy has potential to be extremely prosperous and have a great impact on patient care–they just need to figure out how to promote themselves, their convenience, and their professional expertise.

Although this rotation started very slowly, I found plenty of ways to occupy my time and make the most of the rotation. I had the opportunity to participate in a great deal of compounding, everything from progesterone suppositories, to butt balm, to testosterone cream. I was also able to collaborate with physicians on occasion and assist in the care of patients.

One thing that did bother me was the number of drug reps that crowded this clinic. About every 4th person that walked into that clinic was a drug rep. As we all know, prescription drug costs can be astronomical, and therefore I am a huge proponent of generic drugs and make every attempt to save patients money. Don’t get me wrong, I support pharmaceutical research and appreciate the advancements that have been made. However, I can not justify a patient receiving, for example, an antihistamine that costs them $40, simply because it is a new isomer of an older drug, which would have only cost $10. I am especially critical of “me-too” drugs–those that are only slightly different yet cost two or three times the price.

During this rotation, I was able to see the influence that drug reps have over prescribers. The pharmacy and doctors’ offices were littered with pens and notepads and calendars branded with names of new drugs. Not to mention the daily drug rep-sponsored lunch that lured in the entire clinic to feast, only to open the way for the reps to pounce on them, touting why their new $80 blood pressure med was superior to the $4 beta-blocker that has been around (and effective) for decades.

Overall, the rotation was interesting. There was potential for much more, but I wasn’t too disappointed. Tomorrow I start my next rotation–Correctional Pharmacy Management. It is supposed to be a rotation centered around care of patients in the prison population, namely Kentucky’s major medical prison complex. I have already spoken to the student who just finished this rotation, and she seemed to be pleased with the projects that they undertook, and the hours. I would have to say that I am looking forward to this rotation the most–hopefully I won’t be disappointed. I will be sure to post my conclusion at the end of June.

————————–

In other news, I had my stitches removed and I’m almost completely healed up. The final biopsy showed that they had removed all of the abnormal cells. So I am doing well and don’t even have to follow up with the dermatologist. Please take my advice and lather up the sunscreen this summer and try to avoid the tanning salons!