FINALLY!

Finally, after 7 years of college, lots of hard work, and even more student loan debt, I am officially Dr. Dustin F. Salyer, Pharm.D. That’s right, I have finally earned my Doctor of Pharmacy degree from the University of Kentucky. I must give props to my Wife, Amanda, for supporting me throughout school, mentally, financially, and emotional. Now that I am finished, I can provide for her and return to her what she has given me. Thanks must also go out to all of my family that supported me throughout my years in school and for making the trek to Lexington for me graduations. Thank you all so much for everything you have done.

Sorry it has been so long since I’ve posted, I have just been extremely busy finishing rotations, working at the pharmacy, and enjoying life. I am currently working at the Pharmacy as a Graduate Intern, but I am scheduled to take my Boards on May 21 and 22 (wish me luck!). Hopefully I will be licensed to practice pharmacy in Kentucky by the first of June. Talk about excited! Then I will hopefully get licensed in Tennessee  soon after.

As for my rotations, I must say that I learned a ton of information that was never taught in school. All of my rotations went pretty well and I especially enjoyed being in the indepenent pharmacies here in Bowling Green. I would say that all in all, the best rotations were UK Internal Medicine, VA Med Center Geriatrics, Springhill Pharmacy, and Clinic Pharmacy. The last year of pharmacy school certainly flew by and it’s almost hard to believe what I have accomplished.

Thanks again to everyone for their love and support. Here are some pictures from graduation.

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.

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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!

More White Coat Ceremony Pics

Here are some more pictures of the UK COP 2009 White Coat Ceremony, courtesy of the UK COP Website. Click the link below.

http://www.mc.uky.edu/pharmacy/news/py3_whitecoat.html

White Coat Ceremony

Here are some pictures of yesterday’s White Coat Ceremony for the UK College of Pharmacy Class of 2009

In other news…I met with my Pharmacy District Manager yesterday and he offered me a job…and the terms were much better than I had anticipated. I won’t disclose the exact salary, but it is very good (better than I was expecting–if you really want to know, ask me and I will probably tell you) and the benefits are excellent, including medical, dental, vision, company-paid and supplemental life insurance, 401(k) with company matching, short and long-term disability, and employee stock purchase plan. You also start off with 3 weeks vacation. You must take 1 week, but you can cash out the other 2 weeks if you want. He said he didn’t want to rush me into anything, but he would like for me to make a decision within the next couple months. We didn’t really discuss a sign-on bonus, but he did offer me a “commitment bonus” if I sign on now. I would get that money now (within the next couple of months) and would have to commit to one year with the company. Sounds pretty good, huh? I think it is great that I already have a job offer when I don’t even graduate for another year. It is very exciting. I am afraid to commit, though, without talking to a few other companies. I guess we will see what happens!

Lots to talk about…

Ok, since I rarely post anything, I thought I would give you an update on everything that is going on right now. I have successfully completed my PharmD. coursework and have two exams left to take this week. Yes, I said successfully completed. I failed to make the grades I had anticipated, but nonetheless passed all my courses and remained above average. Friday evening the Doctor of Pharmacy Class of 2009 will mark their transition from didactic coursework to clinical application with a White Coat Ceremony. It seems a little overrated to me, but during the ceremony two faculty members will cloak each student with their very own fancy white lab coat, with embroidered name and school logo. Fancy, huh? Amanda plans to take me out to celebrate afterward, although I’m not sure where.

I also have good news regarding my employment. I get a yearly raise after I complete each year of school. It is usually only a dollar or two, but I found out yesterday that I will actually get a $5 raise. That’s not bad, huh? I won’t disclose my actual hourly rate, but I’m sure it’s more than yours. The only bad part about this is that I won’t actually have the time to work enough to really bring in the cash, except for my months off from school.

More good news… I have been with the same company for about 4 years and I like to think that I am a pretty big asset (considering both of my bosses, as well as pharmacists from other stores, often rely on me to complete certain tasks because they lack the knowledge). Anyway, the pharmacy district manager (who oversees the entire state of Kentucky and part of Ohio) had mentioned to my pharmacy manager that he wanted to sit down and talk to me about a job. Well, yesterday he was in the pharmacy and told me personally that we wants to meet with me–our meeting is this Friday. I will definitely post another blog and let you know how that goes. I am extremely excited that I will might have a job offer and don’t even graduate for another year or so.

Now that I have finished my coursework, it’s off to clinical rotations. I have 10 rotations in the next 12 months, starting May 1st. May through December I will be in Lexington working at various pharmacies for free (and paying tuition, mind you). I will be at several community pharmacies, institutional pharmacies, and even a prison. I have September and December off and I have my last 4 rotations in Bowling Green (Jan. thru April). I am excited about starting rotations, but a little nervous too. I just have to remind myself that I will probably do better than most people and remember that no matter how big a fool I make of myself, someone else is probably making an even bigger fool. Then, once I finish all my rotations, I will receive my Doctor of Pharmacy and then I’ll have a month or so until I have to take the board exams. Once I pass the Boards, I will be a Licensed Pharmacist. I can’t wait–it has been a long haul.

In other news…If you have read Amanda’s Blog, then you already know that I went to a Dermatologist about 3 and 1/2 weeks ago and had a biopsy done. I had a mole that had changed appearances and look a lot like this. Or maybe like this. Anyway, it didn’t look good. So I went to the dermatologist and he looked at it and immediately said “Yeah, that needs to come off there.” So they took a picture, numbed me up, and sliced it off. They sent it off to the lab and gave me a number to call to get the results. They told me it would be 5-7 business days before I would have the results. It’s been 3 & 1/2 weeks and still no results. I called the office and the nurse said that the cells were abnormal and they had to send it out to a specialist for a “special procedure.” So I don’t think it’s very good. Hopefully I will find something out soon. Amanda is more worried about it than I am. They should be calling us soon.

Well, I guess that’s about all I have to say right now. So leave me a comment and check back soon to see what’s new!

Pharmacy School Hell

As you may already know, I am in my third year of pharmacy school. The Doctor of Pharmacy curriculum requires at least 2 years of undergraduate studies (prerequisites like Gen. Chem, Organic Chem, Biology, Anatomy, Physics, etc.) then pharmacy school itself is 4 years. Most people usually do 3 years of undergrad and some even get a Bachelor’s Degree in Chemistry or Biology. Pharmacy school consists of three years of coursework then the final year is entirely clerkships, or rotations. There is not a lot of flexibility in the PharmD curriculum. During the first year, all 125+ students take the exact same courses (Physiology, Bio Chem, Drug Design, etc). Then, beginning in the second year, you have the “flexibility” of one additional elective course. Pretty much, you get to see the same 125 faces everyday. You average 19-23 credit hours per semester. Yeah, it sucks. Especially when you only took about 15 hours as an undergrad. Add in work. Add in marriage. Add in social life. End product: Lots of stress, no free time.

The worst part of pharmacy school is block exams. Unlike high school and undergrad, where you have exams scattered here and there in different courses throughout the semester, in pharmacy school we have block exams. Once a month, every month, we get the pleasure of one weekend filled with all of our exams. We typically have 2 exams Friday, 2 on Saturday, and 2 on Monday, lots of caffeine, lots of stress, and very little sleep or pleasure (Unless you are like me, sitting here procrastinating).

The last 2 and a half years have really been hell. Nevertheless, they have flown by and it is almost over. I have 3 more months of coursework, then it’s off to do my rotations. During rotations you spend 1 calendar month at a different location (i.e. one month at Walgreens, one month at the health department, one month at a hospital, etc). It will be a huge relief to not have to study any longer and I am sure it will really fly by. Even though school has been trying, I know that it will pay off in the end, when I reap the fruits of my labor. I am counting down the days…