Pharm.D. To Be

FINALLY!

dsalyer — Fri, 15 May 2009 21:06:10 +0000

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.

dsalyer — Mon, 25 Aug 2008 20:23:43 +0000

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.

Better than I thought

dsalyer — Mon, 07 Jul 2008 22:54:13 +0000

Well, it is 1 week into my most dreaded rotation, but I must say that it really isn’t that bad. Actually, it may turn out to be one of the best rotations I take. It has been very busy, but I definitely needed that after the last two dreadfully slow months. I am usually there from 7 until 5, although I am occasionally there by 6 a.m. to prepare for rounds. Even though the hours are long, the time flies by because I am so busy. I have already learned a ton of stuff and seen lots of new and interesting problems/people. I probably won’t have much time to write because projects, papers, and presentations are coming up, on top of all my other duties, so I expected to be even busier! I will be sure to write a post at the end of the month summarizing this rotation…So far so good!

In other news…Amanda and I went to Nashville for the 4th. Despite the sunburn, we had an awesome and relaxing (for the most part) time. We spent some time on the lake, where I got to command the G-Daddy across the lake and was the first to pull boat with the in-laws new Dodge Ram. We also attended Amanda’s cousin’s Graduation party and saw three Firework shows.

We also went to Franklin, KY and checked out some houses. We will hopefully buy a house this fall instead of renting, pending our loan approval. Here is a link to the first house we picked out. The picture definitely doesn’t do it justice. Everything in this house is custom made and beautiful–there wasn’t a thing we didn’t like. The grass still needs to be sewn, and a few other minor details finished before the house is completely finished, but it is almost done! Hopefully it will be ours in a couple months! Check it out here and here!

Until next time…

Not so bad

dsalyer — Tue, 01 Jul 2008 21:22:09 +0000

Well, the first day of my most dreaded rotation is over and I am still alive. Tired, but alive. Luckily, the rotation will be more Adult Internal Medicine and less Pharmacokinetics. I started at around 7 with a short orientation to the rotation and expectations, then 1 1/2 hour computer training, then got to round with the physicians and residents for about a half-hour, then another hour of orientation. After that, I got the chance to review the patients assigned to my medical team. The number of patients can range from about 3-5 to about 16-18. Luckily, I only had 7 patients, and 2-3 will be gone by tomorrow. However, my team is on-call tomorrow, so I expect to gain several more patients. Thursday will definitely be rough. But at least I get out early Thursday and am off for the weekend and get to go to Tennessee to visit the family and hit the lake!

I pretty much spent most of my afternoon reading my patients charts and getting to know them and whats going on with their care. Then, for about 2 hours, the PharmD resident, my preceptor, and I met and discussed our patients and their drug treatments & monitoring that is needed. My patients range from those with MRSA staph infections and Urinary tract infections to end stage kidney disease and HIV. When I go in tomorrow morning, I will have to review the charts to see what transpired overnight. Then, around 9, I will meet up with the medical team to round with the physicians and visit the patients. Who knows what I’ll be doing in the afternoon. The first day wasn’t too bad at all. I expect to carry long hours, but I think I will learn a ton of information this month. I need a fast-paced, information rotation, because the last two were surely lacking! I will keep you posted!

Disappointed…

dsalyer — Thu, 26 Jun 2008 02:52:10 +0000

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!

Picture This

dsalyer — Wed, 25 Jun 2008 02:08:08 +0000

It’s not very often that anyone from Virginia, especially my friends, come to Kentucky to visit. I think the last visit was from Paul in…well, a long time ago…2006 I think. I’ve been trying to convince my old friend Brandon to come visit for quite some time now. He kept saying he would, but nothing ever transpired. Finally, after about 2 months of discussion, he called for directions. Amanda still doubted that he would actually come–but he did. I tried to show Brandon a good time, although I am unsure if I succeeded. Hopefully he wasn’t too bored.

First I showed him around town and then we all went out to dinner at Texas Roadhouse–who has an excellent NY Strip, mind you. Although the brewskies were less than palatable (but hey, at least we didn’t have to pay for them). After dinner, we headed underground to Redmon’s for some live music and a few drinks. Unfortunately, we arrived long before anyone else. But hey, at least we got to skip the cover charge. After Redmon’s, we headed over to Saddle Ridge Saloon.

Saturday, once we rose from bed around noon, we headed over to Woodford Reserve distillery. There are about 7 distilleries here in Central Kentucky, all within about an hour drive of our house. I have always wanted to visit one, so I made sure to include a visit in the weekend’s agenda. I had planned to also visit the Wild Turkey Distillery, but slept in a little too late to hit them both. After our Woodford Reserve tour, and a taste of delicious Kentucky Bourbon, we headed back to Lexington to eat at the best [reasonably priced] restaurant in Lexington: A. P. Suggins Bar & Grill. Were I also had a delicious NY Strip. Actually, it was even better than the Roadhouse. If you live in or near Lexington and haven’t been to Suggin’s, you are missing out. You definitely need to check it out. Call me up–I’ll meet you there and buy your dinner! After our delicious meal, we headed back to the house to plan our last night.

We headed over to Comedy Off Broadway (I’ve found that the openers tend to be funnier than the main act), where Auggie Smith and Dax Jordan provided more than a handful of laughs. Nothing beats a little stand-up comedy, followed by some drinks and pool at Marrika’s. I don’t think there’s anything I would rather do than hear some good stand up and shoot some pool. Since Marrika’s has a HUGE selection of bottled and draft beer, I decided to try a few new tastes. Then I feel in love with Carlsberg, which is brewed in Copenhagen, Denmark. I don’t know what it was exactly about this beer, but its taste was superior to all others. Although Amanda disagreed. But who cares what she thinks, I LOVED IT! After Marikka’s we headed home and just hung out for a bit and reminisced about old times.

Here are a few pictures for your viewing pleasure. Be sure to check out Amanda’s blog about our Six Flags trip. [sorry about all the hyperlinks, I got carried away]

Dinner at Texas Roadhouse

Brandon Chillin’ at Redmon’s (Notice all the people? Give it an hour though, and you won’t be able to move!)

Um, you better watch it, Big Guy….there are plenty of ladies out tonight.

Outside Redmon’s

Just the three of us

Woodford Reserve Visitor’s Center

Outside of the Distillery

What’s left of the day’s bourbon
(The barrels are pushed out of the distillery, then a mechanical arm knocks the barrels and rolls them to where they are now. Then, one of the workers will shove the barrel and roll it 500 yards down the steel track to be housed…Sorry, I thought that was pretty neat)

Entrance to the distillery…Exciting huh?

A look inside the sour mash cooker

5,000 Gallons of Sour Mash fermenting…Looks yummy, huh? Yeah, it smells even better

A look inside the empty fermenter

Copper Stills imported from Scotland. These are the only copper stills in use in the United States.

(Sorry for the blur)

A closer look at the still in operation. (These were originally used in Scotland to make Scotch. Did you know that you can only make Scotch in Scotland? And bourbon can only be made in the U.S.? Interesting fact that I didn’t know.)

Look at all that bourbon! (One of those barrels could be yours…for a nominal price of $8,000)

Finished product…straight from the barrel.

Very small bottling facility

Ready for the Liquor Store shelves!

Time for a taste!

Or two…

Me and my beautiful Wife, Amanda

Time for some pool at Marikka’s

Thanks for checking out the pics. Be sure to leave a comment!

Committed

dsalyer — Fri, 20 Jun 2008 01:25:37 +0000

I have verbally committed to my present employer and let the other company know. The District Manager will contact the Corporate Office, who will send me a written offer/contract. After I read, sign, and return it, I should receive the first installment of my bonus within a few days! That’s awesome. I think I have made the right decision, I just hope everything turns out for the best.

I’ll keep you posted if anything new transpires.

My current rotation with the Department of Corrections is going alright. It is slow at times, but interesting also. I will post a brief overview at the end of the month.

An old friend from Coeburn is coming up to visit this weekend. I am excited to get some company, since no one has been up to visit in a while. Hopefully we will have a blast. I will try to take some pics and post another entry Sunday or Monday.

Oh, all you people who are reading and not posting comments, please do so today! You don’t have to say much, just say something. Today is my birthday, so the least you could do is wish me a happy one!

Until next time…

Update on Job Offers

dsalyer — Mon, 02 Jun 2008 01:41:04 +0000

I posted a blog a while back mentioning a job offer made by my current employer. Right now, I am only considering working for three companies, one of which does not have pharmacies in KY, so I can only work for them once I move to Tennessee. So basically I am looking at only two pharmacies: my current employer, and another chain, probably the largest major pharmacy chain. After my district manager offered me a job, I contacted the other company to see if they could meet with me. I liked the offer that I had already received, but I wanted to see what other companies had to offer. Surprisingly, the other company was excited to meet with me…and meet with me quickly. So I arranged to meet the recruiter, who is based out of Indiana, for breakfast one morning. I wasn’t expecting an interview, per se, but that is what I walked into. Overall, it went pretty good. She discussed the benefits and pay, the location and hours, and all the other details…but she said she couldn’t technically offer me a job until I filled out an application online. So I completed the application that night and received an offer from her within 24 hours.

So lets break this down a little and see how my present employer, Pharmacy A, compares to the other company, Pharmacy B.

Pharmacy A has the higher salary (about 8k more per year)–if you want to know exactly, just ask–and most of their benefits seem to be better. Most of their benefits go into effect within 30 days, whereas Company B requires 30 days, 90 days, or 1 year before benefits kick in. Also, Company A would start me at 3 weeks paid vacation–Company B would only offer 2 weeks after 1 year of service, and wouldn’t increase to 3 weeks until 5 years.

Company B has two big advantages: 1. The company match on their profit sharing is around $3 to your $1 up to 2% of your salary…Company A matches dollar-for-dollar up to 3% of your salary and 50-cents on the dollar for the next two percent. So, to me, they almost equal out, since Company A will match a higher percentage of your salary. 2. Company B is offering a $30,000 sign-on bonus for the area in which I want to work. Yeah, you heard me right. This would require a 3 year commitment. I would receive this bonus soon after I sign on, and if I break my commitment, I would have to repay it, obviously. Company A had only offered a $5,000 incentive for a 1-year commitment.

Me, being the bargainer that I am, brought Company B’s offer back to Company A. They weren’t able to match it entirely, but I would receive the $5k I already mentioned, plus a $15k bonus for a 3-year commitment. They usually pay out these bonuses by giving 1/3 up front, 1/3 after 1 year, and 1/3 after 2 years. He is currently ironing out the details and trying to get me all, or most, of this bonus at the time of licensure, which would help me out tremendously tax-wise. The least I would get though, is $5k at signing, $10k at licensure, and $2.5k at 1 and 2 years. So even though the sign-on bonus isn’t quite as good, I would be able to make it up by the additional annual salary. Plus, I would have slightly better benefits and I feel much more comfortable committing to a company that I have worked for over the last 4 years, rather than walking into a company that I have never worked for.

Basically, I have already made up my decision, I am just waiting on the final details. I am very excited to already have a job landed when I still have a whole year left before I graduate. I will let you know when I finalize my decision. Please let me know what you think!

One Down, Nine to Go

dsalyer — Mon, 02 Jun 2008 01:12:39 +0000

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!

I’m Alive!

dsalyer — Mon, 28 Apr 2008 20:24:08 +0000

That’s right…I survived my surgery!

I go back in next Friday to have the stitches removed. They are also going to send this sample to the lab to make sure they removed all the abnormal cells.

Thanks for your support.