Thursday, December 4, 2014

7 Quick Takes #45

Here is my Ultra-fast 7 Quick Takes

#1

Yesterday I posted an update about my latest pharmacy clinical rotation.  Here is the link: APPE #3 - Pharmacy Rotation in Ambulatory Care: Anticoagulation and MTM Clinic

#2

Tomorrow is another day in the NICU (Neonatal Intensive Care Unit), shadowing a NICU pharmacist. BAAAABIEES EVERYWHERE. SO CUTE. And tomorrow afternoon I have to present one of my projects, which involves analyzing clinical trials of medications. A little stressed, but I'll survive.

#3

 

Overall, I just cannot wait for tomorrow to be over. One project off my plate, AND a 4 day weekend coming up. Did I mention it's in CALIFORNIA???? For the sake of my time (since it's getting late and I have to wake up at 4:30am tomorrow, like I have been for this entire rotation so far...and commuting 37 miles to and through downtown Chicago), here is a description posted from their website:










ASHP’s 2014 Midyear in Anaheim
Pharmacy’s Greatest Adventure!
The Midyear is the largest gathering
of pharmacy professionals in the world
and attracted over 5,000 students last year! Whether you are just entering pharmacy school or about to graduate, you will find a wealth of programming and activities designed just for you.
Highlights include:
n Interactive and informative student programming
n The Residency Showcase and PPS
n Dozens of opportunities to network with your peers and seasoned practitioners to help jump start your career
 
Basically, I'm going there to talk to residency program directors and to find out more about certain hospitals' pharmacy residency projects.

But my hubby is coming along for the weekend as well (I couldn't survive without him) and I rented a car so hopefully we will be able to hit up LA and maybe San Diego on Sat/Sunday. We have never been to California before so we're both excited!

#4

The keynote speaker for the opening session at the ASHP clinical meeting is JAY LENO!!!! That'll wake everybody up on a Monday morning!



#5 

I found a Catholic Pharmacists group on facebook and I swear it was GOD who put it in front of my face. I have been asking God to give me people in my life that would share my beliefs and support me and my faith ( I was feeling lonely on my faith journey). And somehow I found this group: and it turns out THEY'RE HOSTING A CATHOLIC VIGIL MASS specifically at the ASHP Midyear. So on Saturday, all of these lovely Catholic pharmacists that are only living inside of my computer right now ... I will actually get to meet them on Saturday (and confirm they're real, haha...sorry, it is still hard for me to believe I stumbled upon a group of devout Catholic pharmacists), And guess what, I am going to be a lector at the mass - I'll be reading the first reading. And guess what else? The local bishop is the one celebrating the mass! I AM SO SO EXCITED about Saturday!


#6

 GOT A JOB OFFER for a post-graduate intern position from the pharmacy I'm working for right now. The post-grad internship basically lasts from the period between one's graduation and one's obtaining of licensure (after passing board exams). After board exams are passed and a pharmacist license granted, a post-grad intern transitions into being a pharmacist.

The position is not exactly in the same state though. It is in Northwestern Indiana (which technically is only ~1 hour away). But this relieved some stress. At least I have a plan for after-graduation, if I don't get matched to a residency program.


 #7

Random picture of my cat to fill in the space, haha :-)
This is what happens when I get home.



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Wednesday, December 3, 2014

APPE #3 - Pharmacy Rotation in Ambulatory Care: Anticoagulation and MTM Clinic

So I'm a little behind in updating my blog with my 4th year pharmacy rotation experiences. 



It feels like I just started 4th year, but I am already on rotation 4 of 6.
 
And let me tell ya....I'm ready for a brrrreak. Good thing a 2 week Christmas Break is coming and that my next block after that is my vacation block, which means 6 weeks with no rotations! By that time, I will only have 2 more to go and then graduation (May 22nd). And  hopefully my last 2 rotations are going to be a little bit easier. Thank the Lord that I am almost done with all of my brain-crunching, critical-thinking-skills-requiring ones.

So going back to APPE ROTATION #3, with which I got done in mid-November.

By the way, here are the links to posts about all of my rotations so far:

The rotation site was Advocate Health Center or Advocate Medical Group (I still don't know what the difference is and why they use two different names)...which is part of a very large health system network throughout Chicago. In addition to multiple Advocate clinics, there are also 4 large Advocate hospitals around here. My current NICU/Peds rotation is at an Advocate hospital as well (same parent company).

So within this Advocate Health Center site, the pharmacists run what's properly called "The Advocate Anticoagulation and Medication Therapy Management Clinic" or in street language "The Coumadin Clinic." I'm sure some of you have heard of coumadin clinics...or at least of the drug coumadin (warfarin).

So as you can tell by the lengthy name of the clinic, there are 2 major components of care that these ambulatory care pharmacists specialize in: 1) the Anticoagulation part and 2) the Medication Therapy Management Part aka MTM

Most of our patients that came in were there for warfarin management. Managing warfarin is a very delicate and tricky business and it definitely not a drug that a doctor can just put a patient on and never worry about it again. It is a blood thinner drug and it has a very narrow therapeutic spectrum and so it is very important that patients are on the proper dose. If they're underdosed, they're at risk for clots, heart attacks, strokes. If they're overdosed, they're at risk for bleeding. And unfortunately, there is not a standard dose that will work for everyone. The actual milligram dose (ex 1mg, 2mg, 5mg, 10mg) tells us nothing by itself. The only way to see if the patient is on a proper dose, within the therapeutic range, is to measure the patient's INR (Internalized Normalized Ratio), which tells us how fast the blood clots, or how "thin" the blood is. Again, blood too thick = more risk of clots that can get stuck in the veins, or travel to the brain, lungs, or heart (stroke, pulmonary embolism, heart attack, respectively). Blood too thick = does not clot = more easy bleeding that will not stop. The most dangerous is GI bleeding (aka gastric or intestinal hemorrhage)  and brain bleeding (aka intracranial hemorrhage). So we have to constantly remind and counsel our patients to immediately report signs/symptoms of bloody or dark stools, vomiting that looks like coffee grounds, and to go to call their MD or go the ER if they bump their head hard. The other tricky business about warfarin is the fact that it has a million drug-drug interactions and another million food-drug interactions. So at these visits, when patients come to get their INR, our job is to ask them what changes in medications, foods, and alcohol intake they had, whether they noticed any new symptoms of bleeding or bruising, etc. 

 Wow, I got a little carried away (LOL).  Enough pharmaceutical education here.  

Apart from thoroughly educating the patients, we had to take their INR test and based on the result we got, adjust (or not adjust, if INR normal) their warfarin dose.

<-- This is the INR testing device. You just put a drop of blood on a test strip, kind of like with diabetic glucose testing.

Now, the non-anticoagulation part of this rotation was Medication Therapy Management (MTM - a buzz word in the pharmacy world nowadays).  Doctors would refer their patients to see the pharmacists at the med management clinic if patients were on multiple diabetic meds, or multiple blood pressure or heart failure meds and their disease states still weren't controlled (their blood sugars and pressures were still outrageous and dangerous). So we optimize their medication therapy regimen and follow up with them frequently. 

But we don't just play with meds. We're very big on lifestyle changes. We first and foremost educate patients about how to change their lifestyle habits to improve their diabetes and blood pressure control. We talk to them about diet, exercise, and quitting smoking. Specifically for diabetes, we teach them food portion control, and methods such as carb counting. When we place patients on medications that can cause hypoglycemia (low blood sugar) such as insulin (usually only happens when you skip a meal), we make sure they know the symptoms of hypoglycemia  and how they can tell they're having an episode and what to do to treat the episode.

Of course, for persons with pre-diabetes, we teach them to recognize symptoms of high blood glucose (picture below).



On my rotation, I met all kinds of patients.
patients that were nice
patients that were indifferent
patients that were grateful
patients that were ungrateful
patients that had a terrible attitude
patients that were easy
patients that were complicated
patients that raised my blood pressure and heart rate SANCTIFIED ME  

In the end, all of the difficult patients I had, I offered them up for my sanctification, like a good Catholic would, haha! So it all worked out. I didn't take anything personally.

And on my last day, I saved someone's life! Well, I called an ambulance and they saved her life. But it was still my intervention! (If she would not have come in, she would have probably suffered a hemorrhagic stroke and/or some serious organ damage from a hypertensive emergency). Now that's what I want to do when I grow up: save lives (instead of destroying it, like some medical professionals who bought into the culture of death, do).


And of course as always, there were plenty of lovely (sarcasm) projects for me to complete over the course of the rotation.

Working on my patient case presentation late at night. It was on Crohn's Disease.

And this is one of the power point slides from my presentation.



THEEEEE END
 (yes I leave you with pictures of inflamed intestines)

And for a sneak peak of my current rotation, read my latest 7 Quick Takes post, where I explained what I do and why it makes me sooooo fired up and excited!

Friday, November 21, 2014

7QT #44 I missed you

#1
I really really did miss you and miss my blog. Haven't had time to update as frequently lately. 

And will you look at this?
Someone actually cares.



Whoever you are anonymous. Thank you. I opened this up while at the hospital after my pediatric rounds this morning and it made me smile. Actually, probably made my day.  And it motivated me to get back to writing. Like I stated in the comment above, I have been randomly writing down my thoughts, reflections, revelations, and other fun things in this one particular blog post, which will probably end up super loooong, but it'll be interesting I promise. 

For now, let's just get my blog updated :-)
Lots of fun and "un-fun" things have been going on in this lady's life.
Ummm...where shall we start???



#2 
I just finished my APPE (Advanced Pharmacy Practice Experience) Rotation #3 last Friday. 

This was an ambulatory care rotation at a Coumadin and Medication Therapy Management Clinic. More specifically, we saw patients that required monitoring and medication management for their warfarin (Coumadin) for various clotting conditions or for stroke prevention, and also for management of their blood pressure and diabetes medications. I even had two patients who were coming in to get counseled and managed for smoking cessation. (Hence, I have a lot of good educational materials about quitting smoking, if anybody is interested. I can also talk to you all day long about the nasty and scary effects smoking can have on your health and body).

'Twas fun while it lasted. 

The most intense patient happened on the very last day. Stay tuned for my APPE#3 post. 
Buy yes, as of Friday, I am now officially HALFWAY DONE with rotations. 


#3 
And here are some other bouts of excitement in my life shared through facebook status updates. I don't have much time to summarize it all (really need to read up on pediatric asthma because my preceptor will probably grill me about it later, and I only have 1 hour before I have to start working up patients before the NICU rounds), so this is a quick way to share it with you guys.




 
#4
Yes, yes I did. I  started my APPE Rotation #4...which is a NICU (Neonatal Intensive Care Unit) and Pediatrics Rotation. OMG. BABIES!!! BABIES EVERYWHERE!!! SO CUTE. Most of them are very premature so they are just tiiiiiiiny and have little button noses. Everyday I walk into the NICU I want them all!


There are a lot of sad, sad things I have seen too (and it's only week 1) :-(

The other "un-fun" part is that this hospital is 37miles from my house and  I literally have to drive through the entire length of downtown Chicago to get there. I live in the Southwest suburbs and AIMMC is in North Chicago. So in the morning I have to leave the house at 5am in order to make my commute manageable. But in the afternoon, no matter what time I leave, the commute takes like 1hour 40 minutes. So I may just end up staying here super long, working on projects, and letting traffic pass. But that'll mean 13-14 hour days. We'll see how it goes. (But that may be a better and less frustrating option than stop-and-go traffic for almost 2 hours)

But again, I will expand upon my full experience soon, once the rotation is over (not until January since we have a 2 week Christmas break in between)


 

#5

Still discerning my future. And RESIDENCY.

Just reading up about programs in the area, talking to current residents and clinical/hospital pharmacists, and polishing up that Curriculum Vitae.

I have come across some great Catholic hospitals that offer pharmacy residencies. I met the residency director of Franciscan St. Margaret (in Indiana) and the program sounded really good. Plus the hospital has a great mission and values.

This PGY-1 program sounded really good.

I'm still keeping in my good old Loyola, which was my first rotation (general medicine), and which really impressed me as well in its excellence in healthcare and its Catholic values and Catholic presence throughout the campus. (I wouldn't mind doing a residency in a hospital whose chapel is like a big, underground Catholic Church, which is what Loyola has, hehe)




#6

The ASHP (American Society of Health-Systems Pharmacists) Midyear Conference is in 2 weeks!

And I'M GOING!!!
Why? Because they have a 2 day long residency showcase. It's where I'll be able to go and talk to different residency program directors and current residents and to help me decide where to apply.
And guess where it's at???
Anaheim, California!
Yes...and right across from Disney World, too!
Got these lovely fashionable sunglasses in the mail. Well, at least it reminded me that there might be like a 70-80 degree difference in Cali as opposed to Chicago.

And some great Catholic pharmacists who put together a Catholic pharmacists interest group on facebook are organizing an official ASHP Midyear Catholic Mass! And ASHP actually added this to their official activities schedule on their website! Yay! Hopefully we have great attendance. I'm beyond excited because I'm actually going to be a lector! :-) :-) :-) (smiley face x 100)


#7 

Just for fun


That's all for now guys!
More updates coming soon :-)

Yours in Christ, 
Agnes

Thursday, October 16, 2014

7 Quick Takes #43

Join Jen at Conversiondiary.com for more Quick Takes

#1

"Hi......I'm so adorable that my human cannot stop taking pictures of me, even while I sleep"

Well...when you sleep in hilarious positions like these...humans can't help but laugh and take pics!
Must be dreaming of partying and having her "paws up in the air"

 

 

#2 

 

 

HAPPY FALL YA'LL! 

(This pic was actually taken on the first day of fall...I just have not posted on here for sooo long)

 

 

 

 

 

 

 

 

 

#3 

"HealthCare Begins Here" Health Fair

I was in charge of promoting and administering immunizations last weekend at my store during our health fair. We also did blood pressure and blood glucose screenings.

 

 

 

 

 

 

 

 

 

 

 

 

  

 

 #4 Harvest time is over....

:-(

The Chicago weather lately can only point to the fact that cabin fever will probably start developing soon...No bueno.

 

 

#5

We went to this Polish fest / picnic a few Sundays ago and they of course had lots and lots of delicious polish food but also offered horse carriage rides. 'Twas fun.

 

 

 

 

 

 

 

 

 

 

 

 


 

#6

My latest baking adventures....

 

 

 

 

 

 

 

 

 #7

I've been obsessed lately with "Adoro Te Devote," especially the Latin version. I have never even been to a Latin mass and the only thing I know in Latin is how to say "Hail Mary"...and that's only because I love the famous Ave Maria song so much that I memorized it in Latin. But even though I don't speak Latin, "Adoro Te Devote" just speaks to me. I read it and I feel like I am really getting into the depths of this wonderful prayer. I especially love reciting it in front of the Blessed Sacrament during Eucharistic Adoration (which, by the way, I have been trying to attend every week, and I absolutely love and treasure that Holy Hour I spend in front of Him every week).

I'm also falling more and more in love with Latin and might consider learning it, at least in the context of my Catholic faith. I've been listening to some Gregorian chants lately and even all the songs/chants of the Latin mass. Saying prayers in Latin makes me feel so close to our beautiful, ancient Mother Church.

Here is a picture from my prayer book, with the Latin part on the left and English translation on the right.

And some of my art (if you could call it that) straight from my journal.


 

 


For latest updates on my pharmacy school rotations etc, read this: APPE #2 (2nd Pharmacy Rotation)

Tuesday, October 7, 2014

APPE #2 (2nd Pharmacy Rotation)



Yesssss.....

I finally have time to sit down and blog!!!!

Hooray!

I have not written in over a month and I missed writing and reflecting and sharing on my blog a lot! I have been writing things in my journal here and there - because I think I would go nuts without some form of reflection in my life.

But now I get to catch up...at least a bit. (Since I promised I would be taking you through the journey of my 4th year of pharmacy school aka experiential rotations by writing regular blog posts about them). I know I do have some readers that follow along for that part of the journey because they're either in pharmacy school or are considering pharmacy school. So here's an update about ROTATION block 2 of 6, which I just finished this past Friday. Of course I jumped right into my 3rd rotation and had my first day in clinic yesterday, learning all sorts of great, life-saving pearls. But I digress...

To make sure we're all on the same page, there are the 6 types of rotations we get as 4th year pharmacy students: a general medicine rotation, clinical specialty, community pharmacy, hospital, ambulatory care, and elective.

My 1st rotation block, which I described here and here, was my general medicine rotation. I was mostly working alongside internal medicine doctors on the 3rd general medical floor of Loyola University Medical Center.
--------------------------------------------

This 2nd rotation block is my elective rotation.
And I elected an academia-focused rotation with one of our clinical pharmacists who is also a professor at our school of pharmacy. I spent most of my time on campus at Midwestern University, helping the professor revise lecture content, grade assignments, and facilitate laboratory sessions and workshops for the 1st-3rd year pharmacy students.

This rotation has also very much helped me to discern my interests and passions, and made it easier for me to discern my future career path (more about that coming up also). It really did confirm my interest in teaching students or at least precepting them on their experiential rotations. My "I want to be a teacher when I grow up" that I used to say all of my life came back to me. And came back strong. I love love love the position that my pharmacist preceptor has. He is employed by the university but spends 50% of his time doing clinical stuff at Rush hospital and 50% of his time teaching on campus. Sounds like a dream job to me. But again, more on that in another post...because that does deserve a whole another one, that's currently in the making :-)


So this rotation involved a lot of independent learning. We didn't really follow a strict schedule and did not have strict deadlines for projects. It was nice, but at the same time challenging, because I had to figure out a way to pace myself so I don't fall behind. It helped me to increase in the virtue of self-discipline. I had to work out a schedule and to-do list for everyday so that I could get my projects done in time, on top of grading papers, and facilitating lab.


The preceptor also gave me an opportunity to develop a lecture. This was counted as one of my projects. [Un]fortunately, I wasn't able to give an official lecture in front of a 200-person pharmacy class (I kind of wanted to have that experience to see if lecturing is for me), but I did give a short, 20 minute presentation in front of a small group of students. My lecture was about restarting warfarin (coumadin) in patients with a recent history of a GI bleed. My preceptor gave me some feedback on how to improve that lecture (the content and presentation) so that I could use that presentation at residency interviews and impress my Residency Director and Pharmacists that will be interviewing me. (And I'm actually giving this same presentation again this Friday at the coumadin clinic since my new amb care preceptor was excited about it and wanted to hear it).


1) Grading papers was an absolute blast! I loved writing comments and missing answers in red! But I was easy on them, even though some groups gave funky answers.
2) Being a lab facilitator was also a lot of fun! It was very cool to teach things to small groups of students at a time and to see the interest in their faces. I think I know what I'll be when I grow up!!! JK, I got some more discerning to do, of course...and still 4 rotations ahead of me.

But in all seriousness, this rotation and this type of work totally matches my studious, nerdy personality and perhaps God put me there for a reason. We shall see :)

-------------------------------------------
This current rotation (my 3rd one), which just began yesterday, is my ambulatory care rotation. I am at an Advocate Medical Group site, which has a pharmacist-run anticoagulation and medication therapy management clinic. 2 of the 4 pharmacist that run the clinic are adjunct professors at my school of pharmacy as well, so they are very receptive to pharmacy students and they love to teach, so we generally learn a lot (one of the reasons why I chose rotation sites and preceptors who are MWU faculty, because I know they care about the students, they're up to date on all of the guidelines, and they have clearly laid out expectations and projects). But more on that later....

My 4th rotation, which begins in November, is a clinical specialty rotation with a cardiology focus. This will be at a major hospital that's located downtown Chicago, in the medical district - Rush UMC. I have already been there for a brief 3rd year critical care rotation and it was super fun.

(Update 10/16/14: Scratch that 4th rotation! It was cancelled and replaced with a clinical specialty rotation in NICU/Peds!!!! Did you hear that???? Oh Em Gee...IS GOD LISTENING TO MY PRAYERS OR SOMETHING???? He must be at least sneaking into my head ;-) Well, Thanks God. I WILL WORK FOR 6 WEEKS TO SAVE BABIES!!!!! = DREAM COME TRUE)

After that block, I get most of January and February off, which is perfect because that's when residency interviews happen (that's if I get any).

My last 2 blocks are my community pharmacy rotation, which is Jewel-Osco, and my hospital pharmacy rotation, which is a community hospital in Aurora, IL.

I will try to write at least one post about each rotation for those interested in hearing about them. If I have any super awesome experiences, I'll write more!


I'll also be writing about my continued struggle about determining whether to do a residency or not.

[Turns out the Residency Training chapter in the Introduction to Hospital and Health-System Pharmacy Practice textbook was written by 2 of our professors, one of which was my preceptor at Loyola during my last rotation. Ha, it's pretty cool to know someone that's somewhat famous in the pharmacy world]

Talk to you soon!

Thursday, September 11, 2014

7QT: Summer 2014 Updates #3

#1

Just me...in all of my nerdy glory...
on my first day of my teaching rotation

Not too much news around here other than....

I'm done with my 1st rotation (internal medicine) and onto my 2nd Advanced Placement Pharmacy Rotation. This one is my elective rotation, which I chose to be a teaching rotation right at my school of pharmacy. So I am assisting a very nice professor, who is a course director for the Institutional Pharmacy class that 2nd year pharmacy students have to take, and also a co-director for the Critical Care elective that 3rd year students can take. This is also the same professor that was my preceptor during my critical care rotation at Rush University Medical Center back in April/May. I'm pretty convinced He's the nicest preceptor/pharmacist/professor on Earth...but more about that rotation coming up in a separate post...since I promised you that I'll be giving you updates about each rotation (especially for those of you who are reading this blog for that purpose).


 

#2

The other major [crappy] news is that my beloved husband went back to working nights. :'-(
Yes, yes he did. 3 months (June, July, August) passed by at lightning speed and now we're back on opposite shifts...and back to hanging out on weekends only. 

This time though, I am trying to be strong from the start....to see things in a positive perspective...telling myself that this is the Will of God and that this time of loneliness for me will surely bear fruit... like it has in the past. And this is because when I'm lonely, I fill those gaps in my heart with God - He is the only one that can fill those gaps and satisfy the soul. And my faith and closeness to Him usually grows...even though sometimes I resist and despair in those times of loneliness. It's all for the greater good :-)

#3 

It's SEPTEMBER = It's HARVEST TIME!!!!!!!!

(and not to mention, September 1st was my 24th birthday...which we celebrated with a huge bonfire, lots of food, and delicious cake in Michigan with the whole family)

 

#4

So with this huge boom of veggies in my garden...I've been cooking, pickling/jarring, making salsas, etc.

           Zucchini & Parmesan Fritters

Zucchini fritters / pancakes, maple glazed wings, and veggie fried rice

Maple syrup and Herb glazed chicken wings
 

#5 I started using Evernote as a tool to organize my life, documents, pharm school notes...

It's a free app and it syncs across all your devices (laptop-->phone-->tablet). 

So when I remember that I need something from the grocery store as I'm working on my laptop, I put it onto my grocery list in one of my notebooks in evernote, and it automatically shows up in my phone as well...so I can access it when I'm at the grocery store.

I suggest you go on youtube...there are some pretty cool videos on how you can utilize Evernote to organize your life.

Yesterday I used it on my iPad to do an examination of conscience before confession. I'm also using it to keep track of my exercise, as you can see from the screenshot above. I made this cool weight loss document. I can share it with you if you like the set-up.

I'll let you know how that goes eventually. So far, I love it. But we'll see how long this excitement lasts :-)

 

#6 Just some silliness. Cause we all need silliness in our lives...

My brother let me cruise in his mustang and take it
to church on Sunday

 

#7 Saw my friends (acquaintances, actually) post this on facebook. 

 

This is someone, who I know, is a lapsed Catholic who doesn't go to church anymore. I figured out what her "feeling" or "this thing she's missing" is instantaneously, without even talking to her. The other girl in the comments is missing the same thing, too, she just doesn't know it.

I figured this out for myself once:

  Now I won't let Him go...

 

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