Going International: Where Do I Start?

First, I apologize for being so MIA!  With graduation, family, and packing then unpacking, my poor little blog got lost in the shuffle.  Sorry, friends!

But before I write posts about graduation and the process of applying for boards, I wanted to wrap up a topic that started with Brian’s post:  how to go international during your 6th year rotations.

I think Brian and I have reiterated several times that our international experiences were some of the best experiences we had during our sixth year, and that neither of us would trade them for anything.  What you gain from an international rotation is so much more than just, “Oh, this is how they do pharmacy in this country.”  It’s an experience in culture, life, and different social norms and standards.  To see what life is like outside of the U.S. is one of the most valuable things you could do for yourself.

That being said, I have had several students tell me that they really want to go overseas during their sixth year but they have no idea where to start.  I totally sympathize.  I was completely lost at first too.  Here’s what worked for me, and I hope it helps guide you as well!

1.  Do your research first.  Figure out what country you want to go to, what the possible practice sites there are, and if possible, send out a few emails inquiring about potential preceptors.  In my case, I knew I wanted to go to Singapore, and I knew that there was one pharmacy school (National University of Singapore Pharmacy School) on the island.  I went to the pharmacy school’s page, looked up faculty members, and starting sifting through profiles to see what I could find.  I was lucky enough to find that a couple of faculty members graduated from U.S. pharmacy schools (which is always a plus), and I simply sent out emails asking about the possibility of doing a rotation with them.

This is what my preceptor’s page looked like on the NUS website.  See how he graduated from a U.S. pharmacy school?  Definitely a good thing.

If this step is a bit intimidating for you (if, for example, you’re not quite sure where to start digging or who to contact at a hospital), then I’d say to do your best but move on to step 2 (below).

2.  Set up an appointment to talk to one of the Advanced Pharmacy Experience (APE) coordinators.  For me, that was Dr. Berry or Dr. Grice (I spoke to Dr. Grice), but double check who the coordinators are because sometimes things change before the school year starts.  In the meeting, simply express your desire to go overseas, and the coordinator will let you know what pieces of the puzzle you’re missing.  For example, during your sixth year, you must fulfill a certain number of assignments and go through a certain number of experiences, so the coordinator will be trying to make sure that the overseas rotation you are proposing will fit in with the requirements you need to graduate.  Both Dr. Berry and Dr. Grice are supremely kind and will do their best to help you set up an international rotation.  However, keep in mind that you need to meet certain requirements in order to graduate (which is the most important thing!), so remain flexible and keep your options open.

3.  Fill out a “New Rotation Proposal” form and submit.  This is the easiest part.  Whether you’re trying to set up a rotation in San Diego or Singapore, if the rotation you want isn’t already established with Stlcop, you’re going to have to fill out this form.  It’s only two pages and pretty straightforward, and all you need to do is fill it out to the best of your ability and submit.  I filled out three of these forms for my sixth year rotations, so trust me when I say they’re not terrible :).

Here’s the “New Rotation Proposal” form I filled out for my Singapore rotation for your reference: New Rotation Proposal – Patient Care Selective.

And honestly, that’s pretty much it!  The APE office will contact the site and sort out all of the paperwork to get the site approved by the Missouri Board of Pharmacy.  If the APE office needs to verify anything or talk to you, they will contact you by email and let you know what they need.  Again, be flexible and patient… setting up a rotation halfway around the world isn’t easy, so there might be a few obstacles to overcome.  🙂

I hope this was helpful for anyone who is considering an overseas rotation.  If you still need help, I would suggest getting in touch with the coordinators, but feel free to ask Brian or I any questions if you need anything!

<3, Ruthie

Guest Blogger: Brian Ogweno Pt. II (Going International)

Hey guys!  I hope you guys enjoyed Brian’s post about his experience in Tanzania (if you missed it, you can read it here).  As promised, here’s the second half of Brian’s post, where he talks about things to consider if you’re thinking about going overseas for your rotations :).

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Considerations:

Now for some important considerations you should take into account to increase your chances of getting an overseas rotation as well as making it a personally meaningful experience.

1)      What do you want to do?

Trying to find possible rotations overseas can be terribly overwhelming & knowing where to start can be difficult. My advice is to start by figuring out what kind of experience you want to have to help narrow down the field. Just off the top of my head, you can teach like I did; you can be in a clinic or hospital, like Ruth; you can be in a pharmacy, or you can be at a pharmaceutical manufacturing company, which by the way are huge in Western Africa and the Middle East. That’s just a start. There are a ton of other experiences that are out there. Remember, your sixth year is your chance to truly explore your passions in pharmacy and healthcare, and your experience abroad should complement this objective. Once you figure out what you want to do, you can then try and identify your options abroad.

2)      Where do you want to go?

This is a tricky. Normally, I would say keep an open mind and take advantage of any opportunity to experience a new culture. However, if your experience abroad is for a 6^th year rotation, you want to make sure you go somewhere you feel safe and can be functional. Due to the requirements that are required for every rotation, if you can’t speak the language or communicate to others, completing assignments can be difficult.

3)      When do you want to go?

Give this some serious thought so it doesn’t interfere with any of your other goals while on rotations. For example, if you plan on doing a residency, January and February are probably not the best times to be out of the country. This is around the time most residency applications are due and interviews are scheduled. From experience, the first two or the last two blocks usually have the fewest conflicts.

4)      Cost

Unfortunately, 9 times out of 10, tuition won’t cover the cost of the trip. However, don let this discourage you. Some programs have scholarships and financial assistance programs to make the trip more affordable. In addition, STLCOP offers numerous merit based scholarship opportunities once you get into the professional year. Budgeting these towards the cost of travel is another strategy to ease the burden of cost.

5)      Credits

If your experience will be part of a rotation, make sure the site gets cleared by the MO (or any state) Board of Pharmacy so it can count towards your intern hours. Each state has a minimum number of intern hours that are required in order for PharmD candidates can sit for boards. The majority of students meet requirements by simply completing all the 6^th year rotations. However, if your rotation abroad doesn’t qualify for intern hours, you may come up short on required hours depending on the state you want to get licensed in. I would highly encourage anyone thinking about completing a non-traditional rotation to discuss this with your APPE coordinator and make sure you know if your rotation overseas qualifies for intern hours.  

 

I hope all this information helps! If anyone has any questions or needs any further advice with setting a rotation up overseas, please feel free to contact me at alexanderogweno@gmail.com.

 

Cheers!

Guest Blogger: Brian Ogweno goes to Tanzania

I’m so, SO excited to introduce you guys to one of my favorite people at Stlcop – Brian Ogweno!

Some of you younger Euts might not know Brian by face or name, but I guarantee you he’s influenced your life at Stlcop in some way.  The man is a large part of why the Student Body Union exists, along with a lot of other behind-the-scenes things that I probably don’t even know about.  And what’s worse, Brian is unbelievably nice and HUMBLE.  I’ve never met a guy with more humility and kindness… the man is impossible to hate.

But anyway, the real reason why Brian is headlining on Stlcopruth is because he went to TANZANIA for one of his sixth year rotations.  Tanzania… as in AFRICA.  Totally awesome.

Brian and I were the only two sixth years to have international rotations, so while you guys heard a lot about my rotation in Singapore here, I thought it would be great for Brian to share a bit about his experience in Africa.  🙂  So without further ado, here’s Brian’s guest post!

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“Greetings everyone! Ruth being as awesome as she is, has invited me to guest post on her blog about my rotational experience abroad, in East Africa. For those of you who are thinking about trying to set up a rotation overseas, or prospective students that are interested in travel abroad opportunities, it’s definitely possible & I would highly encourage it. On this post, I’ll tell you a little be about my experience.

My Experience:

I had the opportunity to participate in Global Service Corps’ (GSC) eight week HIV/AIDS Prevention and Nutrition Education program in Arusha, Tanzania. GSC is a San Francisco based non-for profit organization whose mission is to provide international service-learning opportunities, which center on providing sustainable urban and rural based community service projects.

GSC offers a few different service trips around the world, but I was immediately attracted to the HIV/AIDS Prevention Education program they offered in Tanzania. I knew being able to teach small groups would be a meaningful way to contribute to the global battle against HIV/AIDs, and would also allow me to explore and develop my ability to teach, something I hope to do in the future. In addition, being a native of Kenya, which neighbors Tanzania, it was a great way to get back and see where I was born and get a taste for how health care operates in case I want to go back someday.

While in Tanzania, our charge was to teach a Peace Corps based HIV/AIDS, nutrition and hygiene curriculum to various vocational school classes and community groups in the local area and nearby rural villages. Each week, a pair of volunteers and a Tanzanian counterpart was assigned to a different group in the region, and would teach a week long course covering everything from the epidemiology of HIV/AIDs in the region and how the virus affects the body, to addressing the cultural and societal factors that contribute to the prevalence of HIV/AIDs and general illness.

In addition to this, for two weeks of the program, we were deployed to Namanga Secondary School, located in a small town on the border of Kenya and Tanzania, to lead a health focused day camp for high school students. On top of the usual curriculum, we offered instruction on avoiding peer pressure, setting long term and short term goals, and developing personal value statements, among many others. Ultimately, it was our goal to reinforce a strong character ethic and give the participating students a reason to avoid what we deemed “risky behavior.” In retrospect, these were probably two of the most memorable weeks of the entire summer!”

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Brian was also kind enough to jot down some of the things he thinks students should consider before going on an international rotation, and after receiving some questions from younger students, I have decided to post some tips on how to go about setting up an international rotation.  Tune in next week for the full story!

CABG? Cabbage?

Call me strange, but I totally have a bucket list.

Learn how to drive stick.
Go to Africa on a humanitarian trip.
Watch a CABG surgery in person.
Watch all six Star Wars movies in one day.

And two weeks ago, I got to scratch “watch a CABG surgery in person” off of my list :).

So the abbreviation “CABG” stands for coronary artery bypass graft, but it’s pronounced “cabbage” like the vegetable…

or the creepy dolls…

(No, your eyes aren’t fooling you… it really is Cabbage Patch Sarah Palin, Barack Obama, and John McCain, haha)

And if I ever became a cabbage farmer I’m going to take a picture like this:

I would be fully awesome and the world would be a better place because of it.

But moving on…

When I was a kid, my family would visit science museums and I always loved watching the movies about heart surgery with my dad.  My mom and my brother weren’t really fans, but my dad and I would always park ourselves in front of the screen and watch.  Since then, I’ve always wanted to see a heart surgery live, so you can imagine my excitement when I got a chance to watch one when I was at St. Clare’s :).

I decided to make a video to explain my experience in the operating room watching a CABG instead of typing out a really, really long and wordy post (you can thank me later).  So if you wanted to take a break from studying for finals (or if you don’t have finals, and you just really like to hear me talk), then you should watch :).

Part 1:

and Part 2:

A big, loving thank you to third year (almost fourth year!) Cindy for being in my video, supposedly against her will ;).  As referenced in the video, Cindy’s first mention on Stlcopruth was in this post.

And another thank you to Mrs. Tranel (who previously starred on Stlcopruth here and here) for letting us use the anatomy lab and heart model.

Hope you guys enjoyed the post!  Best of luck on the rest of your exams!  🙂

T-P-N

Today’s post comes to you courtesy of third years Jasmine Mathew and Sherin Oommen, who happened to be next to me when I started writing and chose today’s topic :).

I was surprised when Jasmine and Sherin chose TPNs as the topic of the day, because as a third year I definitely had no idea what TPNs were.  But apparently, it was serendipitous that they chose TPNs, seeing as how fifth year Jincy Philip (who’s also sitting next to me) is talking to me about TPNs, which is going to be a topic on her Therapeutics 4 final.  So apparently the fates have decided that T, P, and N are going to be the letters of the day.

First, we have some defining to do:  TPN stands for total parenteral nutrition.  This is just a big fancy term to describe what happens when a patient gets all of their nutrition through a central IV line.  Some patients in the hospital are so sick that they aren’t able to eat anything by mouth for days on end.  Clearly, we can’t just let these patients go without sustenance for that long, or they would die and we would have a lawsuit on our hands.  So to help supplement a patient’s nutritional needs, we can provide the nutritional basics in a variety of ways, and TPN is one of those ways.

So what makes up a TPN?  Personally, I think of a TPN as a liquid hamburger.  You have your nutritional staples:  fat, protein, and carbohydrates…

… and your additives and micronutrients:

Typically the electrolytes added into TPNs are sodium, potassium, phosphate, calcium, magnesium, and chloride, and on top of that,  a couple of milliliters of multivitamins and trace elements are added for completeness.  Depending on what the patient needs, other things can be added in to the TPN, such as insulin (if the patient is diabetic) or famotidine (if the patient needs acid reduction).

Of course, we don’t just willy nilly choose how much of each TPN component to give the patient.  Everything needs to be calculated based on the patient’s weight and their caloric needs.  In school, you’ll learn how to calculate everything by hand like this:

And while knowing how to do the calculations manually is undoubtedly important to know, in real practice, the computer does all the calculating and prints out a sheet like this:

The TPN is now ready to be compounded!  The tech usually starts the process by gathering and measuring out the electrolytes, vitamins, and additives, since this is probably the most labor intensive part of the whole TPN.

The pharmacist (or in this case, two pharmacists :)) double checks the amounts in the syringe and compares it to the order sheet to ensure safety and accuracy.

Before the electrolytes, vitamins, and additives can be added to the TPN, the basics have to be infused using this machine:

From left to right, the giant bags and bottles connected to the machine are lipids (fat source), amino acids (protein source), dextrose (carbohydrate source), and sterile water to fill it up to its final volume.  The machine is hooked up to a computer monitor that displays how many milliliters of each basic component need to go into the TPN, and it also counts down how many milliliters have been injected as the machine fills the TPN bag.

Don’t worry… Tatyana Thompson is the tech’s name who is preparing the TPN, not the patient’s name.  We at Stlcopruth are HIPAA compliant :).

Once the basics are in, all the extra stuff that we pulled up into syringes in the beginning can be added in:

And voila!  That’s it.  This giant milky white bag is what will feed the patient until they are able to feed themselves again.

One thing to note as pharmacists, is that TPNs aren’t exactly desirable.  If we can avoid giving a patient a TPN, we will, because TPNs come with their own set of problems.  TPNs aren’t perfect nutrition… they’re only a guesstimate of what the patient needs.  So because of this, there’s a possibility of overfeeding, which can lead to azotemia (too much nitrogen), hyperglycemia (high blood sugar), or hypercapnia (too much carbon dioxide in the blood).  And since all the patient’s “food” is being given through an IV line directly into the bloodstream, the stomach and the intestines don’t have anything to work on.  As a result of having nothing to do for a long period of time, the GI tract kind of shuts down, and this can result in problems in the gallbladder and bile duct.  So bottom line, TPNs are only for people who really, really need it, such as patients who aren’t going to be able to eat for at least a week.

But anyway, that’s TPNs in a nutshell. 🙂  Not really too difficult per se, but it’s definitely intricate.

Friday is OVER, which means it’s officially the weekend!  Hope you guys have a great weekend 🙂

Stress, stress, stress.

Stress.

I’m sure that’s what so many of you baby Eutectics are feeling now with finals looming around the corner :).  But finals are not the reason why I’m writing this post (sorry).  The stress I’m referring to instead is the physical stress that patients are under whenever they’re severely ill and hospitalized.

It makes sense, doesn’t it?  If a patient is not able to eat well, has tubes sticking out of them and IV lines going in, and they’re really ill and their body is completely out of whack… their body is bound to freak out and be stressed.  You don’t need to be Sheldon Cooper to figure that one out (Sheldon’s from Texas by the way… Texas – 1, Missouri – 0 :D).

So why do we care so much if a patient’s body is under stress in the hospital?  At Stlcop, you would just take a walk and scarf down another donut before chugging along, and the worst thing that happens is that you gain 2 pounds and go slightly loco (don’t go loco please… finals are just tests that you’ve already studied for all semester – remember that!).  But in hospitalized patients, the physical stress of being sick can actually cause stress ulcers in the stomach, what with all the stomach acid hanging out with nowhere to go and nothing to do.  Once ulcers develop, they can bleed… definitely not something we want.  So to prevent stress ulcers from forming, we initiate stress ulcer prophylaxis in certain hospitalized patients.

Notice I said certain hospitalized patients.  Not all hospitalized patients.  The guy coming in to the hospital because he fractured his toe and the guy who came in for respiratory failure are clearly not equally stressed.  In general, from what I’ve seen and learned, the two major risk factors for developing stress ulcers are 1) mechanical ventilation for more than 48 hours, and 2) coagulopathy (clotting/bleeding disorder).  Mechanical ventilation is a big concern for stress ulcers because having a giant breathing tube down your throat isn’t fun and your body is a diva and will throw a hissy fit.  As for bleeding disorders, these aren’t so much of a concern for developing stress ulcers, but what is a concern is that if these patients do get a stress ulcer and they bleed, they’re going to bleed a whole heck of a lot more.

There are also some other “minor” risk factors that we consider when deciding to start a patient on stress ulcer prophylaxis, such as sepsis, receiving high dose steroids, or being hospitalized for a long period of time.  But by far and large, mechanical ventilation and coagulopathy are our big red flags that tell us to start stress ulcer prophylaxis.

So now we know which patients need stress ulcer prophylaxis.  Hooray.  Next question is, what do we give them?  Well, if part of the reason why patients develop stress ulcers in the first place is because of all of the stomach acid sitting around, it makes sense that lowering the amount of acid in the stomach would help prevent stress ulcers from forming.  And who are our best friends for lowering the amount of stomach acid?  Why, the proton-pump inhibitors (PPIs) and histamine-2 receptor antagonists (H2RAs), of course.

Just a tip:  the PPIs end in “-prazole” and the H2RAs end in “-tidine.”  Super easy to remember.

Now here’s something I see all the time on rotations:  doctors who prescribe a PPI AND an H2RA for stress ulcer prophylaxis.  And it always gives me a heart attack when I see it.  They might have a good reason as to why they want double stomach acid reduction, but in general, two acid reducers is overkill.  So repeat after me:  only.  one.  agent.  for.  stress.  ulcer.  prophylaxis.  Either a PPI OR an H2RA.  Please and thank you.

At the risk of making this post too long and complicated, I wanted to quickly explain why we don’t hand out stress ulcer prophylaxis out like candy, and why we don’t like double agent acid reduction.  There’s a reason why God gave us stomach acid… it kills any nasty bacteria who come up with the genius idea of trying to invade our bodies through the stomach.  Lowering stomach acid unnecessarily and/or for long periods of time weakens that first line of defense against bacteria and predisposes patients to infections such as aspiration pneumonia.

I see stress ulcer prophylaxis all the time while on rotations, and a lot of the time it’s either not appropriate for the patient or the patient is being prescribed two acid reducers.  So it’s definitely, definitely the role of pharmacists to double check and give the doctors a friendly reminder if they notice this going on.

Anyway, I hope you guys are having a great week!  Tomorrow is Friday and I already know that I’ll be on campus for sure, so hopefully I’ll get to see some of you guys and say hi 🙂

The Tell Tale Heart

I actually hated “The Tell Tale Heart” when I read it in high school… I’m a complete chicken who couldn’t even read “Clue” in elementary school because I was afraid Colonel Mustard would come at me with a candlestick.

But despite my aversion for all things Edgar Allen Poe, I thought “The Tell Tale Heart” was an appropriate title because the other day when I was in the radiology department I saw this…

… a myocardial perfusion scan that used thallium-201 and technetium-99 to fluoresce the heart.  Or, in layman terms, a glowing scan of a patient’s HEART that shows us the TELL TALE signs of coronary artery disease!  Pretty neat, right?  And now you understand why I picked such a gruesome title for this post, hehe.

But right about now you may be asking, “Ruth, what does this have to do with pharmacy?”  So here it is:  the only reason why we are able to view the heart in this way is because of the work of nuclear pharmacists.

I will be the first to admit that when I first came to Stlcop, I thought that the only thing that pharmacists did was fill and dispense prescriptions.  Man oh man, was I in for a big surprise.  I quickly learned that pharmacists can work in almost every setting imaginable, from veterinary to military to (surprise!) nuclear.

Nuclear pharmacy.  DEFINITELY not something that had even crossed my mind before becoming a Eutectic.  Who even knew that pharmacists worked with radioactive thingamajiggers?  Not me, that’s for sure.  From what I know, nuclear pharmacy is the art of combining radioactive substances with certain drugs for the purpose of fluorescing certain parts of the body for imaging.  It’s like being half mad scientist/chemist and half pharmacist.  Nuclear pharmacists get to play with all of these cool radioactive substances, and at the same time still work with medications.  Pharmacy knowledge comes into play in drug selection… the drug that’s chosen to become radioactive depends on the organ we want to look at.  For example, we know that the thyroid uses iodine, but a hyperactive thyroid would use more iodine than normal.  If we wanted to confirm hyperthyroidism, we could give the patient radioactive iodine, then scan the thyroid.  A hyperactive thyroid would take up more of the radioactive iodine than a normal one would, and as a result, the scanned image would be super, super glow-y.  Make sense?  In the picture above, it was the heart that we wanted to look at instead of the thyroid, but the principle is still the same, and you can see how the heart glows when seen from different angles under stress and under rest.  Neat, neat, neat.

Of course, the actual science of nuclear pharmacy is much, much more complicated than this simple illustration, and it involves a lot of chemistry and molecules and a bunch of things that I’m not super good at.  And as you can probably tell, I’m definitely not an expert on the science of nuclear pharmacy, and since it’s such a specialized field, it’s not something that’s very prevalent in the pharmacy curriculum.  But if nuclear pharmacy sounds even remotely interesting to you, I do know that there’s a nuclear pharmacy elective taught by Dr. Gattas (the Mr. Gattas, not the Mrs. Gattas) that I hear is really interesting.  Or if you want, I know there are nuclear pharmacy rotations available during your sixth year if you want to try that instead.  Bottom line is that if it interests you, TRY IT!  You might find your true pharmacy calling :).

I think that if I was really awesome at chemistry I would totally become a nuclear pharmacist, but this might be because I really like glowing things, haha.

Happy Wednesday!

Oh poop.

*** Before I get started, I discovered there was a glitch in my post yesterday!  The post that was published to the blog was a draft and not the final version… that’s why it didn’t make sense at the end.  But it’s fixed now, and you can read the real version here. ***

Now on to today’s post…

I debated for a long time whether or not I should write this post.

Does it have to do with pharmacy?

Yes.

Did I see it while on rotation?

Yes.  Multiple times.

But…

It has to do with laxatives, and laxatives are all about pooping.  And that’s just gross.  Not to mention really weird to blog about.  And making poop into cute cartoon drawings doesn’t help.

Nonetheless, I feel like laxatives are a pretty important part of being a pharmacist, and the story behind this topic discussion was interesting to see and experience.  So we’ll see how this goes.  Fingers crossed.

Last week, Jacque and I got to hang out in Endoscopy.  In a nutshell, endoscopy is the part of the hospital where they stick cameras into any and every bodily opening and take pictures like they’re the paparazzi.  Really, the name “Endoscopy” for the department is a bit of a misnomer, since they not only do endoscopies (sticking a camera down your esophagus), but bronchoscopies (sticking a camera down your trachea/bronchi) and colonscopies (sticking a camera up your butt) too.  And while we did get to see one endoscopy and one bronchoscopy, the real kicker were the three colonoscopies that we got to watch… and henceforth the lovely discussion about laxatives and poo :).

Obviously, if someone is going to be sticking a scope up your butt, it would be nice if they didn’t have to try and navigate around anything… shall we say, solid.  We ALWAYS want patients to be as cleaned out and “evacuated” as possible, because not only is it easier to do the colonoscopy, but also because it’s easier to spot those tiny, troublesome polyps if they’re hanging out in the colon.  Looking for polyps is the main reason why we do colonoscopies in the first place, because large amounts of polyps cause us to become hyper-vigilant and watchful for possible colon cancer later on.

But anyway, the three colonoscopies I saw were pretty uneventful.  All the patients had nice, clean, healthy colons.  The GI doc was really nice and explained what was going on, and I learned that the transverse colon has a lumen that is kinda triangle shaped.  I think that’s pretty cool, but I think we’ve already established that I’m a nerd, haha.

Good bowel prep is super duper ultra important before having a colonoscopy (even U.S. News says so!).  To clean them out, the three colonoscopy patients that I saw had all received the same two laxatives:  magnesium citrate and polyethylene glycol (aka Miralax).  When I first started rotations, I was always a bit confused as to why patients received two laxatives… wouldn’t one do the trick?  In this case, I learned that two saline laxatives are used for colonoscopies because not only do we want to prevent anything solid from lurking around, but we also want the walls of the colon to be washed out and clean so we can see any polyps.  And the best way to wash things out is with two osmotic laxatives that will cause water retention in the colon (hooray for magnesium citrate and Miralax!).

But what about other hospitalized patients who aren’t going for a colonoscopy?  Why do they always have two laxatives on board?  Good question, young padawan.  The ever-wise Dr. Lusk taught me on my acute care rotation that in hospitalized patients, we want a gush and a push… one laxative to soften things up, and another one to help things along and out.  Most often, this dynamic duo consists of docusate (the gush) and senna (the push).

Pharmacists definitely, definitely, definitely have to always be on the lookout for constipation in patients.  Sick patients lying around in hospital beds while not eating a regular diet is constipation waiting to happen.  And the class of medications that cause the most constipation?  Opioid pain meds (Vicodin, morphine, etc.), which many hospitalized patients are receiving because they’re in pain.  Every time I see a patient on an opioid I automatically check to see if a laxative is on board, because constipation is pretty much guaranteed in those patients.  Doctors already have so many things to think about and consider, that if we as pharmacists can help watch out for something as easy as constipation, it just makes everyone’s lives better. 🙂

I hope this post wasn’t too ridiculously long that you guys became pooped from reading it (HAHA, c’mon now, that was punny :D).

The ‘betes.

Happy Monday everyone!

This weekend, I looked at my list of “to write” blog posts and realized that in order to post everything I want by the time school is done, I pretty much have to post every day.  So fortunately (or unfortunately?) for you guys, you’re going to get Ruth-spammed.

So, to start your week off right, here’s a big heaping post about diabetes and my day with the diabetes educator :).

I would guesstimate that diabetes (or as my friend Brock says with a strong redneck accent, “the ‘betes”) is the third most common condition I see, behind high blood pressure and high cholesterol.  Diabetes, in simple terms, is when the body is unable to produce or use insulin (a hormone that lowers blood sugar) efficiently.  Without insulin to lower the amount of sugar in the blood to normal levels, sugar builds up and keeps floating around in the blood, which can cause major problems in the long run.

Diabetes is categorized as either type I or type 2, and if you were like me when I was a wee Eutectic, you will have no idea what the difference is until you sit through the diabetes lecture in Patho with Dr. Brooks or Dr. Pearce (who are both fully awesome, by the way).  While I won’t go into too much detail about the differences between the two, here’s a simple pictoral illustration that I always think of:

This is type 1 diabetes:

And this is type 2 diabetes:

Teenybopper heartthrob Nick Jonas and Butter Queen Paula Deen, ladies and gentlemen.

I always think of Nick Jonas when I talk about type 1 diabetes because type 1 is most commonly diagnosed in younger patients.  Type 1 diabetes is actually an autoimmune disorder, which means that the body attacks its own pancreas and destroys the insulin-producing cells.  Since the disease is autoimmune, it kicks in early in life, and this results in younger patients.

Type 2 diabetes, on the other hand, is typically diagnosed in older and/or overweight patients (sorry, Paula). In type 2 diabetes, the problem is two-fold: the pancreas slowly stops producing enough insulin, and the cells in the body become resistant to the insulin.  Since this is a process that takes a while to kick in, it’s no wonder that type 2 diabetes is usually diagnosed in older patients.

Why do we care so much about high blood sugar?  If anything, it just makes you that much sweeter, right?  (Wah-wah, lame Monday morning joke).  The reason why we’re worried is because over a long period of time, high blood sugar can cause a lot of problems, such as tingling and/or decreased feeling in the fingers and toes, retinopathy (damage to the retina in the eye), kidney problems, heart attack, and stroke.  Definitely no bueno.

OK.  Now that the basics are down, it’s story time :).

Since diabetes is so prevalent, more and more clinics and hospitals are utilizing diabetes educators to ensure good diabetic counseling and proper patient education.  In my opinion, diabetes educators are WONDERFUL people because no matter if a patient has had diabetes for ten months or ten years, they always need friendly reminders and counseling because diabetes is such a complicated disease.  Case in point: when I was on rounds with the diabetes educator, we visited this little old lady who was diagnosed with diabetes over ten years ago.  The physician had asked us to talk to this lady because he had noticed that she was injecting her insulin too close to her belly button.  As much as I hate to admit it since I’m so close to being a “real” pharmacist, I had no idea why proximity to the belly button mattered for insulin delivery.  I quickly learned that the belly button is scar tissue, and scar tissue is more fibrous and denser than regular tissue.  Injecting insulin too close to the belly button (or other scars) might prevent the insulin from being fully absorbed.

Oh the things I still need to learn before being released upon the unsuspecting world. 🙂

Anyway, that’s diabetes and my day with the diabetes educator in a nutshell.  Remember everything you learn about diabetes, fellow Euts!  As sure as I am Asian, you will see a diabetic patient while on rotation or in practice. 🙂

P.S.  Speaking of diabetes, Stlcop hosts the Boofest every year for kids with type 1 diabetes.  It’s a lot of fun, and the kids are always dressed in THE CUTEST costumes.  And you know that picture at the top of my blog?  That was taken at the BooFest in 2010.  I dressed up as Hello Kitty (still my favorite costume of all time), and the little girl in the picture who looks like she’s being assaulted is Scarlet, daughter of Stlcop’s own Rebecca Jones.  She was supposed to be a fluffy cloud :).

California shout out!

The other day I got this lovely Facebook message from my dear friend Amanda:

Talk about getting the warm and fuzzies!  So, if the two West coast dads who toured with Amanda on April 5th are reading this, here’s a big, BIG HELLO!!!!! and thank you thank you thank you for reading my little blog :).  I wish I could have met you both in person to say hi instead of having to do it over the internet!  Regardless, I hope you guys enjoyed your tour of Stlcop with Amanda (she’s seriously one of the best), and I hope your kids liked Stlcop enough to become a Eutectic in the near future… we would love to have them!

Happy Friday everyone!