So my first week at the internal medicine clinic has flown by. It felt weird to return to Des Moines because it did not feel like home. After the first week, I am back into things here.
I have started my ambulatory care rotation at a physician's clinic in Des Moines with a pharmacist, one of the Drake faculty members. Ambulatory care means that the site has to focus on outpatient service. So at this rotation site I help the staff pharmacist monitor, assess and modify patients' warfarin therapy. Warfarin is a potent anti-coagulant, a medicine that thins blood. Many people have to be on it if they have underlying heart valve problems, history of clots or problems with circulation. The medication is very effective but it has to be kept in a certain range so that the blood is not too thin or too thick, hence the aggressive monitoring. Some patients come in every two weeks while others once a month. The pharmacist and now me are in charge of following these patients and their progress.
Also at the clinic I work with the physicians and most of their diabetic patients. I will review a patient's history, complaints and glucose readings before they come in for appointments and discuss with the physician what I think the patient may need help with. With these patients I also provide them with diabetes education including how to use glucose meters, what glucose numbers mean, how to take their medications and non medication strategies to help improve their life.
I really enjoy the clinic because I get to talk to patients throughout the day. I get time to talk to the patient and the physicians and make choices that can help improve people's lives. I feel like I am making a difference even if it is small.
Sunday, June 27, 2010
Thursday, June 24, 2010
"Wicked" was Wicked!
While in St. Louis I got to see the musical Wicked with my sister. It was an outstanding performance with great music and a wonderful cast. It was my first time seeing it and I thought it was easily one of the better musicals I had ever seen.
I also got to see it in one of the most beautiful theatres, the Fox Theatre, in St. Louis. It is a very old theatre that has been renovated and now looks like a million bucks. Thanks for the great show!
I also got to see it in one of the most beautiful theatres, the Fox Theatre, in St. Louis. It is a very old theatre that has been renovated and now looks like a million bucks. Thanks for the great show!Monday, June 21, 2010
One of the Coolest Experiences Ever (Cont.)
For all of you that could not keep your pants on long enough to find out the rest of the story. Here is "The Rest Of the Story"
Patient Brunno came into the hospital for a routine cardiology catheter exam which is similar to an x-rays in motion that show the anatomy and flow of major arteries and veins including the coronary arteries (the hearts source of blood and energy). Patient Brunno needed two heart valves replaced so was getting the scans done in order to see what needed to be done for surgery.
Patient Brunno looked healthy and happy before the scan. The patient was put into conscience sedation (the patient will not remember the events but is awake enough to follow commands). The incisions in the leg are made to put the catheter and dye into the arteries so the scans can be made. Some of the pictures (xrays in motion) are taken. The rotation student asks why the images have a small bleep in the arteries. The cardiologist looks at the images and cannot understand what is going on. He asks two other cardiologists for their opinions. The surgeons then decide that the women's arteries have a tare in them and it is getting worse (like a tare in pantie hose that gets worse and worse).
Patient Brunno was supposed to have two heart valves replaced the next day but in this condition would never survive the surgery. The cardiologist decides he has to keep the arteries open as best as possible. The cardiologist gets other specialists opinions on the matter. Wires and stents are started to be placed to keep the arteries open so the heart will not die. The patient begins to deteriorate. The patient goes into Atrial fibrillation (irregular heart beat) 4 different times and needs to be shocked back. The entire time the patient is still awake and in excruciating pain due to the screaming and attempts to unhook all the monitors and drugs. The room fills with nurses, technicians and doctors as they try to keep the patient calm and finish up the stent placement.
Multiple doctors comment that the patient will die if the stents are not placed but the patient will die if they try to perform the valve replacements. "If she survives this, it will be a miracle" is repeated a few times by the chief of surgery as he watches in grief while ordering one of the operations rooms to be prepared just in case. One hour later the anesthesiologist shows up and is able to sedate the patient and place a tube into their lungs to provide mechanical oxygen.
Two hours later all the stents are placed, the patient is stable and the pharmacy rotation student is staring in shock with all the other surgeons and nurses. Patient Brunno is moved to the ICU where the patient is monitored like a hawk. The patient goes into irregular heart beats once again during the night and is shocked back bringing the total to 5 shocks.
Five days later the patient is stable and recovering. The patient is scheduled to return home in a few days and undergo surgery in 4-6 weeks.
I was shocked, sad, happy, hopeful, praying, helping and all enthralled in the situation as it was happening. I felt as if I was on a nail biting episode of Grey's Anatomy. The adrenaline was great, as I think I could do that everyday and the story is even better knowing that the patient survived.
Patient Brunno came into the hospital for a routine cardiology catheter exam which is similar to an x-rays in motion that show the anatomy and flow of major arteries and veins including the coronary arteries (the hearts source of blood and energy). Patient Brunno needed two heart valves replaced so was getting the scans done in order to see what needed to be done for surgery.
Patient Brunno looked healthy and happy before the scan. The patient was put into conscience sedation (the patient will not remember the events but is awake enough to follow commands). The incisions in the leg are made to put the catheter and dye into the arteries so the scans can be made. Some of the pictures (xrays in motion) are taken. The rotation student asks why the images have a small bleep in the arteries. The cardiologist looks at the images and cannot understand what is going on. He asks two other cardiologists for their opinions. The surgeons then decide that the women's arteries have a tare in them and it is getting worse (like a tare in pantie hose that gets worse and worse).
Patient Brunno was supposed to have two heart valves replaced the next day but in this condition would never survive the surgery. The cardiologist decides he has to keep the arteries open as best as possible. The cardiologist gets other specialists opinions on the matter. Wires and stents are started to be placed to keep the arteries open so the heart will not die. The patient begins to deteriorate. The patient goes into Atrial fibrillation (irregular heart beat) 4 different times and needs to be shocked back. The entire time the patient is still awake and in excruciating pain due to the screaming and attempts to unhook all the monitors and drugs. The room fills with nurses, technicians and doctors as they try to keep the patient calm and finish up the stent placement.
Multiple doctors comment that the patient will die if the stents are not placed but the patient will die if they try to perform the valve replacements. "If she survives this, it will be a miracle" is repeated a few times by the chief of surgery as he watches in grief while ordering one of the operations rooms to be prepared just in case. One hour later the anesthesiologist shows up and is able to sedate the patient and place a tube into their lungs to provide mechanical oxygen.
Two hours later all the stents are placed, the patient is stable and the pharmacy rotation student is staring in shock with all the other surgeons and nurses. Patient Brunno is moved to the ICU where the patient is monitored like a hawk. The patient goes into irregular heart beats once again during the night and is shocked back bringing the total to 5 shocks.
Five days later the patient is stable and recovering. The patient is scheduled to return home in a few days and undergo surgery in 4-6 weeks.
I was shocked, sad, happy, hopeful, praying, helping and all enthralled in the situation as it was happening. I felt as if I was on a nail biting episode of Grey's Anatomy. The adrenaline was great, as I think I could do that everyday and the story is even better knowing that the patient survived.
Tuesday, June 15, 2010
My First Cardinals Game!
I had a WONDERFUL time at one of the best Cardinals game last night! It was my first Cardinals game and they definitely put on a show with 3 home-runs, a 9-3 win, and fireworks at the end! Thanks for the great time to all those involved (you know who you are)!
One of the Coolest Experiences Ever!
I had one of the most heart pounding, exciting, full involving, Grey's Anatomy type experiences today in the Cardiology Catheter Lab this afternoon!!
1 patient, 12 nurses, 5 technicians, 3 surgeons, 3 cardiologists, 1 anesthesiologists, 1 respiratory specialist and 1 pharmacy intern and......
I will follow up with the details later.
Sunday, June 13, 2010
At The Hospital
What I been up to with the pharmacy hospital experience:
I was able to observe and learn about the new pathology, microbiology and general specimen lab housed within the hospital. The lab is two years old and seems to be one of the most technologically advanced labs in the nation. The lab is about 80% automated with analysis machines and tracks doing much of the work. The lab took care of the hospital's specimens as well as specimens from hospitals and institutions from around the area. The specimens go through the analysis process with bar codes determining their route and final record. The microbiology is slightly less automated as the microbiologist do more of the testing and analysis of pathogen susceptibility. The lab is very efficient with results available within hours rather than the days that other hospitals may experience.
Physicians ordering antibiotics such as aminoglycosides or vancomycin can request that the pharmacy initiate and monitor the antibiotics through pharmacokinetic protocol dosing. The pharmacist entering new orders for antibiotics with special dosing requirements can call the clinical pharmacist to dose the medication. I was in charge of PKS dosing for a portion of the day with some assistance from the residents or pharmacists. I initiated antibiotics that required additional PKS consideration for 4 patients. I had to look into patient profiles for pertinent information such as weight, height, SrCr, age and health status. I also referenced the patient's chart for microbiological labs, any additional scans and physician notes to determine why the patient was requiring certain antibiotics as well as appropriate doses. For certain medications such as Zosyn the severity of the infection was critical, while for medications such as vancomycin or the aminoglycosides the patients SrCr and weight were more critical to take into account.
I was able to observe and learn about the new pathology, microbiology and general specimen lab housed within the hospital. The lab is two years old and seems to be one of the most technologically advanced labs in the nation. The lab is about 80% automated with analysis machines and tracks doing much of the work. The lab took care of the hospital's specimens as well as specimens from hospitals and institutions from around the area. The specimens go through the analysis process with bar codes determining their route and final record. The microbiology is slightly less automated as the microbiologist do more of the testing and analysis of pathogen susceptibility. The lab is very efficient with results available within hours rather than the days that other hospitals may experience.
Physicians ordering antibiotics such as aminoglycosides or vancomycin can request that the pharmacy initiate and monitor the antibiotics through pharmacokinetic protocol dosing. The pharmacist entering new orders for antibiotics with special dosing requirements can call the clinical pharmacist to dose the medication. I was in charge of PKS dosing for a portion of the day with some assistance from the residents or pharmacists. I initiated antibiotics that required additional PKS consideration for 4 patients. I had to look into patient profiles for pertinent information such as weight, height, SrCr, age and health status. I also referenced the patient's chart for microbiological labs, any additional scans and physician notes to determine why the patient was requiring certain antibiotics as well as appropriate doses. For certain medications such as Zosyn the severity of the infection was critical, while for medications such as vancomycin or the aminoglycosides the patients SrCr and weight were more critical to take into account.
Wednesday, June 9, 2010
Reminders of the Weekend
Saturday morning fun at the Soulard Farmer's Market (oldest farmer's market west of the Mississippi River):
What do you get with a pharmacy student, an engineer and a transportation situation on a Saturday afternoon?
After Sunday, I will NEVER again miss a spot with the sunblock! Porky the Pig Pink! OUCH!!
Sunday, June 6, 2010
Thursday, June 3, 2010
The Patient Had What In Their Leg???
As the pharmacist and I are entering new prescription orders we come across an interesting yet sad story:
Patient had surgery three weeks ago in which the foot was amputated. Patient was being readmitted with complaints of pain and pus coming from the surgery wound.
Upon inspection, the doctors found that the bandages around the surgical wound had NOT been changed since the patient left the hospital three weeks ago. Upon further inspection, the doctors found that the site was in fact draining white pus filled fluid due to MAGGOTS that had infested the surgery wound.
Patient had surgery three weeks ago in which the foot was amputated. Patient was being readmitted with complaints of pain and pus coming from the surgery wound.
Upon inspection, the doctors found that the bandages around the surgical wound had NOT been changed since the patient left the hospital three weeks ago. Upon further inspection, the doctors found that the site was in fact draining white pus filled fluid due to MAGGOTS that had infested the surgery wound.
Gross? Interesting? Sad? Unbelievable?
All of the Above!
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