I just returned from a weekend trip to New York City. We did lots of walking up and down Manhattan. Saturday along included 38,000 steps on my FitBit. The sights and sounds of the city were amazing, but one of the best parts was a Broadway show. We saw The Book of Mormon, written by the guys from South Park. I didn't know what to really expect, but if you go to any show, this one is worth it.
Here is their performance from the 2011 Tony Awards:
Monday, September 8, 2014
Friday, September 5, 2014
Fall PY2 - Week 4
Week 4! The Labor Day Edition. The week went easily with only 3 days of class and something to look forward to this weekend. So let's see how it was:
Monday - Labor Day
No classes today which meant some quality time with the wife. And a little preparation for this week's classes.
Tuesday
Drug Lit actually turned out to be pretty painful. We were assigned two articles to read and then discuss in class. The idea was that they were random controlled trials and we would analyze them and discuss how they worked. But it did not feel like many people actually read the articles as the professor worked to pull 150 students along. I really liked the step-by-step method of going through the articles from the title to the abstract and then into the body. There were many layers to breaking down what was in a paper. In the end, we only got through one of the articles. It was about the use of long term hypertonic saline in patients with cystic fibrosis. They thought that their lung function, measured by FEV1, should improve significantly. It didn't, so the authors added a couple of numbers together to force in some significance. While it wasn't their goal, they did show that hypertonic saline correlated with less infections in CF patients.
Med Chem was also a difficult class with another new professor talking about histamines.
Specifically at this time we are focusing on the antihistamines that block the H1 receptors mostly responsible for allergic reactions. Mast cells in your skin release histamine when they sense injury which causes inflammation by triggering H1 receptors. The first generation of antihistamines do a good job of blocking this reaction, but they can also cross into the brain which also has some H1-receptors. This makes a person drowsy and we can use something like Benadryll (diphenhydramine) to help people sleep. Newer, or second generation, antihistimines are designed to stay out of the brain. Zyrtec (cetirizine) reduces inflammation but is also non-drowsy.
Therapy in the afternoon focused on the management of Type 2 Diabetes. As it runs through my family, I have an interest in Diabetes. The first treatment is easy - diet and exercise. Then you get into the drugs - primarily metformin. After that, things get complicated. What do you add and when do you add it.
Wednesday
Lab was also about diabetes. We checked our feet with a monofilament for neuropathy. We checked our blood sugars - 95 after breakfast. And we made an ointment for a foot ulcer. The product took four hours to produce. Lots of melting, mixing, and stirring. Lots of stirring. I stirred the mixture fairly constantly for an hour. We had to come back later to package the ointment into a jar.
We didn't do any calculations this week in kinetics, but talked about the concepts of the equations. I liked it better than the calculations which I could have just done on my own time. These actually sparked intense discussions within our groups and as a class.
Thursday
Statistics in Drug Lit. Only an hour going over descriptive statistics like mean, median and standard deviations. A quiz determined if you needed to come back for the second hour. Since I got all six right, I could go work on other things.
Med chem focused more details on the structures of first-generation antihistamines. I had read the book on the section and felt a little lost. But class really helped focus on the important details.
Therapy wrapped up the non-insulin portion of diabetes. Start on metformin, add another drug, add another drug, start on insulin. There are a lot of choices when it comes to diabetic meds and a lot to consider.
So that's the week of class. I actually did a lot more for getting ready for next week when we have MTM, SOAP note, diabetes quiz, kinetics homework, kinetic quiz, lab preparation, and exam #1 for med chem. My wife and I head to New York for our anniversary so I won't be doing to much school work. I got many things done, but next week might be rough. Until then, Have a great weekend!
Monday - Labor Day
No classes today which meant some quality time with the wife. And a little preparation for this week's classes.
Tuesday
Drug Lit actually turned out to be pretty painful. We were assigned two articles to read and then discuss in class. The idea was that they were random controlled trials and we would analyze them and discuss how they worked. But it did not feel like many people actually read the articles as the professor worked to pull 150 students along. I really liked the step-by-step method of going through the articles from the title to the abstract and then into the body. There were many layers to breaking down what was in a paper. In the end, we only got through one of the articles. It was about the use of long term hypertonic saline in patients with cystic fibrosis. They thought that their lung function, measured by FEV1, should improve significantly. It didn't, so the authors added a couple of numbers together to force in some significance. While it wasn't their goal, they did show that hypertonic saline correlated with less infections in CF patients.
Med Chem was also a difficult class with another new professor talking about histamines.
 |
| Diphenhydramine - popular antihistamine |
Therapy in the afternoon focused on the management of Type 2 Diabetes. As it runs through my family, I have an interest in Diabetes. The first treatment is easy - diet and exercise. Then you get into the drugs - primarily metformin. After that, things get complicated. What do you add and when do you add it.
Wednesday
Lab was also about diabetes. We checked our feet with a monofilament for neuropathy. We checked our blood sugars - 95 after breakfast. And we made an ointment for a foot ulcer. The product took four hours to produce. Lots of melting, mixing, and stirring. Lots of stirring. I stirred the mixture fairly constantly for an hour. We had to come back later to package the ointment into a jar.
We didn't do any calculations this week in kinetics, but talked about the concepts of the equations. I liked it better than the calculations which I could have just done on my own time. These actually sparked intense discussions within our groups and as a class.
Thursday
Statistics in Drug Lit. Only an hour going over descriptive statistics like mean, median and standard deviations. A quiz determined if you needed to come back for the second hour. Since I got all six right, I could go work on other things.
Med chem focused more details on the structures of first-generation antihistamines. I had read the book on the section and felt a little lost. But class really helped focus on the important details.
Therapy wrapped up the non-insulin portion of diabetes. Start on metformin, add another drug, add another drug, start on insulin. There are a lot of choices when it comes to diabetic meds and a lot to consider.
So that's the week of class. I actually did a lot more for getting ready for next week when we have MTM, SOAP note, diabetes quiz, kinetics homework, kinetic quiz, lab preparation, and exam #1 for med chem. My wife and I head to New York for our anniversary so I won't be doing to much school work. I got many things done, but next week might be rough. Until then, Have a great weekend!
Thursday, September 4, 2014
Measuring Medicine
Just a spoonful of sugar can help the medicine go down. But how much medicine are you taking. Most of the time, that is an easy question. The tablets come presized with 200 mg or 25 mg. They might be scored for turning into half-sized tablets. But what about liquids? And more importantly, what about kids?
NPR published a story on the dangers of ineffective measurements. Pediatric medicines require specific doses. This is because kids come in all different sizes and side effects can cause serious problems. But because kids don't like to swallow pills (even mixed up in apple sauce), many medicines are give as liquids. Cough syrup, Tylenol, and Vancomycin all have versions as oral solutions. So how much are you supposed to give the kid? A teaspoon? Tablespoon? This can be a very important detail that leads to drastically different outcomes. Studies show that neither teaspoon nor table spoon should be the best answer. They are unreliable can mess up a child's therapy.
Instead, we turn to the more structured metric system. You don't give the kid a teaspoon, but rather 5 mL. You can give a syringe or graduated cylinder to help measure. It's easier to measure, visualize and gives the right dose. No matter what Mary Poppins says, the answer is not a spoonful.
NPR published a story on the dangers of ineffective measurements. Pediatric medicines require specific doses. This is because kids come in all different sizes and side effects can cause serious problems. But because kids don't like to swallow pills (even mixed up in apple sauce), many medicines are give as liquids. Cough syrup, Tylenol, and Vancomycin all have versions as oral solutions. So how much are you supposed to give the kid? A teaspoon? Tablespoon? This can be a very important detail that leads to drastically different outcomes. Studies show that neither teaspoon nor table spoon should be the best answer. They are unreliable can mess up a child's therapy.
Instead, we turn to the more structured metric system. You don't give the kid a teaspoon, but rather 5 mL. You can give a syringe or graduated cylinder to help measure. It's easier to measure, visualize and gives the right dose. No matter what Mary Poppins says, the answer is not a spoonful.
Wednesday, September 3, 2014
The College Football Playoff is Real!!!
I have been waiting a long time for this. Every year since 2006, I have drafted my own fictional College Football Playoff system that I believed should have determined the true National Champions. At the end of this season, that dream becomes reality. Well, almost. The NCAA playoff will only feature the 4 teams at the top of a poll determined by a committee. So close. They have have control of 6 bowl games, that sounds pretty easy to get a 12 team playoff. But hey, one step at a time. The popularity of the College Football Playoff will generate enormous profits which will quickly lead to its expansion to include 8 and then hopefully 16 teams. It never hurts to keep dreaming.
If you don't understand how the new system works, Slate put together this nice summary for you:
If you don't understand how the new system works, Slate put together this nice summary for you:
Tuesday, September 2, 2014
TED Talk Tuesday: Tony Robbins
Tony Robbins brings his powerful speaking ability as a life coach to TED. He helps people make their invisible dreams become a physical reality. Focus on the right details can make all the difference. I told my players all the time that little things can make a big impact.
Enjoy!
Enjoy!
Monday, September 1, 2014
Thursday, August 28, 2014
Fall PY2 - Week 3
It has been a long strange week, but it is coming to an end with a long Labor Day Weekend. So here's what happened in Pharmacy School this week:
Monday - Exam #1
With the morning off, I spent a good deal of time studying for the first exam of the year - Dermatology. I didn't think the test was that bad. Rumors were spread about the impossibility of this first exam. But the professors anticipated it and seemed to have changed the format. Then again, I never expected it to be too hard because the answer should usually be hydrocortisone, moisturizer, sunscreen, and/or antihistamine. I will admit that because of this section, I used moisturizer on my face for the first time. The result: several pimples on my nose. No thanks!
By the way, the exam took about 30 minutes which meant a 90 minute break before the next class. Jumping on a bus to head home was a thought that crossed my mind. But I stayed for our Pre-Lab. We had our first MRAP - an action plan for the patient's medication problems - due this week. I wanted to make sure that I knew what I was doing. I am still not sure, but it is done and I have three more this semester.
Tuesday
Back in Drug Lit we went through examples of searches through Secondary Resources. We answered some questions by searching PubMed, EMBASE or Google (jk). Simple process. I like MeSH terms when applicable and I need to remember when to filter out options. I particularly liked the article about the professionalism of pharmacy students on Facebook. Hint: They are not too professional. But then again, is this?
Med Chem finished up a lecture about G-Protein Coupled Receptors (GPCR). Essentially a specific drug will either turn the receptor up, down or off. Therapy returned with our first day on Diabetes. It is a big section, and getting bigger. A full 40% of Americans will be diagnosed with Diabetes during their lifetime. Even more will have a loved one with Diabetes. I expect a lot of future questions about managing the disease.
Wednesday - 2 Quizzes, Again
Today we made Coal Tar in lab. We started with a quick quiz and more practice with Drug Information questions. In the lab, we combined coal tar and salicylic acid into a cream/ointment to treat a patient's psoriasis. The mixing process took a long time. It looked and sounded like a training session to work at Coldstone. We also made another batch using an unguator that only took 90 seconds. Much easier.
At lunch we had a CAPS meeting and I was forced to do a Phlash Mob dance. I ended up on the side out of the way expecting to follow the person next to me. But she didn't know it either. Oh well. It was all good fun. Afterwards we had another quiz in Kinetics about the basic equations that we used last semester - V, Cl, X, etc. I think that I will like kinetics. It's a math class. Basically plug and chug. But sitting in the class reminds me of my first year teaching physics. While I might think that the algebra is intuitive and easy. You have to go through everything step by step. I worked my way through the practice problems for the day and then worked on the crossword puzzle.
Thursday
Drug lit featured one of my favorite professors giving the classic scientific method lecture about randomized control trials. Instead of lima beans in saltwater, we talked about Cystic Fibrosis patients and hypertonic saline. Med chem flew through Histamine receptors and their role in the body. Histamine is released during an allergic reaction, but it also controls the acidity of your stomach and even your wakefulness. That's why Benadryl makes you sleepy and Prilosec treats acid reflux. After lunch, we had a second med chem presentation on diabetes drugs. The number of medications just to treat a diabetic patient's blood sugar keeps going up. They all have different methods of affecting the body. We get to learn/memorize all of them. Yeah!
It was a good week of classes. I get a bonus day by working in the Inpatient Pharmacy on Friday. I will be pulling drugs from the large, turning carousel from 7 until 3:30. But after that it is Labor Day Weekend and the beginning of College Football!!!
Monday - Exam #1
With the morning off, I spent a good deal of time studying for the first exam of the year - Dermatology. I didn't think the test was that bad. Rumors were spread about the impossibility of this first exam. But the professors anticipated it and seemed to have changed the format. Then again, I never expected it to be too hard because the answer should usually be hydrocortisone, moisturizer, sunscreen, and/or antihistamine. I will admit that because of this section, I used moisturizer on my face for the first time. The result: several pimples on my nose. No thanks!By the way, the exam took about 30 minutes which meant a 90 minute break before the next class. Jumping on a bus to head home was a thought that crossed my mind. But I stayed for our Pre-Lab. We had our first MRAP - an action plan for the patient's medication problems - due this week. I wanted to make sure that I knew what I was doing. I am still not sure, but it is done and I have three more this semester.
Tuesday
Back in Drug Lit we went through examples of searches through Secondary Resources. We answered some questions by searching PubMed, EMBASE or Google (jk). Simple process. I like MeSH terms when applicable and I need to remember when to filter out options. I particularly liked the article about the professionalism of pharmacy students on Facebook. Hint: They are not too professional. But then again, is this?
Med Chem finished up a lecture about G-Protein Coupled Receptors (GPCR). Essentially a specific drug will either turn the receptor up, down or off. Therapy returned with our first day on Diabetes. It is a big section, and getting bigger. A full 40% of Americans will be diagnosed with Diabetes during their lifetime. Even more will have a loved one with Diabetes. I expect a lot of future questions about managing the disease.
Wednesday - 2 Quizzes, Again
Today we made Coal Tar in lab. We started with a quick quiz and more practice with Drug Information questions. In the lab, we combined coal tar and salicylic acid into a cream/ointment to treat a patient's psoriasis. The mixing process took a long time. It looked and sounded like a training session to work at Coldstone. We also made another batch using an unguator that only took 90 seconds. Much easier.
At lunch we had a CAPS meeting and I was forced to do a Phlash Mob dance. I ended up on the side out of the way expecting to follow the person next to me. But she didn't know it either. Oh well. It was all good fun. Afterwards we had another quiz in Kinetics about the basic equations that we used last semester - V, Cl, X, etc. I think that I will like kinetics. It's a math class. Basically plug and chug. But sitting in the class reminds me of my first year teaching physics. While I might think that the algebra is intuitive and easy. You have to go through everything step by step. I worked my way through the practice problems for the day and then worked on the crossword puzzle.
Thursday
Drug lit featured one of my favorite professors giving the classic scientific method lecture about randomized control trials. Instead of lima beans in saltwater, we talked about Cystic Fibrosis patients and hypertonic saline. Med chem flew through Histamine receptors and their role in the body. Histamine is released during an allergic reaction, but it also controls the acidity of your stomach and even your wakefulness. That's why Benadryl makes you sleepy and Prilosec treats acid reflux. After lunch, we had a second med chem presentation on diabetes drugs. The number of medications just to treat a diabetic patient's blood sugar keeps going up. They all have different methods of affecting the body. We get to learn/memorize all of them. Yeah!
It was a good week of classes. I get a bonus day by working in the Inpatient Pharmacy on Friday. I will be pulling drugs from the large, turning carousel from 7 until 3:30. But after that it is Labor Day Weekend and the beginning of College Football!!!
National Immunization Awareness Month
As August comes to a close, so does National Immunization Awareness Month. Unfortunately, I was unaware that vaccines received a whole month of education until the last week. One of our Pharmacy Organizations has us posting Immunization Facts each day on Facebook and/or Twitter. I support it. Mostly because I believe in the proper education of patients about vaccines. But also because I am allowed to immunize people as a PharmD student - which will be doing either at the Student Union or hopefully at the NC State Fair!
I stand by my claim that vaccines are the most important breakthrough in medical history. We can actually prevent disease by taking the buggers, stripping them of their nastiness, and putting into a person. Then the patient's own immune system can develop the defenses to fight off any attacks. We have eradicated polio and small pox and made it so people don't die from the common infectious diseases of our past. If you don't care about that, realize that kids don't have to get chicken pox anymore! There a lots of other facts swarming Facebook, like Women should get a flu shots and a Tdap while pregnant to protect their babies. If you want anymore factual information about vaccinations go to this CDC site. It is a great resource.
Sadly there is still a thread of people who became convinced that vaccines give children autism. There are even some Facebook threads spreading their "information" as well during NIAM. Thankfully, Penn and Teller devoted an entire show to proving why their claims are "Bullsh!t".
Please go out and get vaccinated and help teach others about immunizations.
Wednesday, August 27, 2014
How Are You Still Alive?
The Universe is conspiring to kill you. You body is under constant attack. But most days, you don't die. You don't even get sick. This is thanks to your enormously complex immune system. Full of B cells, T cells and antibodies, your immune system fights off invading armies of bacteria and viruses.
This video by Kurzgesagt explains the basics of keeping you alive. I could have used this during PY1.
This video by Kurzgesagt explains the basics of keeping you alive. I could have used this during PY1.
Tuesday, August 26, 2014
TED Talk Tuesday: David Kwong
David Kwong writes crossword puzzles for the New York Times. And he's a magician. Sounds like my kind of guy. He spoke at TED about why we like puzzles. Remember, we are all natural scientists. We want to figure out what's going on. We want to solve puzzles. And we all want to know how the magician did that amazing trick. Kwong performs such a feat on the stage that leaves you wondering about how he could possibly pull it off.
Enjoy!
Enjoy!
Monday, August 25, 2014
Black Dog Syndrome
I have heard about this before, but Slate reminded me of the Black Dog Syndrome. Americans love our pets. And I love mine. But there is a serious form of discrimination in the pet world. People do not adopt black dogs. Compared to their brown or golden cousins, the black dogs remain in the pounds and sadly end up being euthanized far more frequently.
Cultural stories cast black dogs (and black cats) in a negative light but it has a lot to do with the aspects of being a black dog. Black dogs do not take good pictures. We have far more pictures of the photogenic Augi than of the monochrome Charlie. That's because Charlie's pictures don't turn out very well. You only see his tongue or his outline. I have to use the special filters on Instagram to get anything to show up. This is true to animal shelter websites. They post pictures of the animals up for adoption and people make their choices based on those images. Making it hard for the black puppies.
So is it blatant racism? Well not really. It is all about connections - immediate connections. Especially in the form of facial expressions. Humans are hardwired to recognized faces and to understand what those expressions mean. A brown dog can show a wider range of facial expressions which take advantage of our evolution. It's also why puppies have big eyes. Black pups simply can't demonstrate many facial expressions through their dark fur. But that doesn't mean they don't feel or can't make great pets. They have a marketing problem.
And now for gratuitous pictures of my dogs.
Cultural stories cast black dogs (and black cats) in a negative light but it has a lot to do with the aspects of being a black dog. Black dogs do not take good pictures. We have far more pictures of the photogenic Augi than of the monochrome Charlie. That's because Charlie's pictures don't turn out very well. You only see his tongue or his outline. I have to use the special filters on Instagram to get anything to show up. This is true to animal shelter websites. They post pictures of the animals up for adoption and people make their choices based on those images. Making it hard for the black puppies.
So is it blatant racism? Well not really. It is all about connections - immediate connections. Especially in the form of facial expressions. Humans are hardwired to recognized faces and to understand what those expressions mean. A brown dog can show a wider range of facial expressions which take advantage of our evolution. It's also why puppies have big eyes. Black pups simply can't demonstrate many facial expressions through their dark fur. But that doesn't mean they don't feel or can't make great pets. They have a marketing problem.
And now for gratuitous pictures of my dogs.
 |
| Charlie (Charles Robert Darwin) |
 |
| Augi (Augustus Caesar) |
Friday, August 22, 2014
Fall PY2 - Week 2
Made it through another week. It still feels like they are easing us in a bit. My week was easier that it didn't involve a dog emergency. Augi is doing much better now. His liver enzymes dropped from almost 8,000 to about 1,500. Still above the 700 value of a normal, healthy dog, but he is headed in the right direction. So let's look at how the week went.
Monday was a half-day. We had the morning off, which I appreciated to get some work done. I really only go 3.5 days on and 3.5 days off this entire semester. I am going to enjoy it. The first class of the afternoon was some more pharmacotherapy of dermatology. Just so you know, the answer is always sunscreen and/or moisturize. Has to be. We talked about sunburns which was helpful for our SOAP note due on Wednesday. The Large-group Lab class was more introductory and prepping for the labs this week. There was much concern over how much we needed to learn about how the drugs work. Since it is supposed to be about explaining things to patients, you didn't have to go into too much detail. Instead of "amoxicillin inhibits the penicillin-binding proteins which damages the cell wall and leads to cell lysis due to osmotic pressures", you just needed to say "amoxicillin is a bacteriocidal antibiotic". Done.
Tuesday went back to a full day. We went through some cases (or applications) of tertiary sources in drug literature. The type of question determines the source, but most of the time you should use Micromedex. IV questions go the Handbook of Injectable Drugs. Pregnancy questions go to Brigg's Guide to Pregnancy and Lactation. Otherwise, go to Micromedex. Med Chem was more about receptor signaling. Specifically, about turning off the signal. Cyclic GMP is turned off by
Phosphodiesterase (PDE) into GMP. Viagra blocks PDE to keep cGMP on and help with erectile dysfunction. The professor also talked about oxytocin. It is such a weird hormone to me. Oxytocin manages milk production and uterine contractions - both female jobs. But males make it too, plenty of it. That's because it is also related to trust and stress relief. An increase of oxytocin makes us feel more relaxed and the easiest way to release the hormone is through hugging. Which is why a good hug can make all of our problems fade away. After lunch we had more therapy and more about sunburns and sun cancers.
Wednesday is lab day which means dressing up. Or at least I thought so. The number of ties on the male population dropped dramatically from week one to week two. I will continue to represent. We talked about our answers to the SOAP notes about a 20-year-old female with severe sunburn and acne. I felt like I had all of the right answers, but I didn't give enough information. Last semester's intense notes got Eurostile font to give myself more room. I will have to go back to that. Our quiz was straight forward. The drugs aren't that difficult and the calculations are all review from last year. After some other work, we looked at ourselves under the UV light (like the post from Monday). I was scared. I've coached outside through the middle of summer for a long time and very rarely ever used sunscreen. A lot of freckles and clogged pores showed up, but nothing too bad. There will not be a dermatologist trip in the near future. After lunch came Pharmacokinetics and our first quiz - a review of pharmacodynamics. Straightforward. We answered some cases as a group by holding up letters to our choice.
Thursday rounds out the week. Drug lit introduced secondary resources. Pubmed and the Cochrane Review are my favorites. I feel confident searching a database for articles. But the term Boolean search through me off. I could only think of boullion - the cubes of dehydrated meat stock - or boulliabase - French stew. It only means the use of conjunctions to make to search broader. Med Chem dove more into the important GPCR, receptors that make up about 1/3 of drug targets on the market and the most of drugs in the research pipeline. Therapy, after lunch, returned to more about skin cancers. I shared the UV video with the lab professor who sent it to the derm professor, who wanted me to introduce and show the video to the class. Now, we have to get ready for the first exam of the year on Monday. Thirty-six questions about dermatology. That will make up a large chuck of my Friday.
Monday was a half-day. We had the morning off, which I appreciated to get some work done. I really only go 3.5 days on and 3.5 days off this entire semester. I am going to enjoy it. The first class of the afternoon was some more pharmacotherapy of dermatology. Just so you know, the answer is always sunscreen and/or moisturize. Has to be. We talked about sunburns which was helpful for our SOAP note due on Wednesday. The Large-group Lab class was more introductory and prepping for the labs this week. There was much concern over how much we needed to learn about how the drugs work. Since it is supposed to be about explaining things to patients, you didn't have to go into too much detail. Instead of "amoxicillin inhibits the penicillin-binding proteins which damages the cell wall and leads to cell lysis due to osmotic pressures", you just needed to say "amoxicillin is a bacteriocidal antibiotic". Done.
Tuesday went back to a full day. We went through some cases (or applications) of tertiary sources in drug literature. The type of question determines the source, but most of the time you should use Micromedex. IV questions go the Handbook of Injectable Drugs. Pregnancy questions go to Brigg's Guide to Pregnancy and Lactation. Otherwise, go to Micromedex. Med Chem was more about receptor signaling. Specifically, about turning off the signal. Cyclic GMP is turned off by Phosphodiesterase (PDE) into GMP. Viagra blocks PDE to keep cGMP on and help with erectile dysfunction. The professor also talked about oxytocin. It is such a weird hormone to me. Oxytocin manages milk production and uterine contractions - both female jobs. But males make it too, plenty of it. That's because it is also related to trust and stress relief. An increase of oxytocin makes us feel more relaxed and the easiest way to release the hormone is through hugging. Which is why a good hug can make all of our problems fade away. After lunch we had more therapy and more about sunburns and sun cancers.
Wednesday is lab day which means dressing up. Or at least I thought so. The number of ties on the male population dropped dramatically from week one to week two. I will continue to represent. We talked about our answers to the SOAP notes about a 20-year-old female with severe sunburn and acne. I felt like I had all of the right answers, but I didn't give enough information. Last semester's intense notes got Eurostile font to give myself more room. I will have to go back to that. Our quiz was straight forward. The drugs aren't that difficult and the calculations are all review from last year. After some other work, we looked at ourselves under the UV light (like the post from Monday). I was scared. I've coached outside through the middle of summer for a long time and very rarely ever used sunscreen. A lot of freckles and clogged pores showed up, but nothing too bad. There will not be a dermatologist trip in the near future. After lunch came Pharmacokinetics and our first quiz - a review of pharmacodynamics. Straightforward. We answered some cases as a group by holding up letters to our choice.
Thursday rounds out the week. Drug lit introduced secondary resources. Pubmed and the Cochrane Review are my favorites. I feel confident searching a database for articles. But the term Boolean search through me off. I could only think of boullion - the cubes of dehydrated meat stock - or boulliabase - French stew. It only means the use of conjunctions to make to search broader. Med Chem dove more into the important GPCR, receptors that make up about 1/3 of drug targets on the market and the most of drugs in the research pipeline. Therapy, after lunch, returned to more about skin cancers. I shared the UV video with the lab professor who sent it to the derm professor, who wanted me to introduce and show the video to the class. Now, we have to get ready for the first exam of the year on Monday. Thirty-six questions about dermatology. That will make up a large chuck of my Friday.
Thursday, August 21, 2014
Who Wants to Live Forever?
In 1986, the rock band Queen asked a simple question, "Who wants to live forever?" Everyone has asked that question, and Dr. Elizabeth Blackburn and her team won a Noble Prize in pursuit of that discovery. They found an answer the the biological cause of aging: telomeres. Jalees Rehman wrote an extensive piece on the topic on SciAm's blog page.
Not long after the discovery of telomeres and their enzyme, telomerase, people began dreaming of a magical elixir of life to reverse aging. Aging is, unfortunately, a very natural process. As cells live, they because damaged due to various forms of stress and attack. To survive, they must reproduce to make more cells. This requires the replication of the genome. DNA synthesis splits open the double helix and copies the unpaired nucleotides to produce an identical strand. Well, almost identical. The ends of the chromosomes get a little bit difficult and some parts of the ends don't get copied. The best analogy is the ends of a string. The ends fray the longer it gets used. So how do you protect the ends? Shoe laces have plastic covers called aglets, and your DNA has a telomere. The telomere is noncoding DNA at the end of a chromosome. A little bit of the telomere frays away every time the cell divides. This determines the lifespan of the cell. Once the telomere erodes away, important coding genes become damaged and the cell must die. The accumulation of this type of death is called aging.
Dr. Blackburn learned that a sample of DNA can provide enough information to learn about a person's health. People with longer telomeres were biologically younger, even if not chronologically. Those with short telomeres were three times more likely to have cancer. Cancer cells have activated telomerase that repairs the vanishing telomeres producing a cell that never dies. Cancers cause problems because they have too much telomerase. Every cell has telomeres, but not every cell has telomerase. This is so that cells can naturally die out of the way, but cancer messes that system up.
So having too little telomeres can cause the problems of aging. Too much telomerase can cause the problems of cancer. Then the healthiest has to be right in the middle. So their might not be a magic potion to reverse aging and rebuild our telomeres. At least not without significant risks. Instead, have have to protect the telomeres we have. Reduce the stress we put on our cells and let them live out their full potential. You won't live forever, but you might make it a long time. Besides, who wants to live forever?
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| Telomeres protect the ends of our chromosomes |
Dr. Blackburn learned that a sample of DNA can provide enough information to learn about a person's health. People with longer telomeres were biologically younger, even if not chronologically. Those with short telomeres were three times more likely to have cancer. Cancer cells have activated telomerase that repairs the vanishing telomeres producing a cell that never dies. Cancers cause problems because they have too much telomerase. Every cell has telomeres, but not every cell has telomerase. This is so that cells can naturally die out of the way, but cancer messes that system up.
So having too little telomeres can cause the problems of aging. Too much telomerase can cause the problems of cancer. Then the healthiest has to be right in the middle. So their might not be a magic potion to reverse aging and rebuild our telomeres. At least not without significant risks. Instead, have have to protect the telomeres we have. Reduce the stress we put on our cells and let them live out their full potential. You won't live forever, but you might make it a long time. Besides, who wants to live forever?
Wednesday, August 20, 2014
LLWS Coach Inspires His Losing Team
What do you say to kids after they lose? After the lose in the Little League World Series? On National TV? David Belisle's post-game speech to his team might be one of the best things you will see in a while. A lot of bad is happening in the world - from Iraq to Missouri. But this is some much needed good.
I played sports from Kindergarten to College - basketball, football, wrestling and more. I was a coach for 7 seasons. I love competition and I absolutely hate to lose. This guy puts it the right way. No this doesn't mean to always be proud of losing. But when you play the right way, do the right thing and put all your effort and intensity into the game, sometimes you still lose. If you Play Hard, Play Smart, Play Together, you can be proud. This speech reminds me why America loves our sports. Why athletes are more likely to be hired than non-athletes. We want people that work hard, people that can come together, and people that can learn from their losses.
I played sports from Kindergarten to College - basketball, football, wrestling and more. I was a coach for 7 seasons. I love competition and I absolutely hate to lose. This guy puts it the right way. No this doesn't mean to always be proud of losing. But when you play the right way, do the right thing and put all your effort and intensity into the game, sometimes you still lose. If you Play Hard, Play Smart, Play Together, you can be proud. This speech reminds me why America loves our sports. Why athletes are more likely to be hired than non-athletes. We want people that work hard, people that can come together, and people that can learn from their losses.
Tuesday, August 19, 2014
TED Talk Tuesday: Charlie Todd
Charlie Todd does improv in New York City. In one of my favorites, he talks about the shared experience of the absurd. People doing weird things in public just for the amusement of others. Which is very different from doing weird things just for your own amusement. The most important thing is that it is all in good fun.
Enjoy!
Enjoy!
Monday, August 18, 2014
Your Skin Through UV
In our therapy class, we are talking about dermatology. Our first SOAP note, due Wednesday, is about skin care and sunburns. Most of the damage caused to our skin comes from Ultraviolet Radiation. UV rays come in three flavors - UVA (aging), UVB (burning), and UVC (blocked by ozone layer). To protect yourself from burning, aging, and potential skin cancer, everyone should use sunscreen. The fairer your skin, the higher the Sunburn Protection Factor (SPF) should be.
The video below will show you why. We have ultraviolet cameras now which can show you what your skin actually looks like. Thomas Leverit took a UV camera into a park to show people their skin. The more freckles that appear the more damage had been done. Look at the kid's skin compared to everyone else. BUT most importantly, stay until the end and see the effect of sunscreen on the camera. You will not be disappointed.
The video below will show you why. We have ultraviolet cameras now which can show you what your skin actually looks like. Thomas Leverit took a UV camera into a park to show people their skin. The more freckles that appear the more damage had been done. Look at the kid's skin compared to everyone else. BUT most importantly, stay until the end and see the effect of sunscreen on the camera. You will not be disappointed.
Friday, August 15, 2014
Fall PY2 Week 1
Classes have officially begun on a new school year! The PharmD program always begins a week earlier than the rest of the university, but then we also finish earlier too. As expected, this was a week of introductions. But any excitement for the new year was quelled by a family trauma.
To start the week, I had an afternoon meeting of CAPS leaders. Deciding to get to campus early and work a little in the library, I took the dogs out for their last pee break about 10 am. After a few moments of running around like normal, Augi got a weird look on his face. He stopped moving and stood in place. I had to tug on him to get up the stairs and into the house. I thought he was going to throw up or have a problem on the other end. He didn't respond to any commands or even his name. He just laid down struggling to breathe through his very white mouth. I called the vet who told me to go to the emergency vet immediately.
Getting a collapsing Augi into the back of an SUV was not easy, but he was in the emergency room within 30 minutes of showing signs of shock - white gums, cold ears and limbs, unresponsive. He did not care about any of the people in the waiting room. And the nurse had to put him on a gurney to take him back. The scariest part was signing a sheet to authorize CPR on a dog, which is $600 and has a 10% success rate. The vets in the emergency room did a great job though. He was hooked up to fluids immediately and started getting some tests done. He started getting fluid in his abdomen and had low platelets and high ALT. Augi was in Acute Liver Failure. The cause is still unknown. Maybe a mushroom or some kind of infection. But thanks to the staff at the Vet Specialty Hospital of Durham, Augi is back at home after 3 days in the ICU. We are still worried about him and giving him a wide assortment of medications. Most importantly though, he is home again.
So a lot of my enthusiasm for the beginning of classes was diverted toward worrying about Augi and Emily. But I did have some excitement and learned a lot in just three days.
Monday - No classes yet.
We had a CAPS Leaders Meeting at 1 pm, which I was late to. My main role that day was to take the pictures of the leaders. Sounds easy, but for some reason I am missing quite a few people. Some of my spare time this week was spent updating the CAPS website.
Tuesday - Official first day of classes.
Our first class of the day begins at a lazy 9 am - two hours of Drug Literature. After some introductions, the Drug Information Specialist at UNC Hospitals began the first of three classes. This is all about how to handle requests for information from doctors, nurses, or patients about a medication. Most important message - understand the question. All requests fit into some kind of category - Interactions, Reactions, Compatibility, etc. Knowing what kind of question you have lets to pick the right resource and tailor your response. Remember, an expert is not someone that knows all the answers, but the most efficient way of reaching it.
After Drug Lit, we were introduced to Medicinal Chemistry. The professor went over the syllabus and that class ended in about 15 minutes. After lunch we met with Pharmacotherapy. Our first unit is dermatology and we jumped right in. We had to review 100 slides before class to be ready to go over the first set of cases. Not to bad. Remember to moisturize, moisturize, moisturize.
Wednesday
During registration I chose the Wednesday morning lab. I like it. We met the professors in charge of the class, and then headed to our groups. My group was very quiet, but efficient. I think I decided I am ready to take the lead in the small section. I want to assert myself and answer questions. Taking the backseat just gets you through. For the agenda, we took a quiz (23/25) and went over the drugs for next week's quiz. For compounding today, we made a hydrocortisone semisolid in what looks like a deodorant stick. The process was more complicated than I expected. We used beeswax as the stiffening agent, which had to be melted. No problem there until you remove the heat. Beeswax cools incredibly quickly, even when mixed with mineral oil and hydrocortisone. I cannot guarantee that my compound will pass inspection this time around. I may be going back to redo it in a couple weeks.
After lunch, we had Pharmacokinetics. As another introductory class, the professor explained the course and his travels over the summer. Mostly he was making time until the Dean showed up for the second hour. The Dean talked about the tragedy of a professor that was murdered over the summer just off campus and the changes to the school.
Thursday
The courses are a repeat of Tuesday's schedule, but we did more work. In Drug Lit, we went over the Tertiary Sources for Drug Information. These are the textbooks or databases that we all search online. I have two booked marked on my computer. There are some resources that are specific to certain questions, especially IV drugs or Pregnancy questions. Essentially, a tertiary source provides a summary of the research available. Some are more detailed and others are more specialized. It is just important to know where to look for what information.
MedChem had one of my favorite professors reviewing some terms. Autocoids are signaling molecules that usually send information over a short distance. They usually activate a GPCR (G-Protein Coupled Receptor). All of this was covered last year in Biochem and Therapy.
Dermatology was very similar to the previous class. This time we talked a lot about fungal infections like dandruff and an allergic reaction to codeine. The answers are fairly similar. If it itches, take diphenhydramine (Benadryll). If it is inflammed, a steroid should work (hydrocortisone, triamcinolone). Always check the vehicle that carries the drug. Creams, ointments, and lotions are not all the same thing. Apparently, general practitioners only pick the right vehicle 50% of the time (they aren't dermatologists). This is where the pharmacist can intervene and make sure the patient gets the right combination.
Friday - NO Classes
Friday is my day off. Well, off is a relative term. I hope to write my weekly update on Fridays. And then I have a lot of work to do for the next week. We already have our first SOAP Note due next week. SOAP Notes are a patient case that we have to analyze and make recommendations for treatment options. This one is about dermatology so I am sure moisturize will be one of the answers.
 |
| Augi had a ruff week |
Getting a collapsing Augi into the back of an SUV was not easy, but he was in the emergency room within 30 minutes of showing signs of shock - white gums, cold ears and limbs, unresponsive. He did not care about any of the people in the waiting room. And the nurse had to put him on a gurney to take him back. The scariest part was signing a sheet to authorize CPR on a dog, which is $600 and has a 10% success rate. The vets in the emergency room did a great job though. He was hooked up to fluids immediately and started getting some tests done. He started getting fluid in his abdomen and had low platelets and high ALT. Augi was in Acute Liver Failure. The cause is still unknown. Maybe a mushroom or some kind of infection. But thanks to the staff at the Vet Specialty Hospital of Durham, Augi is back at home after 3 days in the ICU. We are still worried about him and giving him a wide assortment of medications. Most importantly though, he is home again.
So a lot of my enthusiasm for the beginning of classes was diverted toward worrying about Augi and Emily. But I did have some excitement and learned a lot in just three days.
Monday - No classes yet.
We had a CAPS Leaders Meeting at 1 pm, which I was late to. My main role that day was to take the pictures of the leaders. Sounds easy, but for some reason I am missing quite a few people. Some of my spare time this week was spent updating the CAPS website.
Tuesday - Official first day of classes.
Our first class of the day begins at a lazy 9 am - two hours of Drug Literature. After some introductions, the Drug Information Specialist at UNC Hospitals began the first of three classes. This is all about how to handle requests for information from doctors, nurses, or patients about a medication. Most important message - understand the question. All requests fit into some kind of category - Interactions, Reactions, Compatibility, etc. Knowing what kind of question you have lets to pick the right resource and tailor your response. Remember, an expert is not someone that knows all the answers, but the most efficient way of reaching it.
After Drug Lit, we were introduced to Medicinal Chemistry. The professor went over the syllabus and that class ended in about 15 minutes. After lunch we met with Pharmacotherapy. Our first unit is dermatology and we jumped right in. We had to review 100 slides before class to be ready to go over the first set of cases. Not to bad. Remember to moisturize, moisturize, moisturize.
Wednesday
During registration I chose the Wednesday morning lab. I like it. We met the professors in charge of the class, and then headed to our groups. My group was very quiet, but efficient. I think I decided I am ready to take the lead in the small section. I want to assert myself and answer questions. Taking the backseat just gets you through. For the agenda, we took a quiz (23/25) and went over the drugs for next week's quiz. For compounding today, we made a hydrocortisone semisolid in what looks like a deodorant stick. The process was more complicated than I expected. We used beeswax as the stiffening agent, which had to be melted. No problem there until you remove the heat. Beeswax cools incredibly quickly, even when mixed with mineral oil and hydrocortisone. I cannot guarantee that my compound will pass inspection this time around. I may be going back to redo it in a couple weeks.
After lunch, we had Pharmacokinetics. As another introductory class, the professor explained the course and his travels over the summer. Mostly he was making time until the Dean showed up for the second hour. The Dean talked about the tragedy of a professor that was murdered over the summer just off campus and the changes to the school.
Thursday
The courses are a repeat of Tuesday's schedule, but we did more work. In Drug Lit, we went over the Tertiary Sources for Drug Information. These are the textbooks or databases that we all search online. I have two booked marked on my computer. There are some resources that are specific to certain questions, especially IV drugs or Pregnancy questions. Essentially, a tertiary source provides a summary of the research available. Some are more detailed and others are more specialized. It is just important to know where to look for what information.
MedChem had one of my favorite professors reviewing some terms. Autocoids are signaling molecules that usually send information over a short distance. They usually activate a GPCR (G-Protein Coupled Receptor). All of this was covered last year in Biochem and Therapy.
Dermatology was very similar to the previous class. This time we talked a lot about fungal infections like dandruff and an allergic reaction to codeine. The answers are fairly similar. If it itches, take diphenhydramine (Benadryll). If it is inflammed, a steroid should work (hydrocortisone, triamcinolone). Always check the vehicle that carries the drug. Creams, ointments, and lotions are not all the same thing. Apparently, general practitioners only pick the right vehicle 50% of the time (they aren't dermatologists). This is where the pharmacist can intervene and make sure the patient gets the right combination.
Friday - NO Classes
Friday is my day off. Well, off is a relative term. I hope to write my weekly update on Fridays. And then I have a lot of work to do for the next week. We already have our first SOAP Note due next week. SOAP Notes are a patient case that we have to analyze and make recommendations for treatment options. This one is about dermatology so I am sure moisturize will be one of the answers.
Thursday, August 14, 2014
Before I Fall to Pieces
Here's the British band Razorlight with their 2006 song, Before I Fall to Pieces. This song includes perhaps my favorite lyric of all time.
Now I'm just waiting for something that might never come
If it's a million to one shot I'll make sure I'm one.
Enjoy!
Wednesday, August 13, 2014
Robin Williams Gathering Rosebuds
Robin Williams died this week. He had a unique wit that allowed him to perform amazing feats of improv. But as we now know he had his demons. Still, his work will live on forever. As an actor he showed incredible range. One of his best was Dead Poet's Society. In the clip that follows, Robin Williams plays a new teacher with his class. His lesson is to see the people of the past as just like us - with ambitions, dreams, and hormones. We should appreciate those that came before us and learn from their successes and failures. Use this short time on Earth to do as much good as possible. Mork, the Genie, Popeye, and on an on made people happy.
Gather ye rosebuds while ye may,
Old time is still a-flying: And this same flower that smiles to-day To-morrow will be dying.
Gather ye rosebuds while ye may,
Old time is still a-flying: And this same flower that smiles to-day To-morrow will be dying.
Tuesday, August 12, 2014
TED Talk Tuesday: Richard St. John
Everyone wants to become successful, but how do you stay successful? Richard St. John tells a quick story of building, collapsing and rebuilding. Success is a continuous process that doesn't end once you reach the top. Other people want to get there and will keep improving themselves, so you have to keep improving yourself. It's not good enough to graduate with a PharmD, you have to keep educating yourself and updating the newest drugs.
Michael Jordan was the greatest basketball player of all time. His success came from athletic ability AND intense, continuous practice. How many times do we see a champion team fall apart the next season? Michael Jordan and the Bulls didn't fall into that trap they continually improved and stayed ahead of the NBA. What's true in sport is true in life. Champions, winners, and other successful people who stay on top keep improving themselves through practice, through education, through passion.
Michael Jordan was the greatest basketball player of all time. His success came from athletic ability AND intense, continuous practice. How many times do we see a champion team fall apart the next season? Michael Jordan and the Bulls didn't fall into that trap they continually improved and stayed ahead of the NBA. What's true in sport is true in life. Champions, winners, and other successful people who stay on top keep improving themselves through practice, through education, through passion.
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