Public Education and Political Parties

If you believe in Public Education - as a force for good, a weapon against poverty, a vaccine against ignorance - then you must vote for the Democrats. The other political party consistently shows itself hostile to public education by cutting resources, eliminating assistants, and outright attacking teachers.

I am a proud product of public schools -  K-12, Undergrad, Masters, Doctorate. I taught in public schools for 7 years. I would not be where I am today without public schools. And I firmly believe that all children deserve a quality education. The Democratic Party stands for education, stands for children, and stands for teachers. 

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You cannot say that you support education while voting Republican. If you believe in education, believe in a better future, better citizenry, and better economy. It is a simple choice - Vote for the Democrats.

Compounding in Pharmacy School

One of the more stressful parts of Pharmacy School so far has been compounding.  Compounding prepares a specific product for a specific patient.  As opposed to manufacturing that provides a more generalized approach.  You can remove excipients that might cause allergic reactions or you can simply change one formulation for another.  A lot of this is done for pediatrics turning a large tablet into a liquid.  So far in three semesters, we have made creams, sticks, solutions, and suppositories.

The actual compounding can be fun.  Manipulating ingredients to help a patient.  The stress comes from rest of the process.  We have a quiz on the various formulations in the form of questions written by the man who wrote the textbook regarding compounding.  We must complete a compounding record that includes the manufacturer, lot number, and exact amounts of every ingredient.  We counsel our TA as if s/he were the patient, so we memorize the major counseling points.  And every product is tested to make sure it is within 10% for the stated strength.  If your products falls outside of 10%, you have to come back and remake it.  If you are too far outside, especially too high, you have "killed the patient" and receive a zero without the option to remake it.

But I learned last week that not every pharmacy student goes through this.  In fact, only half of the pharmacy schools do any compounding at all!!!  For some, compounding is little more than an elective course that students take for a semester.  Few compound as regularly as we do.  Of those, very few routinely test the products for accuracy.  And we seem to be the only school that tests every product that gets made.  That means that they just go through the motions and hope that the products are good.

Much of this comes from budgeting concerns.  Compounding is expensive.  I know.  I bought lab supplies for my classroom.  It's not easy.  Checking the products takes more money and time.  Things that can be rare in a pharmacy school.

But compounding is important.  A study randomly checked some compounded products from some pharmacies and found a wide range of accuracy, from drastically underdosing (essentially a placebo) to dramatically overdosing (more than 400%).   A lot of the range comes from technique.  We hear a lot about quantitative transfer.  We routinely make 10% extra product to account for loss.  But in all, compounding is an important skill.  A licensed pharmacist may never, ever compound during there career.  But all pharmacists should know how to do it.  It's like parallel parking.  I avoid parking that way, but to get my driver's license I had to display enough control of a car to complete the task.  Maybe compounding should become an essential part of a PharmD degree.

A Different Timeline of Earth

One difficulty in teaching biology was explaining the history of Earth.  How do you effectively show 4.6 billion years to 15-year-olds?  I have used timelines, football fields, and even a piano to represent deep time.  There was a great TED talk on the subject as well.

I think that I like this one the best.  The details would be hard to show, but everyone would understand it.  Just use your arm!

It would be like a built in cheat sheet.  Everyone can bring their arm to the test.  I don't know if it would work, but it is an interesting way to think about time.

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.

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.

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 McMap of the US

At the start of a class, I would put up this picture:

The description would have been removed and I would offer extra credit test points to the first person that could tell me what this picture represented.  They came up with a lot of answers - the US, cities in the US, cell phone towers, Facebook users, and on and on.  Eventually, someone would get it right - every McDonald's in the contiguous United States.  Wow!

That is a lot of McDonald'ses.  They are everywhere.  I really like the brighter spots that show you the locations of cities.  You can see Raleigh-Durham, Greensboro, and Charlotte pretty clearly.  Stephen Von Worley constructed this map in 2009 to demonstrate the our collective proximity to the fast-food chain.  To be clear, the map has actually changed since then.  Von Worley also determined the McFarthurest spot - the place on the map furtherest from any McDonald's.  If you ever visit Glad Valley, South Dakota, you would have to drive about 145 miles to buy a Big Mac!

I Hate These Word Crimes

"Weird Al" Yankovic returns with an awesome parody of Blurred Lines.  The American language has devolved into text-speak and emojis.  Weird Al takes on every complaint about language in this video that will probably show up in every English class across the country.  I mean ... these grammer mistakes literally makes my head explode and I definitely LOLed at it's message.

Enjoy!

Be A Man

While I coached high school football, the school board became attached to a 1970's football player turned coach and pastor, Joe Ehrmann.  His son played for Wake Forest and since he was around a lot, he would come and speak to us ...  a lot.  He spoke at a Faculty Meeting, School Coaches Meeting, County Coaches Meeting, and a Youth Camp.  Every coach in the county was given the book Season of Life, by Jeffrey Marx about Ehrmann's successes as player and coach of Gilman High School.  Recently, Joe sat down with NPR's All Things Considered to talk about what it means to be a man.

Coaches have an enormous power to mold young men, and women, through their high school career.  During those four years, a scrawny 14-year-old boy develops into an 18-year-old man about to head out into the world.  No doubt that at some point, every male has heard the phrase, "Be a Man".  But mostly, no one ever explains what that means.  Joe Ehrmann believes that the old view of masculinity revolved around three basic lies - Athletic Ability, Sexual Conquest and Economic Success.  Your manliness is essentially on a scale based on these three attributes.  Instead, Joe argues, manhood should be about your capacity to love and your commitment to a cause.  We should be building relationships instead of walls.

Joe Ehrmann gives a great talk and I urge to to listen to the NPR link or to check out the book.

Be a Good One

If you are going to do something, be the best at it.  Doesn't matter what it is, try your hardest.  You may not become the best, but you will get better.  You will find where your talent lies and potentially impress the right people to get you where you want to be.

This is Rule #2

Lucky Fish

In high school, my favorite wrestling shirt featured this quote.  Learn it.  Live it.

This is Rule #3... more to follow.

The Broken Escalator

Do you ever have some place to go, but then get stuck on the path.  Maybe you are in school for a specific target, but don't feel that the teachers or professors are helping you get there.  Do you complain and wait for them to help you?  Or do you take matters into you own hands?  Education is not dispensed from on high, but a journey to explore one step at a time.  Pay attention in class, but also read the book, ask questions, go to office hours, write emails.  Most importantly, don't get stuck and do nothing about it.  Take your education into your own hands.    Don't be like the people on the broken escalator.



College has changed a lot since I was last here.  Sure we had laptops and cell phones, but for the most part, students dutifully took notes on paper.  I kept all of my college notebooks, which I actually used a few when teaching.  But now, everyone seems to download the powerpoint onto their MacBook Pro, open it when the professor starts and proceed to Facebook or Amazon.  I am shocked by the number of people that don't really pay attention during pharmacy school.  Then they complain about having to rewatch the lectures and not doing as well on their exams.

I found success this semester with a very simple set up.  I download the PPT file and convert it into a PDF of two slides per page.  I upload it to the Dropbox to transfer to my iPad and open in NoteTakerHD.  That is were I take my notes.  Most importantly, since the iPad only does one thing at a time, I can't lose myself in other websites.  I also read the books, make study guides, based on the objectives listed by the professor, and make flash cards on Quizlet.

My problem is to remember that education is more than making A's in the classroom.  As introverted as I am, I must force myself to get out there and participate in the various clubs and talk to professors.  They gave us a professor as a mentor, but I failed to utilize him.  I am going to correct that next year.  I did some CAPS activities, but I plan to do much more this year.  I am now the webmaster/historian, putting me into a leadership position.  I am joining the Recruitment Ambassadors to spread to word about pharmacy and specifically the UNC Eshelman School of Pharmacy.  I plan to join the SHAC clinic and actively work with local patients during the semester.  Take control of your education and make your weaknesses you strengths.

IPPE Yippies

During the entire month of May, I interned at the University of North Carolina Hospital.  The coveted Chapel Hill placement gave me a ton of opportunities that other PY1s may not have experienced.  The first thing you need to know is that UNC Health Care is huge.  The campus covers the entirety of South Campus and houses the Memorial Hospital, Children's Hospital, Women's Hospital, Neurosciences and Cancer Center.  There are three amazing places to eat and the world's largest Starbucks (24/7 and a 20% discount).

My internship was called the Introductory Pharmacy Practice Experience (IPPE).  Working with a preceptor, we are expected to learn the ins and outs of being a hospital pharmacist.  Almost every other pharmacy school sends their first year students into the community first, but we do things a bit differently.  You definitely start off feeling out of place on a content level and lost on a physical level.  My goal at the beginning was simple - find out if there was any area of hospital pharmacy that I could not see myself doing.  In the end, I felt comfortable throughout and could not find anything to mark off the list of possible future careers.

I and my 14 fellow IPPEs experienced many different areas of hospital pharmacy during our rotation in May.  I feel that we probably received a broader education than IPPEs that went off to other hospitals, especially the smaller ones.  While spending more than one day in an area would give depth to the experience, I would not trade the breadth.  I will be writing about each of the different areas that we went in much more detail throughout the month.  I have a lot to say about each of them and maybe they help some other people.

One major difference to mention now would be the set up.  Instead of a single pharmacist in charge of us, UNC delegates the IPPE education to two outgoing PGY2-Administration residents.  The Pharmacy Administration Residency is a two year program and they do a lot regarding management and leadership.  As a former coach, I have great respect for those particular aspects of the pharmacy world.  Our 15 students were divided into two groups for a challenge to have a pizza lunch with the Director of Pharmacy at the hospital.  My team, the IPPE Yippies, took on the Conformational Floppies through several tasks.

1. We wrote on Wiki site through the School of Pharmacy about pretty much anything.  Whoever wrote the most received the most points for their team.  I hadn't planned on doing, but a another student pounced on it early.  I soon made my goal to catch her, but she had such a huge lead that I could only achieve second place.  
2. One day we debated the merits of the 340B program that UNC Hospitals use for cheaper medications.  Our team won that by having the pro-340B side with all of the judges being hospital pharmacy residents.  I will write more about 340B later.
3. We wrote SBAR memos to the director to make suggestions about improving the hospital.  SBAR is a common method of communication in the hospital to deliver ideas or information quickly and efficiently.  The Conformational Floppies dominated us in this one.  They wrote 7 suggestions while my team only wrote 3 (and I had 2 of them).  At this point, it did not seem like my team was interested in winning the competition.
4. Finally, we mapped out the flow of medication through the hospital from order, verification, dispensation and administration.  Each team had to make one in a group effort to understand the hospital.  The Conformational Floppies apparently met for several hours on a Sunday to do theirs.  The IPPE Yippies put it off until the last second.  I tried to organize a lunch meeting to work on it, but it was a no go.  We really did not want to win apparently.  On the last day, we knew that we had to turn something in, so someone put it together quickly.  We looked it over on Google Docs and submitted it with no color and very little effort.  Whichever team won the map would win for the month.  

By a vote of 2-1, the IPPE Yippies prepared the most accurate medication map for the hospital.  Theirs was prettier, but ours was better.  You could say that we were shocked at the announcement.  We did not expect to win, nor did we really try.  Oops.  In the end, I suggested that everyone should be invited to the lunch with the Director.  And on the last day, after evaluations, we ate pizza and said our anticlimactic goodbyes for the rest of the summer.  It was weird leaving the hospital that last day.  Our badges had been taken and we had nothing left to do.  Classes wouldn't start for 2 months and all the stress and anxiety of our first pharmacy rotation had come to an end.  I am grateful for the opportunity to experience each of the areas at the UNC Hospital.  I have much more to say about everything that happened for my own reflection and for those interested as well.

TED Talk Tuesday: Adam Savage

The Mythbusters bring a excitement and beauty to the scientific process that inspires millions of kids in the science classroom.  I used the Mythbusters a lot during my teaching days to help them understand the scientific method.  Especially in Physical Science, we would watch an episode after every test and they would dutifully require the Hypothesis (Myth), Experiment, Data, and Conclusion (Busted/Confirmed/Plausible).  Kids need to learn that "Failure is always an option".  Too many people see failure and quit, but the Mythbusters rightfully view failure as an opportunity to try again.

Adam Savage brings some of that wonder to the TED stage in this TED Ed Talk about how simple ideas lead to important scientific discoveries such as the speed of light or the circumference of the Earth.  We are all explorers attempting to understand the world before us.  Somethings are known, but a lot remains in question.  As the Mythbusters show, some of the things we know are not.  

The best part about these TED Ed talks is that it is animated.  My students always liked the animated talks more than normal lectures.  They can follow the images even when they don't fully understand the words being said.  So if you are showing TED Talks in classes, I urge you to check out their animated videos.

Enjoy!

PY1 Review - Physiology

Starting pharmacy school marked a major shift in my life.  No longer do I stand in front of the class talking about science and lighting things on fire.  Now I sit in the front row, taking notes and answering questions.  Before a couple years ago, pharmacy school was never an option that crossed my mind.  Not because I did not think that I could do it, but because I had never learned anything about it.  Teachers, counselors, nor professors ever presented pharmacy as a potential option.  I hope to change some of that.  Obviously, I am attempting to write on this website and twitter, but I also hope to talk to teachers and students about an exciting career path.

In attempt to help, I thought that I would review some of my experiences in the first year of pharmacy school.  My first topic will be Physiology.

Since I taught anatomy, I figured physiology would be one of my advantages this year.  But the way I taught the course was completely different from my first course.  In high school anatomy, most teachers begin with an overview of terms then on to cells, tissues, skin, bones, muscles, brain, endocrine, and whatever else can fit in before the final exam.  The pharmacy physiology class began with Cardiology.  It makes sense.  Heart attacks and congestive heart failure are among the biggest killers in the United States.  Next to pain, medicines to control blood pressure top the most prescribed and sold drugs each year.  HCTZ and other diuretics balance the accumulation of water while ACE inhibitors and statins affect the diameter of blood vessels.  Rather than primarily focusing on the structural anatomy, pharmacy physiology appropriately addresses the function of the body.

This particular course was set up differently from the others.  Before the unit, we read a document that reviewed the system and then took a quiz.  We answered the quiz questions individually and then as a group.  In the next class, the ever changing professors (clinicians in the specific field) taught through case studies.  Before exams, we faced cases that integrated several systems together.  Despite the strange course set up, I felt that I learned quite a lot.  My knowledge base as an anatomy teacher definitely helped, but would not have carried me through the course.  I really like learning anatomy through the lens of medications that alter or restore baselines.

For any teachers interested, I will list the order topics here.
Module 1 - Cardiology
Module 2 - Renal
Module 3 - Hematology
Module 4 - Gastrointestinal
Module 5 - Central Nervous System
Module 6 - Respiratory
Module 7 - Endocrine

Obviously, not much discussion about skin, bones and muscles.  Instead, the course featured the primary health care related systems.  Millions of people live on blood pressure medications and kidney problems drastically affect a patient's response to drugs.  How many people suffer from acid reflux or take mood stabilizing medications.  I like the idea of teaching the human body through clinical importance instead of easy memorization and textbook order.  If I had really thought about it when I was teaching, I would have strongly supported this curriculum.  Like 25% of the students take some sort of ADHD medication - Concerta, Adderall, Strattera.  Many kids suffer from asthma taking Proventil, Combivent, Advair.  Maybe more high school anatomy teachers can bring a clinical pharmacy perspective to the classroom.

De-Pict-ing Biology

At the end of each biology semester, I drew a similar picture.  I wanted to put an entire curriculum worth of biology into one picture.  Or at least get as much of it as I can.  I tried to show as many main ideas as possible and to tie everything back to one main idea: Life will continue...

I made the picture better with each semester, but since I have finished teaching I thought that I would put it on here.  Maybe someone will come along and make it a bit better.

Doing Science

As a former science teacher, this sounds about right.  Most of the activities students do in class follow the very basic, structured Scientific Method.  You know: Observation, Hypothesis, Experiment, Data Collection, and Conclusion.  Classroom labs generally involve an experiment that has been done millions of times and the procedure carefully typed into a word document.  Typically, the idea is to emphasize the main point of a lecture like finding the density of an irregularly shaped object.  These "Science Experiments" come sterilized and prepackaged.  No really, you can buy a lab in a box that comes with everything you need including the student worksheets and answer keys.  

Rarely, do students get to actually participate in science.  Probably because it is messy, complicated, and can't be finished in a 90-minute period.  State curriculums and tests drive the science classroom to prevent the exploration of good science for students.

Let the Kids Decide

I posted this before, but blogger had a hiccup and erased the article.  Creationists often say that teachers should teach both sides of the Evolution-Creation debate.  They continue this ploy as if a scientific consensus hasn't been reached.  They also pretend that no other scientific idea doesn't have a controversial alternative.  

I suggest that if the poorly named "Academic Freedom Bills" pass in a state near you, embrace the sentiment and teach these alternative theories.  Let your kids decide which makes more sense: Alchemy or Chemistry; Neurology or Phrenology, Astronomy or Astrology; Physics or Magic.  While your are at it, teach the kids why intelligent design fails as science.  If they want you to teach the controversy, explain why no controversy actually exists.  Give them the accurate information and let the kids decide.

TED Talk Tuesday: Jamie Oliver

A few year's ago, Jamie Oliver gave an inspired talk about food.  No one can doubt that America has an eating disorder.  We eat way too much in general and then focus on the bad stuff.  In fact, our government subsidizes the barely nutritious, prepackaged food-like substances with food stamps and other means.  As I am on my way to becoming a pharmacist, I probably shouldn't say this - but food is medicine.  A lot of our problems could be solved with proper meals and learning how to cook.

Oliver went to West Virginia to help their problem with childhood obesity by going straight into the schools to teach the kids about food.  He later went to Los Angles, only to be kicked out for trying to help.  This British Chef makes a lot of great points in this breathless overview of our problem.

Enjoy!

Science if Awesome (GIF)

Speaking of Goldenrod Paper.  I forgot that I had tried to make a GIF of the process.  We were doing something in class for them to make animations, and I wanted to try a GIF maker on my iPhone.  As you can tell, this particular message has be read so many times that the words kind of show up at the beginning.  When you first do it, no one can see it - especially from across the room.

I need a little bit more practice with my GIF making, but I think it is a good start!