APPE Reflection- Surgery

Wow. I’m finally done with my APPE rotations. All that stands between me and my PharmD is a 1-month NAPLEX review course. This rotation was a really good experience. I feel like I learned a lot and was able to help improve patient outcomes.

You might be wondering what in the world a pharmacist or pharmacy student would be doing during a surgery rotation, so let me give you a little insight into what I was doing.

My preceptor and I sat on the surgical floor (near the nurses) and worked through our patients. We dealt with any pre or post-op medication issues or issues relating to a patient’s home medications. We made sure the patients got their antibiotics on time and didn’t get them if they were not needed. We also worked directly with the nursing staff to make sure the patient’s pain was well controlled. The main reason we sit with the nurses and not down in the main pharmacy is so that we can hear everything that goes on and can act fast when something happens.

Every day this month, I looked at about 7-10 patients, went through their medical chart, and completed a whole workup on them. A “whole workup” includes their background, the reason that they were in the hospital, any pertinent lab values, drug allergies, home medication list, current inpatient medication list, etc.

Along with working the patient up, I went to speak with them after their surgeries to make sure that their medication list that we have was correct (i.e. a medication reconciliation) or ask them any questions that we had about their medications.

I also spent a lot of time talking to the nursing staff and the providers to try and get antibiotics corrected or stopped on time or change doses of a patient’s medications.

Overall, this month I have become more confident making recommendations to the providers and talking to patients. I was able to get patients sent home on appropriate antibiotics and stop antibiotics when they were no longer necessary. I feel like I was truly able to make an impact on the care of the patients that I interacted with.

Over the course of the month, I also had 4 topic discussions with my preceptor (Post-operative Nausea and Vomiting, TPN management, Appendicitis, and Septic Joint Infections) and a presentation to the pharmacy staff on Post-Operative Ileus Prevention and Management.

Of course I also helped in several COVID vaccine clinics as well.

I cannot believe that it has already been a year since I started this journey.

I cannot believe that I’m almost a pharmacist. If you know me, you know that I’ve wanted this for as long as I can remember and now its ~6 weeks away (well.. I guess a few months until I’m licensed to practice).

I hope you’ve enjoyed walking through this journey with me.

I’ll keep you all updated on my post-graduate plans, and I’ll continue to blog as a practicing pharmacist.

Once I pass the board exams, be on the lookout for a blog post on helpful study tips!

Stay Golden,

Emily

APPE Reflection: Internal Medicine

Wow… I cannot believe I only have 1 rotation left! This month went by so quickly. This month was a whirlwind in terms of everything happening all at once. I had several post-grad job interviews, and I had a lot going on personally otherwise. However, I feel like I was really able to make a difference for my patients during my Internal Medicine rotation.

I made countless recommendations to providers (primarily changing up insulin regimens and adjusting antibiotics), but one in particular stands out. We had a patient that was in for possible infective colitis (inflammation of the colon caused by bacteria) who subsequently got a new diagnosis of Non-Alcoholic Steatohepatitis (NASH), which is a type of liver disease. He had ascites (fluid buildup in his abdomen due to the liver disease), which increased his risk of a bacterial infection of the inner abdomen called spontaneous bacterial peritonitis, or SBP.

Why this is important is that I have had experience with patients with liver disease and ascites who do develop SBP and actually did a case presentation on a similar patient a few months back. I noticed that his white blood cell count (WBCs) had been trending up and he was on appropriate treatment for colitis. I mentioned to the provider that the patient could now have SBP and that we should consider getting a paracentesis (sample of the ascitic fluid) and possibly switching antibiotics. Once we got the results of the paracentesis, it was noted that the patient did have SBP, so the recommendation to switch antibiotics was accepted. This provider was extremely thankful for my input and this recommendation, which I made during the first week of my rotation, helped me to build a great professional relationship with that provider.

I took part in another mass COVID vaccination event at the beginning of the month.

A lot of this rotation was focused on learning antibiotics, which I really needed. I have always had a hard time keeping antibiotics straight, but now I feel like I understand them a lot better. I also gave a case presentation on bacterial meningitis at the end of the rotation.

Overall, this rotation was a great experience for me, and I am so glad that I got the opportunity to experience it.

Stay Golden,

Emily

A Gluten-Free Guide: Raleigh-Durham, NC

Living the Celiac life is challenging enough without having to worry about tracking down Gluten-Free restaurants on your own. Here’s a list to get you started.

All of this information is based on contributions from members of the Raleigh Celiac Support Group, per their website.

Restaurants with Gluten Free Options

Cary

  • Barry’s Cafe  in Cary that has GF food choices
  • Outback Restaurant, 901 Walnut St, Cary
  • Brixx, 4112 Bradford Green Square and 1111 Parkside Main St, Cary
  • Burger 21, 14220 Bradford Green Square, Cary – chain serving burgers; restaurant website has GF menu of burgers, salads and shakes; restaurant advises to let them know about allergy
  • Glory Days Grill, Publix Pointe Shopping Center,1413 Kelly Rd.,Apex, NC 27502  (919) 629-6111, glorydaysgrill.com, Glory Days Grill in Apex does a great job with gluten free food items and processes. 
  • Goji Bistro, 100 Maynard Crossing Ct, Cary  – Asian; review of restaurant website shows they have GF menu
  • Gonza Taco Y Tequila, 525-105 New Waverly Place, Cary– Colombian and Mexican; no GF info on restaurant website
  • Lugano Ristorante, 1060 Darrington Dr, Cary – Italian and American; review of restaurant website indicates they have a GF menu, has GF dough and GF pasta, GF menu also has appetizers, salad and other entrees
  • Red Robin Gourmet Burgers, 2260 Walnut St, Cary
  • Sassool Mediterranean Café, 1347 Kildaire Farm Rd, Cary  – Mediterranean and Lebanese; review of restaurant website shows few items marked GF though if look under nutrition then indicates full list of menu items that are GF
  • Stellino’s, 1150 Parkside Main St, Cary  – Italian; according to restaurant website, has GF menu restaurant; review of restaurant website has select menu items marked GF
  • Bang Bang Bahn Mi – GF Vietnamese food truck

Chapel Hill/ Carboro/Pittsboro

  • Bartaco, 201 S. Estes Dr, Suite E3, Chapel Hill – tacos-chain; review of restaurant website doesn’t indicate GF info
  • Brixx, 501 Meadowmont Village Circle 
  • The Living Kitchen. 201 South Elliot, Chapel Hill
  • Mediterranean Deli and Bakery, 410 W. Franklin St, Chapel Hill (also in Elon); (919) 967-2666– Mediterranean/ middle eastern food; restaurant, bakery and market; GIG certification, GF pita; see catering menu to identify GF items; serve falafel, gyro, hummus, shwarma, kebabs, etc. Note: not all dishes are GF; note: marinate. 
  • Zoe’s Kitchen, – chain; need to review allergen chart
  • Al’s Burger Shack,516 West Franklin St – have bunless burger; dedicated fryer for GF French fries
  • Fearington House Restaurant – special occasion restaurant, take care of celiac’s food 
  • Oakleaf, 480 Hillsboro St, Pittsboro – knowledge of dietary restrictions (according to Rachel, a celiac who posted this info on web); mains priced in high 20’s
  • The Pig Restaurant – GF barbecue, focus on pork and hog
  • Venable Rotisserie Bistro, 200 N. Greensboro St., Carroboro – careful with celiac’s order, GF items marked on menu (according to Rachel, a celiac who posted this information on web)
  • The Living Kitchen. 201 South Elliot, Chapel Hill

Durham

  • Treforni Pizza, Hope Valley Commons, 1125 W. NC Highway 54, Durham  27707 https://www.facebook.com/treforni
  • Red Robin Gourmet Burgers, 5313 New Hope Commons Boulevard, Extension; Durham
  • Firebirds, South Point Mall, Durham
  • Bonefish Grill, South Point Mall, Durham
  • PF Changs  Southpoint Mall
  • Maggiano’s South Point Mall limited GF items
  • Ted’s Montana Grill, Renaissance Center, 6911 Fayetteville Rd, Suite 102 – GF menu
  • Zinburger Wine and Burger Bar, 8030 Renaissance Parkway #905 – Burger; have GF buns; celiacs report shown a menu with GF items, have dedicated fryer for GF items and told to inform server to prevent cross contamination
  • Guasaca South American Grill,  Venezuelan  food,  in Raleigh and Durham, 2200 West Main Street,  Durham  and 4025 Lake Boone Trail, Raleigh

South Durham and Near Brier Creek (BC), Mall

  • Lugano’s (GF menu)
  • Travinia (GF menu)
  • Georgina’s Pizza (GF pizza crust)
  • Red Bowl (small GF Menu)
  • Smithfield’s Chicken and BBQ (Pork BBQ, cole slaw and French fries- GF) *check if dedicated fryer.
  • Chipotle (Qdoba as well)
  • Mez Mexican Grill
  • Page Road Grill (GF menu)
  • Pei Wei (BC)
  • Brixx Woodfired Grill (BC) (GF pizza crust)
  • Red Robin (BC) (GF burger bun or lettuce wrap)
  • Tasu Asian Bistro (Pad Thai only) (BC) (haven’t been in quite a while not sure if this is still the case)
  • Los Tres Magueyes or El Dorado (BC) (corn taco shells)
  • Jason’s Deli (BC)
  • Tomato Jakes Pizzeria, 8202 Renaissance Pkwy, Suite 101, (Southpoint Mall),   website, shows only has GF pasta
  • Brasa Brazilian Steakhouse (BC) –options avail on the appetizer/salad bar- all meat GF
  • Hibernian (GF menu) 
  • Carrabbas, 5312 New Hope Commons Ext – chain restaurant
  • Bull and Bean Café – serve breakfast all day; GF items marked on the menu; GF bread from Imagine That Gluten Free for “toast” menu items; local neighborhood eatery; M-F 8:00-6:00; Sat/Sun 8:00-3:00
  • Neomonde, 202 Corcoran St, Durham  – Mediterranean; review of restaurant website indicates has GF options
  • Dos Perros, 200 N. Mangum St (downtown) – Mexican; many items  menu are GF, staff are knowledgeable according to web reviews; Tuesday – closed; lunch: M, W, Th and F 11:30-2:30; dinner M, W & Th 5:00-9:00; Friday/Sat 5:00-10:00; Sun 12:00-9:00
  • Geer St. Garden, 644 Foster St – burger and sandwiches; appears on Find Me Gluten Free; have GF bread for sandwiches
  • JuJu Asian Tapas Bar, 737 Ninth St, Suite 210, (919) 286-3555 – menu has GF items; restaurant and chef won award 
  • Local 22 Kitchen and Bar, 2200 W. Main St., (919) 286-9755 – GF items marked on the menu
  • Nasher Café at Nasher Museum of Art on Duke university campus
  • Outback Steakhouse, 3500 Mount Moriah Rd
  • Parizade, 2200 W. Main St – innovative Mediterranean food in fun atmosphere; online restaurant menu notes GF items; longstanding Durham restaurant; appears on Discover Durham restaurant list
  • Piper’s in the Park, 2945 S. Miami Blvd, Suite 112 – has GF bread and sweets; according to web reviews, cooks separately for celiac
  • Refectory Café, 2726 Durham-Chapel Hill Blvd – health food restaurant; according to Find Me Gluten Free, celiacs report staff knowledgeable and eat here, try to accommodate different dietary needs; online menu notes gluten friendly (not gluten free) items; appears on Discover Durham restaurant list
  • Sitar Indian Cuisine – Indian, appears on Discover Durham restaurant list; GF dishes according to Durham blog; need to talk to restaurant since only a few dishes marked GF on restaurant menu on web; Durham local favorite
  • Taberna Tapas, 325 W. Main St – GF items marked on menu, celiacs have eaten here based on reviews
  • The Parlour – ice cream shop makes own ice cream; according to Find Me Gluten Free, celiacs report mark GF items on menu and have GF cones, will change utensils and bring out fresh container but may need to ask; staff knowledgeable about ingredients in ice cream; appears on Discover Durham restaurant list
  • Toast Paninoteca, 345 W. Main St, (919) 683-2183 – Italian sandwiches; Durham favorite; according to Find Me Gluten Free, celiacs report GF bread available and put on foil to prevent cross contamination and have eaten here; Tues-Fri 11:00-8:00, Mon and Sat 11:00-3:00, Sun closed; can dine in or take out; use bread from Imagine That Gluten Free; appears on Discover Durham restaurant list 
  • Twisted Noodle, 4201 University Dr, Suite 112 – Thai; according to Find Me Gluten Free, celiacs have eaten here and report staff knowledgeable and can modify dishes; small casual local favorite; appears on Discover Durham restaurant list, and been mentioned  Bon Appetit according to Discover Durham

Morrisville

  • Fount Coffee + Kitchen, 10954 Chapel Hill Rd, Morrisville – review of restaurant website, according to restarauntant they have 100% GF dishes but also has cautionary note so need to let them know when ordering 

Raleigh

  • Bonefish Grill, North Hills, Good gluten free menu, knowledgeable wait and kitchen staff
  • Carrabbas 4821 Capital Blvd, Raleigh (also in Apex and Durham)Gluten free menu, separate grilling surface for gluten free, gluten free desserts
  • Red Robin  7860 Alexander Promenade Place, Raleigh
  • Vivo’s Italian Restaurant This restaurant is on Six Forks Road. Has separate area in kitchen for preparing gluten free meals.  Food is excellent. 
  • Outback Restaurant two locations in Raleigh: 3105 Capital Blvd and 7500 Creedmoor Rd – Gluten free menu, separate grill surface for gluten free food, gluten free brownie dessert
  • PF Changs  4325 Glenwood Ave, #2089, Raleigh near Crabtree Mall
  • Bella Monica Restaurant  Extensive gluten free menu including pastas and desserts 3121-103 Edward Mills Rd, Raleigh – according to Raleigh Celiac support group,Extensive gluten free menu including pastas and desserts; also recommended by WakeMed Cary Celiac Support Group
  • Centro  106 S. Wilmington St, Raleigh, Mexican restaurant downtown, make their own corn tortillas.  They are so good I actually called the waitress back thinking she had given me flour tortillas by mistake.-http://www.centroraleigh.com
  • Angus Barn  9401 Glenwood AveHighway 70, east of RDU, ask the waiter for Gluten Free options.
  • Big Al’s BBQ  They have lots of GF options to choose from.  The staff is aware of GF people. The only item you may not want to eat is the french fries as they are cooked with other items.
  • Winston’s Grille Winston’s  6401 Falls of Neuse Rd, Raleigh www.winstonsgrille.com
  • Milton’s Pizza and Pasta8853 Six Forks Rd, Raleigh (also in Wake Forest) – based on review of restaurant website, have GF pasta, alert them to special diets; make their pizza from scratch, have GF pizza crust; choose toppings for pizza; www.miltonspizza.com
  • Grabbagreen Food and Juice, 4421 Six Forks Rd, #103B (North Hills) (also in other locations)  – organic, healthy quick food; review of website shows they serve bowls, soups, smoothies, juices; can make own bowl
  • Fresh Levant (100% GF)
  • Arepa Culture (100% GF)
  • Medley (100% GF)
  • Akshi Sushi Bar(Serv Safe certification for Allergen handling)
  • The Melting Pot (GIG certification for Gluten Free Food service)
  •  “Vic’s Italian Ristorante.”  On  Lake Boone Trail, near Rex and have had their G.F. pizza and salad.  They also have G.F. Lasagna and other items to choose from.  There is also another Vic’s Italian Restaurant in downtown Raleigh owned by the same family.  
  • Mellow Mushrooms – Several locations in the area.  They have “Imagine That Gluten Free” gluten free pizza crust and prepare in a separate area. They also they have vegan cheese
  • Gonza at The Factory (This location is very knowledgeable about which items can be made gluten free and also has a dedicated fryer for chips. I love the fish tacos on gf tortillas w a side of rice and the queso dip w gf chips.)
  • Village Deli. They have a delicious gf pita that they can use with most of their sandwiches and burgers. They also have gluten free sandwich bread but the pita is so much better. They are very knowledgeable about which menu items are gf. Most of their sides are gf except the fries. The french dip, the pulled chicken sandwich, the roast beef and may others and all are delicious, esp on the gf pita. They also sell JP’s desserts. I have heard that all of their locations are just as gf knowledgable.
  • Over the Falls  They have an extensive gf menu. The manager who is very committed to making it safe to eat gluten free. 
  • Cowfish in North Hills at Raleigh. Have a great gf menu. and have fed me safely several times. 
  • Jason’s Deli on Falls of Neuse and at Brier Creek is a go-to for me for lunch. 
  •  Firebirds  in North Hills at Raleigh  
  • Shaba Shabu on Wake Forest Rd. In Raleigh
  • Vivace (North Hills)
  • McCormick & Schmitt (Crabtree mall) (very small, limited GF menu)
  • Burger 21, 6196 Falls of Neuse Rd, Suite 116, North Raleign  – chain serving burgers; restaurant website has GF menu of burgers, salads and shakes; restaurant advises to let them know about allergy
  • Bida Madagluten free options and dairy free., Laotian Restaurant in Raleigh. 222 south Blount Street, Raleigh
  • Guasaca South American Grill ,  Venezuelan  food,  in Raleigh and Durham, 2200 West Main Street,  Durham  and 4025 Lake Boone Trail, Raleigh
  • Bida Mada gluten free options and dairy free., Laotian Restaurant in Raleigh. 222 south Blount Street, Raleigh
  • Zoe’s Kitchen catering, Zoes’s Kitchen, Mediterranean –141 Park Hills, and 6004 Falls of the Neuse, Raleigh; need to review allergen chart
  • Triangle Gluten Free LLC, catering service.
    Order ahead for desserts, pies, casseroles too. https://triangleglutenfree.com or email contact@tringleglutenfree.com

Rolesville

  • Rosalini’s Pizza and Subs,6210 Rogers Rd., Rolesville, NC. Tel: 919-453-1466. – based on review of restaurant website; Menu states has GF options (pizza, pasta, salad, dessert) at additional cost; prepare in dedicated area; www.RosalinisPizza.com

Southern Pines (NEW)

  • Petro’s Chili and Chips, Open on July 2, 2020 drive-thru only for awhile .  

Gluten Free Bakeries

Grocery Stores with Gluten Free Options

Of note, “Imagine That Gluten Free” is a triangle-based bakery that sells only gluten-free products. Here’s a list of locations where you can buy this brand, per the Raleigh Celiac Support Group:

  • Raleigh– Mellow Mushroom, Village Deli Cameron Village, Village Deli Lake Boone Trail, Winstons, Café Sola
  • Wake Forest– Village Deli , Mellow Mushroom
  • Cary– Ruckus Pizza Tryon Rd., Ruckus Pizza Harrison Ave., Mellow Mushroom
  • Apex– Daniels
  • Durham– Bulldega, Kings Red and White, Durham Co-op Market, Geer St. Garden, Mellow Mushroom, Primal, American Meltdown, Durham Farmers Market, Bullcity Burgers
  • Chapel Hill– Mellow Mushroom, Root Cellar, Merritts, Weaver St. Market Southern Village, The Loop, Bagel Bar, The Pig
  • Carrboro– Weaver St. Market, Neals Deli, Elmos Diner , Carrboro Farmers Market
  • Hillsborough– Weaver St. Market, Bella Bean Organics
  • Pittsboro– Phoenix Bakery, Virlies Grill, Mod Deli, The Root Cellar
  • Morrisville– Ruckus Pizza 3, Village Deli
  • Saxapahaw– The General Store

Stay Healthy and Stay Golden,

Emily

APPE Reflection: Oncology

Let’s start this post on a high note… I absolutely loved this rotation! One of my favorites, but honestly, all of my experiences have been amazing. Also, I received both doses of the Pfizer-BioNTech COVID-19 vaccine during this month, so I will briefly be going over that experience.

On this rotation, I spent the month in the Oncology Clinic Pharmacy, where I assisted the pharmacist as well as nurse navigators and providers to ensure exceptional care for our patients. Oncology, if you don’t know, is a fancy word for cancer… or rather oncology is the study of cancer.

I spent some time helping the nurse navigator with educating patients about their new chemotherapy regimen.

On the very first one, I met a patient who I was able to help more than I knew that I could. She was a patient with newly diagnosed breast cancer and had already received surgical intervention and radiation. Through our conversation, I was able to get to know her better and learned that she was really interested in meeting the president of my university, Nido Qubein. She kept mentioning it, and at the end of our discussion, she mentioned it one more time stating “tell Nido I’m here.” After contemplating whether or not it was appropriate to contact him on her behalf and discussing it with my preceptor as well as the nurse navigator that was in the room when the conversation took place, I decided to email him. After he put me in touch with the appropriate person, we were able to get flowers sent to her on his behalf when she was there for her first treatment the next week.

She told me that she was so thankful and that it really made her day.

That is the first time that I felt like I had the opportunity to go above and beyond what is asked of a GOOD pharmacist or pharmacy student and give her something that she would likely not forget.

Some other things that I was able to do is sit in on some of one of the provider’s new patient visits. I got to learn a lot about ways to break bad news to a patient in a way that shows how compassionate you are and how you are truly there to help them the whole way.

I also researched and got answers for questions that providers had for me. I was able to teach them something new. This was a very rewarding process for me.

I spent a lot of my time in the clinic’s pharmacy assisting the pharmacist in being a part of a 2-check verification system. This was a way for the pharmacist to have someone check their calculations, requirements of diluting/mixing the product, and other pertinent patient information to insure that the patient was safe to get their medication that day and that it was made properly.

Another important aspect of my rotation was going through the concise treatment plans of all new patients to insure the therapy was both appropriate and safe and verifying those things with resources available to us.

Also, I participated in a mass COVID-19 vaccination clinic where we vaccinated >1000 patients. Along with that, I occasionally helped the hospital provide vaccinations at their smaller clinics (Here’s an article detailing the mass vaccination clinic).

Overall, I feel like I learned a lot over the course of the month, and I feel much more confident in my ability to understand oncology and various chemotherapeutic regimens.

Moving on, I’d like to talk a bit about my experience with the Pfizer-BioNTech COVID-19 vaccine. I received the 1st dose on January 5th. I didn’t have any side effects from that one. The injection site was a little sore, but it was less than I typically get with my annual influenza vaccine, so it really didn’t bother me at all. I got my 2nd dose on January 22nd (I know that was only 17 days after the first one, but it’s the only day I was able to get it). It is recommended to get the 2nd dose 21 days after the first. Anyways, the side effects that I had with the 2nd dose were severe pain at the injection site and swollen and severely painful axillary/armpit lymph nodes (on the same side) for ~3 days. I also had a mild headache and felt a little nauseous. I understand that my experience was a lot milder than some people, but I just figured I would explain what happened to me.

Anyways… I only have 2 more months of APPE clinical rotations and then I’ll be in my NAPLEX review class for 1 month and then graduation!

Also, I got a job offer!! I’m still waiting for a community residency to get back to me so I haven’t accepted yet, but it really seems like a great opportunity!

I’ll keep you all updated on that process.

Stay Golden,

Emily

The Journey to My Celiac Diagnosis

Hi everyone! I hope you’re having a great week so far. I got my official biopsy results and diagnosis today, so I figured I would sit down and write a blog post about my journey.

For about 2 years now, I’ve been experiencing a lot of new health problems, from migraines and alternating constipation and diarrhea to even these weird bumps on my upper arms. Now I cannot prove that all of these things were caused by Celiac Disease, but it is definitely possible that they are. I’m really just going to focus on the GI symptoms that I’ve seen over the past few years.

I’ve experienced a lot of bloating, diarrhea, constipation, nausea, gas, and severe abdominal cramps and pains. Along with that, if I had a really fatty meal, my stool would turn a yellowish color. Honestly, I’ve been so busy that I wasn’t concerned with getting it checked out because I self-diagnosed it as alternating IBS. However, it appears that ignoring the problem for 2 years did way more damage than it did good (duh!).

Honestly though, I was never really able to find a trigger food. At least not that I could tell. Part of that is probably because gluten was in almost every meal that I consumed. Finally, I decided that I had enough and decided to make an appointment with a gastroenterologist.

Flash forward to early December, I met virtually with a gastroenterology PA, who recommended that I get a celiac panel and an inflammatory marker panel drawn from my blood and return a stool sample for testing.

The celiac panel (IgA and Tissue Transglutaminase IgA) was positive and so was the inflammatory marker panel (CRP and ESR). That was the first clue that I had something inflammatory going on and that specifically, it had something to do with gluten.

Moving on to my stool sample, they were measuring inflammation in my bowels by looking at the calprotectin level in the stool. This level for me was slightly elevated (upper limit of normal), but not concerning to my provider. Therefore, I likely do not have inflammatory bowel disease (IBD). We decided to then move forward with an upper endoscopy to confirm suspicions of Celiac Disease.

Prepping for that procedure was pretty painless. Luckily, I was able to get in to have that procedure done about a week after I found out the results of my bloodwork. So on December 17th, I went in to the gastroenterology clinic to have my procedure.

Of course, I had to go in 3 days ahead of time to get a pre-procedure COVID test, which was negative. I was instructed to continue to eat gluten in my diet from the time of positive celiac panel results to the time of the endoscopy. This was to make sure that everything was inflamed and that it was pretty clear whether or not I had Celiac Disease.

I got there an hour before the scheduled surgery time, and I had to go through the pre-operation paperwork and prepare my IV for analgesia drug delivery. The endoscopy was pretty quick and painless. It lasted ~15 minutes and the only pain I really had afterwards was a minor sore throat and bruising at the site of IV insertion. They looked around the first part of my small intestines and took 4-6 samples to biopsy. Anywho, the surgeon told us after the procedure (in the hour of post-surgical waiting) that my small intestines (specifically the duodenum) were very inflamed and had damage consistent with Celiac Disease, but that I would get the biopsy results in 10-14 days to confirm.

The surgeon recommended that I go ahead and start eating Gluten-Free because even if I don’t have Celiac Disease, I have a gluten sensitivity or intolerance.

Six days after the surgery, I got the results of my biopsies and they confirmed that I do in fact have Celiac Disease and must adhere to a 100% Gluten-Free diet. Luckily, I had already been living the Gluten-Free lifestyle for almost a week at this point.

Now that I’m a diagnosed Celiac, I can start my new journey to becoming healthier and get to feeling better.

I just want to say how thankful I’ve been for all of the support I’ve had in just the past week. I know I’ll continue to receive support, and I’ll be here to help anyone else that is trying to go Gluten-Free.

Even though I would rather not have this diagnosis, I’m planning to use it as a tool to help others who need someone to talk to.

Stay Golden,

Emily

APPE Reflection: Entrepreneurship

Originally, my November rotation was supposed to be a medical mission trip to Jamaica. However, because of COVID, the whole thing got cancelled. While I was disappointed at first that I was not able to go on that trip, this rotation was amazing, and I really learned a lot about myself.

This rotation was designed for us to be as independent as possible. We were tasked with creating a new pharmacy product or service. Throughout the whole rotation, we worked on this project and presented it on the last day of rotation. I’d give you my idea, but then you may steal it, and I actually might act on it in the future.

We were also tasked with choosing a book on innovation to read throughout the rotation and come together weekly to discuss what we learned from the book with the other students and our preceptor. I chose “The Innovation Stack” by Jim McKelvey (co-founder of Square credit card readers). This book was a great read and made me think a lot about what it means to be truly innovative in a world where we are trained to copy.

We also each watched an episode of Shark Tank and summarized it to the group. I think this was critical to the process in that we could see how people were really able to sell their products just based on their pitches and how some flopped for the same reason.

Overall, this experience was great and something that I definitely needed since I would like to own my own independent pharmacy in the future. It opened my eyes to the possibilities of creating a new product, business, or service and rolling it out.

I’m excited to finally have a month off of rotations, and I know I’ll be well rested and ready for my Oncology rotation that starts in January.

Stay Safe and Stay Golden,

Emily

APPE Reflection: Ambulatory Care

The rotation that I had over the month of October was my Ambulatory Care rotation. I completed this one at the Naval Medical Center at Camp Lejeune in the Family Medicine Clinic. I spent a lot of time with patients in the clinic, but I would consider this rotation a “blended” Ambulatory Care rotation.

In the mornings for most of the month, I was on the inpatient Family Medicine team doing rounds. During these rounds, I would work with the pharmacist to answer any questions that the medical interns/residents/students had for us about the different patients and their medication regimen. We also pre-rounded on the patients so that we had suggestions of regimen changes ready to go when we met with the team.

For the rest of the day, I was working in the Family Medicine Clinic with my preceptor or another clinical pharmacist to take care of patients. We saw a variety of patients for different chronic conditions such as diabetes, hyperlipidemia, hypertension, and anticoagulation (with Warfarin, for INR checks and regimen changes).

I didn’t really start writing up patient encounters in the electronic medical record (EMR) until the last week and a half. At that point, I wrote up pretty much all of our encounters and had them sent to my preceptor for review before he signed them.

Because I was at a military location, the clinical pharmacists were able to change medication regimens without a collaborative practice agreement. It was really a great experience being able to see the impact of pharmacists on a clinic. It reinforced for me the true value of pharmacists in the clinic environment.

Over the month, I was able to watch 2 eye surgeries and was also able to shadow a variety of different practitioners (NPs, PAs, and Physicians) and see how they interacted with patients.

I’m so thankful for the opportunity, and although the military environment isn’t really for me, I’m confident in the care that they are receiving.

Stay Golden,

Emily

APPE Reflection: Advanced Community & Enhanced Clinical Services

As with any new rotation, I was very nervous going into this one. However, I had an amazing experience. I got to do things during my community rotation that I feel like a lot of people don’t get the chance to do.

What were those things? Lots of clinical services! I worked with several of our Chronic Care Management (CCM) patients and was able to call and check in on them and see how they were doing with their chronic conditions and how they were dealing with COVID. This is a task that I feel not many people relate to pharmacists, but we are in the perfect position to do these types of services! It’s important to check in on these patients and make sure that they do not have  any pressing issues with regards to their medications or their health in general. Pharmacists partner with physicians to provide these services to their patients. Another important clinical service that I was a part of was Medication Therapy Management (MTM). This involves calling patients and making sure their medication regimen is up to date, they are adherent to their medications, and they are not having any unwanted side effects. It’s important to make sure patients are taking the medications as they are prescribed to them. 

I also participated in 4 flu shot clinic days where I was able to give ~200 flu shots to teachers and other government employees. 

Aside from the clinics, I also gave flu shots, shingles shots, pneumonia shots, and tetanus/diphtheria shots in the pharmacy. 

I also did a lot of blister packaging. For those of you who may not know what that is, it’s where the pharmacy packs all of a patients medications in a weekly or monthly pack with the foil backing to so that the patient can see that they did or did not take their medications on a certain day. Not only did I pack them, I was able to check a few that my preceptor packed (to get experience actually acting as the pharmacist) and looked through patient charts to make sure that their medication regimen made sense. I was able to find some areas where the packs could be improved and was able to prevent some medication errors.

I was able to also check a few prescriptions (with my preceptor) to make sure I understand what it’s like to actually be the pharmacist.

Here’s a couple pie charts that show some of the things that I was able to do over this rotation!

August Patient Care Tasks
September Patient Care Tasks

I really, really enjoyed my time at this rotation site, and I’m so excited for my Ambulatory Care rotation next month! 

Stay Golden,

Emily

To My Love,

Hi, it’s me. The girl who fell madly in love with you. Truth is, we’ve known each other and been best friends for over three years now, so it shouldn’t surprise me how quickly it happened, but it does.

You were truly a blessing in disguise. Three years ago, you helped me to get over my ex, who honestly broke me to the point that I didn’t know who I was. I didn’t know if I could ever love or be loved again. And by “help me get over him”, I don’t mean in the way a boyfriend would. I just mean that you were a friend to me when I needed it the most and you showed me just by being you and my friend that there were still good guys in the world. It was so easy for me to fall in love with you. You made it simple.

I’m writing this because I really want you to know how much you mean to me.

You mean the world to me. I hope I never let you forget it. I used to be the kind of girl that got anxious when I didn’t hear from my boyfriend for a while. I used to worry that he was out with another girl because that’s what I was used to. I can honestly say that being with you, I’ve felt more loved and less anxious than I ever have before. I’m able to trust that you aren’t going to do anything to hurt me. It’s an amazing feeling.

I appreciate you. I appreciate everything that you’ve done for me so far. I appreciate you just being here for me. I appreciate you supporting me in everything that I do.

I’m incredibly blessed to have you in my life.

You are so handsome. Every time I look at you, it makes me smile. Heck, you ALWAYS know how to make me smile/laugh even when I’m in a bad mood.

I have a really good feeling about us and the future. Thank you for allowing me to be a big part of your life.

You are so perfect for me… it’s honestly crazy. We complement each other so well. I lack a little in the common sense department and you help me with that. You help me grow as a person, and I think I can say the same thing about my influence on you. I’m so glad I can be myself around you.

I’m so proud of you. You’re an amazing teacher, and I can tell that you love what you do. I know that you are gonna do such great things with your life, and I can’t wait to be with you every step of the way.

Never stop being you.

Stay Golden.

Yours,

Emily

APPE Reflection: Critical Care

I was very intimidated going into this rotation because it is only my 2nd APPE experience and the CCU is such a fast-paced environment. However, I have learned a lot over this rotation, and I had the best experience I could have imagined. My confidence in making recommendations to providers has increased significantly, and I was able to do a lot of independent learning.

During the first week, I had my first counseling experience of the month. I was able to counsel a patient on a new prescription for warfarin. It was a great experience because there are so many different things to consider when counseling on warfarin (diet, bleed risk, goal INR, etc).

I also had my first ED shift of the month this week and was able to complete several medication histories as well as make calls to pharmacies to gather information/cancel prescriptions that were sent to them by mistake. It is the job of the ED pharmacist to make calls for patients who tested negative for COVID and make sure that they no longer had a fever. I was able to practice with this on week 1.

I witnessed my first rapid sequence intubation during week 1 and was able to assist the pharmacist in drawing up medications to make sure it ran as smoothly as possible.

Week 1 was also where I began rounding every day on the CCU. Every day, I spent half of my shift sitting on the unit by myself and assisting with any medication related questions that the nurses/providers may have. Of course, being a student, I had to report to my preceptor with all of the recommendations that I had to make sure they were appropriate before recommending them to the provider.

Moving on to week 2, I was able to dose a new start vancomycin in a patient and adjust a heparin drip based on the patient’s aPTT level.

Week 2 was also where I had my weekend ED shifts. I completed 7 medication histories, 16 negative COVID callbacks, and another intubation.

The rest of the month was pretty chaotic. I attended 4 rapid responses, 2 codes, rounded on a total of 35 patients, dosed and prepared TPA, and made daily recommendations to providers. I pretty much handled the CCU patients on my own, with verification with my preceptor.

My big projects for the month were to present a case presentation on a COVID patient that had been in the CCU for most of my month long rotation and create a reference sheet on how to treat hypertensive crises.

I also had 1-2 topic discussions a week on critical care topics such as FASTHUGS, Sepsis, the ABCDEF bundle, RSI/NMBA, PADIS, and ACLS.

The hardest part of this rotation was experiencing codes and seeing how intense and emotionally draining they can be.

I have nothing but good experiences to report for this rotation, and I’m so sad to be leaving this hospital until January. I have really connected with the pharmacy staff here and really have started to feel like family. I hope to have as good of an experience during my Ambulatory Care and Community rotations that I have over the next few months.

I will continue to keep you all updated with all of my rotations!

Stay golden,

Emily