Return to Laguna Honda Hospital

I realized that I have not been giving my account of the last few times that I have visited Laguna Honda Hospital. So here goes.

I saw my resident again on Friday. He was sitting in the lobby in Claredon Hall playing black jack or whatever game was on the computer in front of him. He was busy jabbing the screen or rather drawing his finger horizontally across to select his hand of cards. The screen would spit out some points for him and he would start the whole process over again. The same San Francisco Giants beanie covered his forehead and the same Harley Davidson jacket covered his shoulders. When I approached him, he introduced himself as if I was a fresh face and I immediately confirmed my suspicions that he had dimentia. He was friendly nonetheless and retold his story with a few more details to fill in the gaps from last time.

This time he talked more candidly about his family, the beginning, and end of it all. Painting an image of powdered mountain ranges, hot fireplaces, and rooftop icicles of Colorado springs, he spoke about where he raised his 2 daughters, Barbara and Denise. Chloe wanted him to stop associating with his racing buddies whom she considered a distraction from his role as a father and his dedication to developing a career. He never really made a decision one way or another.

It is funny how easily a rope falls apart after the knot at the end comes loose.

It was not until they graduated from high school, did he split up with his wife Chloe. He moved to San Francisco, Sunset specifically, only 2 blocks away from my current apartment. Then came the heroine. Cocaine. The old drown your sorrows in whatever substance you can get your hands on. He mostly veered away from talking about his ex-wife very much. But he was more than willing to offer information about his daughter Barbara whom lives in Riverside currently. The smart one, he pointed out, who took community college classes after high school then took a job as a claims officer in a real estate insurance company. I imagined a Nancy Drew holding a larger than life magnifying glass up to typewritten font on documents nearly bleeding with accounts of fraud or extortion.

As I pulled myself back into the moment, I listened to updates on Denise. She started waitressing after high school and apparently moved to New Orleans where she waitresses at an upscale restaurant. He kept affirming how different they were when you juxtaposed them, a common thought wheezing past the daily thoughts of parents. Barbara was silent as a mouse but not in a way that made you uncomfortable, just that she used far less words to convey what she wanted to say. Denise, on the other hand, was always very witty and talked up a storm whenever she had the chance. He was glad that they came to visit him just last week and spent every day visiting him that week. I told him that was excellent. He nodded in agreement. I assumed that they were able to work past his recent fallout with alcohol.

California Pharmacist Association(CPhA) Outlook Conference

About 50 UCSF Pharmacy students spent a good portion of their weekend in Palm Springs to attend the CPhA Outlook Conference. The UCSF alumni breakfast bright and early saturday morning was an excellent way for us to see how far UCSF network really stretches in hospital, community, and academic settings. Dr. Bob day who held the first continuing education seminar ever when they were not required for renewal of the pharmacy license.

I even was able to briefly meet my sponsor for the meeting, Chet Yee. We shook hands with him before we had to run off to go to the all school caucus, which was a session to introduce to pharmacy students new policies and ammendments up for the house meeting the next day. They could discuss possible changes to the wording or assert a unified stance on the policy.

For example, there was a rather radical policy to change marijuana from a schedule I to schedule II drug. From CP115, we learned that the only difference between those classifications is that a schedule I drug is not been shown to be safe and effective while a scheduled II drug is safe and effective. In other words, the policy is showing to the legislature that pharmacists in california recognize the abusive potential of marijuana but generally support the legal dispensing of marijuana for medical purposes.

For us pharmacy students, reading pharmacy law can be rather dry but applying it to a situation like this really puts everything we learn in class into perspective. It was rather exciting for APhA members to attend the main event which was the House of Delegates. The select few who were delegates voted on policies ranging from prescription legibility to supporting awareness programs for tylenol associated hepatotoxicity. We were able to watch the speeches and vote on the speaker-elect of the house, a close run between Dr. Gupter and Dr. Scheidmein (I apologize if I wrote that incorrectly). One of our ammendments did get passed concerning that Rx's should be clear and legible regardless of format. The attended continuing education classes alongside practicing pharmacists about new drugs, antibiotics, and Medicare Part D.

Not to mention parties, reception, buffets, brunches galore alongside an exhibition hall of freebies from pharmaceutical companies and chain pharmacies looking for interns. I even saw some pharmacy students whom were my classmates in undergrad. I wish I had more time to catch up but it was great to see them again. We all were competing for the trophy in the School Quiz bowl, which ucsf lost to UOP. There was speculation that UOP might have been using PDA's to look up answers to the questions, but I think since their entire curriculum is solely concentrated on OTC's and community pharmacy laws, of course they would be very well prepared. Plus, UCSF had about 5 times the number of attendees as other schools, so it was just harder to coordinate answers between everyone.

Red was all the rage last friday night! Students, faculty members, all pitched in prizes, bought raffle tickets, or just enjoyed the show. The big event that was held friday by the pharmacy school was the UCSF Red Dress fashion show benefiting the American Heart Association. Dr. Cocohoba, who is on the UCSF Faculty and practices at the UCSF Aids Clinic, was modeling a traditional southeast asian dress for the show. Dr. Joe Gugliemo, chair of the department of Clinical Pharmacy, also participated as a model. Jen Yang, first year pharmacy student, was loaned a dress from designer Jessica McClintock.

After finishing 3 midterms in the past week, we could unwind a little before the next midterm Biochem midterm on monday. Last night, several 1st year pharmacy students attended a panel to answer questions from interviewees and those interested in attending pharmacy school at UC Berkeley. Even though the commute was long and it was pouring throughout the bay area, we managed to attend a dinner in Wheeler Hall with about 50 students. After some spring rolls, we talked about the different pathways at UCSF, small close knit community here in like the 2 buildings where we have our classes, some undergrad classes like pchem, or physiology that may help, getting recommendations from professors who we did research with, and clerical positions in pharmacies to improve their application. Some students were asking about whether they should attend UCSD. The main problem with UCSD that we had was the fact that UCSD was denied accreditation this year and no one knows when they can grant a Pharm.D. degree. So the 1st graduating class is in limbo and they currently can only work as a graduate intern. This caps their income since they cannot get the 80-100 grand salary that registered pharmacists can recieve. Along the walk back to our car, we grabbed boba with a few undergrads who still had questions, and then headed home.

UCSF has ties to berkeley through the Pills program which hosts mock interviews, essay editing, and social events where undergrads can get some help during the rough interview process. We are seeing a lot of john smith style black and white suits marching across campus since it is quickly approaching prime time for interviewing for the incoming class of 2011. Wow, I cannot believe that I was in their shoes only a year ago. I have really delved into the health professions, seen so much, gotten to know new and old groups of people. It has been quite a ride so far and a quite a distance from the sunny shores of the La Jolla beaches back in june.

Our class fundraiser at Club Rouge raised almost 1400 dollars, which is a large amount for a single fundraising event. A small portion of it was spent this morning in the form of doughnuts and juice. I think the rest of this money will be used to fund our graduation party, gifts, banquet, photos, caps/gowns, and class gift. We have to pay for all these ourselves. It is astronomical that it will cost about 36 grand for this event. I was a little confused why our class president and the cabinet brought this to our attention in the first quarter of our first year. I suppose it is better to start planning sooner than later. UCSF only pays for the reception and graduation ceremony itself.

In CP112, we are starting on pain topical and systemic pain medications and probably continue this section through next week. I think this is a major field for us to familiar ourselves with since so many pain medications are OTC, so it is up to us to make good recommendations and prevent people from overdosing on them. Only 4mg/day would cause serious toxicity in an adult.

On a side note, orlistat, has just become over the counter recently. Orlistat reversibly inhibits gastric/pancreatic lipases and cholesterol esterase to decrease fat absorption. Therefore, orlistat is indicated to treat obesity and high cholesterol. We already finished lipid metabolism and synthesis in biochemistry; now we are finishing heme metabolism. Sharon Youmans, who taught CP111, held a clinical correlate to review a case of a 9 month old baby with anemia. She tied the symptoms of jaundice (yellow skin/sclera) and bilirubin accumulating from red blood cell breakdown.

Midterm Crunch!

Basophil (left) and eosinophil (right)

We are in the midst of midterms! Our weekends are going to be filled with studying for advanced organic chemistry on monday, clinical pharmacy on wednesday, and then turning in a draft for our ethics paper on thursday.

Today, we just finished our histology midterm in ANAT115. It is fair to say that we have been spending the past few days memorizing pictures of tissues and cells from lecture slides. For someone like me who has never taken anatomy, only anatomy lab, I did actually learn something about how to differentiate between an eosinophil and a basophil. I did not know the different types of connective tissue in the body before either. For example, type IV collagen predominates in the meshlike structure known as the basal lamina which underlies all epithelial cells. I think I forced myself to know the molecular structures in hyaline cartilage such as type II collagen fibers bound to other fibers by perpendicular strands of proteoglycans and parallel strands of hyaluronic acid. And if you zoom in on a collagen fiber, you can differentiate how filaments are bound together by chondroitin sulfate.

The reason why this applies to pharmacy is that I notice customers asking about glucosamine, hyaluronic acid, and shark cartilige (chondroitin sulfate) supplements. Since these are over the counter, it is important for pharmacists to know why manufacturers are claiming that these supplements strengthen cartilige. The reasoning is that if you take in dietary components of cartilige, you will be able to regenerate your cartilige. This claim is not particularly substantiated by anatomists since the human body cannot regenerate cartilige once it is damaged because there are no blood vessels that innervate cartilige. A blood supply is necessary to bring nutrients and mesenchymal cells that can differentiate into chondroblasts which can synthesize cartilige.

Bone, on the other hand, is richly innervated with blood vessels, which is the reason why bone can regenerate after a fracture while cartilige cannot. That is why pharmacists advocate taking calcium supplements especially while your body is healing from a bone breakage. Daily calcium intake is mainly for preventing osteoporosis since cells such as osteoclasts actively dissolve bone to maintain a rigid blood calcium level.

My main complaint about the class is that it is not as interactive as a lab class where we can look at samples on microscope slides.

A growing number of students are becoming increasingly unsatisfied about the assessment lectures that we have had in CP112 because they are not directly applicable to most of our internship experiences in the retail, compounding, or hospital outpatient pharmacy settings.

In my opinion, the problem is that Dr. Ron Finley specializes in geriatrics and even though he is a pharmacist, he can only give us advice about how to diagnose alzheimer's or hypertension (blood pressure monitoring). He does not know much about general prescription and over the counter drugs like what we are actually being tested on: opthalmics, pressurized metered dose inhalers and other asthma/COPD Rx drugs, and upper respiratory infections. So we have all these guest lecturers come to teach these areas. The disparity lies between the objectives laid out by the guest lecturers and what he expects us to get out of the class. He neither confirms nor denies the details (the age at which is appropriate for kids to use eye drops). He ultimately writes the tests, so we are which will come from our giant OTC book. It seems that we will have to memorize like the adult and pediatric dosages for 20 drugs covered throughout the quarter in addition to the 60 drugs that we are expected to know the therapeutic class, brand/generic name, indications, and schedule. Hopefully, I have adapted to this kind of class, which has a different schedule every week depending on whether they have arranged workshops, lecturers, conferences, field trips, etc.

But I hope there is a method to this madness.

There is an exciting event going on tonight which is the Red dress fashion show and raffle in the Milberry Union Gym to benefit the American Heart Association. A lot of Pharmacy 1's are donning designer dresses and walking down the catwalk holding informative statistics about Heart disease. More on this in the synapse to come...