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...

A Mix of Sunshine and Rain

Like the weather about deciding whether this was a week of gloom or sun, I also was equally as ambivalent about whether this was one of the better or worst weeks of the quarter. We had a guest lecturer in biochem who outlined the mechanisms of lipid metabolism and cholesterol synthesis. Since the last time I have taken biochem, it seems there has been progress towards understanding how cholesterol negatively feedbacks on the rate limiting step in cholesterol synthesis and a certain type of lipoprotein receptors. He seemed to have a wicked sense of humor: the whole room was laughing when he enthusiatically talked about how cool this unusual sequential cyclization step of squalene toward cholesterol involved atmospheric oxygen and an epoxide. We could have been delirious from sleep deprivation as well.

The downpoint was Clinical Pharmacy when we had to endure physical assessment, psychiatric assessment, and patient adherence lectures. And these series of lectures are just too vague to really apply seriously. (Example: What do you think the condition of a woman with a large belly is? Pregnant). Currently, pharmacists are not be able to diagnose so we are all wondering why he is teaching us these semi-common sense methods of assessing people's condition. I mean Ron Finley seems like an alright guy, but we need a very structured style of lecture to know specific material we need to study and retain for our future careers.

In contrast to Finley, we were lucky enough to participate in a Pulmonary inhalation workshop held by the renown Robin Corelli. I thought it was a great idea for each of us to have the opportunity to counsel faculty members and be critiqued about our performances. I honestly that I can speak for my classmates that we all can counsel patients on the differences between using the albuterol pressurized metered dose inhalers from Advair diskus from handihalers.

In APha, we met with Lori Rice and shuffled ideas for ledge day, to educate pharmacy students about current developments in pharmacy law. Rice is quite brilliant with knowing how to create a vision and taking steps to drive it forward. She took our brainstorm of topics like direct to consumer marketing or universal health care. She may even be able to get Gavin Newson to come and speak to UCSF, which would really let students participate in the policy process. Hopefully, he has an interest in getting our support since we are all old enough to vote. Hopefully we can show him and the city that we are not too busy filling prescriptions to speak up about our views about whether we should be selecting which drugs will be blockbusters or which will be recalled simply by making recommendations, conflict of interest between promoting a retail store generics vs. the brand name, and what should be done to formalize a reuse program to take care of the unexpired unused drugs in the city. A lot of ideas in the works.

A number of us attended a lecture held about emergency contraception and how to legally dispense it in California. Since the beginning of 2007, we can dispense Plan B OTC to anyone over 18 years. For minors, we have to be trained and pass a test online to prove it. We would have to register our pharmcy on the Pharmacy Access Partnership website so that women could find which pharmacies sell it. But the trick is that our supervising pharmacist must also be EC trained if we want to do the counseling. Since this med is somewhat controversial, the curriculum does not include certification and we must go through our student organizations to arrange training outside of class.

Beyond anxiety over transitioning to becoming pharmacists, I am visiting my friend in the hospital after his surgery virtually every day until 8 or 9pm at Mount Zion. I saw such an improvement in his condition when he was switched from morphine to toradol. But the impact on your body after this kind of major surgery is the equivalent of having the pick up truck slammed into your abdomen. I just imagine having my organs readjusting in position and how the strain on the nerves attached to your internal organs can be mindblowingly painful. Painkillers could not deaden every single one of those nerves, at the most like 30-40% of them. And I even talked to my parents afterwards about how difficult it was for me to see my friend so helpless at a grown age and struggling sustain even the shallowest breath. I am not sure if I could be around people in this condition every day in my life, which would be my life if I wanted to be a clinical pharmacist.

Week 3 of Winter Quarter

Peugeot 404

It was nice to have MLK off but it really meant condensing all the events and business and studying that we had to do in a limited amount of time. Some of my classmates are doing introductory pharmacy practice experiences, like following around our past Clinical Pharmacy professor, Kathy Dennehi, while taking medical histories/ screening for immunization eligibility. It is apparently a pilot program that was jumpstarted so that UCSF Pharmacy School could claim that at least 5% of its curriculum is dedicated to IPPE's. They can use this to leverage with the Board of Pharmacy to get reaccredited. I think that it is a great idea to have something in the pharm.D. program to introduce students to applying these skills that they teach you in school about patient assessment and counseling. From my experience in retail, you will eventually learn some patient counseling, but IPPE's can give you a much easier time during rotations and not have to climb such a rough transition from textbooks and lecture notes to real life therapeutics and patient interaction.

We took our first midterm today and it was not too bad. I actually had a harder version of biochemistry in undergrad and this class was more emphasized on getting you to understand the clinical correlate of biochemistry instead of learning every annoying enzyme for those who want to become lab scientists. Our professor is really great; her name is Tracy Fulton. One class that I really enjoyed was the clinical correlate taught by our Dean, Mary Anne Koda Kimble in conjunction with Tracy Fulton. She had a mock interview with a diabetes patient while we learned about insulin and glucagon control of metabolism. One interesting point was on sulfonylureas, which increase insulin secretion from pancreatic beta cells by blocking membrane bound potassium leak channels. She even went on to explain how diabetes patients often get foot ulcers, from poor circulation and poorly functioning clotting factors.
APhA had its first legislative committee meeting which assigned us first year members our own projects towards promoting the profession.

My second visit as a volunteer to Laguna Honda Hospital was much longer than the first and incredibly worthwhile. I walked in to the main hall feeling like a thousand eyes upon me, knowing that I was out of place in a room of elderly patients with dimentia. I was silent as he played Bingo for about half an hour because I was afraid if he could speak coherently, percieve and be capable of interacting with me, or even have a shred of short term memory. To my surprise, he asked me very clearly what my name was and proceeded to enter a perfectly normal conversation. He was able to respond and converse with me more capablely than many of my contemporaries.

So apparently, Robert was first admitted into LHH when he overdosed on alcohol. Ever since he's been residing there. In the past, he recieved his first dirtbike at the age of 11 and rode on racetracks and jumps while attending a baptist church. Throughout his life, he has traveled the entire country. Born in Chicago, he was raised on a farm in Arkansas by Swedish and Irish parents. He became a professional motorcycle racer and came in 3rd nationally in 1968. Behind the public image, many bikers spent their play money to shoot up on heroine and coke, and he was not exception. Then he moved to Riverside as a car mechanic for peugeot. Check out their website. It's a beautiful european car. After splitting with his ex-wife, he hitchhiked to New Orleans. I'm not sure about what he did in New Orleans but eventually he made his way to San Francisco. He tells me that his Swedish father, a retired stockbroker, is still alive somewhere in America.

So hearing him recall his life as a hyperkinetic zigzagging path, transcending state lines, dotted with 151 proof rum, irish carbombs, and car girls. It was a perfect description of an existence that epitomized the American ideal. Living with the freedom to be susceptible to sin, ut have enough of a safety net to recover, roam but always have ties with loved ones in the past, and connect with the land but not to be tied down to it. And I think it is such an important concept to travel in order to understand America but not objectify it. His middle class values reminded me of my own father. I haven't heard anyone say the word America so many times with such gravity and with such respect that only the wise can grace upon it. It was not a conversation of problem solving or thesis writing, but it was the most intellectually stimulating conversation that I have had in a while, much moreso than with classmates whom have master's and all sorts of degrees and scholarships under their belts.

His gaze started to drift and his attention dissipated as he felt a craving for a cigarrette. He bummed one off of another resident and we stepped outside so he could smoke it. He began to repeat his entire story to me as if I had never heard it before. Then I suddenly got the sense that he was not as aware of me as I was of him; the feeling you get when the person you are trying to interact with does not remember you hurts. I was subconsciously assessing his disorder in order to cover up my own emotions. He had dimentia.

First Visit in Laguna Honda Hospital Project

I returned to Laguna Honda hospital for the second time to begin my Clinical Pharmacy 112 volunteer project, but this time I met with the volunteer coordinator about my resident and visitations. I was introduced to Araceli, my coordinator, who seemed welcoming and competent. She warned me about my resident, whom she said may give me a hard time. Initially, she said that the residents, including mine, would be quarantined for the rest of the week until the nurses disinfected the ward and contained the norovirus epidemic. She explained that the virus was responsible for a type of stomach flu that included symptoms such as diarrhea.

This detail shocked me somewhat because it brought forth in my mind how easy nosocomial infections spread in hospital environments in the immunization reading to reality. This was an unfortunate circumstance of day care centers, residential homes, or any living spaces where people lived in close quarters. It is easy to breeze past this detail when you are cramming for a test, but it is much more difficult and fearful to have to live with it for the rest of your life in a hospital. Two elderly gentlemen were sitting outside in the cold and gazed at us while we walked by.

Next to them, we felt young.
To us, their sun-tanned skin and white hair made them seem old.
We are continuously being educated in one of the world’s top health sciences institutions.
They have been out of school for decades.
Many of us are working and serving patients as interns in pharmacies, encountering a flux of new faces every day.
They were the ones whom are served.
Our presence disrupted their routine lives confined to this one building.
We were moving. They were still.

My thoughts were disrupted once Araceli questioned why we were volunteering at LHH. At that moment, I felt that my answer to her question would shape her perception and the perceptions of the people she talked to about the profession of pharmacy. I told her that historically pharmacists were not trained to be sensitive, develop relationships with patients and UCSF is trying to lead a new generation of clinical pharmacists whom are capable and willing to give better quality patient counseling by learning how to care about them. This was an effort to develop our introductory pharmacy practice experience before our advanced rotations during our third year. She returned a smile and a gaze of understanding about the importance of having pharmacists volunteering in hospitals, more so than the degree to which I substantiated my claim. It was odd for me to so fervently defend the institution that I have spent the entire quarter severely criticizing.

My resident, R.L., happened to be in the lobby and Araceli introduced me to him. He was too focused on his video card game to respond immediately, but when he managed to step away from it to shake my hand. He wore a beanie and a thin flannel over a t-shirt. He had sharp eyebrows and gave me a quick smile before returning to his game. I sat next to him for the remainder of the hour just learning how this game worked. He selected his hand so fast, I kept inquiring to figure out how he determined which would give the most points. He tried to tell me that it was like second nature after playing it so many times. He was much more pleasant than his description stated: “sarcastic, likes to mock others, may be difficult. Likes Ferraris and fast cars.” This paper description seemed so far from my own interests, and I was unsure about how I would approach relating to him. But this first meeting made me not want to just give up but instead try to find something else that we could bond over.

When we were leaving, I told him that I would be back to visit perhaps on a Sunday when I am not working.

First Pharmacy Class of 2010 Tahoe Ski Trip

I drove into SF tuesday night after working all day and started class on wednesday at 8am the next day. We were all somewhat hesitant in participating in the Laguna Honda Project, which involves volunteering to visit a resident every other week in the hospital. Dr. Finley assigned each of us to a resident and mine in particular was described as sarcastic and enjoyed mocking people. We were kind of scared about the innappropriate behavior of some of these residents. For example, some residents liked to run away while others were described to behave innappropriately sexually. We will meet them next week and continue visiting them and documenting our experiences for the better or for the worse.
Human metabolism (BC112) or biochemistry is taught by the popular and renowned Tracy Fulton. We heard from the P2 class that she is a really good professor because she cuts out the minute details and regurgitative memorization. She instead supposedly focuses on the important overall concepts.

Advanced organic chemistry (PC113) for the most part does not particularly seem to venture beyond the reaches of our undergrad experiences. The syllabus for the most part is just condensing a year of organic chemistry into a quarter. So, the proper title should have been "Organic Chemistry Review." It is slow so far and she has barely brushed the surface of stereochemistry, optical rotation, and recognition of basic functional groups. A good number of classmates with a masters in organic chemistry were able to waive out of the class.

I allowed myself one last escape before I really had to break into those textbooks...and was it worth it? Yes!
















25 of the more sporty or crazy first year pharmacy students bundled up in our winter jackets and rented 2 suv's to transport the remaining students and their baggage. We drove almost 4 hours to Lake Tahoe. The drive was more like a crawl since it seemed we were not the only ones who realized fresh powder offered the promise of a good slope the next morning. Grabbing In and Out along the way and stopping by an authentic burger joint in Auburn made the trip more enjoyable.


It was my first time in ages since I have ever been to Tahoe and my first time snowboarding. The 2 story UCSF cabin with 2 car garage and driveway was really nice It was equipped with linens, dishes, cookware, games, cleaning supplies, and of course a hot shower after being in the snow the whole day. It was like living in a dorm all over again, except with board games. It really looked like a winter wonderland complete with treacherous mountain ranges and towering pine trees. We took a midnight walk under the full moon that night which was comparable to being surreal. We visited the P2s next door to join in on the festivities. The next morning we managed to get everyone out the door by 8am that morning to Alpine Meadows. Some of us took major tumbles and few attempted the diamond peak ski lift. Whether we were skiing or snowboarding, I think we can all concur that it was a hell of a workout. I wish we had another day, but by 4pm, we had to return to the cabin.


A few of us went with the P2's to Reno to go clubbing and gambling. The more conservative majority spent Saturday night watching Chronicles of Narnia, playing blackjack, and telling fortunes. Before we went to bed, we spontaneously started telling ghost stories in the dark. One particular story scared us straight, which involved her true experience with seeing a ghost. Having heard that after research universities have shaped my core understanding through empirical evidence and the material world was jolting. We had a hell of a time though and really had an opportunity to bond with each other outside of such a stressful school or urban environment. We even had two guests who were significant others of members of the first year class, who fit in quite nicely.

The End of Winter Break

Even though I was working during winter break, I still managed to enjoy my time off. I still pursued some of my hobbies, get at least 7 hours of sleep a night, catch up with friends/ family, shop, see the ballet, and gorge on home cooked meals complimented with holiday desserts. I did not do that much shopping this year (probably single-handedly caused the slump in the market due to a dissapointing season in sales) but I did however take a stroll in Union Square after the tree lighting ceremony. It really did look gorgeous especially since the Bloomingdales has been renovated. We are returning to school on wednesday which means that I need to get my "back to school" tasks done. Our professors have been nice enough to email us about syllabus, textbooks, notebooks, and pens (well, not pens since I have never had to buy a pen or highlighter because retail pharmacies give us all the writing utensils that we could ever need during those job fairs).
Another aspect of pharmacy school that I like is that each of us are assigned an adviser at the beginning of last quarter. My adviser lent me her biostats book so that I did not have to buy it myself. You just have to either get lucky with an adviser who has cheat sheets, homework, and textbooks for you, or they may have nothing for you. Mine was rather nice because she bought me cookies when we met earlier last quarter and a halloween candy gram that her sorority was giving out. Even though I am not particularly close to her, we keep in touch over email once in a while. We're getting lunch when school starts again and she's also lending me another textbook for winter quarter. I plan to do something nice for her for her advice and all.
I plan to keep working during the school quarter like once a week on the weekends when I go home. I can make enough to pay off my rent every month (yeah!). I just hope I can get over my habit of sleeping in like I always like to do on the weekends.
Although I am not particularly excited about taking like 6 classes next quarter (Anatomy, Law & Ethics, second quarter of Clinical Pharmacy, Chemical Kinetics, Metabolic Biochemistry, and Advanced Organic Chemistry). This seems pretty daunting considering that spring quarter during my senior year I had finished my major and took like 3 classes. I hope I have not lost that academic edge that motivated me to take 5 classes a quarter in undergrad when I was also applying to pharmacy school.
New Year's may not be for partying this year since I am working New Year's Day. Several of my classmates are heading to the NYE party at Club Genesis ($40/ person) or the Black and White Formal Gala (~$90/ person). Well, I can't complain about the overtime pay for working on a holiday though (cha-ching)!
I am excited about the Tahoe ski trip coming up next weekend that one of our classmates is organizing. We will be going snowshoeing, skiing/snowboarding, and shopping in Reno.

Life as a Technician

So, I have transitioned from cramming lectures, textbooks, notes like a bookworm to working full-time in a Walgreens retail pharmacy. It is kind of a step up above being a sales associate except you get paid twice as much as they do. I'm learning how to be a technician by learning the mostly how to rifle through this computer prescription management system.

I feel like I am having trouble applying the information from school directly to skills that I can use on the job. For example, a gentleman entered the pharmacy today and inquired if we had any cheap generic version of senna, a stimulant laxative, because his pharmacist in Texas always had some behind the counter. Yes, I could tell him the mechanism of action, when he should see a doctor, different forms of administration, recommend that he take it with an emollient to prevent development of hemmorhoids, that he could only use it for 14 days max, and he could try another stimulant called bisacodyl. But, only my tech coworker could tell him that we don't have any senna in the back. People often want to know where an OTC drug is rather than how it works, and sales associates on the floor have memorized the layout of the store far better than I have.

Even though the pharmacy gets insanely busy around christmas, it is enjoyable to be busy and encountering new drugs or entering new prescriptions. Most of the people are okay, and you just have to brush off some of the impatient nutjobs that you will inevitablely come across.

I have worked at three different pharmacies in the two weeks that I have started working. My managers are all really nice. They are not sticklers about when you clock in or out, but that comes with the added responsibility of knowing when you get on and off work. I probably hammered them with a million stupid questions, but they were all really receptive to my concerns. For example, I was clueless when a patient asked for a generic 1.0 mL medium insulin syringes. I now know to look for the walgreens 1.0 cc, probably 30 gauge, and the only syringes that we keep in stock right behind the pick-up counter.

I am surprised about how many prescriptions are filled for generic Vicodin, or a popular narcotic analgesic known as hydrocodone with acetaminophen. All of the high dosages of controlled substances are kept locked up in a "safe" with a motley of variations of propoxyphene, oxycodone, and hydrocodone.

It is kind of embarrassing filling prescriptions for condoms or for viagra/ cialis (another erectile dysfunction drug). I can't believe they would shell out 30 bucks for like 2 viagra tablets. I guess it can be worth it...

Some drugs that may become the next blockbusters, if any of you are looking to buy stocks in pharmaceutical companies, are Lamictal and Risperidal. Lamictal is a newly FDA approved prescription anti-convulsant to prevent siezures in children and bipolar disorder. Risperidal is the only antipsychotic recently FDA approved to autism in kids.

Winter Vacation

So, you would think that 1st year pharmacy students would probably have an entire month separated from pharmacy right? Well, I personally have spent this break with a heightened sensitivity to anything remotely related to all the knowledge I stuffed into my head this past quarter.

We all still had general nervousness about recieving our first grades in pharm school. That translated to checking student portal every day to see whether our grades were posted and emailing each other the good or bad news. And it did not help that Schaffer, our PChem professor, did not post grades until 2 weeks into winter break. P2 students keep reminding us that grades do not really matter anymore. But since a lot of us have residencies on the back of our minds, we all strive to get at least a 3.5.

Another example is that I have a greater awareness to every single new prescription drug commercials that comes on. Whenever I hear about controlled release Ambien CR, see dancing nicorette gum pieces, or hear the selling point about the "only asthma medication that fights the inflammation and allergic reaction" (Advair diskus which has the generic name of Salmeterol/ Fluticasone). You know you are a nerd when you say in your head "I know why that is!" when you see the ad about why "only Pepcid Complete acts to fight heartburn immediately and throughout the night."

Also, starting interning in a retail pharmacy (Walgreens) really drills all those random facts from Clinical Pharmacy 111 into your head. The training site is actually different than the site where I would be working (all results of a centralized human resources department). My first week working was spent at the computer watching all the orientation videos and taking the online technician drill quizzes. This was an overview of HIPAA (Health Information Portability and Protection Act or something of that nature), DEA (Drug Enforcement Agency) required paperwork to fill out for dispensing and keeping inventory of scheduled drugs. What I didn't expect were quizzes of what looked like information taken straight out of our pharmaceutical calculations quizzes: all the abbreviations used for prescription signia, factor analysis, etc. And obviously there were tests about matching brand and generic equivalent drugs.

I finished orienting myself with using their website "Storenet" which contains all the information about stock options, which you can't really take advantage of until after a year of employment. There were also retirement plans and other benefits listed, but that only is applicable after you become a full-time pharmacists. It was kind of cool how they gave out free drugs during Hurricane Katrina. Another area that caught my attention was the specialty pharmacy programs, diabetes, HIV, and infectious disease immunizations. I had no idea that Walgreens even provides home care, specifically only infusions in the east bay. Their Medicare Part D assistance program provides plans customized for each senior's health situation. The aspect that was particularly of interest to me was the scholarship information. Walgreens provides a few grand, that increases with each year that you are enrolled in pharmacy school, if you work as a registered pharmacist for the number of years that you recieve scholarship money. It is tempting but also a large commitment. My classmates and I were all thinking about this option, but it seems too early to make any decisions at this point.

I was bored during the last few days because I finished all the computer-based orientation and there wasn't really anyone watching over us, so I decided to read some other information on Charles Walgreens. He was Swedish and his last name was originally "Wahlgren." I just didn't realize that this multi-million dollar CEO was also a pharmacist who believed very much in promoting his profession. It's amazing how he built the retail pharmacy as we now know it today. He took out loans to increase the number of stores in Chicago in the 2o's, when Walgreens was originally known for their soda fountains and famous "malted milks." Back then, only 4% of their profits came from pharmacy. Now the restaurant services have been torn down, and over 50% of Walgreen's profits come from pharmacy. Walgreens tore down the shelves that blocked the view customers have inside the pharmacy because he caught a pharmacist drinking in the back on the job with female cosmeticians on his lap. Ouch.

Most pharmacies back then displayed glass bottles of powders, liquids, dyes, sweeteers. They were compounded and mixed in the pharmacy while now most of the compounding is standardized in manufacturing. Apparently, Walgreens still upholds its compounding traditions by still offering flavoring or alternate dosage form preps, but is much less likely to be conducted.

Post-Finals

If you saw random pharmacy students loitering around inner sunset, that was probably because everyone got out of the last final of our first quarter this afternoon. Like a group of lost cattle, we collectively were in a state of shock from not having another textbook to study. During finals week, we were in a limbo state between going out to long, drawn-out large group lunches at a new Thai, Chinese, or Indian restaurant and frantically cramming as much information as humanly possible into our heads into the wee hours of the night. So in between fresh naan and Burmese sambusas, we had to work desperately to figure out how to apply hours and hours of lecture to a 3 hour test. I'm not sure if I can define this behavior as balancing work and play or a morbidly zombie-like bipolar way of existence.

I think during the first quarter I personally was trying to do everything I could in terms of attending classes, socializing with an entirely new group of people, maintaining my relationship with my parents, seeing the city, getting involved in leadership positions, absorbing the broader perspective of where the profession of pharmacy was going and where the system would allow me to start experiencing it (as in internships). It reminded me of the anxiety that I felt in my first quarter of college, except more intense because you realize this is actually your profession and your profession is you. A lot of my classmates from Southern California are homesick, a common symptom of your first quarter attending school so far away from your familiar surroundings. A common complaint is that they can't stand the chill of the city, miss their late night mexican joints, the freedom of having a car and finding parking, and the distance between them and their signifigant others/ families. But at the same time, the Thai, Korean, Chinese, and Sushi restaurants are pretty good quality for what you spend. There's always public transportation everywhere you go so you don't need to deal with paying for gas or taking care of your car. And well, it's cold, but you deal with it? lol.

What is nice about being a pharmacy student is having an entire month off as opposed to the medical students whom only have two weeks of winter vacation.

So what are the pharmacy students going to do with a month off from school?

A large number of people are heading to Anaheim during Dec. 3rd-7th for the American Society of Health-System Pharmacists Conference, an entire 4 days of conferences about policies pertinent of pharmacy students and pharmacists. The appeal is that UCSF reimburses them for the registration fees. Most of the people going are So-Cal natives and want to do a little partying, networking, and get involved in policymaking.

The weekend we get back, we are going on a class ski trip to Lake Tahoe. We are getting a cabin that will house about 25 people maximum. I'm certainly excited since this is the first time I will be skiing in like 10 years.

As for myself, I plan to stay in the city and start interning at a retail pharmacy. That does not mean that I will not have the opportunity to go out and enjoy some eclectic holiday shopping that Union Square is known for, watch some of those new movies of actual substance that come out around Christmas, and maybe make a trip to somewhere like Vegas for New Year's. I figure most things that I want to do, I can probably do in the Bay Area.

Complimentary and Alternative Medicines plus Tobacco Cessation

On Thursday, AphA-ASP sponsored an "OTC Herbal Medicines" Talk. This doctor who was trained in western medicine went to do a post-doc in china and then later taught Chinese medicine at UC Berkeley. She apparently received government funding to treat outbreaks of measles in the Chinese children and was active in promoting MMR vaccinations as well. She reviewed various herbs and medicines that could relieve common ills such as the cold, mild rashes, or pain. She stated that all of these remedies are available in Chinatowns throughout San Francisco and the Bay Area. Someone even asked how lay people can select effective Chinese medicines for their illnesses since these herbs are not FDA approved ( officially evaluated for their effectiveness, safety, or harmful interactions with pharmacologic agents). Her response was that people should consult knowledgeable Chinese herbalists who can give recommendations based on clinical trials that support the effectiveness and safety of the herbs.

But gathering from her talk, most of her recommendations come from her patients’ clinical outcomes, and not standardized clinical trials. But what was interesting was hearing the theories about imbalance of elements within a person that causes a disease to manifest. For example, too much heat or cold in the body could create an imbalance. Too much wind in a woman results in menstral cramps. It sounds like Feng Shui meets biology. The theories are too abstract for someone like me who has an empirical understanding rooted in the western medicine that is taught here at UCSF.

Even in our Clinical Pharmacy class, the herbal supplements section is mostly taught in a self-study format. We will only be covering 10 herbs this quarter, like Gingko Biloba and St. John’s Wort. And we do not even learn how to counsel someone how to use them, only know when to recommend to a patient to change dosages or not to use the herb concurrently with a drug due to an adverse drug reaction. St. John’s is well documented for inducing Cytochrome P450, which is an enzyme in the small intestines and the liver, that can decrease bioavailability of P450 substrates. It is daunting but interesting at the same time to realize the wealth of active ingredients that can be sequestered from natural sources. Optimistically, further research into uncovering new herbs can compliment or replace current accepted methods of treatment. It seems evident from her talk that we as future health professionals have a long way to go in terms of bridging these two systems of health care to call truly call it integrated medicine.

The pharmacies that are on the frontier of this movement is Pharmaca, a chain pharmacy that is growing at an exponential rate across the bay area which specializes in integrated medicine. I talked with their corporate recruiter a month ago about how they model their store after european pharmacies that provide herbs as well as pharmacological treatments. Their staff even includes acupuncturists, massage therapists, and other alternative medicine specialists.
The topic that we are delving into in clinical pharmacy class is Tobacco cessation. The program basically trains us about the importance of encouraging patients to quit, review of the physiological effect of nicotine and smoke on the body, how to counsel them about lifestyle changes that can improve rates of quitting, and pharmacologic treatments that can ease the withdrawal symptoms. I think this is the best series in the whole course since the instructors did a really thorough job on everything that we need to know about understanding how these treatments work, how to talk to a smoker, and the goals of how ending this behavior can decrease their chances of cardiovascular disease, stroke, asthma, COPD, and lung cancer.

They even did a shpeel on how the Tobacco industry has done everything they could to hook people on this drug for profit. For example, "Light" cigarrettes were marketed to be cleaner than regular cigarrettes. They were designed with ventilation holes to allow smoke to emit without entering the body, but they contain almost the same amount of nicotine and people inhale the same amount of smoke by covering the ventilation holes with their mouths when the take a puff. It is designed to be addictive since the nicotine reaches the brain to increase release of dopamine in the brainstem under 11 seconds, faster than most drug delivery systems developed today. Therefore this fast delivery of pleasure immediately after smoking a cigarrette reinforces the behavior of smoking.

Post 2nd Round of Midterms

This week was as busy as ever with another round of midterms and flurry of various club meetings. We took our last physical chemistry midterm, which was the most challenging out of the three that we have taken in terms of the material. Ever since we switched professors from Voigt to Schaffer, our lectures and homeworks have become increasingly complex. Part of the difficulty comes from Schaffer using calculus-based explanations of the material, for example understanding equilibrium between a pure liquid with its vapor as a discontinuity between two chemical potential curves, but mostly it is the result of shifting the focus of the class from understanding the concept of state functions to thermodynamics applicable to protein binding and pharmacodynamic studies. I enjoy this second half of the course much more because it is conceptually challenging while still keeping the problem solving understandable (basic calculus and algebra).

We also took our second biopharmaceutics midterm, which went ok. I could have done better since this class is really a simplified version of the pharmacology class that I took in undergrad at UCSD. Our curve was exceptionally high, with about 85% of the class getting an A. This is somewhat intimidating coming from undergrad classes where the curve was 50-60% which allowed you to make mistakes. But I suppose the expectations in biopharm and clinical pharmacy are a lot higher since the material is relatively easier and absolutely applicable to your future career. Every time I make a mistake I think about what a miscalculated dose could do to a patient. I wonder if this burden will ever go away (probably not).

As for extracurriculars….Here are a few out of many…

APhA is having its annual Patient Counseling Competition and a whopping 70 pharmacy students signed up to compete! This is about three times the number in previous years and can only be attributed to a growth of participation in my fellow classmates. I went to the info night and watched the video of last year’s national winner of the competition, also UCSF pharmacy student Eric Ip, counsel a patient in the national competition. He was so thorough when it came to knowing any side effects, customizing his responses to the patient’s needs, and reviewing proper dosage instructions. I still can’t believe he only had 5 minutes to prepare for the session. I realize that I have a lot to learn before I can reach his level.

Last week, we turned in our pledge cards for which fraternity we would pledge for. There are only two pharmacy fraternities at UCSF: Kappa Psi and Phi Delta Chi. From talking to the members, my impression is that Kappa Psi is more social (work hard play hard mentality) while PDC is like a low-key sorority. Pharmacy is already severely polarized (our class with about 100 females and 20 males), so it doesn’t really help the integration of the class when most of the males, non-asian ethnicities, and other minorities all pledged Kappa Psi. The break down this year was 75 pledged KY and only 20 pledged PDC (it was about 50:50 last year). They surprised us this week with breakfast and carnations in the morning before class. I never joined a frat in undergrad, so having such an intense frat presence in my school experience is very different for me. It is nice to have organizations that bring different class levels together.

We had a mandatory meeting for the California Society of Health Pharmacists information session about the conference in Anaheim Dec. 3^rd through 7^th. A large number of our class is interested, especially since the school will reimburse up to 184 dollars of the registration fees.

Also, there have been a series of talks given by some of the major experts in the developments in Medicare Part D. I am really happy that I came to UCSF so that I can hear some of these professors and 4^th year pharmacy students give these really informative talks about what a donut hole is, how late sign-ups for Part D can result in penalties, how benzodiazepines/barbiturates are not covered under the formularies, differences between this program and state run insurance plans, etc.

Summary of October

Let me first say that my experience here at UCSF Pharmacy School is just one voice and not representative of the diverse opinions about the curriculum and student life here. I have a lot of respect for the vast majority of my classmates because they are really genuinely caring, intelligent, and dedicated individuals. The first month is a flurry of orientations, social events, exploration of the city, and food food food!! Our biggest event was the White Coat Ceremony where we donned our new white coats and pledged our duty to the profession of pharmacy.

I attended this AIDS forum on October 13-14th as a one-unit elective class. It was pretty interesting to hear lectures about everything from the most recent research in AIDS treatment, epidemiology of the disease on an international scale, to real life anecdotes about what it was like to live with the disease. Since I did not have a strong grasp on the molecular biology of the disease, I learned that a patient's CD4 Helper T-cell count, the number of infected cells that spread the virus, can be used to measure the progression of the disease. New research suggests that CD8+ Killer T-cells may serve as a treatment solution to suppress CD4's. I learned a little about protease inhibitors, non-nucleoside reverse transcriptase inhibitors, and these new integrase inhibitors that are coming out. Apparently HiV clinics have this 20 minute blood test for HIV, but it's ridiculous cuz there's a 99% chance that it tests positive when you don't have it.

In terms of classes...
I was stressing this whole weekend about this clinical pharmacy midterm that's coming up on tuesday. So far, we covered gas, hemmorhoids, diarrhea, and constipation. The major source of anxiety that I sense among the class is condensing all the important information we need to work in a pharmacy into a "self-study" format. In conference, we analyze two cases per class. But we barely have enough time to cover the first case before we can thoroughly discuss the second one. I feel like I'm being immersed in this task of memorizing all the condraindications of drugs, side effects, mechanisms of action, and brand v. generic names, and therapeutic classes without understanding how they really work. I think taking a crash course in physiology would have given us the foundation to understand and retain why drugs work a certain way. For example, if our professor would have explained in lecture that Ca2+ influx into Ca2+ channels into heart muscle cells leads to heart contraction, then many more people would understand why Ca2+ channel blockers like Amlodipine can lower cardiac output and blood pressure.

Biostats is just like undergrad statistics that I took in UCSD. The tests are more difficult though, but our professor is an excellent lecturer. The compilation CD that a Pharmacy Frat (Phi Delta Chi) made is absolutely essential for preparing for tests.

I have taken physical chemistry in undergrad, but this class is still challenging nonetheless because our professor expects us to know and have equivalent problem solving skills as chemical engineers. This class is not particularly necessary to pursue a career in pharmacy, but understanding thermodynamics, colligative properties, phase changes, equilibrium of chemicals may be an advantage in a compounding pharmacy or pharmacological research.

I think I was stressed out because I had this interview for a pharmacy internship position at Walgreens the day before my Physical Chemistry midterm. It was random because I had to take the 34 to Laguna Honda Hospital and switch to metro L to meet my interviewer at Walgreens. I passed through the more expensive houses west of downtown until I reached 40th and Tarval. Not only was my interviewer half an hour late, but I was worried cuz I planned this study session at later that night. I got so bored that I started passing down the aisles and studying the drug facts on the OTC drugs, since I needed to know them for my midterm.

The interview went pretty well. Since I volunteered at a homeless clinic before, he asked me my opinion of the growing number of people without adequate health insurance in california. Since I was taking this health insurance elective CP198, I pulled out a common theme that the professor kept reiterating, which was that pharmacists have this essential role in educating the patient about redeeming benefits of government-sponsored health insurance like medical or medicare Part-D. The pharmacist can play a key role in deciphering the world of formularies, co-payments, premiums, and quarterly changes to insurance policies that lead to a lot of confusion for people.

It was basically like going through another pharmacy school interview, but somewhat less formal. He said that I could start as a script writer even though I did not have my intern license yet, so I told him that I could start training in december.