Thankful

Hi all,
We are sitting here at the grandparents home in Claxton, Georgia. All the family has left and we are enjoying the company of grandma and granddaddy. Just got back from having the usual Friday night Mexican dinner at Cilantro's. We had alot of people here for Thanksgiving and it was so nice to see everyone. I was especially excited to meet my newborn niece Amelia. I still can't believe my brother-in-law Jason is a daddy but she is one adorable little girl.

Here are a few pictures of my beautiful little niece





Last Friday I completed my Drug Information rotation at the Mayo Clinic. The Mayo Clinic is super nice and the rotation was pretty good. I just do not miss the early morning drive to Jacksonville and the long walk from my car to the hospital. It seemed like it was a 5 mile walk every morning. I had to text Dave one morning these pictures just so he could see where I had to walk to, the pictures just don't do it justice...



Getting a little bit closer...



I also had a classmate with me that completed his Drug Info rotation as well. A normal day consisted of coming in bright and early and we would sit at our cubicle desks. Physicians, pharmacists, nurses, and other healthcare professionals would either call the drug info center (me and frank) or send us an email and ask us a question that they need an answer for. We would get about 1-2 questions a day but there were a few days when we were working on like 4-5 questions. We would do alot of research using several different resources (PubMed, Micromedex, Clinical Pharmacology, Facts and Comparisons, package inserts, calling the Manufacturer [my favorite!!], and then google). We also had to complete 2 presentations during our month at the Mayo Clinic. One presentation was a Journal Club presentation and the other was a presentation on one of the questions we had received in the drug information center and we had to describe the process of answering the question. Overall, it was a pretty good rotation. I just didn't like not seeing patients at all and being cooped up in a cubicle all day long with no windows to see the sunshine. But one day we came in to find a gift from the residents...

Reese's for Halloween!!



There was also a day when they were giving treats to all of the workers at the Mayo Clinic. So frank went and got us some of the treats, they were these huge caramel apples with mini M&M's on the outside. I had to share with Dave when I got home. They sure are nice to their employees at the Mayo Clinic.



I can't believe I'm already a week into my 7th rotation. I'm at a Super Target near the base in Jacksonville. Three more weeks then I get a couple of weeks off for Christmas. I can't believe I am graduating in May. It just doesn't seem real. I don't wanna leave, I love school! Especially now that Dave is in school. Next year we wont have mailboxes next to each other in the office :( Someone else will be below his name.

Had to take a picture...



I feel like my life is perfectly described in the lyrics of the new Lady Antebellum song, American Honey. There is a line in that song that says "Couldn't wait to get goin' but wasn't quite ready to leave." I feel like our lives are going to be changing so much in the near future. From moving from our first home in our one bedroom apartment to a home on 3rd street, to graduating and actually having a grown up career, and then just maybe, Lord willing, we could start a family... but no comments please, this is a while down the road :) I love the place that David and I are at in our lives. He is such an amazing husband and God has blessed us so much.

Here's a picture of downtown where you can turn to come to our new home on 3rd street, can't wait for it to be done :)



Coming down 3rd street :)



As I had mentioned in a previous note, we were trying to read through the entire Bible chronologically in a year. We have been doing our reading but it doesn't look like we will make it in a year. We are currently in Leviticus. I am really loving the Old Testament. We have been learning about the history of the people of Israel and reading all of the stories of God's creation, promises, and protection of His people. I look forward to learning so much more!

We love you all,
Dave and Lins

Slow Progress

Hi all,
Just a quick house update. Things are moving along slowly and hope to start getting the ball rolling here this coming week. The city has put a few kinks in the plans. Before we can get a permit and do anything, they want to know everything. What's going on the floors, what's going in the kitchen, what's going in the backyard, what's going on the outside, who is going to be doing the work, yada yada yada. So we (mostly mom and Fred) have spent these past few weeks getting quotes from different companies and we have had to pick out EVERYTHING before getting started on anything! Today me and mom went and finally picked out all of the flooring materials. Here is a picture of what we decided on. It's going to be dark wood floors throughout the kitchen, living room, and front hallway and then the carpet in the three bedrooms. The white piece of wood is the cabinet sample that we decided for the kitchen. Going for the classic Pottery Barn look :) (on a budget)



This is the kitchen look we are shooting for



Here's the backyard. Fred and his workers are probably going to be finishing this first. I'm so excited about our backyard! We're getting pavers!!



Hopefully we will get the demolition on the inside started shortly! Sure hope so because our lease ends at the end of January. It's kind of a bitter sweet feeling having to move out of our apartment. Even though we are renting, it's been our first home for me and Dave. I will always look back and be thankful for this little one bedroom apartment.

There are so many great things going on. The holidays are coming up, we get to spend time with family and friends, another rotation will be ending at the end of this week, another rotation will be starting in a week, small (very small) groups have been a great encouragement and a time of learning and growing in God's Word, there is just so much I am thankful for. God has so richly blessed us beyond measure!

On to the next one...

5 Rotations down and 4 to go!! Graduation is coming up so fast! I'm not sure how I feel about that either! I'm excited but I'm really going to miss school. I feel like I'm going to be a real grown-up with a real job. That's scary! But I guess that's life.

I just completed my academic rotation yesterday. It was one of my favorite rotations! I just spent 4 weeks at the college at Shands Hospital going to all of the classes and helping out. The very first class to attend on my schedule was one of David's classes. He had a presentation to give that day and I got to sit in and listen to him. I'm so proud of him. He is so brilliant! There were two other academic students with me and we were able to see what goes on behind the scenes in the academia world. We had the responsibility of grading student performances, teaching some courses, and holding student evaluation meetings. Just attending class to help out provided a great review of alot of information. On our last day we were treated to lunch at bb's (very nice place!) in the San Marco area. That was so nice of Dr. Motycka to take us out! If you've never been to bb's, you should try it out!

Dave is now half way done with his first semester of pharmacy school! As he would say, "I'm 1/16th done with pharmacy school!" I still can't even believe he is already in school! Time is going by so fast! I just want it to slow down a little! Dave is doing great with school. Hes making alot of A's (not gonna lie, I'm a little bit jealous!). It's fun to see what all he is studying and to talk about medical stuff with him. I get a great refresher as well. Next year he will be learning all about the drugs and I can't wait!

The house is slowly starting to get rolling! We just got a permit this past week to get the demolition started. We also received our floor plan this past week and that is all planned and finished. We went to Lowe's last night and picked out all of our appliances!! That was pretty exciting! They had a sale going on until Sunday where you can get 20% off Whirlpool appliances as well as a 400 dollar rebate if you get 4 appliances! So we saved alot of money!!! We decided to go with the gas stovetop!! I'm so excited about it but I still have to do my research to make sure we can put a gas tank on our property so everything is to "code". All these rules and regulations are really frustrating to deal with! So if all is ok then we keep the gas, but if for some reason it can't be done we will have to take that back and get an electric stovetop. So we will just have to see.

My next rotation starts Monday. I have Drug Information at the Mayo Clinic. I've heard it's a pretty good rotation so we will see how it goes :)

Miranda also spent a day with us around town takin some pics for us. Gotta decide which one is Christmas card worthy...







And this one was all Dave's idea...

We're Moving!!!

Moving back to Fernandina Beach! When we got married we moved into our apartment which is in Yulee. I am not a Yulee gurl! My amazing parents are in the process of remodeling a house in downtown Fernandina. It is like the best place in Fernandina!

As you can see in the pics, the place is in really sad shape, but the location is incredible! We are about to start tearing all the walls down and gutting the entire inside. The floor plan will be changing. We have planned for 3 bedrooms, 2 bath, and 1 car garage. After graduation, we plan on buying it from my parents. I don't think were gonna know what to do with all the space! This little 1 bedroom 1 bath apartment is gettin a little small after 2 and a half years!

We have met our neighbors-to-be and the one lady that lives next to us is 101. She reminds me of my sweet granny stone, whom I miss dearly.

So the cleaning out has begun and since these pictures have been taken, the whole inside has been cleaned out, the back yard (formerly the jungle) has been tamed, and the trees have been cut and trimmed away from the house. There is still so much work ahead of us but we plan on being in by Christmas time. We can't wait!

Our home-to-be, right across the street from the museum in downtown Fernandina Beach



This is where the garage will be. The only thing staying in this house is this tile floor which will become the garage floor.



Another view of the garage:



The backyard!



More of the jungle



Look at this mess!



Our future bedroom... again it will all be gutted!



The current bathroom! This is def going!



Fred, the head of the project!



How disgusting!



I will post pics throughout the process... or should I keep you in wonder until it is all finished?!?!? Hmmmm...

Transplant Rotation

Hi all,
A few weeks ago I completed my transplant rotation in Tampa, FL. I've been so busy since returning home (currently on my month off), that today is my first real day of being lazy with a very short to-do list. Just wanted to share some of my experiences from my time in Tampa.

Prior to my rotation starting I was excited that I had a transplant rotation in the hopes of getting to see the more clinical side to pharmacy and maybe even seeing a transplant done. But as I soon found out I would not be in the hospital at all, rather at a specialty community pharmacy near Tampa General Hospital, called BioScrip Pharmacy. BioScrip Pharmacy specializes in HIV, transplant, and other complex conditions. This rotation was actually more of an HIV elective in that we saw and counseled so many more HIV patients than any other. It was a good opportunity to see certain medications that I am not as familiar with dispensing.

There were a few days that my preceptor scheduled me to visit the transplant floor at Tampa General Hospital and also LifeLink (located right next to TGH) so that I could see the entire process that a transplant patient goes through in order to receive their new organ. The following is a little of what I learned and sort of a picture that you can see of what all the journey entails...

For a patient requiring a transplant they first come to LifeLink which is where they will have an entire medical assessment of their current health status and will be approved to be placed on the "waiting list". I was able to sit in on one classes for patients who are trying to get on the waiting list. Its was really kind of cool to come into a big room and see all of the faces of the people waiting for an organ with their loved ones (spouses, siblings, children, and friends) and also so sad to witness the desperation in all of their lives. The class lasted all afternoon for several hours and here is a bit of what I learned.

The United Network of Organ Sharing, also known as UNOS, maintains the national waiting list and keeps all the transplant statistics. The first kidney transplant done was in 1954 and was done in twin brothers. Because they were twins there was no need for immunosuppression therapy (medications that help to decrease the immune response your body may have that would reject the newly transplanted organ). There is also a way to test for matching today that is a simple blood test, however back then they tested for a match by doing a skin graft. If the skin graft did not die then they thought that transplanting an organ might be a success.

So for todays transplant patient they will come to LifeLink for a series of blood works to do crossmatching and such and also a full day of assessments that include (but not limited to) getting the patients weight (transplant surgery has a BMI limit of 35), chest x-rays, ECHO, abdominal CT scan, EKG, doppler, pap smear, mammogram, stress test, and colonoscopy depending on patients age. The transplant patient is not allowed to smoke because of the concerns of not being able to come off of the ventilator after the surgery. After this day of assessments are completed the medical review board will assess all of the medical and financial information and will either approve or reject the patient from being put on the transplant waiting list.

Once the patient is on the waiting list, they do just that. Wait. The average wait time is about 1-2 years depending on what organ you are waiting for and what your blood type is. While you are on the wait list you must call your coordinator to inform them when you are going on vacation, have any change in phone number or contact information, when you get sick or have been taking any antibiotics.

Once an organ comes available, the patient gets a random phone call, may even be in the middle of the night, and will rush safely to the hospital. Just because you get the phone call doesn't mean you get the organ. They call about 2 people to come in at once so it is important to ask whether you are the primary or the secondary person when you are called. Once both patients arrive they do another blood test to check the antibodies for matching and also weigh the patient and assess if they have recently been sick, etc. If the primary patient is unable to receive the organ than they will give it to the secondary patient so the organ is not wasted.

Lets talk about kidney transplants. I learned that when they do a kidney transplant they leave your kidney in you. They just put the healthy kidney in and connect all the goods. So kidney transplant patients could be walking around with anywhere from 3 to 5 (or maybe more) kidneys in them depending upon how many transplants they have received. The surgery for a kidney transplant will last about 3 hours and the patient will stay in the hospital for about 5 to 7 days. It is important to monitor for graft rejection in this time and to ensure that the transplant is a success. I spent a day at Tampa General Hospital on the transplant floor and was able to go in and assess the patients and to help monitor them during their stay at the hospital post transplant. This was a pretty cool day.

Then comes the after care. Transplant patients must be on numerous amounts of medications for a very long period of time (some they may take the rest of their lives) to prevent their body from rejecting the organ that was transplanted. These medications also require blood tests to monitor levels, have some pretty terrible side effects, and may cause infections since they are taking immunosuppresant therapy. And when infections occur, this requires more medications to help treat or prevent the infection. See how all this gets real complicating real quick. So then there is me, on my rotation at BioScrip pharmacy, where the transplant patients come in to to get their medications and I will be counseling them on all these regimens. So it was a pretty cool month but sort of just another community/retail pharmacy setting.

Once I got back home from Tampa, we went to Destin for a week and went to the beach and just relaxed. It was so nice. We celebrated Laurens bday while we were there and then when we got home we celebrated Mirandas with a surprise birthday party. I am so thankful for great friends! I have about 3 more weeks until my next rotation starts so I am really being lazy and it feels so good!



One Big Thing I learned is that if you want to be an organ donor then TELL YOUR FAMILY. Just because it may say so on your drivers license, doesn't mean you will be able to. Your family can override this if they dont know your wishes.

Two Years of Wedded Bliss

Tomorrow, I will have been married to my best friend for 2 years. Wow! These past two years have been amazing. I always heard people say that the first two years of marriage is the hardest but they have been nothing less than great. We didn't even really have the "growing pains" I heard people talk about. We just really like hanging out with each other, talking about everyday things, and learning together. Well more like me learning from dave. He is alot smarter than I am. I am really excited for him to start pharmacy school in a few weeks so I can study with him and review all the stuff I learned a couple of years ago. Anywho, we plan on celebrating the night at Carrabba's. I think we have made this kind of a tradition. The day after our wedding, before we left for the Dominican Republic, we went to Carrabba's and then decided to go last year for our anniversary. So it looks like we will be going tomorrow night for a great dinner!

One thing we recently began doing is reading the Bible through in a year. To be quite honest I have never read the entire Bible all the way through. Our daily readings are in chronological order. So far we have read part of Genesis and then jumped over to Job. I am learning so much and I wish I would have done this sooner. I am learning so much about my Creator, my God, my Savior. He makes Himself so real through His Word and I am learning so much about His character.

Dave and I have also been researching the benefits of juicing. Yes, that's right, juicing. We have watched several documentaries and read up on the topic. It's a great way to consume the appropriate amounts of fruits and vegetables for the day. By juicing, you are able to consume all of the nutrients that the fruits and vegetables have. Whereas when you cook your veggies, you are cooking out all of the good nutrients they have. Fresh juices are a tremendous source of enzymes. In fact, the "freshness" of juice is one of their key features, because enzymes are destroyed by heat. Since fruits and vegetables are juiced raw, the enzymes are still viable when you drink the juice. Also by juicing, it aids in the initial digestion of your food so your body can use the good stuff better and gets absorbed more efficiently. During the juicing process, indigestible fiber is removed and this allows the nutrients that would be "trapped" if eaten as a whole fruit/veggie, to be released when juiced. So instead of getting a small percentage of the nutrients, you get 100% of the nutrients from the food. Today was our first day trying the process and it was actually quite simple. For breakfast we had juiced two apples and 6 carrots. This made about 8-9 ounces of juice for each of us. For lunch we had juiced 2 tomatoes, 4 celery stalks, 2 carrots, and 1 whole cucumber together. This also made about 8 ounces of vegetable juice for the both of us. Its actually really cool and definitely curbs your appetite.

Here is a pic of our juicer:



I have 2 more weeks here in Tampa and then I will be back home. Dave will be heading home in about a week to start preparing for classes and going to orientation in Jacksonville and in Gainesville. Time for him to start jumping through all the UF College of Pharmacy hoops. :) I remember those days :)

Where are you summer?

Hi all,
Thought it was time for a blog. I haven't written one since my last week in St. Augustine over a month ago. I just completed my Adult Medicine Elective at Baptist Hospital in downtown Jacksonville. My preceptor was awesome!! I learned so much from her! I just wanted to post a few things we had learned during the past 4 weeks that I think everyone should know...

- There is a "weight limit" for the birth control patch. Use over this weight will decrease the effectiveness due to varied absorption.
- Depo Provera may make you infertile for life, even after only one injection.
- Viagra is best absorbed with a fatty meal, so go eat a big ole steak!
- What's the new statin available for cholesterol? pitavastatin (Livalo)
- Pantoprazole (Protonix) is now available in granules
- What's the reversal agent for clopidogrel (Plavix)? desmopressin (DDAVP), titrate up based on urinary output
-Can only shock a patient with a rhythm (VF/VT), don't shock a patient in asystole
-Can you give platelets to reverse abciximab (Reopro)? No, because it has a short duration of action
-What's the treatment of hyperkalemia? Regular insulin 0.1 units/kg IV with 50 ml D50W (50% dextrose)
-What's the dose of aspirin in Aggrenox? 25 mg, so it's ok for your patients to keep taking their 81 mg
- What would be the color of the urine if patient is experiencing severe myopathies? pinkish
- Brand name of Vitamin K? Mephyton
- If patient has HIT, don't use heparin to line the tubing
What's the pretreatment for contrast induced nephropathy? Nabicarb, NAC

I also got in to see a surgery during my last week at Baptist. I watched a pancreatic resection surgery. It was similar to a gastric bypass in that they did the Roux en y technique except it was done on the pancreas. I watched from the very beginning when they put the patient to sleep, saw the intubation process, an A line and central line started, and then the stomach cut wide open and splayed everywhere. I was feeling very woozy. I stood with the anesthesiologist for most of the procedure at the head of the patients table. It was neat to see what he did during the surgery, controlling all the medication administrations and learning about all the machines used for monitoring. Surgery is definitely a different world. And definitely not an interest to me, I thought I was going to pass out the whole time!

So, I've just finished up this elective rotation and I am about to head to Tampa for a month for my transplant rotation. This will not be so bad because David gets to come with me. His last day of work was Friday (yesterday) so he will have 3 weeks with me in Tampa before he has to come back and start pharmacy school! It's kind of a weird feeling that we will both be jobless for about a year, but no worries, the Lord will provide for us.

About 10 more months until I graduate (and hopefully pass my boards)! I'm so ready to be a pharmacist already!

Bring It On Home

My work at Flagler Hospital is soon to be done and I will be heading back to Fernandina to be with my family. I have experienced alot here during my time at Flagler. During my second week here, I experienced losing my first patient in the ICU. It was a very difficult thing to experience. For the first week and a half I was involved with the care of my patient. It was the strangest feeling when I came in the next morning and received the news. After this I knew I could not make a career in the critical care setting. Death is too common a theme. It seems like there is a code called daily. Most of them are Code blues where there has been a patient that went into cardiac or respiratory arrest. When I hear them coming over the intercom saying "Code Blue in Room ___", my heart just sinks. I can only think what if it's one of my patients?? And to be quite honest, the first thing I think about is whether or not they know the sweet saving grace of Jesus? It makes me want to be by their bedside sharing the good news instead of being at my computer monitoring their medications. One announcement I love hearing is when a baby is born. The sweetest lullaby comes over the intercom throughout the entire hospital. One day there were twins and they played the lullaby back to back.

During my time at the hospital I attended two P&T meetings (Pharmacy and Therapeutics). This is a meeting of about 10-15 doctors, nurses, and pharmacists. They meet monthly to discuss hospital issues and to come up with solutions to the problems. At one P&T meeting, there was a case presented about a mistake made by a nurse. The nurses that were present at the meeting were very defensive about the the knowledge that they hold. A solution to the problem was to provide educational material to "refresh" the nurses knowledge of pharmacology so they can differentiate on the front lines when something is not right. Well the ladies in the room said "You should not punish us all for one person's mistake of something she should have known once she graduated!" So I quietly sat back and listened to the back and forth discussion. The leader of the group said, "Ok well let me test you on some common nurse pharmacology knowledge and see how much you know since you graduated 20 years ago. Think about Lasix (furosemide, a loop diuretic used often). If the doctor chose to start Gentamicin, an aminoglycoside (also commonly prescribed), based on the pharmacology of these two drugs what would be your concern and what would you monitor in your patient?" I was like dun, dun, dun... you could hear a pin drop. He only wanted the nurses to respond and nobody said a word. In pharmacy world I immediately thought... the patients hearing!!! Because both of these agents together can contribute to ototoxicity or hearing loss. So needless to say I think we can all learn a lesson from here. Not one of us is more perfect than the other and we all have room to refresh our knowledge and learn new things (and old things again).

What else? I have spent the last 3 weeks straight tutoring the secretary so she could take the certification exam to become a certified technician. She took her exam last Friday and passed!!!! I was so proud of her! I will miss her the most!

After completing this rotation, I am terrified of becoming a pharmacist. Most days I feel so inadequate. But I learn more everyday. UF has provided me with a great education and handy tools so I know where to go look up an answer if I don't know it off the top of my head.

But I have learned all I am going to learn here in St. Augustine and it's time to go home.

Dave, get ready to have your snuggle bunny back :) I miss bed time the most :) I love you and thank you for being an AMAZING husband. You are such a wonderful encouragement to me and I am thankful I get to walk through this life with you by my side.

Adult Medicine Rotation: 7 weeks and 1 day left!

Hi all,
This past week I started a new rotation at Flagler hospital in St. Augustine. It is my adult medicine rotation and it is 8 weeks long. This week has definitely been a challenge. This is the longest I will have been away from my family, especially David. I always get really nervous starting new things and not knowing what to expect. So my tummy was in knots all day Sunday when I had to leave and then all the anticipation of having to meet new people and learn new life stories and build quick relationships with so many people. Not to even mention the unknown academic task ahead of me. I felt so unprepared come Monday morning. Well, let's just say it's a good thing I am typing this blog tonight and didn't type yesterday. I think tonight will be alot more positive and optimistic than if I were to have typed yesterday (Yesterday was melt down day at the pharmacy, it was one of THE WORST days I have ever had).

Here's kinda how my week has been going:

I show up Monday at 8 am. Right on time. I met the secretary and was then informed that my preceptor is involved with this antibiotic stewardship program where he rounds with the physicians every morning until around lunch time. I was then instructed to go have a seat in the corner at my new desk and wait on him to be finished. So I wait patiently and finally I meet with my preceptor. He is a very nice man, an incredibly brilliant pharmacist.

Ok, so my instructions for the week were to "play around" with my daily assignments until I can figure it out. Well I'm not the "playing around" with stuff kinda person. I like checklists, study guides, notes, a person to tell me exactly what I need to do and the process to make it correct before I just do something. This really didn't sit well with me and the first part of this week I was feeling so ill toward this rotation. So this was Monday and Tuesday. Now here comes melt down day, Wednesday, dun dun dun. My preceptor arrives in the pharmacy after his rounds and says, ohh by the way I'm leaving in 5 minutes to go out of town and will be gone until Monday. I was like ok so how am I going to learn what I need to do if you don't show me? Then he told me to just "finish playing around" all week and we will spend more time training you next week. Little did I know that the pharmacists working thought that by Wednesday, they were depending on me to get my tasks done for them. And I had no idea. I was just "playing around", as directed by my preceptor. So then when it was crunch time and everything was due, the pharmacists came to me and asked for all the work, and I had nothing. Nada. Now don't get me wrong, they weren't upset with me, just that I hadn't been trained for any of the time I had been there. I was beyond embarrassed, but there was nothing I could have done. When I got off Wednesday, I did not want to go back to that hospital, not one bit.

Today has been a completely different experience! With my preceptor out of town, a pharmacist saw a need to train me and took it upon herself to sit with me all day today and show me what needed to get done. I am so thankful for her.

So now that I know what I will be doing, here is what my days at Flagler Hospital involves:

Daily TPN Monitoring
Daily Antibiotic monitoring, kinetics, and dosing
Daily Anticoagulation monitoring
Weekly Case presentations
2 In Service presentations

So what the heck is all that? So many people think that a pharmacist just puts pills in a bottle, puts a label on it, and gets paid alot of money to do so. I hope that by blogging people can see that our profession is so much more than that.

My tasks explained:

TPNs, or total parenteral nutrition (no, not toilet paper nonsense Aunt Kate) basically means the patient is receiving nutrition by an iv instead of eating food. There are several reasons a patient may not be able to obtain their nutrition by mouth. The TPNs contain many different things and each TPN is individualized to the patient receiving it. The TPN will contain/but not limited to dextrose, lipids, amino acids, vitamins, insulin, and electrolytes like sodium, potassium, chloride, magnesium, and all that. It is the pharmacist's responsibility to determine what and how much of each component should be placed in the patients bag. I am responsible for obtaining all the patients most recent labs (sodium, potassium, magnesium, glucose, etc) and determine what goes in it. And I am doing all this with an old school computer system that is not easy to navigate. After I have determined what needs to be added, removed, increased or decreased, I then get a pharmacist to approve my recommendation and the TPN goes to a technician to be made. Pretty tedious work!

The daily antibiotic monitoring that I am responsible for is pretty frustrating too. I have to assess my patients, which include open heart recovery, medical ICU and surgical ICU, every morning. For each patient I have to check to see what the most recent vancomycin level was, when the last dose was given, whether the patient has a fever or not, what their kidney function is (the medications may worsen kidney function), what their white blood cell count is (if elevated, will indicate an infection), has the microbiology lab submitted any positive cultures so we can narrow our antibiotic coverage to only the bugs we are dealing with, how many days has our patient been receiving antibiotic therapy, and what is the indication, or reason, the patient is getting these iv antibiotics (will tell us the different ranges we want the antibiotic levels in the body to be so we get the effect we are trying to achieve)? And to answer all of these questions, again, I have to navigate this horrible computer system that is so outdated. Once I have obtained all the patient data, I determine the appropriate dose for the patients and make any changes to the doctors orders if they have been prescribed the wrong dose or dosing interval.

My daily anitcoagulation monitoring is pretty easy. These are patients I have to monitor because they are receiving a certain type of medication that puts them at risk for bleeding and having negative effects on their kidney function. So every day I pull up my anticoag patients and look at their most recent platelet counts and creatinine levels (gives me information on kidney function). If levels are missing, I have to order a level for my patients so I know that they are getting the appropriate care and not experiencing any adverse effects from the medications. If their creatinine levels are elevated then I am responsible for renally dose adjusting their medications to help prevent any further complications due to the medications effect on the kidney's.

The weekly cases and presentations will be given to my preceptor and will cover a variety of topics. This week I have been following a pneumonia patient and will present my case on Monday.

Geez we really do earn that Dr. title when we graduate!

So this has been my week. The Lord has carried me through it and I pray that He uses me at Flagler Hospital to be a light to the people around me. I pray that through my initial struggles that the people around me were able to see my perseverance and my being slow to anger and frustration. Pray for me. I miss Dave terribly and it's hard to crawl into an empty bed at night after a hard day. Ok sorry to be rambling, this was a really long blog. If you stayed with me, wow! You are a great friend!

Produce Day!

Thursday has become my new favorite day! I feel like I get a surprise every afternoon when I go pick up our bag of random fresh organic fruits and veggies. Here is what we got this week:



We got a ton of fresh green beans, sweet potatoes, bananas, peaches, apples, mushrooms, cantaloupe, onions, and beets. Yes, beets. I have no idea what I'm going to do with these things yet. I have never cooked beets in my entire life. Let me rephrase that... I have never even ate beets in my entire life. But you know what? What? I'm going to try it!

So we did alot of cooking this past week with everything we got last week. I realized after I blogged last week that the lettuce I said we got was actually kale. Yeah I have never had kale (that I know of) ever before. Here are a few things we fixed:

Kale Chips:
Preheat oven to 350, lay a bunch of kale on cookie sheet, drizzle with olive oil and sprinkle a little salt and bake for 15 minutes. The leaves come out crispy and are a good healthy substitute for potato chips.

Other Kale Ideas:
Mix into any soups. It's very similar to spinach and goes well with alot of different flavors. Also good in salads, especially with a homemade dressing.

Broccoli Soup:
Saute 1 large onion, garlic, salt and pepper until onion is translucent. Add 1 diced potato, bunch of broccoli (frozen or fresh), 2 cups of chicken broth, 2 cups of nonfat milk and bring to boil. Reduce heat and simmer for 15 minutes. Use a hand mixer and blend until smooth.

Baked Potatoes:
Chop potatoes into cubes, chop onion into medium/large pieces, mix in 1 packet of Lipton Onion Soup Mix and bake at temperature listed on soup mix for 40-45 minutes.

Well that's been our week in the kitchen! I will update next week and I may just have a recipe for beets. :)

I'm leaving for St.Augustine Sunday! Not ready for my Adult Medicine rotation at all! I have alot to read up on in 3 days. Night all!

Exciting Times

Hi all,
Thought it is about time to do some blogging. First, I just want to say that David was accepted to the University of Florida College of Pharmacy!!!! He received an email last Friday informing him that he was smart enough and that they wanted him. He will be starting in August and will graduate in 2014 as Dr. David Ashley White, PharmD. I am so proud of him and I am so thankful he is my husband. Since he was not previously a gator fan, he said he would not be a gator until he was finally accepted. So, in preparation for him getting accepted I bought him a gator shirt (I just had a really good feeling he was in since he is such a genius) and hid it under our living room chair. When he got the email I gave him a nice little present. :)



Here's a picture of Dave with his acceptance email and his new gator shirt:


So, what else is new? I finished my first rotation!!! I'm going to miss the VA so much! The people there were awesome and I loved teaching my diabetes, hypertension, and cholesterol clinics. I learned so much from the other physicians and pharmacists I worked with in the wound, GI, mental health, and cardiology clinics. I just wanted to share some things that stuck out in my mind the most. I asked the cardiologist why she picked cardiology as her focus. Her response: "In med school, I knew for sure I didn't want to do GI because rotating throughout the clinics and sitting through colonoscopies, we were always told the air has to go somewhere during the procedure and in the recovery room." I couldn't stop giggling until my second month at the VA I knew exactly what she was talking about. I sat through my first colonoscopy and the patient is just passing gas like crazy! The doc is just chillaxin and acting like its normal. I was mortified! And then I knew exactly why that field was not for her. But if you ever have a colonoscopy, you will have meds that will knock you out and you won't remember a thing! Just a word of advice: Please do the bowel prep just as prescribed. I saw what it looks like (your bowels and large intestine) when patients have a sub-par bowel prep and it's not pretty! Plus you will just be sent home and have to do it all over again!! But on a serious note, these docs are just as important because they are able to detect cancers and so forth. So go get your colonoscopy if you are at that age!! The cardiologist also taught me what the word "Pendulous" means in terms of describing a certain anatomy. During a breast exam, if you have long and flabby breasts, they will describe them as pendulous. hehe, thought that was a funny random fact of the day, especially from a cardiologist. When I went to the wound clinic, I saw so many things I never thought I would see. So many amputations from toes, feet, and legs due to diabetes and smoking! I also got to see a skin graft put on a patients leg that was burned. The doctor was telling me about the company that they get the grafts from and its a very neat story. The company that supplies the VA with skin grafts, Apligraf, had donated all of their grafts to the victims of Sept 11 at no charge and due to this, the company went out of business. After several years a large company came in and got them up and running again. The grafts are made from fetal foreskin and 1 foreskin sample can grow over a football field amount of graft tissue. I'm so amazed at science and technology, its so cool! I don't even think I can type my experiences from the mental health clinic. All I can say is interviewing schizophrenic patients is a rare opportunity and boy was it interesting! So this was my first rotation. I was exposed to so many different things, people and places. I will miss it so much, I kinda got teary eyed when I left today because I didn't really want to leave.

Anything else new? Yes! My aunt and uncle were telling us about this Organic produce co-op that they have been a part of for the past several weeks along with alot of families from our church. Every Thursday they pick up a large bag full of organic grown vegetables and fruit and you get whatever is in the bag for $25. Every week you get a variety of things and it's always different. David and I decided to become a part of it because you can't beat the price and you get so much fresh fruits and veggies! I also thought that since you can't pick or choose what you get every week, we will be getting things that we may not necessarily buy at the grocery store. So we can try some new things that are healthy for us. Here's a picture of what I picked up today from the co-op:


We got a cucumber, asian pears, a pineapple, avocados, new potatoes, big juicy navel oranges, kiwi, huge broccoli florets, snap peas, and a huge head of lettuce! It's so much for so little and it's all organic. I'm so excited to see what we get next Thursday.

Prayer request needed: My next rotation will take me to Flagler hospital in St. Augustine. This is too far for me to make the drive daily so I will be staying with some family friends for 8 weeks. I will be able to come home on the weekends but I don't like that I will be away from David and everybody else for this long. I know everything will be fine but 8 weeks is a long time to be away. But I keep reminding myself that I can do anything for 8 weeks.



Love to you all,
Lindsey

Just some thoughts

Recently God has been showing me and teaching me so many new things. This past month at our church we have been challenged to "Live simply so that others may simply live." Our pastor has been preaching a series of messages from the book of Colossians that have opened my eyes to some very familiar truths, however I am seeing them in a new light. Not to be viewed as "legalism" but rather sacrificing so that others may receive, our pastor has challenged us to save anything above what we "need" for the month. At the end of March, we will be taking up an offering and what is given will be used for local and global missions. A few include a local crisis pregnancy center, the Barnabas center, South America mission work, and even overseas groups that help women who have been sold into prostitution because their families don't make enough money to allow them to remain at home. If anyone would like to listen to the Sunday sermon's you can find them at experiencecelebration.com. My initial reaction was "Lord, how are Dave and I going to be able to give when we don't make anything now?" And I began to think about all the useless things we spend "our" money on. The fact that "our" money is not "ours" to begin with. God has given each according to their own ability, and we are certainly blessed beyond measure. We could for sure not eat out like we normally would, or make a trip to the Gap, or go out for an ice cream date at Chicken fil a. So the money that we would normally spend doing these things, we are going to save, so that others may be able to have a nice meal for dinner, or even just a meal for that fact. One verse in Colossian's continues to stand out in my mind, chapter 1 verse 24 says, "Now I rejoice in my sufferings for your sake, and in my flesh I do my share on behalf of His body, which is the church, in filling up what is lacking in Christ's afflictions." Now just to make a note real quick... the big picture of the book of Colossians is that Paul is writing to tell of how God is sufficient in all things and how Christ is completely adequate. So why would this one verse say that there is something lacking in Christ? It reminds me of the song that goes like I wanna be your hands, I wanna be your feet... Christ no longer has a physical presence in this earth, and it is our place to go and bring the message of Jesus to those around us. It's also important to realize that God doesn't have a bank account that He uses when there is a need to be met. It's up to us to use what He has given us. One point pastor mike brought up was why did he pick you and me, people, to spread the good news? Simply put, because we have experienced His salvation and tasted of His grace. That is why we should be passionate for the Lord's work. Back to the parable of the talents in Matthew 25:14-30, the Lord gave to each according to his own ability and when we are faithful with a few things, He will put us in charge of many things. My prayer for our family is that we won't be lazy to the calling of God's work and that whatever He leads us to do, he will provide a means for us to go or give.
~ Lindsey

The beginning to an end

Rotations are here!!! For the past 3 years, I have worked very hard to make it to this place in my life. My family has sacrificed alot for me and they have been an awesome source of encouragement throughout this journey in my life. So let the countdown to the finish line begin. In a previous post I listed my rotation schedule and a little about what they are. I would like to post my personal experiences with each so you can see (and I can remember) all the great things I get to do and see. March 1, 2010 was Day 1 at the VA medical center in Jacksonville. This is still my first week but I'm just too excited to tell of all that I have experienced in just 3 days. After having to drive to Gainesville just to get an ID and fingerprinted at 6am, I made it to my rotation at 10:30ish am. I met all the wonderful people in the pharmacy, including my great preceptor and wonderful pharmacy resident. For monday and wednesday afternoons, I get to teach a diabetes glucometer class to the veterans. Basically I encourage them to have a good handle on their diabetes and then I get to teach them how to use their new glucose meter. I watched the pharmacy resident teach the first class on monday and she would say some pretty cool things to help the veterans remember what to do. My favorite is when she would teach them how to use the finger pricker lancing device. She would say ok guys, its just like loading a gun and you all can do that, "You gotta load it (put the needle in), cock it (pull the back part back), and shoot it (push the little button)." One of my favorite repsonses so far has been "Is 393 a good reading?"... welllllll.... so I used my handy dandy ptx interviewing skills and said hmmm, when did you last eat? WHAT did you eat? Response: 2 cheeseburgers, a small fry, a large coke (i asked if it was diet and they responded "I filled it 3/4 with regular coke and then topped it off with diet, does that count?" hehe, I'm gonna love this diabetes class. So what else do I do? On wednesday's I sit in at either the GI clinic or the Wound care clinic. Today it was all about wound care. I saw some of the nastiest, smelliest, oozing, fungified feet around! I had a very weak stomach watching the podiatrist clip, trim, and clean out these wounds. Next week I will not be eating breakfast before I go to the wound clinic. Next month I will experience the GI clinic and will sit in during colonoscopy procedures. At the end of the week I will get to experience mental health. We will have topic discussions on all kinds of different mental health conditions such as depression, bipolar disorder, schizophrenia and many others. I will also get to sit in on visits of schizoprenia patients and watch them get depot injections of their medications and use some more interviewing skillz. And the best part is my hour and a half lunch break!! Yeah thats right, an hour and a half!! So thats just a little bit of what I'm doing. I dont have much to do or research once I get home, but I come home so exhausted that I either take a nap till like 7 or I'm in bed by 9.

One thing I am really enjoying about this new adventure is I am able to spend more time with David, my family and friends. Over the past 3 years I have not had a lot of time to just sit and relax and spend quality time with the people I care about most. I am excited to finally get some freedom back. David and I have started teaching the single/college/career small group in our church and we have an amazing group and we are looking forward to what the Lord is going to be doing in our lives and in others. We love studying God's Word and sharing with people around us.

Update from a previous post:
DAVID GOT AN INTERVIEW WITH THE UNIVERSITY OF FLORIDA COLLEGE OF PHARMACY!! This doesn't mean he is definetely in but it is the very last step to being accepted. His interview is April 9, 2010 at the Jacksonville campus. We are praying that if it's God's will, He will open the door.

Thank you for your prayer's and ecouragement. We are so blessed.

January, already here and almost gone!

So where do I begin? I now have my finalized rotation schedule for this upcoming year. I am not happy with a few to say the least but I am trying my best to be a good sport. Here is what my rotation schedule looks like: March and April I will spend my time at the VA Clinic on 8th street in Jacksonville. I am excited about this one because I will get to counsel patients on Warfarin therapy, diabetic management and other common disease state therapies like high blood pressure and high cholesterol in an outpatient setting. May and June I will have to move away from my husband for 2 months and complete my Adult Medicine rotation at Flagler hospital in St.Augustine. This I am not to excited about but I did hear that this is a pretty good rotation. I will need alot of encouragement during this time because it will be hard to not have David to come home to every day. During my adult med rotation I will be helping to monitor patients drug therapy in an inpatient setting. I will be dealing with a wide variety of disease states and drug therapies. In July I will be at Baptist hospital in Jacksonville for an adult medicine elective. I'm not really sure what to expect since this is an elective, but I'm pretty sure my previous 2 months expercence with adult medicine will prepare me for this one. I'm very excited for August. Although this rotation takes me away from home for another month, its a rotation I was so excited to get. It is a transplant rotation in Tampa but I have a good friend who is offering her home to me while she is away on her honeymoon for this month. And the best part is Dave will most likely get to come and stay for a while. Ok so I just said August is the one I am most looking forward too but actually September is what I am counting down to! It's my month off!!!! Heck yes! I can't wait to sleep in, lay out, go to the beach, read whatever I want and just chill. October, I am doing an academic rotation at Shands where I currently go to class, and will be seeing the academic side to our profession. Basically I just go to all the first-third year students classes and help out and do some other behind the scenes work. November, I will be at the Mayo Clinic in Jacksonville for my Drug Information rotation. This is mainly going to consist of answering drug information questions or investigating drug use issues in a variety of settings. I will learn about literature evaluation, drug information source selection, statistical analysis, research design, drug use evaluation selection, design and interpretation. December should be a pretty good one as it is what I am most familiar with. I will be in a community pharmacy at a Target in Jacksonville. I am excited to see how different (most likely more laid back) Target is from Walgreens! Then the start of 2011! The year of my graduation... hopefully! January I have a geriatrics rotation, working with old people. Most likely to include cardiovascular( MI, CHF, Arrhythmias), Diabetes, Neurological (Stroke, Alzheimer’s), arthritis and vision problems. I will help assist the healthcare team to find, solve, and monitor for drug therapy problems. And this leads us to my last rotation. February, I will be at Shands in Jacksonville on the cardiology floor. I am very excited because the heart fascinates me and I love all those meds! However, I am a bit nervous because I heard my preceptor is a toughy and expects alot out her students. As you can see there is alot more to the profession of pharmacy than just working for your friendly neighborhood Walgreens. My rotations end at the end of February and I will graduate (prayfully) in May. What a long and hard journey this has been. I have alot ahead of me but I know it will go by so fast. David and I ask for your prayers and encouragement. We have such wonderful family and friends and for this we are thankful.
~ Lindsey