Do You Stand All Day?

I started my first hospital pharmacy job during the winter of 1988. It was a great learning experience, as my supervisor at the time helped me understand all the intricacies of running a hospital pharmacy.
My shift was usually from 12:30 PM to 9 PM, which freed up my mornings. Being young and full of energy, I took a morning job 2 to 4 days a week helping out a 77-year-old pharmacist named Fred who still ran his own successful independent store. I’d show up at 9 AM and work until noon, and then I’d drive across town and present at the hospital for my 12:30 shift.

Fred had varicose veins and it hurt him to stand for any length of time. His normal process was to sit in his chair with his leg up on a stool and verify the work his technicians and clerks did for him. He’d tell me stories about the 50+ years he spent standing behind the counter, paying no attention to the oncoming pain in his legs until it was too late.

At 24 years old, this was my first exposure to varicose veins. I’m sure we discussed it in pharmacy school, but it certainly didn’t stick as something important to remember. At the time, 77 years old seemed like a lifetime away, and I didn’t think anything like that would ever happen to me.

Ten years later, I was sitting in an orientation session for my new job at an outpatient pharmacy at the local community hospital. Sitting next to me was a gentleman named Howard, a retired pharmacist who owned his own store in town for many years. He’d recently sold his store to one of the chain entities that made him an offer he couldn’t refuse, and now he was working relief in the hospital outpatient pharmacy.

Over the next 7 years or so, I had the privilege of working with Howard at least 1 or 2 days each month. He was one of the most respected and knowledgeable pharmacists I’d ever met. There were many occasions when a patient came to the store when Howard was working and asked a question about a device or product. Howard would go into great depth answering the patient’s question, while at the same time gaining another customer for our pharmacy. 

At 70+ years old, Howard had been standing on the job for well over 50 years. At one point, for some reason or other, he said he wanted to show me something. He bent over and pulled up his pant leg, lowered his sock, and showed me the dark blue, swollen knots all around his calf. 
Howard’s legs hurt all the time. He needed to take regular breaks to put his feet up. He said he wished someone had warned him about it when he was a young pharmacist. I hadn’t listened to Fred, but I was definitely listening to Howard. 

I was about 35 years old when Howard showed me his varicose veins. Now, I’m nearly 53 and have worn support socks to work just about every day since that discussion.
How Varicose Veins Form
Blood circulates through the arteries, providing oxygen to all of the tissues. The unoxygenated blood then needs to be returned to the heart through the veins. Over time, gravitational forces begin to fight against all the blood returning from the bottom of the leg all the way back up to the heart. 
When a vein becomes weakened in one particular location, or one of its tiny valves isn’t working well, the unoxygenated blood will accumulate, leading to a small, blue bulge. Over time, more blue bulges will form. They’ll become larger and begin to compress the surrounding nerve endings, making them difficult to ignore.

Varicose veins may form because we’re overweight or our veins have become weak over time. For Howard and Fred, however, they formed because they’d been standing all day, every day. That constant gravitational pressure over the course of 50+ years made it very likely for varicose veins to develop. Therefore, those standing all day long at work need to pay special attention to the health of their legs.

A Simple Fix
Support socks are made from strong, elasticized material that help our veins push the unoxygenated blood back up to the heart. If you start wearing these socks before you need them, chances are you’ll never develop varicose veins. 
If you stand all day for your job, do yourself a favor: buy some support socks.

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Excuse Me, Could You Please Direct Me To The Psychiatric Ward

I was in my final year of pharmacy school and midway through my clinical clerkship. Although many of my peers ended up in San Francisco Bay, Central Valley, and Los Angeles basin areas, the stars aligned for me to go to Oahu, Hawaii, for 9 months of practical training.

We cycled through 6 rotations, each lasting 6 weeks, to gain a broad look at the upcoming and changing pharmacy practice. We had 4 required rotations and 2 elective ones, and I chose a psychiatric rotation. 

We were in a large military facility, and I clearly remember how long it took to find the psychiatric unit in this tremendous hospital. Hospitals are always in some state of construction, and there’s always one portion of the facility that’s much older than the rest. In this hospital, it was definitely the psychiatric unit. After rounding many corners, walking past vast areas of plastic sheeting hanging from unfinished walls, going down long hall ways, riding multiple elevators, and crossing an open-air bridge 10 floors high, I finally entered its doors.

This particular rotation chronologically fell during the 6 weeks spanning Thanksgiving through Christmas. At the time, I had no idea it was the peak season for psychiatric professionals.

I was the lone pharmacy student on the unit during this rotation with 3 medical students, 2 psychiatric residents, the charge nurse, and the attending psychiatrist. Meeting with them every morning was intimidating initially, but I soon received an opportunity to participate.

We were all sitting in rounds one morning as one of the residents was talking about Buspar, which at the time in December 1986 was recently approved to treat anxiety. He had a question about the medication, and the entire room turned to look at me, the pharmacy student. I was able to stumble my way through the answer; however, the attending promptly stopped the discussion and asked me to please prepare a short presentation on the topic to discuss with the group  the following morning.

As students (and practitioners), this is how we learn. We’re asked questions, and if we don’t know the answer well enough to teach it to our peers, we study, research, and return to present our findings. So, I took my question back to the pharmacy office, shared it with my pharmacy student peers, and prepared a short presentation.

The next morning, I had the fantastic opportunity of presenting my first, of many, educational sessions to a group of physicians and nurses. I was surprisingly pleased at how attentive they were, listening to my words, asking pertinent questions, and engaging in meaningful discussion about the medical treatment of anxiety. At the end, there was neither fanfare nor flogging—we simply closed that portion of the meeting and went on to the next topic. 

So, I cut my teeth as a real participant in educating a medical team in a drafty psych unit at Christmastime on the island of Oahu. Whatever your setting or field of study, I hope you have the opportunity to take the time to answer questions with appropriate thought and meaning. There’s great personal satisfaction in researching the appropriate answer to a question and delivering it to your team.

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Common Barriers to Effective Patient Counseling

As a patient, have you ever had a difficult time communicating with your pharmacist?


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Health Care Providers and Care Givers; Follow-Up Medication Information

As pharmacists, we all know that a face-to-face consultation with our patient or their caregiver allows for the most complete level of education.  We are also aware that patients rarely remember all we discussed after they get home.
Upon completion of a pharmacy counter counseling session, we close with an invitation for the patient to phone us back if they have any questions about their medication.  We also fold up the all-important consumer medication information flyers and put them in the patient’s bag.
We counsel patients in order to help them understand their medication therapy so they may optimize their treatment.  In addition to understanding their treatment, patients will benefit from understanding the consequences of not taking their medication. 
Ultimately, it is our goal for the patient to achieve their best possible outcome of therapy while avoiding any medication misadventures that may lead to emergency room visits or hospitalizations.    
Rather than the medication flyers, how about sending the patient home with access to the AudibleRx Consumer Medication Information audio library?
After listening to a medication specific counseling session, a patient or caregiver will have a clear idea of what they do and don’t know about their medication and be more prepared to take educated questions back to their own health care provider.
Health care providers, who have licensed AudibleRx as an education tool for their patients, may invite their clients to visit the consumer medication information library and CLICK & LISTEN to their specific information.  Alternatively, a health care provider may click on a link on the AudibleRx website and send an invitation directly to their patients email.
Visit the Provider page at AudibleRx and sign up for your 30 day free trial today.
Consumer Medication Information, provided in audible format, as an alternative to the paper handouts patients receive with their prescriptions.


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