Monday, March 26, 2012

Momming + ugly semester = I miss my kiddo

I think I might call this semester a fiasco.  What with the miscarriage at the end of last semester making moping necessary (well, grieving really), then the health fiasco that started in the end of January and meant a week out of school in February, then working more than I should really, it is overall a bit of a fiasco.  I don't really have a sense as to whether I'll make it through the semester passing everything.  I've decided not to get overly fussed about it and to do my best.

However, my best requires about 10-14 hours every day, which means I see very little of my family.  The kid has a nasty cold, as do I, and I wish I had a few more hours to sleep every day.  It's a struggle. I keep absconding to study elsewhere and studying not nearly enough because I'm at work too much or trying to figure out some way to cope with everything or doing whatever other glorp I get up to.  Writing this blog as a way to cope!  Letting the cats in and out of the house every ten minutes!

It's hard. I don't like trying to balance like this for any length of time and it's been way too long.  Knowing that there's only 5 or 6 weeks left of school is either exciting or terrifying or both. And now, back to the slog. I have imaginary patients to try not to kill on "paper" and sleeping to be getting around to sooner than later.  For now I'll have to listen to the kid requesting that I go with her to the zoo to see something, and tell her that eventually I'll get there with her, but maybe not the next time she goes.  Hopefully we get to the zoo this summer and have time to go enjoy it all as much as she wants.

Who is legally responsible for "failure to warn?"

There are a lot of things that can happen when you take a medication.  We hope you get better, or stop getting worse.  A great many medications are proven to do just that in most people.  Sometimes something bad happens, sometimes it's very bad.  Example: if you get an anti-nausea medicine given IV and it accidentally goes into an artery instead of a vein, you can lose your arm due to gangrene.  It's a pretty safe medication with very rare side effects (we call them adverse effects officially) if you swallow it or take it as a  suppository.  When you're in the hospital or ER vomiting, you need something by another route, and nobody wants to try a suppository, so you get a shot.  Many hospitals have stopped using this drug and give one that works better but has different risky side effects (I'd probably pick the newer drug for my patients but it would be a hard choice, given the risks of that one too).

BUT then there's the complicated web of who pays for the cost of all that medical care you need? Whose fault is it? Is it anyone's fault that people are human and make mistakes sometimes?  Legally, right now, it can be the pharmacist's fault if we didn't ask you if you had any questions about your medication (in a community pharmacy where you see a pharmacist in person, at least) depending on state law.  It could be the person who gave you the shot's fault.  It could be the hospital's fault.  It could be your own fault if you took something and didn't read the warning labels and information that came with it, or if you didn't ask in the pharmacy for help doing so.  If the bad thing that could happen is something that wasn't listed anywhere on the packaging/in the information sheets that came with your medication, then it can be the drug maker's fault for failing to warn you of the risks of taking that medication. 

In the realm of strange things, the drug company that patented the drug is in charge of preparing a label and information to go with it for the both the patient and the pharmacist.  Anyone selling a generic version of that drug must use the same label and information.  Last year the U.S. supreme court decided that generic manufacturers could not be liable for damages because they didn't make the label, and so any failure to warn wasn't their fault.  It seems to me the logical continuation of this is that the brand manufacturer ought to be liable for the lack of information, but I'm sure this is impossible because the big drug companies fight hard and would make the case that since they didn't make the drug, it was some flaw in the manufacturing that caused the bad thing to happen.  It also doesn't address what happens if nobody makes the brand product at all anymore, and possibly the original patent owning company doesn't exist anymore.

So let's all get together and figure out some better way to do this than suing drug companies to get someone to pay for zillions of dollars of medical care that patients can't otherwise afford.  There must be a solution somewhere.

Tuesday, March 20, 2012

Health care reform!

I hate to say "I have my head buried in a book and I'll see you in a few years" but to some degree (ahahhahahahah the PharmD degree...) this is true.  I have little time to think about anything besides surviving school, work, and parenting (like say having a relationship with the spouse).

So today when I saw that it has been 2 years since the big deal federal healthcare reform law passed, I was shocked. 2 years have vanished in all this school and life craziness, and I haven't finished forming an opinion about the reforms that are going to change my field and healthcare all together by the time I finish school.

I was reading a post on the public health perspective, which is my favorite, and it linked to a discussion of part of healthcare reform that I care a great deal about: women's health.  Note I don't care about women's health issues just because I'm a woman.  I care about them because it's so weird to me that we have health issues, and separately WOMEN'S health.  Aren't we all people? I mean now. Obviously historically there were people and women and slaves/servants.  Hopefully we're beyond those divisions now. I really hope.

Anyway, health care for women is a big deal.  Here's my take on why insurance for women is so much more costly than men (and why for some reason nobody is unhappy enough about this, in my opinion).

Somehow we figure that women get pregnant all on their own, and because it isn't easy to prove paternity, only women bear the consequences of pregnancy (extra health care costs in this case).  Clearly this isn't the case.  Babies are a two-person creation, even if they both aren't complicit in the initial creation (say someone is drunk or raped).

My solution: men pay healthcare premiums equal to women, and if not insured by the same carrier, when a baby is born (and the newly mandated paternity test done, because this is my perfect world with unicorns, rainbows, and magic ponies) the father's insurance company pays 50% of the first year of life insurance costs plus 50% of labor and delivery costs (which include prenatal care for some reason).  Look at that! I fixed it!  Any care needed beyond the normal would have to be split 50/50 too.  After year 1 of life, baby ought to get his/her own personal insurance of some sort.  I'm sorry to all the men out there not having children, but you ought to be paying to support men who are parents just like women without children are paying to insure women who have children.

Infertility insurance coverage is a discussion for another day. Oh, I am gonna go there. But not in this post.

PAIL March Theme blogroll

Check out a whole host of blog posts by Parenting/Pregnant/After Infertility and Loss folks about breastfeeding.  This list is curated by Elphaba at Yolk: a Blog About Eggs and Sperm (also Alice in Diaperland! Yay for babies!)

Thursday, March 15, 2012

Ooooh... expanded scope of practice... shiny...

But wait! Not yet! Maybe some day people will visit their pharmacist to get their over the counter blood pressure medications, asthma meds, high cholesterol meds, and others, but not yet. Alas, I think.  The FDA is collecting input on making a great number of medications OTC after you talk to the pharmacist and get some basic diagnostic testing done. 

I think I'm in favor of it because it reduces the burden of writing refill prescriptions on doctors, gives patients more flexibility in scheduling appointments since pharmacies have more hours than doctors (because I don't think even Walgreen's is insane enough to say you can get a prescription by walking up any old time), and lets pharmacists do what we are trained to do - manage medication use.  If I'm unsure if I can take two medications together, and it's 3am, I don't leave a message for my doctor.  I call up a 24 hour pharmacy and ask a pharmacist.  Plus pharmacists are often in towns where there are few if any doctors, making a pharmacist visit much easier to get than driving 50 miles to see a doctor.

Tuesday, March 13, 2012

I moonlight as a domestic goddess

Why look at those excellent dinosaur cupcakes! Don't those look delicious? Because they sure were!  I got to eat a T-rex that was ripped in half coming out of the pan. mmm... and the rest were for the kid's birthday.

Monday, March 12, 2012

Baby fever

This weekend I went to a friend's bachelorette party, which started with a late lunch at a bar/restaurant at 2pm and then continued with a scavenger hunt around the mall.  The drunkest person (dare I say drunk at all? the person who had the most drinks) had 2 strawberry something or other drinks.  It was a lot of fun getting to visit with my friends because we hardly see each other these days! Sheesh!

Anyway, we all had to stop and window shop at the stores that sell cute baby stuff (and I pointed out that our age was showing when we did so, on several occasions, including Baby Gap).  And it was the kid's birthday (that I got up early to have a birthday breakfast to celebrate) and so it was extra much on my mind: more babies...

I've been tiptoeing around it, but it is time for honesty.  And really, who is reading this blog but me anyway, right?  We've actually been hoping for baby #2 for the last 18 months now and are 2 miscarriages in to the waiting game.  It stinks.  I don't like waiting and being taught patience and to take good care of myself in this manner is hard.  It's just painful to see folk getting pregnant immediately and it just isn't so simple for us.

So far we know that I have PCOS and my doctor decided we'll try some drugs to treat it if I'm not pregnant within 6 months of my last visit (which was January, so half over and presumably no dice).  By "drugs" I mean ones that deal with the PCOS and not necessarily Clomid just yet (and we haven't looked at the other half in the equation yet, although there's a likelihood of some problems there based on childhood illness).

Since losing potential baby #2 (since yes, I don't think that the embryo we lost was a baby yet, but it's still sad and a struggle and I reserve the right to change my opinion on the matter at any time) I waver between getting rid of everything baby that we've saved to this point and getting it all out to cry over before putting it away more properly.  It isn't something that I've shared with anyone really, outside of a few close friends.  It's my grief (our grief) and I don't want to talk about it with everyone because so many people are so heartless and say stuff that just makes me think badly of them (when I know it's probably the grief talking, or that they just don't know what to say and stumble into something insensitive).

Today the kid's daycare provider had her 3rd child. Her oldest is the kid's age, the middle one the age our second pregnancy (first miscarriage) would have been, and I would have had my anatomy ultrasound this week.  I'm not sure there are words for the complexity of it all.

But I live in hope anyway.  Today may be hard, tomorrow may be worse, but there will be a good day eventually.  Even if we don't get another biological kid, we will have more children through adoption.  Maybe the kid will appreciate sibling(s) more if she has more time to ask for one.  In my magical free time I'm reading the Bible from the start and am noticing that a great many women in the old testament are infertile.  I'm glad to read that Sarah laughed when she heard that she'd conceive, and I hope she didn't laugh bitterly but out of joy at the idea of a dream finally fulfilled in her old age.  Isn't that a funny thought, getting something you always wanted long after you thought it was possible?  Like I always wanted to go to Disney World as a kid and finally went for a conference in college.  Hearing that I got to go made me laugh, to have that long-time dream come true in such a surprising way. 

I hope because I breathe (someone else said that first, not sure whom).

Wednesday, March 7, 2012

Mom topic: the feeding of wee babies

So my kiddo nursed. Forever. wait...that's inaccurate. She nursed until she was 13 months old and I cut her off because I was done.

I read too many blogs to have missed the Mommy Wars about formula versus nursing (oh keep your breasts on, ok, call it breastfeeding if you like. I don't. Get over it.) and all the grief both camps give each other.  Here's my take and how I decided what was best for the wee kiddo when she was a baby.  Your mileage may vary.

1. Laziness. I am an inherently lazy person, and it's a lot less work to whip out the boob and feed a howling baby than it is to find the water and measure formula and shake the bottle, all that jazz.  Do not confuse lazy with inept or unwilling to work, and work very hard, to take care of my patients in my profession.  I just don't like to do extra work if I don't have to do it.  Like I don't roll my socks into pairs when (ok, if) I fold the laundry.  Why go to that effort when it has no benefit and takes extra time?

2. Cheapness.  We were incredibly broke when the kid was born because both of us were in school for a big chunk of the year before she was born and the expected post-graduation job opportunities for the spouse were just not there.  It costs nothing extra (except an absurd amount of time, probably equal to or exceeding feeding formula even with prep and cleaning of bottles) to nurse a baby, so that's what we did.  The crappy student insurance did pay a big chunk toward a proper breast pump so I could continue nursing while attending school full time. So I didn't even save money by not buying bottles! Shucks! Everyone deserves that level of support for nursing if they want to do it.

3. Hypochondriac tendencies.  I have a zillion food allergies/sensitivities and not knowing exactly what was in my kiddo's formula made me really nervous, so I decided she would have none of it.  In retrospect, this was a moronic decision and I should have just let it slide sometimes so I wasn't running around in the middle of my school day to go over to her daycare so she could nurse when I hadn't managed to pump enough.

If I had it to do again, I'd try to hang out with nursing moms more often to see other ways it could be done.  Reading a book and having the labor and delivery nurses help you figure it out (and then the lactation consultant, thank G-d that was free and readily available at our hospital) is not the same as actually watching moms of various sizes and shapes with babies/kids of a variety of ages and temperaments nurse.

What do I think about nursing versus formula?

Well, I think a few things.  I think that every mom ought to be able to feed her child anywhere and any time she wants or needs to.  I think that no mom should be told to "go somewhere else" or "cover up" if she's nursing.  My kid nearly died choking because I was being all discrete and covered her too much so I missed that she was choking at first.

I also think that if you want to feed a baby formula, more power to you.  Do what's right for your family.  I loathed nursing the kid for the most part, although I'd do it again given the chance because I am stubborn and continue to experience the above cited 3 reasons we nursed the first time around.  Beautiful bonding relationship blah [caveat: IN MY EXPERIENCE. lots of people have great things to say about it, I'm not one of them, that's life, try it yourself and see if you just love it].  I would have enjoyed giving the kiddo bottles too, and she would have gooed at me and whatever.  Nursing hurts (and it hurt A LOT for the first 2-3 months), it took forever, and when I was in school (starting when she was 3 months old) pumping was no fun at all.  I did it, but to get a day's feedings at daycare it took me about an hour and a half of pumping.

Realistically, unless child #2 turns up while I'm still in pharmacy school, odds are low that I'd be able to nurse again.  Pharmacists don't get to eat lunch sitting down some days (unless you work somewhere awesome that closes for lunch break ::drool::) and there's no way as the pharmacist I could sneak off to pump twice in an 8 hour shift (for hopefully less than that 45 minutes it took me as a student hiking across campus for a space to pump besides my car).  BUT the cool thing about living here is that I'm entitled legally to get to take that time to go pump.  Every state/province ought to have laws that say any employee is entitled to unpaid breaks to go pump and a private place to do it (besides a bathroom stall).  We need to support parents if we expect to have happy and capable children growing up to be happy, healthy, capable adults.

So I support you taking good care of your baby/small child (please don't nurse past kindergarten, it weirds me out, sorry long-term lactivists).  Use formula properly (don't water it down cuz you're broke. Babies die that way and it's sad) or nurse and have a good time.  OR mix it up, do some nursing, some formula, call it good.  A happy baby and a happy mom are the key features in my view.  Although I didn't love nursing, it worked for us and I have a happy and healthy almost 4 year old now.

Friday, March 2, 2012

On anonymity

You may have noticed I choose to be anonymous.  But why?  Well, I'm a student and I don't want to get in trouble.  I don't want my kid or someday kids to have people google them and see naked baby pictures or stories about how lame they were (or ADORABLE! but they won't think so as angry teens).  I don't think it's my place to grandstand.

Then there's the professionalism.  I take this gig seriously.  Does this mean I don't curse? Of course not. Does this mean I don't go hide and giggle sometimes, or curse quietly at the cranky patient who just cussed me out for 5 minutes because it took 16 minutes to get their prescription filled? Of course not.  But this is not the place for that, in my estimation.  You'll see I added my favorite pharmacist blogs to the sidebar.  They are also anonymous, but very crass.  Also absolutely hysterical to me.  But I am of the opinion that there's funny content like that out there, so you don't need me to be a comedian. 

I deny all accusations that I'm funny.  Any humor in what I say is the result of me being me, a plain spoken, pseudo-professional person.  I know lots of words as a side-effect of having a BA in English (they make you read lots of books to get those, books have words, ergo, know lots of words).  If you keep reading stuff here, and if I keep writing stuff here, it's likely I'll talk about a patient eventually.  But I'm de-identifying myself to add an extra layer of de-identifying my patients.  They deserve that.

When I get to work I wash my hands.  Why?  Because I figure that if I screw up everything else, I owe my patients at least that much.  So I also owe my patients the double-blind of y'all the wide internet not knowing who I am (ok, so the 2 of you who read this are friends, but you see what I'm saying here? The text says things when I'm not watching, the internet is a big place, all that jazz) and where I am.  That way there's extra safety for patients who might get mentioned in passing.

So sorry, no pictures of the kiddo. Maybe pictures of her Lego creations, but no people pictures. No names. No locations (although from the snow the other day, you know I live where it snows 14 inches overnight).

Thursday, March 1, 2012

Genetics is so cool

In another life, given a friendlier first year science major course schedule (yes, 8am class 4 days a week is why I didn't take chemistry my first year in college and therefore probably why I didn't realize until much later that chemistry and science are MY FAVORITE!), I probably would have gone into genetics research.  It's really amazing.  I'm still geeking out about that lame "if I were an enzyme, I'd be DNA helicase so I could unzip your genes" joke from basic biology... anyway...

I was just reading a really neat article about a study of alcoholic and non-alcoholic brains (of dead people, that is) to see if there was a difference in what genes were expressed.  They found that the alcoholics were expressing some genetic code that is generally thought to be "junk" and the authors wildly speculated that the junk mRNA being expressed was contributing to the alcoholism as well as being caused by it.  That's a pretty interesting idea, isn't it? That something we do changes our brains' genetic expression, which in turn changes our behavior?

Admittedly I don't totally understand the entire article in detail, and I totally didn't even try to read the original study.  Despite now nearly 2 years of learning to speak medical and scientific garbledy-gook, genetics has an advanced version of the two that I am not at all well versed in.  Don't think this means you shouldn't go read the article though! I just bet, dear reader, that you are far smarter than me right now.  Case in point: I'm about to tell you about my lovely night at work in brief.

So it was a slow night at the community pharmacy where I work as an intern/tech tonight (yay! usually it's insanely busy somehow) so I was filling more prescriptions than average rather than handing out prescriptions like candy at a parade.  There was one for an ointment that we stock in a 4 or 5 pound tub that needed to be filled for 90 grams of ointment (this is that slimy stuff you put on your skin that's oily, in case you were wondering).  Options for measuring slimy stuff into a small container: either weigh it on the scale we may or may not actually have, or take an appropriately sized container and eyeball it.  The ointment jars come in ounces instead of grams though.  MATH! NO! Flashback to Calculations, which I did very well in, but IT WAS SCARY! 

For the life of me I couldn't figure out how many grams to an ounce and gave up and asked the pharmacist, who not only told me, but also showed me about where on the jar to fill the thing to (very nice of her, indeed).  Then I beautifully (I mean elegantly, pharmaceutically elegantly) filled the little tub up and reshelved the big one.  About 3 minutes later (and maybe 4 prescriptions filled) it dawned on me that I needed to go get the big tub for the pharmacist to check that I'd put the right ointment into the little jar... clearly my mind works very slowly these days... or... I could never get the hang of Thursdays...