CXXIII : Health Fairs

One particular aspect I absolutely enjoy about being a pharmacy student is attending health fairs. I like being able to translate those medical connections into terms that other people can understand. I want people to understand their own health and how to take care of themselves. What can they do for themselves. Because ultimately, it is the patient who is in charge of how their health will progress. Will they get better? Will they stay the same? Will they get worse? Participants who come to the health fairs are people who need to understand in order to prevent developing health problems such as hypertension (high blood pressure), diabetes (high blood glucose), dyslipidemia (high cholesterol and/or triglycerides), osteoporosis (low bone density); people who are interested in learning more about certain diseases such as heartburn, sexually transmitted infections, and asthma; people who want to take advantage of getting a free flu shot and find that they learn about vaccines as well; people who know they have health problems or are at risk of developing health problems and want to know how to combat it.

This is what I am Director of...

I want to tell people all that I can about over-the-counter medications, but what do people want to know? What do people know? What have they tried? What are their experiences? Some people don't feel comfortable revealing any of this, which makes it difficult to talk to them.

I participated in a health fair yesterday in a primarily Chinese community, so I was forced to use my limited Mandarin skills to counsel participants on body fat. We used a machine that measures a person's BMI and % body fat. It's called a BIA and it sends electric signals through your body as you hold its two metal sides, and it detects the conductance of these electric signals. Muscles conduct electricity more than fat does, so a slower conductance registers as increased fat content. Since water and food could potentially make the measurement inaccurate, it is best to measure your body fat in the morning before you eat. The BMI is calculated using your height and weight, so it sees whether your weight is acceptable/healthy for your given height. It does not tell you if your body is composed more of fat or of muscle. BMI should not be 25 or greater, as that is generally indicative of being overweight. At the health fair yesterday, most of the participants were Asian and had good BMI. However, their fat % reached as much as 40%, which is obviously too high. The recommended body fat % for women is 22-25% and for men is 15-18%.

So how does it make sense to have a normal, good BMI, but have a high body fat percentage? This is because high weight does not always correlate to fat, and normal weight does not always correlate to less fat. Fat may not be evenly distributed in the body, so when you lose weight, you may not be losing fat, you might be converting muscle into fat instead. It is important to know that just because you see your BMI is 24.9 doesn't mean you should go on a diet or you should immediately think you have to lose weight. What you should be doing is modifying your lifestyle. Exercise, again, is a key factor. Consuming less glucose foods (because excess glucose to your body means more conversion to fat to store energy for later) doesn't mean avoiding fruits. It is better to consume mono and polyunsaturated fatty acids than saturated. Completely avoid trans fats.

So I had to say this and more in Chinese to the participants, who kept coming nonstop for a good 4.5 hours. It was the busiest health fair I've been to, which was a good experience, though it did have it's negative aspects. I wasn't able to rest so sometimes I'd feel compelled to say less to a participant just to get them over with. Usually, we hope to get to know the participant's lifestyle to help them make beneficial small changes that can help with their health, but at health fairs that are nonstop busy, it gets impossible to do so. This makes me want to open a clinic to provide these services to people. Have them feel comfortable talking about themselves, their lifestyles, their concerns with a health care professional who wants to help them control their health to the best they can. This is just one possible future I can have...

CXXII : Dear Nurse,

I understand how anxious and frustrated you can get when you're trying to find a medication to give your patient on time. And I understand that it makes sense for you to call the pharmacy to request your medication in that urgent tone of yours, but do you really need to emphasize how you looked everywhere for the medication just now-- the patient's cassette, the patient's room, and by the tube station? and when I say I'm sure I just tubed it to you 5 minutes ago, you doubt me and retort "I just checked 5 minutes ago and it's not there." I know you're waiting for me to say "ok, I'll fill it and send it to you" because of course, it's not your fault the patient is going to get the medication late. Although I really want our professions to work well together, to have a mutual understanding and respect for each others positions and responsibilities, I was irritated with your response and so I adamantly did not want to fill a medication I clearly remember sending to you already. When I said, "can you check the tube station again and call back if you don't find the medication?" couldn't you trust the one who sends you the medications? What is pharmacy to you? I do remember most of what I fill and send out. But I know you didn't think it was there when you said "okay-y" in a doubtful tone. But hey, you didn't call back. Now can you trust the pharmacy when we say we sent it to you?

Seriously though, I want all the health professions to respect each other, to understand how important each one is in the treatment of patients. Some nurses give off that "my profession is better than yours" air when they call pharmacy wondering "where's my medication?" [I'm glad that most nurses do understand the importance of pharmacy though] One satellite pharmacy covers the whole FLOOR of patients (and sometimes it's multiple floors and at night, one central pharmacy covers the whole hospital), while nurses have a few (maybe around 5) specific rooms to look after.

At the hospital I'm interning at, they separate inpatient pharmacists into two types: dispensing and clinical. The dispensing pharmacist is in charge of verifying medications, making sure that the active orders are still necessary, and answering a lot of phone calls from nurses and physicians. On the other side, the clinical pharmacist is in charge of monitoring TPNs (liquid food that is given intravenously [IV] for patients who can't take in foods by mouth), drug levels for dose adjustments of IVs (something I just learned called pharmacokinetics [PK]), and pharmacy-controlled medications like warfarin. There's a bunch of duties I'm missing, but overall, pharmacy's impact can be seen on cost. Regulate the meds, regulate how much is spent on them.

There are a bunch of other types of pharmacists involved in the hospital (administrative positions and outpatient), but I haven't really been exposed to those yet. I have a vague idea, but not much, and now I'm not sure if I want to stay in inpatient. I like it because I'm seeing so much of what I learn from class, but I don't know... It's starting to seem like I can't really be picky about where I end up in. As long as I get a job, I'll adapt to its environment and enjoy it as much as I can.

I want people to understand what each other's responsibilities are. More trust among professions would be nice.

CXXI : Disney

Growing up Mufasa was my father, Bambi's mother was my mother, Ariel was my sister, Peter pan was my younger brother, Hercules was my older brother, Esmeralda was my aunt, The Genie was my weird uncle, Woody & Buzz were my best friends, Baloo & Bagheera were my babysitters, The Dalmatians were my pets, Growing up Disney was my family. I'm proud to say I am a 90's kid.

Someone commented this on a youtube video, and I can completely relate to it. Hoping the future will be as sweet and leave great memories as the past.