Thursday, January 3, 2013

She's got CF, she's 7, and she can run faster than you

Posted by Tom Vassas at Thursday, January 03, 2013

Being on break for 8 weeks has a way of making you lazy apparently. While I had aspired to catch up on the blog, it would appear I also aspired not to. So without further adieu, I'll jump in to where I left off and what you missed.

Peds! My general medicine rotation at Mott hospital to be precise. It was a cool rotation I will say that. As soon as I heard we could do a peds option for gen med, I gave it no second thought. There was a lot to get used to at first; cardio was full on 15 patients a day on rounds with heavy input from pharmacy, whereas on the gold team in peds we were lucky to get 4 kids a day and pharmacy would be even luckier to make one recommendation.

Since much has been said about the rotation already, I claim brevity and here's the attention-grabbing version of the interesting things, now in parable form!

Here is the story of the little girl who was largely epileptic refractory to nearly every safe seizure medication. The treatment that stuck with her though was a ketogenic diet (think Atkin's, but with some real science behind it). She was spry and happy, but her finicky diet would make most fad diets seem normal. Lucky for her, she had a brilliant pharmacy student to aid in her recovery. As the gallant pharmacy student discovered, diet was but one thing to monitor for her treatment at Mott. Food, medication, IVs, boluses and beta-hydroxybutryate levels oh my. Carbohydrate counts in everything needed to be known, and the pharmacy student was amazed that the dietician taught him all this!

I did figure out a few weeks in that a majority of patients on the gold team are psych and neuro kids. Psych in this case really means autism and neuro means epilepsy. A LOT of kids I saw had seizure meds and it was a great time to brush up on the differences in AEDs and what to be aware of when monitoring these kids.

Now is the tale of one poor little girl in particular, who was no more than 8 months old and had a near SIDS episode, resulting in an anoxic brain injury and subsequent seizure disorder. To the girl's dismay, she was trached and tubed (tube feedings that is) and her days were wrought with high doses of phenobarbital Q12. Her body was failing her, and her eyes showed the struggle. Her solace came with being able to take the phenobarb, but she could not stomach it and she could not hold a line (IV access that is). The gallant pharmacy student could see this, and act he did. With kids you may learn unique ways of giving meds, and this girl needed one. The gallant pharmacy student knew she had an NJ tube, and commenced the privelage of spending 6 or 7 hours trying to find out if phenobarb can be put in solution, then stable in the feed going through the NJ tube, and would be absorbed well enough. Long story short it could and it did and the peasants rejoiced.

Overall the rotation was just one of those chances to see a side of pharmacy rarely seen and not well understood at that. I would recommend it for anyone slightly interested in kids, and anyone who doesn't mind learning new info that could set you apart. I can't say how many times at my internship I've been able to help solve a problem because I had experience with peds.

Up next is drug info! Stay tuned -- TV

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