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Parents, Medicine, and Kid Gloves

A woman with two children in tow came into the pharmacy sometime last month to pick up a medication for her daughter (I think the girl was 13 years old, but it's been so long, I can't recall). The prescription was for acetazolamide, a drug with many indications, and even more potential adverse reactions. I noticed she had not taken the drug before.

In the community pharmacy setting, I have two counseling styles. The first is a "lite" version I use for medications with minor side effects or refills the patient has used before: I simply ask the patient if they have any questions about using their medicine, to which 80% of patients say no, and with that, we're done. My second style is the "deluxe" version reserved for medications that have potentially serious or unpleasant adverse effects that may not be well tolerated; when the patient says they don't have any questions, I tell them the serious and common adverse effects they should watch for.

Acetazolamide is a "deluxe" counseling drug, because it has a wide range of adverse reactions, most annoying, but several which can be serious (although uncommon), so after mom said she didn't have any questions, I told her this drug was used to treat numerous conditions, but also could cause some strange side effects, and she needed to be aware of them. Then things got weird.

Mom told her daughter, the daughter who was going to take this medicine, mom told her to go to the front of the store and get her something to drink. The daughter, who was about 12 or 13 years old and obviously old enough to understand something was up, something involving her, whines, "But mom, why?" Mom replies, "I'm thirsty and forgot to grab something when we came in. Now, go!" Strangely enough, the little boy with her was allowed to stay.

I thought to myself, "Oh, shit... something I've said or something about my attitude has pissed this woman off." I prepared myself to be ripped into. But that didn't happen. Instead, mom explains her daughter has epilepsy, everything was well controlled until recently, when she began menstruating and started having seizures around her period. She concluded, "The neurologist prescribed this for her seizures, and that's why I sent her away, so we could talk about it."

Fortunately for me, when I'm nervous or in a confrontation, I abhor even a second of silence, so I tend to ramble, which easily allowed me to begin rambling off acetazolamide's serious and common adverse effects, and thus prevented me from making a facial expression that would have betrayed my true thoughts about how this mother was handling her daughter's medical therapy.

I hoped for the daughter's sake that mom maybe just hadn't come to grips with the fact that her daughter was growing up and capable (willing, even) of being involved in discussions about her health. But even so, it seemed strange to send her away like that, when she obviously didn't want to be sent away so we could keep her in the dark while we discussed her medicine. My brother has numerous congenital heart defects, and when he was a child, my parents had to make some tough decisions about extremely risky surgeries. He always got to stay in the room.

I felt deep empathy for that girl. Epilepsy is difficult to deal with at that age. Middle school kids can be brutal, and everyone tries to fit in. I tried to imagine what she was going through. If menstruation was causing break-through seizures, it was entirely possible she'd experienced at least one at school or in front of friends. It's not uncommon for diabetic kids that age to try to hide the face they have diabetes from their friends, because they just want to eat pizza, be normal, and not have to take insulin. But this poor girl couldn't hide her epilepsy, and another thing, if you haven't witnessed an epileptic seizure, epileptics tend to be very disoriented, panicked, and emotional when they wake up after a seizure. It's traumatic to wake up on the ground with a crowd of people staring down at you, knowing you've had a seizure as you also become aware of the very visible urine spot soaking your crotch.

As I later reflected later on that girl's body language and tone of voice when she was sent away, she was embarrassed and frustrated.

Certainly, parents do worse by their children, and maybe there was more to it than I knew. Maybe the girl got upset and frantic whenever she had to talk about her medicines. Maybe it was me, the way I had begun the counseling session, that startled the mother. Whatever it was, I couldn't get past a patient being denied the opportunity to participate in their own healthcare. Especially with a condition like epilepsy, which can make patients feel betrayed by their own bodies, I think it's important for patients to be involved with their treatment, if for no other reason than to feel they have at least some control of their disease.

:: Bryan Travis :: 02/26/2007 @ 07:58 :: [link] ::
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The Light in the Tunnel and Stuff

In 70 days, I will be finished with pharmacy school didactic coursework -- that is, no more lectures or exams. Oh, glorious day.

To quickly bring you up to speed, first round of exams for this last semester are complete. The pharmacy practice exam was no problem, but therapeutics was a stinker, covering renal and oncology. They tested rough and tough. The renal portion was insane; I swear they were asking questions on stuff we hadn't covered very well, if at all, in class. Four of six questions dropped on the exam were in the renal section. Oncology was going better until the questions began asking things like what reasonable second and third line chemotherapy regimens would be for lung and breast cancer. Cancer has a nasty habit of recurring, so these are important questions, but they're something you'd expect an oncology pharmacy resident to know, not a pharmacy student.

I discovered green tea with brown rice in the local Chinese grocery store. It has the health benefits of green tea, but tastes like a full-bodied-not-quite-black tea with an earthy, smoky quality imparted by the rice.

Gave blood February 5. Watched Talladega Nights and This Is Spinal Tap last weekend. Completed hematology module in therapeutics. Single digit temperatures outside, and snow still on the ground after a week. Have entered another SimCity 4 playing phase. Made lentil soup -- I love this stuff, and it's crazy healthy.

Walked to class this morning at a brisk pace with interspersed jogging because I got to the stadium parking lot at 7:40am, and given long lines to board the buses, waiting for a bus to pick you up before the 8am rush, and university traffic, you can't count on the buses to get you to class in 20 minutes. Also walked back to the stadium in the afternoon.

Lectures today included introduction to the endocrinology module in therapeutics, which was actually a review of diabetes care followed by a two-hour in-class case discussion. CAPP lectures were ophthalmic and otic preparations, ergogenic aids (performance boosters), and herbal product review.

Had a haircut today... I see more scalp after every haircut.

:: Bryan Travis :: 02/12/2007 @ 21:23 :: [link] ::
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