This week in OJ's life

Verli happening

First had to deal with a family on pertussis prophylaxis, went to the wards to get their details then on hindsight decided to get the missy to send the details down via fax. Now my sp and me kena secondary exposure. But then clarithromycin 500 bd 5 days is for primary exposure. Now coughing up yellow phlegm, coughing with wheezing sound, congested chest and it all started off with a flaming irritating sore throat. Luckily I had the right mind to pop by polyclinic to get clarithromycin. Usually I go see doc if thymol doesn't help.

I have met one of the super grateful patients this week. There was a foul up with the script which I caught during triage.Patient had to wait. Tried to contact doc, missy gave wrong number, so kena scolded by hp owner. But so had to check directory myself and had to go get the script myself....Boh pian had to mail the script to the patient since partial supply.

Next week do dispensing loh. Got all the farnie stories about dispensing pessaries to patients. I hope the women dun give me blank stares when I counsel them on drug use. So far, had only done P items and KLKK (kia lai kia ke) but then I more used to GLGK (gia lai gia ke).

IRB submissions this week!!!! chong ahhh. Nid to do all the online tests (about 2 hrs each), did the wrong tests then had to redo another set.... Jin tian bu huay jia. Filed up the whole thing then realised medical collaborator's cert expired!!! But luckily, we can submit the cert next week.

Yesternight went for pharmacy DnD - i think my class has talent! The food sux but the entertainment rocks!!! <3 the Emcees. They rock! I felt as if I stood out as a sore thumb as I came stright from work - stayed back to do some personal administration. I'm a workaholic, a slow workaholic - verli scary. I had being photographed as I'm not photogenic. Look like road kill on photos, so I stood around to find people to chat with. PHZ's erhu skills verli good, until my classmate also give standing ovation. Too bad no encore. Interesting ensemble - zhong ran, keyboard, pipa, clarinets, harmonica and guitar.

Went home late - tong panged the PLO's car to Clementi then shared cab with the MBLO home. It was fun. I think next time must follow the medical people - each hospital book one table but then can they do it as well as the class of 2007?

Week before was ASM. Doc WHHC really hilarious even though his script writing sux and is prone to dispensing errors. Showed all manner of prolapses after lunch and when he came to the uterus "now u can do a shelf administered PAP smear" =.= "Just let it come out then u give it a name."

I think it would be nice if next year a pharmacist presents during the ASM.

All the Dendro carroniis are in flower now. Same thing, dun bother to photgraph.

Every night come home late late

This song keeps be company for the 2km walk from MRT. Easy to sing with simple lyrics

So sorry to those who nid to endure =p

Sianz got simi CITI to complete, IRB, project write up until brain going wrong liaoz.

Today one patient gave me an evil eye when I was trying to clear the triage queue alone when I failed to entertain him.

Seriously, not many people want to come to this poorly paid profession even though we are subtly important and the things we do are not drama material like the docs. The hospitals are understaffed because no one wants to pay us enough. At this rate, I will end up a well-informed and clever pauper - and parents wonder why we sometimes work harder than HOs but with lousier pay outs. or may be it's just the workaholic me?

Yesterday at PCBunk.

After work before church, I walked into PCBunk to get my PPCs which I collect. When I was queuing up, suddenly, a woman and a plump girl started fighting. They exchanged blows and words. The woman appeared to be the mother asking the daughter to go home straight away as she felt that the girl was playing games for too long. The mother tried to take away the bag from the daughter (assuming it contains money to play more hours of games) while the daughter retaliated saying that the women recognised a wrong person.

The staff wearing an Asiasoft T-shirt just brushed the mother aside as he tried to get into the booth. The PCBunk salesgirl told the mother to leave and settle their score outside. Then she came back to serve me.

I quickly bought my things and left. Then I saw a group of ah lians looking at the scene as if in support of the daughter.

When i reached my bus stop, I reflected:
- Are children getting out of hand already?
- Are they living an alternative lifestyle until they knock out of reality?
- Or is it mere addiction?
- Are they losing respect for their parents to the point the parents become ATMs while their friends become parents?

Seriously, Asiasoft and PCBunk should have guidance counsellors on duty to handle these cases as their staff appeared incompetent or ignorant of the greater social issues. The staff appeared to be either ignorant that some kids can stay away from home for a few days just play their online games at 24hr cafes or their addiction have gone to the point of no return (waste money all the time). Some kids do resort to violence just to play the games they want. We live in the where kids are now devoid of feelings of responsibilities and they must get what they want.

For me and the group of adult gamers, we play when we are free and can stop abruptly when we are needed else where. Some of us are "noob gamers" but we use the game as a socialising tool to expand our social circle.

I dunno wat to say about these chewren

They can turn everything into monsters

http://forums.playpark.net/showthread.php?t=68549&page=2

Very Moody today

As soon as I stepped into the office, I've got a piece of breaking news from my admin officer:

Due to some form of admin lapse, my hours which I've completed and submitted by 18th of June will not be paid until 7th August....

Couldn't do work well today because I'm super moody.

My bankbook's in the red

Got debts to pay back

Got my own birthday to splurge on. Wanted to buy a cake to share (luckily haven't placed order if not really gone case!)

But noooooo I've to skimmed this month because of an admin lapse.

Felt like a jilted boyfriend. Put in so much hours then felt like the hospital dun wan me.

Wanted to get Martindale or Koda-Kimble's complete set. Now can forget about getting these at all.

Don't worry about me - I've my pride. I want money that I've earned so dun bother to loan me any. Just give me some speech bubbles to grumble into.

Tomorrow is ASM, perhaps I can find some temporary reprive.

Alamak

DIPIRO dun have chapter on neonates....

May be it's time to slurge on a Koda-kimble liaoz.

Shocking fact: Docs here are not taught PT; they go by experience. They NEED pharmacists.

The role of a pharmacist

WRT the medical health team

Pharmacists are a special breed of healthcare professionals which belong locally to the Allied Health Division. Pharmacists stand in a position where there is a need to grasp what the Medical and Nursing divisions are doing to help the patient get the best out of their drug therapy and make sense of their medication. When in comes to medication, doctors usually have a rough gauge of what medication to use on patients. Nurses know how to administer the medication. Pharmacists have to know accurate dosing, manufacture, storage, stability, interactions and accurate dosing in certain age groups and co-morbidities in addition to the doctors' intentions in treatment as well as the methods of administration of the medication in order to safeguard the rational use of drugs as medical therapy and the patients' health.

We do not just give out medications on requests or just on doctor's orders - we have to ensure that anything given out is rational, safe and effective. We are not shopkeepers. We are drug therapists. We are all part of the healthcare team. We look forward to helping you get well soon and maintaining good health in you.

Support leh

Donate to the first Pharmacy student fund ever

http://www.annualgiving.com.sg:80/c2007_pharmacy.shtml

Commencement liaoz

All decked out in blue and lilac, the pharmacy graduants stand out from the crowd. To add on, our valedictorian had scores of prizes and very emo, matured and touching speech that we stood up and gave a round of applause for. nearly cried.

Left after snapping a few pics with friends, classmates and profs. Then I siamed. Apologies to the profs whom I did not have a chance to catch up with.

I abhor ceremonies and crowded events though. It is hard to catch hold of the people you want to speak to either ebcause it's very disorganised or they are occupied with others. Anyway, I've got their contact numbers and next time we can meet again - like during our DnD I refer to have small group meetings rather than a huge event where everyone's fighting against the background noise.

Hoped to stay in touch with them real soon as I escaped abruptly. I personally felt that I'm nothing to llok at thus camera-shy.

Sianz - tomorrow go back to work to face the roaring crowd again. Please be gentle with the pharmacists

Med. Dinner and Convo

Just finished the Medical Dinner and going to Zzzz before I go for convocation/commencement in 14hrs in my fleeting lilac and blue gown. Very outstanding.

Met my army mates 2 the Medical dinnerr today. Sat with one of them today. At our table was a registrar (endocrine), M2 student and a GM MO. plus one AH pre-reg and one CGH pre-reg. I remembered being very blunt and my dear classmates are trying to tone me down.

Felt very deprived - in OP, got no access to eMR yet, so have to kah lo-goon all the time. Dunno how my other 2 classmates managed to get access. TMDKKJ.

Food was ok. Verli healthy. Chockful of veggies and ended with sinful mango pudding. To TYC: Awwwwwwwww.

The old alumni (approx85yo) was very interesting. Very blunt and true. I like the bluntness of elderly on the stage where facts become jokes. Can't remember the jokes clearly as we were also chatting amongst ourselves to make up for the loss of contact.

As usual, MDs are not clear of the role pharmacists play, but some like SA are yearning to find out. Which I find quite pleasant. It's for us to complement one another to make things work out for the patients. PS, if more nursing and allied health join MA, may as well rename to Healthcare Alumnus.

Reached one late at night and while walking past a freshly completed condo, spotted a 1.5 m long python. Must warm mom when bringing the puppy out for walk walk must be careful. Westies are traditional ratters and can be very curious.

Wah scary

http://www.straitstimes.com/ST%2BForum/Story/STIStory_134414.html

June 30, 2007

Cough syrup should have been allowed after checks
WE
REFER to the letter by Ms Ong Seok Hwee, 'Airport needs to be clearer about
medication' (ST, June 26). We have contacted Ms Ong to address her concerns and
would like to thank her for her feedback.

Since May 8, restrictions have
been implemented on the amount of liquids, aerosols and gels that can be taken
in hand-carried luggage on flights from Singapore. Liquids, aerosols and gels
must be in containers with a capacity of less than 100ml each. These containers
are to be placed in a transparent re-sealable plastic bag of a capacity not
exceeding one litre and presented at the security screening point. Liquids,
aerosols and gels in containers larger than 100ml will not be accepted, even if
the container is partially filled.

Medications in liquid, aerosol or gel
form (such as insulin, cough syrup or nasal sprays) in quantities needed for the
flight are exempted from the restriction. A doctor's letter or prescription,
while not mandatory, would help to facilitate the security screening. If the
medications are in containers of a capacity of less than 100ml, passengers are
encouraged to place them in the re-sealable plastic bag. If this is not
possible, or if the medications are in containers larger than 100ml, the
medications will be subjected to further checks at the security screening point. Passengers may also be asked to taste their
medications. We encourage travellers to visit Changi Airport's website
http://www.changiairport.com/to find out more about the guidelines.

In
Ms Ong's case, the security screening staff should have allowed her to take on
board her cough syrup in the 125ml bottle, after making the necessary checks. We
regret the inconvenience caused to her. We would also like to reassure her and
the public that our screening procedures allow for flexibility without
compromising security.

Phillip Mah
Head (Aviation Security)
Civil Aviation Authority of Singapore


Toh Boon Ngee
Assistant Director
(Media Relations) (covering)
Singapore Police
Force

I think the following "Passengers may also be asked to taste their medications." is rather scary.
-The sample taste is of an unknown quantity - may lead to O/D
-The timing of tasting may be close to previous dose - may lead to O/D
-There may not be an experience doctor on the flight - so patient may die of O/D
- If bottle not handcarried may break in cargo hold, patient no med to take - patient may get a U/D.

What are they thinking!? They think that medicine as mere sugary placebos?! They are potent drug substances where a little will trigger a therapeutic effect and a little more may kill. I soooo dun wan to be at the scene where the patient is told to sample liquid digoxin.

Dendrobium lichenastrum

Bought from WL last time. Think was sourced from TW. High light. Smells funky. Normal form has red lip.

This week

Last week before the GST hike kicks in.

A lot of patients trying to get the long supply ( approx 6 months +) items before the extra 2% comes in and to get their more expensive drugs such as Forsamax, Actonel and Evista.

Some patients came in with their expired prescriptions (normal scripts - 1 yr from date; CD scripts expire in 30 days). Some of them really bugged me at triage while I'm clearing the nong nong queue - and I tot I could have it easy since the chewren hols are soooo over. But noooo the ladies are now free-er since their chewren or grandchewren are in skool.

Met a patient who came in without script and insisted we dispense - it is as if not many knew that a original complete script (date, signature of doc, name of doc, place of practice of doc, drug, dose, duration, patient's name and address) is required. Depending on the severity of the matter or whether we can entertain such cases, we had to call the doc and ask for authorisation and a prescription to dispense.

Got another bring a photocopied script and left the original for safekeeping.... Luckily that patient not so hard-up one.

Got another no show at clinic for so nong and so many times then come in to ask for emergency supply to tie over until next appointment.

Then there's one who came down from the wards to ask whether nutritional supplements are claimable by medisave or not then about this supplement that supplement. What's worse was the patient came down during the peak hours. The patient was a bit unhappy that we could not entertain her enough.

Then we had drugs with short expiry and the patient complained why the expiry is so short and the patient demanded a discount for the product in lieu of the short expiry. Shouting at the pharmacist some more. The script calls for a short supply and what we issue is within the expiry date (= manufacturer's warranty). As long as it works, please take it or forego a period of therapy. So do you want to withhold therapy for some time while waiting for "better expiry date" or would you want to take the medication which is still under the manufacturer's warranty? Choice is yours. The price is fixed by the hospital's board, so please quit yelling - I assume you don't yell at your doctor or nurse right?


After knocking off, I had to stay back a while to check through some papers since my uni's e-library membership is expired. Then the EP people ask me to pop by to do some translation for a Chinese patient. My Chinese sux, need to revise. Apparently the hyperative son had a severe attack of asthma but themother didn't want him to be warded. Turns out that she had gotten an aerochamber and was using it wrongly.

The dose of the salbutamol was very high although tapering and the turbuhaler worked better than the MDI. The son had been using a spacer the following manner:
- Spray
- Breathe
- Hold for 10 seconds....=,=
- Spray

Should be be
- Spray
- Breathe in and out 10 times.
- Spray again

I would like to reiterate the role of the pharmacist.
- We are not there as shopkeepers
- We are there to help you make sense and make the best of your drug therapy
- We are there as authorities in drug therapy and there to ensure rational use of drugs to reach therapeutic endpoints.
- We would appreciate a level of respect given to all the other medical professionals. Work with us, and we'll work with you to ensure optimum health.
- We need time to prepare your medications and do the necessary intervention lest a mistake happens and there's dire consequences.
- We hope that you give us a listening ear, so as to understand the reason behind why you are taking such steps in your health management.

Wah liaoz ehz

Yyyyy today so siong?! All the chewren shoulda gone back to school. Then one huge mob of gynae patients flood in =.=

Hit about 500 by noon. Constant stream of people - losing voice until one momma had to lean close to me to listen to me.

Bad time for me to do triage - couldn't cope with the mob. Had a whole bunch of people asking for OTCs and I'm still a bit noob with OTCs. I think tomorrow I should take a break from triage and do the extempo liaoz. Need to do at least 2.

One patient wanted return but then meds > 3months post dispensing liaoz. Even the meds changed colour liaoz.

May be I'm the zhao cai mao - I stand there scripts come in. Eeeeee

Brain's busted until so many people said I looked tired when I was collecting my gown - lilac purple trimmings ^^. So special. My fave crochet cotton colour.

Reminders:

Vagifem ok for lactating ladies as it's localised in vagina.
Dimetapp as an antihistamine mix (brompheramine + pseudoepi) but polaramine is the preferred knock out drug
Gentamicin in chewren infusion approx 2-3 mg/kg
Promethazine syr can be used up to tds although it stated bd

Dockrillia wasselli

Aussie native
Honey scented
Available from WL.

This spike is really long - usu about 50% of the length. ^^

2 Cool to be trueeeee

Went out yesterday after my trip down to IMH for pre-reg opening ceremony.

Reached SUNTEC @ about 1300hrs to see nong nong queue. Chewren are so eng and the four of us were like the very few big buffaloes around who publicly dare to show out affection for the online game.

Went to 3rd floor to verify our gaming passports to get free spin at gachapon. Got a water bottle, the biatch got a poster AND BENGZ GOT A PLUSHIE KEYCHAIN. He selected a mushmom plushie. Vonz kena missed.... Later when viral joined us @ 1700hrs, he got a poster but poor ting got a miss.

Had to change used PPCs to play games or pay $1 a try.

Later we queued nong nong to play all 7 stations to get the card chopped as to redeem a mushmon hat. Got some meso coupons for winning games which could be used to exchange for other items. 99% of our time was spent queue and yakking in the queue - good to have company.

Saw the squishy cake which was selected to be the BD cake for maple. Looks extrememly noob - could have decorated it myself. Even the squishy colour was imba and very pigmented.

The longest queue are with the bowman and the mind master. The staff are unlikely service trained - dunno how to smile one.

Swopped my retrieved meso coupons for some notepads which hopefully can be used during my CIP rotation.



Didn't get the 15 meso wiz and bowman pads - not my type. The big hard covers are functional for my own notes and the small mage one can be used to send notes to others.

Threw in 1 used PPC just for fun for the lucky draw - but I saw one kid who had 300 +++ PPCs with him. If he's a solo user, it means his cash slot confirm no enuff one.

Ladda went to kenny rogers' (a first for me), met viral and ting. Then later went to see Nancy Drew. I'm a person with very weird taste - I like the young martha stewart that was potrayed. As usual, the biatch realises that all the Nancy drew stories will have chloroform and a secret passage way involved.

Going to loose my voice soon

Did triage at the outpatient pharmacy for the past couple of days. Talked so much to the patients until the PT asked me - your throat not dry ar? Actually hor, it's more like descicated (sic?). Face also cramped from smiling. I need to yak continuously if not I start nodding off.

However, I still really need to brush out on the store organisation and the OTC meds available as well as the chewren dosing. CHEWREN DOSING .

Luckily, I have a couple of PTs with me doing triage - today's the last day of the skool hols, so a flurry of last min medical visits flowed in and 200+ patients decided to all come in at 1700hrs - until the cashier queue can line up to the side aisle pharmacy.

Had to endure an elderly husband who came to collect meds for his dear wife. He asked plenty of questions about the meds, and I had a trying time explaining in layman terms. Sometimes I dunno whether patients have the fear of offending the omnipotent doctor or pharmacists have a better listening ear and are more receptive to the patients or does the public have a vision of us being product promoters and shopkeepers? I hope it's not the latter 2 options as that is not what I strived to be in the profession.

Reminders:

Promethazine für die Kinder ist 0,1mg pro kg VPT und nicht mehr als 10ml
Prophylactic dose of cephalexin for UTI in chewren is 25mg/kg ON max 2g
Prophylactic dose of cephalexin for endocarditis is 50mg/kg 1 hr b4 procedure max 2g
Treatment dose of cephalexin for UTI is 50-100mg/kg depending on severity.

Orientation

Today HR conducted orientation.

I think i went overboard - I'm lidat when I'm having fun. I usu carry myself too far and my mouth startes to sprout offensive stuff - like linguistic Tourette's. I hope I didn't offend anyone out there.

Actually should orientate us with the docs and nurses - more fun. We could buddy one another to make workflow better.

HR told us we should be able to recognise the key docs via faces but the fact is we recognise them mainly thru' the scriptual handwriting =p.

The gang of nurses are very fun. Never expected that they have the occasional bout of insanity to cope with the stressful nature of their work - very far cry from my very stoic mom. May be because different field of speciality. Very fun nurses.

I started with triage on Tuesday - I was deemed lucky that I wasn't scolded by any patient (yet) - mum trained me to be a thick skin so I think I should not have a problem. Had facial cramp from smiling too much.

Had an interesting view of patient behaviour - even had one that brought shopping list of meds and a calculator to calculate her supplements needed to tide her over her next TCU. In the end rejected the whole lot because it was not written by the doc and not subsidised.

We are pharmacotherapists - we are there to make sense of your treatment and there to ensure rational drug supply and use. We are not anyhow suppliers. If it's detrimental, we have the right to refuse to dispense.

I think I need a pricelist on standby as patients kept asking for drug prices (esp those with external scripts) - had to check for one patient until kena reprimand from one of the PTs for holding up the queue then the patient started to apologise profusely - patient first like they say, I got thick skin anyway - may be too thick though.

I think it's fated

Yellow opening flowers of Cynoches herrenhausum


Yellow-based Paphiopedilum godefroyae


Yellow flowers of Laelia rubescens var aurea



Yellow ripening seed pods of yellow flowered Dendrobium canaliculiatum


And now my new yellow dispensing jackets

Kena pang sei by SBG (again)

After a trip down on the east to Jason's place, took 14 then changed midway to SBG to do my monthly volunteer guiding. The rain was pouring, giving me 2-toned cargo pants- the rain was so bad that my pants remained soaked after in the shelter while waiting at the visitors' centre.



I am usually the one taking the late afternoon slot and I do get people joining me - and recently, a lot of trainee tour guides (commercial ones not the volunteer ones - IMHO, they should go for the morning slots with KH as he gives a lot more historical tibits; I'm more focus on culture and the plants).

Walk past the busy hall at the Tanglin side, dunno wat's happening and saw this lying on the floor


Came from these in Symphony Lake?


I did my general survey at the NOG before heading down to the meeting point - this to to prep me as to wat to show and wat to say later on. Some parts can skip, some parts can tok a bit more

Reached the meeting point already, boh lang. Even the 2 gals at the desk were MCC and the office was empty. LL, had to give JP and ring ring and she also MCC because this was THE SECOND TIME LIAOZ. Everyone abandoned post to service the crowd at the Hall in Tanglin core on Self-esteem.

Then one staff rush over to set up the sign up desk etc. But then hor, it was about 1615 - the tour was to start at 1600 and guests should register by 1545 as stated on the webby. Last ditch attempt to get people to sign up was futile. Even if the staff whole heartedly set the things up to appease me which I appreciated, it was no short of wayang as the time's up. Those who walked past must have left on their own accord thinking that there's no session today.

At least it was better than the last time when I entered the office and the guy started stammering and smacking his lips.

Waste my time travelling it's ok. Making me pang sei my fellow pharmacy staff for the annual BBQ in East Coast, it's ok, but to deal disservice to the public not giving them the opportunity to go through a guided tour, I think the management have to sit down and think about it - after all they are part of a PUBLIC institution; and I dun like to blame staff whole are poorly managed, poor managers have poor manpower allocations and task designations.

The 1600 slot is very important for a lot of people. There are still a lot of people (like me) who work 5.5 days. 6 day work weeks? wait nong nong. People will complain that they can't do this and that because some places are not opened on Saturday.

So at 1630hrs, I had waited enough, I just say bye and thanks and left walking in the rain - too distaughted to catch a cab down to East Coast - I may just ruin the partay mood with my brooding

Anyway some pics

It was raining at the gate





Tanglin Core





kapok tree (fibres to stuff pillows)


Nice pretty flowers



Brassavola Singapura (basker!!! mine not yet flower =/)



Flowering brommy


Variegated Crinum asiaticum (to add to the confusion as to which is the type, the Japanese version, the blah blah blah version)


In the cool house
Dendrobium goldschmidtianum


Phalaenopsis schilleriana



Dendrobium dearei


Dendrobium uniflorum


Phragmipedium spp.


Phalaenopsis pulchra


Bulbophyllum echinolabium Scent of a million dead pachydermis


Ensete superbum