From the Pharmacy to Kitchen Counter

I became a pharmacist long before I became interested in baking. In fact, my first batch of chocolate chip cookies were too salty. The second and future batches were too hard and oddly shaped. I did master oatmeal-craisin cookies, which made it into my repertoire of baked goods. Soon this list expanded to banana bread and chocolate cake from scratch. Recently, I made pumpkin bread, pumpkin pound cake, banana-chocolate chip bundt cake, and oatmeal-chocolate chip-craisin cookies. I noticed that I have been bringing my pharmacy skills into the kitchen. Perhaps, like my techniques used on the pharmacy counter, my baking skills just needed practice and, more importantly, accuracy with the measurements and the order of combining ingredients. Baking is essentially compounding the extemporaneous formulations that I used to love making in the hospital pharmacy. So, now I'm measuring milk, oil, and water with a measuring cup instead of cherry syrup or water in a graduated cylinder. I'm molding cookies instead of suppositories. I'm crushing cloves instead of tablets with a mortar and pestle. I'm storing the finished products in Tupperware instead of medicinal bottles and jars. The ultimate users were pediatric patients; the ultimate consumers are my children. Who says I'm not practicing?

Is it a positive or negative PPD?

I took my 4-year-old daughter for her physical the day after her birthday. Since she will be entering kindergarten next year, she needed some vaccines (MMR, varicella, DTaP, and IPV) and a PPD (purified protein derivative) skin test for tuberculosis (TB). I was prepared to bring her back to the office in 2 days (usually 48-72 hours after being placed) to have her forearm read, but was told by the nurse that I just have to call an extension and leave a message. Did I make a face when I heard that? Surprise is probably a good word to describe how I felt. At work, they were very religious about making a worker return to the clinic for the reading by a nurse. If one were to miss it, then a new test had to be planted. I know, different situation. It's a good thing I was a clinical pharmacist and have seen what positive PPD results can look like. I am also confident about reporting negative PPD results through personal experience. However, I cannot imagine placing this kind of responsibility on a parent, especially without any written instructions. Granted my daughter is not at high risk for having TB, nor has she been recently exposed to someone with TB, but some pictorial guidance would be helpful. What if the parent forgot to look at the arm or call the office? Hopefully the nurse will call and remind the family. My daughter's arm has no raised bumps or redness, and yes, I called and left a message. When in doubt, though, ask the doctor to check it out.

For more information about TB and testing, check out:

• Tuberculosis Facts for Parents (about.com)
• Tuberculosis (keepkidshealthy.com)
• Tuberculosis tutorial video (National Institute of Health)
• Get the Facts about Tuberculosis (Centers for Disease Control and Prevention)

Take the key and lock 'em up

I'm talking about medicine bottles. I just saw a blurb in a recent issue of Fairfield Parent about the new MedSafe, "a first-of-its-kind electronic lockbox...to help parents safely and conveniently store prescription medications and keep their children safe." It holds up to 15 (standard) bottles of prescription medicine. (Bottles for liquid medicine would probably change that number.) Good to know that if your child figures out the combination, there are over 19, 000 changeable ones (yikes, another password to remember with mommy brain)! Affix it to the inside of any medicine cabinet (a medicine cabinet within a medicine cabinet?) or store it in a dresser drawer, kitchen cabinet, or closet. Personally, I'm content with storing my family's medicines on a high shelf where even I need to tiptoe to reach.

While MedSafe looks like a good idea, it does not replace education. Begin explaining early in a child's life that medicine is not candy or food. Try to avoid taking medicine in front of children. Mimicry is amazing to watch, but it could be deadly if children have access to your medicine. Oh, and if you do decide to get the safe, please don't store your child's epinephrine pen or other emergency items in there! Precious seconds might be lost from trying to remember the key.

I like to move it, move it

Well, my son is almost 19-months and he still isn't walking. He is one heck of a scoocher, though, and he just started crawling at about 17 months. Although the pediatrician has stated that he will pick up walking at his own pace, I decided to start up once weekly physical therapy for him again through Connecticut's Birth to Three system (early intervention). In a matter of days, he has picked up crawling up stairs on his own. I've also noticed stronger leg strength when he's standing (with support). He's also pulling himself into a standing position more readily. Yesterday, I showed him how to cruise. He can also climb up the steps and put himself into a sliding position on a portable slide that we picked up from a tag sale. This is all great progress within a matter of weeks! It helps that his new physical therapist is more successful in engaging him into activities, whereas our last therapist was not able to connect with him due to his separation anxiety. What have I learned? A little help makes a huge difference sometimes. Also, a little denial can be a setback for major milestones.

Do the Elephant When You Sneeze

Rather than getting caught up and frustrated about the availability (or lack) of the different flu vaccines, why not channel that energy into finding fun ways to teach your child how to stay healthy? Here is a cute song and video by the Jimmies called "Do the Elephant." If you have Satellite Radio, you may have heard it on Kids Place Live.

Click here for a handwashing Video for Children (13-minute musical) by the Handwasher's Brigade about handwashing.

Click here for a 1-minute rap video by DocRock that includes 5 tips on how not to get the H1N1 infection.

Have you or your child come across a video you'd like to share? Please add it to the comment section. Thanks!

Disclaimer of Conflict of Interest: The author has no conflict of interest to state.

Why is my pharmacist asking so many questions?

I remember not too long ago, a friend of mine was complaining that the pharmacist asked her too many questions when she was getting her prescription filled. "What were you asked?" I wondered aloud. It turns out she was prompted to provide information about her weight, whether she was pregnant or breastfeeding, what other medications had she taken in the past, and what other medications is she on now. I explained to her that these questions are meant to help complete her profile so that the pharmacist can identify potential drug therapy problems with her medications before any adverse effects occur. She accepted that and later felt appreciation rather than the initial resentment.

In Connecticut, "a pharmacist shall make a reasonable effort to obtain, record, and maintain...:

(1) name, address, telephone number, date of birth or age, and gender;

(2) individual history where significant, including disease states, known allergies, and drug reactions;

(3) a comprehensive list of drugs and relevant devices dispensed by the pharmacy within the last 180 days; and

(4) the pharmacist's comments relevant to the individual's drug therapy."

This information will be helpful to the pharmacist when a patient presents a new prescription to identify any potential problems with the overall drug therapy. Basically, the pharmacist is looking for any:

• duplication of therapy (e.g. is the patient taking multiple medicines that work the same way or multiple products that contain the same active ingredient?);
• contraindication between the medicine and a disease (e.g. does the patient have a condition that precludes him/her from taking the medicine?);
• drug interactions (e.g. will this medicine increase or decrease the effects of the other medicines the patient is currently taking or vice verse?);
• issues with the dose and length of therapy prescribed (e.g. if the patient stated that he has kidney problems, is the dose going to be too high? or does the patient need to be on 3 weeks of high-dose steroids by mouth for an acute asthma attack? or if the patient is pregnant, she should not be taking certain medicines for blood pressure or cholesterol control);
• interaction of a medicine and allergy (e.g. if the patient stated that she is allergic to soy, she should not be given Atrovent as an inhaler); and
• clinical abuse or misuse and any other significant clinical issues relating to the appropriate use of drugs (e.g. is the patient really still in pain 4 weeks after a root canal treatment?). One's weight can be used to determine the appropriateness of the dose.

It is our duty as pharmacists to ask these questions. Unfortunately, as a patient, I've only been asked about my allergies and nothing else when I have had my prescriptions filled. In fact, I had to ask about the effect of the medications on the breastfeeding baby. I also wish I was asked my children's weight when I present their prescriptions. Well, it's not relevant when it is for a topical cream, but it could be for an oral antibiotic. It really doesn't matter what state you live in, because all pharmacists have been well-trained in all aspects of medications and common disease states. So, if you're visiting a pharmacy for the first time, and your child has a chronic illness or is currently on multiple medicines from a different pharmacy, ask if there is any other information the pharmacist might need for your child's profile. To make it easier, fill out a medication list (The Pediatric Pharmacy Advocacy Group has a sample you can download) and have a copy available for the pharmacist to review. It could save you some hassle later on.