29 June 2010
When i got to the pharmacy today, i was told i would be going with the district nurse to a patient's home today. Maria and i were at the hospital the other day and we were shown how elastomeric pumps/ baxter infusers are used and how they enable patients to get their medications such as an antibiotic at their own homes, when usually this can only be done in the hospital. Today, just to let us get a feel of how they are actually used, we were allowed to go with the district nurse to see a patient with osteomyelitis as a result of a foot infection. The patient needs Flucloxacillin infusions so she was admitted into a programme called Hospital In The Home and she's treated as an inpatient but in the comfort of her own home. We were able to see how the pump is attached to a PICC line on her left upper arm and the pump itself hangs around her waist in a pouch. The nurse carefully changed the pump to a new one that's made up at the hospital and showed us how the pump looks like when all/ most of the drug has been infused.
Besides receiving scripts, dispensing, and receiving payments at the counter, giving counselling for an antibiotic and a steroid cream (Eleuphrat), i also filled up the CONSIS machine today. It was a fun job and i liked it very much. You have to scan the product and bring it up on the computer, then select a channel, and a laser light will appear at the front of the channel to show you where it actually is. I had to use the ladder alot but it was really fun filling up the machine. As instructed by the pharmacist, i tried remembering the drug name and what it's used for as much as i can, before putting it into the machine.
A patient came in with a script for Metoprolol today and requested for Betaloc because he says the strips have days like Monday, Tuesday, etc on it. I was curious and with the permission of the pharmacist, i had a look at the strips and true enough, on the left of the strip is a tablet which is supposed to be the first tablet, and there are two rows of 7 tablets next to the first tablet, each having Sun, Mon, Tues, Wed, Thurs, Fri or Sat on top of it. So the patient is supposed to take the first tablet and then the tablet with whatever day on top that shows the day that he/she is taking it, then go around the strip until the last tablet.
After having a short rest at home after work, we went to a training session by Wyeth on cough, colds and flu. The two main products they talked about were Dimetapp and Robitussin. It was a short but good talk for me because it really makes me understand more about the different products that are available and what each ones are for. I can remember them better now, rather than being confused all the time and not knowing which one to choose. They gave us freebies too, which was good, like some Advil, Robitussin and Dimetapp samples, workbook and gifts from body shop. I won a lucky draw bear too! :)
I'm happy i can show people where the products are in the pharmacy now, and i feel a sense of achievement when i can tell customers more about the products that they are requesting for. I have learnt so much during this 3 weeks of placements and i can't believe i have been here for almost 3 weeks already!
Tuesday, June 29, 2010
Monday, June 28, 2010
Blogposts from pebblepad: An answered prayer
28 June 2010
I don't remember whether it was last night or this morning, i prayed that i'll have lots of cream to make today. Lo and behold, i made 2 creams today! 600g of cream altogether! :) One was a 100g of LPC 5% and Salicylic Acid 2% in Sorbolene Cream, the other one was a 500g of 10% Olive Oil, 2% Salicylic Acid in Sorbolene Cream.
I got to counsel the patient about the LPC and Salicylic Cream. The pharmacy owner was there with me this time, therefore i was extra nervous. Thankfully, the other pharmacist talked me through beforehand. The customer was prescribed Elocon 0.1% cream as well. So, what i told the patient was that he should put a thin layer of the Elocon cream on the affected area (which was his right elbow), and wait for a little while. After that, put the LPC and Salicylic Acid cream on it. The LPC cream can stain his clothes, so just be careful with his clothes (the pharmacy owner added: and bed linens if he applies it at night). Both needs to be applied twice a day. I didn't mention about photosensitivity and the pharmacy owner said it is alright because we don't want to give too much information to the patient, but it is most important that we give them some written information to read at home.
A lady came in and asked for two packets of Cartia 168 tablets. She said one is for her, one's for her husband. She had a heart attack 3 weeks ago and the doctor asked her to get some coated aspirin from the pharmacy. I did a mistake by asking her whether the doctor told her about the strength of aspirin she was supposed to take. She said no, and was quite worried. I called the pharmacist and the pharmacist said 100-150mg is the right dose. It suddenly dawned on me that yes, 100mg is for prevention, 300mg is for acute attacks. I was quite upset at myself actually because i know all this. I should be very sure and confident in what i know, and i shouldn't have to ask the pharmacist next time. I also asked her whether her doctor told her anything about diet and lifestyle modifications, she said the doctor told her to have a low salt, low fat diet, eat lots of fibre and quit smoking.
I also listened to the pharmacist counsel a patient about Symbicort today. She said to twist the bottom to and fro and you can hear a click, that means it's loaded. Exhale, put your mouth at the opening and inhale strongly. After loading the device, do not turn the device upside down or shake it. Also, don't exhale into the device so that it doesn't get clogged up. The last thing was to rinse his mouth after using Symbicort.
I dispensed for some more webster packs in the afternoon and that was pretty much my whole day at the pharmacy today.
The pharmacy owner introduced the forward dispensing model today, but not the full model though. What he did was to put 1-2 pharmacists at the front to receive scripts and attend to the needs of the customers at the first point of contact. He trained 2 more technicians to dispense today, so that he himself can go out to the front more often than he already is. I think he is a very wise man because he went to the talk on Thursday and he immediately made plans and introduced it today. I admire how he say he is not sure how it will work out but he will give it a go see how it goes, and make adjustments accordingly. He said that while other pharmacies are cutting down on staff, they are going to ramp up and improve their service. The pharmacy also employed a new pharmacy assistant today. I am truly impressed.
3 more days, I will miss Terry White Chemist Bairnsdale.
I don't remember whether it was last night or this morning, i prayed that i'll have lots of cream to make today. Lo and behold, i made 2 creams today! 600g of cream altogether! :) One was a 100g of LPC 5% and Salicylic Acid 2% in Sorbolene Cream, the other one was a 500g of 10% Olive Oil, 2% Salicylic Acid in Sorbolene Cream.
I got to counsel the patient about the LPC and Salicylic Cream. The pharmacy owner was there with me this time, therefore i was extra nervous. Thankfully, the other pharmacist talked me through beforehand. The customer was prescribed Elocon 0.1% cream as well. So, what i told the patient was that he should put a thin layer of the Elocon cream on the affected area (which was his right elbow), and wait for a little while. After that, put the LPC and Salicylic Acid cream on it. The LPC cream can stain his clothes, so just be careful with his clothes (the pharmacy owner added: and bed linens if he applies it at night). Both needs to be applied twice a day. I didn't mention about photosensitivity and the pharmacy owner said it is alright because we don't want to give too much information to the patient, but it is most important that we give them some written information to read at home.
A lady came in and asked for two packets of Cartia 168 tablets. She said one is for her, one's for her husband. She had a heart attack 3 weeks ago and the doctor asked her to get some coated aspirin from the pharmacy. I did a mistake by asking her whether the doctor told her about the strength of aspirin she was supposed to take. She said no, and was quite worried. I called the pharmacist and the pharmacist said 100-150mg is the right dose. It suddenly dawned on me that yes, 100mg is for prevention, 300mg is for acute attacks. I was quite upset at myself actually because i know all this. I should be very sure and confident in what i know, and i shouldn't have to ask the pharmacist next time. I also asked her whether her doctor told her anything about diet and lifestyle modifications, she said the doctor told her to have a low salt, low fat diet, eat lots of fibre and quit smoking.
I also listened to the pharmacist counsel a patient about Symbicort today. She said to twist the bottom to and fro and you can hear a click, that means it's loaded. Exhale, put your mouth at the opening and inhale strongly. After loading the device, do not turn the device upside down or shake it. Also, don't exhale into the device so that it doesn't get clogged up. The last thing was to rinse his mouth after using Symbicort.
I dispensed for some more webster packs in the afternoon and that was pretty much my whole day at the pharmacy today.
The pharmacy owner introduced the forward dispensing model today, but not the full model though. What he did was to put 1-2 pharmacists at the front to receive scripts and attend to the needs of the customers at the first point of contact. He trained 2 more technicians to dispense today, so that he himself can go out to the front more often than he already is. I think he is a very wise man because he went to the talk on Thursday and he immediately made plans and introduced it today. I admire how he say he is not sure how it will work out but he will give it a go see how it goes, and make adjustments accordingly. He said that while other pharmacies are cutting down on staff, they are going to ramp up and improve their service. The pharmacy also employed a new pharmacy assistant today. I am truly impressed.
3 more days, I will miss Terry White Chemist Bairnsdale.
Sunday, June 27, 2010
Blogposts from pebblepad: Last day of second week at Bairnsdale
25 June 2010
I did dispensing for 3 other nursing homes today and I am quite satisfied with what I’ve done. When the pharmacist asked me if I wanted to do that today, I happily said yes. However, she insisted I must find out about the drugs that I am not familiar with and spend some time doing that rather than just dispensing medications without knowing how they work. I am actually quite touched by how they try and organise activities for me to get most out of my learning experience here rather than having me work for them.
When the pharmacist told me I’ll be in the front for the afternoon, to see if I get to counsel customers regarding cough and cold preparations, antihistamines or analgesics, I was terrified. We both know it is very important for a pharmacist to be able to do that but I was nervous because that is my greatest struggle. There are too many products available that I don’t know what to do when someone asks for a recommendation. I had a short lunch and got back to the pharmacy to study the AMH about such preparations and went to the counter and have a good look at the products available. I tried to absorb as much as I could but obviously, I’d need more time than just one short afternoon.
We’re all not too sure why but the pharmacy was unusually busy this afternoon. It was raining quite heavily but customers keep coming in one after another, so we were all kept quite busy serving customers. One customer asked me whether I know anything about mouth ulcers, so I asked him a few questions like how long has it been there, what is he using and how did he find it. He told me he’s got false teeth and they are causing him the ulcers. He is using Kenalog and a mouthwash but they are not of any help. He has also used Bonjela before but to no avail. I gathered he has tried most of the products and he has had it for a few weeks already, so I thought I’d just ask him to go to the doctor. When he asked me what stronger medications the doctor can give him, I said he might be able to give you something for the pain. He must have thought that it won’t be worth the effort going to doctor if it’s only for pain relief, so he disregarded the suggestion. What I should have done was to tell him that a visit to the doctor is also important to rule out anything more serious. But then again, if it’s the false teeth that are causing the problem, he should maybe consult his dentist.
Someone asked about Nurofen plus, so I asked the pharmacist. The pharmacist taught me a few questions to ask the customer before supplying it. The customer then told me that it’s actually for her sister and her sister doesn’t want anything that has codeine because she thinks it makes her vomit. I couldn’t think of anything stronger than preparations that have codeine so again I asked the pharmacist. The pharmacist suggested taking paracetamol and ibuprofen for short term pain relief, so I told that to the customer and she was happy to take that advice. That was certainly something new that I’ve learnt today.
I also overheard a pharmacist assistant telling a customer not to take more than 8 tablets of Panamax a day, and I thought that is something I should remember as well. I know all these things, but I lack the experience. Seeing what others do, helps me put my head knowledge into true understanding.
One lady carrying a cute little 3 month old boy came in with a script for Kenacomb Otic Ear Drops. She asked whether it is ok to use it during breastfeeding, so I told her I’d check with the pharmacist. The pharmacist told me to look it up in the breastfeeding book, so I looked up all the ingredients which were Triamcinolone, Gramicidin, Nystatin and Neomycin. All of them may be used in breastfeeding, and the pharmacist also said because it’s used topically on a very small surface area, it should be fine. The pharmacist gave me the opportunity to counsel this patient as well, but she talked me through it before that. So I told the lady to keep the drops in the fridge, and that she may want to warm the bottle with her hands before use because cold drops may hurt a bit. She should also lie down for a while after putting in the drops to let it absorb.
I also counseled a patient on Augmentin again today, and I was much more confident this time. Counselling is not as scary as I thought anymore. And I am truly grateful to the pharmacists at Terry White Bairnsdale who gave me the courage and assurance that I can do it.
It will soon be my last week here. It’s funny how I’m starting to miss this place already. If someone asked me whether I would recommend Bairnsdale for placement, my answer would be YES for sure. And I highly recommend Terry White Chemists Bairnsdale. I have learnt so much there. All the pharmacists there are not only very knowledgeable, but they are also so willing to teach and train you to be a good pharmacist. They always put customers first. Yes, the more scripts done the better but what impresses and inspires me the most is that they constantly try to improve themselves and always find ways to put themselves ahead of the game.
The other thing I like about Bairnsdale is the accommodation. Traveller’s Rest Motel is a very comfortable place with incredible hosts. They borrowed us a microwave, iron and ironing board, can opener and other stuff so that our stay here is as comfortable as possible. They also help wash and dry our clothes, sometimes turn on the heater for us before we’re home and talk to us almost everyday just to ask if we’re alright. I feel very blessed by them.
However, this whole placement here wouldn’t have been the same without great company. Thanks Maria, for making my stay here unforgettable!
Weekend! WooHoo!
p/s maria and i went to Lakes Entrance yesterday. It was a very beautiful place from the lookout but unfortunately it was too cold and windy that we couldn't walk to the lookout from where the bus dropped us. We shared a king's cone with 3 scoops of ice cream, soft serve and nuts. It was a little too much for us though. :p we also shared a silver award beef and burgundy pie. We took pictures at the footbridge and walked on the stones to get down to the beach. We went into a few shops and some of the shop names are quite funny, Pinocchio Inn, Funky Monkey, etc. I had a good time, away from all the work.
Today i went to the St. John's anglican church. I felt very welcome and at home, since i grew up in an anglican church. The visiting speaker talked about doing mission work locally, among the bush people. And i was reminded of how we can reach out even to those in our own community. I was pondering about love today and once again, i am convinced that one who is loved much, loves and one who is hurt much, hurts. And i felt a deep assurance in my heart today that God will take good care of me no matter where i am. Placing my life in Your hands is the best decision i have ever made. I am such a blessed child!
I did dispensing for 3 other nursing homes today and I am quite satisfied with what I’ve done. When the pharmacist asked me if I wanted to do that today, I happily said yes. However, she insisted I must find out about the drugs that I am not familiar with and spend some time doing that rather than just dispensing medications without knowing how they work. I am actually quite touched by how they try and organise activities for me to get most out of my learning experience here rather than having me work for them.
When the pharmacist told me I’ll be in the front for the afternoon, to see if I get to counsel customers regarding cough and cold preparations, antihistamines or analgesics, I was terrified. We both know it is very important for a pharmacist to be able to do that but I was nervous because that is my greatest struggle. There are too many products available that I don’t know what to do when someone asks for a recommendation. I had a short lunch and got back to the pharmacy to study the AMH about such preparations and went to the counter and have a good look at the products available. I tried to absorb as much as I could but obviously, I’d need more time than just one short afternoon.
We’re all not too sure why but the pharmacy was unusually busy this afternoon. It was raining quite heavily but customers keep coming in one after another, so we were all kept quite busy serving customers. One customer asked me whether I know anything about mouth ulcers, so I asked him a few questions like how long has it been there, what is he using and how did he find it. He told me he’s got false teeth and they are causing him the ulcers. He is using Kenalog and a mouthwash but they are not of any help. He has also used Bonjela before but to no avail. I gathered he has tried most of the products and he has had it for a few weeks already, so I thought I’d just ask him to go to the doctor. When he asked me what stronger medications the doctor can give him, I said he might be able to give you something for the pain. He must have thought that it won’t be worth the effort going to doctor if it’s only for pain relief, so he disregarded the suggestion. What I should have done was to tell him that a visit to the doctor is also important to rule out anything more serious. But then again, if it’s the false teeth that are causing the problem, he should maybe consult his dentist.
Someone asked about Nurofen plus, so I asked the pharmacist. The pharmacist taught me a few questions to ask the customer before supplying it. The customer then told me that it’s actually for her sister and her sister doesn’t want anything that has codeine because she thinks it makes her vomit. I couldn’t think of anything stronger than preparations that have codeine so again I asked the pharmacist. The pharmacist suggested taking paracetamol and ibuprofen for short term pain relief, so I told that to the customer and she was happy to take that advice. That was certainly something new that I’ve learnt today.
I also overheard a pharmacist assistant telling a customer not to take more than 8 tablets of Panamax a day, and I thought that is something I should remember as well. I know all these things, but I lack the experience. Seeing what others do, helps me put my head knowledge into true understanding.
One lady carrying a cute little 3 month old boy came in with a script for Kenacomb Otic Ear Drops. She asked whether it is ok to use it during breastfeeding, so I told her I’d check with the pharmacist. The pharmacist told me to look it up in the breastfeeding book, so I looked up all the ingredients which were Triamcinolone, Gramicidin, Nystatin and Neomycin. All of them may be used in breastfeeding, and the pharmacist also said because it’s used topically on a very small surface area, it should be fine. The pharmacist gave me the opportunity to counsel this patient as well, but she talked me through it before that. So I told the lady to keep the drops in the fridge, and that she may want to warm the bottle with her hands before use because cold drops may hurt a bit. She should also lie down for a while after putting in the drops to let it absorb.
I also counseled a patient on Augmentin again today, and I was much more confident this time. Counselling is not as scary as I thought anymore. And I am truly grateful to the pharmacists at Terry White Bairnsdale who gave me the courage and assurance that I can do it.
It will soon be my last week here. It’s funny how I’m starting to miss this place already. If someone asked me whether I would recommend Bairnsdale for placement, my answer would be YES for sure. And I highly recommend Terry White Chemists Bairnsdale. I have learnt so much there. All the pharmacists there are not only very knowledgeable, but they are also so willing to teach and train you to be a good pharmacist. They always put customers first. Yes, the more scripts done the better but what impresses and inspires me the most is that they constantly try to improve themselves and always find ways to put themselves ahead of the game.
The other thing I like about Bairnsdale is the accommodation. Traveller’s Rest Motel is a very comfortable place with incredible hosts. They borrowed us a microwave, iron and ironing board, can opener and other stuff so that our stay here is as comfortable as possible. They also help wash and dry our clothes, sometimes turn on the heater for us before we’re home and talk to us almost everyday just to ask if we’re alright. I feel very blessed by them.
However, this whole placement here wouldn’t have been the same without great company. Thanks Maria, for making my stay here unforgettable!
Weekend! WooHoo!
p/s maria and i went to Lakes Entrance yesterday. It was a very beautiful place from the lookout but unfortunately it was too cold and windy that we couldn't walk to the lookout from where the bus dropped us. We shared a king's cone with 3 scoops of ice cream, soft serve and nuts. It was a little too much for us though. :p we also shared a silver award beef and burgundy pie. We took pictures at the footbridge and walked on the stones to get down to the beach. We went into a few shops and some of the shop names are quite funny, Pinocchio Inn, Funky Monkey, etc. I had a good time, away from all the work.
Today i went to the St. John's anglican church. I felt very welcome and at home, since i grew up in an anglican church. The visiting speaker talked about doing mission work locally, among the bush people. And i was reminded of how we can reach out even to those in our own community. I was pondering about love today and once again, i am convinced that one who is loved much, loves and one who is hurt much, hurts. And i felt a deep assurance in my heart today that God will take good care of me no matter where i am. Placing my life in Your hands is the best decision i have ever made. I am such a blessed child!
Thursday, June 24, 2010
Blogposts from pebblepad: all-smiles-day
24 June 2010
Today is a happy day! What makes me even happier at the end of a long day was an email from my lecturer saying that she enjoyed reading my blog! Maria and I couldn't stop laughing, and it's just out of pure joy! We hope what we have been writing is what our lecturers are looking for and we do enjoy very much in keeping a record of what has happened everyday.
Well, i started my day feeling that i won't have much to do at the pharmacy today because I had a feeling there will be quite alot of staff working today.
When i arrived, i did a few scripts. One had 7 items on it but it was fairly straight forward. Another had 10 items. The person was going to come back in 5-10 minutes so i tried not to pick that script but the pharmacist insisted i did it. Out of 10 items, 5 were last repeats and so i had to put stickers here and there to remind myself which of the 10 needs a last repeat sticker. And then while i was stressing out, trying to put things together within 5 minutes, the label printer went out of labels. Thankfully it happened before, so i quickly changed the roll and continued dispensing. The customer came back just when i finished. Phew!
After that, another pharmacist came in, so she took over the computer and asked me what i was going to do. I remember saying to her "Well, i'll just hang around or maybe clean the bench". She is one of the pharmacists that do HMRs, so i thought i might as well read her letters then. However, having nothing to do was a blessing in disguise because the pharmacist came up with a brilliant idea of letting me have a go at doing one of the HMRs. She has interviewed the patient but has not got around looking for the issues or doing the recommendations yet. I was a bit uncertain at first but i took up the challenge. When i finished doing it, i had a good discussion with the pharmacist and she thought i did quite well. She taught me so much and because she is doing HMRs, she is very updated in terms of all the current studies/ researches. I'm privileged to learn from her and am very proud that my uni has taught me well, so much so i can at least have a little go in doing HMRs in real life.
One thing i learnt today was that, the reason why ACEIs and SARTANs are not used together now, is because although it doesn't seem to increase proteinuria, it still reduced the GFR a little bit, so it is not recommended. Other bits of new things i've learnt today are such as, the incidence of aspirin-induced asthma is about 10-20% (or thereabouts), the cholesterol levels for people with concurrent diseases like diabetes should be below 4 instead of the normal 5.2, and Hiprex (for the prevention of UTIs) is ineffective in renal impairment.
I was stretched over and over again today, being pushed out of my comfort zone a few times. One was the 10-item script, another was doing the HMR which i quite enjoy, the other was giving counselling to the patients/ customers.
I was quite reluctant at first but the pharmacists encouraged me to go and assured me that i can do it. The first case was for a patient needing Lactulose and Normafibe. The pharmacist gave me alot of guidance and stood by me when i gave the counselling. When i finished, she added a few things and once again i had the chance to learn from her. I learnt that 5ml is about a teaspoon, that Normafibe comes as granules and is a bit difficult to swallow, so it's not usually given to people unable to swallow in case they choke. Also, we should start it low because too much fibre at once will make the stomach bloat and feel unwell. So about 5ml once or twice a day would be good to start with to increase faecal bulk. It is also very important to drink plenty of water when taking bulking agents so as to avoid blockage. Lactolose, on the other hand,is 'disgustingly sweet' (according to the pharmacist), so taking it with some juice might be a good idea. The script says 10-30ml but the pharmacist suggested 20ml to start with, using a measuring cup. Whilst Normafibe helps bulking up, Lactulose will make the bowels move. The pharmacist also told the patient that he could increase the doses a little if it's not good enough and go down when his bowel movements become fairly normal.
The other counselling i had to do was Augmentin for a dental infection. I asked about allergies and other medications, told the customer to take 1 twice daily and to take it with food, best before breakfast or dinner (according to the pharmacist) and to take it until all finished. The pharmacist told me that he would counsel patients about antibiotics everytime, not just if the patient is taking it for the first time.
I also finished dispensing for the Webster packs due on Friday and i felt such a sense of achievement when i left for home at 5pm. Hence, the happy day. Or rather, the all-smiles-day! =)
Looking forward to the last day of the week! Time really flies!
p/s: my! so many grammar mistakes and typos in all my pebblepad blogposts! i've edited my pebblepad blogposts but i won't do it here.. hehe! can't be bothered cos i know u know i mean dig when i say fig. haha! good nite!
Today is a happy day! What makes me even happier at the end of a long day was an email from my lecturer saying that she enjoyed reading my blog! Maria and I couldn't stop laughing, and it's just out of pure joy! We hope what we have been writing is what our lecturers are looking for and we do enjoy very much in keeping a record of what has happened everyday.
Well, i started my day feeling that i won't have much to do at the pharmacy today because I had a feeling there will be quite alot of staff working today.
When i arrived, i did a few scripts. One had 7 items on it but it was fairly straight forward. Another had 10 items. The person was going to come back in 5-10 minutes so i tried not to pick that script but the pharmacist insisted i did it. Out of 10 items, 5 were last repeats and so i had to put stickers here and there to remind myself which of the 10 needs a last repeat sticker. And then while i was stressing out, trying to put things together within 5 minutes, the label printer went out of labels. Thankfully it happened before, so i quickly changed the roll and continued dispensing. The customer came back just when i finished. Phew!
After that, another pharmacist came in, so she took over the computer and asked me what i was going to do. I remember saying to her "Well, i'll just hang around or maybe clean the bench". She is one of the pharmacists that do HMRs, so i thought i might as well read her letters then. However, having nothing to do was a blessing in disguise because the pharmacist came up with a brilliant idea of letting me have a go at doing one of the HMRs. She has interviewed the patient but has not got around looking for the issues or doing the recommendations yet. I was a bit uncertain at first but i took up the challenge. When i finished doing it, i had a good discussion with the pharmacist and she thought i did quite well. She taught me so much and because she is doing HMRs, she is very updated in terms of all the current studies/ researches. I'm privileged to learn from her and am very proud that my uni has taught me well, so much so i can at least have a little go in doing HMRs in real life.
One thing i learnt today was that, the reason why ACEIs and SARTANs are not used together now, is because although it doesn't seem to increase proteinuria, it still reduced the GFR a little bit, so it is not recommended. Other bits of new things i've learnt today are such as, the incidence of aspirin-induced asthma is about 10-20% (or thereabouts), the cholesterol levels for people with concurrent diseases like diabetes should be below 4 instead of the normal 5.2, and Hiprex (for the prevention of UTIs) is ineffective in renal impairment.
I was stretched over and over again today, being pushed out of my comfort zone a few times. One was the 10-item script, another was doing the HMR which i quite enjoy, the other was giving counselling to the patients/ customers.
I was quite reluctant at first but the pharmacists encouraged me to go and assured me that i can do it. The first case was for a patient needing Lactulose and Normafibe. The pharmacist gave me alot of guidance and stood by me when i gave the counselling. When i finished, she added a few things and once again i had the chance to learn from her. I learnt that 5ml is about a teaspoon, that Normafibe comes as granules and is a bit difficult to swallow, so it's not usually given to people unable to swallow in case they choke. Also, we should start it low because too much fibre at once will make the stomach bloat and feel unwell. So about 5ml once or twice a day would be good to start with to increase faecal bulk. It is also very important to drink plenty of water when taking bulking agents so as to avoid blockage. Lactolose, on the other hand,is 'disgustingly sweet' (according to the pharmacist), so taking it with some juice might be a good idea. The script says 10-30ml but the pharmacist suggested 20ml to start with, using a measuring cup. Whilst Normafibe helps bulking up, Lactulose will make the bowels move. The pharmacist also told the patient that he could increase the doses a little if it's not good enough and go down when his bowel movements become fairly normal.
The other counselling i had to do was Augmentin for a dental infection. I asked about allergies and other medications, told the customer to take 1 twice daily and to take it with food, best before breakfast or dinner (according to the pharmacist) and to take it until all finished. The pharmacist told me that he would counsel patients about antibiotics everytime, not just if the patient is taking it for the first time.
I also finished dispensing for the Webster packs due on Friday and i felt such a sense of achievement when i left for home at 5pm. Hence, the happy day. Or rather, the all-smiles-day! =)
Looking forward to the last day of the week! Time really flies!
p/s: my! so many grammar mistakes and typos in all my pebblepad blogposts! i've edited my pebblepad blogposts but i won't do it here.. hehe! can't be bothered cos i know u know i mean dig when i say fig. haha! good nite!
Wednesday, June 23, 2010
Blogposts from pebblepad: Visit to the Bairnsdale Regional Health Service
23 June 2010
The Hospital is about 30 minutes walk from our accommodation, so we starting walking a little bit earlier than usual today and reached there just on time.
There were 4 pharmacists on duty today and each of them taught us different things during the day.
We had a quick tour around the whole hospital and at the same time, picked up discharges.
Then, we went back to the pharmacy to do 2 referral cases. One was a referral to the pharmacy due to falls risk and another one due to dysphagia, therefore medications have to be given through routes other than orally.
We were given a little bit of time to do the 2 cases and then we discussed it with the pharmacist. We then went up and talked to the patients, as well as the doctor to come up with the best solutions for the patients.
The major concern with the lady who had a high risk of falls was that she was taking Warfarin, as well as Aspirin. If she falls again and knocks her head, she would have a massive bleed in her head and this would be the last thing we want to see happen. She was on Perindopril and high dose Frusemide as well, which could cause hypotension. MS-Contin and PRN Endone can cause her to become drowsy and fall. The pharmacist needed to talk to the doctor about the patient's meds but before that she counselled the patient about the importance of not having a fall while in the hospital.
The other patient had cancer and was on numerous antiemetic drugs as well as opiod analgesics. We had to go through all the drugs and pick out those that are not given IV, and then think about whether to dissolve the tablets, crush them or use capsules, patches, suppositories, etc. However, when we got up to the ward, we found that he's got no IV lines therefore all the other drugs that we thought we could give IV had to be given using other routes as well. And while we were there, we found that there were a few more meds charted on the drug chart. Thankfully the doctor was there, so we had a good discussion with the doctor. I am surprised at how the doctor valued our opinions, not only the pharmacist's but he valued highly our opinions as well.
Our discussion revolved around whether Nurofen was better than Indomethacin in terms of causing fluid retention; whether the patient should be taking regular paracetamol despite having metastatic cancer in the liver and elevated liver enzymes; whether we should use a patch to replace sustained-release morphine; and whether Cyclizine was needed.
Our conclusion was that Nurofen was no better; that it is alright to take short term paracetamol because it undergoes phase II metabolism, which is less affected by disease; that a Fentanyl patch would be a good alternative as long as he is not opioid naive; and that Cyclizine can be withheld unless and until necessary.
Maria and i were wondering how the PPI tablets can be dispersed in water when they are enteric-coated. Today, the pharmacist showed us what happens when an Omeprazole tablet is dispersed in water. What becomes of the mixture is a cloudy solution with little yellow beads at the bottom and these small little beads themselves are enteric coated, not the whole tablet. Therefore, even if you disperse it in water, it still has an enteric coating. The other thing that i found interesting, was that the pharmacist highly recommended the patient to opt for the Ondansetron wafers if he can because it gives a quicker relief of his nausea.
We also had the chance to see how a cytotoxic IV infusion was made up. The drug was, if i've not mistaken, Temsirolimus. Later on in the day, we observed how Lignocaine and Adrenaline with Hyalorunidase are made up and put in 6mL syringes for eye surgeries. We also had a closer look and understanding of how leur-lock syringes and elastomeric infusers are used in real life.
The best part of today's visit was talking to the pharmacists and hearing their different stories of how they ended up working in the hospital. Most of them tell us that there are pros and cons to working in a regional hospital and one of the pros is that you get to learn to do everything. I can really see with my own eyes that they are skilled in every area of pharmacy, from reviewing medications to making up aseptic preparations, from administrative work to counselling patients. I find this rather impressive.
One special thing about this hospital is that most of its doctors are GPs who come in during the day to see the patients and then come in again the next morning. The other special thing about this hospital is that the blood products are handled by the pharmacy department, where they have to label each and every one of the products before they are given to the patients, where as this is not usually done by hospital pharmacies elsewhere.
Well, that's about all that has happened today and i thoroughly enjoyed my learning time at the hospital pharmacy today.
p/s: my friend and i are a little stressed now, having to do all the homework assigned to us as well as preparing for job applications. But we always come home feeling very tired.. :( she is already snoring away next to me, half way doing her stuff. I shall go join her now, cos my eyes can barely open! Good nite!
The Hospital is about 30 minutes walk from our accommodation, so we starting walking a little bit earlier than usual today and reached there just on time.
There were 4 pharmacists on duty today and each of them taught us different things during the day.
We had a quick tour around the whole hospital and at the same time, picked up discharges.
Then, we went back to the pharmacy to do 2 referral cases. One was a referral to the pharmacy due to falls risk and another one due to dysphagia, therefore medications have to be given through routes other than orally.
We were given a little bit of time to do the 2 cases and then we discussed it with the pharmacist. We then went up and talked to the patients, as well as the doctor to come up with the best solutions for the patients.
The major concern with the lady who had a high risk of falls was that she was taking Warfarin, as well as Aspirin. If she falls again and knocks her head, she would have a massive bleed in her head and this would be the last thing we want to see happen. She was on Perindopril and high dose Frusemide as well, which could cause hypotension. MS-Contin and PRN Endone can cause her to become drowsy and fall. The pharmacist needed to talk to the doctor about the patient's meds but before that she counselled the patient about the importance of not having a fall while in the hospital.
The other patient had cancer and was on numerous antiemetic drugs as well as opiod analgesics. We had to go through all the drugs and pick out those that are not given IV, and then think about whether to dissolve the tablets, crush them or use capsules, patches, suppositories, etc. However, when we got up to the ward, we found that he's got no IV lines therefore all the other drugs that we thought we could give IV had to be given using other routes as well. And while we were there, we found that there were a few more meds charted on the drug chart. Thankfully the doctor was there, so we had a good discussion with the doctor. I am surprised at how the doctor valued our opinions, not only the pharmacist's but he valued highly our opinions as well.
Our discussion revolved around whether Nurofen was better than Indomethacin in terms of causing fluid retention; whether the patient should be taking regular paracetamol despite having metastatic cancer in the liver and elevated liver enzymes; whether we should use a patch to replace sustained-release morphine; and whether Cyclizine was needed.
Our conclusion was that Nurofen was no better; that it is alright to take short term paracetamol because it undergoes phase II metabolism, which is less affected by disease; that a Fentanyl patch would be a good alternative as long as he is not opioid naive; and that Cyclizine can be withheld unless and until necessary.
Maria and i were wondering how the PPI tablets can be dispersed in water when they are enteric-coated. Today, the pharmacist showed us what happens when an Omeprazole tablet is dispersed in water. What becomes of the mixture is a cloudy solution with little yellow beads at the bottom and these small little beads themselves are enteric coated, not the whole tablet. Therefore, even if you disperse it in water, it still has an enteric coating. The other thing that i found interesting, was that the pharmacist highly recommended the patient to opt for the Ondansetron wafers if he can because it gives a quicker relief of his nausea.
We also had the chance to see how a cytotoxic IV infusion was made up. The drug was, if i've not mistaken, Temsirolimus. Later on in the day, we observed how Lignocaine and Adrenaline with Hyalorunidase are made up and put in 6mL syringes for eye surgeries. We also had a closer look and understanding of how leur-lock syringes and elastomeric infusers are used in real life.
The best part of today's visit was talking to the pharmacists and hearing their different stories of how they ended up working in the hospital. Most of them tell us that there are pros and cons to working in a regional hospital and one of the pros is that you get to learn to do everything. I can really see with my own eyes that they are skilled in every area of pharmacy, from reviewing medications to making up aseptic preparations, from administrative work to counselling patients. I find this rather impressive.
One special thing about this hospital is that most of its doctors are GPs who come in during the day to see the patients and then come in again the next morning. The other special thing about this hospital is that the blood products are handled by the pharmacy department, where they have to label each and every one of the products before they are given to the patients, where as this is not usually done by hospital pharmacies elsewhere.
Well, that's about all that has happened today and i thoroughly enjoyed my learning time at the hospital pharmacy today.
p/s: my friend and i are a little stressed now, having to do all the homework assigned to us as well as preparing for job applications. But we always come home feeling very tired.. :( she is already snoring away next to me, half way doing her stuff. I shall go join her now, cos my eyes can barely open! Good nite!
Tuesday, June 22, 2010
Blogposts from pebblepad: Busy Busy
22 June 2010
It has been a busy day at the pharmacy today.
I continued dispensing the Webster packs, did some stock check and made another cream. This time, it's Menthol 1% in Aqueous Cream. I was not exposed much to making creams with menthol at uni but with simple instructions from the pharmacist, it was quite easy to make. She taught me to wet the menthol with a bit of alcohol and then mix it into the cream. I love making creams!
Like i said yesterday, i realise dispensing requires a lot of concentration and better still, your full attention. Otherwise, it is so easy to make mistakes. From checking the date, doctor, script type, drug, dose, instructions, to sticking the labels on the script and medication, not forgetting attaching repeats as well, anything can go wrong and you might be in big trouble. With Webster packs, you have to also make sure you're picking the right prescriptions, for example they need Sertraline 100mg but there are scripts for both Sertraline 50mg and 100mg, so you must make sure you dispense what is needed. Another thing you'll have to do is to sort out which prescriptions are needed, which are not, which scripts are older, and which medications need to be deferred. Also, there may be a few scripts for the same medication in the file, so we must make sure that there are no new scripts before we send the last repeat reminders to the doctors. I learnt my lesson today because i didn't check whether there are new scripts when i was dispensing them, so i had to fig out all the files and go through them again to check for new scripts. If there are, i'll have to throw the reminders in the bin.
I made two big mistakes today. The first was to stick a label for Aspirin onto a box of Prazosin. That is the silliest mistake one can ever make and obviously i was not paying attention to what i was doing. The second big mistake was dispensing from the repeats. I am quite sure i always check the duplicate but somehow i managed to miss this one. The duplicate says 'Alendronate 70mg/Colecalciferol 140mcg' but the person before me dispensed the plain Alendronate. I should have picked that up. I know i was not in my best mode when i got to the pharmacy today, having all sorts of different thoughts in my mind but after realising what could happen when i don't concentrate, i told myself that i must put all my attention onto what i'm doing, because it is that important. Thankfully, i still have pharmacists to check for me now, what happens if i become a pharmacist in the future?
The pharmacist told me that mistakes are bound to happen and everyone makes mistakes but i want to try and make sure i make as few mistakes as possible.
Two of the pharmacists working at Terry White Bairnsdale also do HMRs and RMMRs and one of them showed me some of the letters that she wrote. I didn't manage to have a good look but will take time in the next few days to learn from her.
I was quite disappointed that i didn't manage to finish what i hope to finish today. I wanted to finish at least 2-3 pages of the list of Webster packs due for Friday but i couldn't finish the last one on page 2. Like what the pharmacist told me, dispensing for Webster packs is an ongoing process and it's never-ending, but i want to be able to do more than what i did today on Thursday, if i'll be doing Webster packs again. They wanted to let me have a go at packing them, but it didn't happen today.
Actually, i quite like dispensing for Webster packs. I don't feel as pressured to rush through the script and I can take a little bit of time to find out more about what conditions this person might be having and what medications he is using to treat the conditions. And the fact that it is an ongoing process makes me feel like wanting to get back to work quickly. It's something to look forward to everyday and that makes me feel much more motivated.
Tomorrow, i'll be going to visit the hospital! Wonder how hospitals in VIC are like! Cheers!
p/s: what i didn't say in PebblePad is that I AM SO TIRED!!!! standing whole day makes my feet ache like mad and i go home everyday feeling exhausted! Nevertheless, i like this feeling of having been doing something useful during the day, being productive and learning lots of stuff! hehe, Good nite now, zzzzzz...
It has been a busy day at the pharmacy today.
I continued dispensing the Webster packs, did some stock check and made another cream. This time, it's Menthol 1% in Aqueous Cream. I was not exposed much to making creams with menthol at uni but with simple instructions from the pharmacist, it was quite easy to make. She taught me to wet the menthol with a bit of alcohol and then mix it into the cream. I love making creams!
Like i said yesterday, i realise dispensing requires a lot of concentration and better still, your full attention. Otherwise, it is so easy to make mistakes. From checking the date, doctor, script type, drug, dose, instructions, to sticking the labels on the script and medication, not forgetting attaching repeats as well, anything can go wrong and you might be in big trouble. With Webster packs, you have to also make sure you're picking the right prescriptions, for example they need Sertraline 100mg but there are scripts for both Sertraline 50mg and 100mg, so you must make sure you dispense what is needed. Another thing you'll have to do is to sort out which prescriptions are needed, which are not, which scripts are older, and which medications need to be deferred. Also, there may be a few scripts for the same medication in the file, so we must make sure that there are no new scripts before we send the last repeat reminders to the doctors. I learnt my lesson today because i didn't check whether there are new scripts when i was dispensing them, so i had to fig out all the files and go through them again to check for new scripts. If there are, i'll have to throw the reminders in the bin.
I made two big mistakes today. The first was to stick a label for Aspirin onto a box of Prazosin. That is the silliest mistake one can ever make and obviously i was not paying attention to what i was doing. The second big mistake was dispensing from the repeats. I am quite sure i always check the duplicate but somehow i managed to miss this one. The duplicate says 'Alendronate 70mg/Colecalciferol 140mcg' but the person before me dispensed the plain Alendronate. I should have picked that up. I know i was not in my best mode when i got to the pharmacy today, having all sorts of different thoughts in my mind but after realising what could happen when i don't concentrate, i told myself that i must put all my attention onto what i'm doing, because it is that important. Thankfully, i still have pharmacists to check for me now, what happens if i become a pharmacist in the future?
The pharmacist told me that mistakes are bound to happen and everyone makes mistakes but i want to try and make sure i make as few mistakes as possible.
Two of the pharmacists working at Terry White Bairnsdale also do HMRs and RMMRs and one of them showed me some of the letters that she wrote. I didn't manage to have a good look but will take time in the next few days to learn from her.
I was quite disappointed that i didn't manage to finish what i hope to finish today. I wanted to finish at least 2-3 pages of the list of Webster packs due for Friday but i couldn't finish the last one on page 2. Like what the pharmacist told me, dispensing for Webster packs is an ongoing process and it's never-ending, but i want to be able to do more than what i did today on Thursday, if i'll be doing Webster packs again. They wanted to let me have a go at packing them, but it didn't happen today.
Actually, i quite like dispensing for Webster packs. I don't feel as pressured to rush through the script and I can take a little bit of time to find out more about what conditions this person might be having and what medications he is using to treat the conditions. And the fact that it is an ongoing process makes me feel like wanting to get back to work quickly. It's something to look forward to everyday and that makes me feel much more motivated.
Tomorrow, i'll be going to visit the hospital! Wonder how hospitals in VIC are like! Cheers!
p/s: what i didn't say in PebblePad is that I AM SO TIRED!!!! standing whole day makes my feet ache like mad and i go home everyday feeling exhausted! Nevertheless, i like this feeling of having been doing something useful during the day, being productive and learning lots of stuff! hehe, Good nite now, zzzzzz...
Monday, June 21, 2010
Blogposts from pebblepad: First day of the second week in Terry White Chemist, Bairnsdale
Today was a tiring day at the pharmacy. I did dispensing for the Webster packs most of the time today. It is a tiring job because it requires a lot of concentration. Nevertheless, I learnt so much from it. It’s like an opportunity to brush up my dispensing skills, but without the time constraint. When I’m dispensing for someone waiting, I don’t have to rush through the script without having the chance to think about what the drug’s for, how will it interact with other medications, whether it’s the best medication for this person, etc.
When I had a few moments to myself, I tried to mentally put together the drug names and the brand names, so that the next time I see a brand I will know the drug name by heart. Of course, I was only able to do that for the very common medications. Other times, when I am dispensing, I try to memorise the ancillary labels and remember by heart, which medications need which ancillary labels.
I am more confident now in doing owing scripts and deferred scripts, and I can handle more complicated scripts better. I am also more familiar with what to do when a person reaches safety net.
Besides doing the dispensing for the Webster packs, I did a suspension, picked up a call, took in a few scripts and did a few transactions.
Someone requested something for his cough and I was able to ask him a few questions such as what are the symptoms, has he tried anything before, is he taking any other medications, etc, but I was not confident enough so I still asked the pharmacist whether it was ok to supply him with the Benadryl chesty cough preparation. I should be able to handle that sort of request pretty well already. So, the next time someone requests for something for his/her throat, I shall be more confident and recommend him/her the one I think is best. However, to be able to do that well, I will have to equip myself with the knowledge that is needed and familiarise myself with the products that are available.
Someone came in to ask if the medication she was prescribed has gluten in it. I thought that was pretty interesting. All in all, it was quite an enjoyable day today, just a bit tiring. I got to know some of the staff more and I really like working there, being part of the team is so fun!
p/s: the host didn't come knocking on our door today and we wondered why. When we found him outside our room, talking to the person next door, we were delighted cos we had a list of requests for him. :p he is so funny man, we kept laughing when we were talking with him. And did i tell you i have someone to help me turn on my electric blanket every nite too? :) thanks friend!
When I had a few moments to myself, I tried to mentally put together the drug names and the brand names, so that the next time I see a brand I will know the drug name by heart. Of course, I was only able to do that for the very common medications. Other times, when I am dispensing, I try to memorise the ancillary labels and remember by heart, which medications need which ancillary labels.
I am more confident now in doing owing scripts and deferred scripts, and I can handle more complicated scripts better. I am also more familiar with what to do when a person reaches safety net.
Besides doing the dispensing for the Webster packs, I did a suspension, picked up a call, took in a few scripts and did a few transactions.
Someone requested something for his cough and I was able to ask him a few questions such as what are the symptoms, has he tried anything before, is he taking any other medications, etc, but I was not confident enough so I still asked the pharmacist whether it was ok to supply him with the Benadryl chesty cough preparation. I should be able to handle that sort of request pretty well already. So, the next time someone requests for something for his/her throat, I shall be more confident and recommend him/her the one I think is best. However, to be able to do that well, I will have to equip myself with the knowledge that is needed and familiarise myself with the products that are available.
Someone came in to ask if the medication she was prescribed has gluten in it. I thought that was pretty interesting. All in all, it was quite an enjoyable day today, just a bit tiring. I got to know some of the staff more and I really like working there, being part of the team is so fun!
p/s: the host didn't come knocking on our door today and we wondered why. When we found him outside our room, talking to the person next door, we were delighted cos we had a list of requests for him. :p he is so funny man, we kept laughing when we were talking with him. And did i tell you i have someone to help me turn on my electric blanket every nite too? :) thanks friend!
Saturday, June 19, 2010
Blogposts from pebblepad: mistakes and more mistakes
All i can recall about today's time at the pharmacy are mistakes. From the first script i did, it was mistakes over and over again. Mistakes that i am ashamed of. I keep choosing the wrong product on the dispensing system because i am so unfamiliar with the products that are available. I also keep choosing the ones that have no repeats allowed and they come up as authority scripts. Thankfully i always ask the pharmacist when i'm not sure of anything, so that when the mistake is picked up, it won't be too troublesome to correct it then.
I also learnt about reaching the safety net today. We have to print out the form for the customer to sign and give them a card so that they can use it if they happen to visit another pharmacy.
Small labels are usually printed for things like cream or eye drops but i keep forgetting and stick them on the duplicate.
Well, who never makes mistakes? I'll just try and learn as much as possible from my mistakes and don't repeat them again.
I realise different pharmacies have different systems, different cultures and emphasize on slightly different things. For example, this pharmacy has a very good system that allows the pharmacists to communicate with the technicians and the pharmacy assistants, and vice versa. They put notes everywhere just to remind everyone about a customer's preference, the customer's requests, wants and needs. And i am very impressed by everyone's amazing communication skills. Well, more to learn for me!
The hosts of the place we're staying in are really nice people, they check on us everyday to see whether there is anything we need. I'm loving this place and certainly can't wait for the weekend ahead!
p/s: maria and i have been watching 就想赖着你, it was sooo goood man!!!!! we were shouting in joy, screaming with heartache, laughing out loud like nobody's business because of the show for a few days now. Time to go off to Melbourne for a little treat! :D
The hosts are really very very nice to us. They check on us everyday, make our beds, give us extra hangers when we decided not to ask cos we tot we might be asking too much already, wash and dry our clothes, he even forced (almost) us to use his towels! Well, i'm feeling very blessed with such amazing hosts and a wonderful placement buddy who packs my lunch with a sandwich, a banana, a muesli bar and a cookie (that's sponsored by our host) everyday! :) I didn't watch master chef today, cos 就想赖着你 was tooooooo exciting! Okies, time to sleep! Need to get up pretty early tomorrow! Cheers!
I also learnt about reaching the safety net today. We have to print out the form for the customer to sign and give them a card so that they can use it if they happen to visit another pharmacy.
Small labels are usually printed for things like cream or eye drops but i keep forgetting and stick them on the duplicate.
Well, who never makes mistakes? I'll just try and learn as much as possible from my mistakes and don't repeat them again.
I realise different pharmacies have different systems, different cultures and emphasize on slightly different things. For example, this pharmacy has a very good system that allows the pharmacists to communicate with the technicians and the pharmacy assistants, and vice versa. They put notes everywhere just to remind everyone about a customer's preference, the customer's requests, wants and needs. And i am very impressed by everyone's amazing communication skills. Well, more to learn for me!
The hosts of the place we're staying in are really nice people, they check on us everyday to see whether there is anything we need. I'm loving this place and certainly can't wait for the weekend ahead!
p/s: maria and i have been watching 就想赖着你, it was sooo goood man!!!!! we were shouting in joy, screaming with heartache, laughing out loud like nobody's business because of the show for a few days now. Time to go off to Melbourne for a little treat! :D
The hosts are really very very nice to us. They check on us everyday, make our beds, give us extra hangers when we decided not to ask cos we tot we might be asking too much already, wash and dry our clothes, he even forced (almost) us to use his towels! Well, i'm feeling very blessed with such amazing hosts and a wonderful placement buddy who packs my lunch with a sandwich, a banana, a muesli bar and a cookie (that's sponsored by our host) everyday! :) I didn't watch master chef today, cos 就想赖着你 was tooooooo exciting! Okies, time to sleep! Need to get up pretty early tomorrow! Cheers!
Blogposts from pebblepad: this was supposed to be yesterday's post but the internet was down
Today’s my third day at the pharmacy.
I was mainly working in the dispensary today, learning how to process scripts with Minfos. I was quite nervous at first, typing in the doctor’s name instead of the customer’s name but the pharmacists were very helpful and very quickly, I could process scripts all by myself already.
The few interesting things that happened today were:
Something went wrong with the CONSIS machine. So the pharmacy owner got on the phone and started turning a few screws. After fixing a few things, he managed to get it going again. Actually, I’m quite impressed with the machine because it really helps a lot. It saves a lot of time having to look for the medications on the shelf, and many times it will not be just one medication that you’re after. It’ll be a few, so you’ll have to go high and low looking for the meds and even if you’re very familiar with the positions, you still have to move around quite a lot. With this machine, it just gathers them altogether, no matter how many of them, into a little scoop, and you just pick them up from the scoop and process them. How convenient.
The radio station was doing a promotion or something and had a table set up in our pharmacy. I didn’t get the chance to check it out though.
I made up another suspension today.
I had the chance to look at two different prescriptions for Predmix and they were processed by two different pharmacists. The funny thing was that both pharmacists asked me the same question and that was “what dose do we give for a child?” I can’t forget it now since I was told twice that it’s 1mg/kg and we should always check that the child is at the correct weight to be prescribed that amount of prednisolone.
The other drug that I saw at least twice and having 2 pharmacists asked me what it was for, was Prazosin.
I was also asked to look up what Burinex is. I have never really come across Bumetanide before and am quite surprised to see it prescribed instead of Frusemide.
I tagged along a pharmacist to counsel a customer for Zolpidem and the customer was actually more concerned about waking up and having broken sleep rather than falling asleep because he doesn’t really have trouble going to sleep, he’s just annoyed to keep waking up at night. He was previously on Temazepam but find it ineffective, the pharmacist said that Zolpidem might not help him too much either, since they work like benzos to help you fall asleep. In fact, this works even quicker then benzos and make you do funny things like sleepwalk.
One pharmacist told me, one way to familiarize yourself with the drugs and to help with the year-end exam/ registration exam is to look at every drug on the prescription and run these few questions through your head “What’s this drug for? How much is the usual dose? What are the side effects?” However, I told him that I am already working like a turtle, that will turn me into a snail. Well, I didn’t tell him that but something like that. Nevertheless, he insisted I should do that for every drug I see. I know that’s good advice, and I will try my best.
Ok, tomorrow’s the last day at the pharmacy for the week. Loving it and looking forward to a great weekend!
I was mainly working in the dispensary today, learning how to process scripts with Minfos. I was quite nervous at first, typing in the doctor’s name instead of the customer’s name but the pharmacists were very helpful and very quickly, I could process scripts all by myself already.
The few interesting things that happened today were:
Something went wrong with the CONSIS machine. So the pharmacy owner got on the phone and started turning a few screws. After fixing a few things, he managed to get it going again. Actually, I’m quite impressed with the machine because it really helps a lot. It saves a lot of time having to look for the medications on the shelf, and many times it will not be just one medication that you’re after. It’ll be a few, so you’ll have to go high and low looking for the meds and even if you’re very familiar with the positions, you still have to move around quite a lot. With this machine, it just gathers them altogether, no matter how many of them, into a little scoop, and you just pick them up from the scoop and process them. How convenient.
The radio station was doing a promotion or something and had a table set up in our pharmacy. I didn’t get the chance to check it out though.
I made up another suspension today.
I had the chance to look at two different prescriptions for Predmix and they were processed by two different pharmacists. The funny thing was that both pharmacists asked me the same question and that was “what dose do we give for a child?” I can’t forget it now since I was told twice that it’s 1mg/kg and we should always check that the child is at the correct weight to be prescribed that amount of prednisolone.
The other drug that I saw at least twice and having 2 pharmacists asked me what it was for, was Prazosin.
I was also asked to look up what Burinex is. I have never really come across Bumetanide before and am quite surprised to see it prescribed instead of Frusemide.
I tagged along a pharmacist to counsel a customer for Zolpidem and the customer was actually more concerned about waking up and having broken sleep rather than falling asleep because he doesn’t really have trouble going to sleep, he’s just annoyed to keep waking up at night. He was previously on Temazepam but find it ineffective, the pharmacist said that Zolpidem might not help him too much either, since they work like benzos to help you fall asleep. In fact, this works even quicker then benzos and make you do funny things like sleepwalk.
One pharmacist told me, one way to familiarize yourself with the drugs and to help with the year-end exam/ registration exam is to look at every drug on the prescription and run these few questions through your head “What’s this drug for? How much is the usual dose? What are the side effects?” However, I told him that I am already working like a turtle, that will turn me into a snail. Well, I didn’t tell him that but something like that. Nevertheless, he insisted I should do that for every drug I see. I know that’s good advice, and I will try my best.
Ok, tomorrow’s the last day at the pharmacy for the week. Loving it and looking forward to a great weekend!
Wednesday, June 16, 2010
Blogposts from pebblepad: 2 creams in a day!
16 June 2010
It was another exciting day at the pharmacy today.
I am more confident in using the till now, in approaching customers and serving them. I have also become more familiar the NDSS programme (national diabetes services scheme)and was introduced to some other schemes as well such as the QUMAX.
The pharmacy owner told me it is very important to familiarise myself with how scripts are received and given out at the end of our service to the customer. After working there for 2 days, I couldn't agree more and i'm thankful that he has placed me there. Actually, I have overcome one of my greatest fears just by being placed there and that is to talk to customers, approach them and serve them. I am very shy and i have always preferred to be at the back, not having to deal with customers. However, just by being at the front, i was given the opportunity to learn from the best pharmacy assistants, some having worked there for 8 years already, Within a few days, i am a much more confident person.
I also had the opportunity to make up 2 creams today, one was Salicylic Acid 10% and Olive Oil 2% in aqueous cream and the other was just Olive Oil 5% aqueous cream. I wasn't taught at uni to 'wet' the powder ingredients first so it was something i learnt today but i'm very glad that my compounding skills learnt at uni has made me proud. I managed to make up 2 well-presented creams for my preceptor.
I was curious to know why a patient was on 5 antibiotics at one time and she wanted them dispensed all at once, so i asked the pharmacist. He knew the customer very well so he asked her straight away. I was abit embarrassed but it was satisfying to have know the answer. She said it was for itchy legs but we all didn't really know how it was going to work.
A lot of people have been coming in for flu and cold medicines, i guess it's the changing weather. I will try and familiarise myself with what is behind the counter so that i can recommend some OTC medications to the customers myself, without needing much help from the pharmacist or the pharmacy assistants.
Looking forward to another full day at the pharmacy tomorrow!
Tuesday, June 15, 2010
Blogposts from pebblepad: First day of placement
15 June 2010
Today was a really interesting day.
I was mainly out in the front, receiving scripts, talking to customers and operating the till.
It was a fun and exciting experience especially when i'm placed in a busy pharmacy. Everything has to be done efficiently but with top quality, giving customers the best service we can offer.
I learnt how to receive scripts from customers in a respectful manner, use the till, do eftpos, charge into customer's individual accounts and how to refer to appropriate persons when i need help.
I was taught how to counsel patients, what to ask for and which cough and cold preparations to give when customers ask for it.
I did a Cephalexin suspension and had the opportunity to see an unusual combination of medication prescribed for a lady. A lady came in with a script for Nexium and a script for Somac. The pharmacists asked the customer whether there was a changeover but the lady had no recollection whatsoever about how she ended up having both. She has been on Nexium for a while and didn't want to change that so the pharmacist withheld the Somac and asked her to come back for that next time, after her doctor's visit.
The pharmacy was a really big one, with a very friendly owner and lots of staff, the most amazing thing was the Consis machine that was in the dispensary! It was phenomenal as i have never seen a dispensing machine/ robot before!
The pharmacy has got their own Tony Ferguson couselling corner as well as a webster pack corner with about 3-4 staff working on blister packs at one time.
The first day was a good experience and i am looking forward to learning more tomorrow!
p/s: maria and i have been feeding on microwave food everyday! help! or else it's instant food or junk food. :p but even so, i've been eating til my stomach explodes and emergency exits are warranted. sigh, i guess that's what happens when you're cold, hungry and tired from a long day. Cheers and take care! :)
Blogposts from pebblepad: First day at Bairnsdale
14 June 2010
Today's Queen's birthday and I didn't have to go to the pharmacy.
My placement partner, Maria and I took the opportunity to have a good look around Bairnsdale and we enjoyed ourselves very much.
We woke up to beautiful weather and fresh crisp air, and our day started off with a near 1 hour river walk along the Mitchell River. It was beautiful and the river was so clear, it looks like a mirror. We saw bats, cows, dogs, a horse and a few birds. A few families were also enjoying their day around the area. We had fun taking lots of pictures and learning more about the history and culture of the place.
I am certainly looking forward to first day at Terry White Bairnsdale tomorrow and i'm happy to be here in this beautiful place, with a good friend and a lovely accommodation with amazing hosts!
Blog more tomorrow!
p/s: pebblepad is an e-portfolio programme, i think i have mentioned about it before. We are asked to blog about our everyday experiences while on pharmacy placement and record it on pebblepad. So i tot i'd just copy it here so i don't have to blog twice. The writing style is a bit different tho. Short sentences that are very formal as opposed to my usual super long sentences that has no proper punctuations. :p
Sunday, June 13, 2010
ALL FIVE DOWN and having a good time at bairnesdale
Yes, all five subjects are down with the last one unexpectedly frustrating. Why was the graph parallel!? It couldn't be.. :(
Nevertheless, i will say again, Thank You Jesus for my fifth and last subject!
After exams yesterday, we went home to bake muffins for Carmen for an advanced birthday celebration and cleaned the fridge. We had a 'meriah' time at our house with Maria and Yin Yin, as well as Shaun and Hannah dropping by just to say bye to me.
Right after all that, we had dinner at salamanca and then watched Prince of Persia. Oh, and how he saved the world in such a manly manner! :p
I didn't get to bed until about 3.30am and had to get up at 5.30 to fly off at 7am. From Hobart to Melbourne, Southern Cross train station to Pakenham, Sale to Bairnesdale, it had been a long long journey only a little short of 10 hours. But the long journey was made more bearable and comfortable with a fun-loving and easy-going friend! :D THANKS ALREADY, MARIA WONG QIN!
We quickly settled down to a comfortable unit, rushed out to have dinner and visited a local foodstore that sells very cheap fresh fruits and vege! We were awe-struck and wanted to buy everything! haha, how deprived we were! We asked if we could cook and we were kindly offered a microwave in our room, we asked where to do laundry and we were offered free laundry service including drying our clothes in the dryer! Yippee! Good start to a 3 week placements made better with wireless internet!!!
Bairnesdale is really a very special town with spiky trees, odd park names, cute signs and we are yet to explore more about this place.
Okays, off to watch master chef and lots of movies with my placement buddy! More exploration tomorrow, which is queen's birthday!
Sending much love and greetings to those in Hobart, KK and KL from Bairnesdale!!! :)
Nevertheless, i will say again, Thank You Jesus for my fifth and last subject!
After exams yesterday, we went home to bake muffins for Carmen for an advanced birthday celebration and cleaned the fridge. We had a 'meriah' time at our house with Maria and Yin Yin, as well as Shaun and Hannah dropping by just to say bye to me.
Right after all that, we had dinner at salamanca and then watched Prince of Persia. Oh, and how he saved the world in such a manly manner! :p
I didn't get to bed until about 3.30am and had to get up at 5.30 to fly off at 7am. From Hobart to Melbourne, Southern Cross train station to Pakenham, Sale to Bairnesdale, it had been a long long journey only a little short of 10 hours. But the long journey was made more bearable and comfortable with a fun-loving and easy-going friend! :D THANKS ALREADY, MARIA WONG QIN!
We quickly settled down to a comfortable unit, rushed out to have dinner and visited a local foodstore that sells very cheap fresh fruits and vege! We were awe-struck and wanted to buy everything! haha, how deprived we were! We asked if we could cook and we were kindly offered a microwave in our room, we asked where to do laundry and we were offered free laundry service including drying our clothes in the dryer! Yippee! Good start to a 3 week placements made better with wireless internet!!!
Bairnesdale is really a very special town with spiky trees, odd park names, cute signs and we are yet to explore more about this place.
Okays, off to watch master chef and lots of movies with my placement buddy! More exploration tomorrow, which is queen's birthday!
Sending much love and greetings to those in Hobart, KK and KL from Bairnesdale!!! :)
Friday, June 11, 2010
FOUR and you know what, DOWN!
Yay yay yay yay yayyyyy!!!!
I am feeling a bit guilty for this excitement that's welling up within me.
I should be studying for PK. I should be thinking about how i did in the past few exams..
but i can't help it..!!! i'm too excited!!!
We have programmes lined up from right after our exams to right before we leave for placement on Sunday, which is actually only a span of 16 hours. Well, the fun doesn't stop there i hope, we're gonna be on placementttttssss and we get to tour around and have fun! like... so much fun man!
Okay.. please continue to pray for me, i really need prayers for all the exams!! I have totally no confidence on how i did for the exams, but i put my confidence and trust in You, Lord.
You are mighty, You are able!
Thank You Jesus for another one down. Thank You for Your faithfulness. Thank You for sustaining me. Thank You for taking away the headache this morning. Thank You for friends to walk with. I pray we will walk this journey together till the end.
Increase me faith Lord, increase me love.
I am feeling a bit guilty for this excitement that's welling up within me.
I should be studying for PK. I should be thinking about how i did in the past few exams..
but i can't help it..!!! i'm too excited!!!
We have programmes lined up from right after our exams to right before we leave for placement on Sunday, which is actually only a span of 16 hours. Well, the fun doesn't stop there i hope, we're gonna be on placementttttssss and we get to tour around and have fun! like... so much fun man!
Okay.. please continue to pray for me, i really need prayers for all the exams!! I have totally no confidence on how i did for the exams, but i put my confidence and trust in You, Lord.
You are mighty, You are able!
Thank You Jesus for another one down. Thank You for Your faithfulness. Thank You for sustaining me. Thank You for taking away the headache this morning. Thank You for friends to walk with. I pray we will walk this journey together till the end.
Increase me faith Lord, increase me love.
Thursday, June 10, 2010
Wednesday, June 9, 2010
THREE (and the most terrifying one) down!
Thank you Jesus. Thank you Jesus. Thank you Jesus. Thank you Jesus!
I can tell you that i did no where near satisfying but.. THANK YOU JESUS!
In every aspect of this exam, i can see Your hand working, Lord. I see Your favour, I see Your control, i see You.
Thank You for seeing me through this extremely stressful time (to say the very least), and i am totally relieved now even though there are two more exams waiting for me.
Thank You that when i finally broke down in tears, You sent me daddy to comfort me and speak powerful words into my spirit.
When again i hid at the corner of the room, staring into the air overwhelmed by fear and stress, thinking to myself that i can't do it anymore, You brought comfort, strength and peace to me. Assuring me that Your love casts away all fear and You can give me peace that surpasses all understanding.
Constantly, i received encouragement from daddy and mummy, from che, from friends and from Your word that You are more than able to walk me through this difficult time.
When it seems as if my world was going to fall apart, You brought me to where You are and showed me what my problems look like from up there. As i reverted to and fro between doubt and trust, fear and belief, worry and faith, You took the opportunity to dig deep down into my heart and planted the seed that says "God is in control of the whole universe"..
Again and again, You show Yourself faithful to me, good to me, merciful to me and more than anything, gracious to me. You give me, time and again, what i do not deserve.
Thank You once again Lord. Help me in everything i do so that Your name is glorified.
I can tell you that i did no where near satisfying but.. THANK YOU JESUS!
In every aspect of this exam, i can see Your hand working, Lord. I see Your favour, I see Your control, i see You.
Thank You for seeing me through this extremely stressful time (to say the very least), and i am totally relieved now even though there are two more exams waiting for me.
Thank You that when i finally broke down in tears, You sent me daddy to comfort me and speak powerful words into my spirit.
When again i hid at the corner of the room, staring into the air overwhelmed by fear and stress, thinking to myself that i can't do it anymore, You brought comfort, strength and peace to me. Assuring me that Your love casts away all fear and You can give me peace that surpasses all understanding.
Constantly, i received encouragement from daddy and mummy, from che, from friends and from Your word that You are more than able to walk me through this difficult time.
When it seems as if my world was going to fall apart, You brought me to where You are and showed me what my problems look like from up there. As i reverted to and fro between doubt and trust, fear and belief, worry and faith, You took the opportunity to dig deep down into my heart and planted the seed that says "God is in control of the whole universe"..
Again and again, You show Yourself faithful to me, good to me, merciful to me and more than anything, gracious to me. You give me, time and again, what i do not deserve.
Thank You once again Lord. Help me in everything i do so that Your name is glorified.
Tuesday, June 8, 2010
TWO down
Thank You Jesus.
I need You more, more than yesterday...
and thank you so much daddy, mummy and che..
I need You more, more than yesterday...
and thank you so much daddy, mummy and che..
Monday, June 7, 2010
ONE down
I don't know how i did.
but i'm just gonna say,
THANK YOU JESUS!
I'll take it step by step, one at a time. =)
but i'm just gonna say,
THANK YOU JESUS!
I'll take it step by step, one at a time. =)
Sunday, June 6, 2010
O.O
Okay, tomorrow's first day of exams. In fact, first day of a one-week marathon of exams.
And guess what, Trypsin has arrived and i now have no time for experiments. AHHH!!!!
If all else fails, i'll have to do it Thursday, my only non-exam day. :(
and this... this... this.... ahhhhh!!!!! nevermind... won't be a problem to me for some time now anyway.
okay, this sounds a bit depressing but it shouldn't. i am NOT stressed out! i am NOT!!!!!!!
*hyperventilates* why did i come online!! @#$)(#*$)#(*@$$#$%%*
calm down. calm down. calm down.
....
Okay..
On the other hand, i am a litte bit happy to have online-d. to know that i can dump things on you and you'd just happily carry it for me feels .... good! :D
Okay, i better get back to studying!
"Lord, my heart trusts in You and i am helped. Because You are at my right hand, i will not be shaken. Your name is a strong tower, those who run to it are safe. Lord, i need You more than ever. Please help. Please help me!"
And may you bless all those who are having exams during this time, bless their study time, bless their hands, their minds, their hearts with peace and understanding. May we all do well and pass with flying colours. Thank you, Lord.
And like my dear friend Yin Yin said, bless Wonder Five Lord. And continue to remind me of how blessed i am, how good You are to me and how much BIGGER You are than any of my circumstances.
Thank You, once again Lord. You are my rock.
And guess what, Trypsin has arrived and i now have no time for experiments. AHHH!!!!
If all else fails, i'll have to do it Thursday, my only non-exam day. :(
and this... this... this.... ahhhhh!!!!! nevermind... won't be a problem to me for some time now anyway.
okay, this sounds a bit depressing but it shouldn't. i am NOT stressed out! i am NOT!!!!!!!
*hyperventilates* why did i come online!! @#$)(#*$)#(*@$$#$%%*
calm down. calm down. calm down.
....
Okay..
On the other hand, i am a litte bit happy to have online-d. to know that i can dump things on you and you'd just happily carry it for me feels .... good! :D
Okay, i better get back to studying!
"Lord, my heart trusts in You and i am helped. Because You are at my right hand, i will not be shaken. Your name is a strong tower, those who run to it are safe. Lord, i need You more than ever. Please help. Please help me!"
And may you bless all those who are having exams during this time, bless their study time, bless their hands, their minds, their hearts with peace and understanding. May we all do well and pass with flying colours. Thank you, Lord.
And like my dear friend Yin Yin said, bless Wonder Five Lord. And continue to remind me of how blessed i am, how good You are to me and how much BIGGER You are than any of my circumstances.
Thank You, once again Lord. You are my rock.
Friday, June 4, 2010
tick tock tick tock
"Diazepam has low water solubility... GTN loss to platics is rapid and ongoing... blablabla.."
arrhh!!!!
*facebook break*
"Where is the heartburn and diarrhoea lecture!!!!???"
GGRRRRRR!!!!!!!
*munch munch munch..*
"ohhh, it was from 3rd year's first semester..."
*facebook break*
"ok, i should start now...... wait..."
*munch munch munch*
arrhh!!!!
*facebook break*
"Where is the heartburn and diarrhoea lecture!!!!???"
GGRRRRRR!!!!!!!
*munch munch munch..*
"ohhh, it was from 3rd year's first semester..."
*facebook break*
"ok, i should start now...... wait..."
*munch munch munch*
WOW!
This is SO COOL!
And to quote him "Abstinence is the new cool, purity is the new cool!"
I heard about him from my parents but i didn't know he is THAT cool, man!
Jaeson Ma - Love Lyrics
And to quote him "Abstinence is the new cool, purity is the new cool!"
I heard about him from my parents but i didn't know he is THAT cool, man!
Jaeson Ma - Love Lyrics
Thursday, June 3, 2010
Oh my gosh!
I really hope i know what i'm getting myself into.
It's alot of fun, tho. Cracks me up all the time ^^.
Here's an excerpt from Brooke Fraser's song, The Thief. Enjoy~! ;)
"You sing me to sleep, talk down my walls, look through my windows.. as i wait, you could be the thief that i give the key to..."
It's alot of fun, tho. Cracks me up all the time ^^.
Here's an excerpt from Brooke Fraser's song, The Thief. Enjoy~! ;)
"You sing me to sleep, talk down my walls, look through my windows.. as i wait, you could be the thief that i give the key to..."
amazing grace
I woke up today and put on my mp3 to listen to John Bevere's short messages, and today he spoke to me about Faith.
FAITH is the pipeline to all the power that comes with God's grace. Grace gives us the ability to please God and Faith gives us access to grace. That's why the bible says 'without faith, it is impossible to please God.'
They say mercy is when you don't get what you deserve (i.e. pardoning when you did something wrong) and grace is when you get something you don't deserve (i.e. presents when it's not your birthday :p)
When i look back at all the mess that i once was in, and think about how God graciously and not forcefully carried me out of the piles of mess over and over again, i can't help but thank God in my heart. Thank you Lord, for your saving grace for i did not deserve what you've done for me.
When i think about how blessed i am to have Jesus by my side through it all, behind me in all the things i do and going before me wherever i go, i am thankful for this luxurious life He has given me.
Thank you Lord. I am truly grateful.
And thank you for revealing to me the importance of contentment. My fresh bread for the day. =)
Okies, back to work. Let not your faith limit what God can do for you for He is able to do immeasurably MORE than all we ASK or IMAGINE, according to his power that is at work within us. (Ephesians 3:20)
How much can you imagine? Have faith.
FAITH is the pipeline to all the power that comes with God's grace. Grace gives us the ability to please God and Faith gives us access to grace. That's why the bible says 'without faith, it is impossible to please God.'
They say mercy is when you don't get what you deserve (i.e. pardoning when you did something wrong) and grace is when you get something you don't deserve (i.e. presents when it's not your birthday :p)
When i look back at all the mess that i once was in, and think about how God graciously and not forcefully carried me out of the piles of mess over and over again, i can't help but thank God in my heart. Thank you Lord, for your saving grace for i did not deserve what you've done for me.
When i think about how blessed i am to have Jesus by my side through it all, behind me in all the things i do and going before me wherever i go, i am thankful for this luxurious life He has given me.
Thank you Lord. I am truly grateful.
And thank you for revealing to me the importance of contentment. My fresh bread for the day. =)
Okies, back to work. Let not your faith limit what God can do for you for He is able to do immeasurably MORE than all we ASK or IMAGINE, according to his power that is at work within us. (Ephesians 3:20)
How much can you imagine? Have faith.
Tuesday, June 1, 2010
the 3 blogging friends of wonder 5
Taken from The Babbling Toad..
"What has study done to our sanity? One writes about addiction of sweetness [i♥to dream], one shows unflattering candid photos (which totally entertains me so I don't really mind) [CCYY], and the babbling toad, she's........"
I will attempt to continue her sentence here,
"She's a loving sister and a photography enthusiast trapped in a 4th year pharmacy student's body.."
I love my friends! We're so weird! :p
"What has study done to our sanity? One writes about addiction of sweetness [i♥to dream], one shows unflattering candid photos (which totally entertains me so I don't really mind) [CCYY], and the babbling toad, she's........"
I will attempt to continue her sentence here,
"She's a loving sister and a photography enthusiast trapped in a 4th year pharmacy student's body.."
I love my friends! We're so weird! :p
a time for everything
There is a time for everything and a season for every activity under heaven:
a time to be born and a time to die,
a time to plant and a time to uproot,
a time to kill and a time to heal,
a time to tear down and a time to build,
a time to weep and a time to laugh,
a time to mourn and a time to dance,
a time to scatter the stones and a time to gather them,
a time to embrace and a time to refrain,
a time to search and a time to give up,
a time to keep and a time to throw away,
a time to tear and a time to mend,
a time to be silent and a time to speak,
a time to love and a time to hate,
a time for war and a time for peace.
Ecclesiastes 3:1-8
a time to be born and a time to die,
a time to plant and a time to uproot,
a time to kill and a time to heal,
a time to tear down and a time to build,
a time to weep and a time to laugh,
a time to mourn and a time to dance,
a time to scatter the stones and a time to gather them,
a time to embrace and a time to refrain,
a time to search and a time to give up,
a time to keep and a time to throw away,
a time to tear and a time to mend,
a time to be silent and a time to speak,
a time to love and a time to hate,
a time for war and a time for peace.
Ecclesiastes 3:1-8
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