Does Childhood Obesity Equal Neglect?

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In a world where every minute of the day is jam-packed with rushing from home to school and school to work and work to school and school to extracurricular activities, it is no wonder that parents are feeling the squeeze of where a lot of us are failing.  Our children's diets are suffering in a tremendous way which leads to things we would never wish on our children:  diabetes, obesity, high blood pressure, bone and joint problems, social and psychological problems, and poor self-esteem.  Today, childhood obesity has more than doubled in children and quadrupled in adolescents in the past 30 years according to the Journal of the American Medical Association and the National Center for Health Statistics.

There are immediate and long-term health effects.  Long-term effects are things like heart disease, type 2 diabetes, stroke, cancer, and osteoarthritis.  One study called the Bogalusa Heart Study showed that children who became obese as early as age 2 were more likely to be obese as adults.

In Britain, news was just released claiming that parents of an obese child were arrested for neglect.  Has this gone too far?  

If we spend our days putting priority on "getting somewhere" and not what goes into our bodies, we are missing a vital part of what we should prioritize.  Health.  

“Let food be thy medicine and medicine be thy food.” - Hippocrates

Should a parent be responsible for training up a child on how to be healthy?  Absolutely!  But, where we fail as a society, in America at least, is that our culture is driven around maximizing every second for work and productivity and not health.  We rush about to and fro and forget about healthy foods.  It takes too long to prepare.  McDonald's is so much faster.  Drive-thrus are so much faster.  Our hospital cafeterias are filled with the same foods that would send a patient to the cath lab over time due to the high cholesterol and high fat/sugar.  We have a society problem more than a parenting problem though the children suffering with obesity is a big symptom.

BCPS 2012 Results: Blonde Pharmacist will repeat!

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BCPS Pharmacotherapy ExamSo the results are rolling in now, and if you are at all finding this post because you are frantic about finding your results, you will know today or early next week.  Mine arrived yesterday and though I am a bit disappointed, I am ready to start studying again as soon as Christmas is over.  In hindsight, since it is 20/20, I can say I am proud of how I did.  I graduated with a Doctor of Pharmacy in 1999.  Things have changed a lot since then, including my personal life.  I now manage two toddlers, a full-time job, and a part-time gig.  (Multi-task much?)  I have dreams of all kinds as far as online things are concerned, want to change the world, and decided to take this BCPS challenge on as a way to propel myself, not only in my current knowledge, but as a great resume builder.  There are many reasons pharmacists take this test. The passing score this year is 122.  The average was 130.  The range was 50-188.  Standard deviation 25.

Domain 1:  Maximum score 120, Average score 77

Domain 2:  Maximum score 50, Average score 33

Domain 3:  Maximum score 30, Average score 20

I missed it by very little.  I am not at all upset and depressed or any of that.  I went into it as a practice because being out of school for 13.5 years is very significant.  New drugs have arrived, new guidelines have changed the scope of practice, and residency trained pharmacists along with newer grads (>3 yrs) are the majority of the test takers.  This last point may be an incorrect assumption because I do remember a couple of ladies I met who "had something to prove to the younger pharmacists."  I truly hope both of them passed because those are the types that will be a lot more disappointed with a fail letter than me.  I have a pharmacist friend that was so upset with her fail that she refused to talk to anyone about it and threw away all the material.  I guess if I went into it thinking I would pass, I would feel that way.

Do I plan to retake?

YES.

That was my plan all along, ask anyone who knows me.  I know that many may have thought my comments of "It was tricky.  I know I didn't pass or if I did 'barely.'" was an attempt to pretend or whatever, but it was the truth.

It was tricky.

Know your guidelines.

Realize that A LOT of studying is required unless you have a very diverse clinical program at your large hospital.  For example, we don't see any trauma, very few TPNs, and other big topics on the test.

And if you have children, especially babies/toddlers... it is VERY tough.  Where is the time?

I should have taken this back when I had a more clinical position at a larger hospital, wasn't married, and certainly had no children absorbing every single free moment.  So if that's your current situation, PLEASE for the love of God take the test.  It will be tougher later.  I am PROOF!

So there.  There's my result (missed it by just a hair)... and had I taken it last year (passing was 111) I would have passed by several points.

Every year is different.

I plan to start studying very soon.  May start listening to the lectures in my family van (HA) starting now since I know.

Nothing hard should be attained easily.

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Just Take Care of Yourself

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Sitting in the waiting room of a pain clinic is more uncomfortable to me than seeing a cop's blue lights in my rear view mirror. Not only is it fairly evident that people in my area do not take care of themselves, I wonder why in the heck do I have to visit this place every six months or so? I have a very shoddy lower lumbar. The rest of my back is great, but for some reason God saw it fit for me to have some crappy genetics coupled with a severe love of running. I use the word severe because it is no secret that eventually most runners will have joint problems, and a severe love so great that it is worth the pain is nuts. There, I said it. I like to run. Even when it hurts. So I use radio frequency lesioning (RFL) to burn the nerves (they grow back) so I don't feel the pain in my lower back.

I watched a woman roll into the waiting room this morning still dressed in pajamas. She looked to be around 400 lbs, and I wonder, how have we allowed ourselves to get to the point where a donut or ten is worth being on a ton of medicine? How can we look in the mirror every day and know we are slowly poisoning ourselves? I'm preaching to the choir here because my diet is crap. Another patient limped in. He hadn't taken care of himself. I sort of stuck out like a sore thumb. This is a good thing.

These pain clinic docs would be out of a job if people took care of themselves!

A good friend of mine sent me this link: Why You Should Not Go to Medical School. Basically it really settled some things that my subconscious mind already knew. Although my dad wanted me to be a doctor, he had no idea what kind of life that would entail. It would mean telling someone to lose that weight so you could get off all the pain and hypertension meds. It would mean knowing that most wouldn't give a rats' ass and keep on stuffing their face with processed sugary foods contributing to diabetes and the like. I'm glad I didn't go to medical school. I'm not so sure I'm glad I chose pharmacy, but I seem to be pretty good at it.

The Perfect Medical Model

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I have been doing a lot of thinking lately in regards to my career.  I am still in waiting mode about the BCPS exam, but in the meantime have spent some time making lists of how pharmacists are utilized and even on a smaller level within pharmacy departments.  You see, it is tough being on this side of a career.  I guess you could say I'm in the middle in regards to time and experience.  I have been a pharmacist now for thirteen years. I have watched, usually with protest unfortunately, as pharmacists are labeled and grouped depending on different criteria.  Back in 1999, it was about having a residency in order to be a "clinical" pharmacist.  That is still the case today except in the smaller hospital where residency trained pharmacists aren't in supply.  Other criteria is used at that point.

In a perfect medical model, especially in the small hospital, I think it would be beneficial if the physician handled diagnoses, testing, and collaborated with the clinical pharmacist for treatment.  It is fairly obvious when you study the medical school curriculum that the focus is on diagnosis.  Yes, it is important to know what we are treating, but it does no good if you throwing ertapenem at pseudomonas or if you are dosing vancomycin at 1 gm every 12 hours in a young obese man for MRSA.

Hospitals really should consider encouraging all their pharmacists, especially PharmDs to learn the material that the BCPS requires.  It has seriously helped me in the past several months personally.  It is worth the investment of money and time and makes a FABULOUS resume' builder.

And in the end, it's about the patient receiving the best care possible.  Wouldn't a collaboration encourage that?

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BCPS 2012 | a small review of my thoughts of the test

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The BCPS is the abbreviation for Board Certified Pharmacotherapy Specialist.  Basically according to the BPS website:

Pharmacotherapy is that area of pharmacy practice that is responsible for ensuring the safe, appropriate, and economical use of drugs in patient care. The pharmacotherapy specialist has responsibility for direct patient care, often functions as a member of a multidisciplinary team and is frequently the primary source of drug information for other healthcare professionals. Those who are granted certification in this specialty may use the designation Board Certified Pharmacotherapy Specialist and the initials BCPS, as long as certification is valid.

So, this is what I have been doing with every (or most) every free moment since April.  It is over now, and this is the first day I have had to sit and reflect.  I did not have the opportunity to finish the review of the test itself, and I was seated last (my own choice) for the second part so did not receive the handwritten review of the test.  I really spent all my time on the test itself, and my feedback wasn't given.

I wish it had been in hindsight.

I signed this paragraph at the beginning of the test but I don't remember what it said.  Something about not trying to memorize the test itself or copying the questions in any way.  So with that in mind, my review will not be specific but broad.

I am a hospital pharmacist who graduated in 1999 from the University of TN School of Pharmacy.  At the time we were rated number 7 in the United States, and I have never had any issues with being clinical minded in the jobs that required that role in the past 13 years.  Times have changed.  Schools have multiplied, and the residency which was a "side thought" in 1999 is a must today.  BCPS certification is also important if one did not do a residency or the cherry on the top if you did.

So, I decided at the ripe old age of 39 to study like a fiend and pay all sort of money to this organization to have study materials including written, web, and audio.  I spent most days listening to the likes of pharmacy lecturers discuss things from stats to ID to cardiology to oncology to nephrology.  It kind of made me realize I haven't really been using my brain at work, and to all the patients out there I have treated, I am sorry I haven't been a more thorough and clinically-minded pharmacist.

You see, an order entry pharmacist enters orders and most of the time relies on the computer system itself to flag for interactions and other things, but you know what?  Just yesterday I found something pretty profound.  The computer fails.  I found a place in our current process where I made a difference.  Just one of the many that are to come.

The test:  200 questions.  2 sections of 100 questions each.  I found the first part harder; but many I heard said the reverse.  I have always been the one marching at the beat of a different drummer.  Topics:  tons of stats, pharmacy regulations was everywhere.  I wasn't prepared for regs.  Psoriasis.  Acne.  Both of those disappointing as I haven't had an acute admission to the hospital yet for either.  And I have not found acne guidelines with the American  Dermatological Society yet.  I know I missed the psoriasis question.  Tons of COPD, albuterol, and not so much STEMI.  Angina more stressed.  Maybe due to the new Chest Guidelines that came out.  One chemo question I remember.  Tons of stats.  Did I already say that?

There were a couple kinetics questions.  Guess what?  I bought a $5 cheapie calculator from Walgreens that died.  YEP.  I had THAT luck.

Temperature was given in C rather than F.  I was bummed about that.  Guess it's time to join the rest of the world on that one!

There was one INR question I remember.  Pretty specific.  I got it right ;).

And the usual question that appears every year was there.  I don't think I can say what it is on here, but if you talk to anyone that has taken the test, they can tell you what it is ;).

Psychiatry a couple of times.  All side effects of drugs.  CYP3A4.  All CYP really.  Pharmacoeconomics more than I would have liked.

Guideline driven.  Mostly accp.com material so would recommend studying that.  Keep in mind if there's something not in that material though, you may want to find a review book to read on the side.

If I failed, which is possible (last year passed 70% of test takers with cut-off being 111/200 or so) I will retake it again next October.  I really liked the challenge, liked the things I have learned, and like the possibility of continuing my education in this field to grow in my career.

What did I study?

1.  ACCP materials.  I purchased the slides, handouts, and audio to listen in the car on my iPhone.

2.  http://quizlet.com/  There were tons of BCPS flashcards made by some pretty smart pharmacists.  Just search BCPS on Quizlet.

3.  High Yield Med Reviews  We will see how this goes.  It's a subscription service with test questions.  I think it helped me.  I will probably resubscribe around July if I failed for next year.

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The BCPS and Tackling the Beast

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I decided to take the BCPS this October. First of all, I have to admit the first time I even heard of this test, I thought it was a joke. I just figured it was something that wouldn't be recognizable as anything important. Fast forward thirteen years, and I believe this certification should be something most pharmacists should want to attempt. It is pricey though. I have a little over two months and have a ton of information to go through while trying to become a biostats expert. Wish me luck. I figured I could post some posts about recent guidelines in the next few months... Sort of a way to blog and study simultaneously. Genius?

Physical Punishment and Mental Disorders

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I do not care for statistics.  It's not in my DNA to ENJOY them but this is the perfect example why all pharmacists (and the lay public, for that matter) should understand and interpret study results.  Just the other night, I was watching the news and the anchor states, "Parents should think twice about spanking their children."  Most people would look at the anchor, hear the words, and then turn right around and pass it on as though it was spoken by God Himself. A study was cited:

BACKGROUND: The use of physical punishment is controversial. Few studies have examined the relationship between physical punishment and a wide range of mental disorders in a nationally representative sample. The current research investigated the possible link between harsh physical punishment (ie, pushing, grabbing, shoving, slapping, hitting) in the absence of more severe child maltreatment (ie, physical abuse, sexual abuse, emotional abuse, physical neglect, emotional neglect, exposure to intimate partner violence) and Axis I and II mental disorders.

METHODS: Data were from the National Epidemiologic Survey on Alcohol and Related Conditions collected between 2004 and 2005 (N = 34 653). The survey was conducted with a representative US adult population sample (aged ≥20 years). Statistical methods included logistic regression models and population-attributable fractions.

This is a retrospective study which automatically introduces bias.  Correlation does not imply causation.  That's the biggest issue I see with this study.  For example, the media will pick up a press release about this type of study and report that spankings make children grow into adults with mental disorders, but correlation does not imply causation.  For example, children who were spanked may end up with a mental disorder, but there is no proof that it was the spanking itself that caused the mental illness but perhaps several other factors or combinations of factors.  Even schizophrenia and depression have had genetic components.  What happened to pure genetics?

The next big issue with this study is they looked at many types of mental illnesses since it is not very efficient to run a large study, gather data, and analyze it to look at only one type of mental illness.  Scientific studies, however, rely on statistical analysis to determine whether something is true.  Even if your estimated error is less than one percent, in a study examining thousands of items some will appear to have an effect even though they are just statistical aberrations.  These false positives are then reported, and when a new study fails to confirm them as true, the press reports a scientific “change of mind”.

Finally, when a cohort study is retrospective, the problem is compounded since retrospective studies often rely on memory.  If you developed a mental illness, you may have a different memory recall of punishment and its effect and your perception vs if you did not have a mental disorder.

Be careful with retrospective studies!   As in this case, there are many flaws and biased automatically introduced.

I definitely understand the rationale for wanting to run this study as many parents are probably over the top with physical punishment; however, I don't believe those parents that reserve a spanking for a type of punishment as abusive or that their child will end up with a mental illness due to that one decision.  Too bad the media doesn't know how to interpret studies!

Another critique:

While the new study rules out the most severe cases of physically lashing out at children, "it does nothing to move beyond correlations to figure out what is actually causing the mental health problems," says psychologist Robert Larzelere of Oklahoma State University,. He criticized the study's reliance on memories of events from years earlier, and says it's not clear when punishment occurred.

Afifi acknowledges that it's difficult to change people's mind on this topic, but says "we're confident of the reliability of our data, and the data strongly indicate that physical punishment should not be used on children — at any age. And it's important for parents to be aware of that."

Too Stupid to Be Free?

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Do politicians really feel that passing laws to change the SIZES of soft drinks will actually combat the obesity problem faced in the US? British researchers have been arguing that overpopulation discussions shouldn't be limited to head counts but should also factor in the weight of people. America is GUILTY of being a part of the heaviest nations in the country. New York City and now Cambridge, MA is starting the political process of passing laws that demonstrate that we as consumers know less about what's good for us. North America has 6% of the world's population, but guess what? We have 34% of world biomass due to obesity. Obesity equals money and a drain on the entire health system. I believe that corporations could start changing things at work. Since we are a country at work, including a lot of women, we could start changing the menus at cafeterias. We could start changing the menus at fast food restaurants. The problem I have with the idea of government mandating this is the argument that is essential to more or less government. Does government know better than me when it comes to decisions about my health? Does government believe that it can decide for me? This is a loss of freedom, but at the rate things are going, it's obvious that the freedoms Americans have been allowed to enjoy (eating a large fry at McDonald's and a supersize coke, for example) might be taken away in the future.

For example, where I work, there is a salad bar, but the main food is pretty unhealthy. The portion sizes given could easily feed 2-3 people. This is in a hospital. Just upstairs from this cafeteria, cardiac bypasses are being performed to try to correct the very result of the damage caused by genetics and more often our diets. Irony at best. I'm guilty. Believe me, I struggle with my own weight being about 5'7" and around 150 lbs today is a little too much weight for my frame. I know that my IBW is 133 lbs. This means that I am 17 lbs overweight. Seriously. I believe it, too. Yes, I look thin to some, I suppose, but that is because of what I'm compared to. If the majority of Americans are overweight and obese, well there you go.

So basically, if the entire world was as heavy as we are, that would be equivalent to an extra 1,000,000,000 people.

Put less in your mouth. Move. PLEASE. Please before government mandates it. Though, at this point while sitting in Panera and blogging and seeing the people around me -- maybe it's time we lose a little freedom for the common good of people.

Maybe we are too stupid to be free.

I guess

5 Reasons Why You Should Take Up Running

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Image I finished my last half marathon on Saturday at 2:13.  I am still on the quest to break the two hour mark.  I know that if I actually trained for a race, I would probably be a lot faster.  I still show up at the starting line in the early hours of the morning with all the other runners and beat my body into submission.

Why do I run?

I remember one of the first exercises running years and years ago.  Let us flash back to about 1988.  I was in ninth grade and on the basketball team.  We didn't win a single game that season, but I do remember running.  Lots and lots of running and the reason why was because we NEVER won a game.  I loved running.  Back then I was the fastest on the team.  I was small.  Fast.  Couldn't shoot a basket to save my life but I could almost fly.

I remember running with my dad and sprinting.  Freedom.

I did a little jaunt in college with the cross country team.  I was the slowest.

What ended up happening is that running became something more than I ever thought, and when it was almost taken from my life due to chronic back pain (degenerative disc disease and facet arthropathy with spondylosis).  During the time of the most pain, I could not run.  During that time, I was quite depressed about it.

So you can imagine, the joy I feel when I run today.  Radio frequency lesioning (RFL) found me, and I'm back to running again.  It's different though.  Now when I run, there is an elation that I did not experience before.  There was a moment Saturday when I was running through a shaded area.  The trees were shading the road very heavily and there were tiny flowers floating through the air landing in front of me.  Very ethereal.  I'm just saying the appreciating is way above what it could ever have been otherwise.

1.  I run because I can.

2.  I run because I want my heart and lungs to be stronger.

3.  I run because I desperately need ME time.  I can't pull out my iPhone and fill every void moment with texting or tweeting.  It's a time that I completely check out.

4.  I run because I do some of my best thinking while running.  Have a problem at work?  I tend to work through them mentally.

5.  I run because the runner's high exists, and it is truly better than any drug.

I have had runs that absolutely sucked.  Just keep trying.  Just put one foot in front of the other.

It will change your life!

Pharmacy and Your Niche

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What led you to choose pharmacy as a career? For me, it was a mention of "oh by the way, I am not only a chemistry advisor, I am a pre-pharmacy advisor" by a brilliant analytic chemistry professor, Dr. Anthony Harmon. I was just 21 years old, and I did not know what I wanted to be when I grew up. He pointed me toward pharmacy. I envied the quiet genius a lot of the serious chemistry majors seemed to possess. I was a more outgoing having fun type. Dr. Harmon told me a career in a chemistry lab may not mesh well with my personality. Well, let's be real... I wasn't an A student in his quantitative analysis class either. Pharmacy was suddenly on my radar.

I took the PCAT. Who knows what I made. My undergrad GPA was 3.2. Being female used to be a minority, but not in pharmacy in 1993. In fact at the time, being male was the minority. I was finishing my third year of undergrad and decided I'd apply to a handful of universities.

I had a couple of acceptances but really wanted the University of Tennessee at Memphis. I was told on the phone I was 99.9% in, so go ahead and respond decline to the private universities who accepted you. I turned down the schools and then received a rejection letter from UT. Guess i was that 0.1% eluded by the assistant dean. Talk about a downer. A lot of students do go the political route and a lot of acceptances are based on who you know, but I didn't until the rejection.

I reached out to some "who you know" types with my story and got accepted for the next year. So... I spent my fourth year in undergrad finishing a degree and biding my time. At least I did not have to reapply.

So there you have it. I remember thinking the pharmacist who worked in my small hometown had a large house. I didn't realize it wasn't pharmacy more than the sheer fact he had his own business. This is key.

Thirteen years later I realize you can make a good living in pharmacy or a great one in finding your niche within.

Have you found your niche?