clinical blues

Dearest blog,

i havent visited a while because i've been so busy...i've had two exciting trips..one to sibu and another to kl which are fantastic which i meant to tell you all about but i've just been so so so busy and stressed out.

Today is the start of my second week in the block of clinical ward pharmacy attachment in HBM. Last week was really hectic and i am starting to feel the pressure because i could not achieve all of my targets. But somehow, deep down in me...i can see a truly excited budding clinical pharmacist in my future career. I love ward rounds, doing history taking, chatting to patients and counselling them on medications, finding mistakes that MO's made and correcting them *wink*(no offense pls everyone makes mistakes right?) and the best part of being a clinical pharmacist is being able to truly do an intervention that could possibly change a person's life.

tomorrow, i will try my best to help one old lady, a 66 year old currently on a high dose of insulin therapy. her total dose of insulatard and actrapid is 114 units per day and she weighs about 60kg...thats is a pretty big dose for a pretty small lady...the part that made me so enthusiatic to help her is the fact that she looked at me and winced when i told her that her morning dose of insulin, which is 30 units of actrapid and 38 units of insulatard dose not fit into one syringe, (max only 50 units a needle) means she need to poke herself twice AM and once PM

it makes me wanna cry when she winced, looked at me and said "sakit" and pouted. so i did what i could...i looked up CPG from AMM and hopefully i will be able to convince my MO to do something about her dosing. First point, she is on metformin 500mg bd.....why cant increase to 1g bd?she's not in renal failure or CCF, nor does she have any conditions that cause lactic acid accumulation. is there an indication to increase her insulin dose to so high when her oral agents are not maximised?second point, a 66 year old lady, has to mix up insulatard and actrapid and self inject with a very fine needle that due to her poor vision, couldnt see properly the units. isnt this an indication for perhaps a pre-mixed insulin such as humulin 30/70 and wouldnt it be better for her to use a humapen instead of drawing and mixing things in a fine needle syringe?

hopefully i have strong points...i need expert opinion on this....and God, pls let me be able to help this patient tomorrow.

my dearest blog...i shall write to you again when i can. thank you for listening to me.