the past few days

No matter what I write about, Hannah will make fun of me.  I think that’s how she shows her love.

So I went up to Lafayette yesterday for Troy’s birthday, and I always seem to forget how much of a ghosttown that place becomes in the off-season.  But it was a great time, and I wouldn’t have missed it.  Robbie finished Hard to be Humble and he really liked it, which is still cool to hear.  My art lives on!

Quote of the week goes to Ann from work.

Me: So are you and your fiancé cohabitating?
Ann: Do you mean are we living in sin?  Yes.

Got my first paycheck today from doing what Curtis calls “dealin’ and healin’,” which is, by the way, the coolest way of describing my work.

Thanks for the blog response Lisa (or should I say Sharpay?  YAY!  I am coming to watch you!).  I concede the argument to you and your thorough rebuttal.  Mike is equally to blame.

Headed to Vegas Saturday morning for a week with the old roommates.  So that probably means you won’t see an update from me until the 24th at the earliest.  Sorry this post was so fragmented.  I’m off to catch up on some sleep.

the classic crime

Well, I guess every day can’t be a good day.  For whatever reason (and I could probably tell you if you want to know), I’ve started to avoid resolving problems the day they happen.  And today, one of my skeletons caught up with me.  I didn’t deal with the problem when I should have because I was worried about finals and just didn’t want to think about it.  Not only that, the whole issue was completely my fault, and it seems it’s happened so many times before that I’m either becoming so mad at myself that I’m still messing up or so bored of dealing with the whole situation.  But I guess I still have to deal with it, whether it’s the last time this happens or not…

And I found out that I didn’t get as big of a raise as I thought I was.  But I guess a raise is still a raise…

And I have to revise my statement about Courtney being my favorite character on Dorm Life.  She is the best at acting on the show, which is really what I meant all along.  I’m saying this because she did a very bad thing last night.  I was talking to Lisa S. about all the drama that unfolded last night (drama on Dorm Life is the only drama in my life, thankfully — I much prefer drama to be make-believe), and after we finished talking I realized what may be a difference between men and women, and it may reveal a double standard that I didn’t know I had.  You see, I completely blamed Courtney for the illicit hook-up which is endangering the Perfect Plan to bring Mike and Britney together, but Lisa blames Coutney and Mike equally!  Now the difference here is noteworthy, because I didn’t even think to blame Mike at all.  Is that sexist of me?  Comment and let me know what you think.

I didn’t plan on this blog becoming a media review, but I do want to mention an album I have been listening to a lot lately.  I wish I had discovered it in December, because it probably would have helped me out a lot.  It’s called “Seattle Sessions” by The Classic Crime.  You can listen to a few of their songs here (Seattle and The Test are the only two on that site from this album though).  According to the review on iTunes it is “themed around touring’s heavy toll.”  If your initial reaction is like mine, you’re probably thinking, “OK, I’ve heard of people hating their jobs, but I think we’ve reached a new level when we have musicians, especially touring musicians (meaning people want to pay to hear them), who are envied by most and thought to have one of those one-in-a-millions jobs like playing in the NFL, who, according to this authoritative review, theme their second album around how demanding touring is.”  But then I thought about the toll touring so often took on me, and I can really relate to this album, hearing them sing “We are so far from home,” and “the rigs look so empty when framed by their lights, and that’s how I’m feeling.”  But I guess I’m just glad that I don’t have to feel that way anymore…

And for some reason, I keep getting asked about the course of therapy for tuberculosis wherever I go.  So since I never really learned it in the first place, I’m going to type it here so that it might stick.  The most common regimen for an active infection involves an intensive phase of isoniazid, rifampin, pyrazinamide, and ethambutol for 2 months, followed by a continuation phase of isoniazid and rifampin for 4 months.  For latent Tb, 9 months of isoniazid at 5 mg/kg/day is recommended.

the doctor isn’t in yet

So the last time I tried to update, this site was undergoing maintenance, so I wasn’t able to post.  In the words of Gopher, “Sorry, America.”  I am anxiously awaiting the new Dorm Life episode that will be posted at midnight tonight!  Prediction: Mystery Hot Girl will be involved!!!  Danny B is awesome, but my new and permanent favorite character is Courtney, played by Nora Kirkpatrick.  If you need further evidence as to why she is the best on this show, please watch this video.  She reminds me of my old neighbor Bonnie Herald Glass for some reason…

Anyway, my body keeps reminding me how old it’s getting.  For example, I just ate a bunch of junk food, and my stomach is not happy with me.  I think it’s giving me the cold shoulder.  I’ll eat some vegetables in a bit to get back on its good side.  I was talking to Troy the other night about how old I am getting.  I’ll be 23 in a few months.  I remember Mark E. complaining to me about how old he felt when he turned 23 and I was 20, and at the time I told him that that was not old, and told myself that I would never complain about getting old when I really wasn’t.  But I can’t help myself now.  But I’m really excited for this week because Troy is coming to Indy to celebrate his 25th and it should be a great time!  He’s telling everyone that it’s his 21st so people will pay more attention to him…  He’ll never tell you about the 4 years he took off school to volunteer for the Peace Corps (and that they waived the baccalaureate requirement for him).  Anyway, I miss that kid so much, so it will be good to see him and the rest of his buds.  I’m thinking about going up to Lafayette the weekend after Memorial Day to go to Northview and maybe hang out.  We’ll see…

So yesterday was the first time a real patient called me “doctor.”  It was probably the coolest thing ever.  In school we mock-call ourselves doctors when we’re doing counseling simulations, but yesterday was the real thing.  He said, “Thank you, doctor,” after I’d helped him out.  I corrected him and told him that I still have two years of school left, but the truth is that at work people come to me seeking my advice all the time, and they take it.  It makes me wish I had a really cool last name like Pepper or Dre…

the new director

Yes, I know that Bill Griffel, my old high school choir director, is the new director of PMO, and no, I have no comment.  Can we please never talk about PMO again?  I am trying to move on.

the law

So the big debate at work this morning was over this section of the Indiana Code (IC 25-26-13-25(c)):

Except as provided in subsection (d), a prescription for any drug, the label of which bears either the legend, “Caution: Federal law prohibits dispensing without prescription” or “Rx Only”, may not be refilled without written, electronically transmitted, or oral authorization of a licensed practitioner.

According to my law prof, this means that pharmacists can authorize refills on OTC meds without authorization from the original prescriber.  And the man would know, because he literally WROTE a lot of Indiana’s law as it pertains to pharmacy.

The reason why this is an issue at all is because AB called me on Monday asking for a refill on her daughter’s MiraLax, a newly over-the-counter laxative.  I informed her that her physician had called us and specifically voided the 5 refills on this medication.  She did not believe that her doctor would ever do such a thing, and didn’t appreciate being told what she could and could not pick up.  She ended up so furious that she called the pharmacy supervisor Tomi (I didn’t even have to give her his number because she already had it — it sounds like she’s a routine critic).  Tomi later called me to talk about this, and I suggested we invoke the law cited above.  He said that was a great idea, but the pharmacists on duty weren’t about to authorize a refill without a doctor’s authority, even though the law specifically says they can!  So we had to call the doctor’s office Tuesday morning for authorization.

I brought in a copy of this law this morning, and the two pharmacists had a less than enthusiastic idea about this authority the law has granted them.  One said that she only knew of “older” pharmacists who did this, but only because they had little care for the law (sic) and would have done it just to get the customer out of the store.  The other called this one of the “gray areas” of pharmacy.

I was kind of surprised by these responses.  I would have thought that pharmacists on the whole would be more receptive to more autonomy than they’re used to.  Instead, it’s sort of frustrating to me to see pharmacists shuffling back into their familiar corner of just rubber stamping whatever physicians tell them.  We have the education enough to decide whether a patient needs a laxative or not, and we should be able to bill it through Medicaid without fear of the dreaded audit.

I fear that the only noisemakers in the advancement of prescriptive rights for pharmacists are the vibrant young pharmacists and those in the university setting.  Even our biggest professional organization, the American Pharmacist’s Association (APhA), is not in favor of HR 5780, a bill proposed in the House which would allow for the billing of Medicare Part B by clinical pharmacists for practitioner services.  But I have hope that I’ll see significant and exciting advances in this area during my career, and it starts with pharmacists taking charge of the law which is already written for them!

the election

So yesterday was election day here in Indiana.  I looked at the Republican ballot and it was really boring.  There were no closely contested races, so thanks to our open primary, I decided to vote Democrat as an operative in Operation Chaos.  When the inspector at the election site asked me which ballot I would like to take, I said, “Democrat,” and it felt really really weird saying that.  So I voted for Hil-dog, a couple people in the nonpartisan school board election, and a couple others.  I spent the night watching the results come in, and even though ol’ Hil-dog took Indiana, it’s looking like I might be wrong in the prediction I made a year ago that Hillary would be our next president.

In all honesty though, I was looking forward to her nationalized children’s healthcare.  I don’t know if I’m completely in favor of that, but I sure thought it would be interesting to see implemented on a national level for the first time in our country.

Then this morning, grades came out!  Only slightly lower than expected, I still amazed myself and my family with a top-of-the-class effort:  6 A’s, a B, and an S equaling a semester index of 3.88!  I don’t care if you think I’m boasting, I think I deserve a little credit after doing nothing but studying for 4 months straight.  Not to mention this was the hardest semester of my life — it’s all downhill from here!  The question on everyone’s mind tonight then is, “If you had quit gc earlier, would it have been a 4.0?”  Well, dear friends, in the words of Shane, “Probly.”

the pharmacology

So I’m done with pharmacology courses forever, which is a good thing – not because I don’t like them, but because they’re hard!  It was, however, in my medicinal chemistry courses where I learned the term ‘ternary complex.’  I’ve decided to name my blog after this because the concept has taken on a lot of meaning for me, in all aspects of my life.  So I’ll try to define it for you in terms that non-chemists can understand.  Strictly defined, a ternary complex is any tripartite combination.  Defined chemically, it means the combination of an enzyme, cofactor and substrate or an enzyme and two cofactors (in a multisubstrate enzyme).  Let me give you an example:

One classic example of a ternary complex in medicinal chemistry is the interaction of the chemotherapeutic agent topotecan (Hycamtin®) with the enzyme topoisomerase IB.  When a cell is dividing (which occurs very rapidly in cancerous tumors), the DNA has to be copied.  In order for this to occur, the DNA must be unwound from its supercoiled state to allow access for the replication machinery.  Have I lost you yet?  The TopoIB enzyme (green in the picture below) is responsible for the removal of the loops in DNA which arise when the DNA is uncoiled (think of trying to uncoil an old telephone cord — you get a lot of loops).  The TopoIB protein binds to the DNA molecule, clamps around it and cuts one of the two DNA strands, allowing the DNA to untwist.  Then it joins the untwisted broken ends together, allowing the replication machinery (gray in the picture) to proceed.

That’s what occurs normally.  However, in chemotherapy, we try to disrupt normal cell division in the hopes of killing rapidly dividing cells (such as tumor cells).  When the cancer drug topotecan (shown in red) is administered, it slides into the DNA, binds to it, and forms a ternary drug-enzyme-DNA complex.  This stabilizes the DNA in its broken form, effectively blocking further DNA religation.  This results in accumulation of DNA loops and the prevention of the DNA replication machinery (shown in gray) from continuing, disturbing cell division and causing the cancer cell to malfunction and ultimately die.  Topotecan is frequently used to treat a number of tumors, including those in some ovarian cancers and small cell/non-small cell lung cancers.  Also important here is that the binding affinity of the drug to the enzyme-DNA complex is much higher than to the enzyme or DNA separately.

So why does this chemistry concept have so much significance to me?  Well, I see myself as the green enzyme just floating around exerting my influence on the DNA, the world around me.  Without the red topotecan, I behave one way.  With the topotecan, I behave much differently.  If you’ve read Hard to Be Humble, you’re familiar with my motif of “the intrusion of others,” or what I now prefer to call “the presence of a third.”  My interaction with another person changes considerably when I know I’m being watched or if there’s someone else in the room.  I love this model of the ternary complex because it helps me to remember that the name of Jesus should always be on my lips.  His presence in my heart changes my interaction with everyone around me.  Without Him as my ‘topotecan,’ the cancer in my life spreads rapidly.  With Him there, I can keep it in check, and have a positive influence on others.  And although the drug can bind the enzyme while not attached to the DNA, it binds much tighter if all three are present.  When I am alone, God is working in my life, but He wants me to be interacting with others.  He wants me to be connected to other people.

It all makes sense to me at least.  I hope you could take something from it too!  Enjoy the rest of my blog!  This could be fun…

Photo caption:  A Topoisomerase IB protein (green) is hindered in unwinding DNA loops by the cancer inhibitor topotecan (red).  The DNA polymerase protein (gray), a protein which duplicates DNA, is hindered by the DNA loops.  (Credit: TU Delft/Tremani)

Reference: Koster DA, Palle K, Bot ES, Bjornsti MA, Dekker NH. Antitumour drugs impede DNA uncoiling by topoisomerase I. Nature 2007;448:213-7.