Monthly Archives: August 2014

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The Payback of a Little Charity

A couple weekends ago I hopped on my bike and pedaled close to 100 km in my 4th MS Bike Tour.

The distance is one thing, and the need for a good pair of padded undergarments always provides ample fodder for tour volunteers and non-riding supporters. This year turned out to be one of the best yet, though very different than my previous three. This difference was for reasons that didn’t occur to me until afterwards.

We rode from the Windsor Exhibition Grounds to Acadia University under a comfortable, cloudy sky. After the first day, my new team settled into the residences at Acadia for an afternoon of swimming before the annual banquet. After dinner, we ended up back in our rooms to have a wobbly pop or two. During the evening, the dozen of us took turns explaining our reasons for being there. All were insightful and inspiring, and topics always involved family members or close friends with multiple sclerosis. Some were diagnosed at a young age and deterioration ran the gamut from slow (decades) to rapid (<2 years). You may get the impression that I can sometimes be rather long-winded, and you would probably be right. I’ll share the condensed version here for the sake of brevity:

Thirteen years ago, a mentor and friend began an MS Bike Tour team in support of a longtime colleague’s wife. I was aware of the team, but saw it as a cause with which I didn’t connect. I knew little about the disease, the progression, or the treatment options. Year after year, along with her wife, she would invest time in planning fundraising events, theme designs for the team picture, and seeking corporate donations. Each year she would ask me and I’d hedge. Perhaps I had plans the weekend of the event, or I didn’t have a decent bike, or even worse I was in terrible shape and wouldn’t survive it. It all changed when I found out my aunt was afflicted with a mild form of the disease. As kids, sometimes playdates with the cousins were cancelled for unknown reasons. Come to find out that her fatigue would persist for days or weeks, and she would be unsteady on her feet. At this point, my excuses rang a bit hollow and I made up my mind to commit to the cause.

2011 – The Cycledelics were celebrating their 10-year anniversary on the tour. Our black t-shirts were printed up as tuxedos with red-bow-ties. We sported top hats on our helmets and twirled canes into the banquet hall. I was 30-lbs overweight and my cargo shorts didn’t have a lot of padding. On the way back, I couldn’t stand to sit back on the seat and couldn’t walk for the better part of a week, but I made it.

2012 – We had a cowboy theme this year: plastic ten-gallon hats on our helmets and rodeo shirts. We rode into the banquet on hobby-horses. I bought a better bike, some padded shorts, and lost 20 lbs. Raised more money than the previous year and I wasn’t the last rider on the course this time.

2013 – ‘The Swarm’: dressed as bees, with bright-yellow t-shirts and electrical-tape pinned in place for stripes. We all wore headbands with antennae and big-round shades. This time the banquet attendees had us buzzing around their tables. All in good fun. I felt I was in the best shape of my life to date. I had trained for the 3-months before and my riding partner and I flew through the course. Even managed to do the extra 38 km loop on day 1 for good measure.

This brings us to 2014, and I had since taken on the pharmacy manager role at Sobeys. I was connected to a store manager in town who had also ridden on the tour and wanted to start up a corporate team. We brought 5 stores into the fold and pooled our riders fundraising efforts with a goal of $10,000. We had store BBQs, a poolnight, and two paintball afternoons. We had casual days for staff, we sold MS oatmeal cookies from the bakery, and sold 50/50 tickets. We went on to raise almost $14,000 for the fight against MS. Not too bad for year #1.

2014 MS Team

I was apprehensive leading up to the ride. I had hoped to see members of my former team but wasn’t aware of where they were staying or who would be attending. This new team was a hodge-podge of riders from different stores, and none I knew well. My fears were allayed once we arrived at Acadia. My former team members were two floors down in the same residence and we hung out exactly the way we did in previous years. I even ran into a friend I had not seen in well over a decade cutting fruit in the cafeteria (Nice to see you HB). Our team was the newest of the three corporate teams on tour and managed to take home some hardware for our efforts:

 

Corporate Hero Award 2014-MS  Team Cheer Award - 2014-MS

Our cheer was to the theme of Gilligan’s Island. Not everyone in attendance got the reference.

 

So why was this the best one yet? I didn’t train as much, and had a pair of dead legs 3/4 of the way through, so that wasn’t it. I doubled my previous personal best in fundraising, but that wasn’t it either.

This was the first tour that I felt like a leader. New riders would come to me for their preparation and itinerary. MS Society staff called me by my first name. Most importantly, I had a new appreciation for the passion and dedication shown by the staff, volunteers along the route, and the 330 riders who participated. People were giving of their time and energy to help others not because they were forced to, but because they wanted to. It’s contagious;  we spent the whole night planning fundraisers for next year’s event. I know I’ll be recruiting some of you to join me on the 2015 ride.

When it’s all said and done, we really did pull together to make a difference in the lives of those suffering from MS. Drum-roll, please…

MS Tour Total 2014

Makes it all worthwhile, doesn’t it?

 

 

Disclaimer: The views and opinions expressed in this article are those of the author(s) and do not necessarily reflect the official policy or position of any agency, employer or affiliation.

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Quick…To the Lab!!

I can’t help it. Every time I see the word, ‘lab’, it evokes images of smoke, arcing Tesla coils, boiling green flasks, and crazy Christopher Lloyd hairstyles.

When a pharmacist in A community setting refers to lab values, they’re usually asking a patient directly to ascertain whether all the bases have been covered. More often than not, the patient does not know what they’ve been tested for, let alone the actual LAB values. Fortunately, With our newly expanded scope of practice, coupled with the incoming drug information system, these awkward conversations with patients will soon come to an end.

As clinicians taking on broader responsibilities, performing lab requisitions is one more unknown that we need to navigate. There are numerous applications that scream for pharmacist intervention. A1C and INR are at or near the top of the list, but I suspect that many other practical uses are waiting to be discovered.

In speaking with a close RN friend of mine, she thought pharmacists having access to lab values was a wonderful idea, but brought up a number of pitfalls that we’ll need to consider when we officially begin:

– Shall we be authorized to request all tests, or be restricted in some fashion through a permit system?

– The cost of a test.

– The appropriate monitoring frequency for a given test.

– Are tests to be used to aid diagnosis or strictly to monitor existing therapies?

– Who owns the test results and the right to intervene if necessary?

– What is the lab capacity in a given jurisdiction?

 

There is a fear that once able, pharmacists in community settings will want to create baselines for all patients. Some of these will be absolutely reasonable and will fill gaps in patient care. Others may be open to interpretation and potentially create conflict with other care providers. I offer a couple of examples from my time in long-term care. At the time, the Nurse Practitioner and I routinely spent a couple of hours reviewing 50 patient charts at a time ahead of meeting with the nursing staff and medical director of the 200-resident facility where we worked.

1) B12 – We performed a focused medication review on patients receiving vitamin-B12 injections, noting that many did not have blood counts requested since their admission years prior. Out of a dozen patients, we were able to discontinue six of them that showed upwards to three times therapeutic levels. Although the long-term toxicity was not much of a concern, it was one more injection to track (and thereby eliminate for the time being) and in two of the cases, blood counts had not rebounded due to a relative iron-deficiency that had gone unchecked.

2) T4/TSH – As per accreditation standards at the time, we aimed to have a complete medication review performed with 6 weeks of admission. Often patients discharged from hospital were relatively stable on their current regimens, and needed time to get acclimated to their new surroundings. Usually at this time, we determined monitoring parameters for bloodwork and obtained baselines if the file was incomplete. During one session, we decided to review all patients taking thyroid hormone and discovered that some residents had not been screened in years. Many were frail and drawing blood was difficult, but we didn’t see that as a reason to stop monitoring. Almost all required a dosage adjustment and corrected some previously unexplained symptoms due to hyper or hypothyroidism.

It was not always easy. One of the stumbling blocks was the impact to workflow on Thursdays. Blood was normally collected in the mornings and shipped to the lab in the early afternoon. This of course added some extra work that wasn’t always easy to plan. Another was the attending physician’s apprehension in having us discover an issue that was missed or ignored due to a plausible reason. He would then need to possibly defend his/her action/inaction to us, nursing staff, and perhaps even the resident or their families.

I guess it will be another learning experience for all of us, but I look forward to the day when we can ask and receive a clearer picture of an individual’s health from a lab test. I’ll even bring my own Tesla coils.

 

Disclaimer: The views and opinions expressed in this article are those of the author(s) and do not necessarily reflect the official policy or position of any agency, employer or affiliation.