Creating a Monster: Part 4/4

Today we end Dale's zombie fest. Hasn't it been interesting? Remember, leave a comment for your chance to win two zombie fiction books. Drawing will be midnight tonight!! Must live in the USA to be eligible.

Now-- try not to bite your nails as you read an excerpt from Dale's novel....

What is in a zombie virus? This is not something from a supernatural realm. We are talking about a living organism that changes what we know about human anatomy. In the series, “The Walking Dead”, the zombie virus killed the host, and then reactivated a portion of the brain. While I use that template, I take it one step further.

 Here is an excerpt from the first draft of Smell of the Dead:

           Topher tried to wipe the blood off then Davis stood up fast. Too fast for someone who was in perfect health, way too fast for someone who is sick. He staggered a little as the coughing started to go down. He stood clutching his stomach. He removed his goggles then Topher saw his eyes. Davis had brown eyes before, but now the iris was black with the pupil pearl white. The sclera was reddish white, as if he had been doing some kid of super drug.

            He looked bewildered. He twitched his head about taking in his surroundings. Reddish black blood trickled from his mouth. The smell was atrocious. Topher… confused slowly backed up. Davis sniffed at the air, and then sharply turned his head towards Topher. He looked at his old friend like he was the last meal on the planet. Davis’s lips twitched like an animal ready to devour.



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            Topher tried to jog from Davis but couldn’t get much speed up. Davis breathed hard as he charged towards Topher. Davis grabbed Topher and shoved him down on the ground, biting at his neck. Davis could only clamp his mouth on cloth from the coat.

            Throwing the best jabs he could, Topher fought against his friend. With no air in his lungs to cry out, he kept trying to get his friend off of him.

            Finally he got a hold of the knife he used earlier. He rammed the knife into Davis’s kidney, but he didn’t budge. Stabbing him over and over, Topher was still on the bottom of a violent attack.

            Topher got his arm around to in front of him and thrusted the blade into Davis’s eye socket.

            Davis let out a groan losing his bearings Topher pushed him off then grabbed a small shovel from his pack. He slammed it into Davis’ face, knocking him down. As he tried to get back up, Topher continued to hit him with the shovel.

            Then Topher started coughing this time. It was enough that it made him double over wrenching in pain. A tiny bit of blood spat up with some of the fibers that he had seen in the blood from Davis.

            His mind went fuzzy then became clear, like surreal a dream. Forcing himself to continue on, Topher retrieved a rope from his pack and tied up Davis. Red and black fibers perturbed from Davis’ face, with cloudy blackish circles of swollen skin. Davis got back up to his feet after the final knot was tightened. Ramming shoulder first into Topher’s chest, he ran like a Cheetah through the snow packed rocky path

.

            Davis was a madman.

            Uncontrollable.

            Topher couldn’t understand what the hell was wrong with his friend. One moment he was dead, the next some kind of monster from a Dean Koontz novel.

            Davis jogged up the rocks towards the cave from which they came. Then he collapsed meeting the snow face first.

            Topher wondered if Davis could get frostbite in this weather after what happened to him? At this point frostbite was the least of his worries. This was indeed a strange condition. And the fact that Dr. Michael Davis worked as a microbiologist with the CDC on the same project as Terry Marshal and Lefty Craven, the very project that forced the whole group to run, made him wonder how many of them had come in contact with the virus.

            Ribs ached in pain, another cough tore its way though Topher’s lungs and pried his jaws open in a relentless rapidity of malevolent force.

With the onslaught bursting through his mouth and the hundred mile an hour wind that kicked up out of nowhere, Topher hit the ground embracing himself to keep his body from tearing itself apart.

            Curled in the fetal position, covering the snow carpeted rocks inches from his mouth, Topher projected blood laced with the strange looking fibers. This was a little different then what Davis went through. There was, however, no mistaking the fact that the same virus infected him. The wind hammered his body as the chill swept down his spine. With his coat zipped up, his goggles covering his eyes, and wearing his gloves, Topher could still feel the frigid cold. The chill mixed with the sensation of hot pinpricks throughout his entire body.

            Fibers penetrated his skin as his insides churned.

With the character Michael Davis, I start the story off with him sick. Has been sick for days. As he slowly turns into the undead, not only has he infected others, but the virus changes from subject to subject.

Davis works like a human laboratory. As it grows inside, terraforming his innards, the virus becomes stronger, and effects the host quicker once they are infected.

With the fibers of Morgellons Disease, they have now become a condition of the zombies.  In Smell of the Dead, the zombies start out fast then slowly become slower as they deteriorate. But the trademark that will persist, are the fibers. They penetrate through the skin everywhere. They work like cactus spines that carry the infection.

The Lyme and MRSA are aliments of the turning.

Scientists in the real world are always tinkering with viruses, looking to combine them as either a weapon, or as a vaccine. There has even been talk of taking one type of bacteria and using it as a new kind of energy to power the world.

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Author Dale Eldon lives in a Macomb, Illinois, and takes care of a sick mother while working overnights at McDonald's. He spends his free time with loved ones and writing his butt off. Between blogging and writing anthology submission calls, he is currently working on a zombie trilogy for a series of novellas and a novel.

Up and Coming

Hey everybody... how'd the week go?

Mine... interesting. Glad it is Saturday!!

Here's what we have this week at Redwood's Medical Edge.

Monday: Dale Eldon finishes up his zombie mayhem with an excerpt from his novel. Very interesting read but not for the faint of heart so reader beware. Remember, leave a comment on any of Dale's Monday posts and be entered to win for a chance at two books. Must live in the USA to be eligible. Drawing Halloween night at midnight.

Wednesday: Sarah Sundin concludes her pharmacy series with a focus on hospital pharmacy. They are true life-savers... trust me on that.

Friday: Historical overview of 19th century medicine. Nice post for historical writers.

Have a great week and not too much candy on Halloween!! Watch out for those zombies. Dale is lurking somewhere....

EMS Call: Respiratory Arrest

Dianna is back for her monthly EMS post. I'd like to pass along my congratulations to her for winning in the ACFW Genesis contest this year! This is a much sought after award and will turn the heads of editors her way. I know we will be seeing her books published in the coming years.

Today, she focuses on the aspects of a respiratory call. This will help add those factual details for your scenes.

EMS 18, respiratory distress at 1234 Greene Road, at 1234 Greene Road on TACH channel 7.

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As we climb into our ambulance posting (parked) at our station, my partner and I radio in we’re en route to the above scene. Lights and sirens, we rush out of the garage. En route, we’re notified via our computer that the patient is a 24-year-old female and is conscious and breathing.

Once on scene, we find the scene is safe and no dispatched law enforcement. Typically a fire crew arrives on scene first (prior to us) since there are about three times more firehouses than EMS stations globally, thus they’re closer than we are. However, fire is not always dispatched along with EMS, so for this sample EMS call we’ll say fire wasn’t dispatched.

Upon our arrival at the patient’s side, my general impression of her is she’s SOB (short of breath) and in respiratory distress (dyspnea). She’s sitting in the tripod position (leaning far forward with her palms on her kneecaps) and she’s breathing shallow and fast (tachypnea). She’s not cyanotic (blue lips or fingernail beds), so she’s perfusing fine at the moment and not hypoxic (lack of efficient oxygen), but that can quickly change.

I won’t discuss everything we’d do on a respiratory call like this, but if you need clarification or further explanation for your fictional writing needs, please do not hesitate to ask me.

julezcourt

As my partner whips out a non-rebreather mask and connects it to the oxygen tank at 15 lpm (liters per minute) then slips it over her mouth and nose, I assess her breathing rate and quality and find it definitely out of range, certainly labored and not efficient to sustain life, so I assemble a BVM (Bag Valve Mask), and my partner bags her.

As I continue with my patient assessment, and notice she’s diaphoretic (cold and clammy skin) I consider assembling a nebulizer (I’d squeeze atrovent and albuterol into a tiny circular plastic cup and attach the nebulizer contraption to the NBR (non-rebreather).

I attach her to our cardiac monitor via a 12-lead (ECG patches) to interpret her heart rhythm and heart rate, and I slip a pulse-ox on her finger (pulse-ox is attached to the monitor) to obtain her blood oxygen level.

I won’t go into any detail about heart rhythms, but I’ll simply say she has a dysrhythmia, her heart rate is at 118 (tachycardia = too fast), and her SAT is 87% (blood oxygen saturation), which is too low. Via my stethoscope, I auscultate her lungs and heart. I hear normal heart sounds, but I hear rales in her lungs. We insert a line (IV).

Our patient falls unconscious, and remains unresponsive. Cyanosis (blueness) begins to appear. She still has a pulse, but she’s no longer breathing, so she’s in respiratory arrest (apnea).

Based off my assessment and what information I gained from her roommate on-scene, I believe the diagnosis is pulmonary edema (various causes that I won’t go into). As I assemble the CPAP—Continuous Positive Airway Pressure—and attach it to her face, my partner pushes (inserts into the line) vasotec and fentanyl.

We place her onto our stretcher and load her into our ambulance for transport. En route, I monitor and reassess her constantly, perform any and all interventions as necessary, and retake all vital signs very five minutes.    

Thank you in advance for reading and for your comments.

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After majoring in communications and enjoying a successful career as a travel agent, Dianna Torscher Benson left the travel industry to write novels and earn her EMS degree. An EMT and Haz-Mat Operative in Wake County, NC, Dianna loves the adrenaline rush of responding to medical emergencies and helping people in need, often in their darkest time in life. Her suspense novels about characters who are ordinary people thrown into tremendous circumstances, provide readers with a similar kind of rush. Married to her best friend, Leo, she met her husband when they walked down the aisle as a bridesmaid and groomsmen at a wedding when she was eleven and he was thirteen. They live in North Carolina with their three children. Visit her website at http://www.diannatbenson.com 

Contemporary Pharmacy Practice: Part 3/4

Sarah Sundin continues her four-part series on contemporary pharmacy. Today she focuses on the community pharmacist. This series is providing a lot of great background information for these health care professionals and potential fictional characters.

Back to Sarah....

Fiction writers do mean things to their characters. If those mean things require pharmaceutical care, you may need to introduce a pharmacist character or understand how pharmacies work. As a pharmacist myself, I want to help you get those details straight.

Today’s article discusses community pharmacy practice. Previous articles gave an overview of the profession, and discussed pharmacy education and training, and the following article will discuss practice in the hospital setting.

Community Pharmacy

About 65% of America’s pharmacists work in retail pharmacies inside drug stores, supermarkets, or mass merchandisers such as Walmart, Costco, or Target. There are approximately 23,000 independently owned pharmacies in the U.S., and 39,000 chain stores.

Setting

In the typical American drugstore, the pharmacy is toward the rear of the store, with over-the-counter (OTC) medications stocked close to the pharmacy. A counter divides the pharmacy from the rest of the store, usually with prescription drop-off and pick-up in separate areas. The secure pharmacy area is set further back, usually behind bulletproof glass. Access is restricted to pharmacists and pharmacy technicians. Other persons are allowed inside briefly to make deliveries or for housekeeping, and only with a pharmacist present.

The pharmacy area includes a main counter with computer workstations. Shelves hold bulk medications divided by type—oral tablets and capsules, oral liquids, suppositories, topicals (creams and ointments), eye and ear medications, inhalers, and injectables, plus bulk storage. Each pharmacy has a refrigerator for temperature-sensitive drugs and a locked cabinet or safe for the most heavily controlled substances (C-IIs).

Traditionally, the owner pharmacist ran the complete store as well as the pharmacy, and this configuration still occurs in smaller independent stores. However, in most situations, a store manager runs the main store, while the pharmacy manager runs the pharmacy. The pharmacy manager must be a pharmacist and performs administrative as well as dispensing duties.

Working Conditions

Most community pharmacies employ one or two full-time pharmacists, plus on-call or floating pharmacists to cover absences. Several pharmacy technicians work each shift as well. Most pharmacies are open from morning to early evening to cover the after-work rush, as well as shorter hours on weekends. Therefore, most pharmacists and techs work odd hours—morning shifts, afternoon to evening shifts, and alternating weekends. Larger pharmacies may be open twenty-four hours.

Pharmacists and technicians work on their feet. Pharmacists are required to dress professionally—a dress shirt and tie for men, a nice blouse and dress pants or skirt for women. Technicians tend to dress “business casual.” The traditional pharmacist’s short-sleeved lab coat that buttoned up the side to a high neck is rarely worn nowadays. Most pharmacists and techs wear a white hip-length lab coat with short or long sleeves.

Work Flow

Pharmacy technicians are allowed to do many duties, but those requiring professional judgment are restricted to the pharmacist. The precise division of labor varies between stores.

The prescription is taken in by a technician, who checks to see if the prescription is complete and that the patient’s information in the computer is current. The prescription is then entered in the computer. A pharmacist checks if the drug and dose are appropriate for the patient’s condition, age, and weight, and checks for potential problems due to allergies, drug-drug interactions, or drug-disease interactions. Sometimes the pharmacist needs to call the physician due to illegibility, errors, clinical interactions, or to verify a controlled substance prescription. The correct medication is pulled from the shelf, and tablets or capsules are counted on special counting trays. Larger stores often use automated systems to count and fill. The pharmacist performs a final check, and the medication is dispensed to the patient.

Patient Consultation

As accessible and visible health-care professionals, pharmacists often advise patients on proper treatment of ailments needing over-the-counter medications, including when to see the physician. Also pharmacists consult with patients when medications are dispensed to make sure the patient understands the proper use of the medication and side effects to watch for.

Immunizations

Offering immunizations is a growing role for pharmacists, with 147,000 certified to give vaccinations. Pharmacists enjoy this chance to serve the community and improve public health.

Controlled Substances

Many of the medications used for legitimate medical purposes are also drugs of abuse with high street value. Therefore, pharmacists must balance two conflicting community needs—to provide health care to those who need it, and to prevent diversion, fraud, and theft. High security, locked cabinets, background checks, and multiple counts are used to prevent outright theft and in-house diversion.

However, fraudulent prescriptions are often phoned in or written on stolen prescription pads. The pharmacist must use professional judgment to determine if each prescription is authentic. Does the prescription use improper medical jargon? Unusual and large quantities? Is the patient paying cash for a high bill? Do they come in after the physician’s office is closed? A pharmacist can legally refuse to fill any prescription for any reason. However, recently patient advocates threaten lawsuits if they believe access to medications is blocked.

The Community Pharmacy Experience

Overall, working in a community pharmacy is fast-paced and often stressful, especially when dealing with insurance companies or when disgruntled patients or irritated physicians vent their frustrations. However, most pharmacists can overlook these issues, knowing they’re providing excellent health care and helping patients get better.

Sources:

Bureau of Labor Statistics, U.S. Department of Labor, Occupational Outlook Handbook, 2010-11 Edition, Pharmacists, on the Internet at http://www.bls.gov/oco/ocos079.htm (visited October 17, 2011).

American Pharmacists Association http://www.pharmacist.com/

National Community Pharmacists Association http://www.ncpanet.org/

National Association of Chain Drug Stores http://www.nacds.org/index.cfm

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Sarah Sundin is the author of the Wings of Glory series from Revell: A Distant Melody (March 2010), A Memory Between Us (September 2010), and Blue Skies Tomorrow (August 2011). She has a doctorate in pharmacy from UC San Francisco and works on-call as a hospital pharmacist.

Creating A Monster: Part 3/4

We're continuing our Monday zombie fest. Remember, leave a comment and be eligible to win two zombie books in my drawing on Monday, October 31st! Must also live in the USA.

Now, back to Dale and his zombie virus.

Last week I talked about my upcoming story, The Smell of the Dead, and how I got the ideas for the virus used. Today I want to go into more detail about the viruses.

First off, on the subject of  Morgellons Disease, this has to be one of the weirdest diseases I have ever heard off. After some research I couldn't help but see a connection between Morgellons and a zombie virus. Here are a list of the symptoms:

Skin rashes or sores that can cause intense itching 

Crawling sensations on and under the skin, often compared to insects moving, stinging or biting,  or worms crawling under the skin.

Fibers or crystals, threads or black stringy material in and on the skin

Behavioral changes

Black specks in lesions that do not heal

Memory loss or general brain fog with difficulty concentrating

Imagine one moment you are alive but sick. The next you are coughing up blood with strange looking fibers scattered about in the mess. Then the fibers start to protrude from your skin. And to make matters worse, they spread a virus that turns people into zombies.

MRSA

MRSA can look like a spider bite, pimple, or boil. They can quickly turn into painful abscesses that need surgical draining. The bacteria can stay confined in the skin, but can also burrow deep into the body, causing infections in the bones, bloodstream, surgical scars, heart valves, lungs, and joints.

Why or how could a zombie virus effect the body like it does? Or should I ask, why or how my virus would? This virus would effect the body on such a deep level, though it would begin with the brain, it spreads out  through the entire body. The zombie virus is this story, once in the final stage, is incurable.

Lyme

What drew me to Lyme being a part of the virus, is the fact that the bacteria can hide among the DNA without being noticed. And since so many doctors don't believe it is disease, wold make spotting this kind virus very hard.

The zombie virus is made up of several different types of viruses. Lyme makes it invisible to detect, and so many doctors wouldn't even believe it exist.

Next week I will bring all of these together and show a brief scene of one the characters from The Smell of the Dead slowly turning into a zombie. 

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Author Dale Eldon lives in a Macomb, Illinois, and takes care of a sick mother while working overnights at McDonald's. He spends his free time with loved ones and writing his butt off. Between blogging and writing anthology submission calls, he is currently working on a zombie trilogy for a series of novellas and a novel.

Up and Coming

Today, I'm actually blogging over at the WordServe Watercooler. This a a joint blog with lots of WordServe authors posting about the writing life and publication. If you're an author, it's definitely worth your time to check it out. I'm talking about Klout Scores. What? Exactly... check it out here: http://wordservewatercooler.com/2011/10/22/whats-your-klout-score/.

At Redwood's Medical Edge this week:

Monday: Dale's Zombie Fest continues. Remember leave a comment for a chance to win two zombie books.

Wednesday: Sarah Sundin continues her series on contemporary pharmacy. This post focuses on the community pharmacist.

Also, on Wednesday, I'll be over at Christian Mama's guide offering my "real life" take on all things pediatrics. Erin hosts a great blog and has a wicked sense of humor. Love her! So, check it out... http://www.christianmamasguide.com/.

Friday: Dianna Benson's monthly EMS post. This month-- respiratory distress.

Hope to see everyone stop by and have a great week!

Jordyn

Assisted Reporduction is not for Whimps

Today, I'm pleased to host Bette Lamb who discusses her research into infertility clinics. I was certainly surprised by what she found. Are you?

Welcome, Bette!

"You and I know that without babies we are nothing.

A hiss of surprise escaped Petra's lips. "Dr. Vesey--"

"Oh, I say what's expected to my patients. But you're not my patient anymore, are you? We're just two barren women facing a meaningless future."

This interchange comes from our new novel, Sisters in Silence, where a fertility counselor takes on a ”noble mission” to save her barren sisters from suffering --  by killing them.

That’s probably not what actually happens when you go to a fertility clinic for Assisted Reproductive Technology (ART). I mean you don’t end up dead, but you do end up with a murdered bank account and a pummeled ego hovering around zero.

Consider this: For women over thirty-five who want a baby, the news is not good. That’s no matter what they do -- with technology or without it. To me, that alone was a surprising piece of information. BTW, every time I blink, the age that determines whether your eggs are too old keeps getting younger. The last figure I heard, off the record, was 27 years old.

When I started researching our medical thriller (the novel is co-written with J. J. Lamb), the media buzz was all about women pursuing their careers and waiting to have babies later – sometimes well into their fifties. And women buy it – I mean, against all reason, they believe it.

 I’ve talked to intelligent, savvy women in their mid-forties who say, “I’m just beginning to think about having a baby.” And many might as well keep right on thinking about it. Because no matter how young you look or how much you’re into Pilates, or how many vitamins you take, or whether the forties are the new thirties, you’re in for a surprise when you take that first trip to a fertility specialist who you’ll probably have to end up seeing. You’ll be floored.

When I started delving into this specialty for our book, the statistics for success knocked me over. My day job, for most of my career, was as an RN in Ob/Gyn. I thought I knew exactly the kind of information I would find. After all, these clinics are everywhere. They have to deliver the goods to keep the doors open. Right?  Wrong.

Most women seeking professional help DO NOT SUCCEED. That means they do not walk away with a baby that they carry to term and deliver. In fact, the odds of success are pretty grim: From about 4% for women older than 42, to a high of 37% for women under 35. (After a woman reaches her mid thirties, success rates start to tank dramatically.).

Put yourself in the skin of a 42-year-old woman who has a successful career, a stable relationship, and some money put away. Watch her after starting down the ART runway. In the first steps, she looks like a million – she’s confident, she knows she’ll be in that winning percentage of women coming home with a baby.

And I’ll bet she doesn’t even want to hear about surrogacy (using some other people’s eggs) or adoption. Babies are not that available and who wants some older kid? After several cycles of hormones that make her feel like she’s losing her mind, a love life that is based on her cyclic ticking clock, a significant other who’s now having ED because of the scheduled sexual demands that have nothing to do with lust, life becomes hell in a toaster.

This is the world of our fictional fertility counselor. A world of disappointments, lost love, and unfulfilled expectations day after day. That might drive you off your rocker, too.

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Bette Golden Lamb is unmistakably from the Bronx – probably why she likes to write thrillers. When she isn’t writing crime novels, you can find her in her studio playing with clay.  Her artistic creations appear in juried regional, national, and international exhibitions. She sells through galleries, associations, and stores. She’s also an RN, which explains, Bone Dry, a medical thriller, and Heir Today, an adventure/thriller which also has a medical aspect to it. And just released at Amazon .com, Sister in Silence, a medical thriller about barren women -- available as an ebook or trade paperback. Both books were co-authored with husband J.J. Lamb. You can learn more about Bette here:

http://www.twoblacksheep.us/ and http://www.bettegoldenlamb.com/.

Contemporary Pharmacy Practice: Part 2/4

Sarah continues her four part Wednesday series on contemporary pharmacy. Today, she focuses on education and training.

Fiction writers do mean things to their characters. If those mean things require pharmaceutical care, you may find the need to introduce a pharmacist character. Or if medications play any role in your story, you’ll need to understand how pharmacies work. As a pharmacist myself, I want to help you get those details straight.

Today’s article discusses pharmacy education and training. Last week’s article gave an overview of the profession, and the following articles will discuss practice in the community pharmacy setting and practice in the hospital setting.

austinisgreat420

Entry Degree

The first four-year Bachelor’s of Science degree in pharmacy was offered by Ohio State University in 1925. The four-year program became mandatory with the incoming class of 1932. The doctor of pharmacy (Pharm. D.) degree was first offered by the University of California, San Francisco in 1955. As the clinical focus of the Pharm. D. degree became more desirable, the bachelor’s degree was phased out. As of 2000, the Pharm. D. degree was required for initial licensure.

Pharmacists with a bachelor’s degree sign their names with an “RPh” afterward (Registered Pharmacist) and are addressed as “Mr.” or “Mrs.” or “Miss.” Pharmacists with a doctorate sign their names with a “Pharm. D.” afterward and are addressed as “Dr.” However, it is common practice in modern pharmacies and hospitals for pharmacists to be addressed by their first names—this is controversial within the profession. Please note, the degree is a doctorate in pharmacy not pharmacology. Pharmacology is an academic discipline not a clinical profession, and pharmacologists receive the Ph.D. degree.

Length of Education

To gain admission to pharmacy school, students must complete the prerequisite undergraduate courses in math and science. A dedicated student can complete the prerequisites in two years and apply straight to pharmacy school. However, most students obtain their undergraduate degree first. Common majors of entering students include biology, chemistry, and biochemistry, but any degree is acceptable as long as the prerequisites are filled.

Pharmacy school is a four-year program. Therefore, the typical time from high school graduation to receipt of the doctorate is six to eight years. At graduation, students attend the traditional hooding ceremony. The lining of a pharmacist’s doctoral hood is olive drab.

Course of Study

During those four years, pharmacy students undergo a rigorous course of study in basic science and clinical practice. Studies in the basic sciences include organic chemistry, biochemistry, physical chemistry, anatomy, physiology, and microbiology. More specialized courses include pharmaceutical chemistry, pharmacokinetics (how the body processes medications), and pharmacology (how medications act on the body). The highlight of the academic experience is an intense series of courses in clinical pharmacy, where students learn about disease states and the proper of use of medications. The final year of pharmacy school is spent in the clinical setting. Students work on hospital floors, rounding with physicians and medical students. There they monitor patient care and recommend changes in therapy. Students (called interns) work under the supervision of experienced pharmacists, called preceptors.

During pharmacy school, students also take part-time and summer jobs to obtain their required internship hours. Interns must fulfill a certain number of hours both in the inpatient (hospital) and outpatient (clinic or retail pharmacy) to sit for pharmacy boards.

Licensure

Upon graduation from pharmacy school, completion of internship hours, and a background check, graduates can take the NAPLEX, the North American Pharmacist Licensure Examination. Each state also administers an exam in pharmacy law, since regulations vary from state to state. Since the NAPLEX is now accepted by every state, pharmacists enjoy reciprocity. To move from one state to another requires sitting for a new law exam but not the pharmacy boards.

Pharmacy licenses must be renewed every year or two, depending on the state. Continuing education is required for renewal. Since pharmacists work with controlled substances, pharmacy licenses may be suspended or revoked for crimes involving controlled substances, including driving under the influence. Pharmacy licenses may also be suspended or revoked for other crimes, malpractice, or professional ethical violations.

Residencies and Fellowships

As medications and therapy become more complex, so does pharmacy education. Many graduate pharmacists choose to do a one-year general pharmacy residency—essentially a continuation of their fourth year of pharmacy school. Pharmacists may choose to take additional residencies or fellowships to gain more specialized experience, especially if interested in an academic career.

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Sarah Sundin is the author of the Wings of Glory series from Revell: A Distant Melody (March 2010), A Memory Between Us (September 2010), and Blue Skies Tomorrow (August 2011). She has a doctorate in pharmacy from UC San Francisco and works on-call as a hospital pharmacist.

Creating a Monster: Part 2/4

We're returning to our Monday, Zombie Fest. Remember, leave a comment on any of Dale's posts and be eligible to win two zombie books by David Moody and K. Bennett. Drawing Oct 31st! Must live in the USA.

Now Dale...

In my up coming zombie story, The Smell of the Dead, a group of scientists are now on the run. Their lives are in grave danger from their former employers. They make a plan to fake their deaths and take one last adventure.

High on the slopes of Mount Everest, foremost infectious disease expert Terry Marshall leads the group  to their dream summit, and to a new life, one where they can live without looking over their shoulders. However, a plan is in the works. One of them isn't who they seem, and a deadly zombie virus is transforming inside one of the members.

About the Virus

MRSA under Electron Microscope

 The zombie virus is a combination of MRSA, Lyme disease, Morgellons Disease—or  Elliot's Disease—or Worms-Under-Skin Disease, and the flu. At this point it is a mystery, but it is believed that there are several hundred different DNA strands of other viruses inside one zombie virus.

What made me decide to use a virus instead of the supernatural trend dating back to George Romeros, was the fact I love viral story lines. Even before the movie Contagion. Secondly, my mother who has always been a health nut (in a good way) told me about Morgellons and once she mentioned the symptoms I knew I had to use it in my story.

One of my favorite authors, Brandilyn Collins, wrote a book called, Over the Edge. A wonderfully written story about Lyme Disease. Along with her book, she posts articles about people who have suffered from Lyme, giving me even more ideas on splicing it with Morgellons.

Then the last thing that sparked my interest, I am on a conservative preparedness forum. Though I am rarely on there these days, aside from a lot of pointless bickering, there a lot of good articles on things to be prepared for. One of which, viral outbreaks.

I have read one in particular from a poster who was talking about expecting high death rates over the Swine Flu (H1NI). Although there was indeed a death rate, and a larger one than the media was allowed to talk about, it wasn't near the scale that he had feared. But this article did do a great job at getting to the point on how something like a virus can destroy a world. Though that was only part of the post.

This man made a lot of good points. He is a survivalist, he is brilliant about economics, has even been on interviews discussing the current economy, and is working on a post apocalyptic story to one day publish. But, let’s just say that maybe he was wrong about which virus would cause a huge scale death toll, but not about the death toll of a viral outbreak.

In the past ten to fifteen years, scientists have been dropping dead.  Some are nuclear physicists, others are microbiologists. And the deaths only seem to rise. There is something going on that we don't know about. While some of the scientists can be chalked up to natural causes or events from their own mistakes, a lot of issues raise doubts about how they died. And the fact that so many have perished makes one wonder if there wasn't foul play.

Next week I will break down Morgellons Disease, MRSA and Lyme Disease. The week after that, I will bring them together as the zombie disease.

Thank you for reading!
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Author Dale Eldon lives in a Macomb, Illinois, and takes care of a sick mother while working overnights at McDonald's. He spends his free time with loved ones and writing his butt off. Between blogging and writing anthology submission calls, he is currently working on a zombie trilogy for a series of novellas and a novel.

Aortic Injuries: Part I

When Bad Things Happen to Great Vessels – Part I

Frank J. Edwards, MD

The aorta, as everyone knows, is a high-pressure, semi-elastic conduit coming off the heart’s left ventricle that arches downwards, dives through the diaphragm and courses through the abdomen into the pelvis, where it bifurcates into the iliac arteries.  Major arteries branch off throughout its long course supplying our vital structures with oxygen and nutrients.   The wall of the aorta has three layers under the microscope—a strong, fibrous outer layer, a muscular middle layer, and a relatively thin and delicate inner membrane. 

When something goes wrong with the aorta, it’s going to be a clinical nightmare.   Bullets and blades account for most traumatic injuries, but the aorta can rip when the heart is wrenched and twisted during the first seconds of a high velocity accident or fall.   Patients with traumatized aortas usually don’t make it to the hospital.  If they do, the challenge is not one of recognizing the problem—

But of fixing it . . . very quickly.

Non-traumatic aortic crises, however, can be surprising difficult to diagnose, and are just as potentially lethal.  Such patients may slip through triage looking like back strains, angina, kidney stones, strokes and even constipation.

The nature of non-traumatic aortic catastrophes will vary depending upon location, but fall into two general categories:  the thoracic aorta tends to suddenly dissect, while the abdominal aorta will gradually develop aneurysms that enlarge and eventually rupture.  Today we’ll look at thoracic aortic dissections, and next month the ruptured AAA (abdominal aortic aneurysm).



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The thoracic aorta is that segment running from the heart to the diaphragm.  A dissection occurs when the inner lining develops a sudden, spontaneous tear, which can occur for a number of reasons, including long-standing high blood pressure, congenital connective tissue disorders like Marfan’s Syndrome, and the Ehlers-Danlos Syndrome.

The tear may occur close to the heart (the aortic root) or anywhere further along the vessel as it arches down.  Suddenly, all that blood pulsing out of the heart under high pressure has somewhere else to go, and because the toughest outer coating usually holds, it dissects a new channel between the inner and outer layers, and it does so with a vengeance, wrecking havoc along the way.

It can seep toward the heart and block the coronary arteries—giving heart attack symptoms—or it can compromise blood flow to the brain and resemble a stroke.  Not uncommonly it will dissect all the way down the length of the aorta into the pelvis and throttle blood flow to one of the iliac arteries, causing pain and numbness in a leg.  Furthermore, the outer layer may crack open and allow blood to gush out into the chest cavity.  We are talking serious badness anyway you slice the cake.

While a good number of patients with thoracic aortic dissections have severe upper back pain often described as “tearing” in nature, many don’t.  They may have only chest pain accompanied by EKG changes resembling a myocardial infarction, or they may have stroke-like neurologic deficits—up to and including coma—or they may have back-pain-plus-leg-numbness, or chest-pain-plus-arm-pain, or back-pain-and-chest pain, or . . .  you get the idea.  Chest x-ray alone won’t make the diagnosis, and neither will any single test except a contrast enhanced chest CT scan. 

This is what happened to the actor John Ritter.  He developed nausea and vomiting while on a set and went across the street to a very good medical center in L.A. where an EKG suggested he was having a heart attack.  The highly skilled cardiologist on duty ordered a blood thinner and Mr. Ritter died.  

Once in a while, thoracic dissections will “stabilize.”  The rent will seal, the dissection cease, and the patient may require only good blood pressure control.  But treatment usually falls to the thoracic surgeon, and the already high mortality rate rises the longer diagnosis is delayed.

 The stop watch has begun ticking before you even lay eyes on the patient.

 Emergency medicine providers must keep a high index of suspicion in anyone who complains of upper back pain or chest pain—and especially (here’s an excellent rule of thumb) if the patient has symptoms both above and below the diaphragm.  Next month—the equally dreaded “triple A.”

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Frank Edwards was born and raised in Western New York.  After serving as an Army helicopter pilot in Vietnam, he studied English and Chemistry at UNC Chapel Hill, then received an M.D. from the University of Rochester.  Along the way he earned an MFA in Writing at Warren Wilson College.  He continues to write, teach and practice emergency medicine. More information can be found at http://www.frankjedwards.com/.

Contemporary Pharmacy Practice: Part 1/4

I'm so pleased to have Sarah Sundin back. She's going to give us a glimpse of her real life as a pharmacist in a four-part series.

Welcome back, Sarah!

Fiction writers do mean things to their characters. If those mean things require pharmaceutical care, you may find the need to introduce a pharmacist character. Or if medications play any role in your story, you’ll need to understand how pharmacies work. As a pharmacist myself, I want to help you get those details straight.

Today’s article is a general overview of the pharmacy profession. The following articles will discuss pharmacy education and training, practice in the community pharmacy setting, and practice in the hospital setting.

Meet Your Pharmacist



Sarah's Graduation: UC San Francisco 1991

A pharmacist is the member of the health care team primarily concerned with the safe and effective use of medications. Although the profession of pharmacy is relatively small—268,030 employed pharmacists in the United States in 2010, according to the Board of Labor Statistics (1) —pharmacy plays a vital role in health care.

People drawn to pharmacy enjoy math and science, and tend to be detail oriented, methodical, and conscientious. Although many pharmacists are naturally quiet, they do tend to enjoy working with people. For the record, modern pharmacists strongly dislike being called “druggists.” Please don’t use this term in your contemporary novels. Thank you.

Demographics

Traditionally, pharmacy was a profession for white males, and even as late as 2004, 54% of licensed pharmacists were male, 88% were white, and only 7% were Asian and 2% black. However, the demographics of the profession have shifted dramatically over the past few decades, with extreme gains by women and Asians in particular. In 2004, 67% of doctorates in pharmacy (the entry degree as of 2000) were awarded to women, 23% to Asians, 7.7% to blacks, and 3.7% to Hispanics. (2)

One of the reasons pharmacy appeals to women is the ability to work part-time. Indeed, 24% of female pharmacists work part-time, primarily between the ages of 31-35 during the child-rearing years. Conversely, only 13% of male pharmacists work part-time, mostly over the age of 72.

Areas of Practice

About 65% of pharmacists work in a community pharmacy, filling prescriptions in either chain or independent drug stores. Another 22% work in hospital pharmacies. Others work as consultants for skilled nursing facilities (nursing homes), in pharmacy education, for governmental agencies, or for pharmaceutical companies—in clinical research or to provide drug information for other health care professionals.

Responsibilities

The traditional responsibility of the pharmacist is to purchase, store, compound, prepare, and dispense medications. Most medications are currently available from commercial manufacturers, leading to a diminishment of the pharmacist’s role in compounding—mixing ingredients to create elixirs, tablets, pills, suppositories, ointments, etc.

However, as the quantity and complexity of medications increases, pharmacists have positioned themselves as the medication experts. The practice of “clinical pharmacy” or “pharmaceutical care” involves working closely with physicians, nurses, and patients to assure the best possible care for the patient. Pharmacists are trained to watch for allergies, drug-drug interactions, and drug-disease interactions, and to adjust doses based on kidney or liver function, age, and weight. To increase patient compliance, pharmacists educate patients about their medications and answer questions.

Proper pharmaceutical care has been shown to decrease medication errors and the cost of therapy.

Pharmacist Shortage

A shortage of pharmacists has existed for several decades as the demand outstripped the graduation rate. This bumped up salaries significantly. In 2010, the average salary was $109,000, but this varies widely by geographic region. The shortage protected the profession from the recent economic downturn. However, many new schools of pharmacy have opened in the past decade, and the economic downturn has led pharmacists to postpone retirement and to work more hours. Anecdotally, fewer positions are open, and salaries are leveling off.

References

1)      Occupational Employment and Wages, May 2010: 29-1051 Pharmacists. United States Department of Labor, Bureau of Labor Statistics website. http://www.bls.gov/oes/current/oes291051.htm Accessed 29 Sept 2011.

2)      Report of the ASHP Task Force on Pharmacy’s Changing Demographics Am J Health-Syst Pharm. 2007; 64: 1311-9. American Society of Health-System Pharmacists website. http://www.ashp.org/s_ashp/docs/files/practice_and_policy/workforce/1311.pdf Accessed 29 Sept 2011.

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      Sarah Sundin is the author of the Wings of Glory series from Revell: A Distant Melody (March 2010), A Memory Between Us (September 2010), and Blue Skies Tomorrow (August 2011). She has a doctorate in pharmacy from UC San Francisco and works on-call as a hospital pharmacist.