pap smear debate

We had our calculation exam today... it went pretty well. I was stuck on one problem because I forgot the formula but all turned out well!! I'm sure I passed!!! ^_^
So we are officially about 5 tests away from winter break.  Yes!!!!! Only 5 tests but 3 of them are comprehensive! But it's okie... the next one is Monday, I need to look over some stuffs for the test but I think it shouldn't be too bad.  I don't have to get an A on the test... I only need to pass ^_^
Wanting to write about many things but I Guess you can only pick one and save the other for later...
So another day, another guideline.  This time, it's about PAP smear.  The new guideline recommended that females don't need to have PAP smear until the age of 21.  In addition, once they reach 21, they only need to do it every other year.  Once they are after 30, they can have their PAP smears every 3 years under a condition that they have 3 continuously normal results.
I don't know whether you have a problem with this but I do!  I think physicians need to approach this with care.
Reports indicated that HPV can clear itself without the first 3 years in young female patients without the need of intervention.  It's a good news.  However, it is still important for young female patients to have their PAP smears.  Reports said treatment can result in many pregnancy complications and increase the risk of infections.  It can be true.  But I still think it's important for young female patients to have their PAP smears done.  Why? You may ask!  Well, HPV is infectious disease.  It can be easily spread from patients to patients.  If you don't know that you have HPV, you can unconsciously spreading it.  Looking at how HIV was spread in the third world countries where diagnostic tests were not available and accessibility is a problem.  By imposing this guideline, the experts might have unconsciously decreased STD awareness.  Condom usage could decrease the risk of HPV infection.  Yes!  So when patients who test positive for PAP smears, it might have an indication that she has not used protective instrument that could help her preventing STD transmission.  Where is the patient education coming from?  Without getting tested for PAP smear in the three years where they might be extremely sexually active, it might increase their risk of having other STD because they are not aware of the risk associated with unprotective intercourse.  What will we see?  Will we see an increase in incidence of STD in the future?  It is a possibility.  Will it pose a public health problem?  Possibly.  I don't think the experts have thought about other social complications associated with this.  Trying to cut cost is not a good way to solve the health care problems.  It can worsen the healthcare service if it is implemented incorrectly.  Improving the service and patient education might be the way.

on birthday

It's another day... well... it's been raining pretty much the whole day but I didn't let the weather dampen my mood a bit ^_^
I just added another year into my life.  I am blessed for surviving until this year.  I know I am totally lucky!
I am grateful for all the wonderful people in my life.  I would not have been the way I am had I not met and learned from them.  ^_^  You all are part of my life.

I went to the local senior center with X. to help the seniors signing up for their medicare part D.  Unfortunately, there wasn't any clients available.  I will come back on Friday though (hopefully I am fully prepared for my exam on Friday Afternoon).
Ran a few errands.. finally got to the bank after a few misses... Returned the backpack that was not built as I expected... then I got home and found a small package on my doorstep...
Tiny package but contained so much love and thoughts.  I was completely taken by surprise as I opened the box...no diamonds... no gold... no silver... they are just simply my favorite croissants... I miss them just as much as I miss the beautiful weather and the familiar faces that I will get to see in December...(okie.. I miss the people a whole lot more than the food)... but they are coming from my favorite dessert store... they were shipped express overnight...It was a wonderful feeling knowing that you are cared for.  Thank you with all my heart!  It made me feel so special :-)

I called co P to say happy birthday to her as well (who would have thought we have the same birthday! ^_^ )  We are like best friends...and yes it is better this way than anything else.  I knew had I been her daughter our relationship would not have been like this.  I'm glad she's doing well and everything is going great as well.
I called Mom who was on her way with the rest of the family to the beach...I think they forgot it was my birthday.  I didn't know why but there has always seemed to be a tension between us no matter what I tried.  *sigh*.  I can't be the daughter she wanted me to be and I don't want to be the daughter she wanted me to be.  We are both stubborn. I guess that is how we are so alike and yes so different.  She made a point not to honor my birthday I guess because I followed the solar calendar and to her it's not an appropriate way to do. I don't mind her using her lunar calendar but I couldn't understand why she couldn't honor mine. I am one of the luckiest people on the planet because things always seem to work out very well without much effort.  No matter how many times I told her I will be staying here for the summer, it always crosses her mind that I will be with her... no matter how many times I explained to her... she just couldn't grasp the concept that...there is a life that I would like to follow and it might not be the one she has wished me to go.  I'm trying to mend the relationship... I'm trying to show her... it is about time for her to understand her children will have their own life and go in directions that they would like to.  I guess it's a hard concept because who would like to let go of the things you love.  With her repeatedly telling me that I will be with her for the summer make me realize she never listens to me... but that's okie... because it doesn't matter much.  She has never listened anyway.  It doesn't hurt my feeling, neither will it change anything :-).  Things go on and I'm moving on.
Sometimes... when things like this happen, I try to reflect on the purpose of being born, dying, and being reborn again.  The cycle never stops unless you do something to stop it.  I like my life... and yes I see the suffering.  My mom is suffering from me not listening to her.  She's suffering from surviving my father.  She's suffering from her inability to make differences in her life at the moment.  I am sad for her but this is part of life.  We are living the life that we create... this makes me wonder what I would like to do.  Things are never easy...the cycle continues to roll..
Working with people in my class makes me realize... my reasoning is different from my peers.  But it is okie...no one is the same on the surface...
need to hit the bed now...
happy new day! happy new year ! ^_^

pharmacoecononimic..brief brief..

I'm tired of studying for pulmonary... so I decided to write.
A topic that has been circulating in my head (... yes circulating... this is what happens when you stay in healthcare and start applying medical term in your daily language) is pharmacoeconomics.
I love the idea of integrating pharmacy and economic.  In many cases, we have over-used lab work.  We spend way too much money ordering unnecessary tests.  We also spend a lot of money on medications.  However, as much as people hate Pharma... without Pharma, we won't have the world that we have today.  People don't live as long and quality of life would not have been as high as it is now.  However, when you apply the idea of pharmacoeconomic... you start thinking about the cost of drugs associated with outcomes and decide whether it is worth it to pursue the treatment.  The idea bothers me.... can you really put a dollar sign in a patient's survival. Yes, we have ordered many unnecessary tests but some of them have saved life although most of them have gone wasted.  Would the few life that we save be worth the cost?  I personally don't have the answers but politically it might not be a good choice to do so.
A recent report just came out staying to not use mammogram too early. The report indicated there is no additional benefit in performing mammogram too early. This move will definitely cut medical cost related to breast cancer screening.  In addition, report also indicated that self-breast examination offered no benefit.  I personally have been taught and yes I don't see the benefit of doing it unless you are extremely sensitive and doing it religiously.  It's not discouraging patients to do it.  If they feel better doing it, by no means don't stop it.  It's just not an easy test to perform and not many people would adhere to the steps that are provided.  I wonder.. whether this is one of the first step that the government will come out to try cutting medical cost by making the criteria to be a lot more stringent.  Yes, it's cost-saving... but how about the life that could be saved?
As much as I like pharmacoeconomic, I wonder I would ever go into this field.  How would I possibly one day decide to cancel a medication because it's not cost effective for the company?  I pretty much take away a person's ability to fight for his survival... but again, the attractiveness is there.  Figuring out what is the best way to do this... what is the best situation...it's very stimulating.
As for me, I guess if I am diagnosed with a terminal disease, I wonder what I would do... if I knew there is no cure for disease and no matter what my quality of life is going to be extremely low and I become a burden to people around me...I might choose to follow the natural course of the disease because obviously no one would see the person you care suffer.  As much as we hope there is a cure, cure is still very far away...

random hearing... vibram experience

It's so nice to have a Friday off.  I'm so glad that I took the OSCE on Wednesday instead of Friday.  Things can't be better than this.  I think it justifies me taking Wednesday morning lab for next semester.  Anyhow... dinner was interesting.

I went out for dinner instead of dining in *it's just part of laziness*

Sitting next to the table at which the daughter was in a heated conversion with her father.  It was because of Thanksgiving.  It's interesting how much you know about the person by just being a passerby.  Her father lived in Florida and their plan was to visit grandpa for Thanksgiving.  However, they didn't want to live in Grandpa's house... and it made him really mad.  He decided that if they didn't want to live in his house, no point in coming.  So.. the end of stories...they will not come down to Florida for Thanksgiving because of this.  The family said the kid would bring a lot of toys and there will be no room for it.  I wonder.. how much toys the kid would bring?  there is only one kid! needless to say, I wonder what I would do if it happened to me.  I knew it's hard to live with your parents once you have lived so far away.  At least, I knew sometimes my Mom kind of bothered me a little when I tried to explain to her several times and she still asked the same questions.  Not only this, she's just too smart that I have to think about why she said what she said to avoid being put into situations in which I can't find my ways out. Such is our relationship.  Isn't it funny when you have to do that?  It's because your mom is so clever! :)

I went to get  card to mail to the staffs at the hospital I was at last summer for Thanksgiving.  It's so fast... in less than 2 weeks, I will be on plane going away again.  I miss flying and traveling.  I miss the experience of coming home after a long trip.

Walking to the outdoor shop, I found a few pair of sandals that my sisters really like.  So I bought each a pair... and one for myself.  They are 50% off.  So I think it's okie.  I tried on the Vibram Shoes.

It's an interesting shoeware I have to say. The feel is very different. It's almost like you walking bare-feet but not.. bare-feet actually.  I'm contemplating about getting this for my birthday! ^_^  I guess it works!  I've been running... indoor a lot since the beginning of the semester.  And I start to like my open toe shoes a lot more than my close-toe shoes.  There is something about having my toes seeing the world that makes everything feels so much better and fresher.  If I do get it.. I will post a picture!  If you don't want to buy them, trying them on will definitely be a different and interesting experience.

Anyway.. I finish going over some of the notes for pulmonary... we have another test next week.

Busy weekend!  But.. the highlight is: I'm going to go to dimsum this Sunday!  yay! I love dimsum even though it always gives me heartburn afterward.  Once in a while it's okie! yes heartburn... i noticed it from time to time...pretty bad I would say

irb.. writing

I don't think I've been up this late for a long time...
I guess when you promise something, it's hard to pass the commitment. Maybe that's the reason why I find it hard to commit to anything.  I had hard time deciding whether going to the cafeteria with group of friend or stayed in with another group of friends.  God knows what was going through my mind.

I finish the first draft for my IRB. It wasn't easy because... I have never written one before.  Even though it's just writing, it's the audience that is different.  It's no longer being a graded paper.  It is now a proposal for a study.  It is no longer read by a TA who might or might not have a cup of coffee before he dived into a 10-page essays.  It is now read by our faculties... people who teach me classes.  Anxiety? yeah... scariness? yeah.. but completing it is satisfactory and it's worth so much more.  ^_^

I guess it's important to find what you like and if possible develop it to a skill that can help you in the future.  I like writing even though not a terrific writer.  But I know with practice, things will get better.  In fact, with just being careful, things will get better.  How many times have I overlooked something?  Too many too count.  Simple things aren't often obvious.
But I also realize... even as a pharmacist, there is a niche for writer.  I will keep it in mind and learn more about whatever opportunities there are.
It stops raining for a bit now but the wind is blowing hard.  I'm fortunate to be sheltered in the warm house.  How many people are as fortunate as I am?
Living in this part of the country, I've learned to deal with different types of weather.  Reading from a friend's page "If you think sunshine brings you happiness, you haven't danced in the rain".
It's such a wonderful quote.  What can bring you happiness but yourself? :)  I remembered the walk uphill was hard in the beginning, the feeling of tiredness was undeniable but eventually these feelings are long gone.  Whether it is a sunny day with an unimaginable humidity or an extremely windy and cold condition, who can really take the sparkle in the eyes?  it's all about perspective... and perspective changes with time...

OSCE and the like..

and my blogging continues...
I had my OSCE this morning... it went well or at least I think it did.  It's over now.  I also finished the DI take home exam.  It took a while to finish because I didn't know what she really wanted us to write... so I was just writing down things I think are important. :)

All the patients were nice at the OSCE or at least I think they were.  A couple of them I think were even more nervous than I was for some reasons.  One of the ladies were just too hyper.  Overall, it was a good experience ^_^

So what is OSCE?  It's a patient interview or the clinical portion of our curriculum.  Each student needs to pass this every semester in order for us to graduate.  This semester, we are required to counsel patients on medications and devices that we've learned throughout the semester.  There are about 60 of them or more but Ms. D was nice enough to cut them down for us *big big big kudos*.  This is our first OSCE...so most of us were very nervous.  But ... it was good and I'm glad we have a chance to do this in school.  Better makes mistakes in the classroom than in real life ^_^.

We all got there before 8 am ( I woke up around 6:20 in order to get ready for the exam).  It was raining but I love every minute of it.  We were given a tag with our ID and password on it.  At about 7:50, we were led to a room to get the instruction from the coordinator who was pretty funny.  Then we were discharged into our station.  At 8 am, a big announcer told us to log in and continue the encounter... yes they call it an encounter.  I looked at the prescription and started to synthesize all the materials that I've learned from the past.  A knock on the door and there I was... I started talking and talking... before my patient had a chance to repeat what they need to say... I ran out of time.  I don't know whether I will be graded on this but hey... it's okie!  It went better than I thought.

It's raining hard today.  For some reasons, I felt the rain and the cold wind were just refreshing.  It was bitter cold as I walked down the road but... it was okie because I knew where I was heading.  I guess when you know where you want to go and which direction to take, things are not as scary as it should be.

Too much to do.. too little time.. but i'm hanging in there and trying my best...

I talked to P. today.  I was nice talking to her after a long time.  Listening to her voice and wondering what will happen in the next few years.... when let's say I graduate... and when she moves on and probably will be retired.  Many accidental encounters have been more than wonderful.... I'm not going to count my blessings because... there are too many... and it's nice necessary to do so. Just take it as it is... and learn to continue to learn, to continue to try and make the best out of all the given opportunities... because had I not taken the opportunities in the first place.. who knew where I would end up? :)

back to kinetic   

update OSCE

I want to write so much but I don't have time to spend writing it... I wish I had more time.
I'm so happy that December is coming soon.  There will be nothing like coming home for Christmas (even thoug I'm not sure where I call home anymore)
School has been busy. 3 tests this week.  I'm glad I went over all the techniques this Monday and Ms. D. has been extremely nice.  Things will be good for OSCE tomorrow!! I just need to make sure I wake up on time... and don't be late for OSCE
It's raining hard outside... it will be raining hard tomorrow as well.  Let's hope that I won't be freezing trying to reach to the destination.  I know open toe shoes might not be recommended but this is the only thing I would love to wear in the raining days.  Plus... a lot of pharmacist wear open toes shoes.  I don't think it's a big issue. I'm not in lab!!!
I love our therapy module.  I learn a lot. I'm learning to detach myself and assessing myself from grades.  It has become quite irrelevant to me at this point.  I know what I know.  I don't know what the instructors know.  The instructors don't know what I know. The whole 25 questions test is a big mess.  It has no value and I will sure to make it to the evaluation. If you want to assess us, assess us fairly.  Don't try to give us 100+ slides and give us 25 questions on these slides when 2 questions might be off from the same slide.
I can't be happier... I think I pass!
Pharmacy school can be both love and hate I guess :)

two am post...

it's almost two am ...
With 3 impending tests next week... I wonder.. why in the world do they have a schedule like this? oh well... can't complain because nothing is going to change.  At least, I'm almost done studying for one of them... but just hope I remember all the structures :D

I had something in mind but would probably wait until all is done.

Only a few more weeks than I'll be done with this semester.  It's going by so fast.  I'm counting down... 6 more weeks then I'm half way done being a PY2.

All the anxiety that occupied me a year and a half ago seemed to be gone now.  it's hard to go back to school after you've been gone for a while... you start doubting yourself... you start wondering whether you can make it through the first semester.  But interestingly, I probably spent time studying a lot more than when I was an undergrad.  Things work out nicely and they will all be fine. :)

I wrote a post about recent health care debate... but... it was deleted when my computer decided to turn off by itself...it's the wonderful world of technology...

Anyway... I just can't wait until the end of this semester... 6 more weeks... but only about 5 more weeks of classes... Yay!

on obstacle...

Being.. a strangely crazy person...
I guess I'm very lucky...I know people who are luckier and yes sometimes I did questions how they become so luck.  But I have no less luck.
I was born and raised with enough comfort of material and financial situations.  Got my first paycheck when I was 18 and realized making money is hard work.  I wonder how people do it.  I guess when I was younger, I never gave much thought about money because I didn't use a lot of them most of the time.  Only when you started having expenses, money became an issue.
I hate to admit but sometimes things fall into places without you having to plan for it.  Planning is part of the process but... letting things be as they are is something I need to learn.
Reading a post from a very distant friend and learning about what she had to go through, I realized my life is so much rosier.  Even though my Dad is no longer here, the good memories will always be here in my heart.  Even though it was a sad departure, his passing away has given us chance to realize that nothing lasts forever. Even in his death, he had done something that none of us could have done.  He brought the people who had fought with each other for the last ten years together.  He gave us a new perspective on things.  I guess I'm becoming more positive and seeing lights in different angles.
I am fortunate enough to have a positive and good relationship with my loved ones.  I know many don't.  Some have taken other to courts.  Some have killed others over small things.  Some have denounced their biological strings altogether.  I guess it's ok to do so.  There is nothing wrong in doing that if a person deems it as appropriate.  But for once, I just hope they one day realize what they are going through right now is the foundation, a step for them to be a stronger and better person than they already are.  Strange as it sounds, you do become stronger with whatever obstacles you've overcome.  Take it as a positive force to move forward... even though you are hurt inside...even though you might have to do it in tearful departures...you will if not are a stronger person.

elderly...coupledhood

Learning about the elder adults...
I had/have an interest in learning more about older adults.  Started enrolling in an aging class.  We learned about different aspects of aging.  What is the myth and what is the truth.  Yesterday discussion was about couplehood. I wonder... well, here in the US, in the culture that we live in, getting married and divorce are quite common.  The rate has slowed down but in comparison to my knowledge in another country, it's a lot higher.  I guess living and being raised in a different cultures did have big impacts on you on some aspects.  I was ingrained in my brain that the relationship between husband and wife were never equal.  Having the freedom that I have now refrain me from settling down and starting a family.   But it's a different issue.
One of the questions that was raised in the class was : why would you want to get married?  Who would be the best person to get married with?  Majority answer: you get married because of companionship.. you get married to somebody that you can share your love and hate and many other things in life.  You get married in order to be complete.  I guess they are legitimate reasons.  One thing I never thought of... people still enjoyed sexual relationship even when they got a lot older.  They were still sexually active until the age of 60 or 70.  The performance decreased significantly but medications and medical devices are readily available to enhance the performance.  I guess for some people, it's part of their quality of life.  without it, life would not be very complete or meaningful.
Thinking about the people around me, the people that I know, I don't think I have seen them remarried.  Most stay as they are : single.  Single handedly raised their children to success.
It's interesting to see how diversely people can react when given the same situations.  I don't know what I'll do :D and I'm not sure whether I will reach that state to even contemplate.
I guess as long as they are happy... whatever works :)

napping time...

I should be studying... well I was.. so I'm taking a break probably more frequent than I need to.

It's getting a little bit crazy now but it's okie.  Things will calm down in a few weeks... they will arrive soon enough.

I've discovered the power of napping.  In Vietnam, people tend to take afternoon nap. I never did because I never had time to do so.  Running from different places never allowed me time to nap.  I never developed a habit of afternoon nap either.  But recently, I've discovered that napping really gives me a lot of energy.
I nap when I feel tired.  A 30 minutes nap is so refreshing.  It takes about 5 minutes for you to start feeling the effect after the nap but it's so well worth it.  When my brain gets so wired and tired, a 15 minutes nap would do it.
We learn something interesting in class today...old folks are so smart..."there is a saying... if you watched a lot of kungfu drama show: it takes a poison to rid of another poison..." well, for organophosphate which can be toxic to human due to its ability to bind to Acetylcholine esterase is often resolved when administered or given carbamate ( compound that can compete with organophosphate to bind to acetylcholine esterase).  Both of them, given in excess can be dangerous.  But organophosphate is a lot more toxic due to its ability to bind irreversible with Acetylcholine esterase.  I guess, the older folks don't need to learn about medicinal chemistry to talk about what's happening in nature ^-^

The more I learn, the more I realize, there are a lot of merits in the old saying...
I remember somebody told me that : it's not good to announce your pregnancy too early... wait for about 2 or 3 months or so.  Well, the truth is, spontaneous abortion is very common.  So even if you are tested positive for pregnancy, there is a high chance that your fetus won't be able to survive due to spontaneous abortion in the first few weeks.  So... here you go!  :)

anyway... I should get back to studying...

rainy day...

It's been raining...
the weather is unpredictable as a woman.  One day, it can be extremely cold.  The next day, humidity set in with the coming rain to increase the temperature.  What can I say?
Hearing about motherhood... I can't imagine what it might have meant.
Volunteering yesterday at SPA, seeing all the kids in cute costumes walking in with their parents, I secretly think every child deserves a happy childhood no matter where they are.  I did face painting for the kids.  It was my first time so haha the result wasn't so good.  I didn't even what to use. But everything with color was good enough for the kid.  There was this little girl who was just about 15 months old.  She kept coming back to my table.  She even let me hold her for a while.  Her parents thought that it was great because she was a shy little girl.  She was so cute though.  I had a great time there.  Maybe I'll do it again next year.
Hearing about a friend's labor... I wonder whether I want to go through this.  It sounds so hard... I appreciate and applaud all the moms in the world.  It must have been hard especially with the first one.  I'm a little bit chicken so I'll save these for a lot later time. ;D
Ladybugs are coming back already.  I looked at them and wondered how long they get to live.  She was just alive and kicking yesterday.  They are beautiful creatures.  I live with a lot of bugs.  Most of them don't bother me so much.  Things come and go.  They tend to be active at certain times and not at other times.  Most of all they just want some food and a place to stay.
Talking about bugs... my traveling bug is starting to kick in.  I want to be back in the sky and fly away again.  Whether it is a mean of escape, I don't know.  The idea of settling or being stationary is not here at this time.  But who knows it can change in a month! :D

I can't wait until the break.   it's November already ^-^.
good weekend!