Never Give Up

You never know what you can do until you try. This is how I feel towards everything I pursue!  I will be heading out to Cardinal Health's corporate office located at Dublin, Ohio tomorrow for the next three weeks.  I will be receiving more hands-on lab and clinical training there to get my authorized user license to handle radioactive material!  I have been waiting for this day, and it has finally come.  


I cannot wait to post more about I-131 capsules making.  My colleagues and I have requested and talked about getting a Smart-Fill, and we are getting one!!! It was the best birthday present I have ever received from work:)   Thanks to all who helped in that process of getting us one especially my manager and regional director!


Here's a daily inspiration:
The way to succeed is never quit. That's it. But really be humble about it. - Alex Haley


Tata for now:)

Art of Making I-131 Capsules

I started training and making radioiodine capsules few weeks ago. I-131 capsules, to be exact. Well, my colleague TJ trained me on a Monday, and I started making them myself on Tuesday.  On Tuesday, approximately at 1200hrs, my syringe cap rebounded and poked me on my left thumb.  

In that split second, I was thrilled that I was not bleeding.  Few seconds later, I started bleeding.  I stopped everything I was doing, removed my gloves, and stepped away from the iodine room.  I was hot, literally. As I walk toward the sink while calling out to the RSO (radio-safety officer), "Collin! I poked myself with I-131."  I was calm but frantic inside.  Enough I-131 in your body can ablate or destroy your thyroid.  However, takes a good amount of I-131 activity to do that, but still!  Without going into too much detail, I was trying to squeeze all that blood out as if a poisonous snake just bit me to try to rid all the removable contamination.  

Think of radioactivity as dust particles that you may not be able see and any residue left behind unshielded is radioactive.  In this scenario, my thumb was unshielded and radioactive.  Some of the contamination is also absorbed by the surrounding skin while a little might have traveled into your bloodstream.  I know that there wasn't too much activity in my needle-stick because it was an extremely light stick just barely into the epidermis.   That day, I went home with a blue glove on my left hand.  I was so embarrassed that I kept my mitten on even after getting indoors when I went to Zenon Dance School.  The purpose of wearing the blue glove for the night is so one, I don't ingest any of the activity if there is any left over and secondly, I can continue to perspire out the remaining activity. 

It's been a few weeks since I have been compounding.  I shall say that I am super careful and focused in the Iodine room when I compound these capsules.  I never ever want to go through that experience again-- to have to leave work radioactive!  I continuously challenge myself to work through it efficiently, which means that I need to be fast, but also clean without contamination.  The last thing you want to do is to stay in the iodine room and take your sweet time making the capsules because every second you spend in the room, you are exposed to iodine radiation.

Below is an image of one of the procedures done with the compounded capsules.

To give you a brief overview of what it's like to be in the iodine room, I will show you through pictures:)  We all love visual references!  When it's time for me to compound these capsules, I always feel as if I got punished and have to go to my corner.  It's called the 'iodine room' because it's segregated and it's a small room where all you do is make iodine-131 capsules.

This syringe holds a maximum of 0.3mL.  It's also known as an insulin syringe. 

As you see, the insulin syringe is tiny compare to my hand!  Usual dose of iodine-131 capsule is anywhere from 0.005mL to 0.14mL.  0.005mL is not even a graduated line and 0.14 mL would be on the 14th graduated line.  Essentially, I have to draw the amount, which is in solution, in the syringe, and then inject the liquid into the capsule for ingestion.

This picture depicts how I usually compound capsules.  My arms are in a fume hood called the glove box, and it's a hood designated for compounding iodine 131 capsules.  Because I-131 is volatile, it has to be compounded in a negative pressure hood so the volatile isotope does not get into the air you breathe.  The air is also monitored on a regular basis.  It is very difficult to manipulate in the hood especially having to hold all the heavy, leaded shields.  However, with time, you eventually get used to it.  In my first week of compounding, I took a long time just to make ONE capsule.  Few weeks later, today, I can make one capsule within few minutes.  Unfortunately, on a bad day, it'll take longer than a few minutes to make one capsule because you just canot get the exact amount that you want.  0.01mL vs 0.02mL can be a huge difference in activity given that I'm working with a highly concentrated amount of activity.  If each vial only has 0.25mL, you can imagine the amount of liquid I am working with.

Glove Box- arm holes where to place your arm through then manipulate the compounding procedure

See the barrier between my body and the iodine-133 in the hood? Not the most comfortable position

Side view...If you can see the top of the vial, then you're being blasted with lots of radiation:D Try not to look!

It really only takes one I-131 needle-stick for you to challenge yourself to never get poked again:p  The day after the incident, I really, really did not want to go near the iodine room, not to mention make the capsules!  I was so frightened by the experience I wish I never had to make another capsule.  Although I learned the hard way by setting myself radioactive, I'm glad it happened in this case.  Now, I have better technique, and I am more confident when I'm in the iodine room compounding with I-131.

Look closely! Yes, it says 'piglet' :)

More association to the title of my blog:) I love my job. I get to milk the cows and clean the pigs at my pharm!  Hope you enjoyed my entry! Send me a message if you have any questions or concerns!  

Cows in the Pharm

For the past couple weeks, I have been milking the cows, a.k.a generators on 3rd runs and 5th runs.  3rd run occurs around 0730hrs and 5th runs are around 1200hrs.  For the sake of speaking in correct nuclear terms, from this point on, I will be writing in military times.

The Generators and me

The generators are shielded inside these shields, so you cannot see them and that is for our protection.  And no, I am not wearing a space suit:)  In the compounding area, a.k.a buffer area, I have to gown up into a buffer coat (clean lab coat), booties for my shoes, hair net, disposable sleeves (in case we get our arms "hot"), and disposable hand gloves.  In case I get myself contaminated, I can just dispose items and set the lab coat in the decay room.  Once your lab coat or sometimes, pants are contaminated, you have to let it decay.  Depending on the isotope you were working with, it may take weeks for you to get your personal belonging back from the decal room.

These generators will produce the isotope Tc-99m, main juice of nuclear imaging drugs.  Items needed to milk a generator are: an empty 10mL or 20mL- drug vial, one elution shield, and one vial of saline solution (volume varies).  Milking the generator is the same as eluting and/or hitting.  I can say, "I am going to hit/elute/milk the generator."  After I elute the generator, I will proceed over to a callibrator to measure my Mo-99 breakthrough and assay how much Tc-99m activity I have required.

From left: elution shield, 10mL normal saline, evacuated 10mL vial, 10cc syringe

After you hit the generator, run away for a few seconds because it's HOT!!!

Carefully remove elution shield and replace shielded TechneStat vial.  Now, before using the activity I get, I need to determine the techneium Tc-99m concentration and molybdenum Mo-99 content.  Molybdenum Mo-99 breakthrough acceptable limit is 0.15 kilobecquerel molybdenum Mo-oo per megabacquerel technetium Tc-99m (0.15 microcurie Mo-00 per miliucurie Tc-99m) per administered dose in the injection, at time of administration. To determine that, I use the calibrator.

Calibrator- assays activity of individual isotopes

Step 1: using calibrator, press "Mo Assay" button, get background activity with this empty canister

Step 2: Open the elusion shield and place the evac vial with the activity in the canister, cap canister

Then, you assay the canister with the activity instead for Mo-99 breakthrough.  Next, take activity out of canister and measure the amount of technetium Tc-99m you have eluted.  Recently, I have assayed activity anywhere from 240 milicuries (mCi) to 3,000mCi.

Now, the technetium is used to compound different drug kids depending need for different imaging purposes ie bone imaging, gastric-intestinal studies, lung-ventilation studies, heart scans, etc.  Technetium has a half life (t_½) of 6.01 hours; it is the amount of time for technetium activity to decay its activity by half. Tc-99m has a wide variety of use and I will share more later on:)

There's technetium on the periodic table! 

I absolutely LOVE that all that chemistry and organic chemistry lectures from high school to graduate school have come to good use!  Not to mention, I love that I get to use many of the transition metals-- remember how they were really not mentioned as much as the halogens or inert gases? Try guessing the isotope Y!  This totally intrigues me...another reason why I love nuclear pharmacy!

I am thrilled that I will be starting my authorized user training course on Monday, January 9th, 2012. Good luck to me-- more studying to do for a couple more months!

Until next time!
Sarah


Photographs: Courtesy of Sarah and Gordy

Merry Christmas from the Staff!

I was fortunate enough to make it into our Christmas postcards at work.  Just in time for the holidays! These have been sent to all our clients.  My co-workers insisted that I stand in the front...they're a funny bunch:)

Merry Christmas and have a safe, and happy New Year!

Nuclear World

If you are not aware of the field I work in professionally, this is where you can learn more.  I have separated the blog space between my personal and my working life for those who are more interested in my field of work.  In the nuclear world, the use of the word "hot" is essentially our slang version of referring to anything that is radioactive-- and it can be a contamination of an area or item to anything that is radioactive. Hence, the title of this blog space.  Please, read this at your own discretion, it's all about my work, you might be bored if you don't like nerdy, scientific stuff:) 

An example of what "hot" means-- at work, we get called out by our coworkers if you get something contaminated.  "Hey Sarah, pigs were hot."  If you have sloppy techniques, you can easily get everything you use radioactive, a.k.a hot.  Contaminating the area means that you are exposing yourself and others to radioactivity, and nobody wants that.  And once you contaminated your gloves, you can easily wipe and transfer them off to other items you get your hands on.  Something that is "hot" isn't always a bad thing; it could be a negative if it's a contamination or a description if the area or item is known to be and supposed to be radioactive.

Unfortunately, you cannot see contamination through the naked eye.  One of the ways to find out the location of any contamination is by using a Geiger Mueller Survey Meter.

Geiger Mueller Pancake Meter

Any contamination you find whether it's on your body, an item, or a surface area, you will find that the GM meter will "scream."--  Think of it as an annoying alarm clock beeping at you.  

I have just come to the end of three weeks as a working professional.  It sure feels strange now that I have to grow up and be responsible.  I miss being an irresponsible student and having my parents take care of everything and anything.  Now I don't even get to eat my mother's home-cook meals three times a day! MM...homey, cozy meals sound so yummy right now.

On another note, somewhat work related, relocation is such a challenging thing! I have come to realize why so many people cannot just get up and move for a job!  First of all, I have been having so much difficulty communicating with CA State Board of Pharmacy in transferring all my pharmacist intern hours to MN State Board of Pharmacy.  Because everything is by snail mail, it makes everything that much more difficult having to send written requests for anything you need.  

Unofficially, I am a nuclear pharmacist.  Officially, I am only a pharmacist intern! I still have to take the MN MPJE, which is the state law portion to become licensed as a pharmacist in Minnesota.  I feel like I have not stopped studying since I was 10 years old.  

Next week, my fat three-inch binder full of Authorized User training material will be mailed from corporate.  Anyone who is interested to become a nuclear pharmacist or nuclear technician needs to go through an AU course and become licensed.  In order to qualify to take the course, you will need 500 hours working in a nuclear pharmacy setting.  After the 500 hours, you can enroll in a course that costs on average of $8,000, finally finishing up with a 200 hour didactic course.  Fortunately, Cardinal Health will be covering my training costs and I will be in Dublin, OH for three weeks my final training in April, 2012:)  

Yes, I will be studying and training to become a nuclear pharmacist.  If you're wondering, pharmacy schools do not prepare you to become a nuclear pharmacist.  There are only a couple schools in the U.S. that offers nuclear pharmacy in their pharmacy program.  Essentially, I have learned a lot in my 4 years of graduate school but not sufficient to be a pro in nuclear pharmacy.  

Hopefully, I will be able to open the pharmacy by myself by May, 2012!

PET Nuclear Pharmacy Technician: Brandon McRoberts

I will have to learn how to use the robotic hands to manipulate drawing FDG doses eventually.  No, I won't be working with this on a daily basis because I handle traditional nuclear pharmacy drugs and not PET pharmacy drugs.  You will find out that there are two sectors to nuclear pharmacy-- traditional vs. PET.  And no, I don't work with cancer chemotherapy drugs.  95% of the drugs we compound are for imaging purposes-- heart, lung, bone, liver, kidney scans and more.  The rest are therapy doses ie thyroid treatment. 

Ok- I can go on and on probably.  This is good for now.  

Tata!

Sarah

Welcome Week: November 21st, 2011

First day as a Nuclear Pharmacist.

Definitely appreciate the nice surprise in the break room:) 

Here is my work address:

Cardinal Health Nuclear Pharmacy

1933 County Road C2 W

Roseville, MN 55113

With all my family and friends' support, first week of work passed by fairly quickly.  I am just so glad that I did not have to drive through snow for work this week.  Apparently, this time last year, snow was up to your knees.  


For the first few days of work, I felt somewhat unproductive.  I am still waiting to take my radioactive safety course through the corporate HR website in order to start handling the radioactive drugs.  We had a staff meeting where the staff welcomed me to the team and also gave me a welcome gift! I will definitely be calling AAA or trying to shovel my car out of thick snow. 

Special thanks to my co-workers for my new toys!

There was a funny moment when one of the staff members asked, "So, how long have you been a pharmacist?" He was shocked when I said, "Three days..." It's somewhat crazy to be able to say that I am a working pharmacist instead of an intern pharmacist--it's a great feeling!:D  So, let me credit my friend, Jammy for helping me come up with such a cool blog name!  What is coincidental is that my field of work consist of "farm" terms. 

This is a generator aka "cow"

We "milk" the cow to elude the generators to get Tc99m.

Syringe shield made of Tungsten (aka "W" on periodic table)

This shield will protect us from radiation exposure to our hands. We use this to draw our doses from the drug vials.

Lead shield for drug vials

Drug vials are placed inside this shield.  Simply put, it's like making a chemotherapy dose at the hospital where you just use plain syringe and a drug bag.  However, in the nuclear medicine setting, syringe and drug vials both have to be shielded when we draw doses, making our hand muscles stronger.

Opened and unopened pigs

Finally, we dispense many of our doses in syringes.  Final products are radioactive aka "hot", so we place the hot syringes in the pigs to protect handlers from exposure.

Happy Thanksgiving, everyone!!! Since I started work on November 21st, I did not plan to go back to California to visit, so I actually worked through Thursday and Friday.  I had my first holiday work-day!  I started work at 2A.M. on Thanksgiving Day.  It was another good learning experience.  I must say, though, it was difficult to focus while your body wants to sleep.  Well, that's the life of a nuclear pharmacist-- we rotate all different shifts of the day and on-call nights and weekends.  Our hours of operation at this pharmacy location is 11P.M. to 6P.M..


Today, I assembled my ottoman (really not an assembly--screwed in the legs).  My room is finally completely furnished and feels super cozy and ready for the nice long winter!  I will post some pictures of the completed project on my next entry:)

I wanted an ottoman--particularly for extra storage:)

Tata for now,
Sarah