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The Legal Drug Dealer Podcast

Getting Pharmacy As A Profession Closer to The Patient

February 18, 2020

Geriatrics ~ Aging Healthy

With Dr. Veronica Riera-Gilley & Marilena Grittani, RPh

Hello there!

This episode is one of the main focus of my podcast, and Dr. Veronica Riera-Gilley did not disappoint!

The conversation was informational, in-depth, but easy to flow and such an eye-opener for many of you.

I would love to hear your comments about it at comments@thelegaldrugdealer.com

Some of the most relevant points she made are:

  • Aging does not mean that you have to live in pain or uncomfortable, nor that you must take a lot of medications.
  • Geriatrics is a branch of medicine dedicated to the aging population, as pediatrics is to kids.
  • Pharmacists don’t want to dispense drugs, we want to dispense education and health.
  • Death is a sure thing; you might as well get prepared to make decisions that you don’t want others to make.

"We (pharmacists) are dispensing health by being educators,
about the problems that come with drug therapy,
and the alternatives to it"

Dr. Veronica Riera-Gilley, PharmD, BCGP Tweet
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Listen To The Episode Here

If you think that you or someone you know can benefit from the information shared in this episode, please share it with them. 

And don’t forget that, if you are subscribed to our mailing list, you got the informational document that Dr. Veronica Riera-Gilley prepared for you. On this occasion is about Aging Healthy. 

As an attachment to our weekly email, but if you are not subscribed, make sure you subscribe to it, and you will get immediate access to it, and you will be up-to-date for future episodes.

This is Yankee, Veronica's dog.
This is Luvvie, Veronica's dog.

Veronica is so knowledgable, compassionate and kind.

She, also, knows how to explain stuff the way that we all get it!!!!!
Let me know what you think about our conversation and if you have any questions!!!

comments@thelegaldrugdealer.com

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Thank you!

"We (Pharmacists) do have the time as a consultant directly with patient pharmacist have enough time to deal with a patient in comparison with physicians that they barely have five minutes to exam."

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Episode Transcripts

Marilena Grittani, RPh 0:04
Hola! Marilena Grittani here. Welcome to The Legal drug dealer podcast. I’m a registered pharmacist and also your host. Today I have for you Dr. Veronica Rivera, one of my colleagues and she is the board certified pharmacist. We will be talking about geriatrics and other interesting stuff that I was not planning to do but it was right on the edge of geriatrics. You will be surprised but it’s going to be very interesting and I invite you to participate on this. Also, I want you to know that one of my co workers, the one that is looking at me right now, Zoey Gabriella is going to be making her appearance again, you know in this episode, as well as Veronica’s dog. You will be hearing them in the background so I apologize for that. But we can’t do anything about it. They think we’re talking to them, so they participate. If you don’t know who my co worker Zoey Gabriella is you just need to listen to episode number five, and you will hear everything about her. So let’s get to it. Here’s Veronica Reira. Board Certified geriatric pharmacist. Hi, Veronica, thank you for coming to the legal drug dealer podcast.

Dr. Veronica Riera-Gilley 1:13
Thank you for having me. I’m very excited to be here today.

Marilena Grittani, RPh 1:16
We’ll meet to a lot of reasons. This is one of the subjects that I wanted to talk specifically because I think the audience is going to enjoy that and learn a lot. But also because I feel like we know each other for a long time even though we just met because your dad is from the country that I was born on. And I never said that in my podcast before. So I felt like a family. Thank you. Thank you for being on the podcast and making me feel this comfortable. Okay, let’s just start people might be curious, thinking about what would you want to be a pharmacist,

Dr. Veronica Riera-Gilley 1:48
I decided to go into pharmacy because my mother’s best friend was in a car accident and had a traumatic brain injury. She was on a long list of medications and the side effects were very Severe and intolerable for her. She asked for help from her doctors. And she was told that this was her new normal. And she didn’t know that she had other options. So she discontinued all of her medications. Shortly after this, she died from suicide. And it’s because she had no support managing her withdrawal symptoms. This was a really big part of why I chose a career in pharmacy, because I wanted to be part of a solution to the problem that I saw in healthcare where medications are relied upon, as the only solution and patients are not regarded as experts in their own bodies.

Marilena Grittani, RPh 2:35
They’re not listened to, right. Yes, sadly, a clinical pharmacist would help her tremendously. So yeah, I see the why. And I’m very proud of you for choosing this as a career. That being the drive again, people understand why we become pharmacist I’m having chills as I’m speaking, by the way, because it’s very sweet. Thank you. Thank you for your services. Seriously, thank you. So tell me How long ago was that? When did you become a pharmacist?

Dr. Veronica Riera-Gilley 3:02
I have been a pharmacist 16 years now. Got my PharmD from southwestern Oklahoma State University. And in 2016, I earned my board certification in geriatric pharmacy.

Marilena Grittani, RPh 3:14
So you are a Board Certified pharmacist in geriatrics? Yes, that makes you an expert in geriatrics.

Dr. Veronica Riera-Gilley 3:21
Yes.

Marilena Grittani, RPh 3:22
Before we talk about that, tell me what type of jobs

Dr. Veronica Riera-Gilley 3:24
have you worked in the past I have worked in big box retail pharmacy, like the kind you find in the everything store. And I have also worked for the big chain drugstores, the kind that you find on every corner. I have worked for grocery store pharmacies. I have worked Clinical Pharmacy in a hospital. I’m currently working as a consultant with independent pharmacies, offering medication therapy management, and helping offer their advanced clinical services. One of those is teaching diabetes prevention classes.

Dr. Veronica Riera-Gilley 3:59
That’s the interesting and important actually, two episodes ago, we had a pre diabetes expert talking about this Dr. Theresa Morrow, one of the most important chronic diseases that we have in this country in terms of incidence. Sad, but it’s true.Thank you for doing that, too.

Dr. Veronica Riera-Gilley 4:16
And preventable,

Marilena Grittani, RPh 4:16
yes. Or at least manageable. Okay, Mary. So tell me what is it that motivates you to help patients,

Dr. Veronica Riera-Gilley 4:23
We have so much more power over our bodies and our disease states, than we’ve previously been led to believe. And I find it really exciting to empower people to rediscover the wisdom of their bodies and help them to start making choices so they can maximize their health with minimal medication.

Marilena Grittani, RPh 4:45
Amen to that. Is that what you’re doing as well right now? Is that what you are dedicating your professional life to?

Dr. Veronica Riera-Gilley 4:51
Yes

Marilena Grittani, RPh 4:52
So you do it on your own. You have your own consulting directly with independent pharmacists?

Dr. Veronica Riera-Gilley 4:57
Yes. So I’m collaborating with a pharmacist but I’m also working one on one with the clients. And we have long discussions over their medications, nutritional supplements, and we talk about every aspect of how to support them in whatever health challenge they’re facing. We talk about everything from physical exercise to supplements, food and nutrition, spiritual aspects. We touch a little bit on faith too, because it’s all connected.

Marilena Grittani, RPh 5:30
Definitely. And we do have the time as a consultant directly with patient pharmacist have enough time to deal with a patient in comparison with physicians that they barely have five minutes to exam.

Dr. Veronica Riera-Gilley 5:43
Yeah. That’s all you get with your physician.

Marilena Grittani, RPh 5:46
Yes. And then he starts reading the chart in your presence. It’s not that he prepares for you. Righ? So the 15 minutes is like five for him just to us or her just to ask questions. We don’t do that people. We have the time. That is like pharmacists are different.

Dr. Veronica Riera-Gilley 6:01
Yes, I do a lot of research before I ever sit down with someone, one on one I have poured over their medication list, and everything that they’ve put in that medical history that they give me, I look over all of it. And I look up every ingredient in every supplement, put a lot of thought before we sit down to talk about everything.

Marilena Grittani, RPh 6:21
So you go directly to the point rather than start learning about the patient at the moment that we started conversation.

Dr. Veronica Riera-Gilley 6:28
Yes, so the paperwork is lengthy and exhaustive, but it helps the patient get more FaceTime and more work done in that session, rather than still learning throughout half the session.

Marilena Grittani, RPh 6:41
And and one thing that I wanted to emphasize here is that the patient gets listened to and this type of interviews. My experience with doctors here is that they are the ones that talk you don’t get to talk, whatever you think of where questions you have, you don’t even have time to us because they just cut you off. They just tell you everything and bye next week have that mentality.

Dr. Veronica Riera-Gilley 7:01
It’s amazing what comes up when you let someone speak, and you listen to them. And it’s very surprising what comes out of that when you listen and someone is deeply heard. And I definitely had that experience with you the first time we spoke, and I told you my story about why I started pharmacy and I got very emotional and it’s because, I realized no one had ever sat and really listened to my story. And that’s really special and powerful and valuable.

Marilena Grittani, RPh 7:29
Well, I feel special. Absolutely! I think that we all have a story to tell and listening to people is a good way to learn. To get better as an individual. Yes, we want to talk about ourselves. We all do. But we need to learn about others and that way you get more rich as an individual. That’s my belief. How about if we start talking about geriatrics? What is that? What is it that is so important about it and why did you dedicate your professional life to it?

Dr. Veronica Riera-Gilley 8:00
Well, geriatrics is health care that’s tailored for an aging person. Anyone who carries a certification in geriatrics is going to have additional training in how the body works as we age, and they’re going to also have additional training in social, emotional, spiritual and family matters that can come up with aging in life and at the end of life. So we have additional training that’s very tailored towards aging bodies, and I ended up in geriatrics through yoga.

Marilena Grittani, RPh 8:35
Oh, that’s interesting. That’s a new one for me. Go ahead. Tell me.

Dr. Veronica Riera-Gilley 8:38
Well, I started taking yoga classes for myself, yoga teacher training classes, because I was getting so much relief from low back pain from an injury that I had in my college years. And the relief was phenomenal. And I knew because of my profession that I did not want to go the drug route. I knew what all the sudden effects were, and the interactions and so I knew going into my treatment that drugs were not going to be a part of it for me.

Dr. Veronica Riera-Gilley 9:07
So yoga was a fabulous way to manage my pain. And it was so helpful, I needed to learn more. And as part of that training, I had to give 8 community classes are free to get the certificate. I never thought that I would teach but I really wanted to finish it get that certificate. You know, we like to have all those letters behind your name. I taught those 8 classes at a hospital. It was through the senior circle, which is a volunteer organization that helps keep seniors active and offers them health information, Lunch and Learn opportunities, exercise classes, group travel opportunities, all these things to keep them engaged and connected in the community because, community is essential to our health as we age. It’s very important.

Dr. Veronica Riera-Gilley 9:54
And we see that we have poor outcomes or things don’t go as well and you have a shorter life. Stand when you don’t have that community of support through family or friends. So it was through that organization. I taught those 8 free classes. And it was wildly popular at the hospital, I had an average of 25 students. And that class continued for nine more years until the hospital changed ownership.

But for the nine years that I taught there was wonderful. I learned so much from those women. I realized from all the time that I spent with those women in my yoga class in men, I did have a handful of men that came to my classes, I realized it was a wonderful opportunity to help them invest in their health and that the yoga was a very important part of giving them tools that they could use to age more healthfully with fewer drugs because they were getting body awareness, breathing techniques, exercise that was fun and safe.

Marilena Grittani, RPh 11:07
And stretching that stretching part. And relaxation is so important and health. People don’t think about it. People think that Yoga is a Boodo thing. And it doesn’t really work as an exercise, but it does. And I’m saying people because I’m quoting my husband on that until he started taking yoga classes. And he was like, that was hard. He was sweating. I’m like, see it. Don’t talk about stuff that you don’t know. Try it and then say something.

Dr. Veronica Riera-Gilley 11:34
And there’s this misconception that Yoga has to be for really bendy flexible people and that it’s hard and it’s sweaty. The truth is, if you can breathe, you can practice yoga, and Yoga has something to offer everyone. Whether you’re in a hospital bed or you’re an elite athlete, there is some part of a yoga practice that is going to benefit your life and your health.

Marilena Grittani, RPh 11:57
I totally agree with you on that one. Mrs. Yogi.

Marilena Grittani, RPh 12:02
Okay, let’s just talk about benefits of geriatrics, from the patient’s standpoint. And caregivers or family members. What is it that we need to learn from geriatrics to take care of our aging community?

Dr. Veronica Riera-Gilley 12:19
I think it’s really important, to always assume that a new symptom occurring in the body is a side effect from a medication before assuming it’s a new problem. When you go into it with that mindset, you’re going to be looking from a different angle and not contributing to this problem of polypharmacy. That’s the word that we have given to taking multiple drugs. And we know that the more drugs that you take, the more chances are that you will have a negative outcome from those side effects. Many hospital visits, I think the statistic might be 1 in 6 emergency rooms visits are related to medication problems, medication harm. And so every opportunity that we have to decrease the number of medications, or find a solution that doesn’t even involve, adding another medication is always preferable.

Marilena Grittani, RPh 13:17
And it’s amazing that we’re capable to help a patient You say, Well, you don’t take this in the morning, you need to take it at night. And then a bunch of symptoms, side effects of the patient have had disappear. We didn’t even change the drug, nothing gets added or taken off the list,is simply in a different schedule. Maybe with food, maybe one an empty stomach; Is just little changes that we pharmacists can do that 90% I would say 95% of the doctors don’t even know about.

Dr. Veronica Riera-Gilley 13:48
Yes, that’s a really good point to make that a small scheduling tweak can make a big difference in managing side effects. If it’s a drug that’s essential, and it’s not one that you can get rid of. Yeah.

Marilena Grittani, RPh 13:59
One interesting example is levothyroxine. I had patients when I used to work retail, that would be telling me, I have been ion this drug 20 years, sometimes when I had time, which was not that frequent. While I was working for CVS, I would ask the patient that you have a minute to ask you a couple of questions, and they will be like we taking this drug for 20 years, what are you going to ask? I normally asked, what time of the day do you take this drug? And then they would say whatever answer they want that needed to say, and that would be like, are you sad? Have you been gaining weight? Are you a little slow? Are you a little bit fatigue? Do you just have sadness or wonder? Like, how do you know? And I said, well, because of the drug, you’re taking this drug for something that is not being done, simply because you’re taking it with food and levothyroxine interact with it. So it’s like a teenager girl Than Meets meets a bunch of other teenagers, they start partying and they forget to do their work. And then you just pee it out, it never works. What about if you start taking this and then empty stomach, just put it on your nightstand? take the pill before you touch the ground, and then try for a week and let me know if it works. If it didn’t you take it again the way that you used to take it. And I would say that 99% of the patients that made those changes, they will come to me two, three days later, smiling like, Oh my god, you have no idea what happened. And I’m like, No, Yeah, I did. I did have an idea. You didn’t, nor your doctor, but I did. And I’m sure the next time that you go check your blood, how your drug is doing, your doctor is going to decrease the concentration of the drug is going to give you less drug because it’s going to be utilized. So we are the experts and for me, it’s a nonsense and I know is for you too, if you say I take levothyroxine with food, you’re like oh, it’s not working for you, isn’t it? And they’re like, how do you know? Because that’s my expertise. That example we have a ton.

Dr. Veronica Riera-Gilley 15:57
I asked a lot of questions about Medication schedule, when do you take it? What are you taking it with? Are you consistent? Those are all very important questions to help tease out the medication problems. And that’s what these long lengthy medication therapy management interviews do is they spend a lot of time troubleshooting all the possible side effects from all the drugs, and trying to develop a plan to take back to your doctor to say, here’s what we think, is a medication related problem, and here’s how we want to solve it. And we work with the provider to make any changes.

Marilena Grittani, RPh 16:32
Sharzad Green one of my previous interviewees. She talks about bio identicals or hormonal replacement. She said something so interesting to me, that is a triangle relationship between the patient the pharmacist and the doctor.

Marilena Grittani, RPh 16:48
Because we cannot get a patient better without a diagnosis. But the diagnosis is just part of the solution, the medication and the monitoring of it, and making sure that is working on is not hurting the patient while is helping, if it is, is also very important. It’s not just you see the Physician and they have the Midas touch and then you’re fixed. It’s not that easy. It is not the pharmacist is part of the team to get the patient better. So talking about that, what is your relationship or your interactions with family members or caregivers for your geriatric.

Dr. Veronica Riera-Gilley 17:24
It can be a challenge sometimes when there’s a mismatch of expectations, between the patient and the family or the caregiver. And it’s very important, while you still have your mental faculties, that you make it very clear, what are your wishes for the kind of care that you want? What types of things near the end of life are acceptable to you, not acceptable to you and make that very clear, make sure that you have a will, and then come back to the family members and the caregivers. Be sure that you’re very familiar with your loved one or the person that you’re caring for, know what their wishes are for their health care. And for the kind of quality of life that they want to have left. Make sure that you’re able to separate your own feelings from it and choose the healthcare and the next intervention, or whatever choice that needs to be made, that you are making the choice that your loved one would want; be able to separate your own feelings from that because sometimes we’re choosing care for ourselves. We want more time with a loved one. Sometimes more care is not actually the compassionate thing to do. The Compassionate thing sometimes is to let nature take its course.

Dr. Veronica Riera-Gilley 18:43
That is something that is challenging it is to talk about death. I think it can be scary. We just need to talk about it more because, it’s going to happen to every single one of us. It’s one of the only things that’s guaranteed in life. We have the opportunity to make sure that the life we have now is its best, so that we’re not grasping for more time later.

Marilena Grittani, RPh 19:07
I cannot agree more. And I want the listeners, everybody that is listening to this conversation to be mindful of that. Whether you are 19 years old or 42, or 72. Think about it. Because you don’t want to give that responsibility,of making decisions for your life to others, not only because they might not do what you want to do, but also because for them might be a really, really hard decision to make.

Marilena Grittani, RPh 19:36
When I’m so lonely. When my son turned 18. My husband said joking now Hayden can make decisions for me. And I said, Yeah, make sure everything is written down. So he does not have to decide he will enforce them, not make decisions,is what you want. He won’t decide. Because there’s a lot of pressure. And if you think about it, the feelings of losing somebody that they love so much, whether it’s period spouse, or simply a friend or even a caregiver, you want to honor their decisions and to give them the best life that they can have for whatever length of time they have left. Feeling support, because in this case, you are not the important part is the patient that is going through this. And I’ve seen it so many times. Please think about it.

Dr. Veronica Riera-Gilley 20:22
I saw it so often in the hospital, that there were these very frail, elderly patients. I can remember one in particular, she was 100 years old, and she was admitted to the hospital. I don’t remember what her admitting diagnosis was. But while she was there, she decided not to eat, they were trying to order all of these drugs, that really don’t have a proven benefit in an older population. And they have a greater incidence of side effects and so they are not commonly recommended. Even though these agents that they were ordering might help to encourage appetite, they Have more side effects, then benefits. And let’s be very honest, if you live to 100, you have lived a very good, long life. Her not eating was her way of saying I’m ready to be done. And we were not honoring that. The physician was not happy with me. But I advocated for the patients. And I said, I don’t think that we should give her these drugs, I understand that the family is pushing for these drugs, but given her age; given the likelihood that we’re going to give her five years of quality on the other side of this. I recommend that we do not force these drugs on the patient and we let her not eat.

Dr. Veronica Riera-Gilley 21:38
Animals instinctively know when it’s time for them to leave the earth. And they go off in a quiet place and they don’t eat or drink. We’re not given that opportunity. So I think it’s something to think about when our loved ones start making choices of not eating, not drinking.

Marilena Grittani, RPh 21:55
I think that you should make those decisions early in life and if anything changes, is just make sure you communicate it to those people that would help you enforce those decisions. But, you need to think about it while you have your mind clear, not at the moment that you can’t not talk.

Marilena Grittani, RPh 22:12
And fortunately for him, a very young guy passed yesterday at the moment that we’re recording this is that they asked her Kobe Bryant die. I have chills talking about this because I was one of his fans. I saw him playing more than 20-30 times at this table centers when I lived in Los Angeles. And for me, he’s the greatest basketball player, ever. And he was going to a game with his daughter, and he never made it home. He was 41.

Marilena Grittani, RPh 22:41
So now the wife is the one that is going to enforce whatever he wanted. And even the daughter you don’t think, you don’t expect somebody to pass at 13 years old, but unfortunately it happens. So, we need to be thinking being mindful of this and not leaving others or responsibility for something that might not Be what you want it to do.

Marilena Grittani, RPh 23:02
Same case for when you want to donate your organs, people might not even want to think about it when they’re grieving your death. But, you can save other people’s lives if that is your choice. So you need to make the decision, make sure it’s in your medical records and in your ID. So it would be enforced whether they wanted to set it or not, they would say you know what, this person decided you have no words here, and there will be easier for them to let go is a hard topic.

Dr. Veronica Riera-Gilley 23:27
It is hard and we’ve gotten so good with our modern medical care that sometimes we don’t know. We don’t recognize anymore that wow, we are at the end of life. We need to not give any more of this very invasive, life saving care because the quality on the other side of it is not the same.

Marilena Grittani, RPh 23:46
You heard that was my soul is shaking, you know that she’s my coworker and she always have to make her entrance in our conversations. She cannot stop herself.

Marilena Grittani, RPh 23:56
One thing that I wanted to make sure this is mentioned as well. is at the moment that you’re having a really hard time, whether you’re being treated in the ers for a heart attack or, or you have had a stroke or a traffic accident, the family (being an ER pharmacist) I heard that so many times the family would say, Do whatever you need to do to save them. You know, that’s not always the case. We shouldn’t do that every single time. Number one, there’s circumstances that the life after that is not going to be what it was, and the person is going to end up suffering more, or maybe that’s not their wish. So I think that the family or the relatives, say those words, thinking that they’re honoring this person, but I think an easy way to honor what they want,is for us to establish what we want others to do for us when we can’t make decision. When we’re in this position that we cannot make decisions anymore, and then make it easier for them. So think about that is a real dark topic, but it has to be talked about because as you said, Veronica is going to happen.

Dr. Veronica Riera-Gilley 25:01
And we can make the years that we have now, the best, the brightest, the healthiest, we can be proactive in our healthcare, a geriatric pharmacist can help you maximize the health in the US that you have remaining. There’s no set age, when you need the care of a geriatric pharmacist or a geriatric physician, it’s a very personal choice. But I would say anyone who’s in their second half of life and with the average life expectancy in the United States being around 76. So you know, in your 40s,

Marilena Grittani, RPh 25:31
The earlier you start, the better life you’re going to have, your last years are going to be better.

Dr. Veronica Riera-Gilley 25:36
And if you have someone who’s advocating for you always thinking ahead in the long term consequence, and what does this look like, as you get closer to death? We’re always looking for how do we improve the outcomes and how do we keep you safe, while also not keeping you too safe, if that makes sense? Because think of patients who are at risk for a fall, if we always keep them safe, then we’re decreasing their mobility, we’re not letting them get up. And then we’re putting them at risk for a different set of complications, which may be a blood clot. So we have to, to balance. Bed Sores. We have to balance some of this because there is such a thing as too safe and creating other negative consequences.

Marilena Grittani, RPh 26:17
What’s the point of being the life if you’re not enjoying life?

Dr. Veronica Riera-Gilley 26:21
All of this talk makes me think of a resource that I wanted to mention for our listeners. There was a wonderful book written by a physician. His name is Dr. Atul Gawande, and the name of his book is “Being Mortal:medicine and what matters in the end” and I thought it was a really wonderful resource to read about how we arrived at eldercare in American’s society, how that evolved and what it was intended to be and how it’s turned into something else. It gives a lot of really good examples of what end of life care can look like to improve quality. How choices can differ When we embrace that we know what the end is, instead of trying to always find that last life saving measure, how do our choices differ and really improve the quality as we move through a serious illness.

Marilena Grittani, RPh 27:13
I’ve never heard about that book, but I’m not going to read it. I’m going to put it in the show notes, so people can just click on it and find it. Thank you, for that recomendation.

Dr. Veronica Riera-Gilley 27:22
You’re welcome. And he’s got several YouTube videos, you know, where he’s done interviews, promoting the book and his great information there. If if you’re,if you don’t want to pick it up yet and just want to see little snippets of what he’s about. It’s, it’s a wonderful resource and a great place to get started in this conversation around death and choices as you move forward in your healthcare.

Marilena Grittani, RPh 27:45
I will put those videos there too, so we will learn from him. Thank you, Veronica, for that recommendation.

Dr. Veronica Riera-Gilley 27:51
You’re welcome.

Marilena Grittani, RPh 27:52
Tell me about suggestions that geriatric patients do to find specialists to help them at that point in their lives.

Dr. Veronica Riera-Gilley 28:00
If patients would like to find a physician or nurse practitioner with geriatric training, they can go to helpinaging.org that is put out by the American geriatric society. And they have a listing of everyone who is a certified geriatric practitioner. If you want to find a pharmacist who is certified in geriatrics go to helpwithmymeds.org and I’ve also included a PDF worksheet for you to email to listeners that has more information about helpwithmymeds.org and that’s how to find a senior care pharmacist. So a pharmacist with training similar to mine who is going to be looking for these problematic drug combinations and really looking out for your drug safety.

Marilena Grittani, RPh 28:49
I will have a link on the show notes with that,is a very concise and very simple way to put it together is with lay terms so it will be perfect for the patient, caregivers and also the family.

Marilena Grittani, RPh 29:02
Sometimes, like a my age, I’m close to be 50. And my parents are at least 20 years older than me. And you think about their health and their future. And you want the best for them because they gave you life and they did everything for you was you were little. So, now that they’re a little fragile or sensitive to stuff that you didn’t even know, you feel like you want to give back to them. So, what is a good way for a family or a son or daughter or an in-law that wants to do the best for their aging parents or step parents to truly help

Marilena Grittani, RPh 30:14
He is too young, That’s what we think. Right? But it’s never too early.

Dr. Veronica Riera-Gilley 30:18
No, I need to ask my dad this. And I’m assuming his answer would be, if I can no longer fly the plane. Let me go. That’s my guess. So I need to go home and ask my dad that question. But we need to know at what point is it okay to let our loved ones go? Because then like you said, it’s not our decision, they made it and we’re honoring it so it can help us help guide us; and that will tell you everything you need to know about. The next steps is if you know what’s really, really important to them to continue doing if they have a hobby or, you know, if they love food, if they’re like, oh, if this takes away my ability to eat, don’t give me a feeding tube. If I can’t eat and enjoy it, I rather die.

Marilena Grittani, RPh 30:59
Just keep Some water and let me go at my time.

Dr. Veronica Riera-Gilley 31:03
So I think that’s what I would say is, is really understand what’s important to your loved ones and what kinds of things do they need preserved in their life for them to feel like they still want to be here.

Marilena Grittani, RPh 31:14
We are having a situation similar to this with my father in law. He He used to be a very strong man, and now he’s super weak and I don’t think he would want to see himself like this. It’s not him anymore. And we understand this. We both are and healthcare and we we understand that this is normal, but the very few minutes of clarity that he has on his mind, he knows that all of this is happening and he’s very frustrated and upset with his body that is quitting on him. And his brain, is also doing that to him fortunately have you know, said what he wanted to do. He’s a very religious person so he had made his decisions and every everybody’s gonna follow what he decide. But it’s very hard to see it, if you as a family member or caregiver can see it, imagine them going through it.

Marilena Grittani, RPh 32:04
That is something that I would absolutely recommend to people that have family members that are older aging. If you see that, you know for a fact they are feeling it, just think for a minute what they will be feeling how you can help. And the other thing is, there’s nothing better that you can give them than the most valuable aspect of your life. That is time. Spend time with them. Take them to the bingo game, if that’s what they’d like to do. Give them a ride through flower beds of parks. That’s what they like to see take them to the beach, to do stuff and I know that our lives and I guilty myself of running like crazy all the time. And then forgetting about the ones that really mean a lot to me. We need to dedicate more time to that is when it’s too late. It’s too late. You can’t do it anymore.

Dr. Veronica Riera-Gilley 32:55
In my family. I’ve seen a wonderful example of how we we are taking care of of each other in the home. No one in my immediate family has had to go into nursing care. And we’ve made sure to utilize the support of home health nurses and hospice and there’s wonderful resources available to help keep people at home, if you’re willing to ask.

Dr. Veronica Riera-Gilley 33:18
My grandfather was on hospice for three and a half years before he passed, and I helped with his last clothing change before he passed and his skin was pristine, not the slightest discoloration or start of a bed sore, and he never left his bed for two and a half years.

Dr. Veronica Riera-Gilley 33:37
I really think that that’s because of all the support that we had with home health and hospice. We had a home health nurse come five days a week to bathe them. I don’t know that people know that it is possible to receive that level of care but bed sores and breaking down of tissue and infections and wounds don’t have to be part of the story but It does take some investment on our part advocating for our loved ones. And there was a point when they tried to take the baths away, we had to do some paperwork and some other things. We got to keep that service and we said, this is really valuable. My grandmother cannot move him to bathe him, we really need that assistance. And we knew that, that regular bathing was preventing the pressure source and keeping a skin healthy and we had to do some advocating and say this is for his quality of life and reducing infections and things like that. So this is,this is necessary.

Marilena Grittani, RPh 34:32
That’s a very good point. Now that you mentioned hospice, would you explain to our audience what’s the difference between geriatrics and hospice? Because most people think is the same thing.

Dr. Veronica Riera-Gilley 34:43
ospice care is reserved for patients that have a are expected to have a shorter window to live and they have usually some sort of terminal illness. I do know that hospice care is not utilized as early as it could be in many cases, that we do have this association with hospice means that you’re on death’s door, but it doesn’t. My grandfather lived two and a half years after he was admitted on hospice. Hospice means that you meet a certain set of criteria where it does not look like your survival is good, but it is not an immediate death sentence and that there’s a lot of resources available when you’re enrolled in hospice to support your quality of life, go into hospice care.

Marilena Grittani, RPh 35:29
Well, Juliet tricks is to keep you healthy, you are already healthy or you don’t have them in complications. So the purpose of geriatrics is to keep you as healthy as you can for as many years as we can

Dr. Veronica Riera-Gilley 35:40
Yes

Marilena Grittani, RPh 35:41
Is 2 different things. Not that because you’re seeing the geriatric specialist, it means that will your you’re signing your death sentence?

Dr. Veronica Riera-Gilley 35:49
Oh, absolutely not. It just means that you want someone who’s more in tune with what’s going on in your body and who was really going to advocate for you and has done that extra training to be more sensitive to the issues that come as you get older. And priorities change.

Marilena Grittani, RPh 36:05
One analogy that I like to make is if you had an old car, you knew that you needed to treat it differently, you needed to tweak it here and there more frequently because it was an age piece of equipment. In this case, the same thing applies for our bodies. We have work that poor body out for 60-70 years and it’s not brand new anymore, and things change.

Marilena Grittani, RPh 36:27
And the same way that you have specialists for newborns for toddlers and children. Then you have a specialty somebody that is dedicated fully to this age where things change.

Dr. Veronica Riera-Gilley 36:39
And drugs work differently in a body that’s aging, your kidneys are not as efficient. As you get older, your liver is not as efficient and so, we factor all those things in when we’re looking at your drug therapy and we may even ask your doctor for lab work so that we have a better idea and can better calculate the recommended dosage based on some of the numbers that we use to measure your kidney function.

Marilena Grittani, RPh 37:04
And sometimes weight is taking consideration to dose a patient rather than age them when you get older. Again, everything that to it to a kidney function, your liver function or…

Dr. Veronica Riera-Gilley 37:16
Your body composition changes, your fat and your muscle are not in the same ratios as they were when you’re younger and certain drugs may deposit more in fat versus the water in your body. And so, we take those things into consideration when we’re looking at the drugs that you need to take.

Marilena Grittani, RPh 37:33
So that is some area of expertise, that people like you that are more certified to treat geriatric patients are experts. I’m a pharmacist and I know how to dose stuff but I’m not an expert. I have an idea but I am not an expert. I’m more of a generalist. And if I had a patient that was having polypharmacy, which is more than five or six drugs at the time, which I had patients with 25 more, somebody older than 65, I would say you qualify based on what you have to go talk to somebody that is a specialist like Veronica, that is a geriatric board certified pharmacists that will know way more than I do to help you and to prevent complications in the future. That’s how it works. Everybody has their place, everybody has their area of expertise. And in this case, this is subspecialty would you have for this kind of patients

Marilena Grittani, RPh 38:22
Yes, and I want to say, that sometimes people start with one drug that is for a short period of time, let’s say that you have a teenager that needed braces and they have to take one of the wisdom tooth out, and then they get a control drug for pain. I’ve seen patients getting used to those medications just like that, the patient wasn’t even sick.

Dr. Veronica Riera-Gilley 38:22
Thank you, I would venture to say if you even take one drug, you need to have maybe not a geriatric pharmacist, but you need to be talking to your pharmacist and get to know them on a first name basis. Because they can help you make sure that that one drug doesn’t turn into two drugs on down the line into 12, 13, 14 drugs, because it starts with one and after that it increases. We call it the prescribing cascade where things just multiply as we add one thing well then we need to add two things, three things and we find that there is this strong correlation between having a negative event, an adverse drug event with the more medications that you’re taking. And so, I would encourage our listeners that if you think oh, this isn’t for me, I don’t take a whole bunch of drugs, I just take one. But you take one, talk to your pharmacist and find out, how can you get rid of that one? or How can you make sure that you don’t add any more to that list?

Marilena Grittani, RPh 39:45
So then you need the pharmacist to tell you how to take it, how not to take it what to think what to take in consideration of to expect from it. And as I said in episode number two doctors don’t know about this. Doctors have one semester of pharmacology And one semester of therapeutics, which means one semester about drugs, and one semester about how drugs work in your body. We have more than 20. We find the study drugs and how drugs work for more than 20 classes, full semester classes.

Marilena Grittani, RPh 40:18
So, who are you going to ask about drugs the doctor, or the pharmacist, the expert or the one that has an idea about it? So you would think because the doctor prescribed that he should know more, that’s not the case. We are the ones that know, and any physician, any practitioner that is responsible, and it cares about their patients would say go talk to your pharmacist about this.

Dr. Veronica Riera-Gilley 40:40
We are the experts at the chemistry of the body

Marilena Grittani, RPh 40:44
And how it works and how it interacts with your body. Absolutely. So, use the expert form what you need for situation in which you are don’t think that a generalist knows it all. That’s why we have specialists. That’s us. That’s why I call the podcast the way that I called it. I am a drug dealer. People don’t think that medications are bad or could harm you they are.

Marilena Grittani, RPh 41:07
Guess what? asked every pharmacist that you know, how many drugs do you take? Most likely, they’re going to say almost none, because we know what they can do to you. So if he was so naive and so good to your body, we will be swallowing a bunch of tablets, but we don’t, because we know better. So when you need to talk about drugs, you talked to the specialist to the expert, and in this case is your pharmacist, like Miss Veronica and myself,

Dr. Veronica Riera-Gilley 41:34
It would make me so happy if I could help everyone get off all their medications, and it would put me out of a job that would be my ultimate goal, is to see everyone achieve their best health without being tied to a pill bottle.

Marilena Grittani, RPh 41:50
That might not be the goal of the owner of the pharmacy, whether is a big chain or hospital or supermarket chain, that might not be the business that they’re on. But that is not our idea. We are healthcare providers, we want you to be better.

Dr. Veronica Riera-Gilley 42:04
Well, and there there is a way for us to be sustained in our profession without always dispensing pills, the way that we’re doing that is trying to dispense help being educators about the problems that come with drug therapy and the alternatives to it.

Marilena Grittani, RPh 42:21
I like that, we are dispensing health, not medication. I’m going to quote you on that, Miss Veronica.

Dr. Veronica Riera-Gilley 42:28
Thank you.

Marilena Grittani, RPh 42:28
I love it. I do love it. Okay. Do you have anything else to add about geriatrics that we have not talked about yet?

Dr. Veronica Riera-Gilley 42:36
I have a couple of more resources in the geriatric vein to recommend for listeners. There’s an organization called Death cafe. And they encourage gatherings of people to come together to talk about death without an agenda without a sales pitch for a service, without any sort of religious slant just to come together, and to talk about death, and whatever that looks like these gatherings are happening across the globe. And I’m actually hoping to start one in the community where I live in, there’s not one very close to me. And so I’m excited about hosting some of these conversations and helping people get comfortable talking about death, realizing that it’s not scary, we can prepare for it, we can be happy doing it. And we can be sad, knowing the loss of our loved ones is coming. But we can be happy about what we’re building in the here and now, and that we’re going to have wonderful lives to celebrate at the end.

Marilena Grittani, RPh 43:38
Yeah, I think that that’s the goal. So people are asking themselves, where do you leave? How do you do I know first of all, they need to go to that website.

Dr. Veronica Riera-Gilley 43:45
You can type in your zip code and it will give you a list of gatherings that are happening in your zip code or close to your zip code.

Marilena Grittani, RPh 43:53
Where are you located geographically, if people want to go to your meetings,

Dr. Veronica Riera-Gilley 43:58
I am in Sherman, Texas.

Marilena Grittani, RPh 44:00
Okay, so if you’re close to Sherman, Texas, wait for Veronica’s meeting.

Dr. Veronica Riera-Gilley 44:05
It’s it’s an agenda free meeting. So I don’t get to put my pharmacist spin on it, I just get to show up and hold space for people to talk about it. I would love to put my spin on it my two cents. But the purpose of it is to be very open, welcoming, non judgmental, so that people know that it’s a safe space, and they’re not going to be pushed in any one particular direction, that they can just come and talk and learn.

Marilena Grittani, RPh 44:33
Well, they already know that you care. So I would be delighted to go to your meetings. This is what I’m going to do. Whenever you’re ready to start your group, come over to the podcast, and we will just officially announce it to the world.

Dr. Veronica Riera-Gilley 44:45
I love it whenever you live it and then I’ll let you know.

Marilena Grittani, RPh 44:49
Okay, haha! how we got her. Okay, anything else that you want to add about geriatrics.

Dr. Veronica Riera-Gilley 44:55
I have one more resource to share. Okay, it’s called the endwellproject.org They have a lot of great videos about death dying end of life care issues. So you can check that out. Just for more learning.

Marilena Grittani, RPh 45:08
I’m going to put all of these information in the show notes. Whether is where you listen to this podcast, and also in my website is going to be thelegaldrugdealer.com/10. Because this is episode number 10. And then there you’re going to see, you know, review what we talked about, the links of what she had mentioned, the books and all the resources that she mentioned, specific page that she built for us, so you can download it and remember any other resources that we might have there.

Marilena Grittani, RPh 45:38
And something that is interesting for people to know is that,I get to transcribe every single word that we talked about. I wish sometimes I didn’t because I make so many mistakes that I wish that wasn’t transcribed exactly. But that’s what it is for those people that are not that comfortable listening or they have hearing problems they can read, our conversation and the episode page and normally is thelegaldrugdealer.com/ the episode number, so you can go there and get specific information.

Marilena Grittani, RPh 46:11
So now that we’re done with geriatrics, I want you to go back to being a pharmacist, the generalist pharmacist like we all are once we graduate, and I wanted to please tell us something that you think,that most patient are not aware of being a pharmacist or what pharmacy it is.

Dr. Veronica Riera-Gilley 46:32
I think we’ve touched on that, that we really want to see you well that we don’t think that pills are always the right solution. We genuinely care about your health and well being we really want to see you to the best health. We are not trying to just sell you another supplement, or sell you another pill. We want to get you to the right solution for your health. It’s not always dispensing a pill or a supplement. Sometimes it’s pointing you to another provider or encouraging you to go to a yoga class or attend a church group. There’s so many things that are really important to our health, and our health is not just in our physical body. It’s in our mental, spiritual, emotional. It’s all connected.

Marilena Grittani, RPh 47:20
It is. It sure is.

Marilena Grittani, RPh 47:22
Now, this is the uncomfortable question, but I want you to please help me Let our listeners understand how we feel when this happens. What is something that you felt that it was disrespectful that was said or done to you when you were working as a pharmacist by a patient?

Dr. Veronica Riera-Gilley 47:40
while I was working in Lubbock, Texas at the time, and our clientele was predominantly Spanish speaking, but not everyone. I know the listeners can’t see us but

Marilena Grittani, RPh 47:54
she’s beautiful. She’s gorgeous. I have to tell She sure is

Dr. Veronica Riera-Gilley 47:57
And you are as well, Mary

Marilena Grittani, RPh 47:59
Oh thank, thank you!

Dr. Veronica Riera-Gilley 48:02
So you may not be able to tell by listening to us, we have different skin tones, we looked different. And you would not know by looking at me that I speak Spanish. And now I am not a native speaker of Spanish, my native language is English. And I learned Spanish in school. And I do like to help customers in Spanish. There was a gentleman who approached me at the window and he approached me in English, so I respond to him in English. And when I turned my back to go collect his prescription, he started muttering under his breath in Spanish, oh, the stupid girl, the youth, and they don’t even bother to learn the language. And he was saying all kinds of very unkind things that I don’t think he would have said to my face, had he known that I could understand what he was saying.

Dr. Veronica Riera-Gilley 48:47
And it was also very surprising to me, since I very seldom get mistaken as possible Spanish speaker; I turned to him in Spanish and I said, I understand everything that you’re saying. I’m happy to help you. If you ask, but I cannot read minds, therefore, I will approach you in the language that you approach me. But in the future, senor so and so. I’m happy to help you in Spanish

Marilena Grittani, RPh 49:12
People don’t think about how it’s received. People are just concerned about what they want to say at the moment they think about it. They don’t put in that side. How is this person going to feel after I say or do but I’m thinking we’re there to help you. The last thing that we expect when we’re trying to help is for you to be rude and disrespectful to us. It’s just not kind. It’s just not kind. But, I know pharmacists are in a very uncomfortable situation because we are taking care of people that are sick that might be coming from an emergency room, or after a surgery or the kid is sick and they didn’t sleep for the past three days. You know, it’s uncomfortable, is we know they’re in distress. We understand that.

Dr. Veronica Riera-Gilley 49:58
We are the last stop. We Get that you’ve had to wait forever in the doctor’s office, and you’ve had to wait forever at all these multiple points in the healthcare system, and then you get to us. And sometimes you have to wait with us. And it can be very frustrating. I understand having been on the patient side too; like, I have to wait. Again, I think that comes to something that I I want patients to know is that Quality Matters deeply to us. And you can’t rush quality, we need to take that extra time, sometimes to double check or make a phone call to the physician to clarify a prescription. Because it really matters to us that we get it right. And if we’re not sure, we’re going to take the extra time to make that phone call and double check for your safety.

Marilena Grittani, RPh 50:40
Yeah, it’s the last step but is that taking that what could really harm you. If you’re allergic or if you have an interaction or if works bad with something that you’re taking, we understand that you don’t know what we do. But, we need you to understand that we’re doing it for your safety, not because we’re rude or because we want you to waste your time, or because we don’t care about how you feel, or because we think that we’re important and you are not. We’re taking care of you and people that were there before you that might be in the same circumstances that you are.

Dr. Veronica Riera-Gilley 51:11
Safety first.

Marilena Grittani, RPh 51:13
Always, yeah, taking care of you. Okay, so let’s just switch it and say what is the funniest or the cutest thing that ever happened to you being a pharmacist?

Dr. Veronica Riera-Gilley 51:22
This one comes back to Spanish.

Marilena Grittani, RPh 51:26
Si, Senora, Senora.

Dr. Veronica Riera-Gilley 51:29
I was getting flu shots. And I asked a gentleman and I said, es usted allergico a los huevos? are you allergic to eggs? We should all ask this and his eyes got really big. And I didn’t understand why. I’ve never heard the word “huevos”, used in any other context other than on your plate to eat

Marilena Grittani, RPh 51:50
From a chicken! Yeah

Dr. Veronica Riera-Gilley 51:52
I had a technician who had grown up in the area. So they were, I guess speaking local Spanish and I’m speaking texts. Book Spanish. Yeah. And she turns to me after he’s gone and she said, Why did you ask him if he was allergic to his testicles? I said, I did no such thing. And I said, What do you call chicken eggs? And she says “blaquillos”. wWhich translates little white things, right?

Marilena Grittani, RPh 52:20
Yes. Yeah.

Dr. Veronica Riera-Gilley 52:24
But that’s the funniest, most embarrassing language faux pas, I’ve had in the pharmacy.

Marilena Grittani, RPh 52:31
Again, that depends on where you are because the word, “huevo” technically means where you can reproduce from, and yes, that is part of the testicles function. But the actual proper word translation for words is eggs. Is that simple.

Dr. Veronica Riera-Gilley 52:48
I guess it would be the English equivalent of someone busting your balls.

Marilena Grittani, RPh 52:52
Yes. Something similar to that. If you said are you allergic to your balls, and then they will be like, you’re really are you asking me about my testicle Yeah, I think it’s funny, I think.

Dr. Veronica Riera-Gilley 53:04
So that’s the funniest thing I have to share

Marilena Grittani, RPh 53:08
I bet it was uncomfortable. I’m sorry, Veronica. But you were proper. I have to say that as a first thing. first language here, I can tell you that you did. You were proper. These people were not but again, you have to adapt to what the community where you’re living at uses, and sometimes is complicated. Some words that are food in one country are an insult in other so you need to be careful.

Marilena Grittani, RPh 53:35
To close this episode. What is something that you want to remind our listeners about us pharmacist, drug dealers in general…

Dr. Veronica Riera-Gilley 53:43
That we want to advocate for you in a system that’s not always advocating for you? We, we want to help you get better health care, and we want to have a part in making sure that you’re not one of these statistics that ends up in the ER From an adverse drug event, and we want to be part of your healthcare team, help keep you safe, maximize your health with minimal medications.

Marilena Grittani, RPh 54:08
That’s our goal. Thank you for that. Thank you for reminding that. I’ve been trying to communicate this over and over in every episode, and it makes me feel better that you are doing the same. Because we have no other reason, that is not to protect our patients period.

Marilena Grittani, RPh 54:25
It was fun. It was informative. It was serious and funny, as well. So thank you so much, Veronica, come for coming to the legal drug dealer podcast. It was a pleasure and you’re coming back. I do not care what you’re thinking lady, or you’re coming back. Okay?

Dr. Veronica Riera-Gilley 54:43
Okay.

Marilena Grittani, RPh 54:43
And we need to announce to the public that you’re going to have your group in your local area in Texas. Okay.

Dr. Veronica Riera-Gilley 54:50
Perfect. Thank you so much for being here with me, Veronica.

Marilena Grittani, RPh 54:53
Thank you for having me. Have a good rest of your day. So how was it? What do you think about this episode? Wasn’t it interesting? Was it something that you were not expecting? That second part we were talking about about that and make sure we have plans and talk aboiut it to our loved ones. I think it’s very interesting, because as she said, something that we know for sure is that we all are going to die. I don’t think it’s a dark thing, working in healthcare, we understand that is part of life. And we need to make sure everybody’s aware of what we want. And you communicate that to those that you know, are going to enforce and respect our wishes, and those times that we were we’re not there to make decisions or to express our opinion.

Marilena Grittani, RPh 55:39
Also, I think is going to be very interesting to participate in this event that Veronica is going to start organizing in her area. She promised to come back to let us not that she was going to start them.

Marilena Grittani, RPh 55:50
But meanwhile, I’m going to leave all the links of the book that she mentioned, and also those organizations where you can find geriatrics physicians, practitioners and also pharmacists online. So you can find them really easy maybe for you or for family members.

Marilena Grittani, RPh 56:08
So that is it for this episode. Thank you so much for listening. Please subscribe to the podcast, give us a review. And if you have questions, send them to me at comments@thelegaldrugdealer.com And I will make sure to respond directly to you or I include them on my monthly solo episode where I will be answering all your questions. Also, visit thelegaldrugdealer.com. look around and see what I have there for you. And follow us on Instagram, private Facebook group community and subscribe to our mailing list so you will not miss a thing.

Marilena Grittani, RPh 56:41
Next week I will be talking to somebody very close to my heart. Somebody that was my mentor, my friend, my colleague, and also somebody that I look up to the one that I from all my ideas by her name is Swapna Chakrabarti. She is a pharmacist and She have been working specifically in the past few on what is called MTM which is Medication Therapy Management. She had been doing this for a while and she is so good at it. And I want her to explain to you what is that about and how important it is for you guys.

Marilena Grittani, RPh 57:17
If you heard the sigth that was Bella Christina, my other co she wanted to make her apperance too.

Marilena Grittani, RPh 57:24
Next week promise a lot you will be having fun is like having my “comadre” here at my living room talking and chatting. It will be very informative and we will have a lot of fun.

Marilena Grittani, RPh 57:35
So until then, but before I go, and just in case no one has told you today, I wanted to take a minute to remind you of how awesome you are. And how lucky are those that have you in their lives. Thank you for being the awesome you that you are.

Marilena Grittani, RPh 57:52
Have a wonderful rest of your day. This is Marilena Grittani, The Legal drug dealer. Bye for now.


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