Custom Compounding

Jun 30, 2015

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

School's out and we never have to think about our teachers again, right? My friend Peter Szekely lives in Hong Kong with his wife Lili and their twin boys. Peter was planning the boys' eighth birthday party. The boys and all their friends are crazy about soccer. So much so, it is an unwritten rule amongst Peter's friends that they don't have soccer games at birthday parties as the kids get too competitive. So, Peter thought he'd introduce them to Schram Ball. Lorne Schram was our high school phys. ed. teacher, and he invented the game. In school, we all loved Schram and Schram Ball. Schram Ball was an indoor combination of soccer and basketball, where you could bounce the ball off the walls and ceiling. I was talking to Peter before the party and he was quizzing me about Schram Ball rules. I had to admit my memory was failing and I was having trouble remembering all of them. I was even thinking that I'd have trouble explaining Schram Ball to someone.

In the pharmacy, I find I have trouble explaining what I mean by custom compounding. Custom compounding is when a pharmacist creates a preparation that isnt commercially available for a patient at the direction of a physician, vet or dentist. That usually doesnt mean much to most people. I often have to show people what we do in our compounding lab for it to make sense to them. Fortunately at the Dauphin Clinic Pharmacy, the compounding lab is right out front, with nice big windows so you can see what we are doing.

What can we compound for people? In January I usually talk about how we can compound nicotine lollipops to help people quit smoking. Our most popular compound is called a diclofenac cream. It can be rubbed directly on a sore knee or shoulder to reduce the pain without bothering the stomach. What we can compound is really only limited by the imagination.

A couple years ago a customer came into the store and told me she didnt know the Dauphin Clinic Pharmacy was so special. The customer had just got back from Toronto where her child was seeing a specialist. Her child was taking Vitamin K and it is only commercially available as liquid. We compounded the Vitamin K into a capsule. The child was happier taking the capsule and the Toronto specialists were impressed that we could help her child in little old Dauphin. The customer said she didnt know that the custom compounding we did here for her child was so unusual. There was another local child who was in hospital in Alberta. The Alberta specialists didnt believe the parents that a Dauphin pharmacy had made a liquid form of aspirin for their child. You see if aspirin is just crushed and mixed with water it will break down. So we mixed it in an oil base. I had Alberta hospital pharmacists phoning us to get our formula for the liquid aspirin so the child could continue to receive the medication in the Alberta hospital.

We have been asked to make various kinds of wound preparations. One of the interesting bases we use is a gel that is liquid in the fridge but solidifies at body temperature. We have put antibiotics, medications to increase blood flow, medications to improve healing, pain killers, and others into the gel at the doctor's request. The neat thing is the nurse gets to pour the right amount of liquid medication directly into the wound. The liquid conforms nicely to all the crevasses in the wound and then it solidifies into a gel the consistency of Jello. Another interesting would treatment came from Dr. Kish. He calls it Sugar Paste and it is basically a bunch of different sugars and some stuff to hold them together. It goes directly into the wound, absorbs exudate and promotes healing quite well.

For animals, under a vets direction, we have made a variety of products. We have compounded a liquid antidote for a dog who ate rat poison. We compounded an antibiotic for a fussy cat. We started with a human medication, ground it up and put it into a special fish paste that most cats love. However, this cat didnt like fish. So we did it again in a chicken paste. When the patient is a cat, it is still important to listen to the patients likes and dislikes.

When you are next in the Dauphin Clinic Pharmacy, press your nose up against the glass and have a look in the compounding lab. Check out what we do first hand. When you are watching us mix something together you might get an idea of how we could help you, your family or your animals. Then knock on the glass and ask me your questions. At least I won't have to explain custom compounding to you.

Despite the difficulty of explaining Schram Ball to the uninitiated, Peter posted about the Schram Ball party on Facebook. In our increasingly tiny and inter-connected world, that post eventually got to Schram's daughter Rilla. From there it went to Lorne himself. Lorne Schram messaged Peter back. It turned out the originator of Schram Ball happened to be vacationing in Hong Kong. Schram asked Peter if he wanted to get a coffee and chat. So you never really leave your teachers behind even if you put a quarter century and half a planet between you. But at least Peter had the one and only Schram to talk to in person. Who better to explain Schram Ball than the inventor?

 

I am Trevor Shewfelt from the Dauphin Clinic Pharmacy. The Pharmacy Feature is heard here every Tuesday on 730 CKDM

The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.

We now have this and most other articles published in the Parkland Shopper on our Website. Please visit us at www.dcp.ca

As always if you have any questions or concerns about these or other products, ask your pharmacist.

Closeup view of a pharmacist's hands, using a mortar and pestle.

Closeup view of a pharmacist's hands, using a mortar and pestle.

 

 


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