They Will Come Back...They Always Come Back

Hello all! I had a pretty relaxed week. I hope you all did too.

My week was not super eventful, but I will still share it with you (partly because I have to). This week we had our first patient come back in for their post-90 day survey so that they could conclude the study. All of the patients have a strong interest in finishing the study, because if they do not follow through with it then they get charged something like $1000 because their insurance will only cover it if they finish the study. So, that's pretty cool. I was not actually at my site the day the person came in, but I got to look at the survey that the patient fills out when they come back in and I got to input that data into the same system where I inputted the pre-PGX data. Maybe next week I will be able to take a picture of an example survey but for now I will just describe it to you. Basically, the patient describes the condition that has been causing them harm/discomfort and that information is recorded. Then the patient describes the new medication that was prescribed to them and says whether or not it worked better as a treatment than the previous drugs that they used. That's pretty much it. Not that complicated. All of the post-PGX data is compiled into a system designed by the company administering the study and then their researchers compile and analyze that data. 

Oh, also I have pictures of what the results look like for the test and what the patient sees! Its a practice trial, so don't worry it's not a HIPAA violation (probably). 

Okay, so this first picture is just one of several pages where it gives a list of drugs associated with helping with certain kinds of illnesses (on this page it shows cardiovascular and diabetes). Based on the patient's genes it gives a detailed list of what drugs are ok to take and which ones are not. Every drug in the column titled "Standard Precautions" is ok for the patient to take. Every drug in the column titled "Use with Caution" will most likely react poorly in the patient's body and the drugs in the column titled "Consider Alternatives" are the drugs that the patient can take instead of the drugs in the "Use with Caution" column. Now that's pretty neat!

This second page is the actual results from the analysis of the genes. There are twelve genes listed here and next to each one it describes the genotype and phenotype of the patient with respect to that gene. For the gene CYP2C9, for example, it tells us that the patient is a normal metabolizer for drugs that rely on enzymes created by the CYP2C9 gene to function. This second page is very interesting to me and will be the focus of my future inquiries into how exactly the testing works. I have been doing some studying on my own to try to understand better how these 12 genes operate and how these 12 genes affect enzymatic activity. Once I achieve a better understanding of these phenomena, I will share it in a blog post. Maybe even next week! Well, I hope this post was enlightening. Have a good week/weekend/whenever you get around to reading this. Bye!

Oh, and here's a gif.

First Human Contact

Hello world! Welcome back!

Coming at you with my second blog post ever, I am here to update you on my life from the past week. I learned a little bit more about the study, but what I mainly learned about was how to work in an office.

Throughout this week, I scheduled the follow-up visits for the patients participating in the First Vitals study. After a patient's initial visit with the doctor where they get a mouth swab and state the drugs that have been giving them trouble, they come in for two follow-up visits. The first one is two weeks after the initial visit and that is the meeting where they receive the results from the mouth swab. Then after that meeting, there is another follow-up meeting which happens 90 days after the initial meeting, so that the patient can take a survey about whether or not the new drug that was recommended to them actually worked better. Since most of the patients who have already participated for the study are ready for their 90 day follow-up, I had to schedule them so that they could complete the study.

First, I became accustomed to the program that the office uses to schedule people which was pretty simple. I had to look at when a patient's next regular appointment was at this office (an appointment for something other than the study), and then schedule a short meeting with a nurse practitioner so that the patient could fill out the post 90 day survey after their regular appointment. So, after working to rearrange a bunch of schedules, I learn that the doctor (Dr. Lalani) did not actually want the survey to be taken on the same day as the patients' other appointments. I do not really know why he wanted it that way, because the way I did it made everything way easier but I digress.

So with this news that I had done everything wrong, I had to make a list of all of the patients who participated in the study and call them so that we could book an appointment with them on an entirely different day. Let me tell you about talking to random people and telling them things that they do not want to hear. It sucks. A lot. The first two patients I called were not very happy. The next seven patients that I called went straight to voice mail. The one saving grace is that I ended the day with a phone call from a very nice woman who was totally understanding so that was cool. I think the key to talking to them is using as many big, complicated words as possible to sound official. I got better at talking to them as I made more and more phone calls and once you hit them with a word like "pharmacogenomics" then they will usually listen. The trick is that you make them think that you know what you are doing.

Well, well, well. Here we are again at the end of another blog post. In short, I would say that this week I learned that I never want to go into customer service. With that eloquent summary, I will once again leave you with a gif that I like. So long!

Oh btw, I did actually get to swab a patient's mouth this week. It was pretty awkward I am not gonna lie. I sat down with Carol and this middle-aged woman who was having problems with her meds. I unsheathed the swab. I stared this woman straight in the eye and stuck her with the swab. And then I just started moving the swab up and down in her mouth, At first, it was gentle. I didn't want to break her face. But then Carol was like "No! You have to really get in there!" So then I started jamming this thing into her gums for like 30 seconds. Both my face and the patient's face were panic-stricken. You could feel the tension in the air. In the wake of the aftermath, I pulled the mouth swab out of her mouth like King Arthur pulling that one sword out of that rock in that one story and I looked back up at her face. I didn't know what to say so I thanked her and apologized at the same time. I'm like "Thanks and sorry for all that". She laughed and we all exited the room. So, yeah. It was kinda weird, but hopefully the next swab will go better.

Entering the Bowels of Inputting Data

Let me tell you about data. In an experiment, there is a lot of it. But how do researchers then take the raw data and analyze it to find interesting trends that they can turn into scientific findings? They compile the data electronically and then use various software to study it. But who gets the very important job of inputting this data so that smart people can analyze it? You guessed it. This guy (Me).

When I arrived to the endocrinology office for my SRP, I met with a physician's assistant named Carol and she is now essentially my mentor and I am her trusty side-kick. Together we fight crime and do whatever needs to be done to ensure that the First Vitals study continues and collects accurate data. My job for this week has been inputting pre-PGX data into a website designed to organize that data for this experiment. While performing this task, I have gained a much stronger understanding of how exactly the study operates and I will now relay the full experimental process to you in this blog post.

So, the process starts with a patient who is unhappy with a medication they are taking. Unhappy in this case could mean that either the medication is not working how it is supposed to work or it is giving the patient undesirable side-effects. So, they are recommended by a healthcare professional to participate in the First Vitals study (which is covered by insurance at the moment), so they come into the endocrinology office where I am interning. The patient fills out a survey where they are asked various questions about the medical problems they have and the drugs that they are upset with (this survey is the pre-PGX data). We then swab their mouth and this mouth swab is sent to some other location where their genome is tested for the presence or absence of 12 specific genes. Then based on the results from the genetic testing, healthcare professionals from the endocrinology office work with the people who tested for the genes to see why the patient's medication is not working properly but now in the context of those twelve genes. After this analysis is made, alternative recommended treatments are provided to the patients and then the patient can take that information to their regular doctor and ask for the new treatment. 90 days after the initial mouth swab, the patient comes in again and fills out a survey to determine if this alternative medication worked better (this survey is the post-PGX data).

So, my job for this first week was to input the pre-PGX data into a website so that specialists can later analyze it for trends and take a look at that patients medical history in the context of their genetic code. We do not have a lot of post-PGX data yet, because the study started in December, so I was only inputting pre-PGX data. Carol told me that next week I get to swab someone's mouth, so I am looking forward to that. It should be loads of fun.

Well, that was fun. I wrote my first blog post and did it on time! I will leave you with a gif. See you next week!