This entry is part of an ongoing series where pharmacists describe inspiring patient interventions. Have a story you wish to share? Send it to vwood@ensembleiq.I met a patient for the second time today. She has a tumor in her brain that, although benign, is affecting her mood and decision making. She cannot have surgery until her blood sugars are at target, and, of course, those two problems make it really difficult.She has had challenges with adhering to treatment and irritability, impairing clinical relationships. But I think if something was stuck in my head and they wouldn’t take it out I would be irritable too.She is an intelligent and friendly sort in between outbursts, but engaging in conversation is possible with a healthy supply of empathy and understanding.She also has smoking and familial hypercholesterolemia as co-morbidities (the latter has not been diagnosed yet, but given an untreated LDL of over 9.3mmol/l it is pretty likely). She scored 27 out or 27 on a PHQ-9 for depression, and this is also untreated as she is uncertain about drug therapy for her mood.She really wants surgery. She also wants to stop smoking, but sees it as a helpful coping mechanism. She recognizes her mood is a problem, and we discussed how treating it with medication works and fits with other ways to help mood problems.We explored her blood sugars, smoking, cholesterol, the overall vascular risk, and the impact on healing and recovery from brain surgery from these.We now have set SMART goals for exploring her feelings about smoking, which she will work on with her family. She did not want to take rosuvastatin because she read on the sheet from the pharmacy that it was bad for diabetes.We looked at the note together and I explained the context of what the warning means, and the relative protection she would receive.She has agreed to take it, and we will see how it works in two to three months and see if a PCSK9 inhibitor makes sense. She wants to work on smoking now, and blood sugars later, but she agreed to a monitoring schedule that we can review later to determine what is driving her blood sugars up and down so we can get a safe and effective plan much more quickly.We will speak on the phone in a week about all this and her feelings about going forward with treating her mood.The drug therapy problems (indications without medication, failure to achieve goals, adherence issues, problems from therapy, different or optimum therapies) as well as goal setting and care planning we look for have a real impact. Our unique way of looking at these problems provides benefits patients may not otherwise get.This is my first patient story (I hope neither too much or not enough detail). It is both the interaction and the very real patient that is part of the story we tell.Ken Burns is pharmacist at the Diabetes Care Centre at Sudbury Regional Hospital.
