By PCCA

This Profile in Personalized Medicine highlights Karen Francis, RPh, owner of Compounding Wellness Pharmacy located in St. John's, Newfoundland and Labrador, Canada. A PCCA member since 2003, Karen graduated in 1985 from the College of Trades and Technology, St. John's, Newfoundland and Labrador, Canada.

How did you start compounding? What led you to PCCA? 

My interest in compounding sparked at a young age. In my last year of high school, I worked as a cashier in a family owned and operated independent community pharmacy. To help pay for university, I stayed on and worked part time during the school year and full time during the summers. My plan was to study French and linguistics. However, the owner of the pharmacy asked me if I'd like to work with him in the dispensary during the summer. Parkdale was the go-to pharmacy in St. John's. If you could not find something, you would go to Parkdale, and the owner would find it for you. He always said, "If you can't fill your customer's prescription, you shouldn't call yourself a pharmacy.” He always went that extra mile. 
Their pharmacy was innovative, ahead of its time and, most importantly, always working to meet and exceed their customers’ needs. Compounding techniques were very different back then. I remember lots of powder papers, glass ointment slabs and the torsion balance. My career path changed because of the time I spent at Parkdale.
  
In 1995, I started my own business and opened my own community pharmacy in a neighboring city near St. John’s. I became a PCCA member in 2003. It was a natural fit for me. I never conformed to the fact that one size fits all in medicine. Becoming a compounding pharmacist and working closely with PCCA is a gift that keeps on giving. The guidance and partnership from PCCA, along with the wonderful, caring team of pharmacists, technicians and assistants I work with, has granted me the opportunity to continue Parkdale’s legacy, ideologies and values about patient care by taking it to the next level. 

What was your toughest patient problem? How did you solve it?

A close friend ruptured his Achilles tendon and required surgery. Unfortunately, while recovering and wearing a boot cast, it became severely infected. Due to the location of the infection, traditional therapies for wound care were difficult to apply and therefore ineffective. As a favor, he asked me to look at it and perhaps give him some advice. I was a young compounder at that time and had no experience with wound care. I quickly remembered why I chose pharmacy as he removed the dressing and showed me the wound. It was difficult not to show emotion or get sick from the odor. I was anxious to help. We took photos, and I called PCCA for formula suggestions. The consultant who called back was knowledgeable, and he took the time to explain why he suggested each active pharmaceutical ingredient and base. The next step was to speak to his family doctor. The patient-doctor-nurse-pharmacist relationship is critical for optimal patient care. I offered him another option using multiple active ingredients and Polyox® powder as the base. He reluctantly agreed. With a few tweaks to the original formula (as each patient is unique), there was marked improvement within two weeks. This was noted by the wound care nurses responsible for his daily care. He had a long recovery with corrective skin surgery required, but he will be always grateful for our help.

What is your favorite PCCA base, and why?

MucoLox™.  It's so versatile. It can be used in an endless number of applications. We have had great results both orally and vaginally. 

What has been your most satisfying patient experience?

I have had so many satisfying patient experiences. I can't narrow it down to just one. As a women's health consultant and advocate, I have been blessed to have spoken to and have met with so many wonderful women from all age groups — each seeking advice and help in dealing with the numerous symptoms associated with hormone imbalances, nutrition and stress-related issues through the pre- to postmenopausal years. Most women "knew something wasn't right" anymore. Some may laugh, but in my little corner of the country, I've become known as "the hormone lady.” Women's health will always be my passion. I feel it's my responsibility as a pharmacist to correctly educate around the "taboo" subject of bioidentical hormone replacement therapy (BHRT), by providing each patient and her physician with the most current and up-to-date information and treatment options. This allows a woman and her physician to make an informed decision on if she should use BHRT or not, based on her own individual symptoms and risk factors. Knowledge is power. 

Hopefully, the days of "one size fits all” medicine will soon be over. Compounding has opened so many doors for me. Cyril Lee, my marketer, and I have built relationships in the community by doing lunch and learns with small groups of physicians. These are unique opportunities to meet the doctors in local neighborhoods. Unlike traditional pharmaceutical sales, we are not promoting a particular drug or class of medication. We are adding tools to their repertoires. We give them an opportunity to think outside the box for individualized treatment options. PCCA has given me the confidence needed to advocate for all of my patients. They provide us with current and topic-related formulas and information sessions that are unbiased. They are constantly adding to their product line, making my role as a problem-solver even more exciting.

What’s the biggest “aha” moment you’ve had as a member of PCCA?

Probably the biggest "aha" would have to be the very first compound we prepared. It was actually a double "aha." A first-time mom had a young boy who was experiencing gastroesophageal reflux disease, and she was having a difficult time giving him the medication. He did not like the flavor. The only commercially available product at the time was Zantac®. She and her family were already patients at the pharmacy, so we already had an existing relationship, built on trust. As a young pharmacist, up to this point, I had not developed the confidence to speak to a physician on an equal level as a fellow professional. They would call in prescriptions; I would take their orders. However, I had just recently attended training at PCCA. I learned so much and gained confidence in my ability as a pharmacist. My brain was on overdrive. I wanted to share this new information with any and all who I felt could benefit. 

I suggested to the mother that I would reach out to her son’s physician and suggest something else. This was unheard of at that time in my career. I gathered up the courage to make the phone call and dialed the number. Panic had taken over. He answered. I explained who I was and why I was calling, and I made my first recommendation. I'm sure he knew I was nervous. You could hear it in my voice. 

To my amazement, he was interested! He absolutely approved, and we chatted for a few minutes longer. He thanked me. That was part one of this "aha." Some years later, I told him that story and we laughed.

To be honest, the preparation of that first simple compound probably took us about an entire day to complete. We decided to make a partially sugar-dipped, star-shaped medicated gummy in the color and flavor of his choice. We spoke with the consultants at PCCA many times that day. They held our hand through the entire process. I can't remember exactly how many times we remade it, trying to perfect it. The ultimate test would be with the young boy. He liked it and continued to take it. Mom was happy. We did it. It was a homerun! 
I'll never forget the feeling on that day. That is what pharmacy is all about. This is the true role of a pharmacist. I'm a problem-solver — this was part two of my "aha." That day, we found our home with PCCA. I've never looked back.

What advice would you give new compounders?

Do not be afraid to step outside of your box. There are so many opportunities within compounding. Choose a subject area that you show interest in and become the expert in that area. Patients will seek you out. 

Do not assume that your local physicians will know about compounding, and do not be afraid to go visit them. Some actually want to know more. 

Most importantly: Learn something new every day.