This Profile in Personalized Medicine highlights Michelle Gray, RPh, C4 HRT Specialist, Therapeutic Nutrition Lifestyle Coach and owner of Gray’s Compounding Pharmacy in Kimberly, British Columbia. She has been a proud PCCA member since 2013.

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

I was hired by a small independent pharmacy in 2002 to start the compounding practice for the owner. The owner and I went to Houston for C3 training. This along with the daily PCCA clinical support gave me the confidence to go out into the medical community to educate physicians about what compounding is and how I could help them with their challenges. They would then write prescriptions when appropriate, and I would go back, make the preparations and counsel the patients.
 

What was one of your toughest patient problems? How did you solve it?

I attended the hormone replacement therapy (HRT) symposium in Houston in February 2003. This launched my HRT practice. I would say that balancing hormones and understanding the complex interplay and symphony of hormones has perhaps presented some of the toughest patient problems.

One patient in particular had shown great perseverance. We worked with their health care practitioner and started with some topical progesterone, then adding bi-est (estriol and estradiol). We adjusted strengths, but upon repeat lab tests, found that we hadn't moved the levels significantly — she wasn't absorbing the hormones. In consultation with the patient’s practitioner, we decided to change the formulation to troches, and the patient immediately had a marked improvement of symptoms.

What has been your most satisfying patient experience? What was their health challenge? How did you assist them?

A retired nurse approached me about helping her husband heal a long-standing ulcer on his foot. He’d had an electrical accident 30 years prior and had lost some toes, but this part of his foot kept breaking down. The skin was fragile, and they had tried everything the health care practitioners could come up with, including casting the foot for months. It looked like amputation was the next logical step. After consulting with PCCA, I made a recommendation to the patient’s practitioner for a combination of active ingredients in a powder to be applied to the wound and held in place with a bandage. They prescribed this along with a medicated topical cream in Lipoderm® for the skin that hadn't broken down around the wound. They were very excited to see the wound finally show signs of healing and eventually closure.

What was the moment you realized that joining PCCA was going to make a difference for your pharmacy?

The independent pharmacy I worked for was sold to the Shoppers Drug Mart chain in 2006. Along with the sale, we lost our PCCA membership. So, having to use a competitor, I phoned them for a formulation consultation to help me solve a problem. I was shocked when they said it would be two weeks for them to come up with a formulation. I told them the patient doesn't have two weeks, they have two hours! So I was on my own. Using what I had previously learned at PCCA, I came up with a formula for a very bitter suspension. In 2013, when I opened my own compounding pharmacy, there was no question in my mind about the value that PCCA would bring to my practice, myself, the clinicians I collaborate with and, most importantly, the patients I serve.

What is your favorite PCCA base?

PracaSil^®-Plus for its skin-nourishing qualities. LoxOral ^® for the ease in compounding capsules. Lipoderm for its excellent skin penetration, its feel and its lack of smell.

What is your favorite PCCA event?

The annual HRT Las Vegas Symposium, as it is so great to collaborate with like minds and discuss cases, and it is exhilarating to be at the forefront of HRT therapies. My brain is popping throughout the event.

When was the last time a patient thanked you, and why?

Yesterday, a patient came in to pick up his first prescription of low-dose naltrexone (LDN). He has been suffering for years with his condition and has been waiting to be considered for a biologic. I had talked with him about the potential benefits of LDN the day before and had faxed the recommendation to his rheumatologist. She approved and prescribed it immediately. He was thankful for the chance to try something different because to date, nothing has given him relief.

What do you wish you could tell new compounders?

Listen to all of the patients closely. Ask about their families. Inevitably, someone has an issue that is an opportunity for you to help with. I was surprised when I got a call from a community 600 km (373 miles) away. It was a patient whom I had helped years before with a burn when he was on holiday near my pharmacy. He was now calling for assistance with his sister in the next province who had a diabetic ulcer. You never know when you will be needed, and being present for every patient encounter will earn you a reputation as a "healer."

What is your favorite thing about your job right now?

I love problem-solving. I especially love when I get physician referrals for complex cases. This is my time to shine and to showcase what we can do for the patient. The payoff is huge when you earn the trust of a physician to be a part of their team.

What is your personal motto or words to live by?

Work hard, play harder.

What do you enjoy for fun?

Telemark skiing, cross-country skiing, golfing, hiking, playing hockey, and enjoying family time either doing these activities or playing games.