Nurses Corner

2006-04-20T07:33:00.000-07:00

When Enough Is Enough

People are as variable as snoflakes, this isn't news, but it is true. You never find two alike in response to medical care. I don't see this as a negative, but as a positive for the most part.

Our jobs as health care professionals is to take all those variables (which can be considerable!) and whip them into a care plan that will suit the individual need of each patient. Things that must be taken into consideration range from the big stuff, like timing of antibiotic IV therapy, to the time patients wake up.

I've found people in the North West tend to sleep later. More than I can count don't get out of bed till 10:30 or so. I'm not sure how they function in a work situation. Back in Tucson, most of the people were early risers. We could finish our rounds by noon.

That's not the issue though, the issue is patient compliance. Of course we need to take the individual into thought when planning our care of them, and we do. We have the patient agree on paper, exactly what they'll be responsible for, and what staff will be responsible for.

There's the odd person who for whatever reason, decides after the agreement that they will not be responsible for this or that. Sometimes we can work with their requests, sometimes not. It depends on the Home Health agency involved. My agency is not very flexible in this regard.

Then there's the patient who no matter what you try to do, decides to do everything their own way. Sometimes this can be applauded, because you know the individual, and you know they know themselves and what works for them. Most of the time it doesn't work out that way. It gets to the point that you can not work with this patient, no matter what.

When this unfortunate turn of events occurs, the patient is discharged from the agency for non-compliance.
It does not affect future events - they can be readmitted at a later date. That is unless they have made it a habit of acceptance, then non-compliance. In this type of case, the agency won't touch them, and refers them to another agency.

Working with non-compliant people is a drain on the nurses. It saps our energy, wastes our time, and generally makes working with them unbearable. That's when enough is enough, and the nurse files paperwork, and the patient is discharged.

For me, it doesn't take long to reach this "outta here" mark. There are people that want my help, welcome it, appreciate it, and work hard to help themselves. In a perfect world, all patients would be like this.

The world is far from perfect.

Maybe I should send the next one a big plate of caramel brownies?

2006-04-18T18:15:00.000-07:00

The Difference Attitude Makes

Back in 1994 while working in the hospital on the orthopedic floor, I learned about "short-arm syndrome". This is a term floor nurses use for patients who can but won't help themselves. While it generally refers to the attitude of the person, it also pertains to the lack of will to reach 6" to the bedside table, to have everything done for them.

People with short-arm syndrome are not pleasant to work with. It's more than a temporary problem while in the hospital. When I transitioned from the hospital to Home Health, patients also transitioned, so I saw the same people at the hospital and at home.

Sadly, this syndrome followed them home. People with short-arm syndrome don't fare well after the hospital experience as far as their recovery is concerned.

Recently I met a patient with very long-arm syndrome. This fellow is remarkable, my hat is off to him. He'd suffered a terrible accident years ago, is frequently in a great deal of pain, but manages to continue to live as a bachelor. Even on the coldest, meanest days, even when he doesn't feel like it, he takes his 2 dogs for a long walk. He does everything for himself. I would have caved in like a plastic tub in a microwave.

As a result, he's living a full, productive life, has a fabulous attitude, and will remain independent for a very long time.

Much of what we experience, and the pitfalls of life, shape our attitudes about ourselves, and our capabilities. A healthy attitude makes life easier, even when life is downright mean. It's all in how you choose to deal with it.

2006-04-16T15:30:00.000-07:00

Mercury Hazards

Numerous health reports over the last few years decry the toxic effects of mercury. Swordfish apparently carry large amounts of this metal in their bodies, and now swordfish is considered unhealthy to ingest.

As I was making rounds today, the radio was on the Robert S Bell show. Bell is a renegade health radio talk show host. While some of the information on his website gives me pause, and I just can't agree with it ... other parts seem spot-on. He was discussing mercury and it's effects today, and mentioned that immunizations, including flu vaccine, childhood vaccines, metal cavity fillings, some fish etc. contain mercury. I found the immunization information astonishing.

So what's a safe level of mercury? Apparently very little. If a mercury filled thermometer breaks at a school, the school is evacuated, the HazMat team comes in to clean up the mess. Exactly where is the truth, and who's telling it? Bell, or the government?

I used to play with the stuff when our thermometers broke. Far as I can tell, I'm ok.

How many times have we heard of a "safe" medication, that later turns out to be deadly? Do we really want to be guinea pigs, we must because as a population we take billions of pills of various medications yearly.

Safest bet is to avoid as many medications as possible, for as long as possible.
Health Information

2006-04-14T15:31:00.000-07:00

A Slight Shift In Attitude

As a big fan of mind-body medicine, I am on the lookout for things that help health that aren't pill or procedure oriented. Sometimes I'm lucky enough to stumble onto a trick that works. The other night, I did stumble (so to speak) on a nice little shift in attitude.

I'm an insomniac and have been as long as I can remember. Surely at some point there wasn't a problem, but I do not remember it. At any rate, as you've gathered by now, I'm not a big fan of medication. But, I do like to sleep, just a few hours, nothing out of the ordinary. So I take a medication to help. The problem seems to be that I'm hyper-vigilant. I can be in a dead REM sleep, and if someone quietly says my name I'm instantly awake, even with sleep meds.

And that's the end of my sleep cycle. Any number of noises is enough to wake me out of this deep sleep, annoy me to no end, and slash any hope of return to slumber. (No wonder I'm slightly more than goofy, you think?)

My dog Rio, the chubby little lab mix that wears red high heels and carries a whip, sleeps on my bed with her head on my feet. My son moved back in a couple months ago, and as a young man will do, he goes out and stays out late. When he returns, Rio starts thumping that tail, loud and hard.

The son comes in, the tail thumps, I wake enough to cuss quite a bit ...

then I realized, this pup, though she's old, is still so full of the joy of life, so full of love for those she knows that her tail can't help but THUMP THUMP THUMP X 5000. I found myself smiling, and a little laugh bubbled out. It didn't last long and I was sound asleep again--this NEVER happens. I never return to sleep after awakening in the middle of the night, ever.

Since that night a few weeks ago, the son has come in late a number of times. I haven't heard the THUMP THUMP THUMP ... but I know Rio's waggin' that tail.

That slight shift in attitude has to be the reason. I can not think of anything else that would, particularly since I haven't changed meds, and nothing else can account for it.

I'm starting to like these attitude shifts.

;)

For more info on mind-body medicine click here
and if that doesn't work... http://webnurseonline.com/mind-body_medicine.html

2006-04-13T19:49:00.000-07:00

Home Remedies and Other Good Stuff

I'm a big fan of home remedies, and wish there was a massive compiliation of them to be found. Maybe someone will take that task on, if things go the way I believe they will, we'll all need them pretty soon.

A Navajo man I knew told me of a remedy his grandmother used on him when he was a youngster. His brother accidently slashed his leg with a machete, laying the flesh open. I'm not sure how much was childhood memory and fear, or how deep the wound actually was. Grandmother calmly walked outside, scraped a pine tree, gathered the pitch and put it in the wound. My friend healed up just fine, no infection, no problems.

Another friend who lives in the Dominican Republic asked me what he could do for his diabetic foot ulcer. He was loathe to go to the local doctors, and wouldn't be able to get to Florida for a few weeks. If there's one thing that scares me as a nurse, it's how fast a diabetic foot ulcer can go bad, and how quick doctors are to amputate. I'd never used it, but had just heard of an unusual dressing and told him about it. It's the pulp of an orange peel, the whitish part. Peel the orange, scrape away the fruit, use the pulp on a clean wound bed.

He did this, and when he finally got to his doctor in Florida, she said "We MUST amputate right away!" He said, "No, I just wanted you to see it, it's more than 60% improved, I'll be back next week and show you." He did, she was stunned, and he healed without any more problems.

We've used Aloe Vera meat to keep a wound moist, raw honey to debride wounds, and all sorts of fun stuff.

I've heard of powdered sugar used to heal wounds, the trick is getting in on in a thin, even layer (haven't tried that one yet, though.)

There are so many options, we don't always have to rush to the doctor for yet another pill ... the possibilities are endless, the trick is knowing when to use them, and when not to ... and most important, when you really need to go to a doctor.

2006-04-12T19:16:00.000-07:00

Memory and Hormones

The role of hormones in the human body is truly amazing. Hormones have been studied for many years, and the explosion of information about the endocrine system is astonishing. We live in interesting, phenomenal times.

A study (http://healthfinder.gov/news/newsstory.asp?docID=532022) found that a brain hormone called corticosterone and it's effect when combined with emotion shows that (in rats) an emotional experience greatly enhances memory of the experience. Of course rats aren't human, and researchers decline to state that rats have emotions, instead stating their arousal is roughly equivalent to emotion.

That brain hormones and emotion collide to increase memory is no surprise when you consider PTSD and veterans, or people that have experienced great trauma.

I've held the theory for over 30 years that traumatic experiences not only affect chemicals in the brain, but actually change DNA. I'm no doctor, or researcher, but it seems like common sense to me.

Clearly in Alzheimer's patients, there is a strong connection to emotional experiences and memory. A few rather elite Alzheimer's care homes are built around a time theme. While the patients are in the communal areas that are time-themed, they come out of the haze, and remember. Clearly this connection between emotion and corticosterone-norepinepherine is played out.

* * *

About animal emotion, don't discount it. Any pet owner with a lick of sense can tell you if their cat or dog is depressed or grieving. It wasn't long ago that no animal was believed to have emotion. Studies with KoKo the gorilla, elephants, dolphins, Washoe and other chimpanzees, even dogs and cats indicate animals do indeed have emotions, and they suffer with depression and grief as humans do.

Granted, lab rats may not have a lot of brain to work with, but do they experience emotion that we fail to comprehend, just as we failed to comprehend emotions in gorillas, pets, elephants, and so on? It's possible. We failed to realize much about human behavior until the last century brought study into the fray.

The complexities of this tapestry of life will unravel slowly revealing things we never thought possible.

It's a fascinating time we live in.

2006-04-11T17:07:00.000-07:00

Benefits of Wine

A friend was kind enough to send me this observation about both the benefits of wine and a possible side effect -
enjoy!

"Dear Nurse: after I went to pick up my brandy I checked out your nurse sites and found that nowhere do you mention that drinking wine, although beneficial for the heart also is a major cause of colour blindness. How did I arrive at this conclusion ? Easy ! I wandered through the wine section and noticed they are all in categories of red and white. On further inspection I found not one white wine. They were all various shades of pale tan and upon looking at the so called reds I saw that they were almost all various shades of purple. There were the odd exceptions but even these were more of a deep rose colour rather than a full blown red. I'm sure if you check for yourself you will find that I am right. So that's how I concluded my colour blind theory. What do you think ? ;)"

And whilst we're on the subject, did you know that the benefits of red wine on the heart might be due to plant estrogen in the skin of grapes? (according to http://www.sciencedaily.com/releases/1997/12/971219062019.htm)

Maybe it's not the plant estrogens, maybe it's the laughter the wine produces that's actually what's beneficial to the heart ...

For some reason I'm remembering the famous grape stomping scene in I Love Lucy. For those too young to remember I Love Lucy, try to find it!

2006-04-09T18:04:00.000-07:00

e-GAD!

News today is that people that worry a lot, to the point that it consumes nearly every waking moment, have a disorder called General Anxiety Disorder or GAD.

Of course, there is treatment for GAD, and a host of other disorders in the anxiety and depression group.

You can take a pill for it...heck, you can take a pill for almost everything.

Wouldn't it just be better if we can get it through our heads that worry never has, and never will change the outcome of whatever situation it concerns?

You can worry yourself into an early dirt nap, or to a psychiatrists office, or to the doc for a bunch of pills that may help you, or may harm you in a big way.

So give it up, already. Realize worry changes nothing, except to make you sick. (Ditto with guilt.)

2006-04-07T20:37:00.000-07:00

Platinum Is For Jewelry

Or it should be. Who knew that platinum, the metal, the stuff really nice jewelry's made from is now found in the bodies of women who have had silicone breast implants. Unfortunately the platinum can cause toxicity and allergic reactions in women that have had the same implants for many years.

Silicone implants were the first implants made roughly 30 years ago. When women with silicone implants started having various odd symtoms and illnesses, silicone implants were off the market in favor of saline implants. Women complained that saline implants did not feel as real as silicone.

A few years back, silicone implants were once again cleared after numerous studies seemed to prove they were indeed not the culprits of various and sundry illnesses, but their use was limited to women who had undergone mastectomies.

Apparently now, women who have had implants for a number of years, need to undergo surgery again and have revisions done.

I knew I should have been a plastic surgeon, or married one....hmmm.

2006-04-06T17:50:00.000-07:00

Which Way Should I Go?

Daily Health News from Healthfinder.gov comes to my email daily. Sometimes it's anything but inspiring. Sometimes it's downright depressing.

Today there are two stories of interest, one sites a study that states moderate drinking increases women's ability to think (pass the Scotch, please) -- oddly, it doesn't make much mention of liver problems or other health problems caused by consumption of alcohol.

Don't know about you, but I could use a brain boost.

The second story of interest is in reference to Multiple Sclerosis in men and the correlation of testosterone and brain atrophy. Men treated with 100mg of testosterone applied to the skin showed significant cognitive improvement in brain processing speed and memory, over a 12 month period. That's great news, but not what comes to mind when I'm thinking of victims of MS.

What an incidious disease. Ranks right up there with Alzheimer's, Parkinsons, and all those nasties that rob humans of their dignity.

What really comes to mind is a gentleman I had the privelege of caring for during nursing school. By the time I'd met him, he'd been bed ridden for 10 years. His mind seemed quite intact and sharp to me. His wife deserves a huge credit for keeping him in good shape, too.

He was an absolute delight to work with. I adored the man, and his wife.

One morning, the doctors and their residents came to his room on rounds. One of the residents was doing what residents do, asking lots and lots of questions. This resident was asking the gentleman questions to determine his mental status. He asked my patient the date, and other things. My patient gave him some truly off the wall date. I thought it was odd at first.

As I was standing at the residents elbow, I watched him chart. What I saw outraged me. He wrote, "dementia" and a bunch of qualifying statements to prove his case.

When I saw the resident in the hall, I told him I'd spent quite a bit of time with that man, and he could not possibly have dementia. The resident rambled on about how he was right in his diagnosis, I rambled back why he was incorrect.

I suppose it was a draw.

The point, from my perspective is, this man was bedridden. For 10 years. 10 years is a really long time. When you have not much to do but lay in bed, for t e n y e a r s ...

time doesn't mean a darn thing.

2006-04-05T18:19:00.000-07:00

Spice Up Your Life

One of the federal websites today published two stories about spices that when consumed 1) lower cholesterol 2) improve insulin function and 3) kill ovarian cancer cells.

A few years ago, one of the nurses I worked with found a small study that reported use of cinnamon to improve uptake of insulin in the body. We started encouraging diabetic patients to take a gram or two of cinnamon a day. To my knowledge, none did. But we tried, even suggesting taking cinnamon via capsule if the patient didn't like the taste of cinnamon.

So today comes the news that cinnamon actually does indeed improve insulin uptake, and lower triglycerides, and glucose by up to 10 to 30 percent. That's HUGE news. See http://healthfinder.gov/news/newsstory.asp?docID=531953 for the entire article.

The fed study states that a few grams of cloves per day has the same theraputic effect.

It might be that cloves particularly might cause some digestive upset, if so, peppermint or ginger tea help a great deal.

In the second fed article, studies on ovarian cancer cells either "commit suicide" or digest themselves when bathed in ginger. Further study will be done on some rather unfortunate lab animals.

The full article can be found here: http://healthfinder.gov/news/newsstory.asp?docID=531950

For one, I'm very pleased that natural cures are now more vigorously studied. While our formulary of medications for various diseases is impressive, most are but side-effect producing band-aids. Yes, some cure diseases and illnesses, but some that are commonly given out are downright dangerous. The less medication a person can get away with, the healthier they will be.

2006-04-04T20:16:00.000-07:00

A Little Ticked Off

Not terribly angry, just a little irritated.

Our agency has a "problem child" patient, who has been on service several times. She's ok, I don't have any trouble with her usually. She called the other night with a problem, and I went out to fix the problem, no complaints from her at the time.

I just found out she complained to her doc that I'd put the tape on too tight.

If any RN's out there can explain how it's even possible to put tape on too tight, let me know please.

Funny thing is, I didn't put ANY tape on her.

Her doc was furious with me. I haven't heard any backlash from the office yet, a co-worker told me what happened.

Reminds me of other incidents and other RN's I know. One of which is a former co-worker. I covered her patients while she was on vacation.

I went out to see this patient, and he started complaining about the other nurse whom I've known well for many years. The patient claimed he had missing bags of morphine and he was sure the other nurse took them.

I stared him down and told him that was absolute B.S. and no one in the agency would believe it. I immediately called the other nurse and told her, then the office. There was never a question that the patient was lying. None. We all knew that was pure fabrication.

Things happen, personalities conflict, and almost every home health nurse has been "fired" by a patient at one time or another. It's not considered a big deal, and is expected. What isn't expected is the apparent need for a patient to lie about a situation.

Ah well, a day in the life...

2006-04-03T20:18:00.000-07:00

Advocating for Yourself

It used to be that you could count on your doctor to go to bat for you, and win, against the behemouth insurance companies, and anyone else who got between the doctor/patient duet.

No longer. Doctors try, but are hobbled by the demands HMO's and other insurance companies put on them. You're on your own now.

If your doctor prescribes a medication that is outside the insurance companies formulary, you're out of luck. They suggest other medications that are similar, cheaper, and that may not work.

One way to combat this may cost you a little. Say you need X medication for allergies, but the insurance company will pay for A or B brand. Have your doctor order A brand for you, the next month B brand, have the doctor document that both A and B brands did not work, and the only other option is X brand.

Magic! You'll get X brand, just a bit late.

2006-04-01T19:32:00.000-08:00

The Perception of Age

Let's face it, actress Sharon Stone is a knockout. Listening to the news "comments on the street" I can't help but laugh at some of the comments by younger men. One fellow said he thought she was 75 or so, therefore too old for him and not a sexy woman.

For the record, I'm sick and tired of blatant sexuality portrayed in Hollywood. I'm not a prude, but I think about the children of these actresses, and imagine what unbelieveable embarrassment they are going to face when they become aware of "mommy's nude movie". As sensitive as I was as a child there's no way I could have handled that emotionally, I fear for those kids.

I do find it amusing that young people might think a 49 year old woman is 75 or so. Wasn't too long ago I thought 30 was on the edge of the dirt nap. That perception isn't uncommon. I don't know why there is such a gap in perception of "old" between children, to early to mid-20's, and roughly 30 yr olds. It seems there is a common trigger around age 30, or shortly before, that makes one realize 40 isn't really old at all.

Then at 40 you realize 60. At 50 age 70 or 80 isn't old at all.

90's is almost getting old.

100's is definitely old.

So when do people become unattractive? What is it that takes the sexy out out of people? (And why on earth does it even matter?) What is it about our society that prizes youth and beauty above character and honor? We've gone a long way down the wrong road. Our values and morals are pretty much shot.

As a society we've placed the young and beautiful above wisdom. "Granny dumping" is more common than we want to admit. Our precious elder population is shoved aside and ignored. They're treated poorly, in public, in government, by scammers, and so on.

The vulnerable suffer greatly.

There's nothing wrong with young and beautiful, we'd all like to be young and beautiful forever.

Sorry, it ain't gonna happen.

Seek the wisdom, find the right path. You may not be able to hang onto beauty, unless you can pay a king's ransom for plastic surgery. You can't hang onto youth, the body ages no matter how much you lie about it...but you can learn wisdom. In the end, it's the wisdom that matters.

2006-03-31T18:51:00.000-08:00

The Rebbe's Wisdom

As I'm typing this, the news is on in the background. Hal the coyote that was hunted and trapped in Central Park died as he was being released. No surprise there, the poor thing was stressed for days eluding capture. Obviously the stress was too much for him, though his handlers say they have no idea why he stopped breathing.

Go figure.

Back to Rebbe's Wisdom...I subscribe to Daily Dose from www.chabad.org. It's a wonderful bit of daily wisdom from Rabbi Menachem M. Schneersohn (known as the Lubavitcher Rebbe). Admittedly, his wisdom is over my head at times, but always interesting.

In one of his notes he said, "The worst thing you can do to recover from illness is to dwell upon it. To ponder, "Perhaps I would be better off with this remedy or with that; perhaps I should read up on what happens to people with this sort of thing; perhaps my doctor doesn't know what he's talking about and I'm going to get worse instead of better; perhaps..."

Find a good, caring doctor and follow his advice. Remove your mind from the illness and trust in the One Healer of all creatures, that He will send His healing energy through this doctor. Be confident you will be healed.

And then let your mind rest on good and healthy thoughts that have direction and purpose to them."

How right the Rebbe is! The power of the mind to heal the body is tremendous. We've been so well trained in this Western Medicine world of ours, to take a pill, have an operation, endure endless treatments, that we don't recognize the power of our own minds to heal.

Ponder this thoroughly before you reach for the phone, or for another pill. Give your thoughts to healing, not to the perpetual band-aid.

Be well.

2006-03-30T20:18:00.000-08:00

Back To Alzheimer's Disease

My sister called today with a very unusual request. The request wasn't the problem, it turns out she had a concern that she might have been responsible for our Mother's death.

This is of course, preposterous.

Mom died on Father's Day, 2004. She definitely had Dementia, probably Alzheimer's, though it wasn't completely diagnosed as such. Mom had a problem with her gut, it simply wasn't working correctly. The poor little thing would blow up like a balloon, and subsequently end up in the hospital. At the time she lived in Portland, Oregon.

The last trip to the hospital, the "doctors" kept trying to drag us to the point of euthanizing her. This is a woman that would never go gently into the long night. She was one stubborn old woman. The doctors said she might make it through surgery for a colostomy, but she'd die afterwards because she couldn't perform what's called a "pulmonary toilet." Meaning, she wouldn't be able to follow instructions to deep breathe and cough.
We knew better.

One surgeon told us, "My job is to sell you surgery. This is what can happen..." He was honest and forthright. Knowing Mom would never opt to just cave in and take that dirt nap, knowing she did not want to die, knowing that it goes against the grain of our values to "euthanize" her like a favorite pet...we opted for the surgery.

That stubborn ol' lady showed those docs. She not only sailed through surgery, she "performed the pulmonary toilet" like a champ. The problem that ended her life is those doctors did not send diet and fluid orders to the assisted living home. When my sister left her, she was doing well. When my sister returned 11 hours later, after a much deserved rest, Mom had been without any fluids or food. 11 hours no fluids, no food.

Long enough to start the spiral.

And, she died.

This is old history...but my sisters worry is not. She wondered if Mom started downhill when my sister could no longer take her on outings.

You see, when folks get Dementia or Alzheimer's, their bodies become rigid. It's not necessarily a neurological problem, rather, it's in self-defense. Their perceptions of the world are altered, and the rigidity is one of guarding the self against injury. Unfortunately some care-givers don't realize this and see it as combativeness.

My sister worried needlessly that she'd somehow caused Mom's decline. She didn't. It would have happened sooner or later.

The point of all this verbage is...if you have a relative with Dementia or Alzheimer's, realize this stiffness is not to annoy you, or to make life difficult for you, even though it may seem that way when you're trying to get your loved one to transfer out of a chair, or get into a car.

They're just trying so very hard to avoid injury.

If you're the caregiver of a person with Dementia or Alzheimer's, my hat is off to you!

Feel free to read Alzheimer's and Dementia materials on my website: http://webnurseonline.com

2006-03-29T19:46:00.000-08:00

Cold Showers And Quick Fixes

Several years ago, I had a sudden problem with panic. No idea where it came from or why. I'd just finished showering, getting my makeup on, drying my hair (a long, long process)...suddenly I felt like I was stuck on a railroad track and a train was barreling towards me. I couldn't breathe, my heart was pounding half out of my chest, I was shaking all over.

Instinctively perhaps, I turned around and stepped into the shower fully dressed, and turned on the cold water.

I'm not sure if it was the cold water, or the total aversion to having to change clothes and go through the morning female ritual or what. (Don't you love my grammar?) At any rate, 2 more bouts of panic attacks and 2 more cold showers, and no more problems.

I thought I was a genius for figuring this out on my own. Well la-di-da...someone else did too. Read on.
:)

From http://earthclinic.com

Remedy #1: Cold Showers

5 Readers Report Sucess!

John, from Arlington, TX writes, "I started taking cold showers after I developed panic disorder, general anxiety disorder, and moderate depression. Cold showers have been the best distraction out of any other distraction to get a panic attack to go away. It feels so good when I take a cold shower that it is like an addiction to me. I feel instant gratification both physically and mentally when I take cold showers. They our the best to get rid of negative thoughts, minor physical pains from within the body, fear from a panic attack, and anger....
read more here: http://www.earthclinic.com/CURES/depression.html

Way to go John! Proud of ya.

2006-03-27T20:14:00.000-08:00

Another Drain Of Research Dollars

At least this time it's a Canadian study, and not American...I feel a little better, don't you?

According to Canadian Researchers, "Women who suffer from urinary incontinence are at nearly twice the risk of depression compared to women without the troubling disorder, Canadian researchers report."

Ain't that a hoot? The link to this gem of information is here: http://healthfinder.gov/news/newsstory.asp?docID=531684

Now, let me get this straight. A baby girl is born, a few years later hormones kick in, and suddenly she's budding breasts, very, very painfully. Soon after, her first monthly period starts. Oh joy! PMS strikes with a vengence.

On the years trudge, she blossoms into a beautiful young woman. (Settle down boys.) She gets married...or not...has a baby. Those lovely buds now have stretchmarks and have no shape outside of a Victoria's Secret Super Bra. Naturally, she's not very happy about this, perhaps a bit depressed.

The years pass by...

Perimenopause! Wahoo! Her mother, the saint, never told her about the insane raging hormones of perimenopause, it would have been too embarrassing.

More years pass...

Menopause! Hot flashes, loss of memory, weird skin problems, more sagging of body parts, definite depression when her children leave the nest...sometimes (some see this as party time.)
One day, she sneezes. Oh dear, leakage of urine. Then it progresses, and progresses, and before you know it, she's wearing diapers...again.

I ask you, don't you think you'd be depressed if that happened to you?

C'mon researchers, there are just some things you can extrapolate without spending hundreds of thousands of dollars.

Chocolate, anyone?

2006-03-26T15:55:00.000-08:00

IV's and Pet Cows

IV's aren't my idea of a good time and there's been a rash of them lately. Some RN's love IV's, some specialize in various forms of IV care. Give me a nasty ol' draining, smelly, gangrenous wound any day.

The skinny is that one of the hospitals is having a run of infection, MRSA particularly. MRSA is just evil. It's known as a super-infection. Patients with MRSA continue to be placed in isolation rooms, which is all well and good. The flip side is - pretty much anyone who's been in contact with a MRSA patient now carries this super bug as part of their natural flora. MRSA is a direct result of years of over-use of antibiotics.

One of my patients this weekend was in a MRSA isolation room for his hospital stay. He was so isolated that when a nurse finally came into his room, he quipped, "How long would it take you to come in here if I were dead?"

***

The weekend's gone by in a blur of activity. Wildly busy, the pager is fixin' to take a swim in the Columbia River if it doesn't stop beeping, and as far as can be told at this moment, there's only one more visit to do, unless yet another patient calls.

The tendency is to dread whatever is coming my way in anticipation. The reality is usually quite different. One of the new patients admitted to care this weekend is an absolutley wonderful, charming lady. Since I'm weekend per diem, chances of seeing her again are not likely, her case manager will take over Monday, and is going to be very fortunate to meet and care for this lady.

Another admission is a gentleman we've had on service before. It was just plain good fun seeing him again, so much so that I didn't really mind the wad of paper that goes with this territory. For all he's been through, and as chronically ill as he is, he has a wicked sense of humor. My kinda guy!

Another case turned out to be a man I'd met during orientation, when I first started this job. It was wonderful to see him again. He's got a nice place out in a nearby small town, a pet cow in the front yard, and just recently gave away a goat that rode on the cows back. The cow has since made good friends with a black lab. They nap together on their backs in the grass. I wish I'd had a camera with me.

The initial shock of Friday's assignment has worn off, the weekend's worked out fairly well. I can't complain too much, great patients, fun stuff, cows and goats. Life's good!

;)

2006-03-24T19:41:00.000-08:00

"How Many Admissions Do You Want Me To Do This Weekend?"

A hush filled the room for a moment, even the phones quieted down momentarily. Before me were 7 admission packets. On a good day three is more than enough, seven? For a moment I thought if I just threw up all over them I could get out of this seemingly monumental task.

Then I thought, hmmm...pretty soon I'm going to quit this job, I can handle it. Then panic set in, when one of the names was an IV admission scheduled for tonight. I must have gone pale to the lips because my boss, Anne, started laughing. Yeah, buddy, go ahead and laugh! You're not the one doing SEVEN admits this weekend. SEVEN!

As it turns out the IV visit for tonight isn't...the patient will likely come out of the hospital tomorrow. Another one is Spanish speaking only, and even though multiple messages (and one in Spanglish) was left on their machine, they did not call back, so it's probably a no-go. The third and fourth are Medicares, but Medicare won't pay for IV medications so likely they won't be admitted either (but all could be, you never know till it happens.)

The rest are set up for visits. Mind you one or two, even three admits in a day are a lot of work. It's a good 3 hours of paperwork per person, and if it's an IV plus teaching someone in the home to administer the IV, add another hour on. Generally I get the forms signed, read them the riot act from Medicare (you MUST be homebound, you may only leave home for doctor visits...you may only....you must not...blah blah blah pfffffffftttttttttt!!) then finish the wad of paperwork at home.

So, who knows. All the patients might be admitted over the weekend, or they might not. I might get extra calls for catheter problems, IV problems, dressings that have fallen off, any number of things to deal with between all these admits, or it might be a walk in the park...one thing for sure, I'll find out tomorrow...

I'm praying for the walk in the park scenario.

;)

2006-03-23T19:36:00.000-08:00

Nothing to do With Nursing

This is nothing to do with nursing, patients, or my job (lucky you!) I spent all day and I do mean all day, trying to figure out this auto-responder thingie.

The reason? If you have a question, a concern, a hint or a tip that might help someone, or yourself, I WANT to hear from you!

Note over to the right is this cool little form thing. If you fill it out, I'll get to know what you want to know about, and be able to respond! This is incredibly exciting stuff to me, with feedback, it's just possible I can help. If you need an advocate, that's what I love to do. It's my area of expertise.

I swear on my mother's grave I'll never share any information about you, your email, etc to anyone, ever!

Halleuliah it works :)

Chris

2006-03-22T21:08:00.000-08:00

Hypnosis, Anyone?

Interesting experience today, I met a hypnotist at the Chamber of Commerce. He and I are both new to this organization. We spoke a bit about medical issues, my opinion that the Medicare Drug Plan is really a planned event to force people with limited resources to choose between medication and food.

This choice isn't new, but now it's reached it's tentacles farther into the society of our elders. I could be paranoid about this issue. After experiencing first hand how it works (fails to work) I'm beginning to think it's a planned event to ease the burden on the system.

The young man I was speaking with is a hypnotist. We talked about the power of the mind to heal the body, it's power to maintain health instead of illness, it's power to avoid illness and disease simply by the state of attitude of the individual.

The more I study this issue, the more I believe it to be true, we can control our health, with our minds. Perhaps there are diseases that overcome the power of the mind. Perhaps not. I choose to believe the mind can cure the body of most if not all illness.

2006-03-21T19:42:00.000-08:00

Wash Your Hands

Medical folks have known for a long time that simple hand washing prevents a host of illnesses. Those signs you see in bathrooms aren't put there just to waste paper, hand-washing can effectively prevent the spread of colds, the flu, hepatitis, e.coli, etc.

For doctors and nurses, it just becomes habit. We wash our hands a lot, even if they don't really need it at that moment. It's a good, healthful habit, but it can be troublesome as skin does dry out with that much hand washing. Another reason for hand washing, after removing powdered gloves, that creepy powder clings to your hands...it makes some of us sneeze.

From Health Day News, a study out of Denmark (http://healthfinder.gov/news/newsstory.asp?docID=531649) states that "Everyday workplace irritants such as chemicals, soaps and detergents can lead to prolonged sick leaves from work or even unemployment...Occupational hand eczema has become a disease of increasing importance during recent decades because of its serious consequences, such as frequent eruptions and risk of prolonged sick leave."

Ezcema breakouts aren't exclusive to Denmark, it's a common occupational hazard in most Western countries.

(Hmmm...what do they do in non-Western countries? I don't really want to know.)

The article makes one wonder why employers don't supply gloves and lotions to their workers, if for no other reason than to reduce the number of sick-days called in.

I'll keep washing, thanks.

If you don't wash your hands after a bathroom break...all I can say is, gross! If you're so unfortunate as to have me in the bathroom at the same time, expect to be embarrassed.

2006-03-20T19:34:00.000-08:00

Queen of Pain and Agony

Weird Work Weekend (www)

Maybe not so weird, but definitely out of the ordinary.

My dear friend and colleague handed her patient over to me for a dressing change on Saturday. For some strange reason, my friend Cindy, told the patient I might hurt her! Or that's what the patient heard. At any rate, I busted out laughing, and said "Oh sure! Don't ya know, I'm the Queen of Pain and Agony." (I'll get you Cindy, I will!)

The lady had a large leg wound that was very painful, and a lot of anxiety, naturally. Her face was squinched tight, and I asked if I was hurting her, she said "OH YES!" and I asked her to open her eyes. My hands were no where near her leg.

Since she was anxious, I told her to breathe as if she was giving birth to a baby with a head the size of a Volkswagen, Lamaze style breathing. She complied, and once she got into the rhythm, and I removed the old dressing. The rest of the wound care was slicker than goose poop. Perhaps that's a poor choice of phrase. The rest of the wound care was without incident. (Stated in my professional voice.)

We visited for a while, and I thought, AHA! And happened to mention that Cindy practices all sorts of alternative medicine, uses essential oils, mixes potions of goo that are at best questionable, and she better watch out.

Truth be told, humor goes a long way in dealing with patients, and if you can get them laughing, the visits go faster, easier, the patient's more relaxed and ready to participate. Anxiety levels go down, as does blood pressure and pain.

If they didn't, I'd have to resort to a large bore needle and a wicked tourniquet.

2006-03-17T19:30:00.000-08:00

A study funded by Proctor and Gamble Pharmaceuticals found that "Hysterectomy involving ovary removal (oophorectomy) increases a woman's likelihood of experiencing low sexual desire, and decreased pleasure and orgasm, researchers report."

No kidding? Gee, who would have thought that removing a womans organs, particularly organs that produce hormones would have that effect! Wowza, what a shock!

Is it just me, or does it actually make sense to "study" this type of topic, spending thousands, maybe millions of dollars to come up with what is clearly common sense?

I'm not sure how many years ago it was, far too many to worry about, Texas A&M was awarded a 35K grant to find out why some chickens lay cracked eggs.

As it happens, my landlord at the time raised chickens (Dark Brahma) and I could have called A&M and told them why. SOME CHICKENS LAY EGGS STANDING UP!

2006-03-16T20:28:00.000-08:00

Apple Cider Vinegar and Coconut Oil

Research today was minimal, and on the fly. I got a call about gout. The patient in question has been on 2 gout meds which make him ill, and he wondered if I knew of any gout cures. I didn't so I quickly googled "gout" and found a website that touts the miraculous healing power of Apple Cider Vinegar. Apparently it cures whatever ails ya, so they say.

For the gout cure, a tablespoon of the vinegar in a tablespoon of honey (sounds revolting, doesn't it?) twice a day. Umm...if my foot keeps bothering me and I don't make a podiatry appointment soon, I might be forced to try it. I passed the info on and kept reading. Seems the major problem with this cure is upset stomach and heartburn (nooooo surprise there).

I meandered down to the information about coconut oil. Mind you all these products should be "organic"...nothing wrong with organic at all, but try to find organic stuff where I live, and you'll just get frustrated, and people look at you as if you had grown Mr. Spock ears.

Anyway, the coconut oil applied to the skin or in bath water is supposed to get rid of acne, blotchiness, age spots, and even....ta da!!!!!! enlarged pores. Yippie skippie. Oh well heck, it's worth a try. And if that doesn't work, get the nekkid twister game out and have a joyous evening, besides, the scent of coconut might make you feel for a moment, like you're in Hawaii slathered with suntan oil...

or not.

:)

2006-03-15T20:01:00.000-08:00

Comments and Thoughts

Managed to edit those rather rude comments and get them off the comment list, again, apologies for uncensored rudeness of some posters.

I was reading today about various disaster scenarios and preparedness. Years ago in grade school, during the height of the Cold War, we were taught to dive under our desks to protect us from radiation. Even though I knew next to nothing about a nuclear bomb, I knew for sure this measure was useless. All it managed to do was scare the snot out of a country full of kids.

Nevertheless, some of our friends had bomb shelters and fully stocked pantries with enough food and goods to last a family of 5 several weeks. Somehow I thought that was pretty useless also. In some ways, I still do. Yet there's a difference between the possibility of a suitcase nuke and a full-bore nuclear missile.

Speaking of nuked towns this is an excellent photo essay of Chernobyl Kid Of Speed

As mentioned in the last post, "make like a boy scout" and be prepared. It's just sensible in this day and age of insanity and terrorism. Stay tuned for a link for a preparedness article. I'll post it when the article's finished.

2006-03-14T18:24:00.000-08:00

Comments and Disable Functions

Ahhh, thank goodness for comment moderation. If anyone other than the 3 year old posters saw the delightful comments the children left, I do apologize. See what happens when you turn your back on immature brats? They leave filth in their wake. Such a shame.

At least someone read the blog ;). I've disabled comments to avoid embarrassment or discomfort.
***************************

Speaking of discomfort, my youngest came home on leave and while here, his friend came for a visit. Brilliant young man, hilariously funny. He had some interesting theories, one of which was what life will be like when the oil economy dies. Among other things, he mentioned the medical community and reliance on plastics, which is made from petroleum.

Truth be known, all types of medical facilities throw away untold amounts of metric tons of plastic per day.

If this young man is correct in his theory, our medical system will literally be thrown back into the middle ages overnight.

It's not a pretty scenario. And it's not exclusive to the have or have not of oil.

Suppose the dreaded bird flu does do it's damage, suppose it does live up to the expectations of the experts and millions are killed. What should you expect? It's a long list.

Expect rampant disease, not only from a pandemic itself, but from loss of utilities, loss of sewage treatment, loss of clean water, loss of services including heat, electricity, natural gas. Expect a second wave. Expect you will not be able to get medical treatment. Expect that you'd better figure out a way to keep yourself and your family alive. Expect that if you live in a highly populated area, things will get ugly, and dangerous very quickly. Expect that someone you thought you could trust will try to harm you. Expect the worst, hope for the best.

2006-03-11T13:46:00.000-08:00

Lung Cancer Causes

As lung cancer is in the news this week with the much-too-young-to-die Dana Reeves, it's timely to discuss causes of lung cancer. Smoking leads the pack attributing to 87% of lung cancer deaths.

Another 12% is attributed to radon gas, present in many homes and buildings, according to the American Lung Association. Asbestos contamination is yet another contributor, and genes play a part as well.

Lung cancer claims 160,000 lives per anum, and while mortality from the disease has tapered off for men, for women, it's risen.

It seems that lung cancer isn't just a health issue, it's also a political issue. This stems from litigation that began approximately 25 years ago regarding lung cancer deaths attributed to smoking.

Many health professionals will tell you that they've treated lung cancer patients that never smoked, and were not often in the presence of smokers.

My take on this issue is that when you get down to brass tacks, it doesn't really matter what causes the disease, the human with the disease needs and deserves treatment.

2006-03-09T09:29:00.000-08:00

Confessions of a Renegade Nurse

Several years ago when working in hospital, I had the pleasure of caring for a delightful gentleman who suffered a broken leg. This break required surgery and hardware placement.
He was my patient for 2 weeks, and months later he returned with the leg broken and broken hardware requiring another surgery. He had a history of narcotic use--heroin.

The man never asked for pain medication. How he could bear it is beyond my comprehension.

One night I checked in on him, he was in a sweat and his knuckles were white from gripping the bed. I asked if he wanted pain medication, but he just shook his head. I paged the Resident on-call who refused to write an order. The doctor said “The patient is drug seeking.”

I hit the roof. I’d had this patient for two rounds of hospitalization. Not once did he ask for pain medications. Clearly the man was in extreme pain. I communicated this to the Resident physician who yelled, “I DON’T CARE! HE IS A DRUG ADDICT. I WILL NOT give him pain medication, HE IS DRUG-SEEKING.” I had to hold the phone a foot from my ear to avoid bleeding eardrums.

This only increased my distaste for Residents and my anger at the medical establishment. So, I did the logical thing at 3:00 a.m. I called the Attending Physician.

Calling an Attending in the middle of his sleep cycle is not for the faint of heart. But, I was hell-bent to get this man the care he needed, and as a human being he deserved.

Fortunate for me, the Attending agreed and ordered the appropriate pain medication.

The next day, as rounds were beginning, I could hear the Attending yelling at the Resident down the hall. When they came on the floor the Resident looked a bit smaller than the last time I saw him.

In the end, my patient rested comfortably. He was later discharged, and healed well.
___________________________________________________________

What does this have to do with you?

Plenty.

Your health history is not just a document. Incrementally, histories are working against patients. Insurance companies are seizing on portions of a persons health history and using it for nefarious purposes, specifically, using these bits of information to deny coverage.

If you've ever smoked a cigarette in your life, and told your doctor, it's in your records. If you've ever smoked marijuana (but didn't inhale) it's in your record. If you've ever had an alcoholic drink and told your doctor, it's in your record. If you've ever engaged in risky sex behavior and told your doctor, it's in your record.

Have you ever bungie jumped? Or gone snowboarding? Any risky behavior that you might have mentioned to your doctor is likely in your medical record. Do not be surprised if within the next few years any of the above mentioned behaviors (and many more) are the cause of your insurance denying you coverage.

It's a dirty business that's getting dirtier by the minute.

2006-03-08T08:20:00.000-08:00

Are You Taking Care Of A Parent Or Your Spouse?

If you are, don't forget to take care of yourself.

Taking care of another adult is sometimes like caring for a toddler, with a bigger body. It's imperative that you safeguard your physical health and your mental well-being.

Roughly one in four American families care for someone over the age of 50. Women comprise more than 75% of this population, and more than 2/3 of those caregivers have jobs in addition to caring for an adult at home.

The emotional stress of caring for another person in the home leads to depression and burn-out.
On the flip side, many care-givers report a positive effect on their own lives, and emotional health. I suppose it's partially a matter of attitude, support systems, and the ability to get additional help when needed, such as home health nursing care.

Take time to laugh every day.

Contact your local Area Agency on Aging (AAA) for help. There are resources to help you.

If nothing else, take your loved one to a doctor, ask the doctor to order Home Health in for an evaluation by a medical social worker to assist you in finding help.

Take time to laugh every day!

If you're the care-giver, make sure to ask for and accept help. Take time off. Arrange with a friend, a family member, someone from your church, or respite care to come in and stay with your loved-one while you go out for the afternoon or evening. Try to do this once a week at least.

Stay connected with your friends.

Arrange a call list with your friends, just to chat about the victories of the day.

It's not easy, but stay as positive about the situation as you can. It's invaluable to both you and your loved one.

2006-03-06T18:38:00.000-08:00

Breast Cancer and Antiperspirants?

Here's the skinny on breast cancer and the link to antiperspirants. http://healthfinder.gov/news/newsstory.asp?docID=531342

Thanks, but I'll keep my anti-perspirant.

Those women's libbers that burned their bras back in the 1960's were spot on. Mind you I'm not saying "don't wear a bra!" What I'm saying is every woman should be fit properly for her bras. If she gains or loses weight, those bras must be refitted and purchased.

For you men out there, this isn't a cheap endeavor. If a woman wants utility, "grandma bras" are just fine, but they still have to fit right. Pretty bras aren't cheap. (Plus one must have matching---well, you get the picture.) If you want pretty, then pony-up, buckaroo.

Simply put, walk down any street in the country and you'll see women who clearly wear bras that are much too tight. Just below the armpits and extending down the sides (and in other places) are lymph nodes. Lots of lymph nodes.

And those lymph nodes lie just where those much too tight bra straps settle.
Squish the lymph nodes, and you've already got a problem. They can't function or drain properly. If they can't drain properly, all manner of foul fluid builds up. Foul fluid=congestion, back up, irritation and ultimately, a problem...maybe cancer.

That's my 2 cents.

2006-03-04T20:27:00.000-08:00

Renegade Nurse

Dealing with patients and their families, the medical system, insurance, Medicare, Medicaid and the rest of what comprises our medical system, has taught me nothing is set in stone.

I have become a RN...as in Renegade Nurse. Always was, in some respects. I never apologize to doctors for waking them up in the middle of the night when I need an order, they get paid huge bucks to be on call. When a patient gets a raw deal from their insurance company, or if Medicare is slow to approve a needed treatment, I squawk like a chicken with its head caught in a tin can.
"I'm mad as hell and I'm not gonna take it anymore!"--actually I'm not mad, but I guarantee you I'm planning to bring up issues that would make most nurses pale. There are so many topics that are becoming apparently intolerable for patients, and they have no way of fighting back, other than through litigation. This is unfortunate as it drives up the cost of health care for everyone.

Here's a hot tip for you. If your doctor has determined you need an operation, but your insurance is denying coverage, visit the ER, often. Let them run up a couple thousand dollars per visit in tests. After a few trips, call your insurance company, have them pull up the records and say, "now wouldn't that surgery have been cheaper?" You'll get the surgery.

In the coming weeks, keep an eye on http://webnurseonline.com I'll be exposing areas of the medical community.

2006-03-03T20:10:00.000-08:00

Hard Hearted Hannah

An interesting news story came to my email today.

"A new study shows that hardening of the coronary arteries is more likely in wives when their husbands express hostility during marital arguments, and more common in husbands when either he or his spouse acts in a controlling manner." (http://healthfinder.gov/news/newsstory.asp?docID=531357)

No big surprise there. The mind body connection is alive and well. That the mind would have no influence over health is simply preposterous. Nearly daily we learn just how much our minds influence our health.

"You are what you think" is not only true as far as attitude or self-esteem go, it goes much deeper, into the heart, and down to the cellular level.

For more information see http://healthfinder.gov/news/newsstory.asp?docID=531357

2006-03-02T19:21:00.000-08:00

ADD and Biofeedback Therapy

The volume of information relating to Attention Deficit Disorder (ADD) is staggering, and growing.

Long ago, kids afflicted with ADD were probably considered "high-strung"--whatever that means, and were seldom helped via the public school system.

Today, there are probably hundreds of thousands of schoolchildren, and now adults, taking medications to help them with this disorder. Symptoms can range from mild (day dreamers) to severe (learning disabilities).

Fortunately many teachers now realize that ADD kids have more trouble than the average kid in distinguishing between same-sounding-different-meaning words, and teach ADD kids the difference between them. This is simple and effective for language learning.

Aside from the medication regime for ADD, Biofeedback Therapy has been used for over 20 years and teaches the child to pay attention via a computer monitor and electrodes pasted to his or her head. When attention wanders, the mis-behaving brainwaves signal software, and a beep is emitted from the computer. This beep signals the child that their attention has wandered off.

Some children require a handful of sessions, severe cases may require up to 60. The price tag is not for the faint of heart. But the benefits are well worth the price.

There's a problem however. While the biofeedback-trained child will have a marvelous attention span, if there are any sequelae such as impulsivity, chronic lying, or other disorders, they'll still be there. And since the child can now pay attention, they either 1) stop the other bad behaviors or 2) seem to learn how to perform bad behavior even better!

Still...they're in a catch 22 situation. Part of them is "fixed" and part is not. Eventually most ADD children learn splinter skills to help them deal with the other parts of the disorders. Meanwhile it's stressful for the parents and families, a stress that's not easily relieved.

Some don't believe this disorder exists. All I can say to those disbelievers is--borrow an ADD child for a weekend, then talk to me about it?

2006-02-28T19:52:00.000-08:00

1/3 of Iraq Veterans Seek Mental Health Services

It seems to me that any Veteran that has seen combat would to suffer with post-traumatic stress disorder (PTSD), to some degree. I often wonder why the armed services don't require extensive PTSD treatment, no doubt it has to do with expenses. To think that there is not some damage done to the psyche of an average person returning from a combat situation seems downright stupid.

Years ago, I worked with a patient that clearly suffered from this disorder. He'd been a combat vet during WWII. The man could not talk for 5 minutes without repeating a sentance that had to do with what he'd experienced in combat. Perhaps he had dementia, as far as I know he did not. It was then I realized how sad, and how serious this disorder is.

From primate behavior studies at the University of Texas- Austin, we learned that a traumatic event, or simply an event that has a powerful emotional impact (good or bad) changes brain chemicals. If that is the case, one wonders if therapy would work at all for victims of PTSD. Since behavior modification goes hand in glove with therapy, it should be beneficial.

On a slightly political note, if you're reading this, disagreeing or agreeing, posting your own thoughts, talking in public without fear, or just living in the United States...

...thank a soldier.

2006-02-27T18:26:00.000-08:00

Food Cravings

For me, it's chocolate. In particular, brownies! God Bless espresso brownies. An older report in The Journal of American Dietetic Association states that chocolate craving can be compensation for a magnesium deficiency. When under stress, the body uses more magnesium than it would normally.

Who knew? Now I have an excuse.

Food cravings can be caused by hormonal changes, long-buried emotional problems, everyday stressors, needs that are unmet, and hunger.

Should you deny cravings? I don't think so, give in--just don't go overboard and become obsessive.

The home remedy for cravings fairly simple and centers around aromatherapy. Rub a drop of essential oil of peppermint, chamomile, or lavender into your temples. If you have sensitive skin, apply a thin layer of lotion before using the oil.

Pass the brownies, please?

2006-02-25T17:16:00.000-08:00

Folk Remedies For Arthritis

Need some serious pain relief for your arthritis?

Arthritis sufferers are often give (Non Steroidal Anti-Inflammatory Drugs) NSAIDs for pain relief. Over 16, 000 people with arthritis kill themselves accidently every year with NSAIDs. If you pain isn't controlled with your regular dose, for pity sake, don't take more! Ask your doctor for a more effective pain medication instead...meanwhile, for flare ups try these:

Blanch a leaf or two of cabbage (toss in boiling water for a few seconds), then apply to the affected joints when it's either warm, or cool--however you prefer. Secure the cabbage leaves in place with a gauze wrap or elastic bandage.

This is a great tea for powerful pain relief: combine devil's claw, black cohosh, passion flower, and ginger in equal parts. Use 1 teaspoon per cup of boiling water. Let it steep while covered for 20 minutes, strain and drink a cup, up to three times daily.

Ginger has some very potent anti-inflammatory effects, if you can't tolerate the taste of ginger, you might be able to find it in capsules at the health food store.

2006-02-24T19:47:00.000-08:00

Ecstasy and...

I read an article today about childhood depression increasing the risk of the illegal drug "Ecstasy" among the adult population.

I suppose it could happen, but one has to wonder when people are going to stop finding excuses for their dysfunctional lives and realize they're just like everyone else. At some point in the emotional growth of the adult human, a person has got to realize some things were out of their control as children, they weren't responsible for whatever went wrong.

At some point we all have to take responsibility for our own lives and quit blaming others. I may be way off base here, and I'm sure willing to admit it. But it seems to me that the blame game, and political correctness, and the dumbing down of our population, and the psycho-babble has got to stop.

Ok enough of the ranting.

Here's the article if you want to read it. http://healthfinder.gov/news/newsstory.asp?docID=531188

(This has been mentioned before, but if you're depressed, go to http://webnurseonline.com Scroll down to "Depression Schedule". Try it. It beats taking pills by a long shot.

2006-02-23T19:29:00.000-08:00

Old Spice and Anemia

Us Southerners have a habit of spicing up pretty much everything that we put in our mouths. Spicing greens with vinegar is one, and as it happens, vinegar and lemon juice sprinkled on greens help liberate minerals--thus making iron more easily absorbed in the body.

And ya'll thought we were dumb, tsk tsk.

On that note, there are some veggies that bind to iron and prevent your body from absorbing it, spinach and rhubarb, particularly. Both of these veggies contain oxalic acid, which is the culprit.

If you're taking iron supplements, try having it with a glass of orange juice, or with citrus fruits. These measures will help your body absorb iron, and keep the constipation blues away. Iron supplements are notorious for creating that little problem.

A powerful, yet little known anemia cure is strawberry tea. Pick about 3 tablespoons of the leaves, crush them, put them in boiling water. Steep the tea for 5 minutes. Scoop the leaves out (or use a strainer) relax and enjoy.

While you're at it, you might as well dip the berries in chocolate and really enjoy yourself ;)

2006-02-22T17:55:00.000-08:00

Painful Knees

You can call this post what you wish. I thought I'd share something I've found quite helpful to me and a few other people I know, including a man who lost one arm in a war, and the fingers on his other hand from a terrorist attack.

At the ripe old age of 17, I dislocated my patella (knee cap) during a dance lesson, and again 15 years to-the-day later. Since the age of 17 I've had severe knee pain, and a pronounced limp. That was until about two years ago.

Mind you, I'm not making any money off this, I have no financial interest in any company that sells this product, and I'm not an affiliate of it. I just know it worked for me, and who knows who else it can benefit.

So, about two years ago, my good friend mentioned Ester-C and all the fabulous things it's supposed to do for you. We got some, and tried it, 1000mg/day. Exactly eleven days later, for the first time in 34 years I had NO knee pain. I still have no knee pain.

About the man who lost his arm, and fingers of the other hand--I recommended Ester-C to him. Roughly a month later I asked how his pain was. He said it was unchanged. A few days later, in an email he distributed far and wide, he wrote that he'd made a mistake, he noticed he required less pain medication to make it through the day, but there was a drawback...

...he had gas--"explosive gas, enough gas to power a rocketship to 'da moon!"

Of course, if you decide to try Ester-C (make sure the label says Ester-C and not C-Ester or any variation) check with your doctor first. There shouldn't be a problem.

Let me know if it works for you.

2006-02-21T18:31:00.000-08:00

Red Grapefruit And Cholesterol

A research team led by Hebrew University of Jerusalem Dr. Shela Gorinstein found that patients who ate the equivalent of one grapefruit per day had lower cholesterol levels than those who didn't.

This study was published on the website of the American Chemical Society's Journal of Agricultural and Food Chemistry. The study will appear in the journal's March print issue. The study supports a growing body of evidence that suggests eating citrus fruit is heart-healthy.

Not only did blood lipid levels decrease, but triglyceride levels dropped considerably more when patients ate red grapefruit as opposed to white grapefruit.

The down side is grapefruit is known to adversly interact with certain medications, so as always, consult your doctor.

Dr. Gorinstein's proud of this study, but she won't stop with the grapefruit trials, she states, "The next project will be very interesting. We're going to study the effects of exotic fruit on cholesterol."

I don't know about you, but I'm looking forward to the exotic fruit study.

2006-02-20T18:06:00.000-08:00

Diabetes

Diabetes is an enormous and complex topic. I won't even try to scratch the surface on this one, but rather will talk about some observations and a couple of quick food tips.

First, my famous three food tips:

If you are a spaghetti fan, buy a big ol' spaghetti squash, cook it up, and when it's done open it. The meat falls out and looks a lot like noodles. Slather with spaghetti sauce. It's actually very good!
Rather than a sandwich with that wonderful bread that boosts your blood sugar up, wrap the ingredients in a thick leafed lettuce, like Romaine.
For snacks, try string cheese sticks.

If you've just returned from the hospital and were NOT diabetic when you went into the hospital, perhaps your body is trying to adjust from medications and the lousy food. It's possible you're not diabetic. Consult with your doctor and bring this to his or her attention.
You see, when you are sick, your blood sugar naturally increases, so don't be too quick to jump into the insulin/oral medication routine. Let yourself normalize.

All RN's have dealt with diabetics, no matter what the setting is. In Home Health we have "new diabetics" come on service so often that I for one, am questioning whether these patients are truly diabetic, or if their high blood sugar levels aren't caused by various factors while in the hospital.

In either case, diabetes is a very serious illness, and the complications are horrendous.

Over the years I've noticed diabetics falling into 2 categories (this is only my opinion and it doesn't mean much)

Diabetics that will do anything to get their blood sugar to a normal level
Diabetics that refuse to admit they have a disease, refuse to comply with medication regimes, and who suffer dire consequences.

The first group is very easy to work with. Compliance is never an issue.

The second group is a huge challenge, and not one with which I have any patience at all. Actually, when I'm dealing with a patient with any disease, the less compliant they are, the more quickly I'll move on, there's just no point.

A wise and learned diabetic nurse once said, "Diabetics are unable to taste the sweetness of life."

While this is true in regard to food, it sure isn't true in regard to all the rest of the riches of life, perhaps it's the inability to see beyond the disease. Perhaps not. The psychology of diabetes is far too complex, and out of my field.

I'd just like a world where no one lost limbs or eyesight, or kidneys to this disease.

See webnurseonline.com for more information.

2006-02-19T19:23:00.000-08:00

How To Get The Most Out Of Your Visit With Your Doctor

Talking to a doctor can be intimidating for most people. For years doctors were put on pedestals (usually they did it themselves) and the rest of us schmucks did whatever they told us. Thanks to the information age, patients have access to reliable information and can arm themselves before that visit. Here are some suggestions to help you get the most out of your visit time.

1) Schedule an "extra time" visit and inform the office assistant you'll be bringing a list of questions with you
2) Write that list down! Don't rely on your memory, you'll most likely forget something of importance to you.
3) Take all your medications IN THEIR BOTTLES with you to the doctor. Put them on the counter where the doctor can't help but see them (particularly if you are taking more than 5 prescribed plus any over-the-counter medications)
4) Ask the doctor if you can discontinue any of the medications.
5) If the doctor is hesitant to do so, ask why, if you don't understand, ask for clarification.
6) If the doctor determines you need surgery for a problem, get a second opinion. The doctor should understand your concern and will most likely tell you that's fine with him or her.
7) If your questions are not answered, and the doctor attempts to leave the room, block the door, and sweetly say you're not quite finished yet.

You see, doctors are pretty much forced to limit time with a patient because insurance companies tell them they must. But realize, it's your health at stake--if your doctor is not willing to spend a little extra time with you, then you must either make him or her spend time, or find a doctor that will.

Finding a doctor that actually listens to a patient can be quite a trick. They are busy people, but that's no excuse. They hear, but do not listen. As a patient you must make them listen. By the way, nurses are guilty of hearing but not listening too. All too often medical professionals either assume they know what's going on, or they're looking at a specific condition, and not the overall picture. A good doctor, or nurse, or nurse practitioner will ask you perhaps hundreds of questions during your initial appointment.

Still, you must take it upon yourself to be understood and heard.

2006-02-18T19:33:00.000-08:00

More Good News

Finally, a new insulin therapy for diabetics. Since insulin was invented, it's been given by injection. So not only does the patient have to poke their fingers to get a blood sample, but most often it's followed by injection, sometimes several injections a day.

Pfizer now has an inhaled form of insulin called Exubera, which was approved by the FDA on Friday. This is very good news for the 5 million + diabetics in the U.S. Safety and effectiveness were studied in more than 2500 adults with type 1 and type 2 diabetes, and peak insulin levels were achieved on average of 49 minutes, versus an average of105 minutes with injected insulins.

The bad news, Exhubera shouldn't be used by smokers, or those who quit smoking within the last 6 months, the FDA said. Nor is it recommended for people with bronchitis, asthma, or emphysema.

Pfizer will continute to conduct long-term studies of Exhubera's safety and effectivenss, particularly those with underlying lung disease, the FDA said.

What would be better, would be a permanent cure. I believe they're working on that one!

2006-02-18T18:53:00.000-08:00

Ebola

You might be wondering why on earth a blogger in the USA would post anything about the Ebola virus in Africa. If so, read on.

Since the Ebola plague came to the news here, my tiny brain started trying to figure out what was going on. It wasn't just Ebola, there were a few other horrible and mysterious virii popping out of the jungle.

Ebola hemorrhagic Ebola kills between half and 90 percent of it's victims within days. It is highly contagious, but so far has been confined to Africa. Officials worry that this virus could be used as a bioterror weapon. And that in itself is enough to cause concern. But there are other reasons for concern with Ebola.

I've followed the news on African primates for better than 20 years. One huge problem is their habitat is being eroded away. Inch by inch, meter by meter. Areas of Africa that were never trod upon by the likes of human kind are being penetrated, and nature's nastiest creatures in the form of bacteria and virii live in those areas in great abundance.

These areas of deep forest are buffer zones. When the buffer zones are all gone, all bets are off. Those bacteria and virii will find new vectors to inhabit, and people will be infected at astonishing rates.

What other horrors are just beyond? What might be lurking in the Amazon, and how will we defend ourselves from it? I'm no expert, but I'd bet dollars to doughnuts it's a considerable amount of lethal material in that world.

The good news is there is now a vaccine for the Ebola virus which has passed it's first safety test. It's still very early in the test phase, so far it looks good. The unfortunate thing about working with virii is the rapid rate of mutation. We've heard about this in the news recently concerning pandemic bird flu and it's possible consequences.

2006-02-17T19:35:00.000-08:00

Calls for Help Part II

The other day I wrote about a patient who is off our service, but continues to call us for help. Today when I went to the office to pick up the weekend assignment, I learned that indeed 911 service refused to go see her. I asked what I was to do if she calls again, and was told to have her call 911.

We discussed the fact that because 1) her age 2) her condition 3) her "frequent flyer" miles and so-called abuse of the system, we're not to see her.

Why am I telling you this? For one thing, it's becoming more apparent that personal responsibility for one's health is becoming more important. Second, this patient has known about her own disease for years, there's much she could have done to help herself but didn't. Third, as more baby boomers reach critical mass in the health care industry, we're going to have to rely on ourselves more and more.

I don't think anyone can count on the medical system in the USA at this point. So guard your health carefully.

2006-02-16T19:05:00.000-08:00

Women and Heart Attacks

Women have different heart attack symptoms than men. What's worse almost 50 percent of women who die of a heart attack have no clinical symptoms at all, according to a U.S. national Institutes of Health study.

Rather than the classic symptoms for men: severe chest pain, pain that radiates to the jaw, or down one or both arms, women report cold sweats, light-headedness, nausea.

Additional symptoms that have been reported to Home Health nurses are:

sudden tiredness, so much so that the woman has to lay down and rest
elbow pain
feeling of doom

The elbow pain is an odd one, and personally I've only heard that symptom once. The woman visited her doctor, who diagnosed "Tennis elbow". After several days, with the pain persisting, her husband called 911. The woman's vital signs were fine, so she wasn't taken to the hospital.

As it turns out, she was having a heart attack. Neither she nor the cardiologist could explain how it happened that she survived several days of a heart attack. It was an event for case study. In the end, the damage to her heart was so severe, that she ended up with a transplant.

The lesson here is:

Seek help immediately if you're having a heart attack, call 911
Do not drive yourself to the hospital (yes, people do that)
Listen to your body, pay attention to what it's telling you
If you're not satisfied with the diagnosis the doctor gives you, ask for further tests

If you or a woman you know has had a heart attack, and had symptoms other than those listed, please let me know.

2006-02-15T18:33:00.000-08:00

Health Warning for Premature Infants With Reflux Disease

While cruising the net for pertinent health information today, I came across a page regarding preemies and Reflux Disease. Over the counter (OTC) medications that treat reflux disease can cause death in premature infants.

New reseach suggests drugs known as H2 (histamine) blockers, are commonly given to premature infants to treat acid reflux, which may increase their risk for a potentially fatal bowel infection called necrotizing enterocolitis.

"This study strongly suggests that the common practice of prescribing H2 blockers to prevent or treat acid reflux in premature infants be discontinued, until more evidence on the safety of this practice becomes available," Dr. Elias A. Zerhouni, director of the U.S. National Institutes of Health, said in a prepared statement.

H2 blockers include OTC products such as Axid, Pepcid, Tagamet and Zantac, inhibit the production of stomach acid.

With necrotizing enterocolitis tissue lining the wall of the intestines dies and any surviving tissue becomes swollen and inflamed. The digestive tract becomes unable to digest food.

-------------------------------------------------------------------------

Nursing Tip of the Week:

While H2 blockers may cause this fatal disease in premature infants, they are very helpful not only for reflux disease in older children and adults, but they're also helpful if a person is bothered by persistent itching.

2006-02-14T17:42:00.000-08:00

Calls for Help

Part of my job is to take call, usually over the weekend, but more recently to fill in for a nurse who had surgery, and another who resigned. You never know what'll happen and I suppose that's what makes it interesting.

The problem isn't being on call, or going out in the cold night, it's that sometimes there's simply nothing we can do, or the person needs to go to the hospital rather than wasting time talking to us.

Last night a call came in from a former patient, in dire need of help. Since the person was discharged some time ago, I couldn't call the doctor, couldn't advise, couldn't do anything. The patient called 911, the hospital, and the doctor, and was denied help.

Why? Because the person is well known amongst the medical community, too well known. The problem is one the patient should have had under control years ago, but hasn't. And now, when the patient calls for help, it's seen as a "Cry Wolf!"

Would I have gone out to help? Yes. Absolutely. Legally, and per company policy I'm not allowed to go see discharged patients. Big lawsuit type stuff.

So my hands were tied. I couldn't do anything but tell the patient (repeatedly) to call the doctor. Unfortunately, the doctor made him or herself unavailable to this patient. So did 911. So did the hospital.

Unreal.

2006-02-13T18:52:00.000-08:00

Sundown and Trouble

Sundowners is a phenomena well known to nurses that work in the hospital. It's a condition in which a patient becomes terribly confused and sometimes hallucinates when the sun goes down. Sundowners is associated with the earlystages of Alzheimer's disease, but no definitive connection has been made. It's also considered to be a mood or even a sleep disorder.
The person afflicted with Sundowners exeperience extreme agitation and confusion, and it was once belived that the syndrome was a result of missed "light cues" from day to night.

Whatever the cause it is a most interesting phenomena. It's also disturbing because when in a facility, the concern is safety of the patient. All too often, that concern for safety turns into either physical or chemical restraint.

One such gentleman that we cared for on our floor of the hospital, was a charming guy during the day, then around dinner time, he turned into a wild man. We'd discussed restraints, and perhaps that would have been a good idea, but we weren't willing to participate.

It took a little mental noodling to keep him busy. Since it was a realatively quiet night, we were able to keep him occupied folding washcloths, towels, and pretty much anything else that came into view.

Soon as he got a nice neat stack of washcloths, one of those "darn clumsy nurses" would up-end the stack, and the gentleman would sigh, and start to refold them.

He got a nice reward though, three of us went into his room with midnight snacks.

Soon as morning came, his mental fog lifted, and he was back to what we percieved was his norm. I'm not sure what happened to him, as when I left, it was the end of my work week. When I came back on shift, he'd been discharged.

He left me a little gift though, a washcloth, folded up the size of a postage stamp.

2006-02-12T19:11:00.000-08:00

Last Lists of My Mad Mother

Last year at the gallery, a friend stopped in and asked if we would be willing to host a play, with seating for about 30 people. The play was of a woman with Alzheimer's Disease and her two daughters. I'd lost my mother to complications of Alzheimer's Disease just a little less than a year before. There was no doubt about hosting the play, the doubt was whether or not I could deal with it.

As it turns out, Last Lists of My Mad Mother was a wonderful, heartwarming, hilarious, and sad story. The actors were superb, and most of the audience held it together in fine fashion, until one moment, the definitive moment in Mother's life when "the roof of her mind collapsed."

This horrible disease robs the human it inflicts of every last shred of dignity a person could possibly hope to cling to. Bit by bit. Memory by memory. Word by word.

I've had patients with Alzheimer's. One lady was absolutely the most stubborn, difficult woman I've ever run into. She'd fight with me, try to yank my hair out and pull my toenails out with it. The staff had to restrain her while I changed her dressings. It was one visit I did not enjoy making, ever...

...until one day, I walked in and the lady was listening to some music, sitting completely upright, clapping her hands, singing and smiling. What a profound difference. I realized at that moment, she'd once had a happy life, but this awful disease took that from her. This was the only time I saw her experiencing anything but extreme anger. She looked like an angel, and almost sang like one--but she couldn't carry a tune in a bucket.

Still, with that white hair, that huge smile, she was an angel.

Not long after, the adult care home staff called to let me know she'd been transferred to hospice. I called, and as she had no family, the hospice RN's kept me updated. They called me and said, "Come soon."

I did go, and sat with her, stroking her pretty white hair, remembering a smiling face, and a terribly sung song, and felt the sigh of an angel.

2006-02-11T19:46:00.000-08:00

Check The Mental Editor At The Door

Most of us remember the phrase "A mind is a terrible thing to waste." This tagline was from a television commercial back in the 1980's. There's no question this is truth. What's odd is that people question the minds ability to heal the body.

Perhaps more relevant is the inability of people to realize how much what you think, your attitudes, emotions, and decisions affect health.

I’ve worked as a Home Health nurse for 13 years. After all this time it simply amazes me that most people have no idea that they can control problems, just by using their minds.

Mind over matter is more than an empty phrase, the truth is, your mind can control a myriad of illnesses. Alas, most people simply don’t understand this connection.

You can choose many things in life, but you can’t always choose what happens to you physically—or can you? I’m not talking about the unfortunate people who are born in illness or disease or birth defects. Some things are beyond control of even the most talented physicians.

What exactly can you do to improve your own health? For one, check your mental editor. You know the one, the creepy little voice that tells you you’re worthless, you can’t do anything right, you’ll never get ahead, that you're too sick...

...slap that editor upside the head and make it listen to you! What the mental editor tells you simply is a lie.

If you’ve ever suffered with depression, either from an event in your life, or a change in your health, read on.

I’ve used this technique with my patients, it’s simple, it’s effective. It’s a great alternative to medications.

Set an appointment every day. Choose an hour a day when you know you won’t be disturbed. Don’t answer the phone, your email, the door. For one hour and one hour only, allow yourself to wallow fully in this sad place. Cry, cry, and cry some more. Talk to yourself aloud about the problems you face, kick something (no living creatures, please) do what you need to do to get the emotion out.

For one hour only. Set a timer.

When the hour is over, stop.

Just stop.

Here’s the tough part...for the remaining 23 hours of the day, when those depressive thoughts come into your head, and they will, tell yourself, “NO! I will deal with this at the appointment time.” You will find at first that you’re repeating this quite a lot. But it will become easier.

After the first two weeks, cut your appointment hour down to 45 minutes. The week after that, down to 30 minutes, and so on until there’s no more hour left.

You see, the point of the exercise is that you allow yourself to grieve. It’s perfectly normal to be depressed over any number of events, from the loss of a job or a friend, to a more serious or tragic event. Sometimes people get stuck in the grief mode. This is one simple technique that allows you to put that sadness in front of you, out where you can see it, and over a period of a few weeks, diminish it, until it is gone!

What do you do when that depression is out of your life? Set immediately to work. Every day, write down five things you are grateful for. Keep building on that list. Watch for “love notes.” Love notes are gifts to you for the gratitude you express. It might be something as simple as a bird feather falling at your feet, or a flower growing from a crack in the pavement. You’ll find these notes all around you.

Keep looking...
and you will find joy.

Medicare Woes

2006-02-10T18:16:00.000-08:00

Medicare and Isolation

Catch 22.

A disproportionate number of Americans rely on Medicare as their primary insurance after retirement. In and of itself, that's not a bad thing. If it weren't for Medicare, many of our citizens, both elders and those that are disabled would have no medical insurance coverage at all. I'm thankful that there is a Medicare.

What I'm not thankful for, as a home health nurse is that I have to qualify people who are on Medicare. Anymore, private insurance is following Medicare's lead in some areas.

You see, when caring for a Medicare patient, the nurse has the responsibility of making sure that the patient is "home bound." This means they can go to doctor visits, an occasional hair cut, sometimes to church.

So what's the problem? For the disabled and the chronically ill, being home bound can lead to tremendous social isolation. Unless there are friends left, or family around, the isolation can be unbearable, and lead to further depression. I don't think it's very healthy to be forced to stay home, to not be able to enjoy a few hours out in public. To be chronically ill, and forced to stay home, is to sentence the ill person to focus on their illness. Without the mental break of being with other people in social situations, this can only lead to further decline.

That's just my opinion. My opinion doesn't mean anything as far as Medicare's concerned.

I'm not the Nurse-Police.

On the other side of the coin, abuse of Home Health when the patient can easily get to a clinic or the doctor, is definite cause to discharge from the agency. So is non-compliance, when the patient states they will be at home, yet there are multiple incidences of being away from home.

So how do you balance? How to be fair to the human who desperately needs human contact, without violating Medicare standards...hmmm...

it's a pickle.

Tomorrow....the Oasis debacle, stay tuned!

2006-02-09T18:29:00.000-08:00

What Will They Do?--Medicare Medication Plans

It started simple enough...build it, they will come.

So I did...am. Building a website, major medical issues like Congestive Heart Failure, Stroke, Alzheimer's Disease, Parkinson's Disease, and so on. Included are tips from nurses.

It's not a difficult thing, but it is more time consuming than I'd thought it would be. I just hope that it will be helpful to folks who fall through the cracks. People that don't have insurance, or Medicare. People who need more information, and some practical tips on how to care for loved ones or themselves. I'm adding pages as I go, but it'll be a good month before it's completed.

It seems impossible that in the USA, there are so many people who do not have access to medical care, but there are thousands, if not millions of them. Makes one wonder how people in other countries survive.

Sometimes they don't survive.

Considering how many nurses are leaving the job, the number of baby boomers that are about to enter the rank and file of people that will need help at home, it's a slightly frightening scenario. Teaching a "warm body" to perform basic tasks will become a necessity, in fact it already is.

I've wondered if the new Medicare medication plan isn't in fact, the governments way of knocking folks off. If you've not experienced trying to get a long list of medications covered under this plan, at a reasonable cost, then I'll tell you it's nearly impossible. I'm deeply concerned about our senior citizens.

Stay healthy, guard your health. It's your best chance.

Nurses Eat Their Young

2006-02-07T18:30:00.000-08:00

The following is a reply to a post I'd written...about nurses leaving the profession in droves. The reply is true on every level. It's a sad state.

Nursing isn't a glamorous profession. It almost became a "real" profession. But then, in my opinion, nurses themselves got in the way, and went overboard with absurd rules and regulations that have little to do with nursing itself, and everything to do with turning the system into meaningless paper glop.

This is the reply:

1.Poor managment of staffing ratios, weak leaders and lack of advancement opportunites.

2. An education for a "nurse" varies. Do you think someone asks a MD if he went to a 3 year or 8 year program? That is the number one cause of what is going on with nurses. First off, a "nurse" can be a LPN or RN. An RN can have a 4 year degree or something less. So why are there still programs out there that require less? Poor education standards are still present.

Yes, in the state of Pennsylvania, just a check written every 2 years will suffice for active status. Now, look at all the other states and see the variety of requirements for C.E.U.'s etc. Why is that? If nursing is a true profession there would at least be standard requirements for education and for C.E.U.'s across all the 50 states.

The lack of respect for the profession still continues and nurses continue to judge each other, especially if they are brand new or, God forbid, one with a 4 year degree!
I have experienced both. Thanks for the memories.

3. Burnout. If you never experience it, God bless you. You are a truly one for the books.

4. Corporate thinking of using "cheaper" labor to save costs.
Might work with a computer office, but not when people are involved.
The "higherups" really do not grasp to concept of nursing.
Ah, but when they are patients, they do receive more atttention-better care-and when they wonder where are the nurses for their family and friends?--they just need to look back over their budget and annual reports and they will find the answer.

5. 17 years of experience for me. I would go back, but only if the standards are raised for RN's and the elimination of LPN's.
Yes. I hear the uproar already, but is the current model really working for "nurses" and the patients? Think! about it...

As for #2 above, I've known Registered Nurses with associate degrees, and some with PhD's in nursing.

My experience with LPN's has been quite different than the former nurse that replied to my mail. The LPN's I've worked were remarkable nurses, with tremendous experience. They received much lower pay, and they really did work harder. I have nothing but good memories of them.

Perhaps they were an exceptional bunch. Perhaps not. I was grateful at the time for their expertise, and their knowledge which they shared without reservation.

On the other hand, senior RN's were out to eat their young.

They didn't just eat them, they devoured them.

White Hats & Lures

2006-02-05T18:14:00.000-08:00

Erin's earrings were dangling just above the patients chin, the look in his eyes was sheer disbelief.

Understandable as Erin's earrings were fishing lures the size of small trout.

She had them in a myriad of colors and sizes, color coordinated to match her scrubs. It brought a bit of comic relief to the orthopedic and neurology patients. She was quick witted, and always had a joke for our patients.

I'm not sure what started the metamorphosis, perhaps it was when Erin was injured while out jogging. She'd been hit by a car, broke her ankle, and had cuts and bruises.

Her humor didn't change, her jokes were still good...but something was different.

The lure earrings vanished, as did her colorful scrubs. Suddenly she was wearing all white scrubs...then nursing dresses, white hose, and white shoes. It was about that time I left the hospital to work at home health.

A few months later, Erin was on the local news. I was stunned to see not only the white dress, hose and shoes, but .... a hat? A white nursing hat? Like old time nurses? Huh?

I never found out why, and I'm glad of that.

Thank goodness for Home Health and blue jeans.

Folly and Wisdom

2006-02-04T17:58:00.001-08:00

Folly and Wisdom

They say youth is wasted on the young. Once you get a few years under your belt, you realize the wisdom of that statement. I keep thinking if I had the energy of the young patient I had today, then I'd...

be screaming my guts out. Oy!

In a previous post I mentioned I'm not a pediatric nurse. There's good reason why not. I have no tolerance, not much patience, and kids just don't get my twisted since of humor! I wonder why...

I had the great pleasure of re-admitting a patient we'd had on service a year ago, and he's back. I'm not happy that he's ill, but it was wonderful to see him again.

He's a wonderful gentleman with a wry sense of humor, and he even appreciates mine. It was a thoroughly enjoyable two hours. Fortunate for me, he remembered all too well the dreaded "privacy act" so I didn't have to repeat it for him. He remembered all the paperwork, so I didn't need to repeat that either.
If only...

If only every patient came built in and hard wired for all the questions we have to ask. If only all my patients were as sweet as this gentleman was (most are some are a tad cranky.) If only all of these patients didn't have pain...

If only people would stay healthy until they depart this world. Now that would almost be paradise.

Long ago when I first started Home Health nursing, I drove into the far boonies of the desert to see a young lady. She was 16; she wouldn't survive without a miracle. To my knowledge she didn't get that miracle, but I prefer to believe she did.

I was angry with God when I left her house, because it wasn't just the 16 year old that had this horrid disease, her 7 year old sister was showing the first signs of it too. Two beautiful girls. I cried out and asked why He couldn't pick on someone else...

and I heard that still, small voice...

"My ways are not your ways."

...those words still ring in my ears.

Nurses Cornered!

2006-02-03T15:03:00.000-08:00

Cornered for Evaluations

It's that time of year...again.

The boss called and needs to go with me to a home visit to evaluate my nursing skills. In and of itself, this isn't a bad thing, it's necessary. Knowing that does absolutely nothing for my sanity or my nerves.

I asked if we could choose a wound care patient.

No problem she said.

Another call..."Oh, there's a patient that has a wound-vac, would that be ok?"

"You bet!" I said, "I'm the Queen of Wound-Vac's."

Of course, before we could make the visit, which was to be today, the wound vac was discontinued and the patient is getting a dressing change every other day.

Nuts!

For those of you not familiar, the Wound-Vac system is a nifty little machine that suctions out drainage, and pulls healthy red blood cells into a wound. Healing time is cut dramatically. They are fabulous devises. If you buy stock, get some in this company, it's ticker symbol is KCI.

I've worked with Wound-Vac's for 6 years. They are a gift from heaven.

Oddly enough, since I started nursing in 1993, I've asked doctors why they don't put a topical antibiotic into the wound bed. They looked at me like I was Snake-Woman-From-Idiotand. "Because the infection is in the tissues, not the wound bed."

Duh.

I'd counter with, "However, when the tissues drain into the wound bed, it becomes contaminated."

Deer in the headlights look back at me.

About a year ago, KCI came out with a new Wound-Vac for hospital use. You guessed it. It has an antibiotic chamber that pumps antibiotics into the wound bed, lets it sit a while, then sucks the antibiotic out, and continues to work as a Wound-Vac until the next round of antibiotics is due.

I'm just glad someone picked up on that bit of cosmic genius and invented this machine. It's already saved countless limbs. Amazing.

The joint visit with my boss...rescheduled for sometime in the future. Halleluiah.

Tip of the Day

2006-02-01T16:49:00.000-08:00

Nursing Tip Of The Day

No matter how you look at it, most people are under a tremendous amount of stress. Add to that an illness or disease, and it soon becomes a vicious cycle. Believe it or not nurses deal with stress all the time, their patients stress.

In home care, we often see patients that have just returned from the hospital, and are now coping with a different level of health, or lack thereof. Even though they are happier and more comfortable at home, their stress levels are quite high, measurably so.

A patient just released from the hospital may be confused about the change in medication, treatment received when in the hospital, how their spouses or loved ones are coping with the situation, worries about long term care and the possibility that they may never get their good health back.

A frequent problem is side effects of medications and or chemotherapy. Nausea can be a formidable opponent when a person is trying to heal from injury, surgery, or chemotherapy treatments, among other things.

Often, a prescription to relieve this unpleasant side effect is given. Another pill to add to the pile of pills. Surely there's a better way.

And, there is. Make good friends with your ice pack. If you don't have an ice pack, you can easily make one with ice cubes, and a doubled zip lock bag.

Are you ready? Here's the nursing tip of the day...place that ice pack right on your stomach, not where you think your stomach is, but up high, where the inverted "V" of your ribs is, where they come together. In about 5 minutes your nausea will be relieved.

Not bad, eh?

Nurses Corner

2006-01-31T19:18:00.000-08:00

The Problem with Nursing

Any nurse can tell you that the profession is
rewarding, stressful, challenging. There's always
new technology to learn, or new guidelines, and
always, more paperwork. Patients are sicker, the
job gets tougher by the minute.

Supposedly there's a nursing shortage. I can tell you
why that is, it's not that there are too few nurses out
there, it's because hordes of them have left the
profession, yet they keep their licenses current.

Some call it a sabbatical.

I call it "Runs From Paperwork."

It's atrocious.

In todays litigious society, everything you do as
a nurse has to be documented. A few years ago,
nurses charted by exception. If for example, a
patient had a fever when vital signs were checked
at 7 p.m. this was noted. Other things like administering
medications that were ordered, were considered the
norm, and therefore not charted.

But, that's when life was sensible.

RN Tip Of The Day

The old saying, "it's all in your head" is
often true! More often than is realized,
symptoms and illnesses can be controlled
by what you think, and how you think about it.

A positive outlook, even in the most dire of
circumstances, helps tremendously with the
outcome of the disease process. If the patient
maintains a positive outlook, which isn't always
easy, and manages to keep a sense of humor,
symptoms will be greatly reduced. This in and
of itself, has proven time and again to not only
keep the patient focused on a good outcome, but
in fact contributes to healing.

The mind controls the body, always. That's not to
say that the mind can cure all...or can it? I don't think
that health care professionals have delved into this
aspect of care with nearly the vigor that it needs to
be addressed.

For us average mentality folks, it is said that we only
use a small portion of our brain, the rest lays there,
doing little. Imagine, if we used the power of our minds,
what effect that could have on our health.

Can you think your way to wellness? Yes, I do believe you can.

But it can't be done with just one thought, it has to be a
focused, relentless attention to the problem. Like a tape
recording on a feedback loop, keep in your mind the
solution to the problem. It can be something as simple
as, "I will NEVER have a cold or the flu again."

People doubt me when I tell them I did that 23 years ago,
and have not had a cold or the flu since making that
declaration. But it wasn't just the declaration. I focused
my mind and in my head repeated that single sentence
perhaps a thousand times. 23 years. No colds, no flu, and
I'm around people with both almost daily.

You decide. Then do it.

To your health!