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Archive for February, 2010


So, we are halfway through this term with three heavy-duty courses. Each one is extremely demanding of time and effort, though the prof in Advanced Practice Procedures is giving us a little break, God bless her!  I find that I am almost at a mental standstill. With over twenty chapters to read in the next week; a final, a midterm, 2 quizzes, a case study, a history and physical, a term paper and a group project all to be completed within three weeks. I look at this list and my mind goes blank, my eyes mist over and I can barely get a coherent thought together.

Stress is one of the subjects under scrutiny at this point in Advanced Health Assessment. Is the instructor trying to create it so we can study the effects of stress on ourselves? If so, she is doing a great job. We are supposed to find methods of coping with this stress. In a discussion, students presented various options:

  •  wine: maybe not the best option due to abuse potential
  •  sex: well, for me it isn’t any fun unless I am already relaxed
  •  massage therapy: my idea, but I need the time to go get one
  •  exercise: again, time but I have been making  a go at daily bike rides. This has helped, and I actually am losing some weight, an extra plus.
  •  being organized: not my strongest suit, but I make occasional forays into the list, schedule and sticky note reminder system methods of organizing. My computer desktop is covered in little yellow electronic sticky notes so I can’t see my “best of Bing” pictures.
  • retail therapy: this only works if you have extra money to spend. The stress relief is counteracted by the big credit card bill.
  • eating healthy: this is supposed to make you feel better, and it does, I am sure. For many people, food itself is a stress reliever, but then the happiness is counteracted by the bathroom scale readings. Of course, you could avoid looking at the bathroom scale, but then your favorite jeans get uncomfortable to wear, and that is stressful in itself. Yes, eating healthy is definitely a must. It takes 3 weeks to get over carb cravings, I found that out for  myself. Once you get past that, it becomes easier.
  • getting enough rest: yes, it is tempting to try to fit in more reading at the very end of the day. However, absorbing information by osmosis through your cheek after you fall asleep in the book is not a very efficient way to learn. However, I  read a study that stated you retain things better if you read them last thing before you fall asleep. Timing is crucial here. You still need to get your 8. Hmmm, perhaps reading and then taking a power nap will help me retain the info, will have to try that.
  • meditation: this works for many people, but my head is just too busy. A freight train of thoughts goes through my brain whenever I try to “empty” my head. No matter how hard I try, concentrating on my breathing just isn’t enough to stop this continual flow of thoughts and distractions. The physical effort of bike riding actually works better for me, as I have to concentrate on not falling off and where I am going;  the trees, birds and wildlife keep my attention; and I am constantly aware of my aching butt on the ice pick of a bike saddle. (It actually is quite large, the saddle I mean, and is gel cushioned, but I still have some weight to lose before it is comfortable again.)

Actually, sharing my thoughts with all of you has turned out to be a stress reliever for me, I am now ready to take on my day’s projects…

This week’s Health Behavior Exercise consists of drinking water to reduce the effects of aging.  The ice tea I make at home doesn’t count, nor the coffee. The formula is 1 ounce of water for every 2 pounds of body weight. I am not going to tell you how much water I am required to drink, but being a tall, sturdy Viking kind of a gal, it is a LARGE volume. I will have to do one of four options: 1) not drink that much water and decide to age gracefully,  2)insert a foley for the duration of the week, 3). move all of my study items into the bathroom, 4). wear a diaper (especially at work, where I can’t move my desk into the bathroom.) 

I think I will just age gracefully. I don’t really like water.

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Prostate


Someone I know who is 80 years old told me he went to his physician because he was having trouble urinating. “I went to him and he told me I have prostate problems. I had to go to him 5 times before he fixed the problem. Now I have a good flow. But every time I went to see him he would ask me if I could get an erection. I can’t remember how long it’s been since I had an erection. I finally asked him, ‘Doc, if you could get me to have an erection, what the heck am I supposed to do with it?'”

I guess we need to keep in mind what our patients’ needs really are.

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I have a good friend who has asked that we help out a good friend of hers. He lives in Denmark and suffered a stroke. Due to a broken scanner and inexperienced hospital personnel (how a hospital could be inexperienced with strokes is beyond me, I won’t go into a diatribe about government-run health care, I promise )and delayed treatment, he became paralized. The Danish system only gave him a few PT sessions, nowhere near enough to help and now he has entered a lottery to get the money for his treatments. If you would take a moment and give him a vote, I would really appreciate it.

Here is what you do: click in this link http://fonden.pfa.dk/VisSag.aspx?id=66, click on the button that says “stem”, that means vote. A pop-up will ask you to enter your email address, do that and click on “stem pa dette projekt”. They will send you a confirmation email, click on the link and that is it. If you don’t click on the confirmation link in the email, the vote doesn’t count.

He has 146 votes now, but needs more. Please pass this on to your friends, family, everyone in your email. Whatever you can do. It will be a blessing for this man and his family. Thanks all of you in advance.

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So, clinical test week is done. I passed. I did not make a fool of myself except when I got my finger stuck in the plastic mannequin used to practice the prostate exam. Arthritic knuckles can be a problem in unusual ways…I will leave the description of that incident out, I think you get the picture.

 35 people milling around trying to get signed off on various stations was interesting. In every crowd there are people who are in a hurry, and don’t care who is in their way. The rest of us watched in amazement as a small group pushed and shoved their way around, trying to get ahead. There was plenty of time, everybody would get through the tests. What was the flying hurry? Did it mean anything that they were disruptive to other folks?  I hope that they realize before they get to see patients that that isn’t the way to deal with people.

Having completed this week of learning advanced health assessment skills, casting, suturing, removal of foreign objects from ears, etc. I now know a little more, and could probably sew up a small laceration without killing someone. But the point that really hit home is how little I really know. Having been a nurse for mucho years, you start to feel somewhat knowledgable and wise. But, now, it feels like starting all over again. The instructor said we need to treat our preceptors at the clinical sites like they are God, dispensing their knowledge to us. I definitely see her point. Hopefully, I will get good preceptors that enjoy teaching, who are willing to help me learn. A person could never know enough to be perfect at the job of primary care. I suspect I will be learning new stuff every day for the rest of my career. The plan is not to get so cocky that I don’t recognize when I am wrong, or need more knowledge to safely and effectively treat a patient who needs my help. The plan is also to remember all of this when a future student FNP needs me to teach them what I have learned.

The curve is a little steep right now, I hope it will eventually level off and I start to feel comfortable in my skills again.

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Shoes

I just spent three days looking for comfortable shoes. I have large, wide feet and it has always been a struggle, but now with arthritis in my knee and big toe, it is extra hard to find low/no heel shoes to fit my feet. I got to spend an inordinate amount of time sitting around in shoe stores and department store shoe sections. I noticed how women’s shoes are narrow, pointy at the toes and often with ridiculous heels. I watched one middle-aged lady after another hobble around trying on these pointy high heeled shoes. I had to wonder: what is this doing to their feet?

It didn’t take long to find out, once I got back home and logged in to the research library. Wearing of these shoes does ridiculous damage to women’s feet. It makes me think of the Chinese, who used bind girls’ feet to bend the toes under and make the feet look tiny. The girls couldn’t walk, but the men thought it was sexy. American women seem to struggle along with the same idea: that female feet are supposed to be small, though obviously not to that extreme..

The results of this pedal abuse are: knee and hip arthritis due to the unusual torque forces caused by high heels on the knee (Kerrigan et al., 2005), bunionettes, hammer toe,  hallux valgus, neuromas and ankle fractures (Thompson & Coughlin, 1994). The prevalence of these conditions is much higher in women than in men, whose shoes are made to actually follow the shape of their feet. The damage can be directly correlated to the fashion shoes. Women’s shoes are designed to be narrower than their feet (Thompson & Coughlin, 1994) and so with a narrow shoe squishing your feet, and the high force of the weight pushing the toes down into the pointy toes by the torque from the high heels, well you get the picture:

As you see in these sites, none of these conditions are a piece of cake  They cause pain deformity and often the need for surgery, all in the name of fashion. It is estimated that it costs Medicare $1.5 billion for the surgeries to correct these problems for cases caused by fashion shoes, in ONE year (1991) (Thompson & Coughlin, 1994).

Bottom line: let’s see if we can educate our patients regarding these conditions, and maybe moderate their shoe selections in order to help prevent these needless painful conditions:   

 If the shoe hurts: DON’T WEAR IT!      

References

Kerrigan, D. C., Johansson, J. L., Bryant, M. G., Boxer, J. A., Della Croce, U., & Riley, P. O. (Arch Phys Med Rehabil. 2005 May;86(5):871-5.

Thompson, F. M., & Coughlin, M. J. (1994). High price of high-fashion footwear. Journal of Bone and Joint Surgery, 76:1586-1593

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This weekend I will get on a plane to fly to the university for a week-long skills session. I am a little conflicted about this. I will miss my husband, my two dogs and the warmer weather in Florida. I am looking forward to seeing all the people I have been in classes with and learning cool new skills.

We are getting labs in advanced health assessment. We have to practice on our classmates, except for pelvic and prostate exams. There are supposed to be live volunteers for that. I am a little nervous about that particular aspect. I am never embarassed to do any type of care involving those personal areas, but to do it for no other reason than practice, just feels weird to me. Maybe it is because I can’t imagine what would motivate someone to volunteer for that job; especially when the people performing the exams are fumbling around because they have never done it before. I suspect I am not the only person who feels nervous about this particular part of the deal.

It is going to be fun to peer into ear canals and at retinas, get extra skills in classifying heart murmurs and learn a bunch of new assessment skills in general.

We are also going to have labs in “Advanced Practice Procedures”, which consists of suturing, removing skin lesions, joint injections and casting. That part ought to be a blast! I always enjoyed sewing…I hope we are NOT practicing on each other.

When someone asked me what I would be doing next week and I explained the plan, they said “Wow, that sounds just like what nurse pactitioners do.”  Cool. Yup. It is starting to feel a little real.

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