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Archive for August, 2010


As a teen during the 70’s, I learned to love long hair. I always had a massive amount of dark blonde hair which I kept very long. I started life with wild red hair, which turned light blonde during my childhood and then a dark reddish-blonde as an adult. As I get older the color is getting a little darker with white streaks around the edges, of course. I never dyed it, preferring to keep whatever color God gave me, variable as it is.  

My long hair

The thing about long hair is, that it gets to the point where it owns you, almost defines you. Life can’t be imagined with short hair. Every single morning, I would braid it in a french braid, it was too heavy for a pony tail. While I worked at the jail, I tucked it into the back of my scrub top so it couldn’t be used as a means to grab and hold onto me. People described me as the tall woman with the long braid.    

A woman is often defined by her hair, to a certain extent. It certainly is an important part of her appearance, and any drastic change in hair style has an important impact on her self impression and confidence, either boosting it or affecting it in a negative way.   A trip to the hair salon can be nerve wracking if you aren’t confident in their ability to make your hair look good. Teenagers have been known to hibernate in their rooms, mortified that their hair didn’t look right.  Your hair means a lot. 

So, we come to people who are fighting the fight against cancer, and have to endure chemotherapy. Many types of chemo will cause alopecia, or loss of hair. It will fall out in clumps, leaving you bald as an egg. It will eventually grow back after the chemo is finished, starting as a soft fuzz, but in the mean time you have months of baldness to deal with. I recently heard a woman on the radio talking about her experience with breast cancer. She talked more about her reaction and her children’s reaction to the loss of her hair, than the loss of her breasts. Her daughters were mortified at the thought of their mom with no hair. This brave woman’s way to cope was to have her hair shaved off ahead of time and to pick out wigs which resembled her daughter’s favorite pop singers’ hair. It brought tears to my eyes to listen to her. Thank God she is now cancer free. 

Last year, I decided to break the hold my hair had on me, and cut it off. Well, 12 inches worth. I sent it on to an organization that uses the hair to make wigs for cancer patients. Then six months later, I did it again, the last 12 inches. Now I have a “normal” hair style, just to my shoulders. I am blessed with hair that has some curl to it, so I don’t have to fuss much. Hair styling is not a talent of mine. It was a little traumatic to feel the hair come off, the other ladies at the salon were all smiles, but it was hard for me. 

My prayer is that the girl or woman that gets a wig with some of my hair in it can feel some of the love and encouragement I sent along with it. I imagine it is bad enough to have to fight cancer and endure the surgery and chemotherapy and radiation, without having to feel the loss of your hair, too. Those cute little turbans are one thing, but to me, they look like a sign that says “I have cancer”. Personally, I would prefer not to attract that kind of attention, and hide the issue with a wig. So, for those ladies who aren’t the turban type: I sent my hair. I hope it helps them through a difficult time. 

If any of my readers feel the desire donate their hair for this cause, there are some stipulations. The hair can not have been treated for color or had a perm, it can not be grey, I guess that will preclude me from doing it again. The hair is to be rubber banded in a ponytail and freshly washed. The length needs to be at least 10-12 inches depending on who you send it to. 

Here are links to some of the organizations that accept donated hair: 

http://www.pantene.com/en-us/beautiful-lengths-cause/default.aspx 

http://www.locksoflove.org/ 

I hope you consider doing this great thing! 

 
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There is one week left before my clinicals start. I am trying to arrange coverage at work for the days I will be off, setting up the parameters in the computer program we will be using to log our cases and hours, emailing back and forth with the office manager at the pediatric office to set up a preliminary schedule.

I am not sure yet how many actual hours/days are needed to meet the requirements for this rotation. It seems we are to log 240 hours in 14 weeks, but can’t be sure until the class opens and I can read the syllabus. I also don’t know how many patients we are expected to see per hour. Here’s hoping that the initial expectations are not too crazy…

I bought the Fitzgerald review book for Family Nurse Practitioner, but am thinking of adding the pediatric one to the pile as well. The question and answer, followed by a discussion format of this book is working well for me. It is amazing how many questions I actually know the answers to, this is a good sign. Maybe the boxes in my brain are accessible after all… 

Looking forward to actually dealing with real, live patients is still scary, but also exhilarating. Finally, to be able to put the studying to some use. For me, doing is always better than reading anyway. If I do it once or twice, it sticks better than days of reading and re-reading.  Even if that reading is done sitting on the deck overlooking the forest at the cabin we like to rent in upstate South Carolina!

One week on a nice, quiet vacation does wonders for one’s aged and overflowing brain. It is kind of like a defrag on the computer. The rest and slow pace help to reorganize the bits of information in a more coherent manner, throws out the useless stuff and generally makes those neurons fire more efficiently.

We did learn something while in South Carolina, turtles hide under leaves.

My husband loves turtles, and one afternoon as we were driving around checking out the countryside, we saw a box turtle in the middle of the road. Worried it would get squished by the next car, we scooped her up (Yes, her. My hubby can tell the sex of a turtle by gazing into their eyes, is that weird?) and brought her back to the cabin so we could let her go in the woods far from the road. Our dogs were quite excited, Elwood wanted to open it and see what was inside (didn’t let him, of course) and Jake just stared and stared at it. Back at the cabin we let her go, and the boys just had to watch from the window.

Where did she go?

After that, when we went for walks in the woods, Jake scouted all around us, sniffing in the leaves. Now and then he would pull back some leaves and proudly show us a turtle. He must have found five or six turtles in two walks! I figure either Jake saw we liked turtles and found all he could to show us, or he was looking for the one that “got away”.

Upstate South Carolina is a super nice place, friendly people, beautiful country and neat little towns and cities. Greenville is fantastic, with a park boasting a waterfall right in the middle of town! We love the area and vacation there often.

All in all, I am ready to go! Rested and rejuvenated, functioning at peak middle-aged level…

PS: If any family practice in Upstate South Carolina happens to be reading this blog and needs a nurse practitioner in about a year, you  may respond at any time!

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Okay, that will be my last post reacting to that kind of stuff. I have been told “enough already” (and they are absolutely right), and so I will not respond to anything like that anymore. I will be good… from now on,  will concentrate on looking forward and stop being reactionary to stupid stuff. Being angry really doesn’t accomplish anything and just makes me feel lousy.

Now, to anyone reading this, I have a request. What are the best books to review for the certification exams? It has been recommended by the school that I get some and start studying them in preparation for the test, even now, a year ahead of time. It sounds like a good idea to me, but I have no idea which books are good, and which are a waste of time.

I recently bought a set of flip cards, but I am disappointed because they don’t have questions, only “Discuss xyz“. I like questions, they make you think. So, if anyone can recommend a good study guide for the certification exam that would be great.

Also, for those of you who are NPs, which examination did you take: AANP or ANCC? Any thoughts about the tests? Is there any resource for practice exams?

I would appreciate any input, and thanks in advance!

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I know I said I wouldn’t post about MDs again, but I just read about this on Clinician 1 and had to pass it on.

Florida is a huge state with many uninsured and underinsured people, and whole swaths of the inner state is populated very thinly with many migrant workers. Medical care is in short supply in these areas, and nurse practitioners would love to fill in the void.

Unemployment is astronomical right now, officially around 13%, but actually more like 18-20% if you take into account all the people who have dropped off the unemployment rolls as their time runs out. I heard recently that 250 people applied for a maintenance job in a trailer park for retirees, to give you an idea of the numbers of unemployed. A friend of mine works at a food bank, where, for the first time, they are running out of food to give out, as the numbers of families needing help has tripled.

The Florida Medical Association seems to be aware that there is a crisis of health care in the state, but their way of addressing the problem is cronyism and defensive legislation to protect their turf, and not trying to solve the problems and needs of Florida’s population.

According to their website: “Whatever the issue, we will work tirelessly to ensure that the interests of our physician members, and most importantly, the interests of our patients are fully recognized and reflected in all health care policies adopted by the State of Florida throughout the year.”

Right.  When tey talk about advocating for the physician’s interest, they are right, but patients? Not so much.

On their legislative page they crow about blocking everything related to increased scope of practice this year for anyone without MD after their name, “While every session sees an attempt by allied health professionals to expand their scope of practice, the battles were especially fierce this year. Optometrists, ARNPs and physical therapists pulled out all the stops to be able to do what physicians are trained to do, but without first going to medical school for the proper training. I am happy to announce that the FMA was able to defeat all of these proposals, and that not one scope-of-practice bill passed.”

They were thrilled to have blocked:

  • Legislation that would have prevented physicians from collecting full payment from out-of-network PPO patients;
  • Legislation that would have ended the use of binding arbitration agreements by physicians;
  • Legislation that would have ensured higher malpractice insurance premiums by repealing the wrongful death exemption;
  • Legislation that would have imposed unreasonable reporting requirements on physicians in relation to impaired drivers;
  • Legislation that would have provided an unreasonable standard for the treatment of foster children with psychotropic medications;
  • Legislation that would have allowed social workers and marriage and family therapists to diagnose autism;
  • Legislation that would have ensured that physicians were paid less in automobile injury cases.
  • They called all this “diverting disaster”. Then they talk about their priority legislation for the year: to “exempt medical malpractice insurance premiums from any emergency assessment levied by the Hurricane Catastrophe Fund for three more years. This bill will save physicians thousands of dollars in the event that the CAT fund incurs a deficit.”

    Lastly they are happy that a bill to restrict “pill mills” (places where drug seekers are able to get massive amounts of narcotics). “The FMA was able amend a provision that would have limited dispensing physicians to a 72-hour supply of controlled substances. With the cooperation of Rep. John Legg, the bill’s sponsor, we were able to restrict this 72-hour limitation to registered pain clinics, and then only to patients who pay by cash, check or credit card.”

    So, these almighty doctors (who are perfect in prescribing narcotics and other controlled substances like cough syrup and diarrhea medication, right) stop a measure to restrict illicit drug use fully  prescribed by MDs, for money.

    The pattern here is clear, I don’t have to spell it out do, I? Well, okay: MONEY. That is what they are about, where is the patient advocacy?

    “There is no such thing as a nurse practitioner who is ‘qualified’ to prescribe controlled substances,” said Erin Van Sickle, a spokeswoman for the FMA on Tuesday. “The Florida Medical Association is extremely concerned about the nurse practitioners’ continued attempts to gain prescriptive authority for these medications. The ability to prescribe controlled substances is limited to medical doctors for a reason: to protect patient safety. Physicians go to medical school to learn how to prescribe controlled substances safely and without interacting with other medications. ARNPs do not.”

    “Florida lawmakers have worked diligently to protect patients from those who would attempt to prescribe narcotics to patients without the training required by Florida law, and that is the safe, accountable, and common-sense thing to do,” continued Van Sickle. “We simply can’t understand why the nurse practitioners would make such an unconscionable attempt to throw away the protections they have put in place.”

    “The bottom line is, ARNPs do not have the training nor the qualifications necessary to prescribe these medications,” she said. “If they want to prescribe controlled substances, we would encourage them to go to medical school and receive the proper training to do so.” 

    I mean, really?!?!  This is just sad!

    Florida is one of only two states who restrict NPs like this, all the other states allow it, with no detrimental effect on the over-use of controlled substances.

    Shame on you FMA! And just so you all know, the FMA does not represent ALL physicians. I happen to know quite a few who don’t agree with some of this crap, but it seems the FMA owns the Florida legislature.

    References

    http://www.fmaonline.org/Council_on_Legislation_Newsletter_04-30-10.aspx

    http://www.sunshinestatenews.com/story/looking-write-controlled-prescriptions-nurse-practicioners-looking-engage-mike-haridopolos

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