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Posts Tagged ‘aging’


Well, it is happening. The clinic I work in will be closing its doors soon, partly due to money issues and partly because the physician is retiring, and I am back on the employment search train again. The sad part about this, though the PA I work with is going to try to take as many patients along to the next job (and mine will go with me), is how many physicians won’t take Medicaid anymore. It just doesn’t pay, and the loss of income on each patient, coupled with the impossibility of finding specialists to refer Medicaid patients to, and the restrictions on what we can and can’t order for them, it is not a viable option for a lot of physicians to take Medicaid. On the patients’ side, if they have share of cost, it is often so high, they can’t afford to get healthcare anyway. The whole thing just stinks.

The good news is that there are several options for me and I will not be jobless for long, if at all. The bad news is that things are so up in the air that I haven’t found a lot of emotional space to write in my blog recently, though I did get a new bike, well actually a recumbent trike. An arthritic girl’s best friend! And my dog’s favorite thing, too!

 

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Well, my last term starts Monday. I just got back from a week of vacation in upstate South Carolina, again. We do love it there. I managed to wash and dry my cell phone (we thought the dryer was clumping kind of loud) and so no-one could call me. That actually was kind of nice. We took walks in the woods with the dogs, explored the area and discovered some new things. Generally relaxed and lollygagged (also gained a few pounds, oops). I took several school books with good intentions of doing some reading. Yea, right.

Now, I am home again, faced with the pile of books I meant to do some reading and studying in and the new term looms. I was good today, read a few chapters in my orthopedic book. Orthopedics is one of my weaker areas and I need to bone up a bit. It seems strange that there is only one more term, 15 more weeks. I am so not ready to go out there and BE a nurse practitioner. Emotionally scary, that. I suppose that is how all new grads feel when they go out there, so I will try not to perseverate about it.

My big concern this time is the SCHOLARLY PROJECT…..the dreaded thesis of yore. A classmate who is a term ahead of me stated she almost threw up when she read the syllabus and expectations of the scholarly project. Okay, I suppose that is good to know ahead of time. She did say to really work your ass off the first week to fill in the “matrix” and the rest would flow.  Now if I could just think of a good subject, which is a little hard to do if you don’t know the expectations. I have fiddled with the ideas of diabetic foot care, the shingles vaccine, medication compliance issues and fall prevention in the elderly. 

Last term I was still excited about getting the books and prepping my work space. This term is different, motivation seems to lower. The difference must be pretty much sheer exhaustion, mental and physical, and also the realization that, once this is done, I need to go out there and apply for jobs. Yuk, I hate applying for jobs. In the past, every time I thought I was getting a good one and the people seemed nice and all that, the job turned into a disease. The employer owned you for a salary, and always took advantage. I am too damn old for those games now. I hope that I can find a nice quiet little corner to do my thing, working with nice people who appreciate me. Is that too much to ask? Hopefully not. I work hard, I am honest, I care about how and what I do. Sending up prayers, God, that the right place will come up for me. Heaven knows I have worked hard enough to get to where I am educationally.

So, here we are, sitting at the desk. It is dusty, there are coffee rings on the surface. The books are stacked a little haphazardly. The pencils are not sharp. Piles of old clinical log sheets and papers take up half the space. The laptop is new, the old one fell off the sofa and died a spectacular death. I never saw such weird patterns on the display before…at least that was after I took my final. Do I feel like making it all pretty and tidy? Not this time. The piles of papers will have to go on the floor to make room for the new ones. I will push enough stuff aside to make space for the new stuff, and I will continue to plug away at all of this, including the “matrix”, until is done. 15 more weeks…

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One thing I have learned is that the presenting complaint is never what you think it is.

Foot pain: An elderly lady came in complaining of foot pain. She had told the nurse it was bothering her a lot and wanted to know what to do about it. On examination there appreared to be a crusty area between the last two toes of one of her feet. She points out “It was pretty swollen up for a while”. I try to gently clean away some of the crusty stuff and just see a little bit of a macerated area. I questioned her if she had a podiatrist as she was diabetic and she said she did.

 “He operated on that toe a while back, and the nurse came and dressed it and they took out the stitches last week”. Okay……..Well, I advised her if it was still sore she should check with the podiatrist. She agreed that was a good idea, she denied any other issues when I asked if there was anything else she wanted to talk about.

I left to give my report to my preceptor, the good doctor….he agreed the patient should return to the podiatrist to have it checked.

We go back in the room. “So,” he says, ” I hear you are having some trouble with your foot, but that you are going to get the podiatrist who operated on it to check it out.”

“That’s right”, she says, “But that’s not why I came in today, I wanted to talk about my cough.”

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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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I just realized today, that in only seven weeks I will be seeing actual victims, I mean patients.

This thought is exciting and scary. Will I have a chance to see the chart and presenting complaint before I get into the room, so as to formulate something approaching a plan? I visualize me entering a room with a flustered parent holding a screaming infant, and I just freeze. No clue as to what to do next. That would really, well, not be fun, let’s say. The parent is expecting me to do something useful, and I stand there, hopefully not looking like a blithering idiot. Does anyone know what blithering means? Whatever it is, I am afraid I will be doing it.

The idea of doing an exam and then telling the patient to dress, and I’ll be right back sounds very appealing. This gives me the opportunity to look stuff up to make sure I am doing it right. Of course, I expect there will be something I forgot to examine or do, I just know it. I hope there will be a way to kind of sneak that in when I go back into the room without them knowing I forgot it in the first place.

Being a beginner again at my age is something that I don’t look forward to. I will be entering “The Discomfort Zone”. Do not attempt to adjust the situation, we are in control of what happens to you, hahahaha. (evil laugh). I am in that place where I had my students (I taught LPN students for a while.) I knew they were scared, but I told them “Act as if you have been doing this procedure for a hundred years, pretend. The patient won’t know the difference, you actually know how to do this, so just do it.” So, I have to eat my words, because now I am in the same boat. “Just go in there and examine that patient, you know what to do, just do it. Pretend you are confident.” Deep down I know this is good advice, and after a while in clinicals, the nerves will pass, the labels on the boxes in my brain will mysteriously reappear, and I will actually start to feel useful again.  I just have to open the red door and go through.

The syllabus states ” The student is expected to bring ALL books from previous classes with them to clinical.” I somehow think I can leave my APA manual, the nursing theory books, the evidence based practice and research books behind. This should save about 20 pounds, but it still leaves me with about 60 pounds of books to cart in. Thank goodness I have a wheeled suitcase. I will need to sew my “Student FNP” patch onto my white lab coat. I haven’t decided if that makes me feel more professional or not. I never liked wearing a lab coat. I always prefered scrubs. Scrubs are cool, comfortable, cheap and washable. They come in fun colors and patterns that express your personality. If a baby pukes on you, no big deal. A white lab coat is, well, white and clinical. Doctors don’t even wear them in their offices anymore, only in hospitals , to look doctorish and not be confused with lower chickens in the pecking order. It seems a lot of patients like the white coat. A survey once stated that the majority of patients feel that a medical person looks more professional and confidence-inspiring in one.

The good news is that in my first clinical, at a pediatric office, they do not want me to wear “the uniform” because it scares the kids. Cool. Bad news, I must wear “professional” clothes. (Ones that need to be dry-cleaned if a baby pukes on you). Up to now, scrubs were my professional clothes. I only have two outfits that could be remotely called “professional”. Crap. I have to go shopping. I HATE shopping for clothes. If  I was twenty-something and skinny, this would not be a problem. I am fifty-something, not anywhere near a size 10, or 12, or … and I am also unfashionably tall, being a Viking and all. The fashionistas have decided that anyone over the size of 10 and height that can be called petite, has no taste and must wear a mumu printed with zebras and iguanas in loud colors. I had hoped to find a Lane Bryant or something, but no luck with that around here. Sigh. This is not going to be fun. Even that fashion model who was considered “plus size” at size 14, has gotten skinny again and forsaken all of us normal women who have some actual padding covering our pointy bones. Another wall to surmount. I will let you know how it goes.

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New classes start on Monday, Primary Care of Adults and Pediatric Primary Care. Last semester was such a marathon with three heavy classes, going to campus out-of-state for the skills labs for a week, and working, too. I finally have come down and am starting to think a little more clearly. I also realize I am suffering from CRS. (For those of you scratching your heads: Can’t Remember S**t.)

I visualize walking into an exam room with a patient and the parents waiting for me to do something useful for their little tot. The door closes behind me, and the realization hits that I have NO CLUE as to what to do. Pediatrics would have to be the first rotation. I have dealt mainly with older folks for most of my nursing career, and now being one myself, I can relate to their problems. Dealing with the little guys has not been an issue for me for YEARS. My own kids are in their 30’s for crying out loud.

So, groping in the crowded closets of my brain, I try to retrieve all the facts I have been busily stuffing in over the last 3 terms. The labels seem to have fallen off the little boxes. The information is in here somewhere, but seems inaccessible. This is WAY not good.

It never seemed hard to learn and remember things when I was younger, is it true that you can’t learn as easily when you are older? I am somewhat comforted by an article that reports it may take longer to learn new facts when you are older, but you are better at  processing the significance and using the information you learn than young people. Okay, that part is good. So, now the question is, what to do to help learn and remember what I need to.

An article in the Harvard Women’s Health Watch has ideas on how to improve memory for the older person. The first recommendation is to maintain health, Uncontrolled diabetes, hypertension, kidneys disease have all been shown to reduce cognitive function. Exercise is mentioned in this category. I am healthy and we try to ride bike most days for a half hour or more, so that is covered (though hot Florida summers will put a crimp in the bike riding).

Next they want you to keep the brain active by taking a course and learning something new. That definitely is covered and then some.

I like the next suggestion, to use all the senses. Odor is specifically mentioned. Evidently, if there is a pleasant odor while learning something new, you are better able to recall the new material even without the presence of the odor when recall is attempted. Half a dozen scented candles, please! In the bag.

They want you to think positive and not believe the myth that “old dogs can’t learn new tricks”. This old dog is definitely thinking positive. Becoming a nurse practitioner is a goal I have had for a long time, and had to delay for a while. Nothing is going to stop me now. Negative thinking is stinking thinking!

Next, we are not to over-strain the brain on unnecessary things. Like, get organized, dude. Use lists, electronics, designated key and glasses spots, and unclutter the desk. Well, that might not happen so fast. I am a firm believer in a cluttered desk being the sign of a great mind… Oh, you don’t buy that?… Sigh, okay, declutter the desk coming up.

Repetition, repetition, repetition. Say it out loud or write it down. Facts are easier to remember if repeated. And, the repetitions  need to be spaced out for better retention. Check.

Use mnemonics. You know, like RACE for fires: rescue, alarm, contain, evacuate. This has never been one of my favorite devices. I am more visual, pictures and hands on work better than a list of letters like that. We are all individuals and have to tailor things for our own use. 

Daniel Schacter, a Harvard psychology professor and researcher wrote a book called The Seven Sins of Memory: How the Mind Forgets and Remembers (Mariner Books, 2002). He describes common memory flaws, and the ones most common for older people are transience, absent-mindedness and blocking.

  • Transience is the losing of a new memory if it is not recalled. This reinforces the need for repetition in order to remember.
  • Absent-mindedness refers to forgetting because you didn’t pay attention in the first place. I guess that means no studying with the TV or radio on. Focus!
  • Blocking refers to that tip-of-the-tongue feeling, You know you know it, but can’t quite get it out. This is caused by a new similar memory blocking the retrieval. With a little persistence this can be over-ruled and the memory brought out.

Bottom line. I will have to work a little harder, set things up for study with a little more forethought, and repeat more than I did when younger. The good part is the fact that my judgement and understanding is better than it was years ago thanks to many experiences over the years. It’s all good. I’m ready for the next semester. Bring it on.

Thanks Harvard.

References:

Strauch, B., (2009). How to train the aging brain. New York Times December 29, 2009.

 Harvard Women’s Health Watch (HARV WOMENS HEALTH WATCH), 2010 Feb; 17(6): 1-3

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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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