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Posts Tagged ‘exercise’


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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I have now spent four days clinical time at the health department. I like my new preceptor, she is patient and receptive to questions. I tend to ask a lot of questions…

I have seen a lot of patients and am finding that they seem to belong to three groups in general.

1. Those who have no insurance or are on Medicaid, and find that the health department primary care clinic is a reasonable option for basic health care needs. The amount billed is based on financial need on a scale ranging from full pay to free care. It is a pleasure to help them meet their health care needs, I know what it is like not to have insurance, so I can relate. These people are happy to get the care and tend to follow the treatment plan set up for them.

2. The walking train wrecks. These are people who wait until the latest possible moment to seek health care for a problem they have, or they wait until they have several problems, and try to pile them all into one visit. For example it might go something like this: I have had a runny nose and cough for three weeks and now it hurts to breathe, and I have this really big pimple on my butt that just keeps getting bigger, and I ran out of blood pressure medications 2 weeks ago and my back hurts really bad.

3. The yes, buts. These are people who come in very regularly claiming to feel lousy (and they most probably do feel lousy) and want you to fix them up, or maybe really not. This is what I mean…

Okay Mrs. Smith, I see you are here for your diabetes and blood pressure check. Did you bring your sugar readings log?

“I would’ve, but I forgot. They have been much better, in the low 100’s.

Mrs. Smith, that can’t be quite right, your A1c reading is 11.3  which is higher than last time. This reading indicates that your average blood sugar is in the high 200’s, not the 100’s.

Yes, but that was because of the holidays, it really has been lower most of the time.

I really need you to bring in your log next time, okay. Have you been following your diet?

Yes, but it is too hard to follow and I really like to eat, so I don’t always.

Are you walking 30 minutes at least three or four times a week? Remember how important it is to exercise?

Yes, but  a lot of days I forget, or it is too hot out.

You know it is very important to take your blood pressure medication every day as prescribed, are you taking your meds? Your blood pressure is quite high today.

Yes, but I don’t like the water pill. It makes me go to the bathroom too much, and I didn’t get my refills yet, so I ran out yesterday. Do you have any free samples? I just forget to take them sometimes.

Did you get the medication box we discussed that you can fill each week so you can remember to take your meds?

Yes, but I forget to fill it up. Oh, and my feet are swelling up really bad, can you do something about that? I am feeling so tired lately, and I gained 6 pounds last week. Is there a pill I can take to lose weight?

 

I swear, some people just like to complain, and if I hear “yes, but”  one more time, I may scream. Well, maybe not, but I’ll roll my eyes when they aren’t looking.


 

 

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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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