"When you get those rare moments of clarity, those flashes when the universe makes sense, you try desperately to hold on to them. They are the life boats for the darker times, when the vastness of it all, the incomprehensible nature of life is completely illusive. So the question becomes, or should have been all a long... What would you do if you knew you only had one day, or one week, or one month to live. What life boat would you grab on to? What secret would you tell? What band would you see? What person would you declare your love to? What wish would you fulfill? What exotic locale would you fly to for coffee? What book would you write?"

Saturday, February 4, 2012

Gingerale is a Soda, Too

Hey everyone!

So I wanted to do a little piece on patient education, something that has been irking me a little lately while on the job.

When I was in school, patient education used to scare me. I used to think, how can I teach a patient about their health condition when I barely know anything about it myself? Sure, I can research it and tell them what I learn, but what if they ask me questions? What if they find out I know absolutely nothing and am therefore incapable of being responsible for their lives during my shift??!

Okay, maybe thats an exaggeration . But regardless, I still got scared about the thought of effective patient education one day. I never dreamed that one day it would actually come naturally and I would find myself automatically in a "patient teaching" moment that I didn't even have to prepare for. Which has happened many times already, so awesome!

I always used to think I would enjoy teaching patients about something I knew a lot about, because obviously its easier to teach. Well, I was wrong. About it being easier to teach.

Every single time, it baffles me to no end how much the general public does not know about health and medicine. Granted, I don't expect you to know a single thing about a condition we just diagnosed you with. But a chronic condition you've had for years....Is it so wrong that I expect you, as the patient, to know a little bit about your disease/condition? At least a little?

For example, very recently I have had a patient of mine for about 11 days, in with migraines. Elderly lady. Used to suffer migraines years ago, they went away, but all the sudden they returned with a vengeance, which-naturally-worried her, being in her elder years. Brain tumor? Stroke? Brain bleed? Heart attack?

So she comes in and we run all these tests, basically to rule out a stroke. All negative. Not finding anything. So now we are left with the epic neverending pain management for migraines.

So we try morphine. Doesn't work. Try imitrex. Worked, but they came back. Tried DHE, a special migraine treatment. Didn't work. Tried dilaudid, which works but the headaches come back. We tried IV Thorazine, a powerful anti-psychotic also known to treat headaches. Nothing. The headaches would go away and then come back with a startling vengeance.

So, on her eleventh day in the hospital, she was having this return pain problem and wasn't getting any sleep for me. I knew her well at this point (that tends to happen when you have her for eleven days), so I pulled up a chair and had a serious talk with her about migraines, at 4:30 am. Now, this was about a week ago so I'm going to paraphrase a wee bit, but this is a little bit how our conversation went:

Me: miss migraine, I was thinking. You've been getting these headaches and were giving you some pretty powerful pain medications. Then they go away, but they come back. So that leads me to believe that there has got to be some sort of trigger every time that causes them to keep coming back. So we have to find this trigger and delete it.

Miss migraine: okay.

Me: okay. Problem is, migraines are very tricky. There could be many triggers. First of all, let's start at the beginning. When these headaches came back again after all these years, had you just started any new medications?

MM: no.

Me: how about any new foods? Start using any new products, any new restaurants?

MM: *she thinks * no.

Me: okay. I'm going to go over some common food allergens that are known to cause migraines. Do you eat a lot of dairy?

MM: no, not really. I have a lot of stomach issues so I don't drink milk or eat cheese. Every once in awhile I eat yogurt.

Me: okay. How about alcohol use? Any red wines?

MM: no, I never drink.

Me: okay. How about chocolate?

MM: yeah, I like chocolate. My friend brought me a bag of M & Ms to eat while I'm here.

Me: okay well chocolate has been known to cause migraines. Maybe we should lay low on the chocolate for right now, and see how you feel.

MM: well actually I haven't eaten any in about a week, and headaches keep returning, so what else?

Me: okay, how about pig products? Pork, bacon? Ham?

MM: every once in awhile, not really. I cook a sunday dinner, sometimes with pork but rarely.
Me: okay, so besides the chocolate, you don't eat a lot of the big triggers.I also want to talk about dehydration. Do you feel like you stay hydrated?

MM: I always feel dehydrated- I can feel it in my skin. I try and drink lots of fluids though but none of it works I guess.

Me: okay. What kinds of fluids?

MM: well I like Sierra mist. So my son brought me a case of it to drink here.

Me: okay. How about water?

MM: yeah I drink water. But I like Sierra mist better, so I drink more of it.

Me: okay well, actually, the carbonation in soda can actually cause severe migraines in some people believe it or not. So I want you to try and stay away from the sodas for a day or two and see how you feel.

MM: oh, really? I had no idea. Okay,  I'll ask for a gingerale next time, I hear ginger is good for you too.

Me: ginger is good for you, but gingerale also has the carbonation and will generate the same bad effects the Sierra mist does. So how about we stick to water for a couple days?

MM: okay, I can do that.

Me: okay. I also want you to think about allergies. Consider seeing an allergist when you go home, they can help you pinpoint something specific that we talked about that you could actually be allergic too, and your manifesting it as a migraine symptom. I also want you , from now on, to look for patterns. Every time you get a headache again, I want you to think about what you were doing for the entire hour before hand. What you ate, drank, did, smelled, etc. it's helpful to write it down, look for repeats.

MM: interesting. No one has ever told me any of this before. I'm interested to try these things.

And thats basically how the conversation went. Yet another baffling case of a patient that suffered from chronic migraines, and yet didn't know the basics of what caused them. I figured out the basics of migraines before I ever stepped foot in nursing school, because it was something that mattered to my own health significantly.  There are many things that could be causing her migraines that I can think of, including :

- Food allergen (dairy, chocolate, pork, soda, etc).
- Environmental allergen (dust, mold, mildew, trees, pollen, etc.)
- dehydration (drinking too much sugar, carbonated beverages, not enough clear fluids (water).
- ineffective caffeine balance (too much caffeine or too little)
- possible gluten intolerance
- something more serious (chiropractic issue, osteopathic issue, brain issue, etc).

So All of this made me realize that I so desperately want two things.

1) I want to readdress my previous desire to go into a career of a Nurse Practitioner, specializing specifically in holistic practice and nutritional therapy.
2) I want to go back to school for a degree specializing in holistic therapy AND/ OR  getting my nutritionist certificate.

Is it so wrong that I think that I can help my patients already, with what little I do know, more so than any of these nonconclusive, expensive tests and ineffective pain management? I just think that if powerful pain medications like Dilaudid are only masking the pain until it returns, then obviously there is a bigger issue to address that maybe the doctor's aren't seeing. And do they think to send in a nutritionist? Dietitian? No.

I firmly, firmly, very firmly, believe that all patients need a BALANCE of holistic therapy and modern medicine. I obviously support medicine, being that i'm in the center of it. I participate in it as a patient and as a nurse, I administer modern medicine and practice. However, I believe there is a line to be drawn that hasn't been drawn yet. I believe modern medicine has its place, and is very important in some cases. There are some conditions that can be *helped* by nutritional intervention and herbal remedies, but will never truly be cured without an antibiotic, antiviral, surgery, etc. You can't cure cancer by throwing vitamins at it. I get that. But making a patients life significantly higher quality after surgery/chemotherapy and perhaps extending life with the right nutritional intervention? Yes.

I want to be a holistic practitioner, but more importantly I want to remain on the realistic side of it. I don't want to lose the realism that modern medicine still deserves its place. I feel that many "holistic people" shun modern medicine 100% and it ends up being their downfall. Then, other people blame these people for killing themselves because they stuck with holistic therapy and didn't "go to the doctor". Thats not the right way to do it.

Instead, I feel holistic therapy/ nutritional balance is needed for problem prevention. For maintaining patients at a healthy, happy, normal baseline. To help patients deplete harmful substances, practices and carcinogens before they create the problem that needs modern medicine. Get it? I want to always be smart enough to know when to *give up* so to speak, temporarily, and send my patient immediately to an emergency room. Of course, the nice thing is- once I send my patient to the hospital and they fall into the pool of modern medicine- I don't lose them completely. From what I understand, if I choose to set up a partnership or work for a hospital that tolerates and accepts holistic practitioners, then I can follow my patients into the hospital and still maintain my nutritional and herbal interventions so that I don't have to start at square one, and yet the patient can still have necessary tests run, lab work done, etc. Its a win-win.

I just wish I knew how far down the rabbit-hole was acceptable to go. Lately I have been experimenting with a sugar-free diet and yeast-free diet (thats another blog post completely). But that means I am dairy free, sugar free and yeast free, chocolate free, tomato free, butter free...and the list goes on. But I have strong reasoning behind all my choices, but I get it that other people must think I'm a "crazy health freak".  I wish wish wish I could help my friends and family make the same choices as me, and I often have to restrain myself from taking soda or a glass of milk out of my friends/families hands. I cringe when I see billboards for milk still.

This is all a simple problem mostly dealing with self-restraint, but the true problem arises when I'm at work. Thinking back to my patient described above, how much can I really delve into the world of migraines, when everything I have to say is holistic intervention?  Legally, I canNOT say (but would LIKE to):  " Miss Migraine, we are not doing anything for you here. These tests show nothing, this pain medication is actually hurting you more than it is helping and you need to get out of the hospital. You need to go see an allergist and at least a dietitian."  If I said that, I could and probably would lose my job if that patient then in turn said that exact thing back to the doctor. That wouldn't go over well. So how much is in my official range of practice? How much can I tell patients based solely on my own experience and reading, without backing it up with hospital paperwork that doesn't exist?

What I truly want and need here is a hospital that is solely- holistic based. They treat all patients with nutritionists and dietitians first and foremost. They prescribe herbs and understand them greatly. They prescribe drug medications only when extremely indicated, or holistic interventions not working. I wish I wish I wish....maybe, one day. I just wish doctors believed. The problem is more often than not, modern medicine is at war with holistic therapy. When Patients are curious about turning to holistic therapy, they ask their doctor first. Unfortunately more times than not, thats where it stops. The doctor shoots them down immediately and says that is all "hosh poosh" and never works. Its never backed up by clinical trials. It could kill you.  *slam face against wall now*

What we need is a society where the two realms of practice work together, that is all. A balance, not a war.

My lifestyle practices will never change and will definitely be a part of my future children's lives. I hope to find a husband that either will adopt most of my food choices or at least is willing to work with me and not feed anything to my children that I choose for them not to eat. Is that completely psychotic? I just strongly believe children should never grow up on milk, artificial flavoring, sugar (too much)...I hope that doesn't make me psycho. I hope more people catch on to what I've realized about the American food industry and more people start doing something about it, soon. Because its slowly killing us.

THanks for reading this abnormally long blog post, and bearing with me. Much needed post to get off my chest!

With love,


Bernie O'Hare said...

Question: When she stopped drinking carbonated beverages, did the migraines stop?

A Writer in a Nurse's Body said...

That's the thing, Bernie. I don't know. Let me explain.

As an RN, I typically work 3 days a week. So in this case, I had this conversation with her on my last shift for the week, and then had five days off. So when I go back, maybe she'll be there- (in which case-it probably didn't work or she didnt do it), or she'll be gone forever and I'll never know.

As an RN we do education with patients all the time and most times we will never know if our patients listened to what we said or If it's working or if we changed their lives forever.

If I were a nurse practitioner as mentioned in the post, this patient would be MY patient- I would prescribe official treatment (supervised by a doctor), and more importantly- have the opportunity to follow through. That's what I want. To follow through. Otherwise, what's the point? How can I know if I'm full of baloney or if my advice actually works?

Thanks for reading Bernie- I really appreciate your support. _WNB