This is how it all went down last night at work:
patient is young female (younger than me young). Came in with ovarian cyst. Possible OR today, so no food after midnight. I go in to see her at shift start. She's nauseous and vomiting.
me: Hi, looks like you're not feeling good. You're feeling nauseous?
Patient: Yeah. I threw up.
Me: I see that. Are you still nauseated?
Patient: uh, yeah. It's because I just drank orange juice.
Me: okay. Well OJ can be very acidic and hard on the stomach, so how about we stick to gingerale or water until midnight?
Patient: Well they said I couldn't drink or eat anything after midnight.
Me: yes. that's correct, just in case you have to go to the OR.
Patient: So I wanted to eat my dinner really late tonight. My boyfriend brought me McDonalds. Can I still eat that?
Me: As long as its before midnight, yeah, and you're feeling okay.
Patient: Okay.
Patient calls me back again, 10pm.
Patient: I threw up again.
me: Okay. You're nauseous again?
Patient: yeah, its because I had the Mcdonalds.
Me: Yeah.......how about no more food or drinks for the rest of the night?
Patient: Yeah, that sounds like a good idea.
Patient calls back again, 11:59 pm
Patient: I threw up again.
Me: Okay, you're nauseous again?
PAtient: yeah. I had some crackers and juice.
Me: Oh, okay. I thought we agreed you might feel better if we lie low on the foods and drinks for now?
Patient: I know but If I can't eat until after my test tomorrow I was afraid I'm going to starve. I don't want to starve so I just had one more thing before midnight.
Me: Okay.
*At this point I start removing all food and drink from the bedside table, being that it is 12:03 am.*
Patient: No! I want to finish my coffee, then I promise no more.
*Slam face into wall now.*
Some people just don't get it. I thought it was ingrained into human nature that when you're nauseous and especially vomiting- you naturally don't want to eat or drink???? Aye AYe AYE!
~WNB
.
10 + Years in Nursing In Medical Surgical, Women's Health, Telemetry and Informatics.
Wednesday, February 8, 2012
Tuesday, February 7, 2012
It's a Southern Thang
I have spent the last five days in Kentucky, on the border of Ohio (we literally took a walk to Ohio). In my mind, we were travelling horizontal from New Jersey, and it wasn’t until we arrived and the valet park attendant said “Ya’ll have a nice day now” that I realized we were indeed, “South”. How the heck did we do that?
I have had a great time, though! The very first thing I realized about Cincinnati, Ohio was that it was so Clean. Like, seriously clean. I knew Chicago was cleaner than NYC, but is all of Ohio so clean? The entire city looks as if it has been plucked out of one of those freaky Inception dreams where everything is surreal. The buildings so new, the sidewalks so fresh, no construction, the windows so polished….seriously.
But the real funny difference in culture when travelling hours away is the people.
Lets take the following scene, for example.
This is how it goes down in Kentucky:
You approach a Starbucks. But magically, someone has the door open for you already because everyone is just that nice. You walk in. At least five different people (strangers) say hi to you, on your way in or their way out. If you dare whip your phone out and text someone while you’re on line, at least three different people (this actually happened) will find a way to make conversation with you, somehow. The conversation will be a legit conversation that requires effort and adequate responding on your part. Just when you think your conversation is over, someone behind you in line pops in with, “Hey ya’ll I didn’t mean to eavesdrop but I just thought your conversation was so intriguing and I must join in with my own input.” So then you, the original conversationee and another person are still talking about the weather. And none of you have ordered your coffee. The cashier looks at ya’ll standing side by side (makes conversation easier) and doesn’t know who is next. And I kid you not, everyone in line will encourage everyone else to go first and I heard “I’m in no rush, please you go ahead” said at least five times. And everyone smiles, all the time. At 7:30 in the morning. Its like Disney world. When I did make it up to the cashier and ordered, it turned out they were out of my favorite brand of tea. I said it was okay if I got a different one, but she insisted on going to their back room and finding the restock of my tea. And no one in line complained. And their tip jar for the cashiers was FULL. It took four times as long to stand in line and wait for my order, but I made three new friends (two other wedding photographers and 1 other a sound/filmmaker. )
Now Lets take the same typical scene in New Jersey/ New York:
You approach the starbucks. You open your own damn door. You stand in a long line, but it usually moves pretty fast because everyone goes fast. Absolutely no one talks to each other in line and everyone is either 1) talking on a cell phone 2)texting on a cell phone 3) doing anything else on a cell phone 4)playing with a tablet/ipad 5)reading the newspaper in their hand 6) reading the newspaper on their phone 7)watching the TV screen for the latest news. In fact, everyone else has their phone out so you pretty much feel compelled to do SOMETHING on your phone, even if you just checked your facebook,email and all your recent text messages right before you approached the starbucks. Its okay, do it again there could be something new. Besides the business man yelling into his cell phone (usually at the same time he’s trying to order), the only other chatter you’ll hear is the occasional set of friends chit-chatting in line and it will be about business, or about the coffee they ordered. It is RARE for strangers to talk to each other and if they do its usually because one feels like they did something to the other that warrants a half-felt “sorry” (i.e. bumped into one another ever so slightly [northern people never like to touch]). On occasion you’ll have the out-of-stater that asks how that brand of coffee is because he’s trying to make conversation, and he’ll get a “Its good.” (with a smile-maybe) in return. On the good side, you move through the line quickly, you get your order quickly and you get out quickly. On the bad side, you make no new friends. Also, if your favorite tea brand is out- sorry for you. You BETTER have a back up order ready to go in your mind or else you’re gonna get some audibly grumpy people in line behind you. Also, I have never seen a tip jar at a starbucks, ever around here.
It’s not even like I just noticed this. Its not just Ohio and its not just New York City/ NY/ NJ. In all my travels I have seriously generally noticed this sharp difference in American sub-cultures. Its astounding.
I wonder why this is, though? Why the “South” is known for generally being slow (physically- not cognitively), but for being very nice. The “North” I think is known for being fast-paced, grumpy, all attitude and ready to push you out of the way. Also, when I told one of my new found Starbucks friends that I was from New Jersey, she immediately thought “Jersey Shore” and asked if Jersey was all interstates and factories like that. *Slam face against wall now*.
But I guess what I’m trying to say here is that even though the North has that reputation in public, it doesn’t mean we’re automatically bad people, it just means we have grown up where things move fast, you get things on demand, you move fast, you get things fast, you do things fast, you constantly have at least one piece of technology on your body or in purse, and you have checked at least one form of social media (twitter, facebook, email, text) within the last ten minutes. It’s all on how we’re raised, how life is grained into us from the beginning. What’s taught to us about what’s acceptable and what’s not.
On that theory, I would love to meet someone who grew up constantly on the move around the world and United States. I wonder what culture they adapt to. That would be an interesting sociology project.
Even though I brand the North here with a horrible reputation and I give the South a nice reputation (I think I did, at least), I don’t think I could live in the South. Is that so wrong? Is it wrong to love the Northern culture, where everyone is opinionated, grumpy and quick? No. Because I think we’re also intelligent, effective, cultured, and undeniably witty.
I’m sure if I moved to somewhere South and lived there for awhile, I would get used to it. Then, when visiting or returning back North I would probably hate how the people are. Like I said, its all what you are used to at the current time. I think 87% of Humans don’t like change. I just made that up.
In order to survive in the North, you have to make it your own. People will not openly talk to you like they will in the South. If you want to meet people, you have to target them and make your own conversation. You have to be bold. Say what’s on your mind. If you want to be shy here, that’s okay- but you won’t get noticed and that’s just that. I kept to my shy self in Ohio and still 3 people wanted to talk to me in Starbucks.
The reason why I’ve been in Ohio is for another convention (another blog post coming up). At the end of the convention the announcer said, “Well, all that have come from far and near, I hope you all leave with a new friend you didn’t have before”. Me and my dad looked at each other and laughed. “Nope!” We both thought. Oh well. I’ll try harder next time….
See Ya'll later,
WNB
PS- if any of my readers are from Kentucky, Ohio or anywhere thats branded as being "South", then I hope I didn't offend you. You're lovely, thats the point. You're all so lovely its nauseatingly lovely. I'm just astounded how different people are based on where they live, and thats my point. Have a nice day! :)
.
I have had a great time, though! The very first thing I realized about Cincinnati, Ohio was that it was so Clean. Like, seriously clean. I knew Chicago was cleaner than NYC, but is all of Ohio so clean? The entire city looks as if it has been plucked out of one of those freaky Inception dreams where everything is surreal. The buildings so new, the sidewalks so fresh, no construction, the windows so polished….seriously.
But the real funny difference in culture when travelling hours away is the people.
Lets take the following scene, for example.
This is how it goes down in Kentucky:
You approach a Starbucks. But magically, someone has the door open for you already because everyone is just that nice. You walk in. At least five different people (strangers) say hi to you, on your way in or their way out. If you dare whip your phone out and text someone while you’re on line, at least three different people (this actually happened) will find a way to make conversation with you, somehow. The conversation will be a legit conversation that requires effort and adequate responding on your part. Just when you think your conversation is over, someone behind you in line pops in with, “Hey ya’ll I didn’t mean to eavesdrop but I just thought your conversation was so intriguing and I must join in with my own input.” So then you, the original conversationee and another person are still talking about the weather. And none of you have ordered your coffee. The cashier looks at ya’ll standing side by side (makes conversation easier) and doesn’t know who is next. And I kid you not, everyone in line will encourage everyone else to go first and I heard “I’m in no rush, please you go ahead” said at least five times. And everyone smiles, all the time. At 7:30 in the morning. Its like Disney world. When I did make it up to the cashier and ordered, it turned out they were out of my favorite brand of tea. I said it was okay if I got a different one, but she insisted on going to their back room and finding the restock of my tea. And no one in line complained. And their tip jar for the cashiers was FULL. It took four times as long to stand in line and wait for my order, but I made three new friends (two other wedding photographers and 1 other a sound/filmmaker. )
Now Lets take the same typical scene in New Jersey/ New York:
You approach the starbucks. You open your own damn door. You stand in a long line, but it usually moves pretty fast because everyone goes fast. Absolutely no one talks to each other in line and everyone is either 1) talking on a cell phone 2)texting on a cell phone 3) doing anything else on a cell phone 4)playing with a tablet/ipad 5)reading the newspaper in their hand 6) reading the newspaper on their phone 7)watching the TV screen for the latest news. In fact, everyone else has their phone out so you pretty much feel compelled to do SOMETHING on your phone, even if you just checked your facebook,email and all your recent text messages right before you approached the starbucks. Its okay, do it again there could be something new. Besides the business man yelling into his cell phone (usually at the same time he’s trying to order), the only other chatter you’ll hear is the occasional set of friends chit-chatting in line and it will be about business, or about the coffee they ordered. It is RARE for strangers to talk to each other and if they do its usually because one feels like they did something to the other that warrants a half-felt “sorry” (i.e. bumped into one another ever so slightly [northern people never like to touch]). On occasion you’ll have the out-of-stater that asks how that brand of coffee is because he’s trying to make conversation, and he’ll get a “Its good.” (with a smile-maybe) in return. On the good side, you move through the line quickly, you get your order quickly and you get out quickly. On the bad side, you make no new friends. Also, if your favorite tea brand is out- sorry for you. You BETTER have a back up order ready to go in your mind or else you’re gonna get some audibly grumpy people in line behind you. Also, I have never seen a tip jar at a starbucks, ever around here.
It’s not even like I just noticed this. Its not just Ohio and its not just New York City/ NY/ NJ. In all my travels I have seriously generally noticed this sharp difference in American sub-cultures. Its astounding.
I wonder why this is, though? Why the “South” is known for generally being slow (physically- not cognitively), but for being very nice. The “North” I think is known for being fast-paced, grumpy, all attitude and ready to push you out of the way. Also, when I told one of my new found Starbucks friends that I was from New Jersey, she immediately thought “Jersey Shore” and asked if Jersey was all interstates and factories like that. *Slam face against wall now*.
But I guess what I’m trying to say here is that even though the North has that reputation in public, it doesn’t mean we’re automatically bad people, it just means we have grown up where things move fast, you get things on demand, you move fast, you get things fast, you do things fast, you constantly have at least one piece of technology on your body or in purse, and you have checked at least one form of social media (twitter, facebook, email, text) within the last ten minutes. It’s all on how we’re raised, how life is grained into us from the beginning. What’s taught to us about what’s acceptable and what’s not.
On that theory, I would love to meet someone who grew up constantly on the move around the world and United States. I wonder what culture they adapt to. That would be an interesting sociology project.
Even though I brand the North here with a horrible reputation and I give the South a nice reputation (I think I did, at least), I don’t think I could live in the South. Is that so wrong? Is it wrong to love the Northern culture, where everyone is opinionated, grumpy and quick? No. Because I think we’re also intelligent, effective, cultured, and undeniably witty.
I’m sure if I moved to somewhere South and lived there for awhile, I would get used to it. Then, when visiting or returning back North I would probably hate how the people are. Like I said, its all what you are used to at the current time. I think 87% of Humans don’t like change. I just made that up.
In order to survive in the North, you have to make it your own. People will not openly talk to you like they will in the South. If you want to meet people, you have to target them and make your own conversation. You have to be bold. Say what’s on your mind. If you want to be shy here, that’s okay- but you won’t get noticed and that’s just that. I kept to my shy self in Ohio and still 3 people wanted to talk to me in Starbucks.
The reason why I’ve been in Ohio is for another convention (another blog post coming up). At the end of the convention the announcer said, “Well, all that have come from far and near, I hope you all leave with a new friend you didn’t have before”. Me and my dad looked at each other and laughed. “Nope!” We both thought. Oh well. I’ll try harder next time….
See Ya'll later,
WNB
PS- if any of my readers are from Kentucky, Ohio or anywhere thats branded as being "South", then I hope I didn't offend you. You're lovely, thats the point. You're all so lovely its nauseatingly lovely. I'm just astounded how different people are based on where they live, and thats my point. Have a nice day! :)
.
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,
_WNB
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,
_WNB
Sunday, January 29, 2012
Thinking Swedish...
Hey!
So, lately I've become obsessed with the "Girl with the Dragon Tattoo" series.
Being that I'm a writer, every situation in my life has a backstory. So let me catch ya'll up.
A couple months ago, I was hanging out with friend #1. Friend #1 loved the GDT series, and he was telling me how they just finished the original version of the movies in Sweden and how they were soooooooo good and now they are making the American version and whatnot. None of it made sense to me. From what little I gathered from the plot, it didn't seem like a story series I'd like. Well, A couple weeks ago, I was hanging out with Friend #2. Friend #2 wanted to watch a movie, and we picked GDT, the original. Now, being that I had already made up my judgmental mind about this series that I didn't like it, I obviously didn't want to watch the movie. But whatever. I figured we had nothing else to do and I could at least give it a chance.
So the movie starts, and obviously we soon realize its in Swedish, with English subtitles. So Friend #2 decided he no longer wanted to watch it. However, at that point we were 30 minutes in, and well.....I was sucked in to the series. So I watched the rest of the movie by my lonesome, and it was SO.GOOD. As many of you know, I'm sure.
So after that, I bought the book right away at the airport on the way home from seeing Friend #2, and started reading immediately. Throughout the course of reading, the American version was released and I felt I wanted to see it in theaters while it was out. Then, I decided I was so entirely obsessed with this series, that I had to keep watching. So I instant streamed the entire swedish set onto my netflix account, and watched all of them back to back, in what little spurts of time I had (so naturally it took a couple days to finish).
What the entire point of this blog is, is that I discovered a new language phenomenon. Well, discovered is a strong word. I'm sure really smart people already know about this for a bajillion years now, but I just figured it out so its cool.
Since I had watched the series and nothing but the series (no tv, no other netflix stuff- just the series), I had this really, really strange experience. After it had been off, I decided to go for my weekly run . While running, I literally heard my thoughts in Swedish and my brain "saw" English subtitles for me. Now, granted, my "Swedish thoughts" probably made no actual sense in Swedish, but my brain knew enough after hearing nothing but Swedish language and reading english subtitles along with the language, that my brain was able to string together some Swedish words that it had picked up. But how wicked is that!?
So I sat thinking about this, and realized that the brain also does another neat trick. You get SO wrapped up in the movie plot, that you no longer even REALIZE you're reading English subtitles as you watch the movie. In fact, I forgot entirely that they were even speaking Swedish. My brain didn't even hear the Swedish. I think, the brain is smart enough to adapt. It adapts so that you understand things. And after all this time of reading the English subtitles, my brain got so used to it that it started "forgetting" that it was translating, and my brain "heard" the characters talking in English, because thats what my brain was reading. Does that make any sense?? How crazy is that though? The brain is meant to adapt, its part of the human condition. If it didn't adapt, we would constantly be going crazy that we had clothes on- because our skin nerves wouldn't be able to adapt and "get used to" the fact that we had clothes on our skin all the time. Weird!
So, as a little sidenote, I wanted to share something else pretty funny.
Does anyone else sort of "pick up" the entire movie setting, characters, plot, etc., onto themselves after the movie is done? Particularly good, long movies. Particularly ones with characters we identify with or fall in love with. You find yourself so wrapped up in the movie, that when you leave the movie, you totally feel like you are you're own character in that movie, or maybe you feel like you ARE a character from the movie, subconsciously. For example, ever drive faster and take more stupid risks while driving after watching "The Fast and Furious"? Have you ever felt that you can totally cast a spell on someone if you need to after watching "Harry Potter"? Ever started talking in an English accent after watching Hugh Grant? Ever feel like you live in Europe after some crazy good European movie? Ever felt like a super secret spy after watching "Bourne Identity" or "James Bond"? Ever felt like you had to solve some secret mystery (like where the hell did all the socks go?) after watching "Sherlock Holmes"?
It happens in good books too. After reading a plot nonstop, you suddenly feel like you're in their world. After reading the entire Hunger Games series, I suddenly found myself acting like Kat, trying to survive in the dreaded world. Silly, I know. It lasted for like a day. But still. Does anyone else do this ? I think its fascinating how our minds can get so engrossed like that.
Well, point is- I spent the other day after I finished the "Girl Who Kicked the Hornets Nest" (Last one of the movies), impersonating Lisbeth Salander. Which, is pretty kick ass fun- being that I spent at least half the day with my hoodie up- acting all....moody (in a kick ass way), looking for super-killers in the supermarket, etc...It was awesome.
I hope this is normal and everyone (or at least the great vast majority?) of the human species does this, or at least has done this. If not, you should let yourself try it. Next movie you go to, see if you find yourself subconsciously adapting to the movie after you leave. Its fun.
Thats all for now folks! Off to work tonight, yay.
With love,
_WNB.
.
So, lately I've become obsessed with the "Girl with the Dragon Tattoo" series.
Being that I'm a writer, every situation in my life has a backstory. So let me catch ya'll up.
A couple months ago, I was hanging out with friend #1. Friend #1 loved the GDT series, and he was telling me how they just finished the original version of the movies in Sweden and how they were soooooooo good and now they are making the American version and whatnot. None of it made sense to me. From what little I gathered from the plot, it didn't seem like a story series I'd like. Well, A couple weeks ago, I was hanging out with Friend #2. Friend #2 wanted to watch a movie, and we picked GDT, the original. Now, being that I had already made up my judgmental mind about this series that I didn't like it, I obviously didn't want to watch the movie. But whatever. I figured we had nothing else to do and I could at least give it a chance.
So the movie starts, and obviously we soon realize its in Swedish, with English subtitles. So Friend #2 decided he no longer wanted to watch it. However, at that point we were 30 minutes in, and well.....I was sucked in to the series. So I watched the rest of the movie by my lonesome, and it was SO.GOOD. As many of you know, I'm sure.
So after that, I bought the book right away at the airport on the way home from seeing Friend #2, and started reading immediately. Throughout the course of reading, the American version was released and I felt I wanted to see it in theaters while it was out. Then, I decided I was so entirely obsessed with this series, that I had to keep watching. So I instant streamed the entire swedish set onto my netflix account, and watched all of them back to back, in what little spurts of time I had (so naturally it took a couple days to finish).
What the entire point of this blog is, is that I discovered a new language phenomenon. Well, discovered is a strong word. I'm sure really smart people already know about this for a bajillion years now, but I just figured it out so its cool.
Since I had watched the series and nothing but the series (no tv, no other netflix stuff- just the series), I had this really, really strange experience. After it had been off, I decided to go for my weekly run . While running, I literally heard my thoughts in Swedish and my brain "saw" English subtitles for me. Now, granted, my "Swedish thoughts" probably made no actual sense in Swedish, but my brain knew enough after hearing nothing but Swedish language and reading english subtitles along with the language, that my brain was able to string together some Swedish words that it had picked up. But how wicked is that!?
So I sat thinking about this, and realized that the brain also does another neat trick. You get SO wrapped up in the movie plot, that you no longer even REALIZE you're reading English subtitles as you watch the movie. In fact, I forgot entirely that they were even speaking Swedish. My brain didn't even hear the Swedish. I think, the brain is smart enough to adapt. It adapts so that you understand things. And after all this time of reading the English subtitles, my brain got so used to it that it started "forgetting" that it was translating, and my brain "heard" the characters talking in English, because thats what my brain was reading. Does that make any sense?? How crazy is that though? The brain is meant to adapt, its part of the human condition. If it didn't adapt, we would constantly be going crazy that we had clothes on- because our skin nerves wouldn't be able to adapt and "get used to" the fact that we had clothes on our skin all the time. Weird!
So, as a little sidenote, I wanted to share something else pretty funny.
Does anyone else sort of "pick up" the entire movie setting, characters, plot, etc., onto themselves after the movie is done? Particularly good, long movies. Particularly ones with characters we identify with or fall in love with. You find yourself so wrapped up in the movie, that when you leave the movie, you totally feel like you are you're own character in that movie, or maybe you feel like you ARE a character from the movie, subconsciously. For example, ever drive faster and take more stupid risks while driving after watching "The Fast and Furious"? Have you ever felt that you can totally cast a spell on someone if you need to after watching "Harry Potter"? Ever started talking in an English accent after watching Hugh Grant? Ever feel like you live in Europe after some crazy good European movie? Ever felt like a super secret spy after watching "Bourne Identity" or "James Bond"? Ever felt like you had to solve some secret mystery (like where the hell did all the socks go?) after watching "Sherlock Holmes"?
It happens in good books too. After reading a plot nonstop, you suddenly feel like you're in their world. After reading the entire Hunger Games series, I suddenly found myself acting like Kat, trying to survive in the dreaded world. Silly, I know. It lasted for like a day. But still. Does anyone else do this ? I think its fascinating how our minds can get so engrossed like that.
Well, point is- I spent the other day after I finished the "Girl Who Kicked the Hornets Nest" (Last one of the movies), impersonating Lisbeth Salander. Which, is pretty kick ass fun- being that I spent at least half the day with my hoodie up- acting all....moody (in a kick ass way), looking for super-killers in the supermarket, etc...It was awesome.
I hope this is normal and everyone (or at least the great vast majority?) of the human species does this, or at least has done this. If not, you should let yourself try it. Next movie you go to, see if you find yourself subconsciously adapting to the movie after you leave. Its fun.
Thats all for now folks! Off to work tonight, yay.
With love,
_WNB.
.
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