Deep thoughts

I really loved Jack Handey on Saturday Night Live. Some things they mentioned on that segment of the show were delightfully sarcastic.

While some of you might say the same thing about two things I'll address below, I'm going to say them. Because someone needs to mention them. Because my patients mention them.

So sit down and listen, please.

First, I enjoy getting my regular copy of the American Journal of Nursing every month. Since I subscribe to the newsletter, too, I also get a copy of the electronic table of contents. I saw this listed in the TOC and just about blew a gasket. Why you ask?

Because we have a whole lot more idiots, or shall we say "free spirits" out in the world who are so nervous they have to make fun of things they don't like or understand. Since I am not allowed to discuss politics in my home, I won't even discuss a certain political candidate who has endeared himself to the physically challenged, prisoners of war (also military veterans) and something I can identify with: women.

The point: Nurse researchers, please get with the program. While my folks may use safety belts, I have yet to see any "bound" to a wheelchair. If you are so up-to-date, please use modern terminology, please. Wheelchair user would do just fine in your article.

Finally, never assume. Wheelchair users most likely are not deaf, nor stupid. Treat them the way you'd want to be treated. In the fine words of one of my friends with multiple sclerosis (who celebrated World MS Day this past week), "I have MS, but it doesn't have me!"

And now for a moment from our sponsor. Stay tuned! 

Say it!

Can I get an amen from someone out there, please!


Ah, yes, I'm so happy to report that RehabRN will be escaping the confines of the Hotel for the carefree days of waking up sans alarm clock. Sure, I'll be staycationing this time, but I plan on having a good old time, cleaning, meeting, greeting and hanging out with Bubba, who'll be starting his spring break.

My day was startling to start. What happens when you decide to be the nice nurse to one of the biggest pain-in-the-butt patients on the unit and take away his breakfast tray first thing? He sabotages you by positioning his old glass of iced tea just so, that it goes down the front of you as you move to take the tray away. Nice.

Happily, the day was better. The boss let me order a book. He gets it free anyway, so it's nice he's thinking of me. Traveling partner had a good time messing with him, since as brilliant as he is, he's just figured out that we're friends, which is highly entertaining. "Why yes, Boss, I do talk to her every day I'm here." she said as a shocker when he asked if she knew where I was. We just laughed at the irony of that.

My other patient, Mr. D., was simple to take care of today. Get him evaluated, get him ready and get him up. No fuss, no muss. 

His next door neighbors still miss me. I took care of these two characters, who should be called Click and Clack  for a week and now, they're raving fans. They rave to other staff about how much they like me, which of course, irritates the hell out of them. One nurse assistant actually said, "Well, education and being nice isn't everything." when Clack told her he thought I was very educated and knowledgeable.

In terms of what's going on with patients, we had a lot of things going. One guy came in for a specialty surgery evaluation, among his other issues. Another patient had lots of trouble with his/her hot room and his/her MS. The heating and cooling is so messed up with the unseasonable temperatures, that we had to call the maintenance folks to fix things, so said patient could rest and be comfortable. I've become used to it, I guess. So far, I have yet to work on a rehab unit where the heating and cooling works as it should.

Dahey even had time to come visit me at work when I needed him to do a special errand. It was very nice. As a result, my day finished smoothly and I left work on time.

Can't wait to just enjoy the weekend and relax.  Stay tuned!

Nuggets for December 16

Yes, it's Nugget Day, and since I've had some free moments, I've been busy roaming around finding goodies. Here they are, so sit back and enjoy.

The health and wellness section

LiveScience has an interesting article called 7 Thoughts that are Bad for You. As they say, temperament can impact a person's physical health.

Not sure how true it is, but some people claim this PowerPlate thingy can reduce cellulite and keep you in shape. If onlythey weren't so expensive...

One toy I have played with (note: I bought this...I didn't get it free) is the Clarisonic Mia. I love, love, love it. My skin feels much better, and is more cost-effective over time than salon facials (do your math--your mileage may vary). May just have to recommend it to the relative with rosacea.

Fun stuff

WebMD has an entire section (sponsored by EMD Serono, maker of Rebif) for MS patients in a game format called the MS Game center. It's a whole new way to check out treatment options and learn more about MS.


Strange but true

WARNING: If you have a queasy stomach, this may not be for you....
My friends over at Serenity Now Hospital have another good poop tale one that made me laugh just reading it, considering the amount of bowel routines we do at the Hotel. And yes, there is a rating scale: the Bristol stool scale.

Not what you'd expect

It was education night again recently. I am always amazed that new patients and new nurses can really get the conversations flowing.

A new patient came to the unit recently. He won't be with us long, but for the new nurses, he'll be remembered. He was slight with salt and pepper hair. He had just arrived and since one of the newer nurses gave report again, we had little to go on, so I headed to the chart. Not much there, either, but I managed to piece together a little story.

Patient is living his life with family in a successful blue collar job and has a "nervous breakdown" and never returns to his job. A few years ago, he gets diagnosed with MS. He goes from walking around house to pushing himself in a wheelchair.

The most striking thing among the new nurses is that they're hot for a diagnosis. "Wow, look at him shake doing xx," one exclaimed. "Are we taking Parkinson's patients now?" No, I reply to NN1 (New Nurse 1 --we have several right now), remember Mr. X has MS."And so education begins...

Where do we start? We comb the chart again, and finally, the docs update the notes. We know he has MS and from the chart and meds, we can tell a few things about him. He's got those tremors because he's had lots of issues going on upstairs, because of the infamous plaques. He's had lots of seizures, and tried lots and lots of meds, most of which give him reactions, so he's been switched around a lot. Next, we see he's on some different treatments, too, which are often used in areas outside MS, particularly in transplant patients. Following that, we reviewed some neuroanatomy. The brain is a wonderful thing. It's got several mechanisms to tell you that something's wrong and generally gives you an idea of where the problems might be.

After we looked at his chart for more information, we headed on over to the MS Society website for more information. This had the new kids going for at least an hour, but I suspect a few of them will keep learning, eager to absorb whatever they can. The Professionals section at the MS Society has an area specifically for nurses. More good sites for information are the following:

The MS section of NINDS the National Institute of Neurological Disorders and Stroke (from the NIH)
IOMSN International Organization of Multiple Sclerosis Nurses
MultipleSclerosisProfessional.org
Neuroanatomy online has lots of MRIs and other graphic information on neurological disorders.

Sometimes an unexpected event leads to lots of learning. We'll see where it goes.

More to come...stay tuned.

Nuggets for May 6

Here are a few goodies I've found perusing the 'net this week. Enjoy!

Something to talk about later for me at work
Epstein-Barr Virus linked to MS from www.webmd.com

Grow, blog, grow (or things I need to be doing in my spare time)
I found these gems via KevinMD's blog:

How to grow your blog to the next level with SEO from problogger.com
How to write magnetic headlines from copyblogger.com

Etc. (stuff with no category)
Trendy baby names tend to fade fast Surprise, surprise!
CDC: Don't eat raw alfalfa sprouts. Thankfully, I stopped years ago.
Face transplant patient steps forward from www.nytimes.com


Finally, it's about time category
Health insurers agree to end higher premiums for women from www.nytimes.com

Nuggets for April 22

Yes, right on time...almost...is the latest installment of Nuggets from my meanderings on the web. Enjoy!

Could lice prevent asthma? It makes me a little creeped out, though. (Don't think too much and you won't itch!)
http://www.reuters.com/article/lifestyleMolt/idUSTRE53L00M20090422

Walnuts and breast cancer. Another item they'll sell out in the stores now.
http://www.reuters.com/article/newsOne/idUSTRE53K52820090421

Diet can increase risk of kidney cancer
http://www.reuters.com/article/healthNews/idUSTRE53J5M320090420?feedType=RSS&feedName=healthNews

Study Raises Estimate of Paralyzed Americans. Note: the number of MS patients jumps significantly, so take this with a grain of salt.
http://www.nytimes.com/2009/04/21/health/21para.html

Probably the best inadvertent diet film you'll ever see, now on YouTube: SuperSize Me
http://www.youtube.com/watch?v=d7Tv_mihMBA

Blogs to check out

Clinical Cases and Images: The blog of www.clinicalcases.org
http://casesblog.blogspot.com/

Fat Doctor and her recent post on "Lifesavers" is really worth your time
http://fatdoctor.blogspot.com/2009/04/lifesaver.html

Needle phobia is an unreal story you have to read from At Your Cervix
http://atyourcervix.blogspot.com/2009/04/needle-phobia.html

Nuggets for February 10

Here are some interesting items I've encountered on the internet lately, via directed searches or via random reading. Hope you enjoy!

I'm studying for certification this year, and since our boss is a neuro who's big on everything spinal cord, I've done some reading on MS lately.

There are lots of things coming out in literature about treatments that may stall or stop MS from progressing. First, this article from the Saskatoon Star Phoenix discusses vitamin D and its role in MS. Another article discusses the use of immunosuppressants in treating MS.

On the subject of immunosuppressants, I recently went to a great CE presentation on working with post-transplant patients. Kidneys are the most commonly transplanted solid organs, so this presentation discussed many aspects involved in kidney transplants. The docs also talked about things such as CMV, diabetes and osteoporosis.

There was a great graph on kidney disease course and it showed how going on dialysis is just as difficult in terms of quality of life as transplant, but patients tend to bounce back faster from transplant than long-term dialysis. I found a very interesting DaVita article (by one of their social workers) which discusses quality of life. This is a very big deal in kidney disease as jo the dialysis nurse could probably tell us multiple times.

While transplantation short-term survival is up, long-term rates are flat. At the current time, there may be no breakthroughs in transplant treatments this decade, but there are plenty of promising agents in trials, such as ISA247. All we can do now is wait...and see.

Out of order

Everything functioned pretty well today, but the order of our day was a little off with all the excitement.

One of our patients went off on his day pass. He got a big honor and got the full VIP treatment. We don't know if we'll see him on TV, but we're all proud. I just would have felt better if I had not found his meds that I ran to the pharmacy for yesterday at noon today locked in our med room. The night charge forgot to pack them...arrgh! (We got that problem solved, though.)

I had the same two patients as yesterday, minus one, since I inherited the med cart...again. I got lucky and got the slow hall, where no bed bingo was going on and there were no IVs or oddball meds. Everyone was relatively pleasant, so it was a good time passing all the pills down there.

At lunchtime, I got to discharge one of my patients. He was nervous about leaving, which is not surprising, since we have some people who love to visit us. He was "sick" and despite all his vitals being good and the MD's offer to stay, he decided to leave once his ride showed up to get him.

My other patient got a trip to one of his consults, a shower and had lunch and was doing well, when he came up to me in the hall and said, "I need to have a bowel movement." He's an MS patient so I know he knows when he's got to go. I got him to the bathroom, but the strain to transfer him on the commode was too much and he had a little accident. I got him undressed carefully, and got him squared on the commode. He sat there for a while and I finished his bowel program with the famous mini-enema.

He sat some more and when he had transferred to his wheelchair, he said, "I gotta go back." I got him back to the commode for more sitting. While he was sitting, I folded another patient's t-shirts, which were in the dryer, and got his clothes (he already had a bunch) in the washing machine. All was over for him, so I got him some of our famous PJ pants and got him back to the chair. We got his clothes into the dryer and he was on his merry way.

One of my coworkers was surprised. "Why is he going in the middle of the day?" I told her I figured it was because we have him on all sorts of bowel meds (Colace, psyllium, MOM, etc.) and I think that the MOM at lunch is sending him over the edge early. Many of our patients need 4-6 hours for it to work, but some patients go pretty quickly after you give it. Bowel programs in the middle of the day are definitely out of order on our unit!

Finally, we're dealing with loss on our unit again. We're losing a nurse who has to leave due to health concerns. It's scary because this nurse is not near retirement age. Folks are hoping this nurse can use his/her nursing skills to work a desk job in some capacity.

One of our patients, who was a cute little old guy who everyone grew to love during his time with us, died this past weekend. He was friendly and rehabbed himself from being a feeder who stayed in bed, to getting up in his electric wheelchair racing around the unit and even feeding himself with his equipment.

I was happy when I left with J. at the end of the shift. I plan on enjoying my day off! More to come...