... and health care for all

Glitch and Health Care?

2012-02-09T08:41:00.000-08:00

I am going to spend the greater part of today in a hospital here in New York. Not because I am ill, but because a friend is having surgery and I agreed to be their stand-in "person" - as Merideth and Christina say on Grey's. I was thinking I'd take my computer and play some Glitch (try hard not to judge) fully expecting this very well known and well endowed hospital to have wifi for me. It turns out they don't. God forbid you have the internet while waiting hours for a surgery to end.

As I was researching wether I could play Glitch on my ipad (that's a negative) I stumbled across the twitter feed of Stuart, know to the glitchizen as g_d. From Stuart's twitter feed I linked to an article entitled "How Doctors Die" by Ken Murray. I then saw a second link to an article in The New Yorker titled "Letting Go" and was further intrigued. I always wonder what the layman thinks of medicine, disease, and death. So I read each of them. I encourage you to read them as well.

I too have heard rumors of DNR tattoos and my living will is obnoxiously detailed, however "How Doctors Die" swings the pendulum too far in the opposite direction. I agree that often patients go through terrible agony for a poor outcome in the end. There are multiple reasons this happens including the patient not wanting to disappoint family members, family members asking the patient to fight as well as doctors not talking to their patients about the realities of their illness.

"According to Block, about two-thirds of patients are willing to undergo therapies they don’t want if that is what their loved ones want."

I have watched many patients come back from extreme illness. I have seen a number of young women survive teratomas that were at first misdiagnosed as mental illness and watched a young man battle Guillain-Barre and advance from being unable to move anything other than his eyes, to being able to walk again. These are not terminal cancer cases or severe strokes. We're not talking congestive heart failure. Which is why I find it important to point out that advances in each area of medicine are very different. This is why patients need to ask questions and rely on scientific outcomes. This is why you are told to take someone with you to doctors appointments and have them write everything down. It's why I volunteer to go to the hospital and doctors appointments with friends.

As Gawande writes in "Letting Go"-

"People die only once. They have no experience to draw upon. They need doctors and nurses who are willing to have the hard discussions and say what they have seen, who will help people prepare for what is to come—and to escape a warehoused oblivion that few really want."

"Letting Go" is filled with sad stories and very good information for patients. It should be in the book on how to be sick better. Here a few of my favorites:

"The difference between standard medical care and hospice is not the difference between treating and doing nothing, she explained. The difference was in your priorities. In ordinary medicine, the goal is to extend life. We’ll sacrifice the quality of your existence now—by performing surgery, providing chemotherapy, putting you in intensive care—for the chance of gaining time later. Hospice deploys nurses, doctors, and social workers to help people with a fatal illness have the fullest possible lives right now. That means focussing on objectives like freedom from pain and discomfort, or maintaining mental awareness for as long as possible, or getting out with family once in a while. Hospice and palliative-care specialists aren’t much concerned about whether that makes people’s lives longer or shorter.
Like many people, I had believed that hospice care hastens death, because patients forgo hospital treatments and are allowed high-dose narcotics to combat pain. But studies suggest otherwise. In one, researchers followed 4,493 Medicare patients with either terminal cancer or congestive heart failure. They found no difference in survival time between hospice and non-hospice patients with breast cancer, prostate cancer, and colon cancer. Curiously, hospice care seemed to extend survival for some patients; those with pancreatic cancer gained an average of three weeks, those with lung cancer gained six weeks, and those with congestive heart failure gained three months. The lesson seems almost Zen: you live longer only when you stop trying to live longer."

There is also a great argument on the conversations that physicians should be having with patients on death and preparing for it. Of course the problem is cost. Those conversations can be very long - it's not as if you can just tell someone to accept that they are going to die in a month and by the way - fill out this living will.

"The new health-reform act was to have added Medicare coverage for these conversations, until it was deemed funding for “death panels” and stripped out of the legislation. But the issue isn’t merely a matter of financing. It arises from a still unresolved argument about what the function of medicine really is—what, in other words, we should and should not be paying for doctors to do."

What does it all say to me? That we need to be able to admit defeat and work to preserve our quality of life. That there is no "right" way to battle a disease. That there is no "right" time to decide to stop fighting. Just like health care decisions are individual, so are death decisions.
These bodies are all we truly own in life.

Having just gone through the death of a family member. I am forever grateful that he had an explicit living will that we could follow so that I don't have to wake up in the middle of the night wondering if we made the right decisions. He made the decisions for us.

A combination of watching patients die in the hospital and taking care of a family member in hospice has given me an insight to death that I didn't think I would have at this age or at this stage in my career as a nurse.

Consider it your last responsibility as a parent - one you must complete immediately, no matter your age.

Consider it your most important showing of love to your spouse, lover or significant other.

Write a living will and make sure it is legally binding.

For those of you who have a sense of humor - you might like this.
I'm going to get glitchy.

You Can Go

2011-11-15T14:14:00.000-08:00

Jedd Miller passed away this morning after battling Parkinson's Disease for the last ten years. He was loved by so many friends and family, and was surrounded by us through his last breath.

It was more beautiful than you can imagine. More awesome than I can describe.

Those of you who knew him will be happy to hear that he had a Tibetan monk chanting by his side yesterday afternoon, and this morning the Peruvian q'ero indian death rites were performed by a shaman and his pastor performed last rights.

Tomorrow he will be buried in a pine box at the Jewish cemetery in Shutesbury. He will be dressed in the robes he was given when ordained by Cambodian monks.

Elijah, Jenna, Lisa, and Dona would love for you to be there.

And so would Jedd.

The details of the funeral service tomorrow are as follows:

Wednesday November 16th

1:00pm

Jewish Community Center of Amherst

742 Main St, Amherst MA

Following the service we will proceed to the cemetery located at:

221 Leverett Rd, Shutesbury, MA

Adi Bemak and Rob Okun have generously offered their house to share a meal following the cemetery service.

6:00pm

33 Grey St.

Amherst

We will be sitting Shiva at 7PM on Thursday, November 17th at Don and Karen Gallagher's house. Their address is 107 Roosevelt St in Hadley. All are welcome.

You can continue to use Jedd's Donate Button on the top left side of the page. Donations will be anonymous and will go toward burial/funeral arrangements.

Jedd's Donate Button

2011-11-06T13:01:00.001-08:00

I know that I promised a completely different topic, but what can I say other than I have no control over the universe?

Cause I don't.

Even if I squeeze my eyes shut really, really tight - I am clearly not in charge.

So here I am, back in Brooklyn with Elijah after a very long and exhausting 48 hours in Amherst. 24 hour care of someone you love is heartbreaking.

I'm not going to go into too many details, because though I love Jedd very very much, he is not my father and I do not feel it is my place. If you are here because of a link that was sent to you regarding his health and need - you already know what is happening.

We have been trying to keep Jedd's care at home where he feels safe and secure and surrounded by loved ones. Unfortunately his condition has deteriorated to the point that it takes multiple care takers to be with him at all times. We are still fighting to keep him at home but need monetary help from others.

So to the upper left side is the button. You can donate as much or as little as you want. I will keep all donations anonymous and every penny will go towards Jedd's care.

Pathetic Blogger, Dedicated Nurse

2011-10-18T19:20:00.000-07:00

Yes. I'm a pathetic blogger. It's true.

Though I haven't had a full-time job in over two years I can't seem to do this on a regular basis.
I only have one follower (that's your shout out coldbean) and that's a recent development. My mom doesn't even subscribe.

I believe it has something to do with the number of hobbies I have. It must be. I don't even have cable. Though these days an internet connection is certainly enough for me to waste hours on television.

It's getting cooler so baking will begin again. I am absolutely hell bent on being able to make a chocolate cake that is as moist as the one at the Chocolate Room on Court Street. I don't think they have a particularly tasty cake, but it certainly is moist. When I find it I'll share.

I'm also dedicated to having a full-time job with health benefits for me and the Hawk. Or is he the Dove? I can never remember. They say no one's one or the other but we all know they're lying. So I've been doing a little per diem nursing. I did have a full-time job for a month in August. I thought it was my dream job, but it turns out that your heroes can be a disappointment.

I did learn some pretty amazing stuff there and I'm going to blog about it. Soon. And the word anal will come up a lot. So stay tuned.

2011-07-18T10:45:00.001-07:00

I am going to attempt this thing they call "mobile blogging" let's see how it goes...

Michele O'Bomber, Susan Sarandon, and Jamie Mandel

2011-04-20T21:05:00.000-07:00

There's been a lot of talk lately about health insurance and health care and, in my immediate world, surgery. My sister, Michele O'Bomber, wrecked her ankle a month ago while at a Bay Area Derby scrimmage. She had very recently made the Richmond Wrecking Belles and was nice enough to fly me out to take care of her for two weeks. In that time we both realized that there is really just no alternative to having a personal nurse.

I would be interested to see a study done on the healing time and infection rate of post-op patients with home care versus those without. I bet it's ridiculous.

Here's an awesome pic of her foot after having her fibula and tibia joined together with her tendons via a plate and twelve screws.

So... what does this have to do with Susan Sarandon, you might ask? Well, I arrived home only to then escort my friend Jamie Mandel home from another oral surgery adventure.

Jamie is one of those friends who you would kill if it weren't for the fact that he's just that great. He might do things to you in public that are unforgivable. It might be really embarrassing to ride the subway with him. But when he smiles at you, even without teeth, you can hear the Golden Girls theme song playing.

I recently was at an event where Susan Sarandon spoke. No, really, that's her down there...

I was moved by her speech. Prior to this moment I looked up to her and so I'm really glad she didn't let me down. I'm hoping she wont let Jamie down either (we're not peers so that's not peer pressure, but maybe some sort of shaming component that isn't flattering for me).

I hate that we all have to struggle so hard to take care of our bodies. I hope that one day Americans will have the health care that we deserve. Until that happens, I hope that we can continue to support each other.

And while you wait for that amazing miracle to happen, watch this hysterical video of Jamie.

Hearts

2011-02-22T14:22:00.000-08:00

We're not that big on Valentine's Day here on Hoyt Street.

In fact this was the first year that I remember going out to dinner on Valentine's Day - and it was solely because friends were in town.

That said, I do have some pretty great girlfriends (and Jamie) so I decided to make them some cookies.
Butter cookies...

The recipe is from my mom, who's not big on baking, but taught me how to make cookies as soon as I could stand on a chair to stir the batter. And you don't have to ice them because they taste like creamy, melt in your mouth butter, the most perfect ingredient.

I wanted them to look a little festive, so I used red confectioner's sugar icing (adapted from smitten kitchen's black and white cookie recipe). It doesn't taste great (it's just confectioner's sugar and water) but it did the design job.

Normally you would make the batter, squish it into a 8x8 pan for shape and then cut the cookies while cold. I wanted heart shapes, so I chilled it, rolled it out and used a cookie cutter. For fun cookies with a shape, these are way better than using some bland old sugar cookie recipe with so-so icing slathered all over. If anyone has a recipe idea for an icing that hardens well, travels well, and still tastes great - let me know.

Butter Cookies (Kathryn Grossman)
Cream together with kitchen aid paddle or hand held mixer:

1 pound butter - room temperature

1 cup white sugar

1 cup brown sugar

Add in two large eggs, one at a time until completely incorporated.
Add 1 tspn vanilla

In a separate bowl combine:

1 tspn baking soda

5 cups flour

Slowly add the dry mix to the wet mix until completely incorporated - mixture will be stiff.

Super easy rectangle cookies:

Line and 8 x 8 inch pan with waxed paper and push cookie dough evenly to all sides. Refrigerate 24 hours.

Once dough has been thoroughly chilled remove from pan. Cut dough into 4 long rectangular logs. Each log can then be sliced from one end to the other creating rectangular cookies. The thickness that you slice is up to you. I tend to make them 2 cm thick to start.

Cookie cutter shapes:

Once thoroughly mixed, dump dough onto lightly floured surface. Gather all of the crumbs together into a ball and slice into 4 pieces. Shape each piece into a disk and wrap in plastic wrap - chill one hour.

Leave other three disks in refrigerator while working with the fourth. Roll out to desired thickness (1-2 cm) on well floured surface. Flour your cutters as they will start sticking. Work quickly so that dough doesn't get too warm and mushy. I tend to put the cut out cookies directly onto the parchment lined cookie sheet and then refrigerate a few minutes before baking.

Bake at 350F for ten minutes or until becoming golden brown at edges. I bake on parchment but my mom doesn't. I'm sure there's enough butter to skip the paper.

Cool entire cookie sheet on wire rack for 5 minutes and then transfer cookies themselves to rack.

You can do anything with these cookies such as dipping half in chocolate or baking thin cookies and spreading jam or Nutella between them. But they are perfect on their own.

Things Can Always Change

2011-02-09T18:05:00.000-08:00

Six months ago things were looking bleak. And then I met Vilma. It was a struggle for me to finally practice what I preach as a nurse and be my own advocate. I was told that switching physical therapists would "look bad" by Risk Management and second guessed myself.
I'm glad it didn't last too long.
The lesson? Always, always, always go for the recommendation of a friend. Christina at Element told me to go see Vilma at Pro Fitness.
The result?
I'm back. I'm sooo back. As a matter of fact I quit smoking, started pilates, am able to go back to work (with lifting restrictions) and am hoping to be able to backpack by summer.
So get outta my way.

I'm Back

2010-12-14T07:13:00.000-08:00

I know, I know. It was rude to leave all seven of you in the lurch like that. I apologize.
Finals will be over and done with this Thursday and of course the moment I am about to graduate with my second nursing degree I have a crisis of career. Can't a person have two?
The problem is that I want to bake. I realize this intense urge may lessen after the holidays - after I have been baking for a week straight. But what if it doesn't?
Nursing feels like a career. Something to expand on and in, while baking seems so selfish. Well, I guess it wouldn't be the first time.
So stay tuned for the baking vs nursing drama to unfold!!

PPO HMO ABC PPNYC

2010-07-01T12:00:00.000-07:00

My friend Jaron asked me what the differences are between PPOs and HMOs.

Understandable since I'm a nurse. You would think nurses would know all about health insurance, but we don't. We don't have anything to do with health insurance unless it is our own. But as a nurse and a believer in the advantages of preventative care, I do know what things you need to think of when deciding between a larger deductible or larger monthly payment.

So here is your crash course in health insurance.
First, ask around. Take the time to ask people if they like their insurance and why they chose it. Insurance laws are different state to state so stick to your state.
Second, find out how much the following list of things costs and add it up. This is what you will pay on top of your monthly payment for coverage and what will be subtracted from your deductible.

The List:

Dental visit for cleaning twice a year - you really should go twice a year, and I mean it. Dental health is directly related to heart health.
Dental x-rays yearly.
Annual healthy check up with your doctor, including blood tests and depending on your age any other diagnostics you might need - like a colonoscopy.
If you are female, add in your annual Gyn. visit and if you are of the age, the mammogram.
Next add in any medications you take regularly - different insurance covers different amounts or have different copays. Girls, don't forget the birth control pills here.

Okay, so that's what you pay every year. Just to see MDs to keep healthy.

Go to this link to read more thoroughly what you should be doing to take care of yourself:
http://radicalrnyc.blogspot.com/2010/05/family-vacations-and-health-information.html

Now add in one visit to the MD a year when you are super sick and need antibiotics (more if this happens more often and add in another time if you are a heavy smoker and another if you are a heavy drinker).

You should also take a good hard look at your family history. Are you the same age dad was when he went on medication for high cholesterol? Have you been keeping track of it? Did your mother have breast cancer? Do you take big risks? Do you ride a bike in NYC? Do you take medication or recreational drugs that are screwing with your system?

People get into accidents, cut off fingers, and generally mess themselves up way more often than you think. Just ask anyone at B-61. And you're better off having some sort of coverage.

So - now to the explanation of how insurance is packaged.

HMO - Health Maintenance Organization
PPO - Preferred Provider Organization

These are all managed care plans and they have contracts with doctors, hospitals, pharmacies, x-ray centers, etc. This is so that you get a particular service for a particular price and the people they have the contracts with are called the "network". In these plans you can choose from one of the providers that are in the network. Sometimes you can go "out of network" and choose another provider, but it means that you will pay more of the cost out of pocket.

HMOs
You will be required to choose a Primary Care Physician (PCP) who is in the network who will oversee your care. This will be your regular doctor and you will pay a copay when you see any doctor. You will be required to receive all or most of your care from providers in the network. When you need to see a specialist or have an x-ray or MRI you will need a referral from your PCP. If you do not get a referral first, or you go to a doctor outside the network, you will have to pay all or most of the cost.

If you are healthy in general, this might be perfect for you. Take a look and make sure that they offer MDs and clinics that you want to see that are close to where you live. And make sure they have physical therapists nearby - you never know when you might fly off a cliff.

PPOs
This is organized so that there are "preferred" providers in a "network". You will not have to choose a PCP, because you will be able to see other providers in the network without a referral. If you see someone out of the network you will have to pay out of pocket and them place a claim with your insurer. They will then decide what percentage they will pay, based on what they deem an acceptable price for the service.
For example: I went to a doctor out of network and was told my insurance would pay me 80% of the cost they deemed reasonable. I paid $200.00, they thought the MD should have charged me $100.00 so they will reimburse me $80.00 and I am out $120.00.

If you see a doctor in network, you may be responsible for an annual deductible (for some groups) and the copay.

If you have a serious illness you may want a PPO so that you can better manage your own care and choose from doctors that specialize in the areas you need.

Confused? Go to the web site of the carrier and read through what they offer.

Gnocchi and Radios

2010-06-03T14:27:00.000-07:00

A few months ago Dona and Jedd gave us an old Grundig radio. I was ecstatic. It didn't work, but I have a history with Grundig and I believe the only thing that can kill one is a swim in the pool or a grenade. But being a bit lazy we let it sit around until about a month ago when I declared that everything in the apartment we had not used in the last year would be given away. As you can imagine, this horrified Elijah. We piled his old clothes into garbage bags, boxed up the books, and cleaned up the fondu pot. He was afraid for the radio.

Enter Johnny Bravo.

He can fix things.

They got some new fuses or tubes or whatnot but still no sound, so we found an actual repair man and he made the radio work again!

It's beautiful, the sound is fantastic, and it glows in the dark!

I proceeded to give away everything else. I set up shop last Saturday in front of our apartment where Gary and a few other neighborhood hanger-outers kept me company. I was told over and over again that I was a wonderful person for giving things away for free and I lost count after the 20th "God's gonna bless YOU!"

All but one bag of clothes went, including the fondu pot - though I did have to explain how to use it three times to the same woman before she decided it was GREAT for a party!

We spent a beautiful Sunday at the beach and for some reason it seemed logical to me to want to make Ricotta Gnocchi for the band and friends. It's a very simple recipe - I borrowed from 3 or 4 to decide how to go about it myself. Here is what I found.

Ricotta Gnocchi:

You can make any sauce for this. Really. I would suggest something simple so you don't forget to enjoy the gnocchi. I made a red pepper tomato sauce and saw many suggestions for pesto.

The gnocchi.
one large container whole milk Ricotta - usually around 250g (give or take)
1 large egg yolk
1/2 tsp salt
1/2 cup Parmigiano (or Pecorino), grated and fresh
all-purpose flour

So basically this is what you are going to do:
Put the ricotta, egg yolk, salt, and cheese in a bowl and mix together with a spoon.
Add flour a 1/2 C at a time until it forms a ball - the wetter the mix the longer this will take. You want the gnocchi to be a little sticky not dry. The more flour you add the denser the gnocchi will become - you are looking for light and fluffy.

Bring a large pot of water to a boil with a pinch of salt.

Forming the gnocchi can be difficult.
Flour a big wooden cutting board (or your counter top) generously and put a heaping scoop of dough onto it. Dust the dough with flour then roll it into a finger-thick-ish log. Cut it into little rectangles and place them on a pan with parchment our floured. Make fun fork marks in them for the sauce to sit in.

It happens really fast so be ready! Take out with a skimmer and serve immediately.

You can add anything you want to this recipe- basil, nutmeg, lots of pepper, or even lemon! The stickier it is the smoother, softer, and fluffier it will taste. Good Luck!

Gary's Cookies

2010-05-18T16:18:00.000-07:00

So there is this guy who hangs out in front of my building. His name is Gary and he's had some tough luck. He has a son he's very proud of - they were both track stars. Gary always seems to be just outside the front door when I am on my way out of the apartment with a freshly baked sweet and so he has become a fan. He keeps asking me if I've ever baked oatmeal raisin cookies and I can take a hint. He's been feeling pretty down lately and it's pouring today so I thought I'd make those cookies.

preheat oven to 350°F

beat together until soft and fluffy:
1 stick soft butter
2/3 cup packed brown sugar
1 egg
1/2 - 1 tsp vanilla (I tend to go heavy on the vanilla)

add these:
3/4 cup all-purpose flour
1/2 teaspoon baking soda
1/2 teaspoon ground cinnamon
1/4 - 1/2 teaspoon salt

then add these:
1 1/2 cups rolled oats
3/4 cup raisins

put a heaping tablespoon of batter in a ball onto cookie sheet (use parchment please) and then smoosh with your hand so they are flattish.

let cool on rack before transferring

10 to 12 minutes

Family Vacations and Health Information

2010-05-16T07:59:00.000-07:00

So my gigantic extended family is going on another vacation together in Virginia. Virginia Beach to be exact. We will all bunk together in a mansion by the sea. There are TWO swimming pools and the house is ON the ocean. Osteoporosis runs in our family and I thought I'd bring everyone some info, seeing has how I just found out I should have had my first bone scan at 25! So I compiled this crazy list and am going to put it up here because I think everyone should have it. I'm not claiming that it covers everything, but everything I could think of today, so no fair if you get sick and want to sue. You can't. Because this is just some advice, not to be replaced by seeing a health care practitioner (gawd how the health care and legal systems have made me paranoid!!)
So check it out, print it, give it to your family members.

General physical exam
When you get sick and go to see your doctor they treat your sickness. They do not give you a yearly physical exam, which is necessary every year. Why? Because prevention is the part of health care that works best. It tells us where there might be a problem later or shows us the areas of our body that need a little work in order to keep us healthy and strong. So get a physical every year. Make sure you tell the receptionist that you are coming for a complete physical so they schedule enough time. Go to the appointment as prepared as possible so you get the care and attention you need. This means take any immunization or medication or disease treatment information you have.

What your “healthy visit” or “annual checkup” should include:
-A detailed history to learn all about your present and past health (family diseases and such).
-A head-to-toe physical exam including the skin, eye, ears, nose throat, lymph nodes, chest, breast (men and women), abdomen, rectum (men and women), and extremities.

-Blood Pressure: Every time you see your doctor your BP should be checked. Having your BP checked at each visit allows your MD or NP to notice changes and trends.

-Height: Significant loss of height can indicate osteoporosis due to the loss of bone in the spine.

-Weight: Significant weight loss or gain, without trying, can signify serious health problems such as heart disease or cancer.

-Waist Circumference
Your waistline can show the development of obesity-related diseases if you are:
A man whose waist circumference is more than 40 inches.
A woman (not pregnant) whose waist circumference is more than 35 inches.
Excessive abdominal fat places you at a greater risk for developing Type 2 Diabetes, high cholesterol, high triglycerides, high blood pressure, and heart disease.

Measure Your Waist Size-
Place a tape measure around your bare abdomen just above your hip bone. Make sure the tape does not compress your skin and is parallel to the floor. Relax, exhale, and measure.

- Immunizations
There are different reasons to get different immunizations. Traveling abroad is one, living in close quarters with many people is another. Living in NYC is yet another. This is an area where you have to do individual research. I can do this with you.

Annual Blood Tests:

Fecal Occult Blood Test: blood in the stool can be an early indicator of colorectal cancer.
C-reactive protein test – an important test of inflammation and a marker of heart disease risk.
A1C – to test for diabetes (don't settle for a blood sugar level)
Blood Urea Nitrogen and Creatinine - tests your kidney function.
Sodium, Potassium and Chloride - all three are electrolytes. These tests are especially important if you are on medication commonly called “water pills” for high blood pressure/heart disease.
Uric Acid - higher than normal can mean kidney disease/gout.
Albumin - protein produced by the liver. Low albumin can signify liver/kidney disease.
Calcium - Your blood calcium level has nothing to do with how much calcium is in your bones. High levels can point to hyperparathyroidism (excess production of parathyroid hormone), which predisposes you to kidney stones and low bone density.

Lipids-
Often listed together in a separate section on your blood chemistry report. Sometimes only the total cholesterol and perhaps the triglyceride level will be listed if your doctor didn’t specifically request results for the lipid panel. However, you need all your numbers in order to make the best evaluation for heart disease.
Total cholesterol is the sum of your LDL and HDL (see below). High total cholesterol levels are linked to heart disease. The lower your total cholesterol the better. A total below 200 is desirable.
High Density Lipoprotein (HDL) is your “good cholesterol”. Remember, “high density should be high.” The more of this type, the better. Ideally, your HDL cholesterol should be at least 30% of your total amount. In men, an HDL greater than 40 is normal; in women, an HDL greater than 50 is normal.
Low Density Lipoprotein (LDL) is your “bad cholesterol”. Remember, “low density should be low”. A high LDL puts you at risk for heart disease; your doctor will suggest diet and often medication to get your LDL cholesterol below 130. If you have diabetes or heart disease already, your treatment goal for LDL cholesterol should be below 100.
Triglycerides are the other form of fat in your blood. The level will be much higher after a meal. If your level is out of range it should be repeated after an overnight fast. Elevated levels increase your risk of heart disease and could be a sign of early diabetes. Ideally they should be under 150.

Thyroid Function
Under active thyroid is a common condition in women over the age of 50 (younger if it runs in your family. Most women should be tested yearly.

Other Regular Exams
-Dental
A dental exam checks for decay and plaque buildup and to look for signs of inflammation and infection. Women at risk for heart disease, metabolic syndrome or diabetes (women with waist circumference over 35 inches or apple-shaped women) should be particularly concerned about regular every 6 month checkups.

-Vision
Everyone should have their eyes checked on a regular basis. This exam can check for vision, cataracts and even glaucoma. Patients with metabolic syndrome or diabetes should also have an annual opthamology exam by an opthamologist to check the retina as well.

-Total skin exam
Excessive sun exposure and loss of the ozone layer has created an excess of melanoma cases. It is important that you get a head-to-toe check of your skin every year - don't forget the scalp. This cancer grows fast and is hard to fight.

Women - If it runs in your family, go now.
I'm planning to do this asap, as I just found out I should have done it a long time ago.I'm not sure my insurance will cover it and the physician or insurance may disagree with how young a person should have a bone scan so I will do a follow up here later with what I find out. The medical industry says women should have this test at 65, but any woman who is in menopause or has a fracture should go as well. If you don't need a test yet, start preparing your bones for the loss of calcium - do it now.

Bone Density Test (DXA scan)
This is an x-ray which measures your bone density. The lower your bone density, the greater your risk for bone fractures. (There is also a much less accurate heel ultrasound test that does NOT diagnose osteoporosis but merely tells your doctor whether you are at risk and should have the more complete x-ray DXA scan test.) The DXA scan is considered the gold standard for the diagnosis of osteoporosis. The most important score or result to check is your T-score. The T-score tells you how your bones compare to that of a healthy 35 year old woman. If your T-score falls between -1 and -2.5 then you have mild bone loss called osteopenia. If your T score is -2.5 or lower, than you have osteoporosis and a significant increased risk of fractures.
You can also look at your Z-score, which tells you how you compare to a similarly matched group of women your age and ethnic background. It is not unusual for an 80 year old woman to have a normal (for her age) Z-score but have severe osteoporosis (her T-score could be much lower than -2.5). I often hear women tell me their DXA scan is normal yet when I got the actual report I found that their Z-score was normal for their age but their T-score was low and they needed counseling about prevention for further bone loss.

Do:
Consume 1000 mg Calcium and 600 IU of Vitamin D daily
Walk 30 minutes daily and lift weights 3 x’s/week
Reduce intake of sugar, caffeine (especially cola/pop which is high in phosphates that reduce calcium levels), reduce red meat intake, reduce pork products, reduce salt.
Eat calcium fortified foods
Decrease alcohol intake
Stop smoking!

Weird Note: It turns out spinach is not good for you is you have osteopenia or osteoporosis. It contains an acid that reduces the calcium in your body.

Women with osteopenia or osteoporosis should take 1200mg Calcium and 800 IU vitamin D.

*In the first 10 years of menopause women can lose 10-20% of their bone due to the drop in estrogen levels.

Everyone 50 and over should:
Have a waist circumference under 35 inches
Have blood pressure below 120/80
Have blood lipids: LDL cholesterol below 100, HDL above 50, TG (triglycerides) below 150
EKG: baseline and CRP blood test if your waist circumfrenceis over 35 inches
Eat fruits, vegitables, whole grains and good fats
Not smoke and reduce alcohol consumption
Exercise/walk 30 minutes or more daily
Have a fasting blood glucose below 100

-EKG: It is recommended that a baseline EKG be done for both men and women around age 50. It should then be done at least every two to three years, or more often if necessary.
Note: Ask your doctor to reduce the size of your printout on a copy machine. Then carry it with you in your wallet along with your emergency health card. If you need emergency care, a copy of your old EKG compared to a new one can help your doctors decide how best to treat you.

Colon Cancer Screening: Colon Cancer is Treatable if Found Early!!
Talk to your doctor about colon cancer screening at the age of 50 – or sooner if colon cancer, colon polyps, inflammatory bowel disease or other cancers such as breast, ovarian, endometrial or prostate run in your family. At the least, you should have an annual rectal exam and check of the stool for occult or hidden blood. Ideally you should also have a look inside of your entire colon once at age 50 (called a colonoscopy) and if it is normal, perhaps this test could be repeated no more often that once every 5-10 years depending on your history.
A sigmoidoscopy should be done every four years or a colonoscopy every two years for anyone with a higher risk of colorectal cancer.
A risk factor is anything that affects your chance of getting a disease such as cancer.
Different cancers have different risk factors. For example, exposing skin to strong sunlight is a risk factor for skin cancer. Researchers have found several risk factors that may increase a person's chance of developing colorectal polyps or colorectal cancer.

Risk factors you cannot change:
Age - Younger adults can develop colorectal cancer, but the chances increase markedly after age 50.
Personal history of colorectal polyps or colorectal cancer If you have a history of adenomatous polyps (adenomas), you are at increased risk of developing colorectal cancer. This is especially true if the polyps are large or if there are many of them.
History of colorectal cancer
Personal history of inflammatory bowel disease Inflammatory bowel disease (IBD) Inflammatory bowel disease is different from irritable bowel syndrome (IBS), which does not carry an increased risk for colorectal cancer.
Family history of colorectal cancer

Lifestyle-related factors you CAN change :

Diet high in red meats (beef, lamb, or liver) and processed meats (hot dogs and some luncheon meats) can increase colorectal cancer risk. Cooking meats at very high temperatures (frying). Diets high in vegetables and fruits have been linked with a decreased risk of colorectal cancer. It's not clear if other dietary components (fiber, certain types of fats, etc.) affect colorectal cancer risk.
Physical inactivity
Obesity raises the risk of colon cancer in both men and women, but the link seems to be stronger in men.
Smoking
Heavy alcohol use Colorectal cancer has been linked to the heavy use of alcohol. At least some of this may be due to the fact that heavy alcohol users tend to have low levels of folic acid in the body.
Type 2 diabetes
Night shift work
Previous treatment for certain cancers

Tests For Older Men
Prostate Exam: Staring at age 50, a man should have a digital exam of his prostate. The physician uses a gloved finger in the rectum to determine if there is any enlargement of the prostate. Enlargement could indicate benign enlargement or even cancer.

Prostate Specific Antigen (PSA): Prostate Specific Antigen is a blood test that can indicate prostate cancer. If the level is high, a biopsy of the prostate may be needed. Routine PSA screening is recommended by some doctors, but not by others. This is controversial because there isn’t enough conclusive info yet.

Tests For Older Women
Mammogram
A mammogram is an x-ray that can detect breast cancer early; often before a lump can be felt. It glandular. If you are taking Hormone therapy after menopause your breasts may appear more glandular or dense from the hormones. Ask your doctor about stopping the hormones a few weeks before the scheduled test. Women over 50 should have this test yearly. Women at high risk for breast cancer should ask about a digital mammogram and an MRI. Monthly self breast exams should also be done, and you can be taught this technique during your yearly checkup.

Pelvic Exam
A regular Pap test to examine the cells of your cervix to diagnose cervical cancer and changes that could signal cervical cancer is important too. Find out whether your doctor does the more sensitive liquid-based Pap test.

Menopause - After childbearing, many women stop going to a gynecologist (too many women think that after childbearing they no longer need a Pap test or gynecologic exam) and rely on their family doctor to do all the routine exams —both general and gynecologic. Yet too many family doctors are already overwhelmed with “too much to do and too little time” that many important tests can get missed or fall under the radar screen.
So for many women, no one doctor takes care of it all — so it is up to you to see that you get all the tests you need — at the right time and on time.

Other Concerns
-You should review all medications with your doctor, even over-the-counter medications.
-If you are a diabetic, your doctor should examine your feet and order additional tests for your blood sugar.
-Your annual checkup is also the time to discuss any emotional problems you are having. If you feel sad or lack energy, tell your doctor. Your emotional health is just as important as your physical health.
-Make sure you understand the purpose of every exam or test your doctor orders for you. Because everyone is different you must be sure to talk with your doctor about your specific treatment goals.
In addition, keeping an ongoing log of any tests or procedures you’ve had and recording the information in your calendar will help remind you to schedule regular checkups such as mammograms and a cholesterol check.
-Make sure you ask for copies of all your test results and keep them in chronologic order in your health record.

Remission

2010-05-03T09:18:00.000-07:00

In honor of Jonah being officially in remission, I have some information on free skin cancer screening. It is being don by New York Presbyterian Hospital. There are no appointments, just walk on in!
This is a great FREE opportunity to get those moles checked out!

Weill Cornell Medical Center
Department of Dermatology
Friday, May 14th
1:00pm – 5:00pm
Registration ends at 4:30pm
1305 York Avenue – 9th Floor
Contact: Leana Tuset
646.962.DERM (3376) | LVT2001@med.cornell.edu

Columbia University Medical Center
Department of Dermatology
Tuesday , May 11th
2:00pm – 6:00pm
161 Fort Washington Avenue – 12th Floor
Heather Koenig-Colon
212-305-3625 | hk411@columbia.edu

Columbia Doctors Eastside
Department of Dermatology
Tuesday , May 11th
2:00pm – 6:00pm
16 E. 60th Street - 3rd Floor
Heather Koenig-Colon
212-305-3625 | hk411@columbia.edu

Grape Street Pub

2010-05-02T19:55:00.000-07:00

So it turns out that Walter the wonder dog has had a shit ton of money sent to him. Yes, I'm a nurse and I swear, get over it. I like beer too. We are not the angels you think we are, though when in uniform I act as professional as possible so that my humanity doesn't freak you out.
Anyway - Walter. he's got tons of cash so you really should concentrate on the humans now. And Toothless was a success, so get yourself over to B61 on Thursday. I'll be baking up a storm in between writing papers and power point presentations.
School is almost over and I have a ton to blog about once this week ends. Hawk and Dove have their first Philly show this weekend. Well, it's in some place called Manayunk so not exactly downtown Philly. The Grape Street Pub?
You should come.
I'll give you free health advice while we drink a beer.

toothless cliffdiving and doggie ventilators

2010-04-23T14:50:00.000-07:00

Life just never stops. I know you know that, but it makes me feel better to complain. Really. It does.
My friends flew off a 600 foot cliff and lived to tell about it, so I have been busy planning a benefit for them. NYC rents don't pay themselves, and bartenders rarely have health insurance.
Turns out though that a friend of a friend (also a bartender, but does have health insurance) was in an accident and lost teeth - but his insurance won't cover replacing them!
AND it turns out that another bartender had his teeth removed from an accident many years ago! You can touch his gums for free at B61 Friday through Sunday.

Then there is the puppy, Walter, that was thrown out of a car in a friends neighborhood. Horrible mange. Acid burns. He had to be put on a ventilator. A puppy ventilator.
So I guess it's benefit season. If you are looking to have a drink on the following dates you should do it at the coinciding bars and the money will go to one of these causes. And feel free to donate to Walter, though with his publicity he might be able to handle the medical bills better than the humans.

April 24th: The Skinny - no cover (Greg and Chloe) drinks
April 27th: Bell House - 8pm $10 admission (Patrick) Drinks, bands, games, prizes, and cupcakes
May 6th: B61 - 8pm-10pm no cover (Greg and Chloe) drinks, raffle, notoriously great pastries, and a silent auction

Maybe the free health clinic should be specifically for bartenders?

Red Velvet Cupcakes

2010-03-28T17:17:00.000-07:00

I'm never one to jump on the bandwagon when it comes to sweets. Cupcakes became very hip, but it's rare that they taste all that impressive. They have portion size going for them but most people make cupcakes too dry and slather on piles of icing that taste like Crisco.
I like a moist cupcake with a thin layer of cream cheese or butter cream frosting.
I've been making these Red Velvet Cupcakes for a few years now and they are a hit every time. They are the desert my dear friend Dan requested before moving to Paris and the one he asked for upon returning to the states this week.

So here you go - this can make 24 regular cupcakes, two 9-inch round cakes (put icing in the middle and on top and sides for a great cake), or a bazillion mini cupcakes.
I usually split the recipe in half.
Note: The first thing I bought with my first paycheck when I became a nurse was a Kitchen Aid mixer. It's red. I love it. Get rid of you hand held mixer immediately.

Ingredients:
3 1/2 C cake flour (regular flour will do though)
1/2 C unsweetened cocoa powder
1 1/2 tsp salt
2 C vegetable oil (canola or whatever)
2 1/4 C + 1 Tbsp white sugar
3 large eggs
1/3 C red food coloring (that's just crazy, add some till it's bright and red)
1 1/2 tsp vanilla extract (the real stuff, not "imitation")
1 1/4 C buttermilk
2 tsp baking soda
2 1/2 tsp white vinegar

Step one: Preheat oven to 350 F. In a large bowl "sift" together the cake flour, cocoa, and salt. I never sift so do it if you want.
Step Two: combine the oil and sugar on medium speed, once combined set the mixer to low and add the eggs one at a time, mixing between egg additions.
Step Three: Add the crazy red coloring and then vanilla in a slow stream until all mixed in.
Step Four: Add flour mixture and buttermilk alternating in 2 batches starting with the flour.
Step Five: In a small bowl whisk the baking soda and vinegar. Set mixer to medium and add making soda/vinegar mixture and mix ten seconds.

Now pour into the cake pans or the cupcake tins. If you want cupcakes with big fat tops that are a little crisp at the edges, fill the cupcake wells a little higher. If you want uniform, rounded tops leave a little more room in the wells.
I use canola spray and cupcake liners or parchment if making the cake.
Bake 20-25 minutes for cupcakes, 45 minutes for cake, and 10 minutes for mini cupcakes.

Cream Cheese Frosting:
2 (8 ounce) packages cream cheese, softened
1/2 cup butter, softened
2 cups sifted confectioners' sugar
1 teaspoon vanilla extract

In a medium bowl, cream together the cream cheese and butter then add in the vanilla. Stir in the confectioners' sugar till smooth.

Dan is very particular about how he eats his red velvet cupcakes.

The Bill II

2010-03-25T08:47:00.000-07:00

Some photos of the history of the health care bill. Aaron sent via Flickr.

Health Reform: A Year in Photos
http://www.flickr.com/photos/whitehouse/sets/72157623676571910/

The Bill

2010-03-23T11:06:00.000-07:00

If you're thinking I'm going to say something smart/insightful because I'm a nurse or you are assuming I have read this bill beginning to end you couldn't be more wrong. That's a lot of reading and I'm in midterms.

I was also stuck in bed for two full days due to a hallucination inducing fever. I woke up with my left ear ringing and to the news that health care reform is alive. I have mixed feelings. I really want health care to be better in this country. I'm jealous of my friends from France, England, and Canada who have experienced life in the states and say they're sorry but they have to move back to their homeland. They want to have a baby and won't do it here due to the health care and education systems. I want to feel that way about the United States. I don't want to be planning my retirement in another country so I can actually get the care/meds I need as I get older.

So I woke up from this crazy fever and was walking down to the store. I slowed to listen in on a rant. This 70-ish year old white guy with a beer belly, bowling jacket, and ball cap was explaining/complaining to his 30-ish male friend/son...

"...so what I'm saying is that I, if I were pregnant, could walk in to a hospital and have an abortion!"

It's almost as if people think health care and the practitioners of, can go about willy nilly doing whatever they want. Need an OR for a sex change? Poof! You got it - no questions we just do whatever we want cause we run medicine! Crazy dimwits.

So the change has come, just like he promised. I like the follow through. It makes me feel like a vote in this political system is finally worth something. But I hope this isn't the end of change in our health care system. It would certainly be leaving many Americans short changed if not broke.

Change

2010-03-18T19:13:00.000-07:00

Change happens all the time. Good. Bad. Whatever. Our healthcare system may change. My location in this country may change. The status of my leg/foot changes daily.
So now this blog is going to change. Get ready.
Healthcare is my big one. The thing I really care about. But there are others and I'm going to start adding them in.
The first is baking. The second is the experience of having a BF that is trying to break out in the music scene in NYC. So those will be two changes.
We will see what happens....

Health Care Resources NY (Brooklyn)

2010-03-14T10:28:00.000-07:00

I've been talking at community centers this semester as part of a community health class. The class sucks but the people I meet out doing the talks are great. What I've noticed most is the need for information on where to get affordable health care. Not a surprise. So here is what I have compiled so far. It is by no means a comprehensive list. I'll add them to the links area on this site once I have a break in my classes...
I know someone who has been to the South Brooklyn Clinic, The NYU Dentistry School and I have volunteered at Callen-Lorde. I'm not saying that people will be friendly or nice, but they will give you cheap or free health care.

NYU School of Dentistry
345 East 24th Street, NY, NY 10010 Phone: 212-998-9872

Dental care at the College of Dentistry is primarily performed by dental students under the close supervision of faculty dentists. The College of Dentistry also trains general dentists to become specialists, and depending on the complexities of your condition, it is possible that your care would be provided in one of these specialty programs.

Your initial visit must be scheduled. It will last approximately two hours and will include registration and appropriate x-rays. A second two-hour visit will be required to complete a comprehensive oral examination and inform you of our findings and diagnosis, at which time we can discuss various treatment options.

Appointments are held in two-hour blocks and are available Monday through Thursday at 8:30 am, 10:45 am, 2:00 pm and 6:00 pm and on Fridays at 8:30 am, 10:45 am and 2pm.
Photo ID is required.

For all treatment that is provided in the dental school, there will be associated fees. After you have received a treatment plan, the fees will be discussed and you will be able to make comfortable financial arrangements.

All patients are responsible for payment for their dental treatment directly to NYUCD. The insurance company will send you the reimbursement.

We welcome patients with insurance coverage. We do not, however, have the resources to file and manage claims with insurance companies. Patients are therefore responsible to file their own claims. To assist you in obtaining reimbursement from your insurance company, the College of Dentistry's staff will provide all the necessary information, including x-rays and a description of services, to include/attach to your insurance claim form

Callen-Lorde Community Health Center
356 West 18th Street, NY, NY 10011, Phone: 212-271-7200

Callen-Lorde Community Health Center provides sensitive, quality health care and related services primarily to New York's lesbian, gay, bisexual, and transgender communities -- in all their diversity -- regardless of ability to pay.
Payment: When you register for your first visit at the Center, you will be asked to present a form of personal identification and proof of address. In addition, if you are uninsured with no dependants and currently earn less than $21,660, you can present proof of/attest to your income to qualify for our sliding scale or other insurance programs. If you have insurance, please present your most recently issued card at each visit.
Services: Primary Medical Care, health Outreach to teens, HIV Primary Care, Lesbian and Bisexual Women’s Health, Breast Cancer Prevention, Mental Health, Support Groups, Transgender Services, Dental Health, Rapid HIV testing.

Community Health Network CABS Health Center

Williamsburg:
94-98 Manhattan Ave. Tel (718) 388-0390
Crown Heights at Carribean House health Center: 1167 Nostrand Ave. Tel (718) 778-0198
East New York at Dr. betty Shabazz health Center: 999 Blake Ave. Tel (718) 277-8303
Many other centers in Bronx, Queens, Manhattan.

Provides access to affordable, culturally-competent and comprehensive community-based primary care, mental health and social services for diverse populations in underserved communities throughout New York City.
Services are completely confidential and as a Federally Qualified Health Center (do not have to have a social security number to receive care)

CHN does not turn anyone away. CHN serves more than 60,000 individuals a year who would otherwise have little or no access to critical health care. Our financial representatives are available to assist you in enrolling in health plans and insurance programs.
Services include: Primary Care, HIV Care, Mental Health Care, Health Education, Women’s Health, and Social Services.

South Brooklyn Health Center
120 Richards Street, Brooklyn, NY 11231
Phone: 718-834-8202

SBHC Hours: Monday-Friday 8:30AM -5:00PM and Saturday 8:30AM - 1:00PM. Pharmacy Hours: 9:00AM - 6:00PM and Saturday 9:00 - 1:00PM. Doctors are on call 24/7 call: 718-834-8202 after hours.

Services: Primary Care, Medical, Pediatrics, Obstetrics/Gynecology, Dental, Optometry and Eye Wear, Podiatry, Cardiology, Psychology, X-ray, Sonogram, Nutrition, OraQuick HIV Rapid Testing, HIV/AIDS Program, Substance Abuse Counseling, Case Management Services, Laboratory, On-Site Pharmacy, Patient Education Lunches, Men’s Health Groups.
Plans: Medicaid, Medicare, Family Health Plan, Child Health Plus, HMO’s Accepted, Most Insurances Accepted,
Sliding Fee Scale for Self -Pay Visits.

Bedford-Stuyvesant:
The Brooklyn Free Clinic
613 Throop Avenue, Brooklyn, NY 11216 Phone: 347-920-8379
Only for those without health insurance!!

If you are over 18 and have no health insurance, we will provide you with highest quality care to help you stay healthy, and to get you healthy if you are sick – all for FREE.

We will also help you find out if you are eligible for free or low cost health insurance; if you are, we will help you register – onsite - and treat you until you have health insurance. Due to limited resources, and since we would like to first see those who have no way to get health care, the Brooklyn Free Clinic (BFC) cannot see insured patients.

These are the services you can get on site:
Checkup – you should do this at least once a year so you can stay healthy! And since it’s free – why not? Health maintenance visit – Diabetes? High blood pressure (hypertension)? Cholesterol? We will help you manage these chronic conditions through lifestyle changes and, when needed, medications. Sick visit (Have a cold? Aches and pains? Just not feeling well?) Preventive care – Find out how to STAY healthy BEFORE you get sick! We provide BFC clients with things like vaccinations, medication review, Blood tests… all for FREE!
Free or low-cost insurance screening and registration - You may qualify! No appointment is needed for this service, just come in on any Tuesday between 6 and 8pm. Call us to find out what documents you need to bring with you (this service is independent of the medical care provided at the clinic which is provided to all uninsured adults). Information on almost any medical condition Information on additional health programs, such as free Pap Smears and City clinics. Information about and assistance registering for programs to help you stop smoking, nutritional information

Brooklyn Free Clinic clients are eligible for:
Referrals to specialists, as needed to treat or maintain your medical condition. X-rays and other imaging studies, when they are needed as part of a physical exam, health maintenance visit or to diagnose your medical condition. Discounted prescription medications through local pharmacies.

New York State Smokers Quitline - 1-866-NY-QUITS (1-866-697-8487)- Free Patches!!

Haiti

2010-01-19T18:54:00.001-08:00

Today I'm having similar feelings to the weeks after Katrina hit.
Uselessness, overwhelming sadness, anxiety and some anger. Wishing I was a disaster relief nurse... It's frustrating to have some experience but not enough. I guess I'll take those disaster training courses when they come around again this summer and one day I'll be the seasoned, sarcastic, no-nonsense nurse I dream of becoming.

I feel better knowing that I will be needed later, once the chaos calms and the relief workers have created some organization there.

I have been a little obsessed with NPR the past week and maybe I should turn it off for a bit. Hearing people call in a talk about "looting and lawlessness and racism" is driving me mad. Who wouldn't loot if they didn't have food and water? I sure would.
I think the worst thing I have heard is about amputations being performed without anesthetic and medical tools being sterilized with rum.

And so I've read a bit about the best ways to help: MONEY.
Sent of course to organizations already on the ground or with a good amount of experience like American Red Cross, Habitat for Humanity (who you could also link up with later for the massive amount of rebuilding that will happen), Doctors Without Borders and Mercy Corps.

Seems that collecting canned food is a bit pointless as it is harder to transport than cold hard cash.

Nurses who want to volunteer can go to the California Nurses Association web site to fill out a form with Registered Nurse Response Network. There is a video here that has a link to donate if you want to help send a nurse to Haiti. They are having some issues getting the nurses to Haiti at the moment but I'm sure that won't last.

If you have disaster relief experience and/or speak French you are in the first pick, though I'm sure we will all be needed before the people of Haiti see adequate relief so save up your vacation time and use it for something selfless this year! And remember that you will need your passport (though they are trying to wave that requirement at the moment), vaccinations, and malaria pills...

Process

2009-12-30T12:22:00.000-08:00

Healing is such a process.
I find myself frustrated once again with how slow these nerves heal.
I've hit another plateau with physical therapy and am playing such a waiting game between doctors appointments, registration for classes, physical therapy and work. I'm ready to scream.
I like things well organized.
I like control.
Maybe I should give them up as my New Years resolution.

Baby Steps.

2009-11-12T11:35:00.000-08:00

You don't truly realize how important your toes are until you lose one, or can't use them properly. I haven't been able to stand on toes of my left foot for three months now due the nerve root being compressed at L5-S1. I haven't been given a good explanation as to why, but have come up with a few of my own.

Possible reasons I can't stand on my toes:

1. Neurogenic Muscular Hypertrophy
2. Foot Drop
3. Nerve Damage

My PT guys have been working with me for the last 2 months, but after doing some of my own research I have developed some additional exercises. Spending 5 days on the beach seemed to help as well. I have crappy balance when standing only on my left foot so I am working on that with some yoga poses and trying to walk on my toes and heels. I also spend about a half hour every day standing on my toes and counting to 10 then standing on my heels and counting to 10.

So today, I was actually able to walk across my apartment on my toes without holding onto anything which was amazing. Elijah was in the far room and couldn't see me so I started yelling "Elijah look!! Look!!" It was like I was a baby walking for the first time. I was soooo excited. Unfortunately by the time I got to the other side of the apartment I couldn't hold myself up any longer.

Baby steps. Baby steps.

Disability

2009-10-21T10:10:00.000-07:00

Today I am happy to be on disability. I feel useful today because I cleaned out the car, a slightly difficult task even two months after a discectomy (removal of a disc between two vertebrae).
But it's sunny here in Brooklyn and I have quite a few things to be thankful for such as not being homeless, being able to walk even if it is quite gimpy and being able to speak without being in pain (unlike Elijah).
Some days I languish a bit and I'm trying not to do that. So after I finish here I will make a run to the thrift store to drop off some junk and then get started clearing out the "garage" as we call our little room off the bedroom.
I'm trying to ignore the nagging nervousness that Elijah and I may not have insurance in a few weeks and what we will do about that. I am also trying to be patient with Hunter College while I await their decision on my "change of financial aid status". Everything is up in the air it seems and I just wait for these organizations to make their decisions. I research Social Security Disability and try to figure out how much I can live on if I can't work for months into the future.
But today I am happy because it is a beautiful day and though I can't feel my foot, my back doesn't hurt.

one step closer

2009-05-19T14:03:00.000-07:00

I am officially one step closer to finishing school and applying for a masters program. Last Thursday was my final final and I officially have one year to go. Whew! I have alot of preparation for those applications and so I am volunteering at Callen-Lorde Link to their site on right hand side of page) to see how a clinic runs. I'm not sure yet in what capacity I will be working there, but I am hoping for both clinical and administrative. They have been running in Chelsea for 10 years now and are a huge operation.
I also am hoping to have an informational project on where to get a free or low cost colososcopy - yippee! I have recently learned that colon cancer is one of the easiest to find and treat successfully. But don't worry, unless you're over 50 you don't have to do it yet.
I am also working on a research project about ovarian teratomas. Neurology is pretty amazing. And I realize that you are going, "huh?" because those two things don't seem to go together, but that is the amazing part about the body. Things you never thought were connected, are.
I have been overly busy between school, a stomach ulcer, and one bulging and one herniated disc. I feel like I see a doctor every 3 days. I did get an MRI though and the pics are coooool. I'm going to post them to facebook soon.
So I will be taking the summer to have absolutely as much fun as you possibly can in SPF 40 and on the anti-ulcer diet. No really. I'm still fun.

vocal cords and sunscreen

2009-03-29T20:07:00.001-07:00

Well, after weeks of Elijah nursing his voice and follow up appointments with Dr. Amin, He was OKed to sing to his hearts content. And then the pain started. At first we thought the worst - that there was some complication from the surgery , but after a quick visit to the surgeon he was cleared in that area. His doctor suggested that he possibly see a speech therapist and since then he has started acupuncture, voice lessons and is learning the Alexander Technique. There was a show at Union Hall a week or so ago and Hawk and Dove will be making a quick stop in at the Cake Shop in April.
The two acupuncturists who have been treating us work at Element in our neighborhood and they are fabulous.

On another note - my friend Jonah at groinstrong.com had this great article posted quite a while ago that I wanted to post again - seeing as people keep popping up in my life with melanoma. It is a sort of expose on sunscreen. Check it out here.
Summer's a comin' so slather it on!!

Finally - I had the fabulous experience of an endoscopy last month. learn more about the digestive system with this creepy video. Luckily I had a really great friend (Greg) take care of me after the procedure as I was on druuugs. Some people need alot of drugs to knock them out, but not me. It was like someone had given me truth serum. So if I saw you that day and maybe said something off color, please accept my apologies.

So it turns out I have a small, superficial ulcer in the greater curvature of my stomach. Which also means I don't get to do anything fun for a while. No chocolate (no chocolate!!!) no alcohol (lost 5 lbs), nothing with citrus, fried or fatty.

And get this - no tight pants.

This is why you haven't seen me at B61. In a few weeks I will go in for a follow up and then another endoscopy after that to double check that it has healed.

Anyone wanna go with me this time?

Speaking is Under Rated

2008-12-22T17:11:00.000-08:00

Elijah and I went to see the Fabulous Dr. Amin today. I got to watch him put the scope down Elijah's nose and into his voice box to see his vocal cords. They looked fabulous! I will be posting the video of his vocal exam as soon as possible. We were told that he could talk, but not too loudly or with too much force, but that he could only sing folk-type music in 2 weeks and would have to wait a full month for rock-and-roll belting vocals.
Bummer.
Total Bummer.
Elijah tried for about 2 seconds to tell Dr. Amin that he doesn't sing rock-and-roll styley, but I set the good doctor straight with a glare from Elijah.
Thanks for all the well wishers. And if you need a voice specialist - Dr. Amin will do you right.

The Procedure

2008-12-19T09:44:00.000-08:00

Dr. Amin (the otolaryngologist and surgeon) stated after the surgery that Elijah was put under general anesthesia (completely knocked out, unaware and unable to move) and intubated (a small tube placed via the mouth down into the trachea/bronchea for breathing - totally normal). They then sent a tube with a camera down the back of his throat to his vocal cords where they removed a 1.5mm cyst, which is extremely small. The small size and fact that the cyst was on the underside of his vocal cord made it difficult to visualize on monday during the in-office scope (trans nasal endoscopy)which is why we were so unsure of exactly what was going to go down in the OR on Wednesday.
Mosby's Medical Dictionary defines a cyst as "any uninflamed closed sack in or under the skin lined with epithelium and containing fluid or semisolid material." Dr. Amin stated that they do not know why cysts occur, but that it was possible it had been there for any amount of time and that the recent increase in using his voice to sing and bartend had irritated his vocal cord(s) enough for him to notice and then to be in pain.
That said, Dr. Amin also stated that cysts are by nature benign and that the goal of removing it was to relieve pain and take Elijah's use of and sound of his voice back to what it was like prior to the cyst causing him pain.
His post operative instructions are that he cannot talk, cough, clear his throat or in any other way use his vocal cords for a total of 5 days (4 left). He will go to see Dr. Amin again on Monday the 22nd to have the scope put down his nose and into his trachea a second time for the doctor to visualize if there has been enough healing (a layer of new tissue/cell growth over the "divit" left from the removal of the cyst) in order to speak. Two weeks later he will go to the office for a third and final scope. The doctor will visualize his vocal cords and decide if enough healing has occured to clear him to sing (that's a total of three weeks of no singing).
Elijah will continue with his voice lessons and as far as we know no other voice rehab is needed, but we will have a better update as of monday.
He can eat normally and as of tomorrow morning can drive (though I'm not sure what he will do if pulled over!) and lift and do all the normal things that he couldn't post anesthesia.
Here are some totally awsome videos of the insides while notes are sung - you might think it is gross so beware. The little parts moving in the center are the voal cords.

NYU Strikes Again

2008-12-17T19:23:00.000-08:00

For those of you who are sooo out of the loop, Elijah had surgery today (to be fair we found out Monday afternoon the surgery was possible and Tuesday afternoon that it was actually happening). Ok, it was same day surgery but it was still surgery under general anesthesia with intubation and recovery. The basics are that a cyst was removed from his vocal cords, a small cyst. The poor thing can't talk for a week and can't sing for three.
Everything went smoothly untill recovery. He had a sour puss nurse who instantly told Elijah's mother (Lisa) and I (both nurses)that we could visit for five minutes every hour. We were in shock to say the least. I mentioned to the nurse that I was "concerned" because he couldn't talk to make his needs known and was in and out of "it" as the anesthesia wore off. She rudely interrupted me by saying that he indeed could talk. She seemed stumped as to why I thought he couldn't. Both Lisa and I informed her that as per the doctor's order he was not to speak, clear his throat or cough for five days. She seemed bewildered and stated that she did not know this! Hmmmmm. Poor doctor/nurse communication?
Well, to make a really long and angering story short, she continued to insist that though he had absolutely no form of communication (he couldn't even hold a pen and paper at this point) that we were to leave and come back in an hour.
The poor woman had no idea who she was messing with. We went out the door and asked the first person at the first desk for a telephone number to complain to patient services. She set us up with the charge nurse who was lovely so we will mention that she is named Carrie. We explained the problem to Carrie and we are not sure what she said to the nurse, but after that the nurse was all "peaches and cream" as Lisa put it. I was very relieved as I was seeing images of myself being escorted out of the hospital by security after yelling profanities at the nurse for her lack of advocacy for her patient as well as lack of compassion and just plain crappy attitude.
On another note, we did see the nurse who took care of Jonah in the recovery room last time and he had that same can't-be-bothered look on his face which just annoyed me more. I really had been hoping never to see him again.
I'm off to finish writing my finals!
Good luck to everyone and remember: If you have to go to the hospital for ANY reason, take a nurse with you - even if you are a nurse.

Marry for love, Divorce for health care

2008-12-08T00:21:00.000-08:00

It looks like people are fully willing to manipulate their marital status to pay for health care. Check out this article on ABC news...
Mazel Tov!

Go Montana!

2008-12-06T23:01:00.000-08:00

Yay for Montana and yay for Judge Dorothy McCarter for continuing the fight for terminally ill patients' rights to a dignified and painless end. Check out this article in the Times.

sick sick sick

2008-12-03T09:39:00.000-08:00

It seems that everyone I know is sick. Which is making me cranky. Here's what's been going on in Brooklyn and abroad.
Firstly, my friend jonah is starting chemo today... I'm calling them "magic pills" and know they will make you heal fast and strong. Groinstrong, if you will.
Next, Elijah's Grandfather ate mashed potatoes yesterday and sat in a chair!! Check out how your gallbladder works here - it's amusing, not dry and boring like you think it is.
Also, someone who obviously trusts me (though he met me at a bar) asked me to remove some stitches today. There were only 6 of them, but they were so perfect and long and slid right out of his scalp. So a big thank you to Justin Tyler who let me have fun on his head! I'm sure it will be the highlight of my day. If you need to remove stitches, this site is fun though I promise you Justin, I searched it after I took yours out. Also, this video shows it being done, not in English and without the obvious finess that I have.
Remember: If you watch these videos and then take out stitches and mess it up because they were major and it got infected or ANYTHING ELSE BAD HAPPENS, you can't blame me because you are supposed to ask your health care provider what to do.... and I am not your health care provider. (kind of dumb that i even have to say it, huh?)
Now. Hear me well, people. I am sick of you being sick and you are sick of being sick. I want an ill-free new year for christmas.

i am not your maid, and this is not a hotel.

2008-11-26T07:09:00.001-08:00

Warning: this is a rant.
I have compassion, yes I do, I have compassion how 'bout you?. I have so much compassion that at times it's not good for me. But after three 12-hour shifts in a row I have less compassion and feel more like this. Can you believe that patients will actually lie to a family member about how much their nurse feeds them? This is in reference to the woman who told me last week to shove the turkey sandwich up my ass. Ok, Ok. It's funny that some lady would tell me to do this with the food she asked me to feed her, but when you stop laughing it's completely abusive. Especially when added to the list of other crap that's been said to you throughout the shift. And then there's the guy who spits at you when you come into his room. You still actually have to go in there!! Then there are the patients who truly believe that you have nothing better to do than to get them a cup of coffee at 10pm or add ice to their fruit cocktail. There's no time for me to help you braid your hair after you take a shower. Like I said, I have compassion, but there are over 900 hospital beds at this place and often they are ALL filled.
Listen, if you have family you should have them at the hospital, helping you get coffee and ice, becuase there are some problems with the helath care system and the nurses are swamped. And to top it off nurses are being laid off at some hospitals - so maybe you shouldn't schedule that optional surgery just yet.
We are in a hospital, not a hotel and i am your nurse, not your maid - so pick your clothes up off the floor and stop spitting at me!

Who Decides your Fate?

2008-11-23T00:30:00.000-08:00

I recently started reading a biography on Dr. Jack Kevorkian aka Dr. Death. Interesting stuff. My curiosity was piqued when a group in my research class presented their findings on pain control at the end of life. As it turns out, as a medical community we aren't so good at this. The research articles spoke on the amount of pain medication given to patients who had expressed a wish to be pain free while dying - even if it hastened their death. I don't know about you, but this scares the crap out of me. I certainly don't want to be in a hospital bed, in pain, unable to communicate and die that way. Miserable. Anyway, I'm not saying I would back Dr. Kevorkian all the way, but he really has some good ideas.
I have added in a few links for those of you who are smart enough to follow them. Say you get hit by a car or fall down some stairs late one night after drinking too much... If you aren't legally married to the person you would want making ALL of your decisions if you should you should fill this sucker out. It's called a health care proxy and designates who can know your health info and make decisions for you should you not be able to communicate while in the hospital. Like I said, make sure you really trust this person becuase they can decide to pull the plug. And if you aren't married and don't have one of these filled out, your parents decide. If that's the case make sure you know 100% and without a doubt that they would make the deicisions you would want. Remeber Terri Schiavo?
So the name of the book is Between the Dying and the Dead. Dr. Kevorkian is alive and well. In Michigan I think.

Attention young ladies...

2008-11-06T19:30:00.000-08:00

Just a baby making alert. Now don't get crazy, I'm not making babies. But it turns out that around 50% of pregnancies in the U.S. are whoops! pregnancies. So listen up. ALL women of childbearing age should be taking folic acid on a daily basis just in case your whoops! sticks around. Folic acid intake protects against congenital malformations including neural tube defects which result in malformations of the spine such as spina bifida or "split spine". It can also cause anencephaly which results in the absence of a major portion of the brain, skull, and scalp. Scary stuff, eh?
So ladies, start suckin down that folic acid...

Titties

2008-10-31T07:38:00.001-07:00

October is my birthday month and...breast cancer awareness month. So though I don't really like the color pink and honestly think it was a bad choice, I do like titties. I especially like mine and want them to stay right where they are. I don't want to have to be told what their treatment options are. And so I give you breast health/mammogram info!! For those of you who don't know what a mommogram is...you put your bosoms in between two pieces of metal and they get squashed like pancakes. I hear it hurts. But supposedly less than cancer. Just a rumor.
So you can get information on a free mammogramm by calling 311... go figure.
You can also call these numbers
or you can go here.
So go. Get 'em squashed. And don't wait till next month.
oh, and if you don't have a good gyno - this lady rocks:
Orna Kolker, MD

PS

2008-10-27T22:43:00.000-07:00

PS- I just have to say this....
NYU Tisch was totally unimpressive.

What Was PBS Thinking??

2008-10-27T22:24:00.000-07:00

Okay, I'll admit that it has been a bad week of nursing for me. I have felt totally unappreciated as a nurse and even had a melt down on my way into the subway this morning after work. So I apologize if you were witness to that melt down. One of those New York City moments where you can no longer handle it. The crowds come surging through the turn style and you have to stand there in your dirty scrubs, exhausted and in horrible pain from turning patients who are complete dead weights. So seeing the PBS web site tonight has made me froth at the mouth.
Have you seen it? What was PBS thinking? It's as if they didn't do any research at all. And just look at the feedback forum.If you're going to inform the public at least try a little harder.

Cancer

2008-10-20T20:15:00.000-07:00

For anyone who is a survivor of cancer and wants to support my friend, or if you think you might have a spot on your arm that you should get checked out but are waiting till after the holidays, or if you are interested in a 29 year old blogging about what this thing does to people... go to groinstrong.com it's amazing

South Brooklyn Health Center - a review

2008-08-19T09:26:00.000-07:00

This morning I woke up at 7:30 to go to the South Brooklyn Health Center with Elijah. We didn't tell anyone I was a nurse, but Elijah told the MD towards the end of our visit. This is my review.

The place was dirty. There was a water bug running accross the floor of the exam room which had obviously not been mopped in a decade.
The receptionist was whatever and the nurse who took Elijah's vital signs did not introduce herself, explain anything that she was doing or give him any instruction what-so-ever. She also didn't bother to tell him what his temperature or blood pressure were - which I consider just plain rude.

The doctor didn't bother to introduce himself either and his white lab coat was a weird shade of yellow. It too looked like it had last seen the wash in '65. He didn't ask Elijah if he had a health history or if he was allergic to anything. This was fine with me because I know all these answers, not so fine for plenty of other people. Negligence, or did we tell him I was a nurse too early?

On the positive side he answered all of our questions and made sense. He also steered us clear of the local pharmacy saying that it was expensive, so we went to one on Smith street that is way cheaper than Rite-Aide.

Basically I would say that if I had something very simple that needed to be taken care of like an ear ache or sore throat - no problem. Anything more major and I would seek health care elsewhere. Also, we were the only people there at 8:30 when they opened, but by 9 or 9:30 the place was filling up quick.

The visit was 25 bucks and they didn't ask him how much money he makes so it's not so much a sliding scale as it is insurance vs no insurance.

I also realize that the water bug comment is unfair, as I've seen grosser bugs in places where I eat regularly.

LICH

2008-08-13T19:09:00.000-07:00

Well this has been a long time coming.

Each day that passes by, and Long Island College Hospital is not closed down, I fear for the lives of my neighbors. When I was fresh out of nursing school I held a position at this hospital. My first night being trained by a coworker I witnessed patients not being fed through their PEG tubes and HIV+ patients not being given Heparin injections because the nurse didn't want to risk a needle stick!!

I quit the next morning.

I have listened to countless horror stories from people in Boerum Hill, Cobble Hill, Brooklyn Heights, Red Hook and Gowanus who went to this hospital to be treated and ended up in worse condition, were mistreated horribly by the staff or had to sign themselves out AMA (against medical advice) because they were afraid for their safety.

It's disgusting that instead of fixing the problems that LICH has they are closing down one of the most important areas of health care - OBGYN. But were used to that, aren't we ladies?

Gawd forbid the people living in this country receive any decent health care at an affordable price.
We may as well be back in Lawerence, Mass striking for three loaves. Hike up your boots and grab some pipe folks, it looks like we are going to have to riot to get decent health care in this country!

back to work!

2008-08-12T13:48:00.000-07:00

After having an entire 6 days off from work I am back in the game. The dirty, smelly game.

I'm hoping that as I add resources for health care that anyone who knows of other resources will email me. I am hoping this will be a place where the public can help each other as much as possible.

As for now, JCAHO is at the hospital (all the employees quiver in unison). We shall see what they think of the place.