November 22, 2012

Attack of Cluster B

In terns of personality disorders, Cluster B leads the pack as being the most prevalent.  Of Cluster B, borderline personality disorder is the most common, followed by antisocial personality disorder.  Yet lately, I am coming across more patients with narcissistic personality disorder.  It's getting to the point that they are keeping pace with the top 2.  Cluster B is common in dual/addictions as well as in eating disorders.

I haven't seen (yet) a patient with two cluster B diagnoses.  I've seen those with Cluster B and Cluster C (usually obsessive-compulsive, sometimes dependent, never avoidant) but not often.  Never seen Cluster B with Cluster A...which is understandable in a way:  I can't really picture a borderline schizoaffective patient or a histrionic paranoid patient.  A and B just do not seem to mesh.

So anyway, the Cluster Bs have been coming fast and furious in both of the programs I'm working in.  I decided to treat myself to an early birthday/Christmas gift and get "The Personality Disorders Treatment Planner" in order to stay on top of things.  It's a great book for those who have to deal with personality disorders on a regular basis, or even the curious who'd like to go beyond the stereotypical presentations of personality disorders.  Because there really is far more to personality disorders than the image of angsty teenage girls cutting themselves while railing against the world.

Happy Thanksgiving if you celebrate it, Happy Thursday if you don't.

November 11, 2012

Pregnancy 2, Meriwhen 1, History 0

Let's get my victory out of the way:  for the last couple of weeks, my weight has holding steady.  Lest the cries of "but you're supposed to..." start coming out, I should explain that I was already overweight at the beginning of the whole thing, and because of that, my doctor wants me to keep the total weight gain around 20lb.  I'm currently at 14.2lb up.  I'm not dieting, just not overindulging and "eating for two."  Though someone better start taking the leftover Halloween candy out of the secretary's office, especially the peanut butter cups.

I'm also not expecting to land under or even exactly at 20...but that doesn't mean I have to end up at 35 either.

I don't advertise the fact that I'm pregnant, and there's still a few people that are truly surprised when I tell them I'm six months along.   Most nursing staff know and so they keep me out of codes (and I admit  being a little chagrined at that, but I understand they're concerned about me and the baby).

But when patients--who I definitely don't tell--start congratulating me out of the blue, it's safe to say that the pregnancy is becoming more noticeable.

Unfortunately, I am now burdened with leg pain.  Right now it's a muscle-ache, like I've been going to the gym too much (and I haven't), but I'm worried it's going to become the debilitating sciatica pain that I had with the first little one.  I'm already having occasional difficulty getting out of my truck...and even though it's smaller, I can't switch to the other half's truck because it's stick.  I can drive a stick.  I detest a stick in this traffic.

Then came the inevitable brassiere shopping.  Last pregnancy, I didn't hit porn star-esque sizing until just before delivery.  This time around, it's happened a lot faster.  Perhaps that's why some still aren't noticing the belly.

I needed new brassieres that fit, so I took the family to the store and spent the morning determining my new size.  I am now a very annoying size...annoying as it's hard to find the size.   38DD.   Most of the regular brassieres top out at 38D, whereas most of the full-figured sizes start at 40D.  38DD is the black hole of brassiere sizes...guess goes pretty well with my size 10.5 foot, which is the black hole of shoe sizes.

I did find a couple of 38DDs (literally just two of them!), but relented and also got a few 40Ds.  They don't fit perfectly, but they're serviceable enough, and I'm going to keep expanding anyway.

I haven't crossed the high score of last pregnancy just yet (42F), but I'm pretty sure I will at least match it.

The drama in History Part 2 rages on.  Not long after I posted about all of the classmates complaining about the course, the professor finally stepped in to tell them that the class has been this way for three years, the director of the history department is well aware of the class--in fact, they were part of the design team-- and that their energies would be better spent either working on assignments or deciding whether to stay in the course.  That silenced everyone, including the one very annoying classmate who wasn't actually complaining, but instead was taking the sanctimonious "holier than thou" approach as he/she reprimanded those who were complaining.

Peace was not to last...a few days later, there was a rash of complaints about the quality of the week's videos.  Then another violent outcry, this time the complaints of people getting penalized for not completing the plagiarism tutorial.   Problem:  a lot of them didn't read the instructions for correctly completing the assignment.  So essentially it was their own faults that they got penalized...but they still raised holy hell in the help forum.

At least here the professor stepped in faster to deal with it.  Apparently some of the class were writing nasty e-mails to their instructors, and so the professor decided to put a stop to things right away.  I can't say I blame him.

Still, that doesn't do much for lowering the drama quotient.  I wonder what the next blow-up will be over.

November 3, 2012

The ways of substance use

One thing I love about working in addictions and recovery is that I learn something new about substance abuse every day.  Lately, it's been how people are abusing substances.  Some of the most memorable ways, I can't post because I risk running afoul of HIPAA.  Which is a shame because yesterday I learned a beauty that actually had me running for my reference books to see if it was REALLY possible to do the drug that way.  I mean, the patient was doing it that way for more than a decade...but was it really affective for a high?  Maybe it was effective enough for the patient to keep doing it like that.

Let's just say that many substances that are originally meant to be oral aren't always used orally.  A lot go up the nose.  Three years ago, I never would have dreamed that I'd be asking a patient on alprazolam (Xanax), "how much are you taking, and do you swallow or snort it?"  Now I routinely ask even my non-CD patients that.  Apparently you can get a good high using ground-up benzos and opiates intranasally.

Injection--usually IV but occasionally IM--is also popular for PO/sublingual meds.  A few of them use PO/sublingual meds rectally or vaginally.  You'd think that was just a hospice thing, but nope.

Transdermal patches;  not just for the skin.  In addition to placing fentanyl and other patches in covert places to avoid detection (don't ask me where I've found some of them), sucking on them is a popular way to get stoned.   There's also apparently a way to extract the drug by needle for a IV/IM/PO dose, but I haven't figured out how that'd be possible.

Good old THC:  smoked as well as noshed on.  In fact, there are cookbooks devoted to the art of cooking with marijuana!  Out of curiosity, I downloaded one:  the Stoner's Handbook.  Apparently the key to successful (read:  effective) MJ consumption is fat:  because THC is fat soluble, whatever you cook it in has to have fat for it to be absorbed in the GI tract.  I did find a mac and cheese recipe (with bacon!) in there that I'd like to try, except that I'd have to cut out the ganja butter and substitute Land o' Lakes.

Alcohol is alcohol:  it appears the best way that works is PO.  Haven't come across a single patient that tried to IV/IM some whiskey or Coors' Light....not yet anyway.

I tell you, addictions/detox is never dull.

November 2, 2012


Yet more RN-BSN stuff.  If you're sick of the saga, feel free to skip--I won't be offended.

I decided to drop Vulnerable Populations.  I got hold of a course syllabus and saw way too much work...well, not too much if it were a class on its own.  But with History Part 2, working and pregnancy...I can't do it.  At least not successfully and keep my sanity.  I may as well go back to working inpatient while I'm at it.  I also got hold of a Research course syllabus just to see if I'd do better in swapping the classes and taking that one instead, but again:  the extent of work involved for the class is intense.

Since if I was going to drop it'd have to be done today, I spent the whole morning (while I should have been studying for my history test) weighing the pros and cons of everything.  In the end, I decided that having my sanity for the next four months instead of being an insane, overstressed git was far more important than taking a second course right now.  And I have come to some terms with the fact that even if I were to give birth early, it may be too much for me start taking classes right in February anyway.  So the odds were good that my graduation date was going to be pushed back anyway because of the new little one's arrival.

So I logged in and dropped it.

I have to admit that I feel a sense of peace.  I do feel disappointment, yes:  in fact, I am VERY disappointed that I will have to push things back even further.  But I also feel peace.  I was worried about how I'd get through November with working full-time for at least half the month plus tackling the history class.   I've spent the last few weeks dwelling on this (in case you didn't see it in my prior posts).  The past week has been the worst as I've been debating with myself over it.  

Now I can look forward to the later part of pregnancy without having to stress about juggling two classes and an increased work schedule.  I can start knitting for the little one.  I can relax and rest while I can before said little one's arrival.  I will be able to enjoy the holidays and my birthday and not stress over multiple assignment deadlines.  And I can take the last two classes and Capstone during a period where I'll be working less than I am now, if I haven't yet gone back to work.  Taking class without working at the same time--now THAT would be a real treat.

I may even be able to appreciate this history class more.  Though I still wish the drama would get resolved.

History Part 2 Drama, Part 2

It continues on.  Students protesting that the course is too unfair, it's too much work, they should have been warned to take it alone, that they would have taken it at their local CC, that they would have tried to take the CLEP exam and test out of it.

Meanwhile, the instructors remain eerily silent...too silent.  Not only are they refraining from comment on the vent threads, they are not answering ANY of the help desk questions at all.  And students are spazzing over the some of them with valid questions (i.e., questions not related to the course drama).


I'm definitely staying out of the drama.  To be honest, it's starting to be quite the distraction.  I go to the help forum looking for updates and hints--as we are instructed to check this forum daily and first for the latest information--and all I see is the angst and tension from the students, and the lack of input from the instructors.  Many have written that they've dropped the class that was going to start next week just so they could focus on this one.  And truth be told, I'm starting to reconsider that too, especially given that work is picking up.  More on that in a minute.

At this point, I'd consider just aiming for the C.  Consider.  But despite my talking, we all know I'd die before I ever took that drastic of an action.  Even those readers who know me very well are laughing internally when I write that I'm settling for the B.

In other news, I'm gearing up for this month at work.  Between the holidays, a couple of people needing some personal time off, and one program getting so hectic that the regular nurse can't cope anymore, I'm getting more hours than I can shake a stick at.  I'm working full-time two of the four weeks this month, and for the other two I've been told to come in early to be there just in case they need the extra body.  At least I can bring my schoolwork with me and try to stay abreast of things during the downtime.  But one of the reasons I dropped the outpatient for now is because I didn't want to work every day.  And here I am, working every day for at least half the month.

Yes, I know, I could have said No.  I am per-diem, after all.  But given that I will be not working for a while after the baby is born, I want to keep relations with my primary employer as sweet as possible, so I have a job to return to after the birth.   Plus it couldn't hurt to stockpile some money while I can.

November 1, 2012

Well, ****

Overall, an unremarkable day at work.  A very unusual admission that I wouldn't be surprised had an Axis II in there somewhere.  A few patients showed up in costume.  Some nurses wore holiday-themed outfits but no costumes per se.   Me?  I wore all basically, I wore what I usually wear.  I was glad not to be working inpatient that evening though...full moon plus Halloween isn't promising for a psych environment.

History Part 2 is turning out to be like History Part 1, except with far more reading.  There's already several threads in the class's Help forum complaining about the workload.  The syllabus states that the course should take 12-18 hours a week.  The reality is that it takes at least twice that.   Not a single one of us (and I've heard from many) can do all of the assigned in their suggested guidelines.  Even if I cut corners wherever I can (for example, I only read the textbooks and not every single primary reading), I'm still clocking 24+ hours myself. Plus all of us are working at least part-time, and many of us are taking at least one other class.  So there are a lot of grumpy campers in the lot.

Surprisingly, only one instructor chimed in, and it was a sympathy post.  The rest are silent.

I've refrained from complaining since I'm nearly at the end of the RN-BSN program and I just want it over with.  Also, I have limited options as to taking it elsewhere.  I'm also not very grumpy or frustrated about the class...I guess because I've been through History Part 1 so I know in general what to expect.  I have an idea of what they are looking for us to do in the assignments.  I'm also spurred on by the fact that it will be over in 6 more weeks, and that will finish off all of the non-nursing classes.  And I've already given up on the A, and I haven't even taken the first test yet.  

But with all of this activity in the History department, I did think about moving Vulnerable Populations to the spring session.  There's a 5 week session right before the baby is born (literally, it ends on 2/17) and I figured I'd slide it in there and take the chance that the little one arrives right on his due date.  Well, that particular class isn't offered on that date, so I'm stuck taking it with History.   Oh well, I guess it'll be all right.  I survived History Part 1 along with Older Adults and Management.

To make matters worse, the next session for Research (and Vulnerable Populations if I wanted to postpone it) starts on 2/25.  I'm due on 2/24.  So my planned Research class will be started possibly while I'm in postpartum recovery...that's assuming the little one arrives on schedule as planned. 

And just to ice the cake, the Research and Vulnerable Populations classes are offered again until the summer session.  So if I miss the 2/25 session, I'm stuck waiting.  And waiting. 

Well, fuck indeed.  

It's so damn frustrating to be this close to my BSN and have to face the possibility of postponing it even more.  I'm still stinging over the fact that had I paid attention to my class schedule last spring, I wouldn't have missed the deadline for the government class, I could have stuck to my course map, and I would have been taking my Capstone class in January.  At least Capstone is offered nearly every five-week session.

I have to put this all in perspective though.  Short of a scheduled C-section (not likely at this time) or planned induction (more likely:  my last pregnancy would have seen me induced at 39 weeks had I actually made it to that day), there's little I can to regarding when the new little one is born.   Except Let Go and Let God:  I'm praying for another early labor.  But whenever little one arrives is when he arrives, and if it turns out that he arrives on time or *gulp* late, that's when he arrives and like it or now, I'd have to skip the class.

The other reality is that as I'm recovering from childbirth, I may not be ready to take on a class for those first few weeks.  I'll probably be exhausted and crawling out from the baby blues.  I may say that I'm all for starting my Research class one week after childbirth.  After all, a week after my first little one was born, I had family in and was already working on holiday shopping (albeit as a tired and emotional wreck.  I did it though).  This time around, I'm several years older.  Overall I'm handing this pregnancy better, but what about the actual childbirth itself?


Maybe I should just intentionally postpone things and focus on low stress now and post-partum recovery later...but I can't bring myself to do that.  Not after nearly four years of trying to get this degree done, so I can move on to the next step in my career.

*sigh* indeed.