The "B" word

Another post that may be TMI though not gross.  Consider this your warning.

Still here?

OK.

I had my follow-up with the women's health nurse practitioner (unrelated note:  I can never spell the word "practitioner" correctly for the life of me.  I suppose I better learn to do so, especially if I'm going to become one.  

She was an older woman, grey hair with purple stripes.  What's not to like there?

It's also different from having a female gynecologist/practitioner.  I usually have males...again, not because I prefer male practitioners, but because I have no preference and usually get scheduled with males.  So I'm not used to someone who could personally relate to things that I am experiencing instead of finding ways to explain them.  Such as my trying to explain to my male physical therapist what ovarian cyst pain felt like.

We discuss my history and ultrasound results at length.  She brings up various treatment options.  One option is hormones, as in an intrauterine device releasing them.  As I finally have been able to get my melasma under control (read:  it's not getting any worse), I pass, and I don't want it to flare up.

The next step up is fibroid removal.  This can go one of two ways:  remove the fibroids themselves, or just remove it all, i.e., hysterectomy. 

Well, I've had fibroids removed in the past, and they've always come back.  I've had all the kids I'm having.  I've already been surgically out of the gene pool for several years.  And I'm no spring chicken, seeing as my 50th is only a couple of years away.  So why not just take it all and be done with it?  I tell her that these fibroids have been giving me grief for many years, and I would like to propose a trade:  they can take my uterus and put it in a jar and give me a box of hormone replacement therapy patches.  

She doesn't blame me for that decision.  However, it's beyond her scope to go much further in this discussion, so she has to refer me to a doctor.  But there is one test that she would like to do first.  Apparently, my endometrium is, in her words, on the "high-end" of normal thickness.  It's 1.1cm.  So she would like to do an endometrial biopsy just to be on the safe side. 

Fair enough.  I agree.  I didn't realize that it would happen then and there.  It HURT.  And yes, that was with numbing cream.  Following that, I decided that I deserved the night off of work.  So I asked her to write a medical excuse note for me so I could stay home.   

I can get my follow-up with the doctor the following week.  A male doctor, but I don't particularly care.  What I am amazed by is how fast things have been getting accomplished during this whole time.  My medical plan isn't always known for its speediness in its referrals.  So the fact that I went from zero to a second specialist appointment within three weeks is mind-boggling.  It also makes me wonder if the universe is trying to tell me something...

Nah, I'm probably just being paranoid.

I go home, fill in the family, and go camp out on the couch.  I then make the mistake of looking up information about endometrial biopsies.  

NOW I'm paranoid.  And am going to be a bit of a wreck until these results come back.

In which Meriwhen discovers why she is bikini-challenged

No, it's not what you think. And this may enter into the TMI area, though nothing gross.

You've been warned.

Still here?

So here we go.

In 2019, I developed back pain and toe numbness of unknown origin. I lost weight (40 pounds!), and it didn't improve things. So I entered physical therapy, which helped...until 2020. COVID came along, and I had to catch it, so I was laid flat for a week. Over the year, I somehow injured my back, then my foot, then my ankle. Three separate incidents, Then there were the joys of finishing up graduate school. 

All told, I ended up regaining 27 of the 40. OK, life happens.

I follow up with my doctors to make sure there's no permanent or irreversible damage. I work with my physical therapist to get them back and foot up to speed to exercise again. I start weight training, going low and slow to rebuild my strength without reinjuring myself. I pay better attention to my eating habits and lose 10 of the regained 27. And the pain went away. 

Life is good again, birds are singing, squirrels are dancing happily...

Until the pain is back with a vengeance. As in I'm-sleeping-on-the-couch-because-I-can-prop-my-back-up-against-something-hard-all-night vengeance. I don't know what could have triggered it. Perhaps it was a tango with a combative patient: I had been on the psych medical unit a lot recently, and those little old ladies are the ones who usually injure me... generally as I'm helping them with their ADLs. Perhaps I overdid the weights: I did start a new cycle of training with heavier weights. Maybe I'm sleeping the wrong way...who knows?

My poor PT can't think of what is causing it either. I guess I'm going to be the death of him. He modifies my PT exercises, and I plow along with my best friend naproxen at my side.

At the start of April, I began feeling a familiar pain in my left side. It feels like the ovarian cysts have returned. I have to go to my PCP for a physical for school later on in the month, so I'll wait to address it with her. Meanwhile, I just do the best I can around all the pain--back and side--until it finally got so bad that I had to stop weight training. 

*sigh*

My PCP orders the pelvic ultrasound and refers me to gynecology. Surprisingly, I can get an ultrasound appointment scheduled for the following week. Usually, these things take up to a month. Even more surprising, I can get my follow-up appointment the week after.  

So yesterday, I go for the pelvic ultrasound. Anyone who has a pelvic ultrasound knows the joys of that: having to have a full bladder while they press on it for the first half of the exam. If you're female (as I am), you also get a vaginal probe, which actually is nowhere near as bad as the bladder pressing. It's not on my top-10 list of things to do, but there are far worse tests that could be done.

The first part of the exam goes as expected. The second part should all be downhill, right?

Except it's not. 

It hurts. BAD.

Seriously, thanks to three pregnancies, one being high-risk, I've had a lot of pelvic ultrasounds in life. I've never had one that was painful. And it wasn't the sonographer's technique; it was me. She wasn't hurting me. I was hurting. I never wanted an ultrasound to be over so fast.

I needed to recover from this. I go home, get my little one (who, by the way, is now 6' and wears a size 13 shoe), and we go to Sephora. His idea. A son after my own heart.

On the way back, my test results are posted to my web portal—good news: no ovarian cyst. But the fibroids are in full force. 

I've always had fibroids. They grow and shrink. I had them removed once, and they came back, so I didn't bother to have them removed again. My providers and I just monitor them. Usually, they don't bother me, and I learned to live with them. But according to the write-up from my PCP, I should follow up with gynecology because these fibroids may be the reason for the back pain.

Really? Let's meet the players.

A couple of fibroids are embedded in the uterine wall, the larger of two measuring 3 cm x 3.5 cm x 3 cm. It's practically a square. There is also a fibroid on the outer posterior wall of the uterus that measures 7 cm x 7 cm x 6 cm. My uterus is apparently 10.2 cm x 6 cm x 6.8 cm. So this fibroid is almost (not quite) as large as my uterus. 

And this explains why I have a lower belly pooch that I just can't get rid of, making me bikini-challenged. It's not adipose tissue; it's my uterus being pushed to the front by a belligerent fibroid.

What were you expecting, a rant about my thighs?

So here I am, still cuddling with my best friend naproxen, looking up treatment options for large uterine fibroids. I may restart the weight training if the pain permits; otherwise, I'll just stick to the stationary bike and treadmill. 

I forgot to mention how the orientation went...

The NP program orientation went well. 

What I found interesting was that an overwhelming majority of my classmates are already NPs in some specialty, just not psych. I think it was only three of us who were not NPs. I think there was another MSN-Ed in there with me. I'm not sure what the other MSN specialized in. 

I bounced this finding off of my DNP-to-be coworker/friend, and we speculated that this was due to one a couple of things. First, given that there have been more than a few cases where non-psych NPs were being disciplined by BONs for dabbling in psych when they shouldn't have, these NPs wanted to pick up psych certification so they wouldn't fall into that trap. Or they probably saw easy money in psych and wanted to get in on it. To my joy, one of the psych education directors let them know in no uncertain terms that psych was not easy.

In that vein, I also found it interesting that only a couple of us had a significant amount (more than 5 years) of actual psych nursing experience. Most of the NPs had only a couple of years, and it was more from working with psych patients than actually working as a psych nurse. For the long-term ED nurse, same thing: he's worked with psych patients for many years, but not actually as a psych nurse. For the bonafide psych nurses, someone else (a non-NP) had five years in psych, and I was the most experienced in psych at 10+. 

But despite orientating together, all of these people are not my actual cohort. Well, some are. The cohort system is kind of confusing.  

The non-NPs are part of my cohort, and there are a couple of NPs who have to take some/all of the 3Ps, so they would also be part of my cohort. But everyone else has already started the psych NP core classes today. Any of them that can't find preceptors for their clinical hours will have to drop back to the fall classes, and then they'll join my cohort. 

One of my coworkers, who is already an NP, supposedly started today. Though I'm not sure if he had found a preceptor. So there's a chance he may drop back to join my cohort in the fall. Another coworker also supposedly started today, but he's doing the full MSN. Because of that, I think we are technically in the same cohort, and we'll be meeting up in July.  Or maybe we're not because he's in the degree program and I'm in the post-grad certificate program.  So so confusing.

I forgot how expensive textbooks were

The last time I had bought textbooks was when I had taken the emergency nursing preceptorship course in 2015, and that was one textbook at the cost of $60. With WGU, the cost of e-books was factored into the tuition, which was never a concern.  

I don't begin classes until July, but the NP program had published the textbook list for the three courses I am taking that term. I decided to take a look-see and put them on an Amazon wish-list, so I can start picking them off over the next three months. I'm glad I did because it was a bit of a sticker shock. 

$740. In all fairness, this is the total price if each book was a new print copy. Now, I could--should--look at how I could reduce that whole bill.

Obviously, the first way to do that is to rent textbooks as opposed to purchasing them outright. I'd have to decide which ones would be worth the rental as opposed to the purchase...the physical assessment texts may be good candidates for this. I already have a set of them from the RN-BSN program. To be honest, it's not as though physical assessment techniques radically change as human body parts aren't radically changing. The only area that I see that might involve a deep dive into new material is how to assess transgender patients. But otherwise, an ear is an ear. So I'd probably get a hard-copy pocket guide to keep on hand and rent the rest of the books for this class. Pathology textbooks may be good candidates for this as well. I believe I still have a patho textbook or two from the RN-BSN program. Let me look and see. If I don't have them, then I'll purchase one. 

Also, suppose it turns out that I like the book enough to keep it. In that case, I could always purchase it, usually at a reduced price, as rentals are almost always used textbooks, to begin with.

Kindle editions. I will admit that I am not always a Kindle edition textbook fan. As much as I like the Kindle, there's something about having my textbooks on Kindle that turns me off. First of all, not all of them are Kindle-reader ready; instead, you're stuck having to read them on a laptop/desktop computer. Second, the Kindle version format is often warped AF, which can be so distracting that it takes away from the reading. But for some of the textbooks, going Kindle may be a good idea. A drug guide textbook would be a good choice for the Kindle route, as that would be something handy to have on my iPhone.

Used textbooks. I'm not always a fan of these because sometimes the supplemental material that comes with the book (the CDs or the website codes) is more valuable than the book itself. Plus, it can be disconcerting to read through someone else's highlights, notes, and marks. But for a textbook that I'm not planning to keep, such as assessment ones, this is an option.

Then there are some things that I just won't budge on. I will purchase any textbook that I know that I will get solid mileage out of for at least two or three years after completing the program. Since I am going the psych NP route, this would definitely be the pharmacology textbooks.

Last, I've got time to shop around. Amazon isn't the only game in town, which is nice. I've got almost three months to look around and compare prices.

So maybe I can get creative and cut $740 down to about $400-$500.