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. 

No, the thyroid didn't leave. It even invited a friend over.

My birthday was nice.  I did my mourning the day before so I could make the best of the day.  Had a good day at the holiday party with my coworkers, had a good day at home with my family, had a good (sarcasm) time finishing up my performance assessment.  I turned that in the following day and found out yesterday that I passed.  So I am officially done with my first term.  Coming soon:  a post on WGU survival tips and must-haves.

The day after my birthday, I went to my PCP for the follow-up on my blood pressure medication and the investigation into my weight gain.  The new blood pressure medication is working fine.  As far as the weight gain...she agreed to check my thyroid, but she believes that 1700 calories a day may be too much for me.

"Even with being on my feet at work and exercising five days a week?" I ask.

Apparently so.  But she wants me stay at 1500 calories a week for at least two weeks.  If I don't lose some weight in that time (I'm not counting the water weight I'm bound to lose within the next couple of days, thanks to all the Chinese food I had on my birthday), she wants me to go down to 1200.  If that doesn't do it, then 1000.  Even 800 if I had to.

Of course, if I ever had to go below 1200, I'd ask for a referral to a nutritionist first.  No offense, doc, but let's talk to someone who specializes in this.

Labs were done.  My TSH is normal.  But my chloride is 10 points high.  Total protein is a bit low.  Everything else is normal.

Chloride, high?  Odd.

She said she's not worried about it, but I do need to make sure I'm eating enough protein.  Should I do the Atkins diet?

As far as the chloride...I looked it up.  Causes of high chloride include:

• Dehydration (possible)
• Hypernatremia (high blood sodium) (nope, that was normal)
• Cushing syndrome (not likely)
• Kidney disease (kidney-related labs were just fine)
• Metabolic acidosis (nope, those levels were normal)
• Respiratory alkalosis (ditto)

So my best guess is that I need to drink more water.

I'm disappointed yet relieved that my thyroid test came back normal.  Disappointed because hypothyroidism would have explained a hell of a lot of what's been going on with me besides just the weight gain.   Relieved because it's better to have the working thyroid in the long run.

It's going to be tough to keep track of the calories when my mom is here...mostly because I don't want her to know I'm trying to lose weight.  She's always been critical of my weight all my life, even when I wasn't overweight to begin with.  Yeah, I know.  And she tends to believe she knows best about everything...she'll be there, giving me all the diet and exercise advice she has.  Meanwhile, she very overweight, doesn't exercise, and her diet is anything but balanced.  Or she is trying the latest fad diet or quick fix, such as drinking apple cider vinegar in water and expecting it take off 35 lbs. 

Spoiler alert:  it didn't work.

*sigh*

In which Meriwhen wonders if her thyroid went on holiday

My weight loss had stalled, so my psychiatrist started me on a low dose of topiramate which is used off-label for weight loss.  They're not sure how it works, but apparently for a lot of people, it does.  Considering that I've been tracking my diet for a while now with no results, I figured I'd give it a go.

I had downloaded an app (Lose It), and have been pretty faithful about sticking to my calorie allotment.  It helped me calculate my BMR and an allotment to allow me to lose weight at a safe rate, which we (the app and I) decided was a pound a week.  So this translates to about 1700 calories a day.  Of course, this still fits in with intermittent fasting, but I do the fasting more because I find that if I eat at work, I want to fall asleep.  So I don't eat at work, I fall asleep after work, and when I wake up, 16 hours are gone.  1700 calories for 8 hours is no problem.

After I finished my half-marathon almost a month ago, I've also been exercising about 5-6 days a week.  I've been alternating between the treadmill and the recumbent bicycle.  I've also added in some resistance/strength training on the treadmill days, since I tend to spend more time pedaling than walking.  I give myself one day of total rest, usually on the last day of my work week as I adjust back to a daytime schedule. I may do a second day if I feel too tired or achy, as I did the other day when I felt sore and exhausted.

So you think with all of this, I'd have made some mad progress, right?

My scale says No.  My scale had me lose 5 lbs, but then gain 8 lbs.  So I'm up 3 lbs. overall.

Mind you, my psychiatrist's scale has me down 3 lbs. since I started the topiramate.  He (and I) were hoping for more than that, but in his words, "between losing 3 lbs. and gaining 3 lbs., I'll take the loss."  He tweaked the dose a bit more.

But that isn't what got me thinking that it might be my thyroid.  It's the cold.

Being from the Northeast, I'm used to cold.  I love cold.  I dream about snow and rain.  I get excited whenever I see clouds in the sky.  Hell, I consider it a beautiful day if I can't see my shadow.

Except that as of late, I feel like I'm freezing.  It's only 60 degrees, but I'm freezing.  I'm turning on the heat, to the other half's surprise.  I'm wearing my coat at work, to everyone's surprise.

The other half says, "it's not so bad out."

"I'm taking your sweatshirt then."

This is not like me, to be stealing sweatshirts and wanting to go around with a space heater.

I have an appointment next week with my PCP to have my blood pressure medication follow up.  I already messaged about having my thyroid tested.  My PCP is away until the end of the week, but hopefully she'll agree we should rule out any problems.

And if it's not the thyroid, then I guess I finally acclimated to the Southern California climate.

I'm sick of Translational Research

Don't get me wrong:  I loved the content of the course.  I'm just sick of working on this performance assessment for the last two weeks.  I'm already 4 days behind my arbitrary deadline.  Tomorrow will be day 5, but it WILL be the final day of this course as I plan to submit my performance assessment before lunch.  I already did the Turnitin check (6%, well below the guidelines).  I have a last review of it with the Writing Center, then I'll give it a final once-over, and then this toast is toasted.

Today was the weekly check-in with Belle.  I'm strongly suspecting that she's got a strong psych background, if she's not actually a psych nurse.  We spent 5 minutes discussing my weekly progress and 10 minutes discussing adventures in psych nursing.   And she was excited to discus psych as well.

Someone who understands my life!  This pleases me.

I also came to the realization that I REALLY do need those arbitrary deadlines. Don't get me wrong, the self-pacing of the WGU program is great.  But I realized today when I was on the 7th draft on my project that, as I told Belle, I could continue to revise this thing until the cows come home.  Instead, I need to work up to the deadline, submit it, and move on to the next course.  If my performance assessment truly blows, they'll send it back for revision.

I realize that may sound confusing to fellow students, and it confuses the hell out of me to.  To revisions/revising in WGU lingo typically means that your performance assessment was kicked back because part/all of it didn't meet the rubric standards.  Whereas in my lingo, revisions/revising means to edit yet another draft.  The previous paragraph makes it seem like my performance assessment failed 6 times already.

Moving to non-graduate school topics...

I went to the Cheesecake Factory today.  The menu is rather scary...well, not so much the food as the calorie counts listed next to the food.  There was very little in that main menu book that wasn't in the quadruple digits, and a few of those digits even started with 2.   But since I was there last time (which was probably 2012 or 2013), they have introduced an additional menu of lighter-calorie fare.  In this new menu, I'm pretty sure that no one item exceeded 1,000 calories.

I recommend the White Chicken Chili, by the way.  Excellent flavor with a nice spicy kick.  The Chicken Samosas are good too.  I had both and still kept the total calories in the triple digits.

I do regret having the Cinnabon Cheesecake though.  Which, by the way, is not on their new menu as it's about 1300 calories.  But when one is at the Cheesecake Factory, one has to have the cheesecake.  Otherwise, why go to a place named the Cheesecake Factory?  Anyhow, I thought that since I've been able to eat cheese with no issue as of late, that perhaps I was able to tolerate dairy again.  Alas, that was not the case...though it was a very tasty way to put myself in agony.  But next time I go back there, I think I'll have to settle for the bowl of strawberries instead.

A new chapter

So I "met" my new program mentor yesterday.  I introduced myself as "the psychiatric nurse that you're inheriting from Baby Nurse."  She laughed and said "you and I are going to get along just fine!"

She has a Southern accent that could cut glass.  I lived in the South for more than a decade, so I understand almost all dialects of Southern...except mountain North Carolinian.  I understand Welsh better than the mountain North Carolinian accent.   So I shall refer to her as Belle.

I introduced myself, we chatted...she was excited that I enjoyed psych.  She asked me about why I chose education over NP.  I told her it's because I wanted to do more than just prescribe medications.  She stated that she didn't pursue Psych NP for the same reason.  I told her that I wanted to have a more interactive role with others, and that I've always enjoyed mentoring and nurturing others.  She felt the same way.

I never asked what area(s) she specialized in...but could it be my mentor IS a psych nurse? 

If so, that would be awesome!  I often don't meet others of my kind in school except for those who are teaching a psychiatric nursing course.

So things got off to a good start between us.  I have a feeling we're going to have a great relationship.

I talked to Belle and told her that I needed to push my arbitrary course deadline back to August 31 (it was originally August 25) due to being sidelined with a double ear infection and then an allergic reaction to antibiotics.  She said "oh, bless your heart" and understood why.  So my new deadline is now August 31.  That gave me some of my motivation back, so instead of feeling like I was up against the gun, I had a decent amount of time to produce a decent performance assessment.

Southern lingo note:  the meaning of "bless your heart" is very dependent on the context it's used in.  In this case, it was sympathy. 

Speaking of allergic reactions...I hauled myself to the doctor to get it checked out.  Surprisingly, I was able to get a same day appointment with my regular PCP.  She looked at it, said it was possibly an allergy though questionable if its a true allergy (a localized rash, instead of generalized hives that I experience with the other antibiotics I'm allergic to).  So she marked it as an allergy with a note about whether it's a true one.  She also counseled me that if it came down to me taking the antibiotic, to go ahead and take it.  I agreed.

She said I was treating the rash correctly and that it should go away in a couple of days.  Sure enough, today it is gone except for some remnants of redness.

In which Meriwhen has little motivation and an allergic reaction to antibiotics

For the last week, my motivation for doing schoolwork has been...well, not at zero.   If my motivation were measured with a speedometer and 60mph was going full throttle, I'm about at 15mph.  Small progress but not enough.  Baby Nurse--who as of this week is no longer my mentor--told me that baby steps were still steps.  And she is right, though I don't think I will be able to finish this course by the arbitrary deadline of 8/25.  Closer to 8/31.

For various reasons, I just can't pick myself up to get fully going.  Work has been busy, I've been sick and sleeping a lot, the weather is too damn hot...anyhow, I knew this was a risk with WGU.  And I need to nip it in the bud.  I can't let myself run this course into September.  I REFUSE TO.

So I set up some Writing Center appointments for drafts and the final.  That way, I have commitments I can't break.

Baby Nurse has decided to take a position teaching in a brick-and-mortar school.  She was an awesome program mentor and I wish her well in her new position.  She has handed me over to her successor who she said she likes a lot and feels will take good care of me.  I have not yet met her, my first appointment with her is next week.  I wonder if she's a psych nurse...probably not.  There seems to be so few of us running around these programs.

The sick and the sleeping...double ear infection.  Whee.  I waited three days to see if it would pass, then hauled myself to the doctor.  He looked at my history, reviewed my allergies, and started me on azithromycin and decongestants.  The medications worked, and I was feeling fine within a few days.

Then a couple of days after the last dose of antibiotic, a rash appeared on my neck.  I wasn't alarmed at first:  for some reason, the skin on my neck is very sensitive compared to the rest of me, and it's not uncommon for me to have areas of redness there.  But then the rash got bumpy.  And then spread up the sides of my face.  Almost like a bad hormonal acne breakout.  The current state of it is that my neck is less bumpy but still red, while most of the bumps have taken up shop on my cheekbones.

Now, I should have caught this:  the -mycin.  I'm allergic to clindamycin.  Not life-threatening allergic, more like here's-a-lovely-rash-that-won't-die-for-two-weeks allergic.  The doctor was aware of it too.  I guess he figured that azithromycin wasn't likely to cause a reaction.  I thought as much too, and I really needed the ear infections out of there.  Well, we were both wrong.  The last time I saw a rash like this was when I was on clindamycin.  Same exact thing.

The good news is that it does go away.  The bad news is that it takes two weeks.  The worse news is that I have a social event to go to tonight and I refuse to miss it.

My going to Urgent Care is not an option as 1.  the rash is more cosmetically unpleasing than life-threatening and 2.  I'll end up spending hours there, hours that could have been spent doing schoolwork and relaxing before this event.  So I'm doing a little home treatment.  oral antihistamines (Vistaril), and topical hydrocortisone and salicylic acid creams.  I'm otherwise leaving it alone.  Time really is the only cure for it.

Getting excessively harsh with my skin will not clear it up any faster--if anything, it will exacerbate the problem and make it impossible to conceal with makeup.  I do have an arsenal of foundations, so I know I can conceal it for the most part.  I have the perfect one to use:  Tarte Amazonian Clay 12-Hour Foundation.  I strongly recommend this foundation if you have things to hide and want to keep them hidden most of the night.

I can't hide it 100%, but with good foundation, a red dress and a strong lip color, I could perhaps distract from it.

And...

Good news:  the results are negative.

I hadn't been around for a bit because we were short at work, so I was dealing with that.  I was also coming down with something...not sure what it was as I had no symptoms but an incredible urge to sleep a lot.  Plus I decided that I needed to try and stay away from Dr. Google, lest I go down every rabbit hole I find.

So...

During the mammogram, they spotted the growth in the left breast.  OK, I know about that.  But then they became very interested in something spotted in the right breast.  The breast that my PCP felt and didn't find anything in. And they reminded me that I have very dense breast tissue, which can make spotting things difficult.  I'm not sure if that was meant to reassure me, because it damn well didn't.


Then to ultrasound.  The technician finds both critters.  Left growth:  4mm.  Right growth:  7mm.  She doesn't seem too concerned so I try to relax.  Then again, she's not the doctor reading it.  Speaking of which, the doctor reads both, but I'm told nothing.  So I go home.  OK, I'll read about it later. 


That evening, I check my patient portal to see if the results are up yet, since my PCP is pretty good about posting things same day.  And I'm thinking that if there was a problem, they would have told me ASAP, or had my PCP tell me ASAP.  But they didn't so everything must be OK, right?


No results posted.  And I checked like a madwoman all weekend but still, nothing.  At one point, a coworker advised me to take the medical app off my phone because that wasn't going to make the results appear over the weekend.  So I decide to Google things...and yeah, that wasn't a good idea.  After a day-plus of torturing myself with every worst possible scenario, I decided that I needed to shut the computer--and app--down and focus on the task at hand:  work. 

The results were up Monday morning.  Both are enlarged lymph nodes and both appear benign.  Thanks for playing, see you next year.  I guess they're just going to monitor it yearly.  I'm relieved...until I Google what enlarged lymph nodes mean.  And back down the rabbit holes I go, but I managed to break away from Googling it after half a day.


Please, for the love of Doritos, if you are waiting on any diagnostic test results, step away from the computer and try (I know, easier said than done) to wait for the official word from your PCP!!!

Maybe I should have done that exam...

We usually eat Chinese food on Wednesdays.  Well, I eat Chinese food on Wednesdays.  Everyone else has pizza.  My body has decided that it no longer approves of large quantities of dairy, so while I can get away unscathed if I eat one slice of pizza, more than that isn't kind to my stomach.

Today, I opened the two fortune cookies that came with.  One fortune was:

"You will be fortunate in everything you put your hands on."

Maybe if I had done the exam and found the lump, it will turn out to be nothing.

I'm not spazzing...too much.  The odds are definitely in my favor that it will be nothing major.  1 in 8 women get the joy of breast cancer, which means that 87.5% don't.   And even if it is an issue, medical advances have come rather far that the odds are successful treatment are in  my favor as well.  I've had two biopsies that were benign.  Twice, I was one of the 87.5%...

Then again, I was in my 20s.  Now, I'm in my 40s.   And there's that old superstition about the third time of things being not-so-lucky as the first two.

I'm thinking back to several weeks ago, when I felt pain in...wait for it...the left breast, right about where the lump is.  I didn't think anything of it as it was there only for a few days, was intermittent, and was right around the brassieres-no-longer-fit-right time of my cycle.  Now, I'm wondering, "what if..."

I need to go play some Minecraft and relax.

In which Meriwhen...*sigh*

Got back from my annual physical.  My PCP wasn't as cross with me as I thought she'd be.  I need to lose weight, yes.  But she's happy that my labs are in her words "stone cold perfect."  She's also happy to hear that I'm up to working out 4 times a week.  She'd still rather see me doing it 5 times a week...I'm getting there.

And there's another breast lump.  The clinical summary form describes it as "breast mass."  I prefer calling it a lump as it sounds more benign.

I admit that I'm horrible about doing monthly breast exams because the only 2 times that I've done it, I found lumps that were later surgically removed.  I told her it was a stupid superstition, but I've been scared to do them since.  And in the almost 19 years since the 2nd was removed, no provider has found anything to be concerned about.  Until today.

The first words out of my mouth were, "it's always the left [breast]."

So I now have to go for a diagnostic mammogram, which is apparently different from a regular mammogram and may not be covered by insurance.  But I need to get it so I'll worry about the cost later.  And it'll be followed up with an ultrasound.  They were able to schedule it pretty fast:  within 2 weeks.  And because of the EMR, I'll be able to know the results very quickly.

I told the other half today...I thought about waiting until I get the tests done, but then realized that I'd have no way to explain any unexpected stress or anxiety that I would be going through while I'm waiting.  The first words out of his mouth were, "this is the 3rd time."  I guess we're both a little too used to going through this.  

Laissez les bons temps rouler

I've been trying to take a more laid back attitude towards things at work.  There's been some changes I'm dealing with, as well as other possible changes coming down the pike that may or may not affect me.  Now, regular readers (all 2 of you) know I have major anxiety issues that I'm been working on for years.  My regular medications have helped considerably.  I've been using a lot of mental tricks that I've learned to try to relax and deal.  Writing about what is making me anxious also helps.  So does the occasional alprazolam, though I save that for when the tricks and writing fail me.

For the most part, the anxiety issues have improved, but I have weak moments when the anxiety can and does overwhelm me. 

So instead of working myself up into a worried frenzy over what might happen--especially when it might not--I decided that I am just going to roll with things the best that I can.  For the most part, work has been good times, so may they continue to roll and I roll along with it.

I guess it's a modified Serenity Prayer, Cajun style. Le Bon Dieu would approve.

I am finally able to use that treadmill I purchased.  I'm making an effort to put in at least 30 minutes on it before work each day.  It's still mostly walking with some occasional running, but I'm improving.

I've been lurking on a couple of WGU support groups online, one for the general school and one for BSN/MSN students.   I see people in both groups complaining (maybe not the best word but it'll do) about how hard some of the assignments are and how tough the instructors are being on said assignments.  It's reassuring to see this.  At least I know that I'm going to have to work for my MSN kibble.

Albeit 3.0 kibble.  I'm still adjusting to that.  Remember that my lowest nursing school GPA was 3.93.  So to go from that to knowing I'm going to get a 3.0 no matter how hard I work is a bit of a paradigm shift.  But then again, at this point in the game, does the GPA really matter anymore?  It only does is I decide to pursue a PhD or post-masters.  And even then, lots of WGU students go on to get even higher degrees than a MSN.

In which Meriwhen gets a good scare

No story build-up here, I'll just say it:  chest pain.

I had it for about 3 or 4 days.  It wasn't (isn't, as it's still kind of here) aching or stabbing, it's more of an uncomfortable pressure.  It's not radiating.  It doesn't get worse with exertion.  It doesn't get better with rest.  It did wake me up one night.  The only other symptom I have is a little tachycardia one morning, but it was gone by the evening.

Now, if this was someone asking me for advice, I'd say, "get thee to an ED today."  If if was a patient, I'd be seeking advanced counsel and probably calling the MD as well.  But of course, I don't tell myself that.  I'm a nurse and let's face it:  nurses are the world's worst patients.  So I schedule a next-day sick appointment after work.  What's one more day, right?  Let's just ignore the fact that I have cardiac issues on both sides of my family.  And let's ignore the Lisinopril in my medicine cabinet that I take daily.

That night, I was kept busy enough at work that it didn't bother me too much...it was when it was slow, that I noticed it was still there.   Not stressing over it, because I know that in a few hours,  I'll be at my doctor's getting checked out.

But it's not until I'm actually there in the clinic, getting an EKG and cardiac lab work done that I realize that this could be really serious.  Especially when my PCP orders a D-Dimer test for the presence of clots and tells me that if it comes back positive, that I need to drop everything and get myself to the ED for a CT scan.

I'm not young:  according to Erikson, I'm entering Generativity vs. Stagnation.  People my age die from cardiac issues.   I see it in the ED all the time. 

I gave up smoking 20 years ago.  I don't drink alcohol anymore.  I don't do drugs, legal or otherwise.  I'm in decent shape.  II'm physically active, though not as consistently as I should be.  I could stand to drop that 30 pounds I recently regained.   I have hypertension, though well controlled.  I have cardiac issues all over my family tree, including heart attacks and deaths from stroke.

And heart disease is the #1 cause of death in women.   And heart attacks in women don't always present with the typical "clutch the chest and feel the left arm go numb" symptoms.  It presents like indigestion, like heaviness.  Like how I felt.

Yes, I already knew all of this.  But again, nurses make the worst patients.

So I spent the morning being tested 10 ways from tomorrow.  My EKG is beautiful.  Exertion test is great--I actually wore out the LVN that was monitoring me because she couldn't keep up with my speed.  Lab work is beautiful.   Then I get to go home and wait, anxious as hell, for the D-Dimer results.  Because I can't go to sleep until I get this test result, in case I need to call out of work and find a good book to take with me to the hospital.

Fortunately, it was negative.  Unfortunately, I couldn't sleep even after getting that news.  So work that night was challenging, to say the least.

My PCP decided to start off my treating me for GERD, since he thinks it could be an atypical presentation.  So now I'm on omeprazole for a couple of weeks to see if that helps.  It's been two days on the medication, and the discomfort seems to be lessening, which is positive.  It might just be atypical GERD after all...I hope.

All of this was quite the scare for me, as well as quite the reminder that I could still improve my health.  I'm waiting until the discomfort is fully gone before I try out the treadmill we bought with the tax refund.  It wasn't a large refund so it's not a large treadmill.   But it's another way to exercise.

So the last 10 months...

Without writing an entire novel, here's what I've been up to over the last 10 months.

The summer was uneventful.  I picked up quite a few extra shifts during the day (I know!) to sock away some extra money for my leave of absence following surgery.  I trained to a couple of new areas.  My IV success rate still hovers at 50%.

The surgery went well.  I was talking with one of the staff there prior to the surgery.  She wanted to know where I worked, so I told them I was in psych.  "Oh, my kid is in there," she said.  "Cool, what shift is she on, maybe I know them," I reply.  And it turns out that the child isn't staff but a patient.

"Oh."

Then I was told a lot more about this patient than I ever wanted to know.  I said nothing other than, "I don't think I've come across them," which was true, as I hadn't.  But talk about small worlds!

The surgeon and anesthesiologist were awesome:  I told them what I wanted--not to remember anything during the surgery--and they delivered.  Though it would have been nice to be warned that the operating room would be like an icebox.  But they threw warm blankets on me, and then I was put under right away.

My sister took me there and waited to bring me home.  At one point, the staff couldn't find her.  We don't have the same last name, plus the name she has (that I used to have) is exceptionally hard to pronounce, so it's not as though they could have paged her.  So I told them, "She looks absolutely nothing like me."   They found her in less than 5 minutes.

I originally was going to return after one week, but after the first night home, I decided I was taking the full two weeks.  All I did was lie in bed and listen to audio books.  And get off the hook for doing anything around the house, because I was under orders not to lift or strain myself for a few weeks.  Unfortunately, this meant that I also had to stop exercising, so I gained back 15 of the 20 pounds I lost during the year.  I'm still working at getting them back off.

The fall was all right, nothing exciting.   Played a lot of Minecraft.  It's soothing, especially when I'm in creative move.  It's almost as fun as DOOM in God Mode, just without the chainsaw and cacodemons.

The little one officially became a teenager in December.  He asked that we no longer call him by his childhood nickname.  He is also almost as tall as I am (and I am tall!) and has bigger feet than the better half.  Pretty soon, this kid's going to tower over us.

My birthday was hard, as it was also the second anniversary of my dad's passing.  It was a little easier than the first year, but I don't think it'll ever be pain-free though.  Still, he wouldn't want me crying on that day, so I got the tears out while everyone was asleep, and fired up Red Dwarf until I was laughing hysterically.  That gave me the strength to get through the day.

At the start of the new year, I sprained my back by not acting my age.  Seriously, I was fooling around on a trampoline.  I didn't feel any pain then, but two days later it hit with a vengeance.  I was laid up for about a week.  It felt like it was never getting better...I kind of understood why people in chronic pain get depressed and want to kill themselves.  Not that I ever got to that dark of a point, but I certainly felt hopeless and helpless.

The next month, I pulled a groin muscle while exercising.  That only had me down for three days though, but I had to cut back on the exercise program for a while. 

Littler one turned 5.  His speech has improved drastically...he's still hard to understand at times,  but he is talking more and babbling less.  We're hoping he can transfer to the local school next year, but we'll see what happens at the next IEP meeting.

I did another half-marathon.  It wasn't my best time (and as always, I was dead last!), but I did pretty well considering my training was messed up due to the injuries.   I have another one coming up in June...I'm usually not this masochistic to do two half-marathons within six months, but this is also a get-together of sorority alumnae as well, so it's as much a social event as an athletic one.

I dealt with some personal heartbreak.  I'm not going to go into details, but I will assure you that both immediate and extended family are fine.   The pain sucked, but it was a learning experience, so I'm grateful for that.  Though I wish there were less painful ways to learn such things.

And this brings me to now, and my big news...I applied to graduate school. 

I decided to go with Western Governors University for the MSN in Education.  A lot of people--including other staff--at the forum spoke highly about it, so I did some of my own research.  It's accredited and has a good reputation.  I liked what I found, so I decided to give it a shot and apply.   I'm hoping to start in July.

I was looking at local programs, but they would have been hard to work around given my work schedule.  I thought about going back to UTA, but I decided that I wanted a different approach.  It's going to be interesting doing a program at my own pace.  The pass/fail thing is going to be both a blessing and a curse...a blessing since I won't be stressing out over getting As.  A curse because I'm going to end up with a 3.0 GPA no matter how well I ace each test and paper.

I don't want to become a psych NP because I don't want to prescribe all day.  I enjoy being in the trenches with the patients.  Education appeals to me because I like to teach others and I would love to be able to develop patient education programs.  I could help develop the next generation of nurses--I always fancied myself becoming a nursing school instructor...and there's also the potential for staff education as well.

Plus, If I change my mind and decide that I want to become a NP (psych or otherwise) down the road, I could always do a post-masters.  Or maybe I'll go for the PhD.  Or maybe I'll stop at MSN.

Right now, things are still in the application stage...I don't doubt that I'll be accepted, as I'm bringing along GPAs of 3.93 and 4.0.  But I never take any thing for granted.   The transcripts are on their way, and I started talking with my enrollment counselor.

It's kind of exciting to be going back to school.  It's been almost 5 years since I finished the BSN.  I think I'm ready to do it.

Meriwhen the RN, now BSN, soon to be MSN.  I like the sound of it.

It's that time again...

ACLS renewal time.  Time to get the latest guidelines out and remind myself what third-degree heart block looks like.

I am 0 for 4 on my patient surviving megacodes, because I am 4 for 4 on getting the asystole megacode.  Something about me must tell the instructor, "give this one the flat liner." Perhaps it's because I'm usually the only psych nurse in the class, probably the only one they see all year.

I am a pro on the asystole megacode.  The problem is that most patients are not pros at surviving asystole.

I did get a chance to run a second megacode during one renewal--it was supraventricular tachycardia, and that patient did make it.  But as it was after my official (asystole) megacode for the class, and the instructor did it to give other students a chance to perform in different roles, it doesn't really count.  Though since it wasn't asystole, I wasn't used to the fact that my patient was actually responding to treatment, and it kind of threw me...so it wasn't my smoothest megacode performance to date.

Anyhow, here's hoping I get a megacode with a shockable heart rhythm this year.   Then again, being 5 for 5 on getting asystole megacodes is kind of a bragging right in itself.

Surgery stuff

Recovery will be up 2 weeks, so that's what I'm putting in for.  This is going to run into the Labor Day holiday, but I can't help that.   I would like to try to be back on Labor Day so I can get a day of holiday pay, but that's up to the MD.  I have to get the paperwork in June and get the process started.

The mystery of the insurance auth has been solved

The ptosis repair--for both eyes!--was approved.  Clearly, my ophthalmologist's UR office is good.

My ophthalmologist only does surgery on Wednesdays.  Also, Wednesdays is the only day that the surgery scheduling team schedules surgeries.  I called and just missed them.  So I have to wait a whole week before they call me.  Well, I've had this eye issue for this long, what's another week?  And it's not as though surgery will be the week after I call them anyway.

I also need to remind them that if they are going to twilight sedate me, that diazepam will make me turn bright red.  They may decide to use something else.

I'm not sure how to deal with this at work.  I have the sick time accrued for a week off...actually, I have a TON of time off accrued because I never really take it.   I'll only need 7 days off for this.  Maybe 8.

When I schedule the surgery, do I tell work now that I've scheduled it so they can plan around my absence, or do I call them the day of surgery and tell them I won't be around a week per doctor's orders?  I'm guessing the former.  But I'll wait until I schedule the surgery first before I say anything.

So I received an automated message from my medical insurance plan, stating that my "requested services" were approved and to call my PCP.   I'm guessing it may have been the eyelid repair.  Or it could have been the testing for Graves' disease.  I got the call at 1800 on Friday.  So I'll have to wait until Monday to call and find out what it is.

In other news, I worked my first double at my current facility.  I ended up being so overtired that I felt wide awake.  I didn't fall asleep until I had been awake about 27 hours, and even then, it took pharmaceutical help to bring sleep about.

Of acetylcholine receptors and vanity

So I contacted my ophthalmologist's office and asked them to check if the ptosis surgery will be covered by my insurance, and if so, how much.  They're going to check the cost of fixing the affected eye by itself, and fixing the affected eye along with addressing the issues of the other eye.  Depending on what the numbers are, I'll be moving forward with this.

I talked to my sister about the procedure.  I learned that she is as squeamish about all things eye as I am, so that was comforting.  Even so, she's miles more solid with blood and gore than the better half, who once almost passed out during a labor and delivery video.  She agreed to drive me to and from the procedure.

And being the immunologist she is, she wants me to ask my PCP for a blood test to check for acetylcholine antibodies.  She's thinking myasthenia gravis is the cause.   And who knows, she may be right.  I don't think it is, as its rather rare and the only symptom I have from the list is the drooping eyelid.  But I do fit the "at risk" profile, being a female over 40 and being on a beta-blocker for the long-term.  I have my annual physical next week and it couldn't hurt to ask about it.

Here, read up on the disease if you're unfamiliar:  http://www.healthline.com/health/myasthenia-gravis.  I had to refresh myself on it as well.

My research did turn up that ptosis isn't a cause, but a symptom of some underlying problem, be it myasthenia gravis or some other issue.  Fix the problem and the ptosis could go away.  Or not.  But it's not as though they can schedule the surgery next week.  It'll be several months before it would happen, so that gives me plenty of time to do more research and rule out potential causes.  I know that if I don't treat it one way or another, the ptosis is only going to get worse.  It's not going to magically resolve on its own.

I admit that I also want to get this fixed for aesthetic reasons.

While the ptotic (yes, it is a word!) eye is giving me physical grief, I am--or feel like I am--starting to notice the ptosis more.  I feel like it's become glaringly obvious in every picture I take.  I'm wondering if other people notice it.  I'm wondering how to ask other people if they notice it AND get an honest answer from them, with none of the "it's not that bad!" crap.

I feel weird that I'm considering the aesthetic along with the medical.  I feel like I'm getting an eyelift.   Well, technically I would be, as it's pretty much a similar procedure.  I personally have no objection to plastic surgery.  If it makes a person feel better about themselves, then fine.  If it fixes a problem, even better.  And yet, even though I have a valid medical reason on my hands...er, face, for having this done, I can't help but feel like I'm being vain in doing this.

And is feeling that way necessarily right...or wrong?

*sigh*

In which Meriwhen learns she was never meant to go into ophthalmology, and other important life lessons

Lesson #1:  Never schedule an eye appointment after working night shift.

Especially when the night is long and the psych acuity is high.  It was all I could do to stay awake once I got off of work.  I usually sleep immediately or thereabouts after getting home.  But not today.

I went home, showered, ate breakfast (Jack in the Box, how I love thee), and then drove the 45 minute to my ophthalmologist (Blogger autocorrect, how I love thee).

My eye doctor is located in a very affluent part of the entire state.  Not just an affluent area in my city--it's one of the top in the state.   So my little SUV is a bit out of place among the Audis, BMWs and other luxury cars.  I also feel a bit of place there too, as I show up right out of work, in my sandals, old jeans, and AN.com jacket, while both staff and patients walk around in business suits or designer label swag.  Everyone else is (or appears) slim, young and beautiful.

Then after the appointment, I drove the 45 minutes home and had lunch.  And then I tried to pass out...and was unable to fall asleep.  So I ended up staying awake for a full 24 hours.

Lesson #2:  Eye doctors have access to the best toys.

The eye doctor has the most beautiful green eyes...so beautiful and fairy princess-like.  There's no way THEY could have been natural.   But minding my manners, I did not ask.  And it goes without saying that all the vision techs and nurses had long, luxurious lashes...me thinks Latisse is at work.

And nary a wrinkle in sight on anyone.

Lesson #3:  Ptosis is not what I thought it was.

I told her that my right eye had the issues with drooping...she was focused on my left.  Then she took measurements, went over the test results, and I learned that what I assumed was a drooping eyelid was not actually a drooping eyelid.  And what I assumed was the normal eyelid was in fact the drooping eyelid.  It's the left eye that had the ptosis.

That being said, the right eye still has its own issues, so I'm not entirely insane.

The cure for both of these issues is minor outpatient surgery with a week's downtime.  It's not critical--it's more of a quality of life issue.  If I never got the procedure done, no big deal.  But she warned me that given the aging process, both eye issues are not going to get any better on their own.  And I'm also apparently at the border where the procedure would be covered my insurance for medical reasons, instead of not being covered as a cosmetic procedure...at least for the left eye, since my vision is apparently being impaired by it.  The right eye, they'd have to apply for specific approval to fix this problem, as apparently my vision is fine in the right eye.

I say "apparently" because during the vision field test, the right eye was far more uncomfortable during testing than the left.  So naturally, I assumed that it was as I originally thought--the right eye was the issue.  Guess I was wrong.

But we agreed on a conservative "wait and see" approach for now because...

Lesson #4:  I have no stomach for anything involving eye surgery.

She started describing the procedure and I began twitching.  It was all I could do to not go squeamish and pass out on her.  Even recalling the conversation as I type this several days later is making my stomach churn and my body shudder.

We decided that, even though the surgery is a minor procedure and I could drive myself home afterwards, it would probably be best if she put me out for it.

Then there's the scheduling issue.  A week of time off will be needed until the stitches can come out.  The bruising will take longer to heal, but I don't mind going in all bruised up.  I could camouflage most of it with makeup, I imagine.  And if not, it'll have the potential for helping me spin entertaining tales for my patients.

I got home and filled in the better half who agreed on the "wait and see" approach (he's got a much weaker stomach than I).  I follow up in 6 months or sooner if it worsens.  I'm probably going to schedule the surgery for the end of the year.

And of course, not having slept in 24 hours plus all this about eye surgery--the procedure is essentially an eye lift--made me start thinking...

Lesson #5:  I need to embrace aging.  Not necessarily without a fight though.

Mentally, I don't feel my age at all.  I feel years younger than I am.  I know I'm not a teenager or in my 20s, so I don't act or dress like one.  But I refuse to mentally-tack on "middle-age" to anything I say, think or do.

Thanks to a lot of sunblock plus great skincare, I'm fortunate to look 10 years younger than I actually am.  My skin has never looked this good in the last decade.  I'm also steadily losing weight and starting next week, I'm getting back into exercise (my excuse for not starting now is that I have a half-marathon that in this weekend, and I don't want to be sore).   I don't have any greys...though to be fair, I've been coloring my hair since age 19 so if there is grey beyond the random hair or two, I wouldn't really know about it.  So overall, I'm on the upswing.

The fact is, I have to accept that my body has been on the road for 40+ years now and with life happening to it, it's inevitable that there will be some wear-and-tear (tare?).   I'm never going to have the face or body of a 25 year old again.  And even though I'm ahead of the game with the religious sunblock use, I admit to feeling some regret that I didn't take even better care of my face and body (watched my weight, dealt with skin issues, etc.) so that perhaps I wouldn't have felt so insecure in my teens and 20s.  I could have enjoyed them more.

But I am what I am.  I should embrace it.  That doesn't mean letting myself go and not putting up any fight, though.   If I can improve something a little bit, I shall.  But let me be realistic about what I am and what I can achieve.  Nothing is going to bring me back to age 25 nor should I try.  But at least I can look and feel damn good for a 40-something year old.

Health woes

Tuesday and Wednesday's dental work has meant a world of pain on Thursday and Friday.  I must have looked like I was in a black mood the last two nights at work, but that was I was waiting for the Motrin to kick in.

Well, I also was--am--in a black mood as of late for another reason, but that's a story for another post.    

Today, the pain is much better.  The rest of the dental work is next week, then I'm off the hook for six months.  

Meanwhile, the vision field exam went...weird.  I have ptosis in one eye.  Most days it's manageable, other days it's like someone's trying to keep my eye shut for me.  I finally got fed up with it, and now that I have decent medical insurance, I decided to see what could be done for it.  

I had to go for a preliminary vision exam so they can see how it's affecting me.  I drive up 45 minutes--in the rain, of course--to the vision tech.  For some reason, all the specialists I need to see for whatever reason are located at this specific office 45 minutes away from me, and they are all scheduled on days that it's raining or about to rain.  Then I spend another 45 minutes staring at little lights, either trying to keep the eyelid just so or having to have the eyelid taped in various positions to keep my eye open.

You know the movie A Clockwork Orange?  Kind of like that, but without the aversion therapy.

I don't know how I did, other than the fact that it was a lot harder for my affected eye to do what they wanted, than for my normal eye to do the same.  I'll find out Tuesday when I meet the eye doctor...in that same location 45 minutes away from me.  Any guesses as to what Tuesday's weather will be?

I did a little preliminary Dr. Googling on ptosis.  It's not always a medical problem in itself, but usually a symptom of another underlying medical problem.  So the best cure is to determine what that underlying medical problem is and fix it.  Or they can do surgery, but that would depend on what the underlying medical problem is.  Or I can just learn to live with it if it's determined that there's no major underlying medical problem.

As of late, the eyelid hasn't been too bad, so I'm hopeful that whatever is causing it is minor.  I'd rather not have surgery if I can help it.

Of course, between the dental work, the eye issues and the unspecified cause of my black mood, I'm not sleeping well at all.  It's come to the point that I've had to blow the dust off my bottle of alprazolam and take 1-2 tabs of that in addition to my regular HS meds, just so I could fall asleep.  Staying asleep isn't happening either, but when that happens I don't take any more meds:  I just do my best to doze off again.  That doesn't always work.

If this doesn't improve, I think a call to my psych NP is in order, as I don't want to be relying on alprazolam in this way.

On the brighter side, I'm down 17 lbs.  I finally broke the 180 barrier this afternoon.  20-30 lb more to go.