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. 

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.

The half-marathon went well.  No PR, but I wasn't last either.  It was my first time on the course and I enjoyed it so much that I'm signing up for next year's race as soon as they post it.

The registry (a.k.a. Job #2) called to see if I was working and whether I was interested in picking up work with them again.  It's nice to know I'm still thought of well by them...but between work and graduate school, I don't really have the time to spare for a registry position.  So I'm going to decline but ask them to keep in touch.  It never hurts to have contacts wherever you can.

A few of my coworkers asked me if I was going to go for that administrative position.  I didn't directly answer (at the time, it was not yet posted), but stated that it would be nice to have someone consistently there for those of us on nights and that if it had to be me to deliver that consistency, then so be it.  It was nice to hear that I still have the vote of confidence from some of my peers if I had decided to pursue it.  But as I mentioned, it's already off the table of consideration due to its hours.

In other news...the other half's father passed away this spring.  I don't thing I had mentioned it here because it blindsided us.  He went into hospital for a lung issue that turned into a cardiac issue that turned into a ICU stay that turned into the end.  The reason we were blindsided was that he and other half's mom didn't want us to know how bad things really were.  So whenever we spoke to his mom, she made it sound like things were better than they actually were.   Then one day his mom calls and says, "oh, your dad passed away."  No preamble.  Just boom.  Said it as though she was discussing the day's random activities.

Side note:  she's also a psychiatric nurse, which is probably why she had such great emotional control when talking to us.

In a way, I can't fault her.  The other half has never been good with anything medical, so much so that even I no longer disclose any of my own medical issues to him unless I'm certain I have to.  He'd spazz endlessly with worry over every single little thing.  So the family tells him only when he really needs to know.

But at the same time, if his mom knew that his dad was likely not going to make it, she should have been honest about that part so other half would have had a chance to say goodbye to him.  At least I had that chance with my dad.  Other half never got that chance. Neither did I.

I do miss my other half dad.  He was a good guy and you could always count on him for a bad pun.  And he considered me the daughter he never had.

Tomorrow is his birthday, which happens to be the same day as the half-marathon I am running walking.  I was going to wear my one of my usual running shirts (turtles or sorority runners) but found one that he'd love.  It has this printed on it:

Which is totally something my other dad would say to me as I'm slogging along.

I have a half-marathon this Sunday.  I already lost the requisite toenail and the race hasn't even started!

Seriously...I must have somehow injured my toe.  When I went to apply varnish (I always keep the toes manicured.  I can't keep my fingernails from breaking to save my life), toe #2 on the right decided that it didn't need the toenail anymore.  And this injury must have occurred quite a while ago, because the next toenail was already halfway grown out.  How I didn't notice this is beyond me.

Stuff

I finished Research.  It turned out that I aced this one...it came back with a nearly perfect score.  It'd be nice if WGU thought it merited an excellence award, but I guess it'd have to have a perfect score to get that.

I got a few recruiting pitches.  The most notable one was from ICE...yes, that ICE.  Apparently psychiatric nurses can have flourishing careers in Immigration and Customs Enforcement.   And apparently they saw me on LinkedIn and thought I was a good candidate.  I'm going to guess that they saw the last name and figured I was likely fluent in Spanish.  I'm working on it.  And Russian.

Yes, Russian.

I had always wanted to learn it as a kid and even got some sort of course to start with.   But it was no Rosetta Stone and didn't really make it stick.  I decided to take advantage of a summer sale to add on Rosetta Stone Russian online.  I work on Spanish classes during my lunch breaks.  I started working on  Russian classes when I'm on the treadmill.  As far as practice goes, surprisingly there is a sizable Russian/Ukrainian community in my town. 

Anyhow, back to the recruiting pitch...I admit, I was intrigued.  ICE?  Me?   Meriwhen in a green and white car?  It would coordinate with my blog's theme. 

Ah, no, not now. I'm not planning to leave my current gig any time soon, as it took me so long to land it in the first place.

I went on a short holiday.  I brought my laptop with every intention of opening it up to do schoolwork, but I opened it up to look up local attractions and indulge in some late-night Minecraft.  So I technically didn't begin my next course--Informatics--until this past Monday. 

I'm now about a week and a half behind my arbitrary deadlines, but that's OK.  My first program mentor had set the dates up so I'd finish in mid-November, leaving me with 6 free weeks.  I opened up my iCal and plugged in the actual dates, and made a few adjustments.  My adjustments have me finishing in mid-December...on my birthday, actually.

So, for Informatics...

For this class, they recommend taking part in as many of the live cohorts as possible.  I threw myself right into the first live cohort, and the second will be today.  My schedule won't let me hit every cohort, but I can hit two a week.

I went to the first one, which was taught by my assigned course instructor.  So she's going on about the course and mentions an informatics scenario that sounds suspiciously like it occurred in a psych setting.  I could relate.  So she continues on and it turns out she IS a psych nurse.  Well, she's in Informatics now, but she's a psych nurse at heart and loves it.

It was all I could do to keep from squealing.  A fellow comrade from the dark side!

The course being Informatics, she couldn't talk psych nursing for long.  But I must speak with this instructor more.  Since I'm planning to approach the performance assessments from a psych perspective, she will be a valuable asset.  Speaking of which, this course has two performance assessments independent of each other, and I get to use PowerPoint for one of them.  Should be fun.

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.

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.  

Red hair, don't care

Having red hair, even subtler red/brown hair such as what I'm sporting, is hard work.  It's a lot of maintenance because of all the hair dyes out there, red hair dye fades the fastest and the most.  So monthly maintenance is a must, unless you like faded red tones and/or visible roots.  I use demi-permanent dye so the fading means my hair gradually gets closer to its natural color and the roots aren't quiet as obvious...well, in theory, anyway.  In reality, demi-permanent dye never goes completely away.  

Having long hair doesn't make it any easier.  It's not at its longest length, but it's gotten to the point that I've had to move up to using 3 boxes of hair color, as 2 is no longer enough.  I'm not using the entire 3rd bottle...yet.  My hair being long means that dye gets everywhere, so it's a messy process.  Then is the washing out of all that dye:  that alone takes as long as it takes to let the dye sit in my hair to color it.  And the washing out is even messier than the application.

For the best results, one should wait as long as possible before that first hair shampooing:  at least 24 hours.  I color my hair right after my last shift of the work week, so this occurs on my days off.  Then for the next three days, my hair will bleed dye every time I shampoo.  I wear a lot of black during that time.

Overall, I think the results are worth it.  I'm left with a nice plum/burgundy-brown shade that looks stunning in sunlight.  But I don't know how much longer I want to keep all this work up.  I'm thinking about going back to black-brown.  The coloring process is still a lot of work--see second paragraph--but at least I can go more than a month between coloring sessions.

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.

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.

Typing this while wearing high heels

I have a social event to go to in a few days, so I finally bought a new pair of party shoes.  The last pair of high heel shoes I have is more than 20 years old--they're still in good condition since I wear them so infrequently.  I just can't find them, so I decided to get a new pair.  I'm currently wearing them over a pair of red wool socks to break them in.  The following day after the social event is a work day, and I want to minimize the inevitable blisters.

I don't usually wear high heels as gracefulness is not one of my strong suits.  That, and wearing high heels puts me into the "rather tall female" category.  I also don't usually wear dresses but I will be that day, and I am now debating whether to get some Dermablend to conceal the leg ink.  I'm not ashamed of my ink, but I also don't want to commit a social faux-pas.

24 pounds down.  Some of our long-term patients have commented that I've been losing weight.

I don't really see it, though.  I mean, I can tell from the fit of my clothing that there's less of me.  In fact, I had to break down and order some smaller scrub pants, since a lot of the ones I own were unable to be cinched tight enough at the waist (I'm all about the drawstring) to prevent them from dragging on the floor.  But I don't look at myself and say, "you know what, I do look thinner!"  I guess because I look at my face and body every single day so I'm not noticing the subtle changes.

Anyhow, this loss means I'll have 22 pounds to go before I hit my minimum ideal weight--27 until I hit my maximum.  145-150 looks good on me; any less, and I start to look ill.

I'm hoping to lose the rest, or at least most of it, before the eye surgery in August...yes, a date has been set.  Late August.  I have already informed my manager that I will be having some minor surgery (didn't say for what) and will be off work for up to 10 days.   I asked if I should put in for time off now, or just wait and see.  No response yet and it's been a couple of weeks...I think I need to remind them that I will be off for surgery starting on that day regardless of what they say.

My weight loss stalled.  I'm not gaining though, which is a good thing.  But I'm holding steady at the 20-21 lb mark.  My shift in sleeping schedule--and thus my shift in and laxity of intermittent fasting and what I'm eating--is probably the reason behind it.   Plus Easter chocolates.  I've improved on the wake-up bag of Doritos though I did have one this afternoon...I was a charge nurse last night, it was a wild night, what can I say?  My soul craved Salsa Verde.

I'm sure once I'm back on my usual schedule and meal plan, the loss will resume.  I need to get back into exercising as well.

Work has been...work.  I thought about calling out tonight or at least requesting a cancellation.  But given that both the little one and I will have various medical expenses coming up, it's better if I work and get my full pay with weekend diffs than just the PTO at my base rate.

I successfully started 2 IVs in the last couple of weeks, bringing my EVAA (estimated vascular access average) up to around .300.

Acuity has been high on every unit since before the full moon.  There are lots of little changes going on to help prepare us for various site visits.   New staff are going to be starting soon, including a new grad (someone who wanted into psych, no less!), so there's been some shuffling around of who is working what unit, who will be doing what, and what schedules will be changing.

Come to think of it, that shuffling has been happening for a while.  It seems like TPTB are into floating staff around and people are working where they usually don't.  I think part of this is due to new staff coming on board, as well as the budget--they want to fill in the coverage gaps so they don't have to pay people to stay late or come in on OT.

I'm eyeing all of this with a little apprehension and concern.  I thoroughly enjoy where I work and I don't have plans to leave anytime soon.  I'm glad to have new staff come on board.  It'll be nice to have staff more evenly spread so there's fewer gaps.  I'm excited we have a new grad that appears to be want to be here and not just wanting to get their mandatory first year over with to leave for more medical pastures.

But I also wonder with all this shuffling, where I will fit in.  Yes, I know some of this is my well-known (well-known if you've read this blog anyway) anxiety/insecurity.  I know the union means they can't just fire me without cause.  I know they can't change my schedule without my consent.  But I'm hardly on my home unit as it is, so I wonder where I'm going to be stashed with all of these changes...especially since some of this new staff is coming to my home unit.

I'm trying to be Zen about it and take a "wait and see" approach.  See what's going to happen to me--if anything--before I make my concerns known to the TPTB.   It could be that I'm getting rattled over nothing, and everything will be the same as before or better.  Or not.

Whee

The little ones are on Spring Break, which means I've had to adjust my sleeping schedule.  I now sleep in the evenings, go to work, then stay awake to do things with them.  It's been working out so far...its a nice change to stay up after work, and I'll admit that it's easier to fall asleep when it's starting to get darker out as opposed to brighter.  But this won't work when they're back in school, so in a couple of days, I need to return to my regular schedule.  I may shift back to this in the summer, we'll see.

I've been enjoying the last few days off.  I've caught up on sleep.  I'm spending time with the family.  I've turned down requests for work.  I'm just recharging the batteries, getting ready to once again tackle all of the Axis II that seems to have infiltrated the patient population.

The tough thing about personality disorders is that they are how a patient is wired, meaning that nothing is going to cure it.  Sometimes I do wish it was like psychosis, where a shot of Haldol will make the pink elephants go away...at least for a while.  Alas, it's not.  Medications may help them manage their symptoms, but the patients need some good old-fashioned therapy--usually CBT or DBT--to change how they think and respond.  But because they are wired this way, it's also incredibly hard to effect change.

All the Axis II can wear a nurse out after a while.

I'm debating if dealing with Axis II disorders is more exhausting than working with patients in mania.  Both can be challenging, frustrating, and have medications end up with little to no result.

But a manic patient with Axis II...now THAT'S a hurricane!

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.