The "B" word

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

Still here?

OK.

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

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

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

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

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

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

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

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

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

Nah, I'm probably just being paranoid.

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

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

In which Meriwhen discovers why she is bikini-challenged

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

You've been warned.

Still here?

So here we go.

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

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

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

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

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

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

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

*sigh*

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

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

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

Except it's not. 

It hurts. BAD.

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

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

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

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

Really? Let's meet the players.

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

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

What were you expecting, a rant about my thighs?

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

I forgot to mention how the orientation went...

The NP program orientation went well. 

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

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

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

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

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

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

I forgot how expensive textbooks were

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

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

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

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

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

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

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

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

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

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

So I got into NP school...

It's clear from the subject of this post that I got into the NP program. But let me explain the adventure it was.

I'm keeping my plans on the QT at work. Only a few people know, mostly because I had to ask them for letters of recommendation. Plus, anyone that had ever managed to figure out my AN identity and who reads this will now know. The Powers That Be don't know yet, and they won't know until I file my first tuition reimbursement request come winter. 

I'm hoping to keep it that way, but it is a small workplace, and news has a way of getting out...if asked, I'm going to stick with my "neither confirm nor deny" line. Though considering I found that at least two coworkers will be in the same program, one possibly in my specific cohort, I'll have a hard time using that line if and when we're on campus together.  

The first fun part was rounding up several schools' transcripts. This is what happens when you go BA to ADN to BSN take 1 to BSN take 2 to MSN, with a side stop at a tiny community college for just for one class because that was an important class you needed, and you happened to be living there at the time. 

The good news is that due to COVID, official electronic submissions were acceptable, so that would save a lot of time. The bad news is that the NP school itself was so backlogged with stuff that it took forever to get to them. Then there was the fact that two of my schools were in Texas, which had suddenly been quick-frozen by that cold snap. They had more important things to deal with than my transcript requests. But they eventually got them out, and the NP school finally got around to evaluating them.

Second...the three Ps. Every MSN program has the three Ps: Advanced Pathophysiology, Advanced Pharmacology, and Advanced Physical Assessment. I had hoped to use the classes I took at WGU to opt-out to repeat them in the NP program. Alas, the application review board has deemed that the WGU version of the classes is not equivalent. Ironically, the assessment class was the one that I won two Excellence Awards in. It would have been nice if I could have opted out of at least that one. But no, not meant to be.

The NP school advisor then suggested I try placing out of the 3Ps by applying as an APRN. Alas, again, I am not one, so I declined.

This sucks, as placing out of the 3 Ps would have been 15 credits of work and tuition saved. But it is what it is. And to be honest, I think I could use a more thorough review of all three courses than I got at WGU. While the competency-based learning was nice, it was also a lot of DIY, and in these courses, not really a lot of content taught to us. On a related note: if you plan to go to NP/DNP school after your MSN, you may want to rethink going to WGU for that MSN. I enjoyed my WGU experience and don't regret doing it. But at the time, I also had no plans whatsoever about pursuing the NP. If I could have foreseen my considering NP school three years ago, I would have made different plans in 2018. But I can't unring the bell.

Getting everything else submitted was a piece of cake. 

I admit I was nervous about not getting in, especially with them turning down the 3Ps--would they also not be happy with WGU's pass/fail system? So it was a relief to get the acceptance letter. I'm in the post-grad program, but I'm going to be going along with the regular MSN students who have to take the 3Ps. One of the coworkers mentioned above will be in that startup, and I supposedly join them in July. It's a little bit of a weird situation, but then again, things with me usually are.

Now it's time for all the "pending" stuff. You know, "admitted to the program pending a background check, drug screen, immunizations, etc." I have two weeks to get all of this done before my Zoom orientation, which happens to be tomorrow.

Hurdle #1: physical exam. Video visit won't cut it. The earliest appointment is next month. Fortunately, the NP program is OK with this.

Hurdle #2: immunization records. I send an ROI to my providers' records department and am told it will take 15 BUSINESS days to get them. Oy. Fortunately, the NP program is OK with this too. Fortunately, again, COVID vaccination is not required.

For the record, I am NOT an anti-vaxxer. I am very much in favor of vaccines. But because of my health conditions, I merely prefer the vaccines I receive to be thoroughly road-tested and have full FDA approval before I get them. 

Hurdle #3: drug test. This one is always fun because of my prescription medications. I'm guaranteed to test positive in one category. Two if I use the PRN anxiety medication. Fortunately (word of the day?), this has not been a problem for me so far. However, I'm always nervous because you never know when an employer/school will get picky.

I look up the lab to see what locations are available for me to get tested at. The closest is 10 miles away.  After that, 25+ miles. OK. 

I try to set up an appointment for the test...and all available appointments are either too close to the cutoff date or afterward. OK.

I expand the search to all sites...same thing. Too close or too late. OK.

I look to see who takes walk-ins. 10 miles does. So I call them to confirm, and their automated system says, "while walk-ins are welcome, appointments are preferred." That means walk-ins are still good. So I drop everything and go.

I get there and wait. And wait. And wait. And wait. I have no idea how long I was there before I was seen. When I'm finally called, the lab tech tells me that she had to see everyone else first because they don't take walk-ins for drug testing.

"Then you may want to update your website and phone message," I reply.

Well...had I bothered to listen past the initial part of the automated message, I would have learned that appointments WERE required for drug screens. My bad. But she was kind enough not to reject me, and I was grateful. I also learned the valuable lesson of listening to the whole message before hanging up the phone.

The test is done...and it took forever to get the results. I started wondering if they had lost my sample...remember, that happened to me once before, in the first BSN program. They were going to bounce me if it wasn't for the fact that I had my chain of custody receipt. Thank God I saved the receipt then, and thank God I saved it again this time. Then I started wondering if, finally, someone had an issue with my test results and if I had to go in armed with my prescriptions and a doctor's note. 

But they finally arrived today, and I'm good to go.

And here I am. I go to my all-day orientation on Zoom tomorrow. I will have to hole up in the bedroom to do this...or I may hole up in the little one's room. Either way, I need to find a place to hole up in for 7 hours.

I'm alive! And a new path...?

 What has it been, more than two years since I last wrote?  Yeah...life has been busy.

To give you the Readers' Digest version of what has happened in my life in the last two years:

• Adopted a puppy...who is no longer a puppy.  It's nice to have a new dog in the house.
• Had to take a break from moderating duties at the forum because graduate school was just too much work.
• Went to Spain to see family. It was my first time ever in Europe.  If I could move to Madrid, I would.
• Was transferred to a new home unit at work.  I was spending so much time on the psych ICU that they finally decided I should officially be assigned there.  So I was, and then the next day, immediately floated back to med-psych.
• Moved to an even smaller town in the mountains.  Smaller house but more land.  I love living in the middle of nowhere.  There's definitely a lot more space, a lot fewer people, a lot more livestock, and a lot more wildlife.
• Went through three advisors in graduate school.  The first was there only a couple of months before she decided to return to a job in the NICU.  The second was awesome!  We were together for most of my time there until she decided to take a job with the state Department of Public Health.  At this point, COVID-19 was still in its infancy, so she had no idea what she was getting into...
• Oh yeah, COVID-19.  Life upended.  Kids home constantly.  At least in my new small mountain town, I could go outside and not have to mask up like I was going to see a TB patient.
• COVID and I became intimately acquainted.  It was the 10-day headache.  Fortunately, the recovery was quick and full.  And fortunately, the family was spared.
• Graduated with my MSN-ED.  Did not leave my current job as it pays too well.  Plus, I never planned to immediately go into education...that's the long game, for when we leave the state and/or I decide to leave the bedside.
• Got through the strangest holiday season.  My mother decided to fly out from the east coast for two months, so every two weeks, she would shuffle between my home and my sister's home.  
• Meanwhile, our governor was busted violating his own health rules, so he threw a hissy fit and closed the state down through the holidays while she was here.  This meant we couldn't do much except go to the parks and the reservation casinos.
• Things started getting back to normal-ish after the holidays.  
• I was offered the COVID vaccine.  I declined it for now.  I'm waiting for the data on its long-term effects and possibly even on the final FDA approval for one of the variants.  Then I'll consider taking it.   Plus, I have bad allergies which make me very hesitant about taking experimental vaccines.

Which all brings me to now...

I received an interesting business proposition...which requires me to be a psychiatric nurse practitioner.  Since I wasn't rushing to go right into education, I decided to think about it.  

I have a MSN, so I'm already part of the way done.  I could afford school without having to take out a loan (though I'd fight like hell to get as many scholarships as I could!). I'd have a set spot for my clinical hours. I'd have a job when I graduated.  And even if the proposition fell through, having the NP would give me more career opportunities, especially if I am planning to leave the state. 

Overall, I think pursuing the NP might be worth it.  

So let's go apply and see what happens.  After all, I'm not committed to anything by applying, right?

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*