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.

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.  

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.

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.

Back on the wagon

So the theme for the last three days has been Doritos.  Massive amounts of Doritos.  All flavors of Doritos (BTW, whoever invented Tapatío Doritos has my eternal adoration).  Doritos for breakfast, lunch, dinner, and bedtime snack.

OK, not that many Doritos.  But a lot of Doritos nonetheless.  More than usual.

That plus lax eating for the last three days...I'm scared to step on the scale.  The last time I weighed in a few days ago, I hit the "23 lb lost" mark.  I know I'm not going to have gained 10 lb in those three days...but still, I think I'll wait until the weekend--and a few days of intermittent fasting--before I weigh in again.

I just felt like going off the rails these last three days, what can I say?

I broke 20

21 lb lost to be precise.  But today, I'm back across in the high 19s, but I did have barbecue for dinner:  a French Dip sandwich.  And that au jus is seriously a liquid salt lick.

I had a patient yell at me for most of my last shift.  Reason:  I existed.

They started in on me, in full-on oppositional form and at the top of their lungs.  After a couple of attempts at reality orientation--which they were not receptive to--I told them, "OK, whatever you say" and went about my business with my poker face on.   I learned early on in psych nursing not to argue with actively psychotic patients because it's an exercise in futility.   They're going to believe what they want to believe, and no amount of discussion is going to convince them otherwise.

Said patient didn't really like that I was not standing there being a willing target, that they weren't getting a visible reaction, and that most of my responses were "whatever you say" or other blandness.  They tried bating me by calling me a few choice names, but that didn't work either...after several years in psych, I've already been called every name in the book plus a few new ones.  So if you want to offend me by calling me names, just be aware that the bar is set really really high.

Said patient kept ranting on until they found another person or object to briefly distract them, then returned their attention to me.  They were also manic, so their energy didn't wear down.  They kept it up until the moment I left.  Something about me must have touched a nerve with them, I guess.

Funny thing was, they weren't even my patient.  I just happened to be on the floor that shift.

Just a typical day at work.

Is it wrong of me to want to be able to eat a bag of Doritos without interruption?

And without having to lock myself in the bathroom to do so?

I believe not.

Yet the little ones will not let me do that.  But then I realized how I could make it possible.

So on my way home this morning, I stopped at the local 7-11 and got a small bag of Salsa Verde flavored Doritos.  I took it and a Diet Dr. Pepper into the bedroom with me.  Then I turned on my sound machine and went to sleep.

When I woke up, I got the bag of Doritos and the soda, and feasted before I turned the sound machine off.  The family knows that when the sound machine is on, they can only enter if there's a fire or copious amounts of blood are involved.  So I knew I would not be interrupted unless the house was burning down or the little ones got into a playroom brawl.

I have no regrets and I do not feel guilty.  Not. One. Bit.

I'm also almost 20 lb. down since starting the intermittent fasting in the middle of October.   19.75 to be specific.  The fact that I don't eat for 16 hours out of each work day (on days off, I scale it back to 12 hours) lets me eat whatever I want--within reason--during the other 8.

In which Meriwhen shrinks, and crafts a resignation to boot

Since November, I've lost about 15 lb.  I decided to try intermittent fasting...well, the Leangains method, since the idea of going 24 hours without any sort of food is inconceivable to me.  Well, except that time I had my tonsils removed:  I lived on ginger ale for a whole month because it was too painful to eat anything at all.  I lost 30 lb. that month, but I don't recommend tonsillectomies as a weight loss method.

The all-the-ice-cream-you-can-eat thing is a myth, BTW.  And if you can, get the tonsils out when you're a kid.  I was 21 when I had mine removed.  I'm still traumatized from the experience.

So Leangains....you fast 16 hours, eat 8 hours.  So I don't eat at work and go right to sleep when I get home.  I wake up and then I have 8 hours to eat what I want.  I still try to eat sensibly though, but I do feel less deprived doing it this way than I would if I was counting calories and looking at forbidden foods.

So 15 lb done.  20+ to go.  I'll be happy if I hit the low 160s.  I'm tall, so I can carry 160s well.

Anyhow...

I officially decided to resign from Job #3.  You know I've been on the fence about it for a while, and I was going to do it in November until my new supervisor happened to be a former coworker/friend who didn't want to see me go.  So I held off and held on.  I wasn't scheduled there at all in December, which made me realize how much I've been missing my days off.  And the better half and little ones loved having me around more instead of hauling off to the day job after a full week of working nights.

Then I was a no-call/no-show at Job #3 in January.

I'm very meticulous with my work schedules, and often know them better than the schedulers.   For some reason, the day I was scheduled for this month escaped me and my calendar.  I didn't realize what happened until the scheduler called me to make sure I was alive (that's how meticulous I am--if I don't show up for work without calling off, they automatically assume I'm dead or on the way to death).  I reassured her that I still had a pulse (74 bpm), then checked my e-mails...and found the one where I agreed to work that specific day.  Still don't know how it got away from me.

But you know what?  After finding out I was a no-call/no-show...I was strangely apathetic.  I didn't seem bothered about missing work itself.  I was more bothered that I didn't keep the calendar up.  But as for not being there...I sometimes feel guilty calling off when sick and holding a doctor's note in hand.  But I didn't feel guilty about this.

And so I realized that perhaps, it's time to let Job #3 go.

The problem is that I actually have to resign in person...well, via company intranet.  So I have to wait until my next scheduled day in February (and yes, the calendar was triple-checked), and then go resign.  I'm working on my letter that I'll fax over with the computer resignation explaining why I'm going.  The official reason--and actually, the honest reason--will be that I am taking on more responsibilities at Job #1 and that I will no longer have the extra time to meet the PRN requirements.  That is a story for another post.

I called Human Resources at Job #3.  I only have to give 72 hours notice (really!).  I plan give 3 weeks and work all the days I have scheduled in February.  I will talk to my friend/supervisor first, to give her a heads-up so she's not blind-sided.

Some non-nursing stuff

Having settled down in a permanent position, I now have new health insurance.  It's through the same organization.  I'm not too worried about coworkers looking up my info, as the EMR software is very good about tracking such things with employee accounts.  If anything, they'll find out that I'm really not lying about my age.

So earlier this year, I got a physical physical, a psychiatric physical, and decided to address a few chronic problems.

Overall, I'm in good working order.  Labs are beautiful:  total cholesterol is 111 despite my cheese addiction.  Fasting blood glucose is in the 80s.  Blood pressure is well-controlled with my one medication.  I'm exercising about 5 days a week so that's probably helping all those along as well.  I could stand to lose some weight, but that's nothing new.

Psychiatrically, I'm doing well.  Been feeling pretty good.  The medications received a slight dosage tweak, but no major med additions or changes.  The psych NP offered me the option of a seeing a therapist...I declined for right now.  I've done it in the past and have had hit-or-miss results.  Plus I don't have anything going on that I really need therapy for.  I'm coping with my father's death pretty well, though December is going to be hell on wheels.  But I'll worry about that in December.

Most of my chronic physical problems are already as controlled as they can be, so there wasn't really anything they could address.  But there's always one...

Long story short:  sinus problem unresponsive to most treatments and is now playing havoc with my ear.  It's to the point that I've incurred some low-level hearing loss in that ear.  Hopefully it's a temporary loss.  It's an annoyance, because I feel impaired on that one side.   Allergy and sinus meds are not working.  And I've been purchasing so much decongestant from the pharmacy that I'm sure they're wondering if I'm running a meth lab.

Anyhow...

The nice thing about going through the same organization as my job is that referrals are easy, fast and have minimal preauthorization hassles.  Plus they can all access my account, so no need to deal with releases of information.  I left my PCP's office in the morning and by the afternoon, ENT was calling me to schedule.

So since then, I've had several visits, several tests including a CT, and trials on several medications.  Nada.  I'm now at the point where I've been referred to the ENT surgeon.   Great, the possibility of surgery.  Right when I've taken the full-time job and become the primary breadwinner.  At least they could do most sinus surgery on a same-day outpatient basis, with downtime of only a week or so.

Fortunately, he's not ready to operate just yet.  I'm on the latest trial of two medications, and at the end of the month I go for another hearing test and re-eval.  Unfortunately...these two meds don't seem to be helping much.  Though my hearing seems to have improved a little.

I'm entering the final week of my assignment with Job #3.  When I started I thought I would struggle because it was so long since I had worked there (6 months!), but I found that it came back to me pretty quickly.  It's also a nice change not to wear scrubs to work...though I'm ready to get back to them.  I only have two pairs of dress pants so I have to do laundry frequently.  And I can't wear skirts because of the tattoos on my legs, which would take quite a bit of Dermablend to cover them up.

After this is the nursing convention which I am working at.  I didn't schedule any work for most of that week, so even though I'll be "working" for the forum, I won't have to work.  Then after that my schedule is rather light until the middle of June.  I kept it intentionally so since I have to renew BLS, ACLS, CPI and a bunch of other things.  Plus do some things around the house before I begin my summer assignment at Job #1.

Then there's the ED preceptorship, though it may not happen right away.  I finished part 2 of the ED course and wrote the school saying that I would like to do the preceptorship.  The instructor, the school and I are trying to negotiate when this can happen.  We're aiming to do it at Job #1 (the instructor happens to work for the same healthcare organization as I).  I had told them that either mid-May to Mid-June, or I'd have to wait until October after this assignment.  I'm thinking it'll probably be October, since it takes time for my organization to get things processed.  Plus in October, I'll have a lot more freedom in the days and shifts I can work.

So in the meantime, I'm getting all of the paperwork and requirements completed.  I may have to take PALS...I think I'll try to do that before the summer.  I took it once before but I had let it lapse, so it won't be entirely foreign territory.

In the meantime, I started working out regularly.  I actually started on April 1.  I've been doing a workout DVD about every other day.  I don't think I look any different, but I do feel better overall.  And on day #1, I couldn't get through the workout without stopping every few seconds--now my endurance has increased to the point that it's rare if I pause.

I also started paying closer attention to what I'm eating because I didn't like my most recent GFR.  Yes, I know that a GFR measurement alone does not indicate kidney disease...and fortunately, all of my other levels were fine.  But I did have the preecplampsia and then post-partum preeclampsia from my pregnancy with littler one, and since then my GFRs have been below normal.  This one is the lowest yet.  Also, my blood pressure still requires a med to keep it under control, and I could still stand to lose weight.   So let me act on a potential problem now before it becomes an actual one.

Happy New Year!

Long time no write...it's been pretty darn busy around here.  Not all of it has been work though...in fact, I've been cancelled for most of this past holiday season due to low census.  I wonder if I'll even be cancelled today.  I know, it doesn't seem likely--after all, it is a holiday.  Then again, it wasn't too long ago that I was cancelled on a Sunday.  And it being a holiday does mean time and a half pay, and I'm sure there's lot of permanent staff that would like that.  I'll know by 1300 if I'm working or not.

So let me catch you up on everything since the last post.

November was full of lots of work at my main job.  Job #2...I haven't  been to and I'm not sure if I'll be going back there anytime soon.  They're a good agency and I do like where they send me, but it's a significant pay cut to work for them, so my efforts have been pushed at jobs #1 and 3.

Job #3...picking up a few days here and there.  They're debating about going on strike in a couple of months so I've been a little wary.  I've no intention of being a scab, but at the same time, I'd feel bad if we went on strike on one of the days I was scheduled to work for them, so I've been hesitant to be available for them.  I discussed my concerns with one of the staff nurses, and she said that I should just schedule myself whenever I want, and if it turns out that I'm scheduled on a day we're striking to just not show up to work, especially as they wouldn't let me in to work anyway.  OK.

I finished the first ER nursing class.  I learned a lot.  I got to put some of it into practice as at work, we've had to send a few patients to the ER.  And I got to see it in action from the patient POV as I had to take one of the little ones in.  He turned out to be fine.  The class helped me understand a lot of how the ER works, so I had more patience than I might have had otherwise...but it still was a long night for me.

December's work schedule has been skimpier because the census has begun it's annual holiday drop.  As I mentioned earlier, I got cancelled for a lot of the holiday season.  One of the unit managers felt horrible about having to cancel me--really, it was so sweet.  He wrote this long rambling e-mail about how I was valued and how he was happy to have me working on his unit any time...I told him not to worry, I know how things work d/t census so I don't take it personally.  I also mentioned the family coming in and that the cancellation would be a blessing in disguise.

The littler one and I both caught the stomach bug that has been going around.  Projectile vomiting is not fun at all, neither as the one vomiting nor the one being vomited on.  

I am now one year older.  Happy birthday to me!

Holidays.  Shopping.  Family in from the East.  Prepping for all of this took up most of December.  Then they arrived for two weeks...getting cancelled was indeed a blessing as we ran all around town for those two weeks.

I gained a few pounds despite my best efforts.  All that good food...

Last night, I didn't even make it awake until midnight.  Oh well.  I'm at the age where it's not the big deal it used to be.

So today.  New day, new year.  I generally try not to make "will/won't" resolutions but instead come up with some goals that I'd like to accomplish.  I think resolutions are too narrow and don't allow room for human error, whereas goals are more forgiving and I feel less horrible if I stumble along the way.

Though I did take on one spur-of-the-moment challenge.  I signed up for Dryathalon.  I figure that it's for good causes:  sponsoring cancer research, jump-starting weight loss, and giving my hepatic system some time off.   I'm putting my money where my mouth is to help keep me on track...and if family/friends want to support the cause as well, that'd be great.

The last time I gave up alcohol for something, it was for Lent and I ended up pregnant.  At least this time, pregnancy is an impossibility.

The next challenge

The 30-Day Shred is the most agonizing 22 minutes of my life.  I struggle through it grunting and panting.  For whatever reason, I have difficulty with a different exercise each time:  either certain muscles are sore, or I just can't get the form right, or I get fatigued really quickly.  I'm cursing anyone and everyone--especially Jillian Michaels--in two languages.  When I get to the final stretching period, I stay face down on the rug and pray for a swift and painless death.  Then two days later, I go and do it all over again.

The scale isn't budging, but the pants are fitting better and better.  And I've been told by someone that I've really lost weight, so I guess it's working...or they're being too kind.  Who knows?

Soreness notwithstanding--I have a torrid love affair going on with my bottle of ibuprofen 800mg--I do feel better overall  Not that I'm ready to run a marathon...but I feel more "fit" than I did at the beginning of the month.

Anyhow... 

I requested that my transcript be sent to myself as soon as my degree was conferred, so when it gets here, then I can officially sign things with "BSN."  I guess I technically could use BSN in my signature since I did complete all requirements, but I feel weird doing it without having my degree in hand.  Or at least having a transcript in hand stating that I have earned that degree.  

Since I no longer have classes to take and clearly still need another outlet for my energies (besides exercising, I've read several books, already knit a shawl and two hats, and have cast on another pair of socks), I decided that it was time to embark on the next challenge:

It arrived in the mail earlier this week.  I'm joining the elite...or going to attempt to, anyway.  From what I hear, this examination is truly hell on wheels.  So I decided that if I'm going to make the Spring 2014 test, I need to start revising now.  I have this guide, I have a bunch of addictions manuals, books and journals to go through, and I've made arrangements to pick up more hours working shifts in the addictions programs over the next couple of months.  I also need to sort through my CEUs and see how many addiction ones I have finished, because I will need to have 30 CEUs completed before I can test.

I feel a bit better doing this.  I've been working so hard at school for so long than I feel like I'm wasting my time if I don't work towards the next thing. 

It's been a busy several days.  Between both jobs, I've been everywhere:  ER, outpatient, partial, step-down, back to the ER.  Thanksgiving tomorrow....no four day weekend for me...I'm off tomorrow, but on for Friday and Saturday.  I'll do my Black Friday shopping online.

I've done the 30-Day Shred for five times now.  Considering I started on Halloween, I'm averaging about one workout every two and a half days.   I haven't lost any weight, but some of my pants fit a little better.

I've also gained some endurance.  When I first started, I was only able to do five consecutive push ups before stopping for rest.  Now I can do eight consecutively.  I went from doing 15 in a minute (be aware that the minute is broken up into two 30-second sections) to doing 30 in a minute.  That is serious progress for me.

I'm also getting through the DVD with fewer breaks.  It's not pretty, and I prefer that no one be watching me as I workout as I'm sure I look as much of the uncoordinated wreck as I feel like I am.

I had to modify one exercise.  For reasons unknown, I can't mock jump-rope without having severe pain in my right tricep.  Even just the jumping without the mock hand actions hurt.  I can do the jumping jacks with no problem or pain.  I just can't mock jump-rope.  So I march in place for that segment...it's probably nowhere as effective, but it enables me to keep going.

I'm on a new assignment this week.  I'm vaguely familiar with the program that I'm going to cover, but it will be trial by fire.  Should be interesting.  It's at my main facility, so that means guaranteed shifts:  no worries about cancellation.  Three full days, one half day.

I also have no three-day weekend...oh well.  That's nursing for you.

Ow

As the first days of the rest of my life play out, I started doing an exercise workout:  Jillian Michaels' 30-Day Shred.  Tagline is that I can lose up to 20 pounds in 30 days.  Now, the nurse in me knows that losing 20 pounds in 30 days is a.  not necessarily safe, and b.  not likely to last for the long haul.  I'll settle for losing 5 pounds in 30 days.

This is a short yet intense 20 minute workout.  I need nothing but the DVD, a workout mat, hand weights (which I didn't have until today, but I didn't let that stop me), sneakers, and 25 minutes to allow for a little warm up and cool-down.  Little one #2 providing commentary optional.

I opted for the easiest workout level and followed the modifications for beginners ("If you feel like you're going to die, follow Anita").  It was TOUGH.  Seriously.  I would have wimped out and burned the DVD if it was going to be any longer than 20 minutes.  I was so sore that I needed three days and plenty of ibuprofen to recover...and mental note to myself:  do not attempt a new workout before working inpatient.

I wasn't entirely ow-free when I did the workout the second time, but I also knew that if I didn't get back in the saddle as soon as I could, it'd just get harder and harder.  So on day three, I did the workout again.  The second time went a little easier, and I wasn't quite as sore.  I didn't need as much Motrin.

Since I was feeling a little better after this workout, I waited two days and did it again.  The workout is getting easier.  Yes, I still feel sore.

Anyhow, the rate I'm going, it's going to take me about 90 days.  Thank God I didn't opt for Power 90X.  That might have taken me half the year.

Swimsuit model...and happy anniversary

Four years ago today I found out that I passed the NCLEX.  Happy nursing anniversary!

As I wrote earlier, we're going on a small vacation this month. I dug out an old swimsuit which fit me...for the most part. It's passable...but not flattering. 

You see, even though I am now at my pre-pregnancy weight, this body does not look like it did before I actually got pregnant. Two children have wreaked their havoc on the body. The stomach is flabby from being stretched out, cut open and sewn back together. 50 pounds gained the first time and 41 pounds gained the second time...surprisingly, I do not have any stretch marks. My chest is still pornstar-esque in its dimensions, though it has shrunk slightly--I think I may now be an E cup instead of an F. 

The burn scar is pretty hideous...ok, that's not the children's fault in any way, shape or form. But the fact is that I can usually pretend it doesn't exist as shorts/pants neatly conceal it.  Swimsuits do not conceal it.

*sigh*

 So after work, I dragged the family two towns over to where a Lane Bryant that sells swimsuits exists. One day I will graduate from having to shop there...I'm not too far off: I fit into their smallest sizes. 

Anyhow, I go and look at swimsuits. Unfortunately for me, they just had a swimsuit sale and pickings are slim. If I were a size 22 or 24, no problem. A size 14 to 16, however… I did find one that could have worked. However, it had a corset-style lacing that made it impossible to get myself into…but that wasn't the deal killer. The deal killer was the $120 price tag. Seriously, if I'm going to spend over a C note on a swimsuit, it better be easy to get into and apply my sunscreen for me. Plus the fact that I intend not to be this size for the rest of my life, so why am I going to spend $120 on a swimsuit that hopefully I won't fit into a couple of months down the road.

So I went home and ordered a swimdress from their website. $50, which is more than I'd like to spend on a swimsuit…but better than $120. I just hope it arrives in time.

Back in the hamster wheel

I am finally below my pre-pregnancy weight...well, pregnancy #2 anyway.  That weight was 198.  The scale today told me 197.4.  It took 2.5 months to get here, which is pretty much how I planned it.

Yay!

So now the next mini-goal is 190, at which point I will have lost 10% of my starting body weight.

No one believes I weigh what I do though...but keep in mind that I'm tall with a large frame, so I carry it well.   They also don't believe my age--I tell them that's the result of being pale:  I was forced to adopt the sunscreen habit early in life.

Anyhow...

The first day back for the agency went better than I thought.  A lot of faces have indeed moved on...though I was pleased to find three working on the unit with me.  The new grad (no longer new, really) who last year I thought wouldn't make it is still there...I'm delighted to have been proven wrong.  Seriously--I'd rather see people succeed...and feelings of schadenfreude do not really do me any good in the long run, so I try to avoid them.  A lot of the facility staff remembered me though, and asked what had happened to me.  So I showed off little one #2's pic a lot.

There were indeed changes to how things are done there, but I adapted pretty quickly.  They rearranged the staffing plan so there are actually more RNs needed on the unit, with the LVNs functioning more as medication nurses.  I didn't do triage but was placed in the back and given a patient load of 5.  They asked if that would be too much for me.  I remembered what life as a nurse was like back on the East Coast and tried not to laugh hysterically.  Oh California, how I love your ratio laws!

Everyone kept offering me help, which I didn't hesitate to request if I needed it.

The first patient I had to assess was inked to within an inch of his life and had generalized HI with a plan involving superglue.  Oh inpatient, how I have missed thee!

I was a little nervous at the start of the day, but by the end I felt pretty comfortable.  Hopefully I didn't make too many mistakes that they won't ask me back next week, but we shall see.

There weren't many agency nurses, as I had initially heard...scuttlebutt was correct in that the pay cut made a lot of them move on.  They also seem to have hired more permanent staff, though some of them seem pretty green as nurses period.  The last time I was working the unit, it was mostly agency nurses with few permanent staff--now that is reversed.  I'm not sure what this will mean in terms of my getting hours there...I suppose if I get cancelled during the week I can always put in for a weekend shift if I need to.  As long as I work the 4 shifts a month I need to in order to pay for childcare.

11% there

I lost 7 pounds during the week, and I'm betting most of that is water weight.  Still, a loss is a loss!  I did have to adjust the caloric intake up a bit so breastfeeding isn't adversely affected.