Meds for the win.

Saw the power of some medis yesterday, and in a non-addictive, non-benzo, non-narcotic, non-ambien kind of way. Wait, is that possible? Yeah it is so someone better alert the masses that other medications besides Xanax can help. You can try but no one will believe you. 

I met the coolest, brightest veteran yesterday. Talk about someone who didn't let the horror of war bring him down. He went to college, got an advanced degree, and got a great job. Unfortunately he was injured on the job pretty severely and got a head injury. He was then fired from the job and started the process of recovery. He had a terrible time with his speech and memory after he was hurt which led to a terrible depression period. He was suicidal, put on a safety plan, given gun locks the whole deal. He was prescribed an anti-depressant and a non-habit forming anti-anxiety medication and came back for his 1 month follow up this week.

He is doing incredible, and not that I had anything to do with his care, but I am just so proud of his provider and of his will to keep fighting and trying to recover. He goes to therapy for the speech problems and isn't struggling very much in that regard at all. He will be okay, and his life will go on. He is a big success story at the VA because not many veterans who suffer from mental illness are able to recover like he did and his attitude and drive played a huge role. Good job, Mr. Veteran!

Long month ahead.

Oh boy this is going to be a long month. I'm one whole day into my psych rotation and already kind of shook up. The things I have heard today I won't be able to forget for awhile...these patients at the VA have been through, witnessed, dealt with so many terrible/unfortunate/life changing circumstances its honestly kind of amazing they can even get out of bed in the morning.

I am very moderate when it comes to politics and "hot topic" conversations and usually stay right in the middle on most issues and can see both sides. I have a feeling this rotation will make me change a lot of my own views on some of these hot topics. Seeing someone "in crisis" even making very general/vague threats about violence is scary. Seriously, it is scary. I needed my beta blocker like whoa because my heart started racing. I am such a non-confrontational person that it was hard for me to watch such anger and hatred....and also broke my heart. By the end of the session the patient was calm and reasonable and I was amazed at the transformation that took place in 50 minutes. The nurse practicioner I was with today is literally an angel in Danskos. The way she was able to methodically soothe this patient into having a reasonable conversation and push pause on the rage button was incredible. I am so thankful there are providers like her who can take care of these patients....I don't think I'm cut out to do it, but I know I'm about to learn a lot and see a whole new perspective.

Work Hard Play Hard Part 3

Another whirlwind of a month has gone by, and my first Internal Med rotation is over. The exam has come and gone thank goodness, and it's time to move on to Psych at the VA. This month promises to be interesting and eye opening I'm sure.

This month was once again filled to be the brim with academics, patients, work, studying, and with a lot of fun squeezed in too!

                         Off the Smoky Mountains for a fun Labor Day weekend at Brittany's cabin.

Bromance.com

Cabin love.

Downtown Gatlinburg at Burro Loco.

Dog Paddle with Timmy and Abby.

Celebrating Brittany, and Baby Quinn.

                                            Honestly though, could she be a prettier princess?

Oktoberfest (in September?), complete with the world's best funnel cake.

Slow and Steady Wins the Race

Over the past 3 1/2 weeks I have worked in a wound care clinic two days a week. These patients come in every single week and see a 1cm difference on a good week. I can only imagine how difficult it is for these patients to drag themselves into the office (the majority of them either wheelchair bound or amputees) week after week to see such little progress. BUT....the wounds do heal, slowly but surely. Seeing someone get discharged after coming there for 4 months etc is such a good feeling and they are so happy.

One of my favorite little ladies is 91 years ago and is brought there by her daughter who is 70 something, can you imagine that dynamic duo? They are beyond precious. When I first started seeing her she would yelp in pain as her wound was cleaned and it was terribly sensitive. Today, it was so tiny and didn't hurt anymore. She didn't make a peep. After getting double layer compression wraps to get the swelling down from her venous insufficiency, the wound was able to heal.

I will tell you though, the saddest and most heartbreaking patients in wound care are the nursing home patients. God bless them. Pressure ulcers are a horrible thing to witness, and I didn't realize how easy it was to get them (we had a couple people who had them simply from sitting so long during dialysis treatments). The nursing home patients/paraplegics are bed bound or wheelchair bound 24/7 and get no relief from putting pressure on they bony prominences. Or, they have deformities and contractures and their own skin rubs together in a way that causes the ulcers. Its hard for me to handle it, because there truly is not much you can do. They become palliative cases and you just try to avoid infections or progression, but the wounds don't usually heal completely. In these patients I honestly wasn't as concerned about their wounds as I was just talking to them and patting their hands. I will think about them for a long time to come.

I learned an incredible amount about wound care, something we aren't taught much in school. I will be able to take a lot from my experiences at the wound care center and apply them to those patients who have chronic wounds from diseases such as diabetes, venous insufficiency, peripheral vascular disease, osteomyelitis, etc....because we all know those things run rampant in healthcare and they're are lots of patients who need to be treated.

Baby Eli

There is a precious family I know from my hometown who have an adorable 2 month old, Eli, or "nugget" as they like to call him. He was born in July with hypoplastic left heart syndrome and hasn't left the CICU of Children's Hospital in Cincy since. He underwent open heart surgery at about 10 days old and has had an up and down battle since then. His family loves him with their entire hearts and I think of them all day as I see other families fight hard times and struggles with medical problems. I believe Eli underwent his 5th intubation this week as he has been having issues with his lung collapsing. His mom puts pictures of him up almost every day and he is just a little angel and looks identical to his older brother. I ask that you please take a second and send up a little prayer for this family, The Kleckner's, and baby Eli. They have barely been able to hold him and I want so badly for them to take their little boy home to play and snuggle. If you don't know much about HLHS, there is a link below for more information. xoxox

http://www.mayoclinic.com/health/hypoplastic-left-heart-syndrome/DS00744

Small victories

As a student, doing or saying anything correctly is always kind of surprising and just feels awesome, ya know? After all the times I contaminated myself, looked like a moron, used the wrong size speculum, got lost, stabbed myself, etc. it is just nice to know at the end of the day you really are contributing. Sometimes you surprise yourself with how much you do know, what you aren't afraid of, what doesn't gross you out, and what you step up to do. For me, who is typically a scared little church mouse, these small victories add up to feel like big accomplishments....even when I know they aren't. This week I did about a million Tdap injections, influenza vaccines, 1 UA, learned to to do an ear wash, went back to my neuro stomping grounds and did an MMSE, diagnosed an acute gout flare, recognized an acute CHF exacerbation and knew the poor thing was going down hill (she got admitted), made a medication suggestion that ended up being what was prescribed, and was told, "thank you for being so thorough." In the big picture of life these things become the mundane and routine parts of medicine that get taken for granted and receive no pomp and circumstance. So for right now I'm just going to be proud of myself for doing some good things and not having the opportunity to break sterile field (because we all know that would have happened....again.)

I Got 99 Problems But a Lortab Addiction Ain't One.

DO NOT GET HOOKED ON LORTAB. DO NOT START TAKING LORTAB, DO NOT LOOK AT LORTAB, DO NOT GO NEAR LORTAB, DO NOT SPELL THE WORD LORTAB BECAUSE YOU WILL GET PREGNANT AND DIE. (If you didn't catch that Mean Girls reference, I'm sorry...please go watch that movie.)

Lortab is not Ibuprofen, it is not Aspirin, it is not candy, it is a NARCOTIC. I'm sure you are probably thinking um duh everyone knows that...well, no they do not. It is not okay to take Lortab every time you stub your toe or have a cavity. Also breaking news, it is not okay to take your mom's Lortab which she gets prescribed via a pain management doctor for her severe back pain after a car wreck, IF IT IS NOT YOURS DO NOT TAKE IT. These are rules we learn in first grade and yet it seems to be very challenging. Gosh, I sound angry don't I? I'm really not I promise and I 100% agree that there is a time and a place for narcotics...just not after toe stubbing.

Kentucky laws regarding scheduled medications are crazy strict you guys. Indiana folks would go on a rampage if it were this difficult to get some "tabs." Watch out Hoosiers, if you don't start backing off the pain pills we might just roll out the red carpet for these strict laws and welcome them with open arms. I can really see how the strict prescribing laws of KY, which took effect in Oct. 2012, have made a difference for patients and providers alike. It makes everyone's lives more difficult and adds a lot of inconveniences, but it really cuts back on the prescriptions of controlled substances. You don't know how many times this week patients have "no showed" to their appointments because they knew their controlled substances wouldn't be filled, or they don't want to bother with all the 3 month follow up protocols because its not worth the inconvenience to take Ambien every day. To the people who TRULY need those medications, they come. The random urine drug screens sure do take some people by surprise, kind of a red flag when they refuse to do that huh? (I could go on and on about the pros and cons of these stipulations but I will spare you.)

Moral of the story is prescription drug addiction is not a joke, it is a real, troublesome problem that needs to be corrected. I think KY is off to a good start, and I have learned so much about these new laws the past couple weeks.

Nuts and Bolts

So after my first two rotations which focused on pelvic exams and surgical procedures, it was time to get back to the nuts and bolts of medicine....you guessed it....diabetes and heart disease. Would there even be medicine without diabetes and heart disease? Eh, yeah okay fine I'm sure there would be.

Anyways, Internal Med has a lot of diabetes and heart disease. It's not a bad thing, there are actually some patients who are very compliant, have great lab work, lose weight and live happily ever after. I wish I could say that was the majority, but sadly it isn't. Maybe they truly do not understand the risks they are taking with their health, maybe their insulin regimens are too confusing, maybe they don't have the proper supplies or equipment they need, maybe they cannot afford fresh produce or a gym membership, maybe they don't care....I think about all of these things when I see an A1c of 11. Honestly, it can be frustrating, challenging and exhausting. Even as a healthcare provider you can only do so much and that is not an easy pill to swallow.

My goal for this rotation is to be encouraging to these patients and to be their cheerleader. I know that after many years of experience all healthcare providers get a little bitter and a little worn out with non-compliance and I can't blame them. But I'm not there yet so I can still be upbeat and positive and help these patients realize that blood sugar checks and not eating milk shakes for breakfasts is the best dang thing in the entire world. Gooooooo Metformin!!!