I think my doc and I are bonding. He's calling my JZ (he thinks he's the first to call me this and I decided after telling him my former classmates now colleagues have been calling me that) but hey it's "cool" and now I call him Dr. G (out loud), so it's all good. Maybe I should start calling my nurse Snoop.
Random story - cultured some weird foot lesions that i thought were totally vascular in nature but honestly was stuck and had no clue what else to do, so cleaned it up and stuck the lesion with a 27g and cultured what came out of it - blood. There are multiple lesions on the feet only, following superficial veins and no Roth spots... Low and behold heavy bacteria growth. Still not sure what the heck it is but hoping 7 days of Clindamycin will kick it... or at least give the patient diarrhea - i know exactly what to do with this.
Made first loan payment - sigh... I feel lost in the world of loans. I owe so much money. To consolidate or not... that is the question. First third of my check to taxes, then the next third to loans... sad day. Learned my site doesn't qualify for loan repayment after all - need more high or medium security peeps.
Peace out!
Thursday, January 14, 2010
Saturday, January 9, 2010
Distance
Can be a good thing, or a bad thing, depends on what we're talking about. Example of distance being good: not buying a property next to an existing home with a shoddy barn with aluminum roof and siding used for playing with street raced cars - just not a good idea, guess I'm not a "let me hear your engine rev" kinda person (so goodbye lot 48 I think). Example of distance being bad: between us and our family and friends.
On Friday I found myself caught in the middle of good distance. I really care about my patients, I work hard to mange their health care even though many, if not most, work hard to undo my hard work both while in my care or out of my care doing their not so legal recreational activities. One patient in particular caught me off guard - history of heavy meth use, brittle insulin dependent diabetic. I've been revising insulin therapy daily, then on routine labs the A1C is down 3 points yay! but the potassium is high at about 6, chronic anemia not a huge deal, the kidney function crappy, creatinine over 2.4, ECG normal, looks no worse for wear than normal. Thinking these critical lab values are an error in part to shipping labs off to a place 3 hrs away, I redrew them the next morning and sent them stat to the local hospital - only to get a phone call with even higher values. Now off to the ER to get sorted out although most likely won't be returning to our facility and maybe not even back to life as apparently kidney function has continued to decline and critical electrolyte levels on the rise. I was upset and me being me I cried when I got home, I felt frustrated and took it personally that everything was out of whack although I know the chain of events wasn't all under my care. I have to find the balance of distancing myself with patient's care or I'm afraid I will burn out.
Shawn and I had our first mutual patient. Canine dog bite - he scooped 'em up and I took care of the patient the next morning at "the facility". Cool.
On Friday I found myself caught in the middle of good distance. I really care about my patients, I work hard to mange their health care even though many, if not most, work hard to undo my hard work both while in my care or out of my care doing their not so legal recreational activities. One patient in particular caught me off guard - history of heavy meth use, brittle insulin dependent diabetic. I've been revising insulin therapy daily, then on routine labs the A1C is down 3 points yay! but the potassium is high at about 6, chronic anemia not a huge deal, the kidney function crappy, creatinine over 2.4, ECG normal, looks no worse for wear than normal. Thinking these critical lab values are an error in part to shipping labs off to a place 3 hrs away, I redrew them the next morning and sent them stat to the local hospital - only to get a phone call with even higher values. Now off to the ER to get sorted out although most likely won't be returning to our facility and maybe not even back to life as apparently kidney function has continued to decline and critical electrolyte levels on the rise. I was upset and me being me I cried when I got home, I felt frustrated and took it personally that everything was out of whack although I know the chain of events wasn't all under my care. I have to find the balance of distancing myself with patient's care or I'm afraid I will burn out.
Shawn and I had our first mutual patient. Canine dog bite - he scooped 'em up and I took care of the patient the next morning at "the facility". Cool.
Wednesday, January 6, 2010
What's in a name?
Apparently my new nickname amongst my patient population (or code name if you will) is "peas and carrots". If you can name the movie it came from - gold star to you, I think it's much better than Bunny Ranch - the title a former PA held.
The firing has begun or to be more PC the " we're are hiring someone else to do your job and there's not another job opening for you" needless to say the last week has been tough, especially after the article in the Columbian last week that (and I am paraphrasing here, but same gist) ... we (clark county) weren't happy with the current company and they cost too much money for their services, there were also 10 custody officer jobs on the line, so we went with a company that came in $700,000 less that will replace RNs with CNAs to save costs and all ten officer jobs and the 100 beds were saved. Didn't sit to well with the nursing staff considering the new company told them they weren't cutting any ones job. So now it's anyone's guess to see who stays and who goes, although I've heard I am safe, our health service administrator was informed she won't be staying as of today. I'm very grateful to have a job, hope it's all true, I love what I am doing and I really enjoy the people I work with and the patients - it's never a dull moment (well sometimes reviewing 40+ charts daily gets a little monotonous).
The name of the new company is catchy... Conmed. Maybe us PAs can open our own outpatient clinic for followup care called Ex-con med? Just a thought.
And that's all I've got to say about that.
The firing has begun or to be more PC the " we're are hiring someone else to do your job and there's not another job opening for you" needless to say the last week has been tough, especially after the article in the Columbian last week that (and I am paraphrasing here, but same gist) ... we (clark county) weren't happy with the current company and they cost too much money for their services, there were also 10 custody officer jobs on the line, so we went with a company that came in $700,000 less that will replace RNs with CNAs to save costs and all ten officer jobs and the 100 beds were saved. Didn't sit to well with the nursing staff considering the new company told them they weren't cutting any ones job. So now it's anyone's guess to see who stays and who goes, although I've heard I am safe, our health service administrator was informed she won't be staying as of today. I'm very grateful to have a job, hope it's all true, I love what I am doing and I really enjoy the people I work with and the patients - it's never a dull moment (well sometimes reviewing 40+ charts daily gets a little monotonous).
The name of the new company is catchy... Conmed. Maybe us PAs can open our own outpatient clinic for followup care called Ex-con med? Just a thought.
And that's all I've got to say about that.
Friday, January 1, 2010
Welcome 2010!
It's already 2010! YAY! Not that 2009 was bad, because it was really pretty great with lots of new beginnings, a few endings and as always some great Zupfer adventures. We're excited to see what 2010 brings. There are lots of things to look forward to like Cubs vs Seattle in June, family visiting us, us visiting family, learning if Jenni keeps her job with the new company but the top three things on our list to do: find a house to move out of our apartment, car for Jenni and expanding our family by way of a two-legged addition (we're finding we may have to try harder than those who can look at the opposite sex and succeed). So happy New Year everyone wishing you peace, joy and happiness each and everyday of the year!
Friday, December 11, 2009
The ugly got uglier
ANd I thought metofromin type 1 diabetic was ugly, this next patient is even uglier.
Long story short - implanted nerve stimulator, COPD, mild dementia CABG X 5 and hyperlipidemia patient the other day having CP a day or two after their visit for chronic care clinic - reports it's not like their typical angina pain "doesn't feel right" and it's been going on since arrival to the facility (erroneous - denied CP adn SOb at office visit, but oh well)
ECG a couple days ago - NSR, ECG when having CP NSR with PVCs
NTG X 1 drops BP to 107/something, so I start an IV, start some fluids he's got some O2, I'm hesitant to give more NTG incase they are really is having an MI and if it's a right sided MI, well, I'm certainly not helping them with the NTG. After the second one, BP down to 94/something, hmmm, now SOB and really not feeling well and perhaps a little irregularity in the HR. I finally decided to call 911. It's weird calling 911, it's weird to be on the other end of the call and even stranger them going thru the checklist with me, depsite having answered all those questions in my initial report.
EMS arrives (and much to my happiness they know I am ShawnZ's wife - it gives me some credibility), slaps on their 12 lead, now in Afib with a rate between 30 and 79, still SOB, feeling worse. They take the patient to the hospital - and the patient's not back yet.
I have officially set a new CCJ record for the number of patient shipped out not just in a week but in a day as well. I wonder if I get a bonus for that - I'm guessing not.
Long story short - implanted nerve stimulator, COPD, mild dementia CABG X 5 and hyperlipidemia patient the other day having CP a day or two after their visit for chronic care clinic - reports it's not like their typical angina pain "doesn't feel right" and it's been going on since arrival to the facility (erroneous - denied CP adn SOb at office visit, but oh well)
ECG a couple days ago - NSR, ECG when having CP NSR with PVCs
NTG X 1 drops BP to 107/something, so I start an IV, start some fluids he's got some O2, I'm hesitant to give more NTG incase they are really is having an MI and if it's a right sided MI, well, I'm certainly not helping them with the NTG. After the second one, BP down to 94/something, hmmm, now SOB and really not feeling well and perhaps a little irregularity in the HR. I finally decided to call 911. It's weird calling 911, it's weird to be on the other end of the call and even stranger them going thru the checklist with me, depsite having answered all those questions in my initial report.
EMS arrives (and much to my happiness they know I am ShawnZ's wife - it gives me some credibility), slaps on their 12 lead, now in Afib with a rate between 30 and 79, still SOB, feeling worse. They take the patient to the hospital - and the patient's not back yet.
I have officially set a new CCJ record for the number of patient shipped out not just in a week but in a day as well. I wonder if I get a bonus for that - I'm guessing not.
Thursday, December 10, 2009
The Good, The Bad, The Ugly
The good: Doc told me "good catch on the galactorrhea secondary to ablify, good call getting the US, impresive catch"
The bad: patient detoxing from EtOH, was in ER sent to us w/ severe tremor, hx of Afib, last detox in October was and seoncd stay in ICU for this. Today - Afib with RVR while detoxing = out of my comfort arena past the 2 more mg of ativan.
The ugly: trying to start using metformin as adjunctive insulin therapy with a Type 1 diabetic while arm wrestling nutrition to get a different diabetes diet and combatting sugars ranging from 55-405. All because I was dumb enough to say I would give it a try (it worked for the patient 3 yrs ago, hoping it works again)
The bad: patient detoxing from EtOH, was in ER sent to us w/ severe tremor, hx of Afib, last detox in October was and seoncd stay in ICU for this. Today - Afib with RVR while detoxing = out of my comfort arena past the 2 more mg of ativan.
The ugly: trying to start using metformin as adjunctive insulin therapy with a Type 1 diabetic while arm wrestling nutrition to get a different diabetes diet and combatting sugars ranging from 55-405. All because I was dumb enough to say I would give it a try (it worked for the patient 3 yrs ago, hoping it works again)
Sunday, December 6, 2009
Survival
I survived my first weekend of call with one more day to go. it feels good that I only had one phone call and it was regarding an antibiotic for a tooth abscess and some motrin - woot. I interview tomorrow to keep my new job. I'm thinking good thoughts. I also gave in to Shawn's wishes for more electronic toys. But we have 30days to change our mind.... I'm sure it won't be the first or last thing I give in for Shawn. We shall see.
So the other day my CNA and I were discussing what we like to cook or bake. Well apparently she doesn't bake (much to her teenagers and husbands dismay) and I guess I spoke so highly of my banana bread that she actually brought me a bag of banana-bread ready bananas, nuts, applesauce, sugar, salt and flour to work - how she got all that in past security I'm not sure. She politely asked if I would mind making her a loaf to try. How could I say no when she brought me all the ingredients? Plus she busts her butt daily for me to keep things running smoothly for me and the rest of the clinic.
Shawn's birthday is Wednesday, he's working I'm on call so I guess Friday will have to work instead.
So the other day my CNA and I were discussing what we like to cook or bake. Well apparently she doesn't bake (much to her teenagers and husbands dismay) and I guess I spoke so highly of my banana bread that she actually brought me a bag of banana-bread ready bananas, nuts, applesauce, sugar, salt and flour to work - how she got all that in past security I'm not sure. She politely asked if I would mind making her a loaf to try. How could I say no when she brought me all the ingredients? Plus she busts her butt daily for me to keep things running smoothly for me and the rest of the clinic.
Shawn's birthday is Wednesday, he's working I'm on call so I guess Friday will have to work instead.
Subscribe to:
Posts (Atom)