The Agony of My Feet!

Have I ever mentioned that nurses are the worst patients?

I don't remotely pretend to have all of the acquired knowledge of a physician - my nursing curriculum was 4 semesters while they attend for 4 years. I am however relatively savvy on researching health issues and common treatments. I don't generally head to a doctor unless I am completely ignorant of what is ailing me OR I know that I need prescription medication. Maybe that makes me a bad patient, but I prefer to think that it makes me an educated healthcare consumer.

Where is this going?

Well my feet hurt - a lot. I've had problems off an on since last October - yes, October 2009! It first manifested after a 10 mile walk/run while training for the Bass Pro half-marathon. I had recently been fitted for new shoes and after being considered a neutral runner prior to pregnancy, I had now developed some overpronation. I was put in some mild motion control shoes and even saw on a nifty video analysis of my running on a treadmill how the new shoes kept me from rolling inward.

I had managed to make most of my training prior to this and had even done a 7 mile and 8 mile long walk/run without any issues. This 10 miler hurt though and it hurt near the balls of both feet. It started first in the left and then the right, best described as a sharp pain that was worse when I was running but still hurt during the walk. I was sore a day or two and decided to be smart and only do a 10K as opposed to the planned half two weeks later.

Over the winter, I didn't do a lot of training for various reasons and as the Little Rock Half-Marathon approached in March, I started to do some training and began as couch to 5K program again. I was still having problems after going about a mile and a half and it was this sharp pain in the ball of my foot. I went back to the running store and was fitted with another pair of motion control shoes but with a little more cushion in the forefoot. I decided to go ahead and walk the half-marathon because I had already paid my registration. Besides, I've been in decent shape, why can't I walk 13 miles??

Well apparently my feet didn't agree. I was in pain by mile 3, it was pretty bad by mile 6 and by mile 10 I was walking faster simply to MAKE IT STOP! My feet were super sore for several days and I hobbled around thinking that I was a stupid stupid person. I took a break for a good month after that experience.

Another trip to another running store and I was given some over the counter orthotics by Sole. These had a much greater arch support and could allegedly cure the ills of many feet. I did a couple of short runs with them and had no problems and thought all was well. I also bought a second pair of insoles to put in my work shoes because I'm on my feet a lot during my 12 hour shifts and surely this would help. All in all, my feet felt better and soon summer came and the temps became RIDICULOUS (seriously, this is the hottest summer Arkansas has ever recorded - it has been MISERABLE!) which means that I am not keen on doing lots of running or walking.

Right around the time I decide that I need to get back at it, I wake up and have horrible HEEL pain. What? Heel pain? My heel has never hurt?? Each step is misery and after a while, it loosens up a bit and gets better. I racked my brain thinking "What the hell did I do???" and hubby reminds me of the walk we took the prior evening with me in only my flip flops. Hmmm guess that was a bad idea? It takes me no time at all to think heel pain = plantar fasciitis. Some quick medical researching and I realize that the plantar fascia extends from the heel to the base of the toes and ends right near the ball of the foot - you know, the area where I previously had stabbing pain. It finally dawned on me that I had probably been dealing with plantar fasciitis since last October, it just hadn't originally presented in the typical fashion.

I'm no expert, but I've known people who've struggled with this and I know it is NOT a good thing. It's not good if you're trying to get back into running and it's definitely not good when you have a job that requires you to be on your feet for extended periods.

Another trip to a specialty shoe store and I score some MBTs for work. They are ridiculously expensive and not very pretty, but I now have cured the everyday excruciating pain. I can't not walk at work and my new job has me on the feet a LOT more than before. Now, if I can just get my mileage back up without hurting. Today I did almost 4 miles and was just a little sore at the end. Let's see how it goes.

Always look on the bright side of life

It's been a rough few weeks and though I generally prefer to bitch and moan (seriously, it's my nature) - I decided to take a lesson from Life of Brian and look on the bright side.

While it's true that we've had two major Gremlin illnesses since he started daycare and have dealt with what appears to be a neverending fountain of snot, he has been adjusting really well. We have been very pleased with the facility and the caregivers and though he was throwing a nice fit every morning at drop-off, we were reassured that it didn't last long. The first two weeks, we just did half days and picked him up before naptime. We have now progressed to full days and he has been taking his naps and in general having a great time. This week, he even gave up the drop-off drama and happily waved and said "Bye Bye!"

So yes, the germs and sickness which are inevitable in a group care setting have been irritating. Even worse is that I am normally a very healthy person, but I have managed to catch both illnesses which seem to strike during my stretch of time off. Right now I'm practically high on cold meds but I'm going to focus on the positive .... yes, positive Jenn!!! Gremlin is doing well with daycare and because of that, I can now get a full days sleep after I work the night shift. This is the first time since pregnancy that I haven't been sleep deprived - yeah me!!

As for the job, it's been a bit of a stressful transition for me. I was happy in my world of little children, it's all I've ever known since finishing nursing school and I was in my comfort zone. Sure I worked with adults when I was in school, but when you don't do it all the time, you lose that comfort. Most of the assessment stuff is the same, listen to breath sounds, check for murmur, listen to bowel sounds, feel for a pulse. The vital sign numbers are different but that's not hard to relearn. The hardest part for me is the specific stuff you have to deal with after having a baby. (Warning!! anatomical nursing stuff ahead!!!!) You have to press on their belly and find a fundus which is the top of the uterus. You have to make sure it's firm and that it's where it's supposed to be. It is a very important part of the assessment and I have to admit, it can be hard to find it, especially on those women who have a lot of *extra* flesh in the abdominal area. That means you have to push down even harder while trying to find it and shockingly this is a tender spot after giving birth so some moms aren't too keen on you mashing down. I am already preparing myself for the inevitable plea to a fellow nurse to come check my patient because I can't find their damn fundus.

The other thing is you have to look ... down there. Let's be honest, no one goes to school with the hope of looking at vaginas all day, but if a baby comes out of there, it really has to be looked at. I don't really mind and it's not like it grosses me out or anything, it's just the reality that I sometimes don't know exactly what I'm seeing or if I'm even seeing it. Folks, there are lots of different types of bodies out there and I can assure you that no one's nether regions look like a textbook, especially after birth. Did I mention the hemorrhoids? I also have to check for those while I'm looking down there. Again, I don't remotely mind this part of my job, I honestly want to be sure I know what's going on so that I can start helping them heal with the appropriate medicine or therapy. It's just a whole new experience for me to deal with an adult, introduce myself and shortly thereafter look at the part of their body that they find quite private. I've never had to explain myself to a baby, I just do it. I'm still trying to find the script that works well for me to put a woman at ease during examination.

The other issue is that it's been busy at work - REALLY busy. My first week there the unit was full, we were short-staffed on nurses,and everyone was taking a very heavy load. Obviously, if everyone is taking a heavy assignment, it's not the best time to learn. I basically followed my preceptor around and asked occasional questions when I could. I have been in her position with too many patients and needing to train someone, so I was very sympathetic. It was just stressful because I felt like I was in the way and due to my lack of knowledge, I really couldn't help. On my fourth night, they were so short that I volunteered to work in the nursery. Babies are something I know and at least there I can be helpful with taking vital signs, drawing labs etc. It still wasn't a very great learning experience, but at least I was easing the load for the team. My second week was better and I now feel like I'm learning. I really want to be good at this job and I am my own worst critic, I need to remind myself that I have four more weeks to learn what I need to know.

On the bright side, I can already tell that I am really going to love the job. I have enjoyed the patients and the opportunity to work with happy families. I will also appreciate being able to teach on a regular basis as part of the job. For the most part, the staff I have met are very friendly and competent. I just need to get more comfortable in my role and cut myself some slack.

Ooooo, and the best bright side is that I now make more money!!! Wheeee!!! So nice to get a raise!!!!

Ch- Ch- Ch- Changes

I've never been very stressed about changing jobs, likely because I've done it so many times since finishing college. I left my first *real* post college job, after 2 and 1/2 years to move to Denver. Then my I left my position in Denver after almost 3 years to attend nursing school. Since nursing school, I've bounced around a lot because it's easy to do that in a high-demand field and it suits my personality because I get bored and/or frustrated at jobs after a while. Truthfully, the idea of career mobility was one of the things that drew me to nursing - the myriad of directions you could take with one degree.

So it's not a shock that I'm changing things up yet again. After spending the last 6 years doing pediatric nursing (most of them Neonatal Intensive Care) it was time to see what else was out there. My current work situation was becoming a bit unstable with absentee management, a pending closure of our unit on the weekends, and some generalized uneasiness amongst the mostly excellent staff. When casually looking at jobs, I noticed a position in the Mom/Baby Unit at Big Popular Birthing Hospital. When I went back to work after Gremlin, I was told by recruiters that jobs rarely opened up in the women's services at Big Hospital because when they had occasional openings, they were filled from within. When I saw that opening, I knew I had to jump and apply.

I had a great interview, though to be honest I ALWAYS interview well. I'm very comfortable with the process and I think I do a good job at representing myself and my abilities. From the hiring manager's demeanor, I could tell that I had a very good shot though she did tell me that others were interviewing for the one available position. I think my interest in being a breastfeeding educator and my extensive NICU experience were the biggest selling points. Speaking of NICU, I had to spend the first 20 minutes convincing her I did not want to work in NICU anymore (that department also had an opening and she wanted to be sure I wasn't making a mistake). After telling her that I most certainly did not want to work in NICU anymore, we had a great time discussing the job.

I've had a major interest in maternity nursing ever since my experiences as a traveler in Colorado when I was floated several times to their post-partum unit. It's such an awesomely, unique place to practice nursing. For one, it's generally a very joyous time in a family's life as opposed to my years of working in very tense "sick baby" situations. It also provides a lot of opportunity for education which is my favorite part of being a nurse. Whether it's teaching how to change a diaper or swaddle or breastfeed, a great deal of supportive education happens in that brief hospital stay after a baby is born. I had Gremlin at Big Hospital and even though I was a professional baby wrangler, I was so thankful for the breastfeeding support and education.

My new job will involve taking care of pairs or "couplets" of mommas and babies. It will truly be acting as a nurse for the whole family. I am incredibly excited by it though a little nervous about dealing with adults again. I have had occasional teenage patients in the past year and a half, but I haven't routinely worked with adults since my student gig as an extern in the Trauma/Burn ICU. I'm sure it will all come back to me with a bit of practice.

This job is also a full-time position so I will be back to working three 12-hour shifts a week. I really was liking my part-time gig, but decided that I wanted this opportunity even more. As a result, Gremlin will now be going to "school" starting next week. In the end, I think it's going to be a great move. I'm excited about a new phase of my career, I'll be able to get quality, uninterrupted sleep while Gremlin is at school, and hopefully I'll regain the joy I used to have in my work.

What's my cookie?

You know how some people need the promise of a reward - like a cookie - to do something that they don't *really* want to do? Well I need to find my cookie. I have always been highly motivated by sticker charts, little toy surprises and even cookies, but given that the goal is weight loss and fitness, perhaps cookies are not the best way to go.

I do plan on putting together a training chart and then getting some pretty colored stars or stickers to affix to it every time I complete that workout. Yes, it's juvenile but it makes me happy. I also, however, need a prize. Sure the ultimate prize will be a skinner, rock hard body, BUT I need something a bit more tangible.

At this moment, my intermediate goal is to get under 150lbs. That will represent an approximately 15lb loss from where I've been the last year or so and get me closer to the realm of my 140-143lb pre-Gremlin weight. Once I get below the 150lb mark I will reward myself with a spa day! I love me some spa treatments but I haven't allowed myself the indulgence since long before Gremlin came. I think this will be a great motivator and a great prize. I'm hoping to be there by the end of July.

As for longer term goals, I want to be at my pre-Gremlin weight by my birthday which is in early September. I would love nothing more than to get some new skinnier clothes and a birthday is just the time for sure things.

In regards to fitness, I am going to train for an October sprint triathlon. I had *really* wanted to get back into multisport this season but apathy and lack of motivation got in the way. When I saw that there was a race about 90 minutes away and 13 weeks down the road, I knew I had to commit. I'm working on my training plan now and will start it next week. It's going to be more of a challenge to get all my workout in with the Gremlin but I'm thinking that I've got my bike trainer and the jogging stroller so that just leaves the swims. I know I can do it .... don't you agree??

Today is the day!

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Maybe this isn't a good idea?

I'm out of shape, still overweight, and in general feel exhausted and crappy.

So what am I doing this weekend?

Walking the Little Rock Half-Marathon! Isn't that a SWELL idea? The farthest I've gone in the past two months is just around 4 miles, and it made my feet hurt. I'm sure 13 will be no problem ... right??

Yes, this is probably not the smartest thing I've ever done. I know that I can do it, I'm a tough cookie - but it's going to hurt. I'm guessing that I'll start regretting it somewhere between miles 6 and 8, and wishing for death by mile 11. I know that I can walk that far, it's more that my joints, bones and muscles aren't going to be willing to accept that.

My overall hope is that I enjoy myself and remember how much I love to race and how much I love being a part of endurance sport. I know it'll bother me to just be walking, and to be really freakin' slow, so I'm hoping the experience encourages me to get back into serious training. I really want to run again and to shoot for those personal bests and to compete in multisport. Most importantly, I want to feel good about myself and hopefully get back a body that somewhat resembles the one I had two years ago.

I'm guessing that it's not the *best* idea I've had, but it's probably the best thing I could do to kick myself in the ass.

Stay tuned for a report ...

Health Care Rant

This year did not start off in the best manner despite my being so excited about a new diet plan, workout goals and determination to live to the fullest despite chronic sleep deprivation. The working out was derailed when I pass out and fell at work early on the morning of 1/2/10. I apparently had a syncopal episode (I just remember not feeling too hot then waking up confused on the cold floor) and fell on the bathroom floor splitting my forehead open and injuring my ribs. I was at work - you know in a hospital - and I wasn't able to stand and my coworker said I looked white as a ghost and she couldn't get my heart rate to come back up. Before I really knew what was happening, I was in our ER getting a liter of fluids put in via an IV which blew my mind because they never manage to put IVs into any of the patients admitted to my unit ... but I digress. My care in our ER was not the best and I should mention that it was early in the morning, pretty close to shift change and they only had one other patient so it wasn't like they were slammed. They did an EKG, drew some blood, put in the aforementioned normal saline and after I had been in the room well over an hour, I asked if someone would wipe the blood off my face and maybe put a bandage over my gaping wound (which the resident physician didn't even touch when he "assessed me." The next thing I knew I was told that I had to go to an adult hospital since they only do children. Unfortunately this was now Saturday so my doctor's office wasn't open. My husband had arrived by this point but they REFUSED to let him drive me to another hospital that is less than 5 miles away. They said I needed to take an ambulance because, "we can't rule out a cardiac issue." I started to argue the point the best that I could in my weakened state, but the resident returned and said, "sorry you have to go by ambulance." I should have just told them to screw off and gone AMA (against medical advice) but one of my co-workers pointed out that insurance can then refuse to pay any of the claim. DAMN!

So I went in an ambulance to another ER and I should mention that my own hospital gave the paramedics hardly any report on my condition or let them know that labs were pending. I had asked the dayshift nurse if my electrolytes were back and got a breezy, "oh I haven't checked that" prior to my leaving. Once we got to ER #2 (after my hospital told me I couldn't go to my first choice of hospitals because "employee health says you need to go to hospital A or B"), the paramedic proceeded to give the new ER a report on my condition that was shockingly incomplete. I filled in all the pieces and the paramedic specifically said, "wow! Good thing you were paying attention, they didn't tell me ANY of that!" Wow, good to know that they give a good report during transfer of care. ER #2 did a repeat EKG, were going to draw labs when I reminded them that my hospital had already done that but failed to give me results. Saved myself who knows how much because they simply called my hospital and got the labs faxed to them (which should have been sent with the paramedic in the first place). After a very long wait because ER #2 was hopping, I saw the doctor for all of 5 minutes. He did a quick assessment and said the nurse would glue my laceration shut. They also insisted on getting a pregnancy test despite my COMPLETE ASSURANCE that I wasn't pregnant. I was on my period, I'm on the pill, I have a one year old at home, I am NOT PREGNANT. The ridiculous thing is that they weren't doing any x-rays or treatment that would have required a pregnancy status anyway.

Shortly thereafter, ER#2 nurse comes in and glues my head shut - now the nurse did this, not the doctor which is important for later. And then I had to wait, and wait, and wait. Turns out since it was at work and possible workman's comp, I had to wait for a third party to arrive to do drug and alcohol testing. This was finally done, and I was looking to get discharged because it's close to noon, I had worked all night the night before, I'm in a psych patient room with no TV or even handles on the doors, and I just want to get home. At this point all I needed was my discharge instructions but my nurse was busy with a trauma. I flagged someone down, had already pulled out my IV (and had to leave everything on the counter, because psych rooms also don't have trash cans), and managed to get the charge nurse. I told her I'm a nurse, I'm tired, I've been treated, can I please go home? She quickly gave me my paperwork and let me go.

So now the bills are starting to come in ... and man are they ridiculous! I'm lucky that I've never had to use an ER in my life. I've had a broken bone or two in my life, some ankle sprains, a couple of lacerations needing stitches, but I always received care at a doctor's office. Even waiting an extra day with my broken wrist because it was a holiday and I waited til my doc's office opened. Had I not been at work, on a weekend, there's no way I would have gone to the ER, and in NO WAY would I have used a stupid ambulance. Honestly, had I not felt so weak and miserable I would have gotten more bitchy and demanding. I had told my husband that I would NOT get a cat scan since I was not symptomatic and seriously they are REALLY expensive.

So here's how my bills currently stand:

My hospital ER visit = $1045
-This includes one IV placed, a liter of fluids, the tubing for the IV, an EKG, a lab analysis of my blood chemistries

Ambulance = $664
- This included a 4 mile ride and me having to give a report to the paramedic on my care at the ER since they didn't bother to tell him anything. Also, he was the first person to actually assess my laceration and tell me about it since I hadn't seen a mirror yet.

ER #2 = $1078
-This included an EKG, generic supplies, "laboratory" which I still haven't figured out what that includes and the care of the nursing staff.

ER #2PHYSICIAN = $794
-This is for the 5 minutes he spent with me and the interpretation of the EKG. Dude, he wasn't even the one who glued my head shut! That's ridiculous!!

EKG interpretation from my hospital = $29
Pregnancy Test = $18

Total Bills = $3628

All this for one forehead laceration, a liter of IV fluids, and one blood draw. WOW! That's steep!!

Interestingly enough, my employer required that I go to my doctor and have a note that it's OK to return to work. I actually wanted to see my own doctor anyway since he's actually ... well a good doctor. That visit included a consultation and x-rays of my ribs which were in excruciating pain by the day following the injury. For that visit and 2 x-ray?? I was charged a whopping $185

If people want to look at how broken the health care system is, they don't have to go far. Clearly there is a problem with healthcare costs. Why could one ER do so much many more procedures but charge me so much less - especially when you factor in the cost of the physician? Why could my own doctor do two x-rays and treat me and charge only a small fraction?

The kicker is that I do not quality for an employee discount at my hospital because you only get it if you are on THEIR insurance! We have decided to keep the whole family on Bryan's insurance so I lose a 20% discount because of that. Also, I've been totally jacked around by the workman's comp process. They conveniently lost my forms but never bothered to tell me. I'm almost positive they won't cover it but was encouraged to go through the process by our nursing supervisor. Makes me wonder how two of my co-workers had their injuries covered AND time off covered when they slipped on the ice and fell in the parking lots last winter.

Ok, I know that no one really cares about my rants, but I needed to express it somewhere. I just hate getting screwed, especially by my own employer and for truly substandard care in my own ER. Did I mention that my IV beeped for well over 5 minutes and I finally had to get up and stagger over to silence it myself because I didn't have a call light, and apparently no one could hear the blaring noise.

Oh well, on the bright side, we will be making our $2400 family deductible early in the year so I guess this is the year to have lots of random medical visits. Hopefully I can start to focus on the positive soon, because this whole process and dealing with billing agencies and workman's comp really has sucked the life out of me.