H1N1 podcast round-up

With the H1N1 now making the rounds and a lot of misinformation or ignorance circulating about the flu and vaccines, I thought I would post some links to podcasts dealing with the flu. Do you like my grammaphone podcast symbol? No? Well, tough.

NCLEX exam this Monday

Gentle readers,

I have not forgotten you, nor have I failed the NCLEX exam. Yet. The orientation process at work has been so stressful and so literally tiring that I simply gave up blogging and reading my GoogleReader for the time being. At work, they tell me I'm doing well, but it doesn't feel that way. I have yet to go through a day and finish everything satisfactorily.

Also, I have made some mistakes. My worst has been with a patient who was playing games with us on a day when I didn't have time for it, and starting spitting out oral meds, then refusing everything. I eventually got the patient to agree to take crushed the very needed pills at the end of my shift and crushed some extended release pills without thinking about it. Luckily, no advserse results, but you know that was one of the days when I did not feel good after work.

Actually, for a period of about 3 weeks, I started drinking every day and probably drank more in that period than the entire year previous. Not good.

I'm sure most new nurses have the same feelings of inadequacy I do, but it has been very rough.

Anyhow, I am scheduled to take the NCLEX this Monday at the Pearson VUE office. I'm planning on holing up for a while--maybe calling in tomorrow and Friday (Do I dare?) and spending those days and the weekend in a motel or bed and breakfast. So far, I have studied about a total of 4 hours. I do not have high hopes. I find it almost impossible to combine the stressful floor orientation and the book studying, so heinous is the book studying to me. I don't know about other people, but I measure out my time in spoonfuls of anxiety, not spoonfuls of chronology. I have had very little time to study in other words. I have spent some time staring out the window, doing laundry, cleaning the house...

And when I am formulated, sprawling on a pin,
When I am pinned and wriggling on the wall,
Then how should I begin
To spit out all the butt-ends of my days and ways?
And how should I presume?

Anyhow, if I don't pass, I'll have to stop orientation and then I'll be back in the situation I wanted originally, which was to pass the exam before taking a job. I mentioned this to the HR department at work when I went in, but they wouldn't give me a position unless I started orientation right away. Well, they got their way, and now we'll see how things go.

Wish me luck.

Cath lab observation

For whatever reason, I was sent to do a cath lab observation today rather than the floor/ECCO routine. This is nice thing to do, but it wouldn't have been my first choice for the day.

Although the "main event" in the cath lab was an ablation, the most interesting was an ICD interrogation which afforded the first opportunities to see an actual defibrillation and real, live use of conscious sedation.

Isoproterenol: I had a frustrating experience of not being familiar with this med today. I've been reviewing meds every day trying to relearn (a) things I've forgotten and (b) things I learned in a warped, half-assed fashion in school. I had skipped isoproterenol because I never remembered hearing of its use in school or while working as a ward clerk. Today, I couldn't remember what class of drug it was. Sure, go ahead and yell it out: β1,2-agonist. Embarassing to have to look it up.

All day observation was a real downer. I felt like I was being punished by not being allowed to really participate. Like I had been sent back to school. It didn't help that one of the techs was ribbing me about it.

At the end of the day, I helped pick up a patient from ICU for a procedure and got to see excellent Lori (right), who I haven't seen but fleetingly since she left PCU and not at all since I graduated. I got a graduation fist pound. Cool.

The rest of this week is the cardiac arrhythmia class, which I feel pretty good about. But I'm anxious about being back on the floor after that. There's still a lot to learn, not just cardiac-specific but basic nursing. I don't know what I'm supposed to know. They kept telling us in school not to worry about things because we would pick up skills on the job, but when I'm getting ribbed by the cath lab techs about shit it makes me wonder...

Floor Orientation: 1st day

I was fairly anxious all weekend about my first day on the floor, today. My clinical immersion in April, at the end of school, didn't exactly go textbook. From managing 2 patients to managing 5-6 over night was not easy for me. I was worried that today might also be getting thrown into a 5-6 patient assignment.

Actually, it went fairly well, or I should say easily. Patients were not complex, and there weren't that many of them. At 11:00, I left for the computer room to do computerized education and orientation. My unit has purchased AACN's Essential's of Critical Care Orientation (ECCO) program for new nurse orientees. I guess orientation will generally involve a few hours on the floor and then a few hours of ECCO each day until orientation is over. ECCO looks like it'll be a good review for the NCLEX, too.

Re-living Bush vs. Gore

At 13:15, I filmed a TV spot for public relations. A cameraman/producer came from the local NBC affiliate and taped me describing how I came to be a nurse at the hospital. The spot features new grads who have previously worked at the hospital in other jobs. I had tried to plan a statement that'd make all parties look good, but I had trouble remembering it in the blazing lights of the camera. I thought it sort of stumbled out rather than coming out velvety smooth. However, the pro said I was a "one-take kind of guy," which I think is praise in TV speak.

I'm eager to see how it turns out as I have a complex about appearing on TV. During Bush vs. Gore in 2000, I was living in DC and stayed up all night outside the Supreme Court so I could get a chance to watch the proceedings. It was quite an experience. After I came out, I was pulled aside by television crews and asked about what I saw and what was going on. I gave some lame answers that never aired on TV. I blew my 15 minutes! Can you believe it! I realized later that they must have pulled me aside because I was a wearing a nice suit, and they probably assumed I was a lawyer rather than a jobless undergrad. In the grand theme, it doesn't matter, but I can see still the disappointed look on the face of the pretty reporter who was expecting not to waste her time on me.

Orientation: order entry

Back in the computer room today to go over the "order entry" system. This was a little redundant for me since I've been working as a ward clerk, but it was relaxing. The new tele/clerk/aide was with me, so I tried to give some pointers.

Orientation: MAK, allergies, hx

Okay, so yesterday I felt guilty for being one of two people taking up hospital education resources. Today, it was just me. I spent the day in a computer class going over the hospital's "Medication Administration Check" system. This is a computerized med pass. Apparently, the company wasn't able to call their system MAC due to Apple, so it's called MAK. This has led to jokes about "med k'checking". But I guess you got what you wanted, Steve Jobs. Also covered was the computerized allergy and administration history systems.

My educator for this part of orientation is a former ob nurse who I remember from float ward clerk days as having a super short buzz cut, but not being willing to give me the time of day. Sheesh. What's a guy gotta do to get attention from a woman with a buzz cut? Oh well, water under the bridge.

Anyhow, we got to discussing certification and continuing ed today, and she convinced me to sign up for Medscape, from which you can acquire CE's.

Orientation: module 2

On day 1 of general orientation, you're in with everybody in your GO class, from administrators to nurses and food service workers. On day 2, you get just those people doing direct patient care. We were down to four yesterday. On day 3, we start something called "module 2," which is just for nurses. This brought us down to two people: myself and an LPN going to work in the renal center. I feel pretty guilty about this. There's a lot of resources in time that get expended on orientation. I guess they expect they'll have to do module 2 only a couple times a year. Since I wanted to pass the NCLEX first, I guess I screwed things up. Thank goodness for the LPN.

Module 2 is an introduction to IV therapy, beginning Healthstream (computerized) education, etc

GO day 2

General Orientation day two, today. CPR, mandatory reporting of abuse, back safety, etc...

After lunch was a medication usage and calculation test. As I always performed well--and well ahead of the rest of the class--on med calc in school, I thought I was prepared. Plus, last Sunday, I went to the food court at the mall and did the practice exams provided by HR just to be sure. But there ended up being a lot more on the exam about general medication knowledge. Luckily, it was open-book and a Lippincott's nursing drug book was available. Even as an open-book test, I got a couple wrong. However, I did get right a dopamine gtt calc question that George said a lot of people miss.

Listen, nursing students. To do medication calculation, you just have to lay out the formulas and plug in the numbers. It's all ratios; don't sweat it, just do it methodically.

Following the med calc test was competencies in the glucometer, occult blood testing, and a couple other things. There were four of us: myself, an LPN who will be working in the renal center, a new tele/clerk/aide for the PCU, and a new aide for another floor.

GO day 1 (p.s., I got a job)

Monday morning saw me in my first day of General Orientation (or, GO).

Oh, yeah, I got a job. I was worried about this for a while, but when I talked to my director she said there was an opening I could have. This was about two weeks ago. Actually, I believe I signed the H.R. job transfer form (P-5) on exactly the same date I signed my original employment papers some years ago.

I hadn't wanted to be in General Orientation today. My original plan had been to pass the NCLEX before starting any job so that I could forget pediatrics and maternity and just concentrate on wherever I was at the time. However, H.R. wouldn't let me sign the P-5 and not start orientation, so here I was today.

Since I went through GO once before, a lot was repetition today. Fire, hygiene, etc. It was all run by our educator, George (of ACLS fame).

4th annual R-3 barbeque

Although I've been working on the same hospital floor for four years, I've somehow only been to two of the four annual barbeques. This year I tried to provide something tasty by bringing Tanqueray No.10 gin and the fixings for martinis (Vermouth, olives, ice) and tonics (tonic, limes, ice). Unfortunately, nobody seemed to really like these. Who doesn't like a strong drink? Oh well. I left in the middle of the day to do some studying, then went back this evening and cleared up my stuff. At least I got a bottle of good gin out of it.

I enjoyed myself, although I don't enjoy being told that I'm stuck up because I wear a sweater vest sometimes. Give me a break.

Mice grown from skin cells

Luckily, they were grown from mice skin cells. Phew!

Seriously, as the WIRED article says:
The goal was to create an animal made entirely from reprogrammed cells, and to confirm that reprogrammed cells “are as good as embryonic stem cells,” said Beijing National Stem Cell Bank director Qi Zhou, co-author of the study published Thursday in Nature.

Much more research is needed to meet the second of Zhou’s criteria, but fulfilling the first is remarkable enough. Just three years ago, it would have been inconceivable.

This "inconceivable" is a bunch of crap. Political crap. When they say "inconceivable," they really just mean the technology wasn't there 3 years ago. Let us be frank. Matter has an essential mechanical character due to its Lego-like atomic structure that makes it manipulable. Eventually, we will be able to build cells and genetic systems from the atom up if not from the subatomic level up. This idea that we "must" have access to embryonic stem cells because we "can't" use anything else is not only crap, it's silly, and it's disingenuous for anyone to say otherwise.

Hopefully, Zhou's protocols will be easily adapted. It's sad that this technology is being brought out by communists rather than western democracies.

Please oppose House bill 1298

With all the hoopla over the current health care reform legislation (H.R. 3200), it's easy to miss other bills currently being considered. For example, the Pharmaceutical Market Access and Drug Safety Act of 2009 (H.R. 1298).

At first glance, H.R.1298 seems pretty straightforward stuff, saying that pharmaceutical companies can't sell different versions of drugs to other countries and securing the rights of people to purchase drugs sold in other countries.

But wait! Dig deeper. H.R.1298 also seeks to control the purchase of drugs through the Internet, not only purchase through American Internet pharmacies, but also purchase from foreign Internet pharmacies. This means your savvy grandma who used to order low-cost generic drugs from other countries could no longer do so.

The bill controls Internet drug purchases two ways. First, it makes it an offense for a pharmacist to sell you medications unless his website meets a bunch of design requirements and the MD, PA, or NP who gave you the prescription conducted a face-to-face medical evaluation. Second, it prohibits payments to "unregistered" foreign pharmacies.

That's right. This isn't regulation of businesses for the protection of consumers, it's the regulation of consumers. Think about it. You want to send someone money. Nope, that's against the law. Use PayPal on the wrong Internet site, and the Feds will be showing up at your door.

Proponents of the bill will say that outlawing purchases from overseas will protect consumers from themselves. But that is exactly the sort of protection we do not need. At the current time, protected substances are already illegal without a valid prescription. So what real benefit is there to adding laws against making payments?

Cui bono? Who benefits from banning payments to foreign pharmacies? Well, US pharmacies of course. Yes, this is a law passed for (1) the commercial benefit of pharmaceuticals and (2) the psychological benefit of those who see more control as a comfort.

Write your House Representative today and ask him to oppose H.R. 1298. You can also write your Senator, as the bill is in the Senate as well, as S.525 & S.1232.

NIH Wikipedia Academy

WIRED reports that representatives of Wikipedia went to the National Institutes of Health to train the health science types there in the in's and out's of wikis. This has the potential for both good and bad impacts on the health knowledge of Americans. Yes, it's true that, as Wikipedia is the first-stop for information for many amateur researchers, training the NIH could get accurate information to web users in a very timely manner. However, it also implies even more top-down control of information, now even in the primary exemplar of the web's possibilities for bottom-up knowledge building. Will those dissenting from the official government "consensus" on health and nutrition have their opinions deleted from Wikipedia articles? overwhelmed?

Well, anyhow, the government hasn't succeeded in regulating blogs, yet, so you can always follow dissent in the blogosphere...

PowerPoint: Armed Forces Journal almost gets it

An essay by Marine Col. Thomas Hammes, author of The Sling and the Stone, in the Armed Forces Journal takes users of PowerPoint to task for making dumb PowerPoint presentations. If you are an educator, administrator, or otherwise have a need to use PowerPoint, please read it.

Typical PowerPoint presentations suck, and if you think yours doesn't because you attended a "class" on how to use PowerPoint, you're probably one of the offenders. At my SUNY campus the PowerPoint "class" for professors and instructors is run by the IT folks. It teaches you how to navigate the buttons on the PowerPoint presentations, but (regardless of, or perhaps because of, the class) all teachers subsequently use the pre-packaged backgrounds, clip art, layout, and conceptual schemes with which we are all too familiar.

Lectures have become an absolutely horrible experience of visual and mental assault, and it appears that some instructors simply trade their .ppt files around if they exchange lecture topics. They then need only review the slides and make sure they understand the material with enough depth to get through the slide. Not acceptable. When you lecture, you need to be able to discuss the material at a level deeper than what the students get in the lecture. That way, questions can allow you to explain and clarify points of confusion rather than simply being speed bumps on the road to the end of the PowerPoint.

The only criticism I would make of Col. Hammes' article is his arbitrary division between "bad" uses of PowerPoint for discussion meetings and "good" uses for instruction meetings. He talks about those sitting in lectures being able to read through the slide before the lecturer does. Remember, lectures are verbal events revolving around interpersonal experiences. Having students focused on reading slides is a failure to use slides well. A lecturer should be the focus of attention during a lecture, and slides should serve to give graphic (not stenographic) support to the lecturer. The lecturer should need to reference and interact with slides, and, when finished with a slide, attention should revert back to the lecturer.

Nursing instructors, please check out a book like The Cognitive Style of PowerPoint...

GlowCaps and firetrucks

Getting patients to take medications by putting lights and sounds into the caps of their pill vials. This is the idea of David Rose. On the face of it, it's not a bad idea. People are primed for visual cues, so why not use them on med vials? I'm reminded of the change from red fire trucks to incandescent yellow. Back when all the cars, bikes, and most clothes were black, red fire trucks seemed like a great idea. When the city became an even greater menagerie of light and sound, red started to fade into the background, and firetrucks had to change to yellow. If "ambient devices" become widespread, glowcaps are likely to become like red fire trucks.

And then there the's GlowCap Connect, which records when you access your meds and sends a signal to someone who can monitor you. Lovely. Perhaps in the future, all of our feeding times will be monitored as well. Life will be just like a giant hospital!

Bioastronautics: what's in a fart?

Coming on the heels of my last post, I present this exhibit in favor of NASA funding:

Josh Torchinsky, rummaging somewhere, came upon this NASA publication Bioastronautics Data Book from 1964, which is apparently a collection of information on all the I+O's (or at least O's) that a spaceship designer might need to know about in designing a contained false atmosphere to house our fragile bodies in cold, barren space. From the scan of the following page, we learn that a fart is in fact only 3-7% methane, and 3-5% oxygen. For me, this answers the question I have pondered periodically since childhood: if you were trapped in an enclosed space with your farts, could you continue to breath? (No.) Types who were more rambunctious in youth may be interested to know that a fart is 12-20% hydrogen, which is, I assume, why you can light it with a match or a campfire...

via BoingBoing

Apollo 11 anniversary

Without context, if you asked me to name the films that had the most influence on me as a boy, I would never now think of The Right Stuff. But in fact, when I was younger, I nutured two perspectives. On one shoulder sat the daemon of an accomplished pilot I knew from our local AFB, encouraging an interest in sci fi/space, the air force, and science. On the other shoulder sat the daemons of my favorite authors, encouraging an interest in fantasy/antiquity, academia, and neo-Ludditism. With age and the closing of our local AFB by congressional commissions (not to mention the end of TNG), the interest in flying ships began to wane. However, performing acts like re-visiting The Right Stuff (now the book rather than the film), can bring back the sense of grandeur one felt. Reflecting on the Apollo mission and the actual act of walking on the moon is another such act.

Perhaps John Derbyshire summed up the space program best in his recent essay Magnificent Folly. Like him, I used to have the idea that man would of necessity find a way off Terra out amongst the stars. Now I'm not sure how NASA's costs can be justified. There is still plenty to be done down here. However, we cannot write the moon landing out of our history, nor would I want to. It remains a monument to human achievement that can serve a number of purposes today, in addition to its inherent awesomeness and interest.

Intermittent fasting trial, day 2

Today was the second day trialing whole-day fasting. I'm headed for bed and I made it through the day, including a work-out, but it wasn't as smooth as Tuesday. I felt really weak after my work-out, and I was craving food around dinner time. It doesn't help that my brother eats whatever he wants and was grilling something full of fat and protein this afternoon that scented the entire house.

Anyhow, I can't complain much about these last few days. I should have a basal metabolic rate of about 2390. I ate about 300 Kcal per day. So over the last two days of fasting, I should have burned 4180 Kcal plus whatever I burned related to the work-outs I did on each day (which I'll estimate very conservatively at 120 Kcal for a total of 4300 Kcal) or about 1.25 lbs. Was it worth it? Probably. Of course, fasting is not an ideal way to lose weight since in a pre-ketotic state, I was probably relying on skeletal muscle for some of that weight loss. However, I would like to get my total weight down, and if I'm weight training and only fasting a couple times a week, my long-term muscle loss on intermittent fasting couldn't be too severe. I think I will try to continue this routine next week to see how it goes.

Tomorrow morning: hello free-range brown eggs, black beans, adobo salsa, and cheddar cheese!

Intermittent fasting trial, in-between day

Yesterday was a big eating day for me. I broke Tuesday's fast with huevos rancheros. Frankly, I wasn't all that hungy when I got up, and I felt sick for much of the day--an all-over down in the dumps feeling like the flu.

In the afternoon, we had a celebration meal of sorts for an event. It was an all-day affair as we smoked babyback ribs and made ice cream in a hand-crack ice cream maker:


mint juleps
BBQ ribs (dry rub, smoke x4hrs, red sauce)
potato salad
watermelon salad with onion, mint & feta cheese
malbec wine
Sumatran coffee
chocolate cake
ice cream (chucks of chocolate, almond, cherry, zest of lemon & orange, rum)

By the end of the meal, I was unpleasantly full. I don't know if this is typical of eating a lot after a fasting day or if this is indicative that I simply overate.

new about page


I have a Bachelor of Science in Nursing (BSN) from the State University of New York. I post professional and personal items related to health, health care, and nursing. My interests are wide-ranging, and I previously pursued degrees quite different from nursing in both humanities and social sciences. My other appearances on the web can be found through the "more cxlxmx" link in the right column! Look in my Blogger profile for more information about me.

Intermittent fasting trial

As I indicated yesterday, I decided to experiment with intermittent fasting after reading some books on the subject. Today was day 1 of my trial week. It's now 7:41pm where I live, and I just sat next to someone through a meal of lasagna and red wine without feeling deprived. It's been pretty painless so far. Here's how the day went...

I got up this morning and had a shake for breakfast, then went to the hospital for a meeting and went grocery shopping afterward. The grocery shopping was a little difficult, and when I got home around 12:30, I was wanting lunch. But I took a short nap, and wasn't hungry after waking. Later in the afternoon, I went to the gym and did a lower body workout without difficulty. My afternoon since has been fairly painless.

I drank water throughout the day, and the only problem I've had is that after showering after the gym, I walked into the kitchen and grabbed a handful of raw almonds without thinking about it.

The morning shake

I'm fairly happy with my morning shake, which I've been having periodically prior to attempting the fast. Here's what I do...
Simply mix all in blender and add water to decrease thickness as needed. If this isn't sweet enough for you already, I recommend using a stevia sweetener. I've found stevia has less artificial sweetener aftertaste and works particularly well with fruit-flavored things.

You can also try adding other "good-for-you" things like turmeric (not too much and you won't taste it). I've experimented with adding the entire contents from jasmine green tea bags as well. This leaves little green tea particulate matter in your shake, but you can't taste it much. It's an easy way to get a couple extra cups of green tea a day.

Here's how the macro-nutrients break down:
Calories 376
Fat 18g
Saturated 1.9g
Mono 9.75g
Poly 5.9g
Cholesterol 30mg
Potassium 300mg
Sodium 245mg
Carbs 23.5g
Fiber 5.25g
Sugar 13g
Protein 33g

If you're turned off by the total fat content, take a look at the mono- and poly- unsaturated levels. Wow! That from the canola oil. A little canola oil in the shake is flavorless, and according to Dr. Vogel, it's a great way to increase your HDL. I used to use Silk's unsweetened Soymilk, which cut down on the sugar content. But according to the Price Chopper manager, Silk stopped producing the unsweetened variety. If you can find it, use the unsweetened variety and add stevia.

Looking forward to eating tomorrow, yes, but actually not that much...

Dietary fasting reviews

Prompted by FitnessBlackBook to investigate fasting as an adjunct to exercise, I purchased three books by MDs on fasting: Fasting and Eating for Health, The QOD Diet, and The Alternate-Day Diet. These three books have quite different focuses. The first is about extended fasts, the second about intermittent fasting for weight loss, and the third about intermittent fasting as a lifestyle for life extension.

My interest in fasting was not in finding a new lifestyle or panacea. Rather, I thought it sounded like intermittent fasting might be a simplistic (if not necessarily easy) way of periodically reducing calories for weight loss. What I wanted to do in ordering these books was to cover my bases in terms of possible health problems, see if there was a body of intermittent fasting knowledge out there already, and see if there were any interesting tips. The answers to my questions were no, no, and no. Basically, if you take a day where you eat a little protein in the morning and drink water during the day, there's nothing to know about fasting that day except that you don't eat. If you start getting more frequent, there could be an issue with hyponatremia.

I'm probably going to try fasting this week on Tuesday and Thursday. Check back to see how it goes. And now for the book reviews...

What I didn't realize when I ordered it is that Fasting and Eating for Health is not a diet book. It is about long-term (up to 1.5 months!) doctor-supervised fasting as a medical treatment for disease. There's no program you can do on your own. Moreover, most of the book is not even about fasting so much as a promotion of vegetarianism. The Physician's Committee for Responsible Medicine, whose president provides a forward, is a front-group for PETA, and the book makes some extreme claims like meat is more dangerous than cigarettes. Nothing is too corny to prove that self-deprivation is good for you. The author talks about lettuce tasting sweet after the fast and processed foods like chemicals. Well, I know he's right because I experienced this phenomenon myself while on... The Atkins Diet!

Importantly, the book was written in the early 1990's, and we have learned a lot about fitness and health in the last two decades. Even Dean Ornish, who is referenced multiple times in this book, no longer recommends super-low-fat vegetarian diets. Times have changed. Nevertheless, I can believe that medically-supervised fasting can improve symptoms of some diseases. (This is discussed in The Alternate-Day Diet as well.) The only valuable part of this book is an introduction to management and problems of fasting for health care professionals.

Of the three books, The Alternate-Day Diet has the most theoretical background, including discussion of epigenetics. It is lifestyle-oriented and focused on long-term health and lifespan. If you're looking for a program you can do at home but want to be sold on science, this is the book for you. The program (or eating plan, or lifestyle, if you will) is simple and straight-forward and you could easily imagine yourself doing it for an extended period of time, if not years or for a lifetime. The book is a fast read.

Unlike the Alternate-Day Diet, the QOD Diet promotes itself as a short-term weight-loss program that is NOT for a life-time. The main difference between the Alternate-Day and QOD diets is that QOD recommends more calorie restriction on the fasting days. The book also has a lot of minor recommendations about managing your salt intake with vegetable juices and other extraneous matters. If you like to obsess over things (like weighing yourself twice a day) and like being managed with "medical recommendations," then you'll like QOD better than Alternate-Day.

Both QOD and Alternate-Day have companion websites, although Alternate-Day's companion website is mostly just shilling for the author's Resveratrol supplements. If I were only going to recommend one of the three books I purchased for someone else, it would be The Alternate-Day Diet. If I were only going to keep one, it would be a toss-up between Alternate-Day and QOD. If I were talking to a patient, I think I would talk to them about fasting rather than recommending a book. You can take from that what you'd like.

Other interesting-looking books I haven't read yet:
  • The Idiot's Guide to Fasting (by Fuhrman) - includes information on fasting for different lengths of time
  • The Fasting Handbook - includes specific fasts such as fasting from carbs, fasting from proteins, fasting from mucinogenic foods, etc.
  • Fasting: The Ancient Practices - about fasting in the Christian tradition
  • Eat to Live (by Mehmet Oz and, again, Fuhrman) - appears to be a re-packaging of Fuhrman's previous work, including recommendations against eating meat
  • Maximum Muscle, Minimum Fat - this book seems to promote some sort of short breaks from food like the author's other book The Warrior Diet, which recommends eating one large meal a day at night. I find claims by Warrior Diet users of feeling euphoric during the day to be either unlikely or from placebo.
  • The CR Way & The Longevity Diet - these are books on calorie restriction, which is probably the leading (theoretical) method for life extension. The Alternate-Day Diet is supposed to be an easier way to calorie restrict and get health benefits.
Other fasting books:
One Amazon reviewer said all the information on fasting is available on the Internet, which may be true as well.

Pritikin Edge review & EXPLORE conference

Back in early June, I attended a Heart Teaching Day conference on campus hosted by EXPLORE (EXperience and Professional Learning Opportunities Result in Excellence), a committee affiliated with the local hospital, the county department of health, and the local community college and university.

Two of the talks--on current views of lipid management with statins and lifestyle changes for heart health--were given by Dr. Robert Vogel, a cardiologist and author of The Pritikin Edge, which I decided to order after the conference. I was excited because Dr. Vogel's PowerPoints were full of discussions of the research. Charts, graphs, citations. Plus, the things he was talking about seemed like a change from the old "super-low-fat and long bouts of low-impact aerobic exercise" Pritikin advice. He discussed the value of eating the right fats and exercising with HIIT (running can actually be bad for you!). From what I could tell, he was basically saying that the new Pritikin recommendations were converging with other diets that weren't quite so... unpleasant. During the Q&A session, someone asked him to discuss the differences in fish--were there healthy and unhealthy fishes to eat? He ran out of time, so he just said, "well, just buy the book, it's all in there."

Well, it's sort of all in there. The charts and graphs are gone and the book doesn't have any citations. (I suppose most people will think that's a good thing, though.) I don't mean to imply that this stuff is made up, but what if you want to go deeper? The recommendations themselves are the same as at the conference, but the emphasis given to them is quite different. It's as though this book is struggling to put new data and recommendations into the old-timey Pritikin mold so as not to have to admit that the old Pritikin diet had any problems.

For example, the book describes a jogging routine using fast and slow rhythms, but doesn't actually say "HIIT," and this comes at the end of a section on doing more walking. If you didn't already know better, you'd come away from this book with the idea that the exercise recommendations are for lots of... long bouts of low-impact aerobics, like the old Pritikin recommendations. Although "resistance exercise" is recommended, the space devoted and examples leave one with entirely the wrong idea. Squats with 5-lbs dumbbells don't cut it unless you're starting off as a completely sedentary elderly person. Exercises like bicep curls and calf raises are simply dumb if all you're trying to do is keep fit. A much better recommendation would be the three-to-five-exercise routine found in Body by Science. Also, I'm far from convinced of the usefulness of stretching for fitness. Here's a place where the lack of citations really hurt. How can I be convinced?

My main problem with the Pritikin program is that it doesn't seem to acknowledge any sort of perspective. For example, it attacks olive oil because olive oil is only better than butter but not the best oil you could use (canola). Well, honestly, if you could get someone to switch from butter-basis to olive oil, isn't that pretty good? In his forward, Dr. Vogel talks about adding 7 years to your life. Well, how much of that is the difference between olive oil and canola oil and how much is the difference between butter/lard/transfat and olive oil? What's the cost-benefit analysis if you like olive oil but not canola?

An annoying thing about this book is the constant attack on low-carb diets. This is just a continuation of the Pritikin-Atkins wars that go back to the 1970s. Is this book about best practice or about taking book sales away from Atkins? Dean Ornish's old recommendations were also incorrect, but Pritikin doesn't beat up on the 10% solution. Some of the debating points are not even valid (e.g., protein will not cause kidney failure without other intervening factors). Atkins could be done with the same fish, beans, and leafy greens that Pritikin recommends. During the conference lunch, we had a buffet including:
  • whole-wheat roll;
  • chicken breast with peanut sauce on the side;
  • egg plant lasagna;
  • spinach salad with raspberry vinagrette;
  • steamed "Chinese" vegetables;
  • sweet iced tea.
I sat at the same table as Dr. Vogel, who ate a roll, the Chinese vegetables, and iced tea. I ate the chicken breast, the spinach salad, and a half-glass of iced tea. I skipped the peanut sauce. I skipped the roll, the lasagna, and the vegetables (because I didn't know how much sugar and salt was in the sauce). I had one serving and was satisfied. Dr. Vogel went back for seconds on the veggies and had two glasses of iced tea. There's no way he did a better job than I did for calories and nutritional density, but he skipped the protein. To what end? Take that Dr. Atkins!

The issue that ketogenic-to-low-carb diets like Atkins address are the psychology of dieting and weight maintenance. And you won't find that addressed in Pritikin, either, except through their satiety principle, which is basically that if you fill up your stomach with celery you shouldn't be hungry anymore. Voila! Unfortunately, I don't think that works. I've gorged myself on high-roughage salads before and sat back and said "that sucked, I want something else to eat." Satiety is about more than filling your stomach.

During the conference, Dr. Vogel told us, "if someone starts talking to you about the Glycemic Index, you should stop listening to them because they don't know what they're talking about." And then the carrot example comes up... Yes, carrots can be high on the Glycemic Index (when indexed against bread), yet not bad for you. They don't spike your blood sugar/insulin because they don't have a lot of carbs in them--i.e., they have low Glycemic Load. But carrots are an anomaly: a good food that is bad on the GI lists but good on the GL lists. The opposite--a bad food good on the GI lists but bad on the GL list--I can't think of. So, if you're talking to a patient, which makes more sense: (1) teaching them about GI and causing them to skip carrots; or (2) teaching them about GL and forcing them to learn how to weigh and measure foods when they eat out? Look at the chart above. Which would you rather do while standing in a cafeteria line--just choose beans or try to choose the right amount of rice to get a certain Glycemic Load?

This Glycemic Index issue is another example of the perspective-psychology problem that Pritikin seems not to be aware of. The book makes reference to the CEO of Barnes & Noble, Bill Clinton, and other Pritikin devotees who are apparently professionals. The Pritikin Spa in Florida attests to the socio-economic level of the people using Pritikin (see above; this fall, only $3900 per week!). Any recommendations are easy if you live with a lot of resources in environments that you can control easily. Again, looking at cost-benefit analysis and usability in the lives of normal people, does it make sense to recommend only what's going to extend life-span the most in the best case scenario or to balance that with what's going to have the biggest bang for the buck and is most likely to work in most people?

Anyhow, for my complaining, I think The Pritikin Edge is a good book. I'm sure the diet recommendations will go far toward helping your heart if you can follow them. The exercise recommendations will do okay, too, even though I don't think they're all best practice. The book's production is good, although the lay-out probably could have been improved.

Body by Science review

I was prompted to get Body by Science after following author Doug McGuff's comments on the Theory to Practice blog. Body by Science strives to prescribe a work-out routine that takes proper advantage of physiological knowledge to promote fitness, defined as the ability to take part in non-sedentary activities. The book does derive a work-out routine from a presentation of physiology. The recommendations include one short strength-training work-out per week with no traditional cardiovascular work (e.g., jogging) and a "hunter-gatherer"-type diet.

The physiology presented in this book is more extensive than what I've seen in traditional weight-lifting or diet-exercise books aimed at the public. Compared to two text-books for university courses in nutrition and exercise science, the physiology here is about as broad, presented in a slightly more truncated and easy to read format.

The thing that really distuingishes Body by Science, however, is that the physiology is presented in a manner that deconstructs traditional concepts of exercise. To sum up, the book contends (1) that cardiovascular fitness is something that occurs primarily in a diffuse manner throughout the body at the level of the musculature, not primarily as adaptations in the heart and lungs, and (2) that the musculature does not know if it is getting stressed by resistance training or traditional cardio work. The logical conclusion from these two premises is that the best overall fitness training is pure resistance strength training done in a manner that stresses the muscles without stressing joints, ligaments, etc.

I must confess that although I was aware that cardiovascular adaptations occurred at the muscular level, I was also under the impression that there are adaptations in the heart that occur specific to traditional styles of aerobic work such as jogging. However, I am at a loss to say what those are. I have a vague notion that sustained moderately elevated heart rate is important to the heart, but I couldn't tell you what exactly it achieves.

Of course, my failure to refute the physiological and exercise science presented here does not make it correct. That is the biggest draw-back with this or any exercise book--you are always at the mercy of those with more expertise. The only recourse you have as a reader is to educate yourself with some basic knowledge about research and publishing standards and try to evaluate how honest and accurate a book appears to be.

From this perspective, Body by Science holds up well, but not as well as its hype. Subtitled "A Research-Based Program...," you expect a book swamped by citations like an academic paper. The book does have more citations than a typical exercise book, but it is not near what I expected. For example, it says, "Virtually every study undertaken to assess the cardiovascular effects of proper strength training has concluded that they at least equal the effects of more conventional approaches such as running or other steady-state activities." However, the citations given to support this statement are two studies from 1985 and 1988. This is really not acceptable, even if the statement is accurate. Either many more (recent) studies need to be cited (or at least a review paper that examines this issue in depth). This is one example, but I think it fairly characterizes the whole book.

The book's biggest drawback is its failure to present evidence that its specific program has been demonstrated to work. The authors repeatedly mention the years of experience they and other trainers have in using their techniques, but they present no study they've conducted and only one photo of someone they've trained. The use of photos showing muscled young men is dismissed at the beginning of the book by referring to genetic variability in response to weight training. This is true, but in the absence of studies, anecdote shows something. Maybe doing the Bill Phillips Body-for-Life workout won't make you look like those contest winners (see above), but at least we know it can possibly do anything at all. Maybe eveybody's training will stagnate with Body by Science. Who knows?

In addition to its central message, the book touches briefly on a variety of peripheral issues. Some, such as the connection between an attempt to moderate training and a regression in training, confirm my personal experience. Others are silly, like the suggestion to drink cold water all day in order to burn off about 125 Kcal through thermodynamic effects. Any lifestyle cost-benefit analysis of this proposal could not hold up, especially for people living north of Florida.

Despite the criticisms, I think this is a useful book for fitness hobbyists to read. I really want its core recommendations to be correct (and I'm probably going to experimenting with them a little), and even if it is not the best program for otherwise fit and healthy individuals, I can see that it might still have applicability for the elderly, those needing rehab, or those with cardiac or respiratory disorders. It is worth investigation by health professionals as well.

If I were going to improve this book a great deal, I would demonstrate much more thoroughly and specifically that the program lives up to its claim "research-based." If McGuff, an ER doctor, recommended to me that I receive the medication tPA and I found out his recommendation was based on knowledge of two small studies conducted in the 1980s and that he couldn't show me any of his other patients who had success with this medication, I would be flipping mad. If you're going to claim exercise should be approached like a medication, you need to treat it with similar rigour.

Summer thru June

I don't know if it's fair to say I've wasted the summer so far, but I certainly haven't gotten prepared for the NCLEX the way I thought I would. My plan was to take it in mid-to-late June, but now I'm looking at late July. I had a roller coaster of emotions after graduation. I expected to feel elated, but instead I just felt relieved for about a week and then crashed into a funk. What to do with myself? I thought. Get a job, yes, but so what? That's not really going to make me happy.

Finding balance in life

And it isn't. When I first decided to go into nursing, I wanted to find something where I could make a decent dime by punching in and out and not taking work home. Then, in nursing school, I got sucked into the whole "professionalism" angle and started getting invested in things. This is what put me in a funk, because the only way to get invested in the health care system today is to embrace all the things I run away from in other aspects of my life. Over the last weeks I haven't been blogging, I have tried to re-assess where I'm at. The fact is, it would be hard for me to work anyplace and not get involved beyond punching in and out. The key for me is to be selective about involvement so I have plenty of time to balance the plasticized totalitarianism of health care with the values I cherish in other aspects of life such individualism, curiosity, antiquarianism, and nature.

Did I graduate for real?

I was concerned about grades and actually graduating before. I still haven't received my diploma in the mail, but my posted final grades this semester ended up being quite good, so I can't imagine there will be any problems.

End of blogging?

For a while, I considered stopping blogging. I was going to take down my Flickr account and erase all my posts here. I was enjoying being free of the Internet and thought about taking myself completely offline for good. But there's a reason they call it "the web". I couldn't stay away. I'm intellectually entangled. And as I thought about it, I decided that the blogging, rather than eating up my valuable time (or, rather than simply eating up my valuable time), was actually something that helped keep me going. At least for the time being, I need this outlet.

Improving health/fitness

One goal I had for the summer was to lose weight, so I started back to the gym. Whenever I do this, I overwork at first and end up very sore. I spent a week with such bad pain that it hurt to do anything but sit still in a chair. Eventually that subsided, though, and I've been exercising fairly regularly since. My weight started going down, but then we celebrated a birthday with smoked ribs, and it started back up and then a plateau hit. Last night, I was down 9 lbs from two days previous, but that must be water weight. I think if I were completely hydrated I would be about 270 now. I had hoped to be around 250 by the end of the summer, but right now I would be happy just to be at or under 260.

Workplace goings-on; can't get a reference?

At work, I had a good job performance review as a clerk and so, figuring this was about as good an invitation as I was going to get from my director, I gave her my resume and asked for a job. She said there was room for me on staff, so I went down to HR. Then I find out HR requires two references from my nursing school despite the fact that I am applying for an internal job transfer. Everyone I mention this to says, essentially, "yeah, duh!" but I still think it's weird. I graduated, right? Since I've been working in the hospital for 5 years now, what do they want to know about me? If my unit director thinks I am responsible and perform well, are they going to listen instead to a reference who doesn't really know me and who they don't really know? It's weird.

Anyhow, I asked three people for references. One said yes. One didn't respond to e-mail. The third said yes, but now isn't returning my calls and text-messages. Who knows. If it would turn out that I couldn't get two positive references from my nursing school, I would be very annoyed. What would I do? I guess I would have to join the Navy. They probably take anybody.

Vibram Fivefingers

After seeing the Virbram Fivefingers on Mark's Daily Apple and Theory to Practice, I decided to give them a try. So, I rode my bike out to the Kayak Shack and bought a pair yesterday. Here are my initial impressions...

They look nice. Just like the photos online. The sales clerk measures my foot and picks out a Sprint. First time, my toes all go in the wrong holes. After working it a little, toes go in.* First (R) fits perfect. Very comfortable. Then try a KSO (R) in one size larger. Feels okay, but probably too big. Decide to take Sprint and wear out of store.

Fit Comparison

These are very strange feeling compared to shoes--flat and not bouyant, but very light. I know they are supposed to feel like you don't have shoes on, but I wasn't expecting the effect to work quite so well. They aren't like wearing sandals. You can really feel the terrain under your foot. I would imagine they are uncomfortable on concrete for any long period.

With both on my feet, the left feels much snugger than the right and I can feel something in the left sole rubbing on my arch. This is a chronic problem with shoes--my left foot is bigger (same with my brother and mother!). While walking, the left is uncomfortable. However, I discovered that while running, the area that rubs is never an issue because of being up on the balls of your feet.


I wore them to ride my bike home from the Kayak Shack. The grips on my bike pedals didn't touch the Vibram soles, but they did touch my feet right through the soles. It hurt to pedal hard or stand. Very uncomfortable to ride a bike, and not stable feeling. Plus, my big toe almost got caught between the pedal and crankarm while riding. Definitely not recommended for biking.


That night, I took them to the gym and did a very short HIIT workout of 10 minutes. It was not what I was expecting at all. My heart rate barely got up, and I couldn't feel my glutes or thighs being used at all. The entire run was on my balls and calfs. As the website indicates, you really do run differently in Fivefingers. It's hard not to fall back into landing on the heel, but when you do, you know it: bound, bound, bound, slap-lurch; bound, bound, slap-lurch. Mostly, the lateral aspects of my calfs got worked, which I expect is from gripping with all the toes rather than rolling from heel to big toe, as in shoes.

One big difference from running in shoes was a lack of pain in shins and knees. Part of my motivation in getting the Fivefingers was the recent development of shin splints and ongoing knee pain. My thought was that switching back and forth between my normal New Balance 1224 and the Fivefingers might help alleviate the shin splints. It's hard to say. I was once told by an NCAA x-country coach that my shin splints were caused from over-development of my calfs. If that's correct, then it seems like running on my calfs would make the problem worse. But can you argue with an absence of pain? Maybe the Fivefingers are helping me utilize my calfs correctly?

As for knee pain, again, can you argue with the absence of pain? The pounding braking motion I could feel when my heels did come down first (slap-lurch) suggests to me that heel-running is putting a lot more force through your joints with every stride. I can easily believe that a better use of body mechanics could help my knees.

Recommendations from the store owner and the Fivefingers website are for easing into running to avoid hurting previously underutilized parts of your foot. The only foot pain I had was a little place at the top of my right foot, and it appeared after the biking, not the running. I often go barefoot indoors, and in summer wear huaraches everywhere, so it could be that my feet are already better acclimated.

I'm definitely going to try the Fivefingers again. They are a little awkward feeling and hard to get used to. I ran a little pigeon-toed, I think. And I'm not sure how useful they are for fitness/weight-loss if you don't get your heart rate up or use your larger lower body muscles. Too efficient? We shall see.


While at the gym, I also used a stair-climber and did an upper body free-weight routine. The Fivefingers lacked traction on smooth plastic surfaces but were otherwise fine. Wearing them with light nylon running shorts made me feel like I was lifting in the nude, but I kind of liked it. Ancient Greece, here I come!

I'm not sure if I'm going to try them for a lower body routine or not. Since their traction isn't as good as shoes, I'm not entirely comfortable with the thought of using them on hack sleds, etc.


When my brother saw them, he said the Fivefingers were "hippy shoes." As a huarache wearer and general skeptic of modernity, I can live with that.

* The secret to getting these on your feet easily and swiftly is to start with the big toe and work down to the little toe. Once the first three toes go in, the 4th and little slide in automatically.

Nursing textbooks: cleaning out after graduation

Is everyone stuck with a bunch of textbooks after graduation? I keep wondering if the folding legs on my table/desk are going to collapse. I've been looking forward to getting rid of a bunch of these and the day has finally come. So, here are my nursing texts divvied up by post-schooling usefulness...

Books I'm getting rid of immediately

Mosby's 2005 Drug Consult: I bought an old copy of a drug consult to save money. This one was a stinker. Very little info and difficult to read and look things up. The hospital where we did clinicals uses a different publisher's drug consult, and it was much better. Avoid Mosby's Drug Consult. Besides, in today's clinical environment, who needs one at all (Hint: go PDA)? Unless the computers go down, or you want to look something up at home... It's a good thing to have, I think.
Lab and Diagnostic Test Guide: I bought an old copy of this to get one that was co-authored by one of my professors. Not a bad choice, but in general the lab and diagnostic guide was not needed. Does anyone actually use this in school? All the information is available on the web, now, anyhow. Assigning it was not a good use of resources.
Nine Hills to Nambonkaha: ugh. Read my Amazon review.
Masting Project Management: double ugh. When I read books like this, I imagine people in lower and middle management jobs desperately looking for something, anything to escape. It depresses me. If you can't project manage intuitively, you're not going to be promoted much unless you kiss butt, period.
From Silence to Voice: I wanted to like this book, but in the end I thought it was mostly just a guide to common sense political wrangling and English composition. Better to get Strunk & White's and be done with it.
Nursing Diagnosis Handbook: I wrote a poor review for Amazon, although after I was forced to use this book more, I found it handy for school. However, I am still very skeptical about the entire nursing diagnosis project. Creating this entire system that's taught in school and then discarded in clinical practice just for the purpose of demonstrating "professional knowledge" seems like a waste. Plus, I'm not sure it does a good job of what it's supposed to do, which is describe nursing practice. In cardiac and critical care, there are plenty of assessments and interventions that nurses make that are essentially medical in nature.
Essential Drug Dosage Calculations: The math that nurses need to know is very elementary, however important it might be. Even more so now that so many products come pre-measured and pre-drawn. Buying this book was not useful for me, although, inexplicably, many of my classmates had difficulty with the simple math needed for nursing. In fact, there were even errors in the answer keys for some of our quizzes. I don't think this book was necessary, though, unless problem sets were going to be assigned from it.
Clinical Nursing Skills & Techniques: A fine textbook from which we did not have enough reading or test assessments. I am getting rid of it because it is out of date, but I may get another. The only thing is, all this information should be online for free!
Nutrition From Science to Life: The hokey title says it all. It was out of date when I bought it and would have been a waste of money anyhow. The science of nutrition is a lot more undecided and unknown than nutritionists would like to think, although there seem to have been great strides in the last 5-10 years. If I had to teach a nutrition course, I think I would make students more aware of the controversies rather than teaching "best diet" and "best weight."
Sociology in Our Times: Okay book, but I am outraged that this discipline is still teaching discredited crap like The Authoritarian Personality. This textbook has citations from the '50s and '60s. What a joke!
Understanding Psychology: Whatever. Didn't really need it for the Intro Psych class.
A Topical Approach to Life-Span Development: It aims low, but is a well-constructed text from which I was able to learn a lot. As with sociology, psychology has some sacred cows, like Piaget, that seem to me to be almost certainly wrong, although they are still taught without addressing issues like Piaget's out-of-date research techniques and lack of grounding in biopsych. All the background psychology a nurse needs is available online now.
Professional Nursing Practice: Read my Amazon review--this was a real, true waste of money.
Public Health Nursing: I think there was one reading assigned from this book in my community health course. Could have easily taught the course without this book. I think I may change my mind and keep it, though, as a reference. Public health nursing seems labyrinthine to me.
Wong's Nursing Care of Infants and Children: I hated this book. I hated everything about it. The prose, the design, the illustrations--it was all awful. It was almost unreadable, and I stopped trying when I discovered that it was still teaching Freud's developmental levels. These should be relegated to courses on history of psychology rather than being included in practical textbooks. The actual useful material in this book could have been condensed to a text maybe a quarter to a third the size.

Books I'm getting rid of soon

NCLEX review books: I'm tempted to keep Saunders' Comprehensive Review since it has a nice outline, but realistically, I'll never look at it again after the boards. These can all go to next year's students. Gone after the NCLEX.
Medical-Surgical Nursing: an okay text. It needs better design/layout. I couldn't really figure out how to use it efficiently until the course was almost through. Gone after the NCLEX.
Fundamentals of Nursing: why this text and the Med-Surg one? Too much duplication. If I ever want to refer to theory, I can find this in a library. Gone after the NCLEX.
Procedures and Techniques in Intensive Care Medicine: Well, this one wasn't assigned, but I'm getting rid of it after I read about a few of the procedures, like echocardiography. It's out of date, now, I think.
Psychiatric Nursing: Way too based in Freudianism and psychotherapy, but my impression is that without hanging on to these, psychiatric nurses wouldn't have anything to do except pass meds. The "decade of the brain" material seems like an add-on. Good layout, though, and easy to read. I came to enjoy this book.
Ethical Decisionmaking in Nursing and Healthcare: Arrrrrrrggghhhhhhhh!!! As soon as I find a way to make a formal and comprehensive critique of this book, it's going in the trash. What a boondoggle! Instructors can use it to justify any ethical/political opinion, and the book is so circular that they can get away with it.
The Complexities of Care: I read one of the chapters in the library and liked it a lot, so I purchased the book. Then after looking at a couple more, I am less enthusiastic, but I will read it before giving it to somebody else.

Books I'm keeping

Diagnostix: I got my blood pressure cuff out of the box once, when I first got it, to put it together and test it out. Why was this required for school? I will keep it for an emergency kit for the car, however.
Taber's: Whatever. All the terms are available on the web now, but I'll keep it. It was a waste of money to make it a required text, though. Books should be assigned thus: "Here are the web resources, but if Internet access goes down, you might need these."
Essentials of Nursing Research: Not much in here that couldn't be found in a library or online, but if you intend to pursue any research, it might be useful to keep in mind the standards that reviewers and editors will be looking to.
General, Organic and Biochemistry: I never learned this well enough before so will start reviewing after the NCLEX.
Critical Care Nursing A Holistic Approach: I thought this was a good book. I intend to read it cover to cover after the NCLEX. And if I'm going to start studying for the CCRN exam, it may come in handy.
Introduction to Microbiology: From our micro class, apparently a good intro textbook, although I have nothing to compare it to. I wish the micro class was aimed more at nursing and medicine, though if I were to pursue infection control, this will be a good review/reference work.
Pharmacology for Nursing Care: What can I say? I liked it. Others didn't. I want to keep it and compare it with other pharmacology textbooks in the future. I also want to review the material from time to time.
Physical Examination & Health Assessment: As with the pharmacology book, useful review material and I'd like to compare it to other assessment texts in the future.

Books for elective courses

Biopsychology: It was an okay course, but I was hoping for something sexier. I thought the Pinel textbook was weak and hard to read. Useful information is all on the web and changing very quickly anyhow. Getting rid of it.
Essentials of Strength Training and Conditioning: I think this book is outdated. Advice on workout design, nutrition, etc. seems old-fashioned. Getting rid of it.
Fundamentals of Molecular Virology: At first I liked this book, which is organized by viral family, but after getting into the course more, I wished I had a textbook that was organized differently--say, a chapter on known/common methods of cell entry, etc. This would have been better for long-term retention, I think. Keeping it.
Medical Microbiology: This was also the name of the course this textbook was for. It was a good course, and I squandered time and energy that semester being stressed out about Nursing Fundamentals, which turned out to be not much a challenge. Although much of the information in this text can be found online, it is not easy to access as it's in image databases, etc. This would be a good text to have on hand if you were working in a tropical area or even the south. Keeping it.
Emergency Care: I just discovered last week that my EMT license is still good. I thought it had expired, but apparently it's good for three years rather than two. The text is useful since it presents information in the way the EMS system utilizes it, which is different from nursing. Hopefully, I'll be accepted at a volunteer service after I get established in a nursing job. Keeping it.
Biochemistry: This text was for a course that I didn't actually get to take. When I was taking Biopsychology, I tried to get the professor for Biochemistry to let me into the course without the prerequisites. He said no, but I bought the book and started attending the classes anyhow, hoping he would let me in. He didn't. However, even without doing the reading, I was able to follow what was going on well enough, and I got to see a guest speaker who was a VP at a pharmaceutical company give a talk on the drug approval process. Very informative. Keeping it.

Books I bought for my own edification

Physiology: At the beginning of nursing school, I assumed that medical schools must use one, or a couple, standard physiology texts. I couldn't really determine whether this is true from looking on Amazon. However, Berne and Levy seem to be well-regarded authors. So, I got this text thinking that we would be studying physiology in more depth than we had in A&P (buahahaha) and that I would simply read from the Berne and Levy rather than from the nursing textbook. You can imagine how this worked out. Keeping it, though, and may start reading.
Renal Pathophysiology, Primer on Kidney Diseases, Clinical Physiology of Acid-Base and Electrolyte Disorders, Mosby's Fluid, Electrolyte, and Acid-Base Balance, Acid-Base, Fluids, and Electrolytes Made Ridiculously Simple: Somehow, I had the idea that these books were going to help me get way ahead on renal and acid-base info. Somehow, I had the idea we had to know a lot more about these topics than we actually did. Getting rid of them.
PDR Nurses Drug Handbook Cardiovascular Edition: This was a give-away from Bristol-Myers Squibb. Not much better than a standard drug guide. Getting rid of it.
Cardiovascular Physiology: This is the Berne and Levy, cardiovascular chapter only. A great little book that every cardiac, ICU and PCU nurse should read. Keeping it.
Principles of Physiology: A slightly less technical (dumbed down) version of Berne and Levy. Since I didn't have an A&P book, only an A book, this serves very well as a reference for physiology. Keeping it.
Core Curriculum for Critical Care Nursing: As soon as I get my "sea legs" in my first job, will start reviewing this to prepare for the CCRN exam, which I think can be taken after the equivalent bedside hours to about one year of full-time work. Keeping it.
Basic Arrhythmias: For when I thought I would get cross-trained as a telemetry technician a few years ago. Oh well. Keeping it, though.
Color Atlas of Anatomy: This is an amazing book that is actually photos of cadavers. This is about as close as I'll probably come to a gross anatomy clinic. Keeping it.
Atlas of Human Anatomy: Since I borrowed someone else's book for A&P, I don't have an A&P text. At first, when I still remembered all the anatomy from A&P, I didn't think that mattered. But I've forgotten a lot over time, so I needed a reference. I think this one is okay, although its low price and high volume at Border's made me wonder whether or not it might have some mistakes. I'm taking my chances.
Clinically Oriented Anatomy: I bought this after A&P thinking I would get a different perspective. This is a good text, but it's not an armchair book. It really needs to be used in a classroom setting. Still, keeping it.

Well, that's it. Really, there should be a single reference text that nurses could buy to support their practice. Classroom textbooks don't cut it as they present all information with equal emphasis, whereas some things will no doubt be easy to remember after starting practice, while others will not. Something to think about...

Post revised July 2009...

PSU 2009 commencement

In theory, I've now graduated from nursing school with a BSN. In fact, I've completed only the commencement ceremony today, and the actual graduation won't be finalized until after this semester's grades are turned in and all the i's are dotted and t's crossed. My name wasn't in the program for the commencement, but I assume this is because I turned in my graduation application to the registrar too late. Am I concerned? A little. The professor for the Community Health course is not trustworthy in my opinion, and we don't have tests in that course. Instead the final grade is based on her assessment of an overall portfolio of your work that is turned in at the end of the semester. The syllabus was a mess, and I'm not sure I turned in all the work for the course. Even so, I should be okay as long as she decides I'm sufficiently socialist for her liking. Anyhow...

Saturday started sunny but steadily descended into a drizzle with heavy rain later in the day. The commencement ceremony at PSU is split into a morning session--for the schools of education, health, and business--and an afternoon session--for the schools of art and sciences. We started gathering in the ice hockey arena at an overcast 9:30 for a 10:00am ceremony.

Commencement takes place in the gym of the college's field house--the only indoor venue large enough. It's pretty standard decorating fair, although they do well for a gym. A few years ago, a bagpipe band started leading the processional and recessional, which is a nice touch.

The student commencement address was given by a nursing student this year. The practice of choosing a commencement speaker based on grades is fairly dubious. My fellow nursing grad was smart enough but mostly just studied a lot, and her speech reflected that. It was schlock about going beyond your career path to become the type of person you want to be. Spoken like someone who has spent her entire life locked in an academic prison. Most of the grads there were, instead, in the position of having to face a career after spending the last four years exploring what type of person they were! We also had a speaker who's a star on some TV show and came back to college to finish his degree, but I don't watch enough to have any sense of his importance.

Then it was on to filing across the dais to shake the president's hand...

A family friend who is a professor was sitting in the front row as I came across the dais and gave me an embrace, which was really both unexpected and affecting as the rest of the ceremony was both anti-climactic and overshadowed by the aforementioned Community Health question as well as the upcoming NCLEX exam. For myself--and I sense this is the case for most nursing grads--passing the NCLEX is going to mean a lot more to me than graduating from nursing school.

Actually, if I'm honest, I'd have to say that nursing school, despite being in a BSN rather than ADN program, bears so little resemblance to the academic experience that I had in previous university study that I don't feel as though I've finished what I started and finally graduated from college per se. It was more like some sort of boot-camp-college-game-show amalgam for which you had to jump through successive hoops while attending classes and keeping the drill instructors happy. Although I have a full grab-bag of skills and disparate formal training, I don't feel that I've acquired a consistent body of knowledge or methodology. (The "nursing process" is too generalized and accessible to common sense to justify four years at university and tens of thousands of dollars.) At the outset, I was expecting to receive knowledge of "people as patients" and "patient care." Instead, it's a little petite medicine training, a little management, a little social science research... This makes me a little despondent. I came only for job training, but I got something else very different that's supposed to be academic and professional, but I can't define it well.

At end of the ceremony, the mace recesses down the aisle followed by the honored guests and faculty. Then the pipe band leaves followed by the newly graduated students. I had intended to get just a 30 second clip of the pipe band, but since I didn't know where they were in the line, I ended up taping the entire recessional. This has the advantage of showing almost everyone in the ceremony. The original .MOV file can be downloaded from the Vimeo site, and it should have better quality, I think.

The one part of the day I was really looking forward to was having my photo taken outside after the ceremony. Over the years, my father has brought home a stream of photos taken outside in the same place with his graduating students, so I thought it would have been nice for him to have one of me with him as the parent instead of the professor. Alas, it was not to be. By the time we got outside after the ceremony, the rain was coming down quite hard. As my mother pointed out, it was the exact same weather as the day I graduated from high school. I hope that's not an ill omen, as my post-high school plans didn't play out very well. Anyhow, family photos got relegated to the living room.

During lunch that day ("Tuscan tuna salad"--tuna, beans, onions, olive oil, wine vinegar, spring greens--it's nice to be back off the studying/library habits), I asked my father whether he had heard of artist Catherine Hartung, who I mentioned a couple posts back. He said, "Oh, you mean Kate?" It turns out she used to babysit me! The world is a small place, especially in upstate New York.

My brother had told one of the waitresses that he was going to McSweeney's that evening for dinner, so we decided to all go and then on to Harrigan's for dessert. It was a real north country eating out experience.

So now what?

...well, the first thing is to lie low until grades are finalized. Then, after I'm sure I've graduated for real, it's a marathon study session for the NCLEX. Of course, I have to figure out what I'm going to do with my life, too.

Post revised July 2009...