The Intensive Artist has posted a list of ten personality traits that he thinks are requirements for a good nurse. What are we to make of them? Am I a bad nurse? Let's score me one point per trait.
1. Love being busy
I don't like being busy. However, I also don't like being bored. Typically, busy is boring, but it is less boring than sitting around. I think the more operative point here is "don't be lazy." I'll give myself half a point.
2. Love meeting strangers
I hate meeting strangers. I hate small talk. And I hate learning the details of people's lives when I can't turn the chanel at will. Zero points here, but I'm not sure this is really a good personality trait. I see other nurses making pointless banter. I try to be accommodating and polite and mine for information that will make things go smoother for the patient. I think taking an interest in the details of other people's lives is one of the things that people who are like that think is important.
3. Be a great mutli-tasker
No such thing (that's research, not opinion). It is probably more important to have large RAM than large CPU, however, and to be able to maintain a queue of tasks in the back of the mind that is constantly being revised. I'm not good at this, which is one reason I prefer night shift. Zero points.
4. Be okay with body fluids
Check. Actually, I'm probably too okay. Lack of a healthy respect for micro-organisms can be made up for by revulsion. 1 point.
5. Love physical labor
I love physical labor, but I hate the physical side of nursing. Nursing is not like exercise. After a work-out, I feel great. After a shift, I feel run-down and wrung-out. Doing squats or wind sprints for 15 minutes is not the same as being on your feet for 12 hours. And neither is like construction. More operative here: "be able to take the pain." I guess, half a point for me.
6. Be thick-skinned
This is so very important for nurses. Unfortunately, I am about as thin-skinned as they come. This might explain why I feel run down after a shift. Zero.
7. Thirst for new knowledge
I get a point here, but I'm not sure how important this is for nurses. Most nurses, even ICU nurses seem to be happy to be spoon-fed information from the unit nurse-educator, and they are good or even great nurses nonetheless.
8. Hate routine
Actually, I think this wrong. Chaos is not good. I think being a good nurse involves imposing order and routine. I don't mean in the stereotypical Nurse Ratchet way, but in the sense of having enough control over a situation to stay ahead of the game.
9. Be an adrenaline junkie
Again, I think this is backwards. A good ICU nurse is not one who's going to codes all the time but one who stays ahead of the codes and prevents as many as possible.
10. Have an undying positive energy
Yes, but zero.
Okay, so I score 3 points out of possible 10, but I only agree 100% with 5 of the Artist's 10 personality traits, but I may be very wrong.
What I've been up to: now working in ICU
Having not been paying attention to my blog or RSS reader for some time, I was surprised to see recently that my Blogger profile still had my occupation listed as "GN." If you've read this blog before, you will probably note that I started it as, essentially, a coping mechanism for nursing school. But I posted on starting my first job, and then what? Here's a run-down:
In the mean time, I've decided to just relax and do some reading and self-education. Also, start blogging again.
- May 2009 : graduated nursing school and got a job in late summer of 2009
- November 2009: 1st job: the Progressive Care Unit at the ~300 bed hospital where I had been working as a ward clerk hired me. I started my initial orientation in the summer and moved off at the end of October.
- July 2010: 1st job change: although many of my co-workers were friendly and supportive, not all were. After suffering through some personal upheavals at work, I decided to move on... cath lab, OR, some other critical care area... I was just about to decide between going back to school in fall 2010 (biochemistry) or vagabonding around the world when I got a bite from the ICU.
- September 2010: 2nd job: the Intensive Care Unit. I was lucky to get this job. I don't know why they hired me, honestly, but here I am. A few weeks on orientation and, bam!, I'm on my own.
- December 2010: 1st major FUBAR: things were going so well and it was suggested that I might want to take on learning SLED dialysis. Then I screwed something up. No patients were hurt in the making of this error, but I had to have a disciplinary meeting involving the union and the manager said "Do you know how many times I've ever had to call someone into my office for [FUBAR error]? Zero!" Yes, that's me: if I'm going to screw up it's likely to be a unique screw-up.
- Today: ICU, but ready to move on if necessary: so I'm coming up on 6 months in the ICU soon, but I'm not really sure where I stand. I think the staff is split with some well-wishers and some who would like to see me go, and I don't really know where the management staff is.
In the mean time, I've decided to just relax and do some reading and self-education. Also, start blogging again.
Underwear sniffing
For an explanation of this post, see The Sexy Nurse Report.
The thing that bothers me most about this advertisement for JBS underwear is the idiotic way this nurse is dressed, although most people are probably primarily scandalized by the sniffing (more on that in a sec...).
Although the entire ad campaign is genius ("men don't want to see naked men"), this particular ad, produced by &Co. advertising agency for JBS is dumb, and by far the least sexy in the campaign:
As for the sniffing, nurses don't deal with patients' clothes. Here is a real photo of the typical underwear situation nurses deal with--an alcoholic patient in the ER needing adult diapers has taken them off (resulting in urine all over the floor and bed):
The smells nurses have to deal with aren't too sweet, either. C. difficile is an intestinal bacteria that can form a "pseudo-membrane" over the intestinal lining, causing massive, recurrent diarrhea with a distinctive smell like a horse stable that every nurse recognizes and dreads:
The thing that bothers me most about this advertisement for JBS underwear is the idiotic way this nurse is dressed, although most people are probably primarily scandalized by the sniffing (more on that in a sec...).
Although the entire ad campaign is genius ("men don't want to see naked men"), this particular ad, produced by &Co. advertising agency for JBS is dumb, and by far the least sexy in the campaign:
As for the sniffing, nurses don't deal with patients' clothes. Here is a real photo of the typical underwear situation nurses deal with--an alcoholic patient in the ER needing adult diapers has taken them off (resulting in urine all over the floor and bed):
The smells nurses have to deal with aren't too sweet, either. C. difficile is an intestinal bacteria that can form a "pseudo-membrane" over the intestinal lining, causing massive, recurrent diarrhea with a distinctive smell like a horse stable that every nurse recognizes and dreads:
Potassium shifts and dialysis
From the "mistakes were made" file: Patient's AM potassium level came back extremely high. Albuterol and insulin were used to get the levels down in the short term (by shifting potassium into the cells). Dialysis was confirmed for that day. When the nephrologist came in, he pointed out that he was unable to dialyze out the potassium while it was stuck in the patient's cells. Ultimately, no harm done for a patient who lives at a high potassium level, but not optimal. Take-away lesson: if the patient is asymptomatic (bedside monitor necessary) and dialysis is immanent, better not to treat a high potassium level pharmacologically.
χαῖρε
This blog covers health- and health-care-related issues. In particular, my interests trend toward:
Why blog? Probably vanity, although I enjoy the processes of reading and writing, and this is a good outlet.
If you use your noggin', the following image will tell you how to contact me...
...and if you are geeky enough to do some decoding, there is more information about me (and a "faux-tograph") in my Blogger profile. And I can also be found other places on the web, which I have catalogued using Del.ici.us. Off the web, I can be found in the greater Montreal area.
- critical care, with an emphasis on the heart
- nutrition, fitness, and prevention
- viruses and genetics
Why blog? Probably vanity, although I enjoy the processes of reading and writing, and this is a good outlet.
If you use your noggin', the following image will tell you how to contact me...
...and if you are geeky enough to do some decoding, there is more information about me (and a "faux-tograph") in my Blogger profile. And I can also be found other places on the web, which I have catalogued using Del.ici.us. Off the web, I can be found in the greater Montreal area.
Sexy Nurse Report, RIP
For a short time, I kept a blog called "The Sexy Nurse Report." The point was to post lame sexualized images of nurses in skimpy outfits and juxtapose them with images and stories of real nurses. I think the only really successful post was one on underwear sniffing. Anyhow, I don't really care to continue with the blog. Carrying on this sort of PC sociological battle is not really my thing. The truth is, the blog was more about self-interest and annoyance than justice: I don't like the mental association of myself with white-skirt-wearing chicklets, and I find the whole nurse fantasy to be unmanly--a pox on dudes who have it! I mean really, what man wants to fantasize about being debilitated and dependent? Anyhow, in the coming weeks, I'm going to re-post some of the content here, and then delete the rest.
Dear Google, You are starting to suck.
Dear Google, You are starting to suck. I thought you ought to know. Your new design template for Blogger is FAIL in Linux Ubuntu. While I can use it with Firefox running on Windows, if I try to use Firefox running on Ubuntu, it won't load. Mostly, I am annoyed because Blogger's previous layout options were just fine. This seems to be a problem with you lately. I was an early adopter of Google and did so to get away from the mess of Yahoo and Netscape. Now your homepage and functionality is getting all screwy like theirs. Example: instant search results as I type? Did I ask for that? It's a pain in the ass. Between auto-completions that screw up my typing and pauses in my typing before I'm done due to instantly loading searches I don't want, "instant" search actually makes my searches take longer. You should read Google as Fat Elvis. It's a good analogy. (Better than "jump the shark," which I think may have jumped the shark.) Anyhow, please get back on track. I like my websites like I like my women: fast, lean, and competent; pretty is a nice perk, but less important, and tricks and fawning are right out. As of now, I have to leave my house and go to the library to change the font or background color on this silly blog. How stupid is that? Thanks for your time (not that you'll listen). Yours, Chris
The comeback tour
I have really not blogged for a long time. I graduated from school, passed my national boards, and got a job a while back. I plan to blog these activities soon. Actually getting a nursing job has been super stressful. Maybe it's just my personality, but I find the whole thing to be on the verge of overwhelming. I lost over 40 lbs in November and December. I have started and stopped several things over the last few months, including learning the piano and moving into an early-twentieth-century 8-bedroom house by myself. Now, I have cut some stuff out and hope to have a less stressful life and start blogging again.
However, right now I have to decide what to do in the immediate future. Should I take a place in an ICU or start traveling after I pass (hopefully) my CCRN this autumn? I don't know, but an ICU job would mean being in my hometown for at least 2 more years. I don't know if I want to do that. However, ICU would be much better prep for either future traveling or advanced practice training. Do I want to spend the necessary time in the books, or should I continue with the leisure activities I enjoy and have not had time to do recently? Who knows. Will try to figure this out soon.
Also, if you are a reader, stay tuned for a new design role-out when I revise my info to reflect the fact that I am no longer a student.
However, right now I have to decide what to do in the immediate future. Should I take a place in an ICU or start traveling after I pass (hopefully) my CCRN this autumn? I don't know, but an ICU job would mean being in my hometown for at least 2 more years. I don't know if I want to do that. However, ICU would be much better prep for either future traveling or advanced practice training. Do I want to spend the necessary time in the books, or should I continue with the leisure activities I enjoy and have not had time to do recently? Who knows. Will try to figure this out soon.
Also, if you are a reader, stay tuned for a new design role-out when I revise my info to reflect the fact that I am no longer a student.
Volunteering for Haiti, 3
When I was a kid, I had an uncle who held me down trapped under some sheets and blankets so I couldn't move. I started to panic a little. Does this cause claustrophobia or did that come first? Anyhow, whenever there are disasters that involve people trapped in rubble, I can't help think it would be about the worst thing to get stuck in the dark unable to move and not knowing how long you might go before being saved or not saved. Nurses don't clear rubble, but there are always injuries and psychological scars.
My vaccinations are up to date, and I've gotten permission for a leave of absence from work. Everything's set. My name is listed with the Fletcher Allen Health Care team, which said they would get back to me, but so far no call. I hope they do make a spot for me and don't close me out for FAHC staff.
I got another e-mail from the RNRN group asking for more info, but they don't seem very well organized to me. The groups most effective at getting non-governmental spur-of-the-moment volunteers down to Haiti are small ones like FAHC or the Dartmouth volunteers shown below.
My vaccinations are up to date, and I've gotten permission for a leave of absence from work. Everything's set. My name is listed with the Fletcher Allen Health Care team, which said they would get back to me, but so far no call. I hope they do make a spot for me and don't close me out for FAHC staff.
I got another e-mail from the RNRN group asking for more info, but they don't seem very well organized to me. The groups most effective at getting non-governmental spur-of-the-moment volunteers down to Haiti are small ones like FAHC or the Dartmouth volunteers shown below.
Volunteering for Haiti, 2
Been trying to contact more groups to find a placement in Haiti...
Partners in Health is not taking volunteers; neither is International Rescue Committee, although they have a blog you can follow.
Last night at my spinning class, I ran into our ICU pharmacist, who let me know about an e-mail circulated from the department of health asking for information on volunteers. They want people with surgical, pediatric, infection control, etc experience. Not a big demand for cardiac nurses. I signed up today in our Human Resources dept but don't expect anything to come of it.
The Vermont nurses union has sent a team in conjunction with the Red Cross. I don't know how that happened but there was already a Vermont-Haiti group, and someone connected with the union is from Haiti, so that might explain.
About volunteering in Haiti
Recently, I’ve been living without a phone, TV, or much Internet access, so I just found out about the earthquake in Haiti not too long ago. Last night, a co-worker said he wanted to use his upcoming vacation to volunteer in Haiti. American Airlines, he said, is flying people to Haiti for free, and you can join the RNRN network to get placed properly in Haiti if you only have a valid US passport. Sounds great, right? Like the way the world should work?
Actually, you don’t need to know that Port-au-Prince has only one small airport, and that the US military is currently using it to land supplies. It would cost AA an enormous loss to fly people to Haiti when any current tourist travel has surely dried up. And, it turns out, the free flights for medical volunteers meme was a hoax, as per Snopes.com
RN Relief Network
However, volunteering for Haiti is not a hoax (I think). The RNRN network apparently did intend to send volunteer nurses on the US navy ship Comfort. The USNS Comfort is traveling to Haiti, as reported by Voice of America. Then the navy apparently decided to use only military personnel. That’s per an RNRN e-mail I received for potential volunteers, but you can read about it from the Contra Costa Times, and it accords with this Kitsap Sun article on naval personnel catching a red eye flight to Bethesda to meet up with the USNS Comfort.
Apparently, the RNRN network still wants to get their volunteers to Haiti, though. As reported by the LA Times, RNRN nurses traveled to Florida, where they met up with the Haitian-American Nurses Association and started scouting out sites and possibilities for volunteers.
Service organizations
So, you’re a nurse, and you still want to volunteer in Haiti (like I did)? Several possibilities come to mind: (1) the Red Cross is not accepting volunteers for Haiti per their website; (2) Doctors without Borders has a long-standing relationship with Haiti, but they want you to be able to carry on a conversation in French and be able to commit to 9-12 months at a time; (3) the American Nurses Association wants you to volunteer locally and get trained before you do anything crazy like going overseas.
The gov’ment
You could try the US Embassy in Haiti or USAID. Both of them ultimately direct you to the Center for International Disaster Information, which has a registration database but makes it clear that you aren’t likely to get a call back unless you have previous disaster relief experience (chicken vs. egg?).
Freelance volunteers
Who’s most desperate? Haitians. If you try contacting the Haitian Consulate in New York, they have a special contact e-mail for medical volunteers. You provide license and insurance information. But this is the Haitian government, now. I sent them my information, but I don’t expect to get a call back.
Lessons from this experience
So, here I sit, prepared to jump a free AA flight at a moments notice with just my klettersack with stethoscope, sphygmomanometer, trauma shears, iodine tablets, and clean socks. Yet nobody wants me. I signed up with RNRN and the Haitian Consulate, but I’m not holding my breath. I also e-mailed the Haitian-American Nurses Association.
The lesson I draw from this is that if you are really interested in disaster relief nursing, you best join the military. You second best get in on the ground floor of a smaller relief organization like your local Medical Reserve Corps, and start getting trained and getting experience. Formally established organizations are the best route to getting someplace. Plus, nursing is all about assessments and planning, right? You need to know things about disasters before you can do much good. Be honest: in a pinch, your ability to give a SQ or IM injection doesn’t qualify you to do much. Get specific knowledge.
And if you do get a call back from the Haitian Consulate, you might want to browse the CDC’s webpage of recommendations for volunteers in Haiti before you get malaria or Typhoid or something.
UPDATES:
Apparently, some nurses are going to Haiti via Canada, and also I read about nurses going in through Dominican Republic. There is a Haitian Nurses Assocation in Boston. E-mail correspondent Mary Crotty says to stick with RNRN, which has like 8000 nurses ready to go.
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.- Dos Lives, a blog of Latino life, interviewed swine flu survivors back in May and covered swine flu from the perspective of a school nurse in September [ RSS feed, May 11 + Sept 11 ].
- The latest issue of WIRED covered the vaccine controversies and they have posted a podcast on Storyboard as well [ RSS feed, episode 006 ].
- NPR has a swine flu special coverage RSS feed.
- ABC's Science covered new methods of vaccine development recently...
- and ABC's HealthReport covered flu research last spring.
- The CDC has a long list of short podcasts you can choose from that cover topics like s/s of H1N1 and anti-viral drugs.
- British Medical Journal has several podcasts covering swine flu issues.
- EMSResponder addressed emergency preparedness issues in April.
- Johns Hopkins Weekly Health New Podcast has regular updates on H1N1 in their Feedburner feed, such as October 11's coverage of vaccination best practices.
- Last but not least, Columbia virologist Vincent Racaniello's This Week in Virology has featured swine flu several times, such as "Swine flu returns," coverage of vaccine farming, and pandemic mortality and hand washing.
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.
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...
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.
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.
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
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.
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.
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.
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...
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!
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
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!
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:
Menu:
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.
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:
Menu:
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.
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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...
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...
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...
- 3/4 cup Wyman's frozen wild blueberries
- 3/4 cup Plain Silk Soymilk
- 1 scoop Gold Standard Whey French Vanilla
- 1 egg white
- 1 Tbsp canola oil (yeah, that's right... see below)
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:
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.
- Fasting: Ultimat Diet Plan
- The Fasting Diet - as one reviewer points out, ketosis is what keeps your body from burning muscle instead of fat, so the health value of a juice diet seems very questionable
- The Master Cleanser - a piece of fasting history that also seems likely to prevent ketosis
- Fasting Made Easy
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:
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.
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.
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.
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