Cath lab observation

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

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

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

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

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

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

Floor Orientation: 1st day

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

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

Re-living Bush vs. Gore

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

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

Orientation: order entry

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

Orientation: MAK, allergies, hx

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

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

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

Orientation: module 2

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

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

GO day 2

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

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

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

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

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

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

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

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

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

4th annual R-3 barbeque

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

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

Mice grown from skin cells

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

Seriously, as the WIRED article says:

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

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

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

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

Please oppose House bill 1298

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

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

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

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

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

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

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

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

NIH Wikipedia Academy

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

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

PowerPoint: Armed Forces Journal almost gets it

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

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

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

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

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

GlowCaps and firetrucks

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

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

Bioastronautics: what's in a fart?

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



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



via BoingBoing

Apollo 11 anniversary

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

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

Intermittent fasting trial, day 2

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

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

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

Intermittent fasting trial, in-between day

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

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





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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χαῖρε

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...

• 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)

Simply mix all in blender and add water to decrease thickness as needed. If this isn't sweet enough for you already, I recommend using a stevia sweetener. I've found stevia has less artificial sweetener aftertaste and works particularly well with fruit-flavored things.

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

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

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

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

Dietary fasting reviews

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

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

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

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

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

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




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



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

Other interesting-looking books I haven't read yet:

• The Idiot's Guide to Fasting (by Fuhrman) - includes information on fasting for different lengths of time
• The Fasting Handbook - includes specific fasts such as fasting from carbs, fasting from proteins, fasting from mucinogenic foods, etc.
• Fasting: The Ancient Practices - about fasting in the Christian tradition
• Eat to Live (by Mehmet Oz and, again, Fuhrman) - appears to be a re-packaging of Fuhrman's previous work, including recommendations against eating meat
• Maximum Muscle, Minimum Fat - this book seems to promote some sort of short breaks from food like the author's other book The Warrior Diet, which recommends eating one large meal a day at night. I find claims by Warrior Diet users of feeling euphoric during the day to be either unlikely or from placebo.
• The CR Way & The Longevity Diet - these are books on calorie restriction, which is probably the leading (theoretical) method for life extension. The Alternate-Day Diet is supposed to be an easier way to calorie restrict and get health benefits.

Other fasting books:

• 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

One Amazon reviewer said all the information on fasting is available on the Internet, which may be true as well.