pavanneh

I was diagnosed with Fibromyalgia and Chronic Pain in 1993. It was just beginning to be talked about. I had every pressure point and my inflammatory markers were elevated. I couldn't be hugged by my husband or my children. I would cry lying in bed because the mattress hurt so much. I put a mattress pad and tried many other types of padding on the bed and it still hurt. I was in the Navy so I couldn't just quit. I kept going. I did my job. Stood on my feet for 16-18 hours a day and sobbed on the way home because I hurt so much. But, I was determined to finish and not let it get to me. The last two years I have to admit were the worst and I barely made it to retirement, but I did. All with people making fun of me and telling me that I was faking it. Because if I had Fibromyalgia I wouldn't be able to work or do the physical fitness program that was required. I did it because I was determined to do it. I have been tested for MS, RA and other diseases that Fibromyalgia mimics, but nothing is positive, thank goodness. Because as bad as fibro is, there are worse diseases. I have had people tell me it is all in my head and prescribe medications that drove me literally crazy. I use cognitive behavior and bio-feedback to control the pain. I refuse to use alcohol, or drugs to control the pain as it will do nothing but make my problems worse by making me dependent on a drug. Whether it is a catch all phrase or not, the pain is real. Whether it is psychological or not, it is real pain. And it is exhausting and depressing and frustrating. And there have been times I have just sat down and said I am never getting up again. And I did it anyway. The condition is real and people can go crazy from the pain. Not just the physical pain, but from the emotional pain of having people constantly doubt you and accuse you of being crazy, lazy and looking for excuses for everything. I was a Cardiovascular technician in the Navy when it started. It started with me losing sensation in my fingers when I was scrubbing at the table. I had to quit doing that, and boy did I get dirty looks and accusations over that. It was stupid. It was a job that I loved. Then I couldn't do echo cardiograms anymore because the numbness and pain I would get in my hands. Another job I loved to do and can't do anymore. I was tested for Carpal Tunnel and MS at that time and was not positive for either. Then I couldn't stand in the Cath Lab with my lead on anymore. So I couldn't work the Cath lab all the time. I still had duty and worked once or twice a week, but couldn't work it full time. A post-navy career out the window. When I got out of the military I worked as Respiratory Therapist. I did that for almost 5 years and then I just couldn't do the job anymore. I couldn't work the floor all those hours and I couldn't even ambu someone properly due to the pain in my hands. I had to be let go from my job due to fatigue and the depression from the pain. The medications were not helping, they were making me fatigued, confused and very irritable. We tried several different kinds and none of them helped. They made it worse. I saying all of this because I want you to understand that it is a debilitating illness. Some people can tolerate the pain. Some people can work through it. Others cannot. It messes with your head with brain fog and fatigue mentally and physically. You get so frustrated because there is so much you want to do and it is like walking through fire sometimes to even do the simplest tasks. That can make you crazy, dependent on others and comfort seeking. I also know there are people that use it as an excuse and maybe even self-diagnosed themselves, I was clinically diagnosed, and that some doctor's use it when they are being too lazy to find out the real reason. I just hope that someday someone can find out what this is and what causes it and then we can get rid of it. I have found cutting down on Carbohydrates especially Gluten, has helped.

The RN may give you more flexibility and mobility, but there are still plenty of RT jobs out there. Especially for Travel Techs. LTC facilities have never used RT's much. There are hospitals training nurses to do these jobs, but they are finding that as the nursing crunch which is going to happen eventually the nurses WILL not be able to do all of these things. It has happened before and it will happen again that nursing is given the responsibilities for so much that patient care actually suffers. Our nurses in our facility LOVE the fact that RT is now on 24/7 and they are not responsible for the ventilators and BiPaps. The lab does draw some ABG's, but we are called more often than not. RT is not going away any time soon.

I have been a nurse and am currently an RT. I enjoyed both. But I have to say that being an RT has been more enjoyable for me. The job is in high demand and you make good money. With therapist driven protocols you get alot of autonomy in decision making. More than in nursing inky opinion. You still take care of patients but in some ways you have more time to do it. Hope you are happy in either choice.

I should could have been done with excelsior three years ago, but I was too afraid of the CPNE to take the course and finish. Now Virginia doesn't allow Excelsior graduates to take the exam. I will have to find a state willing to let me take the exam and be licensed in their state. Then reciprocate. I will probably get a job at a military facility or VA after graduating here in VA as I am former military and have an edge getting a job in one. Not a guarantee though. I just hope to pass and get a license somewhere. I am just going to start and see where it goes from there.

I did read the article. If a patient needs O2 they are always titrated to maintain the best sats and respiratory response. If they need ventilation they get it, if they need BiPap or CPAP they get it. In no way do I advocate the withholding of O2, whether they are COPD patients or not and they need it. You have to look at the whole patient and see what they need. However, in a patient who is stable, like any medication, O2 needs to be titrated to need. Just because someone is a COPD patient does not mean they need 6 lpm O2 either. * absorption atelectasis, oxygen toxicity, and depression of ciliary and leukocyte function at FIO2 values above 0.5 has been noted. Now to address the hypoxic drive I can understand the premise of the article and I know what they are saying. All I can say is how I have seen people react to oxygen delivery and the improvement of someone's respiratory status by titrating down the O2. It may not be due to the "Hypoxic drive" per se and that's fine, but nonetheless that particular patient (and by the way I have seen it in more than one patient and we discussed it in our office and more than one therapist has seen several cases where that has happened) did not tolerate high levels of oxygen. It is something you have to watch out for no matter what the studies say. The patient woke up and their respiratory status and SaO2's improved with decreased O2. You can't just quote a report and say it never happens whether it is the "Hypoxic drive or not".

Hmmm I replied to the other post, but will again. It is not hogwash. Have personally seen it happen. You are correct though, not all COPD patient's rely on a hypoxic drive. You need to asses blood gases and patient's response to O2 to determine their level of need for O2. Again correct, you don't deny a patient O2 if they NEED it. Not all COPD patient's need higher flows of O2. It may have more to do with their disease process and ability to diffuse O2/CO2. Raising their O2 does not necessarily resolve the issue of their shortness of breath and low SaO2, but can increase the problem. PATIENT ASSESSMENT OF NEED,

Sorry have not been back in awhile. While research may say it is a myth, the reality is seeing a patient who has lived on an anerobe drive for several years at 3 lpm NC, increased to 6 LPM-by a well meaning nurse. Get somnolent and respiratory rate drop to 8 from 20 and SaO2 drop from 91% to 73% until we returned his O2 to 2-3 lpm. So, it doesn't matter to me what the research says, it is more important what happens to a patient who is not in distress and does not NEED the oxygen. There is a difference.

I have a bone to pick with those who say that students with EC don't have clinical experience. As others have said you have to have clinical experience-ALOT to enroll in the school. I have worked with new nurses from conventional programs and find they are not as competent as two of the EC students I worked beside who was a Paramedic and an RT before they enrolled. I was a hospital corpsman, Cardiovascular Tech, Respiratory Therapist, Paramedic, EMT and find it personally offensive that I am continually looked at by the nursing community and nurses that I am inferior to them because I don't have LPN or RN behind my name. Which I was also an LPN for 3years in California. BUt, because I got my nursing degree through the Navy and nontraditional education, I could not practice in Virginia. I have over 24 years of medical experience in more variety of practice and types of practice than many nurses with as much time in the field. I have seen new graduates that couldn't take a proper blood pressure with a manual cuff. They couldn't count the pulse. The machine was broken we were told. Yet, I am still looked at as "less". I have helped patients with end of life issues, I have talked with families and comforted them when loved ones were ill and dying. I have helped change beds, done IV's, put in Arterial lines, etc, etc. I have a Master's Degree in Healthcare Administration/Provision. Yet, I have so many jobs tell me they want a Nurse. When is what I have done going to really count? I guess when I have RN behind my name. Please understand, I am not trying to put down nurses. They are wonderful and I admire anyone who does that very difficult job. Just wish what I have accomplished would be valued as highly.

I would ask the nurses in your facility if you can do "follow on" days with them. You can't do anything out of your scope of practice, but on days you are off you can follow them and see what they do and how they do it. That is one way to get more of an idea of what procedures are and how they are done. I am probably going to go through Excelsior for my degree, so I am trying to plan the same type of thing at the hospital where I work.

I am a Certified Respiratory Therapist and have been for some time. I am in a very progressive hospital that gives alot of latitude and responsibility to RT's to develope protocols and therapies for patient's. It depends on the facility where you work how much you can do. If you want a good combination of technology, patient care and autonomy-which is growing in our field, then RT is for you, you just have to do some homework on the facility's program when you apply. I am thinking of going to RN as a way to increase my skills and flexibility. Go RT first and then RN. It is a good way to start and you can always go on from there. Alot of hospitals will hire you as an RT and then train you as an RN in one of their programs. Our hospital does.

I am currently a respiratory therapist. A sat of 88% at 2 LPM would require that you increase the Liter flow by at least 1 liter and titrate up if needed. However, as someone posted earlier how much depends on the patient's condition, Chronic and current. A Chronic Obstructive Pulmonary Disease patient that lives on a hypoxic drive-meaning they can't tolerate high levels of oxygen in their blood or they don't breathe, can't tolerate O2 saturations above 92% very often. I have a lady right now that lives at 90% and she is on 5 LPM. Always, Always...assess the patient and give them what THEY need. The websites that you were given are good resources as is the NBRC website and AARC website-both Respiratory websites.

That is why I quit working Nursing homes. There was only one I ever worked at that the Nurse to patient ratio was good and that they adhered to good medical practice. Sometimes I feel guilty about "abandoning" these poor patient's because I genuinely cared when it seemed no one else did, but I couldn't afford to lose my license.

I guess the first thing that popped into my head was what I call and some others call "nurseitis". Symptoms start to appear soon after graduating nursing school. Suddenly no one is as good or knowledgeable as a nurse. My sister and my best friend have both done this to me. I have been in the medical profession for over 20 years in various roles. EMT, EMT-P, Hospital Corpsman, Cardiovascular Technician-Noninvasive and Invasive, Respiratory Therapist and yet I am often reminded that what I know is not as valued as what a nurse knows, by nurses mostly. It hurt my feelings to no end and made me angry, when my friend told me that "well, that's okay, you're not a nurse, so you wouldn't know". Don't undersestimate that value of what other technicians and personnel know. Whether they are nurses or not. They may have alot more insight and knowledge than you think. Please understand that I do know and appreciate that a nurse's job is not easy. I am still considereing getting my RN. But, I am also very understanding from the standpoint of technicians and others that may not as "valued".

MCI just started an RN program. I am getting ready to enroll in the next class. Also, there are many programs that will allow you to go LVN to RN and all that matters is that you have your LVN. Many of these are accelerated or have accelerated programs.

MCI does have evening programs. I am applying there right now. I will be taking day classes. However, I may have to start working again, so I am also considering Excelsior College. They are an online school. Check out the distance learning thread, there are several graduates and students there of Excelsior. www.excelsior.edu is the website. Good luck! Pavanne