LindaMarie76

Talk to your doc. I highly doubt the Effexor is causing test taking difficulties. Rather, I believe your anxiety level may skyrocket during tests causing you to forget information that you already know, or read the questions inappropriately. Without knowing you, I would questions whether taking an Inderal before a test is appropriate, or even a small dose of xanax before a test. However, there are other meds out there (Luvox) that is great for focusing if that is your problem. I would encourage you to check with your doc, psych, or NP for further advice. Best of luck. HUGS!

When I was on Zoloft about 3 years I had a large amount of weight gain and loss of libido. I am hearing now that Wellbutrin is being used in combination to combat those adverse effects. What are you experiences with this combination? Another interesting point is that there are compounding pharmacies that manufacture drugs specifically tailored for the aclimacteric woman r/t SSRI use. TIA - Linda

Have you seen a rheumatologist or a pain management specialist? Fibromyalgia is not very well understood but I know what there are pharmaceuticals out there to help, especially with stressful situations. Where do you live? - Linda

So here I am a couple of days later from my last post. This anxiety attack lasted approximately 48 hours and took me to new lows that I never knew existed. I was crying not because I was depressed, but because I was so anxious I would rather have died then kept going on like that. I was lying in bed yesterday afternoon when my girlfriend told me "you have to call your doctor". I didn't want to because he is the doc that is going to be hiring me as his ARNP. So I called my psychiatrist who is on vacation and ended up speaking with a different psychiatrist who is taking call for the week. He was very nice and told me "just because we are in the medical profession does not make us immune to the conditions that can occur." When he said that I felt as if I wasn't such a reject. He also feels that Lexapro may not be the drug of choice for me to be on; however, in the meantime he prescribed Klonopin 1 mg to take at hs and then 0.5 mg BID prn. I've done this along with a GI antispasmodic and am feeling better. At least I am not looking to retreat to my bedroom. :chair: I did some internet research on psychologists in this area and found one called "North Star, LLC". I left a message on their machine since it is Sunday afternoon and was pleasantly surprised to receive a return phone call from the office manager stating that he received my message and although he doesn't have the appt book at hand he will be in touch with me so that I can have an appt either tomorrow or the next day. Their website also has an approved reading list so I went to Barnes and Noble and purchased a couple to help with my positive self-dialogue. I've lost 5 pounds in three days but I know that I will start to get better very soon. Thanks for all of your words and support out there. It helps to feel that I am not the only health professional out there struggling. Linda

I wonder if anyone else is reading these posts anymore but I thought I was try and see. I flipped theough the posts and found my mine from January 2002. Back then I raved about Zoloft and I suppose over the past couple of years lost my way from Zoloft, had reoccurences, and ended up on Lexapro. I have been the proud queen of Lexapro up until a month ago when I started getting more frequent anxiety attacks with the infrequent panic attack (which is still the worse thing a person can go through IMHO). I tried to titrate up the Lexapro but the only thing I accomplished was a higher heart rate and more difficulty sleeping. I think that if the Zoloft worked so well for me in the past, perhaps I should revisit it. Quite honestly, today has been one of those really bad days where I have been anxious the ENTIRE fricken day. I keep looking at the clock hoping to that bedtime will arrive soon. XOXOXOXOXO

Roxan, With respect to his lack of eating, what do you think about getting a psych consult ASAP for him rather than waiting until rehab????

About half and half Proficiency is using a doppler? How so? I am honestly curious. I just ran this by nursing colleague of mine and she agrees with you that med-surg nurses may not know how to use a doppler. However, we both agree that all of our critical care nurses are proficient in doppler use. She also states that Dopplers are not necessarily needed on crash carts because dopplers are readily available in the units. I agree with this, but still believe that dopplers would be advantageous in the carts on the floors. Thanks for the feedback. Linda

We have protocol that states if a H/H is below a certain value, the patient must be admitted to ICU (or ER holding). Same goes for K and Na values Linda

Bought a 22 inch Master Cardiology, had it engraved. Love it. Thanks for all of your help.

I posted a relatively similiar question the other month after my stethoscope developed legs and ran away. I tried other peoples' stethoscopes for a month and finally decided on the 22 inch Master Cardiology (versus 27 inch). I love the 22 inch. It's wonderful. It also fits much nicer in my pocket and doesn't get caught in the bed rails when I am leaning over. AND I hear everything. Bought it on AllHeart.Com and got it personalized. Linda

I am an ICU nurse but I floated to CVICU last month and witnessed the trial use of Precedex on CABG patients. The patient did not fare well on Precedex, became highly agitated and fighting to the point where three nurses were needed to hold him down (fresh open heart with balloon pump, vent, lines, pacer - the whole nine). Ativan didn't touch him and eventually Propofol was started. Over this past weekend, I received an intubated patient from OR after an E-lap. The PACU nurse reported to me that the patient was on a Precedex gtt. It took me 30 seconds before I remembered what Precedex was, considering we do not use it in ICU. I asked them to change it over to Diprivan before the patient was transported, but it wasn't done. The patient arrived groggy but easily aroused, then became highly agitated. I quickly changed him over to Diprivan for the remainder of the night.

It could very well be a control issue. My best advice is to push for a psychiatric consult and a speech therapy evaluation. Always remember one thing....this is your husband. You are not out to make friends with the nurses or docs. That would be the ideal situation, but often times health care professionals become intimidated by lots of questions by other health care professionals/students. Push, push, push - keep asking those questions. Do you have a camarderie with any of the staff? If not, then go down to administration and tell them that you have a lots of questions and would like to arrange a conference with the doctors, nurses, etc. AT LEAST, get social services involved. You need someone on your side. We're all here for you. Linda

IMHO.... I believe that dopplers should have a permanent place on the crash cart. We frequently use them during our codes because there has been more than one time where we thought a pulse could not be palpated, yet the patient was perfusing weakly via doppler. If we know we have a doppler pulse, we can spent time on inserting lines and running meds rather than pounding on the patient's chest.

Does anyone else think that the GCS is a bunch of crap? It truly does not provide a true reflection of the patient. As Laura Gasparis says, if nursing administration was rated with the GCS, most of them would be classified as being comatose (verbal commands = no response = 0). As for your husband, it certainly sounds positive that he has purposeful movement. Regardless of the numbers, look at your husband. Level of consciousness is so terribly important it is often overlooked. If he is squeezing your hand when asked despite being in a Fentanyl drip, I'd say that was a pretty darn positive sign. Linda Websites: http://www.waiting.com/comabasics.html

:balloons: I did some searches on CZI followed by crystalline zinc insulin and have copied and pasted the most applicable answers - Linda ----------------- According to a web-site on the Mass General Department of Pharmacy/ Department of Nursing/ Critical Care, the trade name for Insulin is CZI. http://www.massgeneral.org/pharmacy/ICU%20Guidelines/insulin.htm ------------ A medline search revealed a 1983 publication stating, "Sulfated insulin (SI) differs radically from regular crystalline zinc insulin (CZI). To date, SI has been used mainly for the subcutaneous treatment of diabetics with resistance or local allergic reactions to CZI." Title: Intravenous infusions of sulfated insulin normalize plasma glucose levels in pancreatectomized dogs Authors: Nomura M, Zinman B, Bahoric A, Marliss EB, Albisser AM. Journal: Diabetes. 1983 Sep;32(9):788-92 ------------- Regular insulin , also known as crystalline zinc insulin or unmodified insulin, is obtained for commercial uses from the pancreases of pigs and/or cattle at slaughter. The insulin is prepared by precipitating the insulin with zinc chloride, forming zinc insulin crystals. The commercially available solutions have a pH of 7 - 7.8. http://www.elephantcare.org/Drugs/insulin.htm ------ Many types of insulin preparations have been made available, the differences being chiefly in the duration of action. All are injected subcutaneously, but crystalline zinc insulin, or regular insulin, is injected intravenously when it is desired to study either insulin sensitivity or problems relative to the subcutaneous absoprtion of insulin. http://www.diabetic-help.com/kANIMINS2.txt -------- Regular human insulin is crystalline zinc insulin dissolved in a clear solution. It may be administered by any parenteral route: subcutaneous, intramuscular, or intravenous. Insulin lispro and aspart are also soluble crystalline zinc insulin, but are intended for subcutaneous injection. NPH, lente and ultralente insulins are suspensions with the regular insulin in them either complexed with protamine (NPH, Neutral Protamine Hagedorn, or isophane, meaning stoichiometric proportions) or mixed with excess amounts of zinc ions (lente and ultralente) to delay their absorption and thus extend their actions. (1,11) Insulin suspensions should not be administered intravenously. http://www.endotext.org/diabetes/diabetes17/diabetes17.htm --------------------