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  1. Silkiebyrd

    Pain is NOT subjective

    While I will not flame you; I think that if you think really hard about it that the numbers for the increased ratio of women in the ER are not as dramatically different as you state. I have several years in the ER and I must say that sometimes it is dependent on the time of year, the area of the country and many other factors. I find that women in the ER will report their pain a lot quicker than most of the men. I do think that we will find that their will be a "physical" finding to go along with fibrom. eventually. I remember when the syndrome "chronic fatigue" was the catch phrase in the late 80's and it was associated with wealthy female patients. Strange how some of those cases were later linked to Epstein Barr Virus. (an actual real little bug). I am just saying we shouldn't disallow something as real until it is known for sure, and even then to the person in pain...it is real. I do think in an acute pain situation that there are going to be VS changes, diaphoresis, palor even...kidney stone pt. comes to mind. I do not agree that there will necessarily be these changes with chronic pain. Some people are very stoic and some are great big whiners....but they both hurt. I have taken care of a lot of native americans and you would be hard pressed to tell if ANY of them are in pain, even acutely. I also think that in the US the guys are "weak" if they "whine" about something, in other words, we train you guys to suck it up. Bottom line is that we should treat people's pain. No not everyone should get a mega dose of fentanyl, nor should everyone get tylenol. My drugs of choice are.............shocker........Toradol and zofran...when I get a migraine the benadryl, reglan and toradol combo kick butt. This is just what works for me, is nonnarcotic, and I can work when taking it.
  2. Silkiebyrd

    I'm getting written up! (Very long)

    I am sorry you are going through this...but you were in the right. The doctor probably knows it too. This is an example of admin. allowing him to persist in educating his pts. and their families with BS about medical procedures. You are probably one of the first nurses to go against what he tells them and he finds that he doesnt like it. Sounds like a power issue with him. You are right and like they have said...dont sign the write up....and add an addendum telling your side of the problem.
  3. Silkiebyrd

    South Alabama Online

    Hello Anyone here doing the online program at USA?? I am thinking of doing this and wanted some feedback from people who have been in this program. How is the program? I know they say it is a good program (they being the school) but is it really good from the students standpoint?
  4. Silkiebyrd

    Non emergent ER visits

    As a former travel nurse...I do know the difficulty in finding a PCP. I dont know if it is regional or not, but sometimes here it is very very difficult to get in to a PCP. Many are not taking new patients and the ones that are will give you an apt. that is a month out. Now, to establish myself as a pt I do take the next available apt. even if it is 2 mos from now. I have asked if they have any emergency spots or urgent care spots that they hold for their pts. They say they can sometimes work you in if you are already one of their patients otherwise....They tell me then to go to the ER if a month is to long to wait. It took me 5 clinics and about 15 phone calls to find one that had anything earlier than that. My point is that sometimes depending on where you are and who you see...you dont have much choice. the urgent cares here close at 7 pm and dont open til 9 am. If you go in to them with lacerations, sob, severe headache...they send you to ER. I envy the people who have urgent cares that actually take care of urgent issues and have them open for more hours than we do. I think our healthcare is in very serious trouble. ERs cannot continue to pick up the slack of clinic and urgent cares and not have it affect their care. The nurses get burned out, not because they dont care about Aunt Emme with UTI for 2 months...but they cant take care of their acute pts without sacrificing somewhere...there is a finite amt of nurses and energy and too many places that need it. I dont know what are answer will be but we need one sooner rather than later..before our system is gone beyond repair.
  5. Silkiebyrd

    RN won't give pain meds

    I agree about the University aspect with you, I know that not all places are like this but many are. I worked NICU for many years and when I first started we had a surgeon that everyone was scared to ask things of, he was famous for saying that premature infants of this or that age don't feel pain as their neurologic systems were not mature yet. Well, that is bullcrap...anyone who has worked with them has seen them grimace, cry, and get very agitated with VS changes with only minimally painful procedures...much less post op. I would call him whenever I had a baby of his and harrass him until he gave me orders for fentanyl or versed. I also gave him every piece of literature I could come up with regarding the fact that infants do feel pain. He would then throw them away and cuss at me but I just let it roll off my back...I had orders for my babes. He did it just so I would let him get sleep and not because he came to my way of thinking. The only way I didnt loose my job was because the NICU attending agreed with the nurses and not the surgeon...the surgeon had no pull in our unit but I did pray that none of my actual kids ever needed surgery. I could see him coming in their room and going oh yeah I know your Mom....this wont hurt a bit. Stick to your guns and keep on being a patient advocate; it could be your family member in that bed someday.
  6. Silkiebyrd

    diabetes, the bane of my existence (very long post)

    I sometimes think that SS relies on us getting frustrated and saying the heck with it and not persisting in fighting them. I am in this fight for the long haul. I feel like you and many others here also. I have paid in the system since I was fifteen (which was many many years ago) and now the very jobs that we adore and live for are the VERY thing that has broken many of us in some regard. I do agree with you on the fact that nurses are lacking in care as we are getting older (not lacking in GIVING care..we lack in GETTING care). The further in this the more prounion I become...I am from a nonunion state and have never really understood what exactly they are about. Not trying to get politically into an argument. I just don't know what nurses as a group can effectively do to get the care that I think we need and deserve without some kind of organization. Keep on trying with SS, I hear that EVENTUALLY a lot of people do get approved.
  7. Silkiebyrd

    diabetes, the bane of my existence (very long post)

    Definately wait til your insurance kicks in if you can since it is only 2 weeks. Of course, if you start feeling worse go on in. My long term disability wouldnt cover me because I was officially diagnosed with diabetes a week before my work insurance kicked in. When I developed retinopathy 51 weeks later, prudential said it was a pre=existing condition since it was directly related to the diabetes. I don't know what the sweats are if they are not related to low BS. Maybe something to do with endocrine system? Hormones? Just hang in there. I have bad moments and the people here are so supportive that it is what helps me with depression at times. I just went to MD on Thursday and was told that my "bezoar" has redeveloped and that it blocking the pyl. valve is causing me to have obstructive issues. They are talking about a gastric pacemaker for me as Reglan is not working and I am maxed (having a few distonic symptoms). Good luck to you and lots of hugs.....just know you arent alone.:heartbeat
  8. Silkiebyrd

    Diversion Techniques

    Hello all!! I have a patient that suffers from chronic pain...and I do mean suffers. She had been on duragesic patches at one time and went to be detoxed as she felt she was loosing much of her life due to the sleepiness they caused. She was placed on suboxone and then after a short while was successfully weaned off of it. She now takes neurontin, cymbalta, flexiril, and occassional darvocet. She is now admitted for the 3rd time in less than a year with c/o abd pain with nausea and vomitting. We cant seem to get her glucose down nor stop the nausea very well. The MD is unwilling to give her narcs for her pain due to her past and we the nurses are tired of watching her suffer. She is not demanding...it is just that when we go in to check on her she is rocking and crying or either laying in bed slinging her feet. she says this seems to help with the pain some...we also have caught her spraying her feet with alcohol. She is not one that is constantly on the light...I almost wish she was. I do not know what to do for this patient...none of us do. Do you have any suggestions on other things that may help her other than firing her stupid doc (my choice). She asked for Toradol one night and they wouldnt give it because she is at risk for kidney problems. (No clinical findings to suggest this, just hx of DM). I am desperate for help for this patient. When at home this patient does have some Darvocet but her husband says she won't take them much because she is scared when she runs out that her doc won't prescribe anymore. She seems very depressed and interacts very little with anyone. Thanks for any suggestions!!
  9. Hello all, I usually lurk here in the shadows, occassionally throwing a coment in here and there. I thank you all for being around, even more lately. Some may remember about a year and a half ago, I gradually developed the most horrible pain in my feet and just felt like a balloon with no air left. I thought (like many of us do) it was just work; I have always worked full-time nights, on my feet in a busy ER and Part-time in a NICU. I got a bite that would not heal (Insect) and went to doc several times...we finally drew lab and surprise my glucose was over 900. Needless to say...went in on Insulin IV etc....Got sugars down and kept them in 100's to 200's (am very very resistant). I take 100 units of N TID and 100 units of novolog TID alond with a sliding scale from below. It took endo 3 months to get down to that dose (no the zeros are not typos) (metformin and byetta are helping) I hate going in the hospital because my fellow nurses think I am an idiot when I tell them my doses...even with documentaton already on file. Anyway, finally got my feet under control and things were much better. Then, about 9 months ago, while at work; I suddenly couldnt see out of my right eye. then I noticed little hairs across my left eye. Finished shift out of necessity. Went to eye doc that day. Surprise....hello retinopathy and bleeds. Had bilateral Vitrectomies and the laser surgeries(twice). Now I can not see to drive, chart, start iv's on large muscled guys with ropes for veins much less babies. Everything is curvy and unfocused to see. I also have developed uncontrolled HTN that we cant seem to get meds to take care of (we have tried many). I lost from 320 lbs to 180 and that still hasnt helped. I also have developed SVT....had a heart cath gone bad (developed pseudoaneurysm, had to have thrombin injections) But dig has controlled the svt since then along with atenolol. Well, through everything but the loss of vision I have kept working, but I dont now because I feel that I am unsafe because i am not able to see what I am doing. While working, the EMS brought in a patient, we went to move him (6 foot, 220 lbs) we went on three....but the patient was still strapped to the ems stretcher (ems student forgot that strap and the blanket was over it). well, we all know, force goes somewhere....well, my back audibly popped and bam...herniated disc. Cant have surgery, doing PT, helps some but not much....My doc put me on duragesic patches....I chose to quit taking them (I didnt do anything but sleep on them)but the withdrawal was a tiger:banghead:. We made it through that though. I now take nothing because my doctors cant decide who should address what...I would love it if we had a pain clinic here. I am maxed on neurontin, tramadol, and diclofenac. I have also developed gastroparesis and vomit often and always feel nauseous. I just had a bezoar broke up in my stomach and was put on reglan. have more test this coming week to get an "official" diagnosis. It almost seems funny to do the test now....it seems that forming a "bezoar" of "rotting vegetative matter"(as my gi put it)would be enough. You know I just looked back at my post....maybe I should write a book.:chuckle (i just did) Well, the point of this post is just that I am so discouraged and a little depressed. I feel so lost...work is what defined me and what I was...I am having a little trouble finding myself and seriously wonder what I can do to have a quality of life. I enjoy your posts, my daughter reads them to me sometimes. If get the fonts big enough I can read them on my own. I have applied for SS but still have 2 more doctor appts to go through, it has been 5 months total of waiting so heres to more waiting.
  10. Silkiebyrd

    Just need to talk (long and sad)

    Hello, I was just wanting to talk, not really vent or anything. I work in a level 3, I have been taking care of a littlle 25 weeker for about 2 1/2 months now. He was a twin, he was the larger and went from vent to high flow in a matter of a week or so. Sister was on vent for 2 months or so an is just now on high flow. He perfed 2 times in the first 2 weeks of life and had an ostomy as a result. He had started becoming sick a few days ago and we started antibiotics and did a work up. His mother and I have had a few heart to heart talks because of test results. He had a grade 3 and grade 4 bleed (IVH), blood pressure issues, etc... Monday night I had the baby next to him but helped with his care because he was so sick. His mom asked me to take care of him the next night when I came back the next night; she asked the charge nurse and she said ok. I was ok with it as it seemed so important to her and I have grown attached to both the babies. I got to work last night and found that he had died during the afternoon. I was really affected by it but bottled everything in and took care of the babies I was assigned. I went to check on the Mom but she had already left to go home to regroup; they moved the sister to another part of our unit. I just feel kind of blue and wishing I could not get attached but that is part of our compassion I suppose. I would like to do something for the Mom but I don't know what would be appropriate, just a card seems a little impersonal. I was crocheting blankets for them both for their issolettes. Should I still give it to her?
  11. Silkiebyrd

    very discouraged and tired

    I am type 2, I am 36 years and just found out and here I thought menopause was the worse thing coming at me. I am on metformin, glipizide, actos, byetta, humulin N and Novolog (3 times a day each). They also put me on tricor for triglycerides, Lisinipril to protect the kidney. Now we added Cymbalta in addition to my heart meds. (Atenolol, Dig and cardizem). I feel like a zombie walking around sometimes. :nuke: But my pain is much better this week and my body is finally getting used to all the new meds. Had to get a pill box to keep up with them all. Hope everyone is in good spirits and feeling well Liz:icon_hug:
  12. Silkiebyrd

    Work advice

    Hello to all, hope you are having a good year so far. My husband just started having seizures out of the clear, found some questionable spots on the mri so we had biopsies today. still waiting on the results. Anyway, I am a travel nurse, so hence I have missed days (in reality, rearranged them, having worked my required hours) The manager of my unit got a little snippy with me. I understand her position but I don't really have a choice about missing on some days; I am not going to be at work with him undergoing biopsies and that sort of thing. I really need to extend this contract as we are not able to move right now. I just don't know how to approach her, there is no way to go back and unmiss or unchange days. Just any device would be nice. Thanks, Silkiebyrd:specs:
  13. Silkiebyrd

    very discouraged and tired

    Update: Went to Internist today. We are starting Cymbalta for the neuropathy, a short term pain med, and antianxiety med for sleep and anxiety. He is concerned that the acute onset of such severe pain is related to a possible back problem (back really doesn't hurt much but is a little achy...feet are much worse and lower legs). He was very very positive, we are using a new endocrinologist and I am going to a diabetic educator and a counselor to help me deal with all the new things going on from my health to family responsibilities. I did check out the ADA site and it is great and very informative. To be a nurse, I sure am ignorant about the ins and outs of some adult illness even with ER experience. I have been NICU nursing for the last 5 1/2 years. Thanks again for everyone's support and PM's. I am also relieved that today went so well after the last doctor's visit. :spin:
  14. Silkiebyrd

    Any Diabetic nurses out there?

    Hello, I am a new diabetic and am oral meds plus loads of insulin and byetta. I too am having a little trouble figuring out when to take what. I work in a NICU and usually have 2 vented babies, doesn't sound that hard but some nights are very busy as with most nursing. I have been a nurse for 12 years and time manage fairly well but sometimes stuff just happens that prevents taking a break. But I think with a little time I will figure things out. I think this forum is great and I think the input from different people is very useful. We will figure out what works for us and hopefully we can find an area in nursing that will allow us to take care of ourselves so we can take care of our patients.
  15. Silkiebyrd

    very discouraged and tired

    Thanks for the words of encouragement. Sometimes it just helps to know others out there understand or have been through things and survived. I was going to give an update. I had been doing really well with monitoring glucoses and taking meds but with no insurance just one insulin (Novolog) was 850$ for a month. I went to see my endocrinologist, she was really good about addressing different questions and starting different meds (cheaper). I was very optimistic....until the time that I was getting ready to leave. I had lost almost 80 pounds this past year, I though due to lifestyle change and exercising (now I know a lot of it was probably due to diabetes) She looked at me and in the midst of everything I had been dealing with...money, pain, new illness with new meds, gaining weight rapidly....she says (direct quote) "maybe you should try putting a lock on the refridgerator door":angryfire Needless to say, I was rather upset. I have not gone back to see her or gone to have my labs drawn. I allowed her to make me feel fat and lazy and like I was the one wrong. I know people can't make you feel a certain way unless you let them but that was a little overwhelming to me. I have avoided going to my internist as well because for the last few weeks I have not done anything I was supposed to, I did not even take my meds. I don't know why I haven't, no excuse as I have insurance now. I guess maybe I have hoped that it was all a mistake. I have turned into that noncompliant pt that we all get so angry and frustrated with. I guess that is the bottom line of why I haven't gone, I know that my internist has tried to help me and I turned my back on the life preserver and swam the other way so to speak. I am going to go Friday and am preparing myself for the lecture that I will rightfully get :nono:but I am still not going to the endocrinologist ever again. I have been taking benfontiamine (supplement). We tried Elavil but the dizziness and vision changes were too much. We started low dose and built up. They told me to stop taking it but we haven't tried anything else for the neuropathy...am hoping to get to try to Lyrica or something similar on Friday.:) Thanks for listening to the rant and complaining, hopefully soon some relief in site.