ljr3000

So, is your fiance in school now??? I thought you said the other day that she dropped out for you!! I sure hope not, really needadvice I don't think you have any thing to worry about. Nursing is a wonderful and respected profession and you should be excited for her. Believe me her scheduling won't be that bad, especially if you have a good career and she could work prn or something; then she wouldn't necessarily have to work on Holidays. And if she does; I know at my hospital if we work the holiday one year then the next year we have it off. And if you have to work 7-3 on Christmas you still have the rest of the evening to celebrate it and vice versa. And better yet, if you get to celebrate with the one you love then it really doesn't matter what day it is on. Actually my schedule is better then my husbands. He's in business and he's out of town at least 3 days a week and actually I think it is good for us. And once you're together for awhile I think you would appreciate it too. Sometimes being around each other everyday is not good. Remember, absence makes the heart grow fonder!! :)

It has also been reported that patients with Fibromyalgia have 3-4 times the amount of Substance P found in the cerebrospinal fluid as of that in healthy individuals.

Here is some great info from Dave that I pulled from another thread. He is a Nurse Practitioner and focuses on Fibromyalgia. Hope everyone takes something away from this and maybe even to your present Dr. to try some of these treatments. I know when I was first diagnosed by a Rheumatologist he started me on Prozac for energy and something else (fibro fog) LOL It was in 1995. But with the studying I've been doing on my own it sounds like Dave is right on top of it. Enjoy!! Firstly let me both thank you and apologize. Many of you have sent me lengthy e-mails regarding questions you have about Fibro. I really appreciate you holding my opinion high enough to ask it. Secondly, please accept my sincerest apologizes for not getting back with all of you all sooner. Rather than going through each message and repeating the same information over and over I'm going to post a rather lengthy reply that will hopefully cover everything you've asked. I've always been told that if you're wondering about it, someone else probably is too :) If there is something that I do miss, please smack me very hard and be kind enough to ask me again. Firstly, treating FMS requires a very multifaceted approach. Typically, there are five goals we need to reach toward in an effort for the FMS patient to reach optimal functioning. These five goals are Sleep, Fatigue, Pain, Depression and Cognitive Dysfunction. Each of these requires therapeutic measures to be implemented in a hope of improving the FMS patients, QOL. Many have asked about a Dietary Supplement regimen. In Advance for Nurse Practitioners November 2003 edition, there was a WONDERFUL list of supplements that are suggested for Fibromyalgia. I will post this list below. Folic Acid. 1-10mg/day for months. In taking this supplement, we see a decrease in fatigue and depression. It will also boost immune function. Vitamin B12. 6-70,000 mcg IM/wk. Again looking at a decrease in Fatigue and depression, as well as pain. Will also see a increase in circulation. Vitamin C 10-50 g/day. Vitamin C boosts immune function, decreases pain and increases microcirculation. Magnesium and Malic acid are also suggested by Advance, however I've never used these. They even state that taking these supplements shows a SUBJECTIVE improvement. Perhaps they're something to consider. Advance for NP's does list several additional supplements, however I am choosing not to list those. The other supplements IMHO could effect the FMS patient in a negative way, and since we're not looking at a night and day difference with ANY supplement, I would never suggest them since we could cause more problems than good. The ones I have posted above are ones that I use in management of FMS. Neatly, medications used in FMS. I have NEVER seen a FMS patient managed effectively on one drug. Polypharmacy runs rampant in the management of this disease. You simply cannot hit all of the target zones of the disease and use one drug. :: crosses finger:: Maybe in the future. When it comes to treating the FMS patient, we need to look at four base classes of drugs that IMHO EVERY FMS patient needs to be on. These would be TCA's, Benzos, SSRI's and finally Muscle Relaxants. These drugs treat the fundamentals of the disease and are essential to improving QOL. We should also consider non-narcotic analgesics in this regimen. Once patients are titrated to an effective dosage of these medications, Narcotic-Analgesics come into play. Again, we should titrate all other non-narcotic medications to an effective dose before using narcotic medication. However in extreme presentations, many people will need the addition of a narcotic analgesic right from the get-go. In the treatment of FMS, two other conditions must be considered. These would be IBS and Overactive Bladder. Treatment for them is pretty straight forward, but I will suggest medications for each below. Drugs from the classes. Below is a discussion of medications I use in FMS. Please note that these may not be for you, but if you were my patient ... would be drugs I would consider first. TCA's: Elavil, Elavil and Elavil. NOTHING has been more studied and proven for FMS. I am a huge fan of it and have seen great results from it. Typical dosage for Elavil in FMS is 25-50mg QHS. We can titrate accordingly, but the greatest effects in terms of pain relief are usually seen at the lower dosages. Benzos. For FMS, I like nothing better than Klonopin. With its long acting duration Klonopin provides enough sedation to keep the FMS'er asleep through the night. WHICH IS CRITICAL to maintaining a balance. Klonopin 1mg QHS is usually what I give, but some will need a lower dose of .5mg. For those who experience a lot of night time awakening but fall asleep easily, I will usually give Xanax. Doses range from .5 all the way to 1.5 in what I typically give. Since Xanax has a shorter duration, it is sometimes necessary to give it ever four hours at night time. SSRI's: I have two SSRI's that I pretty much use exclusively. Firstly, NO SSRI has been more studied in FMS than Prozac. Prozac is a wonderful drug and has more uses than I think we'll ever discover. That said, it's not for everyone. I REALLY dislike using it in kids. However I use it a lot in FMS. If I'm giving Wellbutrin, I almost always give Prozac as the SSRI with it, as they work together beautifully. For Prozac, 20mg QAM. AM is VERY important. Prozac is the MOST STIMULATING SSRI of ANY. IT WILL keep you awake at night. Secondly, but my first drug of choice ... is Effexor XR. Simpyl put, IT WORKS! It's the best drug I've ever seen to come out of the SSRI class. For Effexor we start at 37.5mg and increase slowly to a total dose of 150mg. Be warned though, if you suffer from HTN Effexor may not be the drug for you. Effexor can spike your BP. Just something you need to watch for. Finally, muscle relaxants. For FMS I have three that I like. It really depends on the persons presentation when I choose which one to go with. I'll list them and their dosages, then explain which ones I like for which. Valium 5-10mg TID (MUST BE GIVEN TID/QID) Soma BID/TID Cyclobenzaprine 50-150mg BID with occasionally a smaller dose AM and a larger dose HS. For patients with FMS presenting with anxiety, 9/10 I give Valium. This allows the drug to serve two purposes and we all know that anxiety can effect pain. For patients who's pain is intolerable, I usually use Soma. Mind you, that if I have a patient on ANY Hydrocodone containing compound, I do NOT WRITE SOMA. Soma and Lortab are part of a coctail that is very popular in the club scene. Supposedly it gives a rush similar to Heroin. It is not that I am trying to deny patients a medication, or that they don't need a medication ... however our job is to HELP with their problem. Giving them a combination of medication that will produce a Heroin like high? Well, I can't see as how we'd be helping them. Mind you, I do have patients on Soma and Hydrocodone. However I use this combination in patients who get relief from NOTHING else. These patients have also almost always been cleared by an addiction specialist. When considering a non-narcotic analgesic we have a few options. I'll list them below and then describe where and I why I use them APAP 500mg QID Relafen 750 BID Ultram 50mg two tabs QID PRN NTE 6 tabs QD. Motrin 800mg TID-QID Naproxen 500mg TID Toradol 10mg Q-4-6hrs NTE 10days APAP is a Band-Aid. Simply put. I use it rarely. If its Sunday night, someone is out of medication and they don't want to come into ER. I'll suggest it. Relafen is a great drug. It's generally well tolerated and does a good job with the pain. I use it a lot. Motrin and Naproxen. They're OK. I love 800mg Motrin for back pain. Some patients do REALLY WELL with these. When they do, I'm super happy. They're life is alot easier. They run of meds, Walmart will have it :) Ultram. This is the drug I use right before someone moves over to a narcotic medication. Honestly, I'd rather give a Vicodin than this, but it's been my expeirence that if you're treating a patient for chronic pain the medical review boards and SBON REALLY EXPECT to see that you've given this. Ultram is a form of a synthetic opioid and many people get great relief from it. I also consider Ultram to have the same abuse potential as ANY schedule II drug, so I observe it's usage closely. Toradol PO. Toradol has saved MANY of my patients from admission on a PCA. It is a great drug, but you must be aware of the risk of bleeding associated with it. I have several patients who request IV Toradol for pain crisis over ANY narcotic. As a one lady I treated told me "With that Dilaudid stuff you give, I get higher than a kite. Yea, my pain's gone, but it makes me loopy as h**l. That one medicine (Toradol) kills my pain and I still know exactly where I am. I like that!) I've had MANY patients with severe CA pain that I've treated with Toradol IV and allowed them to go home with a few days of it PO. More than one family has said that doing this allowed their loved one to be pain free and spend what little time they had left AT HOME with their loved ones. I'm going to end this message here, however I will soon be posting part two which will cover narcotic pain medications. I will also be posting a set of lab tests which I suggest for all FMS patients to have. Best wishes in your pain control! Dave

I have found some very good information on another thread from a Nurse Practitioner who treats FM. I am going to try to find it and copy it over to here.:)

What happened to Dave? I was very interested in hearing more of his information on meds, lab tests, etc. Has anyone's Dr. ever put them on Guaifenesin for their FM?

I went to St. Mary's Nursing School; Huntington, WV

WOW!! I really think most everyone here needs to do some research on Fibromyalgia. I'm sure you wouldn't feel the way you do if you were the one suffering from it! This is very discouraging that our healthcare workers feel this way. I have never went to the Emergency room due to my Fibromyalgia and didn't realize that people do. It's just something that I have to deal with on an everyday basis and people like most of you; including my husband don't understand. It's hard to know how someone feels especially when they look fine on the outside. I can understand that if people are coming to the ER for treatment of this then "yes" there are abusers; but please remember that this disorder is real and not everyone abuses this diagnosis. For those of you who suffer from Fibromyalgia I Feel for you because I DO know what you're going through!! Just keep your chin up and keep going!!

Just so you know; nursing school is totally different from being a nurse. I didn't have much free time while in school but now it's totally different. LIke someone had said earlier working per diem you make your own schedule and your pay is higher and this is because you don't get insurance benefits. It's really a great way to go if your husband has a good job and has health benefits. Also at my hospital it seems that I am always scheduled for day shift which is 7-3 so if this were her case she would get home before you. Also she has the option of working 3 12's and then having 6 days off afterwards. Overall nursing is very flexible. Nursing is a wonderful profession and she can go anywhere and find a job. Well, good luck to you both and if I were you I would stop worrying about it. Everything will be great!!

First of all you are going to be alone without and instructor looking over your shoulder. That is wonderful. Make sure you raise the bed so you are at a comfortable level. Get all of your stuff together; tubing with saline connected for flush, tape, lot of alcohol pads. Put torniquette ?sp on and look for a good vein. Some people feel them but I am one that prefers to see them. Go at an angle right under the skin, if you don't hit it the first time you can pull back without coming all the way out and move it around a little. If you do see a flash of blood slowly thread the catheter in. Before you take it apart to connect the tubing be sure to take off the turniquette this can build up blood and spew it. I always pull the cath out right to the end and have my tubing ready to quickly attach. Then flush a little with saline to make sure you are in the vein and it doesn't blow. The skin will puff up if you are not in. If it flushes well then put your dressing on and congratulations. The first time I did one by myself I forgot to take the torniquette off so when I pulled out the cath to put the tubing on a lot of blood came out. LOL OH and the alcohol pads are very useful in case a little blood does get out as you are connecting your tubing. Alcohol soaks up the blood wonderfully. Good LUck!! Let me know how it goes.

Well I sure hope you haven't gotten yourself into the wrong field. Just because you may be an Rn and not an LPN or Aid doesn't mean your not going to wipe butts. You do what the patient needs from you when they need it. We look down on our RN's who walk into a room and a family member tell them the patient needs changed and they say; " Let me go get the LPN". If you walk in on that situation then unless you have a great emergency somewhere else you need to help that patient. Also, I agree with the others regarding poop, mucus, blood. If this is something that bothers you maybe you should reconsider. Are you aware that 90% of women have a bowel movement when trying to push out their baby?? Hope this enlightens you. And yes, you will have to work in other areas before getting your L&D job. If you were wanting a position like that at my hospital you would be waiting years!! They are hard to get; people want them and then don't leave them so Good LUck!!

Hello There,I have the same problem that you are talking about; I don't just fall asleep driving or anything but I am always tired. When I had my sleep study, I didn't have any apnea during the night but during the daytime nap study I was alseep within 3 minutes every time they let me lay down. I also carry a diagnosis though of Fibromyalgia and chronic fatigue. Anyway, my Doc just started me on Ritalin. I know it may sound strange because in children it calms them down but it does the opposite in adults. Anyway, another good drug for Narcolepsy that gives energy is Provigil and I go back to my Doc tomorrow and hopefully he will try me on that one. I don't think the Ritalin is helping much. Just curious?? Do you have many aches and pains around your joints?

I have a suggestion for you. Both BSC 250 and nutrition are very hard!! You might want to take one of them preferably Microbiology BSC 250 this summer before you start St Mary's classes in the fall. There were girls that did both but they also were carrying D averages. The classes that you will be taking at St. Mary's along with clinicals and care plans will keep you hopping. I suggest you take one of the Marshall courses this summer and one next summer. That is what I did. I took BSC 250 the summer before St. Mary's started and then I took Psych 311 the next summer. There is no way I could have done them all at the same time. And always remember C = RN As long as you make C's you pass!!! Good Luck!!! You can always email with any questions you may have. Lisa ; )

St Mary's is a wonderful school. I graduated from there in 2001. :) Don't think that you have to read everything that is in your syllabus because it is not possible. Do you have your pre reqs from Marshall out of the way? That is one way to make school easier for you. Just pay attention in class as much as possible. Some of the teachers have there notes typed and hand them out which makes it much easier. I won't say that it isn't hard but I didn't study much and got by. Congratulations and good luck!! If you have any specific questions you can email me.