JackieHouse

I am not specifically looking for a dx, I realize I can’t go online and get that, I’m looking for anything, anything at all to help with finding some sliver of anything we haven’t tried or looked at or didn’t see. A hint of who to see next. What haven’t we looked at. We have seen a string of doctors here and they either say they don’t know or won’t even try anything because he’s on opioids. In desperation and exasperation I came to somewhere I felt would have qualified people who may have an inkling of a clue to help me in the right direction. I am shamelessly asking for help in direction on behalf of my spouse’s chronic pain, apologies if it was worded poorly.

I have searched for years to try and help, but it is getting so bad now I have nowhere else to turn. I hope someone can push me in the right direction. This involves my spouse and I do have his permission to post. Case follows: 41y/o male presenting with moderate back pain, c/o additional nodules on rib cage (photos enclosed) stating they are sore to the touch, also states suffering from muscle spasms in his back. States pain feels like hot acid and spreads from thoracic/lumbar area around chest to abdomen. States he has postprandial pain/spasms. Also states at times he has widespread pain that makes arms and leg muscles sensitive to the touch. States he had severe pain in his knuckle of big toe several days ago, no hx of gout noted. VS stable and WNL. ROM is limited in upper right extremity to about shoulder level, limited in flexion and extension of the spine. Twisting spine to right is at about 50% remaining ROM. Hx of twisting spinal injury in 1999 while closing a lift gate on a utility trailer, hx of abdominal surgery x2 for appendectomy (removal, then reentry for debriedment/infection, thanks USAF!) with deep scarring on RLQ. Pt is unable to 'pop' his spine on his own, has to have assistance via downward bilateral pressure to 'pop' and relieve muscle tension. Muscles around thoracic spinal region are stiff to the touch, present with knots at times in tight areas. Previous MRI/CTs in 2010 show DDD, disc space narrowing from L4 to S1, L4/L5 bulging disc, osteophyte formation along posterior-left lateral aspect of L4/L5, mild stable S curvature of thoracic spine, levocurvature at cervicothoracic junction with cervical spine straightening, mild disc space narrowing at C6-7 and C7-T1, C6-7 show facet degeneration and disc bulge/osteophyte complex with narrowing of the spinal canal. Current MRI shows significantly more degeneration in these areas. Nerve conduction tests show no significant findings x2. Pt has been tested for RA, findings were negative x2. Previous txs include Darvocet, Percocet, cyclobenzaprine, methocarbamol, tizanidine, orphenadrine, baclofen, lorazepam, routine naproxen and acetaminophen regimen, ibuprofen regimen, Voltaren gel, TENS unit, trigger point injections x15+, radiofrequency ablasion x2, epidural x3, massage thx x4yrs+ @ qWeek, prolotherapy x3, kratom capsules, compression bracing, and stretches. Current txs include metaxalone 800mg TID, Norco 10/325 TID/PRN, duragesic 50mcg patch q72hr, gabapentin 300mg TID, clonazepam 0.5mg qAM, nortriptyline 50mg qHS, Centrum Mens MV qDay, magnesium oxide 800mg qDay, ES Tylenol 1gm/PRN up to 3x day, nightly massage with Gold Cup/Tiger Balm PRN. Daily stretches PRN. 6% CBD oil 5gtts SL BID/PRN. Pt is looking to get away from opioid use d/t stigma and it's inability to help with pain after 10 years on the same dose, has future appointment to discuss other alternatives, including medicinal cannabis. Current blood levels show (04/12/2019) BUN: 18 (7-25) Creatinine: 0.94 (0.60-1.35) eGFR: 100 (> or =60) Protein: 7.4 (6.1-8.1) Albumin: 4.8 (3.6-5.1) Globulin: 2.6 (1.9-3.7) Bilirubin: 0.3 (0.2-1.2) Alkaline Phos: 64 (40-115) AST: 26 (10-40) ALT: 21 (9-46) \*\*Creatine Kinase: 465 (44-196)\*\* Previous CK: 68 on 01/20/2015 TSH: 2.12 (0.40-4.50) Zinc 68 (60-130) hla-B27: Negative \*\*Testosterone: 19.7 (46.0-224.0)\*\* TSI: <89 (<140) ESR: 9 (< or =15) Aldolase: 4.6 (< or =8.1) CBC w/ auto diff all WNL Iron, ferritin, B12, Rheumatoid factor, C-reactive protein, CCP are all WNL. Sjogren Panel: Negative Antinuclear Antibodies: Negative Lyme Screen: Negative/Normal Celiac Disease Panel: Negative Hep Panel (A, B, C): Non-reactive, normal Myositis Panel: <11 (<11) No significant muscular injury noted prior to bloodwork besides continuing/worsening chronic pain, nodules on ribs appeared about 12mos+/- ago. Pt is a social drinker, 3-4 beers per week. No kidney issues noted. Pt has elevated cholesterol (229), and very high triglycerides (433), states family hx on paternal side. Pt has seen multiple doctors and specialists over the last 20 years attempting to get answers, from allergist and rheumatologists, to PCPs, sports medicine/orthopedists, and pain management. Pt has been to Shands @ Gainesville to see the orthopedic physician, MRI revealed 'nothing they could do except surgery' and was told that the surgery relief would only last a few years at best. Pt believes this may be a muscular problem rather than nerves or bones, and wonders if anyone has seen this or something similar before and may be able to point him to a dx, certain type of specialist, or test that may help figure out what exactly is going on. Any help or advice, direction, or maybe something you have seen in your experience is greatly appreciated.

I'm looking for advice-good, bad, and ugly. I started a PN program last year and we've been in clinicals since Feb. I befriended another student the first few days of the school year and although we're still what I would consider friends, we're not as close as we were in those first few months. I have realized our age gap of 10+ years more in the immaturity I perceive in her. She's certainly intelligent or she wouldn't have made it this far, however I notice more often than not a different wavelength than I have about what should be considered professionalism in the workplace. For example, I believe if I bend over in my uniform it should cover my behind and back, hers does not (not even in the least). I believe in a fresh bun/pony/style every morning, even a messy bun or plait, whereas she admits to coming to class without so much as combing her hair or re-'bunning' it from the night before. But hey different strokes, as long as she's clean and ready to work; however I am surprised our strict supervisors haven't stepped in to say something about the uniform issue. I told her in the beginning in passing convo that I would not want to work with anyone who was lazy or incompetent, but it's getting harder to work with a person that seems like they don't want to be part of a team or prioritize. I have witnessed her in our clinical setting for a few months now and I notice she is hesitant to do things alone and has some trouble thinking critically at times. She is very blunt and likes to joke, which is what I liked about her initially, but on some things it's getting inappropriate. Thursday we're in clinicals. She gets her assignment, holds on to the assignment sheet and does her initial charting instead of passing it on to the next student to get their assignment. Finally had to ask for it and she waved it off to us (like one of those 'be gone' hand maneuvers). Later that day during med pass, the nurse I was under asked me to get some D5NS from the supply room for a change she was doing-I run down, get the bag, go to charge it to the pt room and the student jumps in front of me, grabs the scanner, punches in her pt number, LAUGHS in my face and says she got it first, and proceeds to slowly walk around the room gathering bed bath supplies. While I'm getting more and more frustrated at the fact that she's blatantly ignoring I have a bag of fluid I need to get to my supervising nurse stat, another nurse walks in. I wanted to just verify I grabbed the right bag (like I said we are about 6 mos in, haven't started pharm yet), I turn to ask the nurse my question, get half of it out of my mouth when said student interrupts me and asks the nurse about the pt she's getting the bed bath items for, telling the nurse the pt wants to go home. Nurse starts talking to student instead. I give up, sigh loudly, student says 'Oh, I'm done with this I guess' and kind of half limp-wristed hands me the scanner to charge my pt's room. Another nursing student walked in and witnessed the incident and I know she could see the frustration building up on my face because she said something to me later. I'm usually a very nice person, I roll with the punches and adapt and overcome, I don't normally hold grudges, I'll give you the shirt off my back if it will help you and I hate hurting feelings. But I will. However, my question would be is this something I should attempt to handle on my own and let her know as a friend she is doing (maybe without realizing it), or is this something I should mention to the student supervisor and let them manage it? I am certainly not looking to get anyone in trouble, I don't like getting the supervisor involved unless it's something I can't handle, but I'm also certainly not looking to let my own mouth get me in trouble as well for trying to constructively criticize. I would much rather help her than watch her flail and be eaten alive eventually, but I've also had my head bitten off for overstepping my boundaries. Should I just play Elsa and let it go? Or should I try to nip this in the bud as a friend to save her grief in the future working on a unit?

How do you like it so far thkh3?

How are the prereqs going??

So we're seniors now! It's been a few weeks more and we're all starting to feel the burnout, even myself-who was amped up fully at the first part of this school year. We can't do much more than the CNA's can (sometimes not even that much), and the restriction paired with the annoyance of the nurses & CNA's that have us on their shifts plus the differences we see in what should be done vs. what is actually done is wearing us down. There's also the classroom shift, we officially took over the senior's classroom as of this past week and although it feels good to move up to the 'new' room, it has us out of our element as well. On my team in particular we switched from doing a narrative charting form to a "Geriatric Assessment Form" which consists of VS, general bed-bound patient questions, and a huge chart on the back where we are supposed to list the patient's medications, what they are for, and their use in our patients. This requires a lot of down time with the charts as they are not always updated and we have to manually search through potentially years of written dr's orders to find medications. We're not allowed on the computers (that they keep UTD) at the nursing home, so this is what we have. It's long, takes time away from patient care, and it's nearly impossible to find a place to set down your chart and paper as there are limited seats available and we're not allowed to 'hang out' at the nurses' station. I get it, I get the whole reason for all of it, the no nurses' station thing, the having to write the medications, but it doesn't make it any less of a pain in the tookus. A few of the ladies in the class sit on benches and use their laps, however I'm a rather large woman with little lap room so that's not an option for me. I can say that I know my forte is not in the LTC/SNF environment. I won't get into reasons, because they really don't matter, but ideally I would like to find a position that was not in this area of nursing (ideally meaning in a perfect world, I would be glad to work wherever I could in the real world). Thankfully tomorrow is my group's last day at the LTC facility we are at and we will be rotating back to the hospital again on a surgical floor. We are all ready. As far as classroom goes, we're having a bit of sluggishness with getting the students to pony up some dough for graduation ceremony expenses (building cost, celebration banquet, awards, class plaque, class photographs). We asked each student pitch in $80 to cover all of these expenses, but only one student so far has come forward with anything. I'm looking into fundraising now, a good prospect has been with Yankee Candle Co., I believe we as a class could sell those easily and we get a good portion of the profits. We lost 2 more students in the last 2 weeks simply due to hours, bringing our total down to 22. We have 30 hours allotted at the beginning of the year we are 'allowed' to miss, then by state law (Florida) you have to start the program over again. A lot of people unfortunately used their hours early through no fault of their own, usually due to sickness or death of family, but it's coming back to haunt them now. The director of the program will *usually* let them restart with the new class that has just come in, starting back in the segments they left off in, but it sets them back 6 months. You get one 'do over', if you don't make it then you have to restart the program entirely. We are sad to see people go because of hours. I think that's actually all I have for now, have a Happy Easter everyone!

Thought I'd post an update though it has been a few months. We have been through a few more segments and are now in the LPN section of the program (the previous sections were basic hc worker). We gained a few students, lost a few more. We're on spring break now, but rumor has it when we come back we will have lost 3 more students. This brings our class down to about 24 from the original 34. We're in clinicals now and I love them, they really make the weeks go by fast. We're in class Tues and Wed, in clinicals M, Th, and Fri. Pretty happy with the program as a whole at this point. I've been voted President of our class so there's that too, I have no idea how to be a president. I'm not the type of person who picks up on cattiness or general disdain towards us students (or in life in general-I stay pretty happy) and I have a naturally happy sarcastic attitude (I have been told I flirt a lot, actually I'm just trying to be friendly....this may be why people get the wrong idea sometimes though), so I'm definitely using these to my advantage with some of the seasoned nurses who are not pleased to have students on shift with them. I guess it never crossed my mind that others would not be interested in teaching or being shadowed, but I can see how extremely busy they are and I get that having to break in new 'volunteers' and answering numerous questions may (would) be annoying. Charting is something new and for now although we can log into the computers to look at admission dx and labs, we're not allowed to actually use them. We are doing full narrative handwritten charting. We get two patients a day, our charting is due at the end of our 'shift' at 11:30am. Post conference is from 11:30-12:45, then we're out for the day. I have to say getting in there and just doing it, it's scary because we don't really know anything more than basic stuff. Right now we're mainly focusing on our vitals and H2T assessments, reporting anything 'unusual' to the RN, and charting everything. They want us to bathe the patients and change their bedding every day we are there. I've noticed more often than not the patients don't have the right fall precaution items on and on their door, even if they've been there for days. It's difficult knowing where our boundaries are still, what am I allowed to do, so you don't really want to step on the nurses' toes but you do want to help without being annoying. All in all it's nice so far. We're in the last few chapters of A&P and the middle of Med Surg I in class. A&P has wiped a few people out, but Med Surg was a surprise attack I think, especially with the second chapter being nothing but IVs and tubing and solutions. Even those (like myself) that had all the prerequisites done for RN courses had not seen or heard of the tubing types, when to use what, why, and drip rates. Thank God we had a week to learn it, but some brushed it off which made the median class grade about a 60% on that one. Not trying to use this as my personal diary...ok, yes I am kind of, but I thought maybe me posting every few weeks might help someone else out that was thinking of nursing school. The one hardest lesson I've learned so far is not to put a lot of faith in others. That seems harsh, but I've had a few friends I've gained through class that I really thought were going to stick with it but they put their personal pleasures first instead. You have to 'do you' first and not worry about anyone else, and when you're doing 2 chapters a night (reading, objectives, workbook) and testing on them the next day you barely have time to sit with your family at dinner. This has been hard for me coming from being a stay at home mom doing part time classes for prerequisites to doing full time classroom work all week and seeing my kids and husband maybe 2 hours a day. It's a bit easier now that we're in clinicals, but it's still a strict schedule and the homework requires discipline. That was not meant to scare potential students, just telling it like it is. Ok, well this has been long enough, I'll try to post again in a few weeks. We go to the class ahead of ours' graduation April 5th, so WE become the "Seniors." Exciting!

Yay! Congrats! It's definitely been a challenge but it will be worth it! Good luck to you too!! We lost another student this week. I really have no idea what went on, but after some snide remarks to the professor in the classroom, she gathered her books up, got in a loud conversation with the other professors and walked out. Haven't seen her again. We started a new segment today, Nutrition. 3 chapters, 6 tests, no room for slacking or failure. Worried about a few of the grades I saw on the posted grade board, but I don't know who's they are nor do I have the ability or spare time to help. I'm doing ok keeping my head above water so far, getting to know who's who in the class, who will have your back and who will throw you in front of the bus, that kind of thing. The new schedule came out as well (the program supervisor does them once a month about two weeks in advance of the new month), found out we have hospital orientation on the 6th of February and start clinicals after that on the 21st. I'm pretty nervous about that, but I think we'll do fine. That will have to be my update as I don't know much more yet.

It's terrifying, tbh. You HAVE to stay on your game, class is from 7:30-2:10 (will go to 2:25 in Jan 17), and we spend about 3-4 hours after class lets out working on reading the chapters, doing objectives and workbooks, and going over rationales to prepare for the next days tests over the subjects. The good news is the program had a 100% pass rate on the NCLEX-PN this past graduation, so this hustling we're doing now will surely pay off. We've only lost one student so far, but I'm afraid it will be more soon enough because of the time limitations on taking off classes and the grade requirements for each segment. I'm looking forward to starting clinicals in February/March. I find myself on this site more often than not asking the questions I don't want to ask in class about things that seemingly are common knowledge to nurses (why wear compression hose? what is a 'step down' unit? what is it like working at ____ hospital?), lol. Will post more later when I know more.

I did! I got into all three, Chipola's letter was received about a week after I heard back from Haney. Gulf Coast called me for an alternate position, but I had already accepted at Haney and politely declined.

It was absolutely brutal. Orientation is Nov 10th, class start is Nov 14th. I'm going down this morning to register for classes.

Yes! I've been told to be prepared. This one is a 46 week course, 5 days/week. It moves very fast, after 3 months we start clinicals x3 days/wk. I read the letter describing what we are supposed to do before starting and on the first day and I'm finished with most of it (even some of the first day stuff). I purchased nearly all my books from a former student for cut price (I checked editions and they're the right ones), had a lot of the medical supplies I need already at the house, and bought two sets of scrubs that I will wash and rotate. I am psyching myself out about the class, my previous endeavors included a bout in pre-engineering classes, the Calculus I was able to feel my way through but the physics was a nightmare. Hours of class time plus 40hrs/week homework (because I struggled so horribly). I'm going to equate nursing school with that so I'm not taken by surprise!

I enjoy reading everyone's topics and debates and thought I'd add my little two cents in. I applied to TWO RN colleges and an LPN college and was accepted to all three! I will be starting as an LPN first (financial reasons, LPN school will essentially be free for me), and working my way to RN transition. They allow students with an active LPN here to enroll in the third semester of the RN program. I am feeling extremely blessed and lucky today and thought I'd share some good vibes!!

All of your advice is spot on. I'm tough, just frustrated. Fortunately I'm hardheaded and persistent enough that I'm not going to quit, just look for more silver linings. I will wait till October for the next round of selections, in the meantime I am also going to apply to the LPN program at our local tech college. Their interviews/selections are in October as well. I have seen some with worse GPA's than mine get in at all of these colleges (a good GPA here is 3.8, average is 3.5, I've seen some 3.1's get in), the first one (that I attend now) has an applicant load of about 2000 and accepts 200, the second college (the one I would like to attend) has about 140 applicants and chooses 60, I'm not sure about the LPN program but I do know here they allow you to merge into third semester RN courses once you have an LPN-plus the LPN program is a little more 'veteran student' friendly. I did write a message last night to "Jane" and asked if I could be considered for the runner up pool for the fall courses, but made sure to let her know I will be looking forward to October selections if not. I have also been in contact with the American Red Cross to do some volunteer work while I wait. As my old supervisor once told me 'adapt and overcome,' right? Caliotter, I cannot even imagine what your friend felt seeing that! I swear sometimes these admissions people don't know their ____ from a hole in the ground. At the larger college (the one I attend now) they assign you a specific nursing advisor who is really part of the health sciences program to guide you and make sure you have what you need and to check/recheck the files. Unfortunately, at the smaller college they don't assign you anyone initially, you're just kind of floundering in the dark with crossed fingers. I have honestly not been able to find a certain person listed in the directory as 'nursing department' besides the Dean of Nursing which is disappointing, but I've heard many many good things about their program so it's worth the wait.

This is a bit of a story, and I'll try to keep names out of it. I decided to go back to nursing school after setting down my pride and realizing I was not going to make it in engineering....around last summer. I have a degree in Legal Studies (A.S., 2012) as well as a Lib Arts with a concentration in pre-engineering studies (A.A., 2015). I studied for the HESI exam off and on starting last September (2015). I took it in January on the first date it was offered and made a 93%. I only had 3 classes left to take besides my clinical hours, so I figured I would finish my RN out. I applied to the college I was attending's RN program in January days after taking my HESI. I stayed in contact with my advisor and selections were in early March. I did not get in, but this was no surprise as I was told by the advisor that the 3 remaining classes (even though I was currently in 2 of them with B averages) would be counted against me. I applied to another nearby college in the next county for their fall semester RN program, though it took me a bit longer to finish their application due to needing a physical exam, shot records, updated vaccinations, and a TB test. After turning all that in, I received a call from one of the health sciences secretaries letting me know I had gotten an old application (off their website of all places!) and I was now going to need a CPR card. I finished ALL THAT with a month to spare for their deadline on the 2nd of June. I was in constant contact with the admissions office because I was nervous about the upcoming deadline and I wanted to be SURE I didn't miss anything. Numerous emails were sent back and forth between myself and the admissions office, needing updates for this, a certain transcript hadn't been delivered, etc. The deadline came and passed and I had been reassured 3 times that they had EVERYTHING they needed. Weeks went by and last Saturday (July 9th) I got a letter saying I had not been selected for the program. I was shocked, but I grieved over it and moved on. Monday night in my microbiology lab, a guy in my class came to me and told me that maybe I should call the second college's office and see what I could do this fall to better my chances of being accepted. I would prefer to be in that college, though it's more of a drive, it's an 18 month course instead of the full 2 years. I told him I wasn't sure what more I could do, I was finished with all my courses besides the microbiology class/lab I'm in now, I have a 3.2 GPA (with nearly 200 credit hours of classes *whew*), and I made a 93 on the HESI. He was as puzzled as I was as to why I wouldn't be a good choice. Tuesday morning I called the college and requested to speak to someone in the nursing advising department or someone with knowledge of the selection process. I was transferred to a lady, we'll call her Jane. I told her my name and asked her if there was anything I could do to improve my chances of being selected in the fall. Without pulling my file, she told me that I could attempt to get a better HESI score. I told her I had a 93, and she sounded a bit puzzled and asked me for my last name. Upon opening my records, she told me they did not have a copy of my HESI transcript at all, it had never been in the file. I WAS LIVID. Through the numerous people that had looked in my file prior to the deadline, through the admissions office and then the nursing office I'm assuming, not one single person told me the HESI was not in there. That is part of the application packet and I should NOT have been told several times it was completed if that transcript was not in there. We are told here that you have to have official copies of everything, so I paid the $15.00 to Elservier and had the official transcript of scores sent to their college, not to mention the numerous other colleges I had to pay for transcripts from (which all made it, imagine that). Jane told me that I should not have simply 'paid for something online and expected it would be mailed to their college.' I replied to her that was the way ALL transcripts are done, and that I had contacted their admissions office many times to assure everything made it there. (I would never insult someone by saying it, but I thought to myself I hadn't just shot random emails off into oblivion and hoped for the best, I followed up closely-this is not a game to me. This is going to be my life, my career!) Jane asked me for copies of proof that I had sent the transcript, a copy of the transcript for the scores, and copies of the emails back and forth to the admissions office. I complied and tried to be as nice as I could muster for someone that felt completely jilted, cheated, and lied to. I just know that my file, as hard as I worked on it, was tossed to the side with the 'did not comply/incomplete' files, and that's just not me. I'm sick and disgusted about it, tbh. At this point, I feel like there is nothing I can do but sit on my hands and wait until selections in October for the spring semester.I'm not sure what I could have done differently other than gone down there and LOOKED at the file to make sure everything was there, which I've never heard of before. I have no idea. A friend of mine that was accepted for the fall told me to hang out and let things run their course, that they may put people in as runner-ups for people who don't pass their drug tests or background checks-however if they didn't even review my file because of lack of a HESI, I doubt they seriously have me in any runner up categories. Thanks for letting me vent, just feeling totally blindsided and a bit (lot) let down.