Be Careful What You Pray For...

"You really should be careful what you pray for. 
I am no longer employed. Though this is difficult it is not necessarily a bad thing. I am looking forward to the next thing."

This was my most recent post on Facebook. Perhaps I should explain. I had just been dismissed from my job after finishing rooming patients for my doctor. He has a short day on Thursdays. I was working on completing tasks for the day, preparing for the next day, putting out fires.

And then I was being told before the day was half over that I was being dismissed, that I just wasn't getting my work done fast enough. The patients love me, I was told. I know this: I love them back. You are a hard worker, i was told. I know that, too. There have been complaints to the board. 

If I am honest, there was plenty of warning before this day, this moment. My guts even knew something was not working right. I felt separated. 

It still felt like a punch to the gut. 

My Facebook post sounds flippant. I feel nowhere near as chipper and cheerful as I sound. I really did like my job, my boss, my team. But I struggled so much with the speed, the paperwork, prioritizing priorities. I worked hard to improve. Stayed late, came early. Wrestled with it. I just maid it over half a year. I really thought I was starting to get it. I really thought I had to stick it out, and that it would be simpler with time. 

My heart is broken and I am embarrassed by failure.

I do believe I got what I prayed for. I have been praying since day one that I would do my best, that people wouldn't get hurt. I prayed for a way to have my dreams as well as work. I prayed that my live outside work would become balanced, and my life inside my work would too. I prayed for direction.

I received experience, friendship, and encouragement. Things are moving fast. "This feels like things are moving as fast as a house of cards falling apart" I told my husband earlier today. He countered by saying "Or like things are flowing together." 

Now,maybe I can think about what I really want to be when I grow up. I know it has to do with people. And I know I will be good at it.

Phone loops and paperchases

I am a healthcare worker, and I absolutely hate health insurance.

I thought at first that this much talked-about health care reform was actually going to reform the insurance providers, not make the medical providers job more difficult.

I hoped that health-care reform would make things simpler for the consumers, too. Medicare would be easier to understand. Coverage would be better.

That's not how it works.

Within an average day, we medical  assistants prep charts, room patients, assist with minor office surgeries, clean and dress wounds, give shots and vaccinations; any number of tasks that are person to person, and will help the provider (doctor, physician's assistant, nurse practitioner) in evaluating the patient for wellness visits as well as sick visits.

We also send out on behalf of patients for various types of testing, specialist visits, surgical procedures, and even elective procedures.

The medical assistant is the one who fields patient questions, passes on refill requests,  calls patient's with results, and manages keeping supplies on hand including drug samples, vaccinations, wound care items, and gloves. This equals a full day of work. Honest. But it isn't complete yet: A huge chunk of the medical assistant's time is filled with paper chases.

This is what I hate.

A  patient who has been under care for years for a diagnosis that will not change (diabetes, lupus, chronic obstructive pulmonary disease) will suddenly be informed by their insurance that a medication that has been helping them manage their illness well is no longer on the formulary.

That sets off a bunch of activity that may include trying to call the insurance and getting stuck in the everlasting loop of doom which, no matter how many times you ask for a representative, they cannot allow you to speak to one now, and tells you here is another bunch of stuff you don't need to hear that might help.

There are forms you can download to fill out and fax to the insurance company or the pharmacy supply company to see if you can get approval for the drug that actually works best for the patient. There must be proof that these other cheaper and kind of similar drugs were tried and did not work for the patient. Sorta like the drug they use. Sorta like this.

People expect this to be an immediate process. Computers are fast, why can't things be resolved fast?

Meanwhile, someone needs a MRI done to clarify a medical issue. Some insurance companies require a prior authorization to be done, and radiology cannot and will not schedule the procedure until the PA is obtained. This is understandable.

The thing is, you practically need to be a physician or at least have an eiditic memory in order to complete the process. Certainly you need to  have the patient's history in front of you when completing these on-line questionnaires. Where is that patient's history? On you EMR, on the computer you are trying to complete the form on.

I am over simplifying these issues, and I am still learning. I will never stop learning.  I tell people that this job, being a medical assistant, is my way of fighting Alzheimer's because there is not end to learning something new. But perhaps with experience, the paperchase will become easier and less of a pain in the hiney.

And pigs may just learn how to fly yet.

Inappropriate Songs to Sing at the Workplace, back again!

If you are like me, you live in a little world where there is theme music to your life. The music sets the pace, the mood, the amount I accomplish in a day, or the amount I do not accomplish depending on the day. There is always music.

My brain radio has been set on shuffle lately, with, unfortunately,songs I wouldn't wish on my worst enemy. Not just MacArthur Park: There are other Very Horrible songs out there. Honest!

Take this song, for instance. I had years of blissfully not remembering this song only to have it turn up, volume high, one morning on the way to work. Do you remember this? You admit it??? I guess I did like it, when I was about 9 or so years old. But, what creepy lyrics!

Of course, the internet doesn't help much at all. I found this gem a few years ago; love it. I still  love Tom Jones.  You have to admit that this is way better than his cover of Prince's song "Kiss"! (ooo scary!)

While looking up songs to include in this post, I actually found some songs that would be totally appropriate to sing at my workplace, which happens to be a medical practice. Like this one and this one.  Very helpful, these medical training songs!

Where would we be without music?

Let me leave you with a very appropriate song to enjoy life to. Watch this video, just see if you don't feel something good from it. Something joyful.

Pulmonary Function Test: Breathe!

This has been the year for new medical experiences for me. I am glad to say, nothing has been seriously amiss. I am sorry to say, oh boy do I have the bills now!

I developed a sinus infection this past winter that morphed into bronchitis and then into walking pneumonia. The cough has been with me every since, sometimes as a little dry cough, sometimes as a phlegm producing nasty choking oh my goodness I am gonna die coughing spell. It really got on my nerves! Sleeping was pretty difficult. I would get up and have to eat cough drops to get the spells to stop. I finally went to the doctor about the cough just a few weeks ago. Doc had his medical assistant do a peak flow test with me. Another chest x-ray later, I am scheduled for a pulmonary function test (PFT).

A Peak Flow test  or spirometry is done to determine how strong a person breathes out. It is used to help manage asthma, and to evaluate lung function with patients who have emphysema or chronic bronchitis. A person breathes out forcibly into a device that measures the force of the exhalation. I hit 320, then 300, then 298. Doc said that was pretty bad. He hits 700 when he does this test. I pointed out that he was athletic and fit, and I am not. Non the less, he had me go for the PFT  to do further evaluation on how I was breathing.

So, I went. The technician took me into a room with a transparent booth. I immediately felt like I was on the set for Get Smart.

Before a person takes the pulmonary function test, they are supposed to stop inhalers and certain medications (Spiriva, 24 hours before, and inhalers, Flovent, Symbicort, Asmanex, Pulmicort, Advair,  4 hours before) so the test provides accurate results. A regular small meal can be eaten before the test. Caffeine, smoking, and vigorous exercise are to be avoided before the test.

This was my tech. I regret that I don't recall her name. She was very helpful and nice!

I was shown the mouth piece that I would be using and given a nose plug. The mouth piece was similar to a snorkel used for swimming but it also had a device to keep the tongue down and out of the way during the test. That was uncomfortable but not bad. The technician explained how I was to breathe and that she would be repeating the instructions to me during the test so I didn't have to worry about remembering all of it. That is a good thing. My memory is full.

At first the booth was left open for the testing. There was a lot of "breathe, breathe, breathe, DEEP breath, hold, BREATH OUT keep going keep going keep going keep going...good... breathe, breathe, breathe.  Then the test got serious. The booth was closed and I had to do more of the same, but then the tech instructed me to pant but that the device would be closed so I would feel like I was panting against a wall! That was scary and I kept messing up because I COULDN'T BREATHE! The tech worked with me to help me relax and finally, I was able to do this part correctly.

I was then given a different device that had a mouth piece and an inhaler of albuterol was squirted in. I took three puffs of albuterol, and then did this same test again to measure the improvement given by this bronchodilator.

If a person has asthma or COPD or any kind of severe breathing problems, this test is really valuable in evaluating lung strength and effect of treatment. It is  hard to imagine doing this test if a person has severe issues. It was hard enough for me, with a little breathing problem!

It was a good experience all in all, and both the xray and PFT came back good. Some things just take time to pass. Getting older means some things take MORE time to pass. Sigh.

On to the next thing.

Mom and Lewy Body Dementia (DLB)

This is a story about my Mom.

Young Ruth, before crutch

               Mom never liked going by her first name. We kids were careful to instruct people to call her Ruth, her middle name, and not Mattie. It was kind of a southern thing, anyway, to go by middle names.

My Mom and I had fun together. I will never forget her taking me to Interlochen to apply for a job and ending up driving on the sidewalks. They looked like roads!  When we got caught in major thunderstorms in the car, it was always at Chum’s Corners in Traverse City.

Mom's first and only snowmobile ride. 

               It was so much fun to hear her and her sister Charlene when they got together for overnight visits. They were like teenaged girls, talking and laughing all night, telling naughty jokes and just being so silly.

               I remember Mom talking to herself under her breath while doing laundry. It must have been a way to deal with things. Sometimes she sounded like a tea kettle, hissing away! I am told that she had a difficult time with menopause. I know that her hip caused her lots of pain, especially during wet and cold weather.

               Then, slowly, she started changing.

               Life stops making sense when a person has Lewy Body Dementia.

               It gets mistakenly diagnosed as Alzheimer’s disease, or Parkinson’s, or even a psychiatric disorder. It looks like these diseases in some ways: the person is unable to care for themselves, they are forgetful. They are old. They don’t move well, motor skills are diminishing.  

Treating DLB with drugs that work well with Alzheimer’s, particularly sedatives like Ativan, can cause horrible problems. My Mom had become reclusive and depressed. When my sister went to Mom’s doctor, he gave her Ativan for Mom to try. The drug triggered a psychotic response from Mom. In spite of being dependent on a crutch to walk, Mom kicked my sister in the stomach hard, twice.

Family photo with Mom, Dad, me (Lin), Pat, Doug, and Sandy

               It was terrifying to know that there were physical altercations going on at Mom’s house. It was no longer a refuge or home. It finally got so bad that my brother took Mom to his house. It wasn’t long before the issues Mom had become too much for him to care for.

Mom had auditory hallucinations: Music was in the walls of the house, and it wouldn’t stop. Someone kept telling her bad news: The house had burned down, my sister and her son were in trouble, all we married kids were getting divorces. It never let up.  One day, when I was visiting her and playing cards with her, she looked at me and got a really ugly angry look, and growled “who are you?” I told her it was me, and she argued and got angrier. I laughed nervously, and she suddenly knew me again.

Calm and happy Mom

               At the nursing home, Mom was taken off many medicines and had one pill, Aricept, which worked well with her especially for the sundowner syndrome, the hour when most dementia patients get restless and angry that they are not in their own homes. She became more social and enjoyed taking care of a niece who has a disease of the myelin sheaths that incapacitated her. She had always wanted to be a nurse. She was a wanderer, though, and that is what led to the fall that eventually ended her life. She was 82.

She didn't like this picture. I love it.

               Some things that seem typical to DLB:  Auditory and/or visual hallucinations, Periods of fluctuations in attention; Illogical thinking. Sleep disturbances. One article states: “They often develop visuaspatial problems and find it hard to navigate or perceive distances, so that they lose their way in familiar settings or misjudge distances and fall.”

               If more families were to know what to look for in their older family member, if Lewy Body Dementia was more recognized, it could help to endure the changes they see in their family member a little better. If the incorrect medicines or treatments are given, the results can be horrific, the family can be divided by anger and misunderstanding and fear. There is a little comfort in that it is rarely genetically transferred. There is no cure, but there is at least a possibility of understanding things a little better, and finding medication that gives the elderly patient some peace from the voices.

               It is encouraging that there are breakthroughs being found in diagnosing and treating Alzheimer’s disease and related dementias. It always seems to come late for some of us, but please, God, let these breakthroughs be a gift for many others.

               A short while before Mom passed away, while she was at Munson for her fractured shoulder and other issues that spang from the trauma, my sister and I were in her room when the nurse came in to check her vitals and give medication. She asked Mom her name, but Mom didn’t hear her. We repeated the question to her, and she said clear as day, “ it’s Mattie Ruth.” Sandy and I about fell off our chairs. “What is your name?” we asked again. “Mattie Ruth.”

Newlyweds in the basement house 

Perhaps she was years back, down in Arkansas with her beloved Grandma and Grandpa Johnson. She was talking about babies, too. Perhaps she was with her little sister, Shirley, or brother, Bernice (pronounced Bernis) who both died so very young.

Howard, Nina, Charlene, Jim, Betz, and Ruth (Mom) moving up from Arkansas.

The following links are here to provide more information regarding Lewy Body Dementia, Alzheimers, and breakthroughs: 

Lewy Body Dementia Association, Inc.

Alzheimers Association

Eight Exciting Alzheimer's Breakthroughs

The Fall of, well, Me.

Just three months ago and some weeks, I fell down. There was no ice to slip on, the sidewalk was dry. I didn't trip over a crack or stumble over a pothole. The days of wearing elephant leg pants have long since passed, and I did not fall off my platform shoes. I just fell. And kind of rolled. And managed to get back up again. Then I stiffly kept walking back to where I was going and didn't think much of it.

My left leg gave me a reminder the next day

. Bruises such as I have never experienced before showed up. Even on my arms, which I don’t remember being much involved in this falling down thing at all, had very colorful bruises on them. Wow, I thought. Maybe I ought to get this checked out.

By the time I did, my left leg was not only very colorful, it was very swollen. I had to wear my too big rubber shoes to work, which I do not feel is proper. The PA took a look at me, and then sent me for an X-ray.

The results? Nothing broken or fractured in any way.

That was in November.

1: Bruises
If you are human it is very likely you have had bruises in your life. Some are very painful, like a bruise on your bone. Those take a long time to feel better! Some are mild, like accidentally bumping into the corner of a counter.

Did you know there are different words for bruises? Contusion, hematoma, owie…It is defined as an unopen injury under the skin, characterized by pain, swelling, and discoloration.

Why did I have Xrays to check for a break? Bruises are a symptoms. They could mean a sprain, a strain, or  a break. The amount of swelling was a symptom, too.

It took a month or two for the bruising to fade. It went all the way down to my toes! I was impressed! When it finally faded, I didn't expect any more trouble. But trouble came in the form of swelling  on my left knee, redness, heat and pain. I finally went to a doctor to have another look see, and he told me I had to go get an ultrasound to check for blood clots.

I have had ultrasounds before, and they really were no big deal. But the ultrasound to rule out deep vein thrombosis was painful! The tech checked my good leg first, to have a guideline or baseline to judge the bad leg by. In order to prove there were no clots, she had to press down pretty hard on the veins. The femoral vein, at the top of the leg and near the pubic bone, hurts like absolute heck when someone is pressing down a device to prove there is no blockage! It has to be done. Blood clots are nothing to take lightly.

I didn't have any clots.

what happened next is the big golf-ball sized lump on my left knee burst open over night. It was messy and ugly and gross. The doctor I had seen had also started me on antibiotics, thank goodness, because my knee was badly infected! So I went in to see another PA (physician's assistant) and she had me get another X-ray to verify if the bone was infected (a terrifying thought!) and also who recommended me to see an orthopedic specialist.

The stuff pouring out of my knee was reddish orange and thick. Very scary stuff.

Exudite, or wound drainage.

There are three main kinds of exudite: Serous exudite is clear and water, and it is what usually comes out from blisters or burns. Sanguineous exudite is from an open wound and it is kind of another way to say you are bleeding from a cut or other kind of open wound. Then there is purulant exudite. Yep, Pus. Nasty, stinky, thick stuff which can range in color from greens to yellows to really to gross to talk about. My exudite was a combination of the last two, purosanguineaus exudite, which meant that I had an infected wound.

So, the orthopedic specialist took a look at my knee and kind of looked like he was expecting really bad things. He drew up samples of the stuff to send to the lab and find out just what kind of infection he was dealing with. Then he drained my knee and packed it.

Oh, holy cow. It was like going to the dentist, having a stubborn tooth pulled, and then having the dentist pack the stuffing into the empty socket. It hurt!

Two days later I heard that I had a staph infection. Glad it wasn't worse! How did I get an infection any way?  I have a bad habit. I cannot leave sores alone. It is one of the ways I show a low self image or nerves. If nothing else motivated me to stop doing that, this sure as heck did!

The next appointment with the orthopedic specialist his face showed something akin to awe at how much better my knee was looking. He suggested surgery to take out the remaining fluid underneath but we both felt that the skin tissue wasn't strong enough to hold stitches. Also, I had just started a new job and really cannot afford more time off than I have already had! He ordered another round of antibiotics and I will be going in for another evaluation soon to see if it looks like it will heal without surgery.

What have I learned?

Listen to my body. Pain is a symptom, swelling and redness, all of these are signs not to be ignored.

Stop picking sores!!! I am embarassed to admit that I do this. It is a bad habit, one that I am making great strides in stopping especially after all of this happened!

I live a blessed life.

The Power of Music

“The rhythm of life is a powerful beat, puts a tingle in your fingers and a tingle in your feel, a rhythm on the inside, a rhythm on the street: The rhythm of life is a powerful beat”

Sweet Charity, Rhythm of Life.

Yesterday, our community bid good-bye to a man who had a huge impact on many lives, a teacher, a musician, a minister in many ways. Robert Fisher has closed the keyboard for the last time here, in this place, anyway. In the photo displays put up to celebrate his life, I found a photo with me in it. I saw a really skinny young man with a huge bassoon at the Interlochen Bowl, I believe. I saw brothers together over the years. The rumpled hair and broad smile over the years. The spark in the eyes, mischief and pure joy of life.

The influence of music is universal. Music is spoken worldwide but with different dialects. It can create, unite, divide, soothe or cause fear. It is a language that is mathematical and factual as well as being emotive and fantastic.

I have been so privileged in my life to have such wonderful and extensive exposure to music, theory, and the power of song. I may joke about inappropriate songs to sing at work, but the plain truth is music is so powerful and so deeply absorbed. It can be healing, soothing. 

Please enjoy some of the music that Mr Fisher had introduced to us choir kids over the years, and think about music that has meaning in your lives.  

Peace Peace with Silent Night

Rhythm of Life

Movin' On

Creation: A Rock Cantata