Joshua

There is not many people in the world who inspire me anymore. Working in the field of healthcare, you see a lot of grumpy, mean, negative, uninspiring people. However, Joshua inspires me.

I didn’t meet him at work like you’d assume I would. I met him at the indoor soccer arena.

Joshua was born without a right arm. Where a stub could be, he has a single finger that he, through the help of surgeons has gotten working again. On this left arm he has a stub, followed by what has attempted by medicine to be an elbow and a few fingers. He makes life work, playing soccer, texting, holding his baby and even working and holding a job. Joshua holding a normal life isn’t the only inspiring thing- it is his attitude about his prediciment that makes him that much more unique- he finds ways to laugh about it. He jokes about being a better goalie than most, he calls himself the T-Rex, he even jokes that the fingers he has are ALL his middle fingers and flips the bird often.

I’ve tried to think of the things in my life that I would give up doing if I were in his shoes. When the list comes to mind and I see him doing it, I don’t feel sorry for him, I start to listen. When I first met him he was angry, a doctor had suggested that he would be a poor father due to his condition. He was out to prove them wrong, and since has many, many times.

He’s strong. When people knock him down in soccer he doesn’t lie on the ground and whine like everyone else does, he jumps right back up and keeps playing.

He’s got heart. He realizes the obstacles he needs to overcome, finds a way to do them and practices it til he masters it.

He’s going places. He’s figured out how to go out and live the life he wants.

He’s better off than 90% of us, and that, inspires me.

We Had Our Baby!

Last blog post I wrote was an hour before all of the commotion of the past week. That was almost a week ago now. I am so thankful I blogged ahead in preparation for the baby so that the blog would not suffer.

Monday afternoon we went into the OB’s office. She took my BP and it was very high. The MA was worried it was her error, so  they did it twice. The doctor asked me about my headaches, if they were like my normal migraines. My hands and feet were more swollen than ever. Things were getting risky. She informed me she wanted to induce me as soon as possible.

We called the hospital and let them know I needed to come in. They informed me I was to go in that night and they’d begin the induction. We went home, grabbed our bags and went to the hospital. I was honestly terrified. We had hoped for a morning induction, for one last night just my husband and I to be at home, sleep in our own bed, go to dinner, but alas, we spent that last night checking into Labor and Delivery.

The nurse was fantastic and explained everything very well. As the night went on my blood pressure kept creeping up higher and higher. After the first dose of induction medication they found that nothing had happened. They started the second dose and we were back to waiting. It was about midnight and I knew I was in for a long adventure. The nurse offered me some pain meds for the contractions I was going to feel until I could get the epidural (I wanted to do naturally if baby came naturally, but if  I was going to be induced I wanted drugs.) I slept for two hours and then woke up in an incredible amount of pain.

The nurse offered me some more pain meds. I hate taking pain meds, I took Tramadol after my shoulder was operated on when the doctors offered me shots of demerol, morphine and lortabs. I HATE how I feel on pain meds and tried to fight it. After twenty minutes I  couldn’t do it anymore. The nurse checked again and I had doubled in dilation (1.5 cm to almost 4). They called anesthesia to come down for my epidural.

Then the anesthesiologist dropped a bomb on me. She was questioning whether she COULD do my epidural due to my Von Willenbrands (my blood doesn’t clot like it should) and my L1-L5 rupture. I literally was writhing in pain and refused to hold my husbands hands because I know I would hurt him. After we talked for awhile (more like her asking questions and me whimpering my answers) she decided she could do it after all. The nurse checked me again, in that thirty minute conversation I was at a 5. We had to get it in now.

I felt horrible while she was placing it, because I was contracting the whole time and wiggling and squirming. I tried not to, but my body wasn’t my own. My husband had to hold my shoulders and back down, while the nurse held my hands and tried to talk me through breathing during contractions. I wanted to cry because I was stressed and because I was scared. I knew I was in good hands, but felt so weak. I remember I kept apologizing, telling people “I’m so sorry I’m such a wimp. I know women have babies in corn fields with no meds all the time and here I am bitching.” They kept laughing at me and telling me I was fine, but I felt otherwise.

Epidural was in and things were okay for a little bit. When I found out the medication was bupivicane I was happier than ever. We work with it a lot at work and I was thankful it was a drug that I was familiar with, as well as have had before. I tried to rest, but before long my contractions were returning with a vengeance. The nurse discovered that the anestheiologist had been pulled into an emergency C-Section and hadn’t connected my epidural pump to me. She had to take the pump into the OR to program it and came running back to attach it to me. I didn’t mind, I just was thankful to have it attached again.

After a long phone call with my doctor the nurse decided I was progressing too fast and that they needed to get me an injection of a drug to slow the labor down. I didn’t quite understand it, but did understand one thing; they knew better and were far more clear minded than I was at this point. We had the same goal: healthy, happy baby, and safe, healthy mom. I agreed and they gave me the shot. At this point my BP was dropping due to the epidural (pain relief), and due to the medication, however, my pulse was now in the 140’s, matching my babys pulse. Again, they were worried.

Night shift was over and the nurses came in to do rounds. I met my day nurse who checked to see where I was at. She said I was at a 5 still and left me to rest. They put me on 15L of O2 and told me to try to relax. I did what I could, and after a little bit my mom and mother in law arrived for the morning. It was only 830 and I told them to go get something to eat. They refused and the nurse came in the check me again. In the last hour I was at a 10 and baby was ready to go, despite the meds to slow things down.

They paged my doctor and she hurried in from her office where she was doing the first visits of the day. She arrived at 930 and we started the delivery process. The only people in the room was my husband, doctor, nurse, student nurse and I. The mothers went out to the lobby and thirty minutes later we had them come back in to meet their new grandson.

Baby boy was born 6lbs, 12oz, 19in. He was healthy and very athletic- rolling over when they did his APGAR test! He has my nose and his dads mouth and chin (and lack of neck). He’s absolutely adorable and I am totally and completely smitten by this new little man in my life.

Since then he’s been well loved by as much family as can be around him. Aunts and Uncles have colds so many havent been able to see the little man yet and are sad. Others have been around every chance they can get (such as the grandmas who haven’t gone a day without seeing him).

He did get jaundiced, as winter babies do get, so he has been on a bilibed and tanning. I call him my little guido and in all honesty our lives have been pretty GTL, Gym; wrestling the little man during diaper changes, Tan, bilibed, Laundry, he’s a newborn, we go through onesies, mittens and socks like mad. We’ve had to go in daily for labs since the day he was born, a Von Willenbrand panel, CBC’s, bilirubin testing. We’re kind of sick of the doctors, but understand it is for a good reason we need to go in.

He’s perfect and I am in love. If someone would’ve told me that the mommy club was this awesome, I would’ve joined sooner. Lack of sleep and sanity be damned. 

 

Stayin’ Alive – New CPR Guidelines

By far the best video I’ve seen in awhile.

Orthopedic Surgery: What You Need to Know Before You Go Under

Working Pre-Op for Orthopedic surgery is what I do when I’m not blogging for you lovely people. I absolutely love my job and love my patients, but I find quite often (think multiple times a day) that there are lots of misunderstandings about the basics of surgery. Never fear! I am here to cover as many of the bases and explain the pre-op process for you to hopefully clear up any and all questions you may have.

Lets start at the beginning; you’ve found yourself injured and need surgery. You’ve found a doctor, a surgical center (whether it be an outpatient clinic or hospital) and are ready to set a date for surgery. My best advice is this; if it is a larger surgery (ACL repairs, joint replacements, rotator cuffs, etc.), or if you have medical problems that could cause problems, schedule your case for earlier in the week. It is much easier to stay overnight on a Monday or Tuesday than it is to be treated on a Friday or Saturday, when many outpatient doctors have the day off. To ensure wonderful quality of care, schedule earlier in the week.

If you must schedule surgery later in the week for whatever reason, make sure you are going to be at a place where they can provide quality care irregardless, such as a hospital or an outpatient clinic that is open on the weekends. I advise going to teaching hospitals because they are usually big-name private hospitals or state funded hospitals.

Don’t forget to make sure your insurance covers your surgery! Believe it or not, sometimes people will schedule surgery, come in for their procedure and discover that insurance will not cover the procedure for whatever reason. It is ridiculous and difficult to work around, so to avoid all the drama, when you schedule your procedure ask to be transferred to the financial staff to have them check for pre-authorization for your case. They’re happy to do so and takes stress off of both of your minds while you’re prepping for surgery!

The week before surgery: Most people don’t think to prep for surgery this far in advance, but trust me, there is a lot you’ll want to do to make sure you are totally ready for surgery.

Make sure you have someone to drive you to and from the surgery. You’ll want someone there while you are under anesthesia so that the physician can talk to them immediately after surgery and give them any photos from the procedure (many arthroscopic procedures have lots of photos taken during them for you, the patient), go over post-op instructions and even give them your prescription to fill while you’re being woken up from anesthesia. Most places will not do your surgery if you do not have a ride home.

Make sure to pack a SMALL bag to take to surgery with you. I would include a small book or magazine (in case the surgery ahead of yours runs longer than expected or for your ride home), your medications (it is nice to have the medications in their original bottles for the pharmacy team and for the surgeons, just in case), and clothes that are appropriate post-op and easy to get into.

Obtain anything you may need post-op now. When I had my surgery I went through band-aids like crazy, so load up on them ahead of time while you can. I also purchased clothing that was easy to get in and out of ahead of time and made sure I could get into and out of them on my own. Many patients are thankful they took care of odds and ends before surgery, such as haircuts (many female shoulder surgery patients cut their hair short to be easier to style), manicures, pedicures and any waxing you may do. Not only will you feel prettier by doing these things, but you’ll feel more confident!

Consider an advance directive or a living will. Most states have a very easy form to be filled out. Consider it and your healthcare options. With Orthopedic surgery you will most likely NOT need it, however it is nice to have on file just in case. I have one and have actually taken the time to go to all hospitals in my area and drop off a copy, just in case of emergency. I also made sure my husband, parents and in-laws have a copy as well.

Odds and ends to consider: If you are having any kind of limb surgery, practice your daily activities without that limb, practice walking on one foot, dressing with one arm, etc. You’ll be so thankful when you are day one post op and realize that you’re fairly well practiced in feeding yourself.

If you are having a hand or finger surgery, get some plastic bags pre-op for showering. Your doctor will let you know when to shower, but having bags and tape handy helps. Consider buying a neoprene glove to cover over the top of your brace or sutures and to keep it clean.

If you are having a shoulder surgery consider what your limitations will be. When I was purchasing clothes I could wear post-op I went to the store and put my arm in a soft sling and practiced putting on clothes. If I could put it on with one arm, I purchased it. For me, it was tube tops and low-rise sweatpants (big and loose fitting in the waist, much more comfortable than other types). Mens sweatpants worked well also. The only thing I regret doing was not thinking of how I’d do my hair. Thankfully my family was willing to help me braid my hair every day (or ponytails, whatnot.)

If you are having a foot, ankle, knee or hip surgery you will be on crutches. Get yourself a pair and practice with them. If you’ve never used them before, call a physical therapy center, they’ll fit them for you appropriately and train you on how to use them. Some places offer crutch training preoperative, however this will take away from your time to prep for surgery, making the pre-op process go quite quickly and in a rush. If you don’t like that feeling of being ‘swarmed’, then do this the week before surgery.

If it is an ankle or foot surgery, consider a knee scooter. This scooter is quite helpful for those who need to get around easily post-op. You can order them in advance and have them delivered before your surgery by the product rep the day of. Many of my patients have them and love them. These are especially useful for those who are older (over 50 is my rule of thumb), overweight (over 250lbs is when it is quite difficult to use crutches), or if they have balance issues. Check to make sure your insurance covers them before ordering one- the rep should be able to verify for you.

The day of surgery: Try to arrive at least 10 minutes before your arrival time. Make sure that you keep your cell phone on you so that in case of a cancellation or if a surgery runs early they can contact you and ask you to get there earlier.

DO NOT EAT OR DRINK AFTER MIDNIGHT. No gum, no candy, no mints. No water, no juice, no fluids. I can not say this enough. It is imperative that you do not do this- it could postpone your surgery by up to four hours- if not cancel it completely. Anesthesia will not do surgery on you unless it is emergent if you’ve put anything in your mouth.

People question me when they come in chewing gum. Sure, you never swallowed it, but did you know gum has sorbitol in it? Sorbitol is a chemical that activates the digestive juices in the stomach, the same as food would do. This is why gum is such as fantastic diet aid.

Wear your post-op clothes into surgery. Do not wear skin-tight jeans, shoes that are difficult to put on (absolutely NO high heels), tight tops or anything that is difficult to put on.  I advise sweatpants and tee-shirts are the safest route to go. Make sure your shoes are easy to slip on.

Most places advise you not to wear makeup into surgery. This is because you will wake up after surgery looking like a raccoon, and frankly the nurses will not let you know (they’re quite busy taking care of you and your pain to worry about your makeup). If you MUST wear makeup, wear as minimal as possible. No false eyelashes or heavy eye makeup.

If you wear contacts, take them out. They’ll have you take them out before surgery anyways, so you may as well bring your glasses to surgery, which are easier for you to wear after surgery.

If you have any metal on your body, take it out. Piercings or body modifications of any kind need to be removed, jewelry need to be taken out (if a ring needs to be cut go to a jeweler- they can resize the ring while you’re recovering from surgery. If the hospital cuts the ring they may not be able to resize it or save the ring due to the poor quality of the ring cutter), and if you have any hair extensions, have them removed. If you have any metal on your body it can cause burns, infections, or can be displaced and cause more problems. Make sure to take bobby pins out of hair- it won’t necessarily cause your hair to burn, but it may make your hair to smell like it was burned- which can last for awhile (hair holds scent longer than skin does).

If you have anything loose or removable in your mouth you’ll be asked to remove it. If its easier to do it at home and leave it there, do so.

Most of all; be thankful you’re going to be feeling better soon! Enjoy the experience of being taken care of, listen closely to the instructions that the medical staff is providing you and make sure to ask any question you may have -they’re always happy to answer them!

If I could offer any last piece of advice, it is this;  feeling better is addicting- be ready to get back to feeling awesome! 

Happy Healing!

Rant: Antidepressants During Pregnancy

I’m sure you’ve seen the commercials, “if you’ve taken any of these antidepressants while pregnant, you could file a lawsuit.”

Let me begin this rant by stating a fact or two. I was on antidepressants when we started trying to have a baby, and I saw that there was a warning for my medication. I then took my medication to a pharmacist and asked about contraindications and drug interactions. I asked for studies and other information about the medication so that I could make an educated decision.

What I found was this (per a pharmacist and my PCP); If NOT taking the drug will kill you, take the drug. If it won’t, you need to find alternative methods of treatment and go off of the medication, because this medication is not safe for a fetus. With the help of my doctor I lowered my dose of the medication til I was off of it. Other methods of treatment were found and I was able to continue trying for a healthy baby.

Now some history on what happens when you ARE prescribed this medication…When you take any new medication that isn’t exceptionally safe for a fetus, your doctor will ask if you are pregnant or trying to become pregnant. If you aren’t pregnant at the time and want the medications still, they’ll prescribe it for you,  but will warn you about the risks and side effects. Anyone else remember the fun with accutane? EVERYONE who went on it was given a pregnancy test beforehand. Wonder why?

I have yet to find a pharmacy that doesn’t have protocol of the pharmacist checking your drugs with you before giving them to you. Even the low-level pharmacies (like Wal-Mart) do it. Once you have the meds in your possession there are these nifty little red and yellow warnings on the side of the bottle. They usually say “may cause dizziness” or “take with food,” but on the antidepressants in the commercials it clearly says on the bottle “DO NOT TAKE IF PREGNANT OR BREASTFEEDING.” It’s a BIG, RED warning. Impossible to miss.

So how exactly do they have a lawsuit?! I will never know.

My stance is this; If you were dumb enough to miss all of the warnings, then you got what you deserved. Let me state this again, YOU got what you deserved. Your baby on the other hand? I’ll forever feel bad for your baby, but you did that to them.

Lesson to be had? READ the warnings and labels. If you have a question about anything then ask the pharmacist or doctor who prescribed it. Drug companies cover their asses, why aren’t you?

Baby Update: A Crazy Afternoon

The last few days have been tough on me and my body. I’ve been cramping a lot, feeling lots of fetal movement and generally not feeling well. While I haven’t been able to get much sleep at all, I have been able to lie down from time to time, in the hopes of easing the pain. No such luck.

Today I ended up calling in sick to work per my OB. She wanted to see if it was Braxton-Hicks or if it was true contractions and wanted me to rest, sleep, drink lots of water and go to see my specialist as per the original plan. I did just that and went into the office at 4pm for my Non-Stress with AFI. (Not sure what exactly that translates into in English).

They listened to the baby’s heartbeat for 30 minutes. In that time he was supposed to have two changes in rhythm from slower to faster. He had twelve. They checked me for contractions but I only was feeling back labor at the time, so it didn’t show up on the screening. They did another quick fluid check, found his fluid levels were low again and checked him quickly. He was not only sucking his thumb again (he’s done it every ultrasound for weeks now), but also has hair that is visible on the ultrasound!

The tech noticed I had elevated blood pressure and checked my ankles and legs. I knew my ankles got swollen when I stood for long periods of time, but today I had quite a bit of swelling. She called my doctor and they wanted me to come over to their office right away so I could get a 24-hour urine test (whoopee- NOT).

We finished the heart test and got the results on paper and headed over to her office. While I was there I talked to the nurses and the doctor about the pain I had been feeling and let them know my methods of trying to get it to settle. My doctor asked me to get changed so she could evaluate me, even though my last eval was last week. I changed and she checked everything out- I was having real contractions and I was already 1cm dilated.

She gave me the clear to go home for the night and asked me to do the test. I’m to return to her office tomorrow for a followup and am a nervous wreck. Lots on my mind, no energy to get anything done (no nesting now), and lots of worries and woes. Until then, I’ll keep distracting myself in bed with my laptop and blogging lots.

 

The Scariest Thing… and the Most Invigorating…

This week I had a conversation with a colleague of mine about life and growing up. This colleague is my boss at work, and he and I butt heads often, however when we finally get along the conversations can be life-changing and fantastic.

“You know…” he said, taking off his glasses and rubbing his eyes. “Nothing in the world is more heart-breaking or scary than looking in the mirror and realizing that you have no idea what the hell you’re doing. Realizing that you don’t know anything.”

I leaned back in my chair and nodded, knowing the feeling all too well. Many days have been spent realizing that life is most definitely NOT what I expected. To have someone twice my age admit this as well was actually quite refreshing, to know that it isn’t just me that feels that way.

He looked to me and sighed. “There is nothing scarier than realizing how far off you are from the reality of it all.”

After a moment I finally found the words I wanted to say in return. “Yeah, it is scarier than ever to realize you don’t know anything…but it is so invigorating when you look in the mirror and realize that its okay.” He nodded his head and smiled.

“Realizing that it’s okay not to know everything…” He sighed. “That’s when you know you’re a real adult.”

A Baby Update

We went to the OBGYN yesterday to see how the baby is doing. I am somewhere between 34-36 weeks (the specialist’s last ultrasound says I’m 36, but my regular Ob says that I’m 34 weeks). We haven’t even started our weekly visits yet, but we talked the OB into checking my cervix and doing an exam like she would at 37 weeks.

She agreed and had me get changed. We heard the heartbeat and she felt my cervix. To her surprise I have been contracting (real contractions, but not true labor), and she stated she was shocked that my water hadn’t broken yet. Afterwards she sat us down and talked to us about what to expect and what to plan for.

Since I have been a high risk pregnancy she wanted to send me back to the specialist and have another ultrasound as well as a ‘non-stress pacing’ done on the baby. We were high risk at first due to my Von Willenbrands (a bleeding disorder), then due to low fluid levels with the baby. The doctor says she thinks everything will be fine, but she wanted to walk to me about my thoughts on being induced early, since baby was already as far as he is.

Frankly, I am just fine with being induced early, because medically my baby is healthy and will still be born healthy. Also, it will give us a for-sure due date and a set game plan. I go in on my induction date, get the drugs, and if he isn’t here in 24 hours, I’ll be getting a C-Section.

Next week we go to the specialist and my regular OB. We will know by then what the game plan is.

I am so excited!

Open Letter to @UKMedic999

Deark UKMedic,

It has been awhile since you have quit blogging, but we all knew you were out there. Between twitter, facebook, your wonderful wife and the rest of the online EMS community, it was hard for us to NOT keep stalking you. Yesterday I saw that your partner in crime and the other half of the Co-EMS bromance (theHappyMedic) posted about your last shift in EMS.

It’s been awhile since we have spoken, or heard from one another, and seeing this post on his blog was so bitter sweet.

UKMedic, I am so glad to see that you are moving on to bigger and better things. Knowing you, this is what you’ve done your whole life, you find something you are passionate about, you chase it, you become it and you obtain that goal. I am so glad to know you are happy doing things that you love, and while we will miss you as an EMS Blogger, as a writer and as a huge part of the Co-EMS movement and EMS 2.0, I am so glad you are doing what I don’t have the courage to do.

I hope to see you posting still on other peoples blogs…and I better darn well see you publishing research here VERY soon in medical journals worldwide!

All the best to you and yours. I miss you and will never forget the legacy you are leaving here in the EMS community.