Wednesday, April 29, 2009

To Close the Borders ... or Not?

At this point closing the borders would most likely be pretty useless...think of it this way...You have a barn, with a horse...said horse leaves the barn through one of any doors you have on every side. You shove the horse back in one door and while you are closing it, he runs out another. You repeat the scenario over and over....until suddenly you realize that all the doors are closed but the barn is empty and the horse is galloping down the road.

Closing the borders would be a little like that. We can't keep the Mexicans from crossing illegally on the best of days. Border patrol agent's are stretched thin just keeping the drugs and illegals from crossing where ever they have a chance. We are in the process of building a very costly and (so far) very unpopular fence between us and Mexico , and of course there is still the river. If I lived in Mexico, and thought I was going to die if I stayed...darn tooting I'd be trying to get out. That is why a pandemic will happen. It will be impossible to contain it within a countries borders...because of fear. People will panic, they will go where they think they are safe...and damned the consequences. They will come here even if they know they are sick. You can run, but you can't hide....bacteria /viruses are everywhere.

How will world responds now that the horse has exited the barn? The next few weeks are going to be very important to our future. Hopefully most of the cases will remain mild and this will be a practice run for all the pandemic planners. They will be studying for the next 20 years on how to get better at planning and making manuals. People will get better at figuring ways around the system. That's just the way people are.

On a more personal note: I am feeling better. Still off work as I'm still hacking, coughing and can barely talk. My throat swabs are still pending, I take it the State Health Department is a little bit swamped right now. Now, if I were dead, they would put a rush on it and would know tomorrow, but since I prefer the present (with me alive and hacking), I'll just wait my turn for my results. Stay safe out there, wash your hands, wash your hands, wash your hands...and avoid people like me who are hacking their lungs out...even if they are using anti-viral tissues that kill 99.9 percent of cold and flu viruses', it's that 0.1 percent that will get ya every time.

Tuesday, April 28, 2009

Swine Flu Panic...or Prudent Caution?

Here in the valley I live close to four international entry ports...or international bridges from Mexico. FOUR! It is inconceivable that at least a few sick people haven't made it across, especially in the days before the warnings...when the flue was still in it's incubation stage. You can be contagious a day before you actually start showing symptoms.

People cross over all the time, and go to the local hospitals for care. They know that due to federal laws that they cannot be turned away without at least being triaged. It is not common practice for the triage nurses, ER staff, Er physicians, out-patient secretaries or ever the security guards to wear protective masks. It's the time of year when we see a LOT of pneumonia , pneumonitis, acute respiratory disease's, increased allergic responses...because there is a lot of changes in the weather, cool at night - hot and muggy during the day.

Add to that the allergens in the air as the farms plow and plant, and the winds have been blowing 30-40 miles per hour for the past month....every day. It has been theorized that there is more molds in the ground this year due to the excessive moisture and standing water we had during Hurricane Dolly last year. These would have lain dormant until the spring plowing.

I keep hearing the question "Why are so many people dying in Mexico and not in the U.S.". My thoughts are these.

1. In Mexico, if you are sick, you don't need a prescription for antibiotics, you just figure out what you think you need and you go and buy it. People take the antibiotics until they feel better...not until they have taken a full course of medications and eradicated the problem. When they get sick again...the pneumonia, bronchitis, or whatever respiratory illness they are experiencing is more resistant to the antibiotics.

2. Because they can get antibiotics without a physician's order, by the time they actually go to a hospital, they are literally at deaths doorway, nothing is working. Influenza, pneumonia, bronichitis, the common cold, cardiac heart failure, Pulmonary Emboli, Tuberculosis...these all have very similar lung symptoms...with sputum production, infiltrates on Chest X-ray, increased WBC's and/or left shift on bloodwork, cough, fatigue / malaise , and with the exception of CHF, fever may or may not be present.

Every illness that fits this criteria is probably initially treated as pneumonia or bronchitis...a throat swab and sputum cultures are not always ordered. With this Swine Flu ... while there is a frequent cough, there is little sputum production...therefore nothing to culture. Add to that the new resurgence of Adult Whooping Cough...and you have one more thing to add to a differential diagnosis.

What really sends up a red flag is a young previously healthy adult in Acute Respiratory Distress that winds up tubed in the ER. The only problem there is again figuring out the problem. To further muddy the diagnostic scenario is also the fact that there is alot of illegal drugs readily available and used in this area. You can get young healthy adults with Acute Respiratory Distress due to smoking crack, or snorting cocaine. So as you can see, the puzzle can be very complicated for a doctor...or a whole group of specialists to wade through.

Then there is the very real fact that a lot of Tuberculosis crosses over from Mexico, because it is not routinely tested for like it is here in the States. The ICE facilities have isolation beds for this to get illegals well and non-contagious before they are sent back to their native counties, we usually get "over-flows" from them...which means there is a lot of TB out there folks.

Now that there is a Possible Pandemic, something which the hospitals have been training for for the last few years...and we actually know what to be looking for, they can add throat swabs for the flu virus to the battery of tests commonly ordered, they can isolate the patients when they come in the door...except so many are coming in and we only have a few true isolation rooms, which are usually used for TB patients.

CDC may not have reported all the cases as yet, as our local news is reporting "confirmed" cases in Rio Grand City (Starr County), some in Navarro County, and Brownsville ...all which have been reports in school age children, with said schools being placed on mandatory closing until May 5-7 (different stations giving conflicting info). You go to the CDC website...and none of these "confirmed" reported illness are reflected on their "board" as they are still claiming only 3 cases in Texas, one in Dallas and two in San-Antonio. I just listened to a Yahoo video that two students in Cibilo, TX (not sure if that is spelled correctly or where exactly that is) have been confirmed with Swine flu. That brings the number of reported to around 9 cases scattered all over the state ...only three of which are through the official CDC website. Trust me ...there will be more. While I was getting my test done yesterday and issued my medications our ER was jam-packed and a number of the patients were wearing masks...something I HAVE NEVER seen anyone doing in the ER.

So I think this is the tip of the iceberg...and if it does turn out to be like the Spanish Flu of 1918 this could be the first wave. The first wave was mild then the virus mutated and came back with a vengeance 6 months later. Hopefully, if I have a case now, it will give me some immunity later when I may need it. Somebody has to be well enough to take care of the sick.

So folks, stay safe out there, wash your hands often, cover those coughs and sneezes, use the hand sanitizer, disinfect shared telephones, doorknobs, grocery cart handles...all the things you would do in the regular flu season. Be prudent with your own health.

Monday, April 27, 2009

Waiting to find out what the heck I have

The Infection control Nurse called me last night at 9, on a weekend, she is going to call me this morning to let me know if I need to come in to pick up a prescription for the Tamiflu or if I need to go to my personal physician to get my throat swab done (only 70 percent accurate for flu type A anyhow). I sit here, with my low grade fever, my now sore throat and nausea, and I getting better yet. The chills come and go, but seem to be less frequent...of course that could have been the soothing shower that lowered my temperature. Ah.....I hate to be sick!

Sunday, April 26, 2009

Is it a Regular Upper Respiratory or is it the Swine Flu??

OK. So, I had already read about the swine flu, like Friday morning. Commented to the hubby...."Wonder how they got a Swine/Aviary/Human never seen before flu...unless (oh now here comes the conspiracy theory) somebody genetically engineered that??? Not trying to be a fear flinger or something, but seems weird to me.

So I go to work Friday and the patient with the FEVER OF UNKNOWN ORIGIN who had been down attending some big MOTORCYCLE RALLY (you know the kind where they get wild and swap spit with people they don't know and will never see again) THEN TRAVELED TO MEXICO to buy his regular medications cheap....WHO HAD THIS COUGH UP A LUNG COUGH...with occasional RED OR BLOODY SPUTUM (that was actually screaming TB a little to me, but what the hell, who am I to tell all the fine doc's that maybe they need to retest the sputum?) WHO COUGHED IN MY FACE (yes it happens all the time) and whose helpful wife kept dragging out SOILED Kleenex's to the DESK to show me said SPUTUM (eewwwkkk!!!!), she was really a sweet lady...just not real bright about SPREADING GERMS.

It seemed to matter LITTLE that I practiced HAND HYGIENE RELIGIOUSLY (that's good hand washing in layman's terms). By the end of the night FRIDAY I was having a weird tickle in my throat...that turned into a HACK MY LUNG OUT dry cough.

Went home went to bed got up and went to work. The HACK MY LUNG OUT dry cough ...still present but which had also turned into a LOW GRADE FEVER, SLIGHT SORE THROAT, SLIGHT NAUSEA, AVERSION TO FOOD (me?????), almost total LARYNGITIS (do you hear my hubby praising God yet???). Anyway, I had to report this to the INFECTION CONTROL NURSE ( at home on a Sunday morning) because the CDC was at the hospital's down here yesterday looking for basically this SET OF SYMPTOMS. She decided they did not need to test me because my temp has not spiked up past 100 degree's yet. Hummmmm nobody seems to care that I always have a sub-normal temp of 96.7 or 96.8 for my ENTIRE LIFE and when I hit 99.7 that's the equivalence of anybody Else's temp being 101.7, and I FEEL LIKE SHIT... actually, pardon the language HAMMERED SHIT really describes it better.

It's probably just the change in the weather and all the wind carrying pollen...but the original cough was really strange. IT WAS EXACTLY like it felt like when I WAS GASSED at the little sharp particles were irritating my throat. I still don't have a runny nose, but it is hard to breath a little. I am going to the doc Monday to get my throat swab for Influenza A or strep. If I SPIKE A TEMP OVER 100 degrees then I WILL MEET THE CRITERIA needed to warrant a trip to the ER...and that's where I will be going.

My KIND AND CONSIDERATE SUPERVISOR has taken me off the schedule for tonight. The STAFF AND VISITORS AND PATIENTS were appreciative that I wore a MASK ALL NIGHT (my face itches like hell from the darned thing!) and DID GREAT HAND HYGIENE. IF I HAD KNOWN I WAS SICK BEFORE 6 P.M. I would not have gone to work. IF I HAD HAD FEVER before going to work I WOULD HAVE DONE THE PRUDENT THING AND STAYED HOME regardless.

So I'm going to lay down and try to sleep, if I am able to breath in the horizontal position.

Stay well.

Friday, April 24, 2009

Oh My Pretty

Dave: Oh My Pretty, you've been playing in the flour again!

Me: But Daddy, how did you Know?

Dave: The floor, the walls, the cabinet....your nose.

Guilty as charged. My favorite neighbors are having a BBQ tomorrow. I cannot go because I have to work, but non-the-less...I will cook, and cook, and cook....and hopefully get a nap before tonight....because I have to work. My neighbor/pastor/friend Joe, has Army buddies coming...he was stationed in Korea with these men when he was a mere 18 years of age. He just turned 68. They have not seen each other in 50 years. One couple is coming from California, I don't recall where the others are coming from. Irene, Joe's wife, the shy one....has been beside herself for days. Cleaning, cooking, planning....changing her mind, planning some more, and getting pink-faced and flustered. My sweet neighbor...who never asks for anything, asked me to make her some pineapple upside down specialty. Sitting in my kitchen, as I blog is a huge 14 X 9 scrumptlitious pineapple upside cake...and a small round 9" cake *ditto* for my sweetheart...who will be washing said floor, walls and cabinet! I have Toll-house cookies in the oven for the coffee and prayer tonight, and I put bread to bake in the bread-machine...nicknamed R2D2. All in all a pretty productive morning I'd say.

ON THE WORK FRONT: At work we've noticed a run on Aortic Aneurysms. We've had those of the dissecting variety (NOT GOOD), the bulging awaiting repair, and the newly repaired back with higher dissection and need of further intervention. These people won't be on a balloon pump, because, no matter how bad the heart...can't risk blowing the aneurysm...that's usually instant death or pretty close to it.

One elderly gent, who also had an MI and is not a surgical candidate...due to age and other made a DNR....I guess they thinks that means he will die right away. Actually, he is doing pretty good, and can probably live for years with his condition, if he doesn't do anything strenuous. He's got a few knots on his head from falling...syncope...and they've been doing a lot of adjusting to the BP meds to keep him in the low 100 systolic range. He's is cute as a bug....he only speaks a few words of English....but who can not love somebody who tells you how pretty you are .... every time you go into his room.... in English and in Spanish? Who cares if he has dementia...I like his touch of made my day!

My other patient, an elderly lady, had a humongous AAA, not dissecting, but bulging...and found by ACCIDENT on a CT for something else. Imagine coming in for some relatively non-urgent testing and finding out you have a time-bomb literally ... tick tick ticking...with each and every heart-beat....scary as hell. I saw the sucker on the CT scan...and as you scrolled down it got bigger and Bigger and BIGGER....her only symptom...claudication (pain in the legs when walking)! Another case of really tight blood pressure control. The bad thing was that they did an aortagram/angiogram it check her heart out and she had multivessel disease. She had to have open heart surgery. I could not be for certain that she really understood the implications...she could die ... on the table, her prognosis was not good. I asked her about family, and she only had a sibling that lived far away...for HIPPA purposes I'll hit a couple of states away, in the Kentucky, Virgina, Carolina neck of the woods. She had called her sis...who was older than her, and sis was driving down, because she could not afford to fly. Sis was coming ALONE because she was widowed. It was going to take her three days to get there, because she would need to stop and rest. The morning I left she was going to surgery, they came and got her at the butt crack of dawn....I was still there...I went in, and held her hand, and told her I'd pray for her and check on her later in the day. She had tears in her eyes, and she held my hand so tight! I couldn't hardly sleep (that was the day the telephone pole was on fire and we had no electricity). Before I went to sleep around noon, I called CVR and checked on her. She had made it through surgery and was doing good. Praise God! Anyway, when I worked my last shift she was back to the floor and getting ready to go home, after she recovers from this she will be back for the aneurysm repair.

Well, going to put the last sheet of cookies in...and make a run to the neighbor's with all the goodies is tow.

Thursday, April 23, 2009

Bible Study...the end of the blog

My broadband link is slipping here in the blog-o-spere...and somehow the last of my blog was deleted. Here is the end...

God is there when my patient is crashing and burning...putting the idea's in my brain of what to do next. he's there for me...why can't I be there for him...on my day off...? If not for God's grace, I could be one o the poor unemployed, wondering where my next meal was coming from. I just don't appreciate the gifts I have been given.

I promise to do better. But, I still think Bible study would be better attended if they served Margarita's...just suggesting...LOL.

Now...that's the rest of the story.

Going back to bed now. I'm still in sleep deficiet. I really wanted to go to the beach today...if the weather I gotta get a couple more hours before I can even think about wrangling three weiner dogs with leashes up and down the shoreline.

Wednesday Night Bible Study

I admit it. I resisted the idea of our small church starting up a bible study program on Wednesdays. I could number my reasons....

1. I work every other Wednesday and would miss sessions in a numbered lesson plan

2. My hubby is teaching, so I would be required to go..even if I don't want to (laziness you know)

3. I jealously guard those days off.

4. I would be expected to go...even if I don't want to...and I simply do not need anymore pressure.

Well I went to the first one last night. There was 5 people there ...Dave and I included. I actually enjoyed it. Even though I had to get our of bed early (on my first day off...I only slept 5 hours with a migraine), looked up all the scriptures (I hate being unprepared for anything), then I actually had to get dressed and do my makeup...on my day off. We were there from 7:30 till 9 pm. It didn't kill me. I got to thinking...well if I didn't work every other weekend, I would be in church every Sunday. Going to church every other Sunday and Bible study every other Wednesday...I'm still only going to church 4 times a month...Gee...I'm giving God like only 8-10 hours out of my life...not counting reading the bible study stuff and praying. I actually felt ashamed. What in the hell was I bitching about anyway??? God gives me more than 9-10 hours a day...He's there when I'm scared, lonely...or just need somebody to talk to. He's there when the no-driving assholes pull out in front of me on my way to work. He's there when my patient is crashing and burning...putting the idea's in my brain of what to do next.

Saturday, April 18, 2009


Some days I should just keep my nurse ass in the bed. Nuff said.

Monday, April 13, 2009

Todays Post

Todays post...posted on Gingerjar (apparently I somehow have two blogs on the same blogspot with the same name, so you will just have to check it out), I would retype it but it was long.


Wednesday, April 8, 2009

You're not in Kansas anymore, Dorothy!

Had a patient last night that just turned all my cranks. She was funny, pissy, and prim all rolled into one. First thing I had spelled her name wrong on my consent form (seeing as how the day nurse was hogging the chart and I couldn't get any lables). With my fine 50 + eyesight I read an "R" as a "K", so I got my first dressing down due to my inability to spell. This progressed to the "Why the hell haven't I got my Nicotine patch, yet, it's been 3 hours?" Well if you've ever worked in a hospital and got sucked into pharmacy hell, you know 3 hours is really just a short wait...figuratively speaking that is.

One hour later I was able to finally present my patient with her Nicotine patch. She wanted me to put it on "good" so it wouldn't fall off. As soon as I put it on her daughter encouraged her to *breath deep* to get all the *smoke*. Oh, and she was serious!!!! I explained that it was absorbed through the skin. At this point the patient reaches over and scratches the patch, and sniffs. (HUH??) Then she asks..."What? They don't come in scratch and sniff flavors?".

Oh, and my patient mentioned that she was from Kansas...her exact remark..."How would you like to be raised in Wichita Kansas and be named Dorothy?????"

Toto...we're not in Kansas anymore.

Follow the yellow brick road.......

Monday, April 6, 2009

Remembering a patient....

Sometimes in the busy days, we get so tangled up in all the duties inherent in just nursing, that we forget to listen to the *people* behind the illness. I had a couple of patients lately that I'll probably never forget.

The first was an 88 year old gentleman who was having a bit of confusion at night. His spouse of 63 years (yup 63 years) was there practically every minute of the night and day. She looked surprisingly younger than him. He had three equally attractive children...who came to visit in the evenings, and were very attentive. You could tell from the family dynamics that this was a very close family. I had taken care of the Mr. for several nights, and he was just not getting better. After a battery of tests the physicians told the Mrs. that his heart was too weak for surgery ... and that he just wasn't going to get better. During the night, he took a turn for the worse, was not breathing well, having bursts of arrhythmia. The Mrs. wanted to call the kids for moral support, but decided to wait out the night, and the Mr. actually got a little better at daybreak.

She could not bear to see him waiting out his death in a hospital room, it was tearing her heart out. I suggested she talk to case management about Hospice care, for some reason no one had even mentioned it to her. She took him home after Hospice had lined up oxygen and a hospital bed. She hugged me before I left that morning. I wonder how he is doing now, or if he died. I think I'll always remember her holding his hand and blinking back the tears. It makes me think of me and Dave, and how lost I would be without him. The thought of losing somebody who is your whole life .... that is what he was to her and she was to him, if the thought made me cry I hate to even imagine the reality.

I don't take the newspaper or check out the online obit's, it's just too hard to take sometimes. I know we all have to die, but some people are so nice, and you do form a bond with them and their families. You just wish they could all beat the odds. But then, we would all live forever, then wouldn't we.

Saturday, April 4, 2009

Summertime in the Valley....already!

Wow. So it seems to be summertime here already. Yesterday was breezy and 86 degrees. The sun was shining and MY MAN was working on installing a pump for our newly drilled well...yee haw!!! Now I feel like a real Texan. I have my very own well with an electric pump and a genuine imitation antique hand pump that actually pumps water. Now if the electricity is off and I am craving a glass of H2O from the ground, all agricultural fertilizers and herbicides inside, I only need to walk out and pump. Of course, in theory, the well is only for "irrigation" because according to our county "laws" we cannot use any of our well water for "residential" usage . Not because of the possibility of fertilizer, herbicides or other contaminates, but because it is the "law" that you must use the water district water if you are within so many feet of a waterline. Now how is that for big brother telling you what to do? Chalk that right up with wearing your seat belt and trash pickup. Oh yes, The County mandates who picks up the trash...for the entire county. The County gets a contract with a company (not necessarily the lowest bid, although I don't understand that one). They kick out the other trash company for "substandard" service and install one that immediately raises the price and lowers the service. The other company actually did a bang-up job following Dolly, but did that get rewarded??? No, their contract was severed and the other big company took their sweet time delivering cans for the "new" customers. It really burns me that everything in this county is so controlled...if you are a citizen that is. Now if you are an illegal alien...and remember I live right next to can dump your trash anywhere you want...ditches, private property, lovely little parks, whatever....seems like the officials cannot catch you, but let anybody else throw out a gum wrapper and the cops are right there with their handy dandy little ticket pads. Just a thought, but since I've moved here I've noticed city and county officials getting handed indictments for just about everything. Could there be a little fraud in this here neck of the woods???? What do you think?