Updates

After clinical one day last semester I was deeply touched, rather scared out of my mind by a patient of mine. She had renal failure and was on dialysis. Also she is diabetic, like me. But she was only in her 40's. I talked to her about her diabetes leading up to the kidney failure. Her a1c's were pretty similar, if not lower than mine.

Quick lesson on a1c's for those who don't know. You have red blood cells and you have sugar in your blood. That sugar also sticks to your RBCs. A normal person has a low a1c, usually less than 6. This is because there isn't as much free floating sugar in the blood to stick to the cells because insulin is pushing the sugar into the body's cells to be used for energy (and lower blood sugar). In a diabetic there isn't enough insulin so the sugar floats in the blood and sticks to the RBC's and also shows up as high blood sugar. Diabetics have a1c's over 7, as much as 12 or 13! Diabetics have their a1c's checked every 3 months or so to see how much free sugar is floating around in their blood over the last 3 months. This tells how well the diabetes is controlled.

Ok with that being said I set myself up for an appointment with an endocrinologist. He's pretty well known and has been one of Atlanta's Top Doctors several years. I figured if anyone would crack down on my diabetes it would be him.

So I meet with him and he runs tons of tests. He doesn't see any signs of nerve or eye damage (that diabetics are notorious for). Thank God. Everything else looks pretty good. He has some blood drawn and wants to see me again in a few weeks.

The few weeks go by and I go back to my appointment. Last time he was talking about strict insulin therapy that would leave me feeling so much better, so I was excited. I can't tell you how many times my blood sugar is sky high and I feel like crap. Every once in awhile I barely have enough energy to get up and do things. I test my blood sugar 3 times a day and it's always in the 200-300's. Normal is less than 120. Around 140 or so your kidneys can't handle all the sugar and it spills over into the urine. Your body wants to flush out all the sugar so you start peeing alot and that makes you thirsty and dehydrated. So you drink and drink, you just pee more and more and your sugar just goes higher and higher. Just an ugly situation.

I give him my daily numbers and he's surprised. He reviews my blood test results and says "I'm not making any medication changes because your a1c is good. It's 6.3." WTF? No medication changes?! Dude! Do you see my 200-300's?!

So it didn't make sense. My daily numbers should have produced at least a 7-8 a1c which isn't good. Why do I barely have a 6? He gives me a replacement monitor to start testing with. Maybe my monitor was bad. I should start getting lower numbers with the new monitor.

Well I don't. Same 200-300's. I still feel sick as a dog.

Sometimes if someone is anemic their a1c can be falsely low because there isn't as many RBC's for the sugar to stick to. But I'm not anemic. Ugh. I can't explain it!

So I go in last week to have my blood drawn again. I went to my appointment on Monday. I was anxious to hear my blood test results. He tells me he's concerned because my a1c jumped AN ENTIRE POINT to 7.3. I've NEVER done a jump that dramatic.

Ok, a 1 point jump in 1 month is really bad. It means something happened and my diabetes is starting to get out of control. My BP has already been high and I'm double dosed on a beta blocker called Atenolol. But it's even higher now. So he prescribes another BP med. An ACE inhibitor called Lisinopril. The good thing about this drug is it will bring my BP down but it will also protect my kidneys against the diabetes. But for the diabetes he adds yet ANOTHER drug to my routine. This drug is a sulfonylurea. Try saying that 3 times fast LOL

I now have numerous medication bottles and I actually have to take a Sharpie and write on it which meds are taken in the AM and which are taken in the PM. I have to check my BP every day and my blood sugar at least 3 times a day. And I've got it good. Some people have it way worse.

From what was explained to me, being on the sulfonylurea will also tell us something else. How much is my pancreas working? This drug works before I eat by telling my pancreas I'm about to eat and to start pumping out insulin. If my pancreas isn't working much at all there isn't much this drug can do and I'll be back on the stupid insulin shots. I don't want to go there again.

Another thing that sucks is 4 of my meds cause drowsiness and I take 2 in the AM and 2 in the PM. So if the diabetes doesn't have me tired, the meds are.

So I just wanted to update those who care on the unwelcomed drama in my life LOL!

Take care everyone!!!!

Semester 2 Clinical Day 1

Up before God at 5 in the AM, trying to clear my contact lenses of sleep gook while I apply black liquid eye liner, hair flying around every which way, my mind focusing on the traffic report on the early morning local news (11 Alive), one leg in my uniform pants, other hand buttoning up my uniform shirt, all while holding back a gallon of pee! Yep, that's how my clinical mornings start. I take my shower the night before, although I'm normally a "don't go anywhere until I have my shower" kind of person. Good thing I prepare my clinical bag the night before. I throw my hair back in a scrunchie and run out the door.

My eyes haven't even started working yet.

Ok, it's before 6 AM and I'm night blind. I hop in my car only to discover the power steering is acting up again. Damnit. I stop by McDonalds before I hit the interstate. I need a coke and a Southern Chicken biscuit. Just enough caffeine and saturated fat to give me a heart attack right as I arrive to the hospital. Ok, let's hope not at least.

I get on the interstate. There are two kinds of people on Atlanta's highways before 6 am. People who aren't awake yet and people who aren't awake yet and are still dreaming that they are racing in the Piston Cup with Lightening McQueen. I am wedged in with 3 sleepers in front of me and to either side. Lightening McQueen is driving behind me in his SUV with his brights directly in my rear view shifting to the left mirror... then to the right mirror... Maybe I'll install a disco ball so next time one of these idiots are behind me their brights create quite the display all over the interstate. I can't go anywhere dickhead. Pick another lane to bully.

Then I hit Panola Rd. That's where people start dozing off again and traffic grinds to a 10 mph halt. 80 to 10 in 1.4 seconds. Not bad. Now I have time to eat breakfast. I really should consider packing a Thermos full of black coffee and purchase a crotch rocket. ZOOOOM!

I 20 turns into 285 soon enough. I speed through the merging curve and SLAM ON MY BRAKES AGAIN. Traffic. Shit. Atlanta drivers are absolutely mesmorized by blue flashing lights. After pacing at 5 mph that my car barely measures for a mile I pass the pretty blue lights. Ahhhhhhhh. Traffic suddenly speeds up again. VRRRRRRRRRRROOOOM!

I'm going at a steady 70 until Church St. This is a bonehead exit. There's high concrete walls on both sides and no visibility until you are already in the middle of the road, which at this point you might as well just chance it.

My next 5 minutes are uneventful. I arrive at the hospital, park, run into a classmate and we run our way in to the hospital with our 90 pound clinical bags. Good thing I went to boot camp and did 10 years in the military. Oh wait. I didn't. Well, we survive the dash and arrive at the elevators. Ok. Let me tell you something. The elevators at Dekalb Medical have codes this early in the morning. You have to hit the "Up" button 49 times. Pause 1 minute. Then hit "Up" another 93 times. Keep count because if you lose track you have to start all over again. Then wait. 2 minutes later... PROMPTLY... the elevator doors open. I think the elevator was there the whole time laughing at us.

The elevator doors close and I completely forget to select the floor I'm going to. I'm surprised it didn't just take me to a random floor. I probably would have got off the elevator too. I'm so not awake. I hit "4" and up we go. The ride is so shaky I start thinking of survival techniques I can use once the elevator cord snaps and we go plunging.

We arrive at the Med Surg floor. We get off. We drag our way down to the conference room for pre-conference. Open the door. Damnit! It's 103 degrees in here! Paint it with Acetaminophen and break the fever holy crap it's hot in here! *sigh* Just cause it's 30 degrees outside doesn't mean you have to turn the ac off in the hospital.

I sit through our pre-conference in the hospital sauna. Every so often I have to add water to the steamer so our skin stays hydrated. I get my patient assignment, but our computer passwords aren't working, so I have to look at the PAPER chart. Yeah primitive. He's 83 with sepsis and colon cancer. Brought in with a BP of 93/42 P 104 RR 22 T 102.3 He's a sick man. I go in his room to introduce myself and the nurse is trying to get ABG's on him. It's painful for him and it doesn't help that she can't find his artery. There's a student nurse from Georgia Baptists Resp Therapy program in the room.

Ok, that brings me to something else. Nursing students from other schools. Do they feel that students from GPC are threats or what? They are SO hostile towards us. Shoot, the way I see it we all have the same interest and we are all coming out as RN's. Why the *(&$ can't we all just get along? I've never had to deal with a student from another school until today and I'm not happy. They have a serious chip on their shoulder! I stood back and watched. We are taught to never pass up on the opportunity to watch and learn. I've never seen a nurse going for ABG's so I watched and casually introduced myself to the patient to "distract" him. Got a smile out of him at least. That's when the other student stepped back. The patient asked if she was scared of blood and she said "No, blood doesn't bother me. I'm trying not to hover. I don't like it when people hover." I KNOW she wasn't talking about me.

After watching an unsuccessful attempt at an ABG collection I go back to the PAPER chart. I collect the data I need to make my diagnosis and care plan and I go back to the conference room we took residency in. I'm sitting at one of the computers looking up some lab values with an RN to my left doing her thing. Next to her are 2 student nurses from Georgia State's Resp School. The same school Miss Thang came from. One girl, probably 18 and fresh out of high school, is talking to the other student talking non stop about every pathetic detail of her pampered life. YAWWWWN! Then she started talking about alllllll the schools she looked into before attending Georgia State. Then she said "I looked into Georgia Perimeter but I just couldn't see getting my associate's degree." She was so ugly in her tone of voice. I know she saw my badge and I know she saw I was from GPC. I turned around to look at her and the nurse next to me did too. Then the nurse turned and looked at me and rolled her eyes. Yeah, this girl sounded pathetic. This is my 4th month at Dekalb and I have never once encountered anyone who had a problem with GPC. Guess this group just needs a mild slap in the face. Maybe tie them to a chair with IV tubing? Hang the chair from the ceiling with Foley catheter tubes?

Ok, outta sight outta mind eh?

Later on I go back to check on my patient again and he's resting comfortably. I'll let him rest. Poor man got tore up by those other students LOL I'll be extra nice to him later on. I know it's hard to find an artery and I know it's painful. But they were downright mean to him. You can be ugly to me all you want. All I care about is me. I just want to pass and get a good job to give my family a nice life and to live out my dream. But don't be ugly to my patient. They don't deserve it. And he was actually a real nice man.

After completing my paperwork I came back to see how he was doing. It was time for him to eat lunch. Because he had a spinal cord injury at home time he was weak on one side. He also has Parkinson's and shakes real bad. So he needs someone to help him eat. This morning he didn't keep his breakfast down. So I repositioned him and got him comfortable. I raised the head of his bed. He has to eat through a straw, except for his pudding. He had vanilla pudding and potato soup. The soup was still hot so I offered the pudding to him. Because he was so sick earlier I got him to take things slowly. We just got to talking and having a great time. He was so nice. We talked about everything from American Idol to World War 2 and which were the best jobs in the Navy. Older people have lived alot in their lives and have great stories to tell. Sometimes you just need to stop and listen.

Then his wife came to visit and boy did she look at me like I was "the other woman". LOL it was so funny. I introduced myself and allowed her to continue feeding him. Good thing too because once I left his room my instructor said we could leave for the day. YAY!!!!!!

I came home and took a 4 hour nap LOL Now it's after 10:00 pm and I can't sleep!!!! Well, I have lots of paperwork to do on my patient. I'll do that. It always makes me drowsy to do paperwork.

MWWWWWWWWWWWAH!