Great week, now a great weekend....

I'm BACK in blogging action!

I've been so busy with the new job, that by the time I get home at night, all I really want to do is make/eat dinner, maybe have a beer or a glass of wine, walk the pups, watch a recorded show on the DVR, and then hit the sack and read before my eyes start to close --- which usually doesn't take too long. It's that time of year where there is at least one TV show on every night of the week (except Friday), that I like to watch.

Mondays: Dancing With The Stars (some day I will learn how to do The Jive with my husband!)
Tuesdays: The Biggest Loser (I absolutely love this show and everything that it stands for!)
Wednesdays: Top Chef (Drew and I dream about being able to whip up unbelievable food without a recipe, instructions, etc. I wish I had all of those ingredients at my fingertips everyday.)
Thursdays: Grey's Anatomy (Duh!), Private Practice, and Project Runway (Thursday's are a big night!)

These shows record every week on our DVR, and I will sit down and watch them when I can throughout the week/weekend. The best thing about the DVR ---- fast fowarding through the commercials!

JOB UPDATE: Oh goodness, things are going really well with the new job! I've been working for about a month and a half now, and I can honestly say that I'm smiling every day while driving into work. This past week was especially epic. I was in some type of surgery every day this past week, which if I guesstimate that time in hours, would probably come out to be around 18-20 hours total. That seems like an incredible amount of time standing, but it really does fly by when you're in the moment. I participated in four CABG's (coronary artery bypass graftings, aka bypass procedures) this week. When you hear that someone underwent triple or quadruple bypass surgery, that's what I'm talking about. What was awesome about this week though, is that I first-assisted from "skin to skin" this entire week...which basically means I started the case, did every single step/procedure with the surgeon, and finished the case. Prior to this week, there were often times during the surgeries where the surgeons would have one of the regular/trained other first-assists step in and help them with the really complex portions of the procedure. Now I'm doing it all! Skin to skin baby! Wahoooo! Granted, there is still much room for improvement, but I took some huge steps last week.

I've also started training on EVH (endoscopic vein harvesting). They harvest a portion of the great saphenous vein out of the patients leg and use that to create the "bypasses" around the diseased arteries in the heart. The first-assistants are charged with the duty of harvesting the vein while the surgeon gets the chest opened, etc. It's going to take a while before I am proficient in doing that portion on my own, but the ball is definitely rolling. It's all crazy cool stuff!

WEEKEND UPDATE: The weekend started last night with a nice dinner at our favorite Indian restaurant in Boise, Madhuban. If you live in the area and have not tried it yet, then I definitely recommend it! They have awesome food and great beer.

I awoke this morning and prepared whole wheat raspberry/vanilla pancakes for Drewbie for breakfast, with fresh peppermint coffee (really just plain coffee with peppermint/mocha creamer). I'd say that's a lovely way to welcome the weekend! We're about to head out for some form of workout and then who knows what the rest of the day will bring....something fun I'm sure!

Maybe we'll head out for another bike ride --- I think I forgot to mention the new road bike that Drew got me for the 30th birthday a few weeks ago. Check it out:



I'll leave you today with this random pic (the lil' guy dressed up for the few tricker-treaters we had on Halloween):

One more for the night....

I can't get enough of these videos.

4 Laughing Babies

Laughing Baby Ethan

It's gotta be the best sound in the world!

Almost 3 months....

.....since I've written on my blog. I've thought about it a lot, but just haven't been able to muster up any incentive or excitement to sit and write. And honestly, I'm not really feeling up to it today either, but I'm going to give it a go. People are hounding me about my blog-less-ness....so I guess I should just be excited that people actually still read this thing.

I get a little overwhelmed when I think of everything that has happened in the past 3 months that I haven't written about, so I think I'll keep things simple and start with what's going on now.

I'm about to start my 3rd week at my NEW JOB! Yes, that is correct folks....I am no longer in school, and am actually employed again. It's quite a nice feeling. What's even better....I get my first paycheck this Friday. The last time I received a paycheck was sometime in July, 2007. It's been way too long!

Just in case you are wondering how I transformed from busy PA student to a member of the workforce again....let me give you a super quick recap.

I traveled to Seattle for my final rotation in Emergency Medicine at Harborview Medical Center. I somehow survived unscathed, except for complete and utter exhaustion (from which I needed about a week to recover).

A week after returning from Seattle, I graduated from Physician Assistant school. Two weeks after that, I sat for my National Boards exam. The evening of the boards, after we were all done, a good amount of my classmates came over to the house for a celebration/cook-out. Man o' man did we celebrate! Twas' a great night.

The day after the boards, I awoke pretty foggy (see the last paragraph for mention of the post-boards celebration). Then my phone rang. It was the office manager from the group of Cardiothoracic Surgeons I had interviewed with, one week prior. I had done a portion of my elective rotation with them. I realize now that I never blogged about my elective rotation. It was shoved in between my Cardiology rotation that I had just finished up in Coeur d' Alene, and before I traveled to Seattle. I had split it up between Internal Medicine and Cardiothoracic Surgery. I left them a copy of my resume when I completed the rotation, but I never actually expected to hear from them. They had called me when I was in Seattle, and offered me an interview.

Then they offered me a job. I about fell out of my chair. Drew and I were starting to think that we were going to have to leave Boise because the job market was almost non-existent for PA's. It was extremely frustrating. I had mailed out 40+ resumes prior to leaving for Seattle, and got nothing. Not even a bite. I had already started applying to jobs in other states. Then came that sweet, sweet phone call. I accepted the job offer, Drew and I did the "happy dance" for a good 5 minutes (we even cried a little), and then I decided to take a 6 week personal sabbatical prior to starting work. There was a mountain of licensing and credentialing paperwork that had to be completed, so there really wasn't any rush to start immediately. I'm actually still waiting on my credentialing to go through. It's quite the process.

During my final 6 weeks of freedom, I lounged around the house, read all four of the Twilight books (in record time I think because it only took me 8 days), lounged some more, worked a lot in the yard, and then eventually got antsy....just in time for the new chapter to begin.

And here we are. I am now a Cardiothoracic Surgery Physician Assistant, I am licensed, I have already written a few prescriptions at work (scary!), and I'm about to become privileged/credentialed at both hospitals in town so I can learn to be an excellent first assistant in the operating room. Yep, we are the surgeons "right-hand-man/woman" in the OR. It's pretty awesome --- and still rather terrifying! I have so much to learn, but that's what I love about this new profession. A never-ending learning curve.

Let's see, what else.....Drewbie and I are giving P90X a try. I was getting antsy and annoyed with my slowly growing backside, thighs, belly, and my lack of enthusiasm with our regular activities (i.e. running). So, on a whim, I just bought it. Then told him about it after wards. :) Tomorrow will be our third day and pretty much everything is sore right now, but in a good way. It's a total ass-kicker, which I love. It's a nice change for the start of Fall. And I'm turning 30 at the end of this month, so I think it's a good way to ring in the new decade.

Unfortunately I'm battling the beginnings of a cold right now. So that sucks. I'm hoping I can nip it before it settles in too much, although often times I'm never that lucky. I've already had my flu shot, and it doesn't feel like the H1N1 flu, so fingers crossed there. There have been numerous cases reported in the Treasure Valley, so fingers crossed we can make it through without a little "piggy flu".

Well, I think that's enough for now folks. I'll admit, once I got started, it did feel good to write. I'll see if I can make this a regular occurrence again.

Almost done...

I realize it's been forever since I've blogged, which is BAD on my part because I've had quite a bit to blog about.

I don't have a ton of time right now, so I can't get into all of the details. I just wanted to give everyone a heads up on a few awesome details...

1) I graduate from PA school on July 31st, 2009 --- which is now less than 2 weeks away. Sa-weeeet!

2) I complete my final rotation in emergency medicine at Harborview in Seattle this coming Sunday (aka, TOMORROW!) --- I need to do a separate blog on my experience at Harborview, but let's just say it's been amazing and totally insane at the same time.

3) I'm driving back to Boise this Monday (aka, two days from now!), and I'm absolutely thrilled to be heading back home. It's been great staying with my relatives in Seattle and catching up with them for the past 5 weeks, but at the same time, I'm just plain ready to be home. Plus, I miss the poofises terribly!

I must get going for now. The only thing that separates me from freedom at this point is two more 12 hour shifts in the emergency department. The anticipation of being done is killing me!

Stay tuned for a better recap of the past 2 months once I return to Boise and have a few hours of free time! :)

I heart Cardiology!

Actually, I "heart" cardiology, and I "heart" Coeur d' Alene! I think Drew is getting sick of hearing me talk about how much I love this area! Let me rewind a bit and get you all caught up.....

We have to complete 8 five-week rotations during this clinical year, and for 2 of the 8 we are required to travel away from our home base. I just started my first of two travel rotations. I'm in Coeur d' Alene, Idaho for 5 weeks total completing my inpatient rotation with a group of Cardiologists.

I'm already at the end of my first two weeks out of five. Time flies when you're inundated with immense amounts of new information everyday! Ahhhh the life of a PA student. Somedays I feel like I know what I'm doing, most days I'm just hanging on by a thread and trying to keep up with all of the 'smarty pants' around me.

This is the second rotation I've been on thus far where I could actually see myself working in this field (the first one was surgery). I do enjoy Cardiology and all of it's complex intricacies, but I think it's the "inpatient medicine" piece of it that I love the most. Rounding on patients in the hospital, keeping tabs on all ordered labs, writing new orders, medication changes, etc, etc. It's a fast-paced environment and I love it! I could totally see myself in a position where cared for patients in the inpatient environment, but then also saw a few patients in a clinical/office setting as well. That's what the PA does that works for this group of Cardiologists, and she totally kicks a$$ at it!

It feels good to finally have SOME IDEA of where I'd like to work after graduation. I probably get asked 3 or 4 times a week, "so, what field are you planning on working in, or do you have a job lined up yet?". Up until now I've never had a great answer because I've always had many interests in many fields --- but none that really grabbed my complete attention. I think I'm onto something now though....give me something with some inpatient medicine and maybe a little surgery and I think this little PA-to-be might find her calling.... While there are many medical fields that meet those criteria, at least I'm starting to narrow things down a little bit! :)

I think that's all for now folks. I gotta get back to reading about atrial fibrillation, CABGs, STEMIs, NSTEMIs, lipid management, hypertension management, anti-arrhythmics, and stinkin' ECG's (that damn squiggly line still trips me up).

GO MICHIGAN STATE in the Final Four!!!! Tip off in 2 hours!

Sick of being sick.

Warning - this blog may contain large amounts of whining, whimpering, complaining, and repeated efforts of self-pity. I'm playing the "patient" right now, and I'm sick of being sick DAMN IT!

It all started last Friday with a mild scratchiness to the throat, a cough, and some hoarseness in my voice. I awoke Saturday, trying to prepare for two back-to-back 12 hour shifts over the weekend. Once I realized I couldn't talk without sounding like I'd just finished smoking 20 packs of cigarettes, or couldn't stop coughing...I realized that going in for a 12 hour shift and trying to treat patients with the exact same symptoms I was having was probably not a good idea. Thus I called in sick to try and combat this "most-likely-viral" illness at home, with all of the lovely symptomatic treatments I'm always telling patients.

Then came Sunday morning. The hoarseness was worse, and the coughing fits were making my ribs sore. I called in sick again.

Granted, I'm working as a student right now... so it's not like I'm losing money from a paycheck by calling in sick (well, technically I am losing money because I am actually PAYING to go in everyday).... but I am losing the experience of seeing the unique patients that walk in the door. AND, as a student, you never want to look like you're slacking off. I got sick once during my pediatrics rotation and was able to tough it out....of course, I still had a voice and wasn't coughing like a spaz either. It was more or less nasal congestion that time around.

I was supposed to work two 12's this weekend, and then have Monday off before I went back in for two more 12's on Tues/Wed. So now it's Monday.... I woke up this morning with a horribly sore throat. The cough wasn't as bad, but my throat was killing me. I instantly got out my pen light and started examining my pharynx and tonsils. They were definitely red, but there were no white patches. With my other 4 days of symptoms up to this point, I wouldn't think that I've got strep throat. But who knows.... I've been seeing at least 2-3 cases of it a day in the urgent care.

So now I sit here obsessing over my symptoms and what to do. I've had no fever, no muscle aches, almost no runny nose, a mildly productive cough, major hoarseness, and now this sore throat. Do I go to the urgent care just down the street from our house and have them swab my throat for strep? Or did I just sleep with my mouth open last night and that's why it's so sore? Or is it just sore from the horrible coughing fits?

I think it was easier being sick BEFORE I began training to become a physician assistant. Now I sit and analyze my symptoms (viral versus bacterial), read labels on over-the-counter cough/cold medicines to see if they have good active ingredients that have been proven in the medical literature to be effective, and "hmmm and hawwww" about going to the doctor. I think about what I would do for this patient, if they walked into the urgent care to see me and presented with my sequelae of symptoms?

Honestly....I'd do a very thorough physical exam (make sure I don't hear anything funky in their lungs, make sure their ear drums look clear), I'd probably swab their throat for strep just because it is a little red and one of their main complaints, and then I'd start devising my "viral vs. bacterial speech and list of symptomatic treatments to do at home" while waiting for the strep test to give a result after 5 minutes.

If the strep test was positive: then it's simple...
Amoxicillin 875 mg T PO BID x 10 days #20
Which equates to the following being written on the prescription bottle: take 1 tablet by mouth every 12 hours for 10 days

If the strep test was negative (which would be my most likely guess at this point)....then it comes down to a little of what I call "sickness psychology" and great patient education:

1) Give the awesome viral versus bacterial speech and explain to the patient why I think their symptoms are most likely viral in origin, rather than bacterial (also explain what symptoms to look for in the future that would make me think they are now getting an overlying bacterial infection). Explain to them that I understand that their symptoms are REAL and they do feel like crap, but throwing an antibiotic at them at this point probably won't help at all and will just expose them to more side effects from antibiotics (upset stomach, sun sensitivity, yeast infections, etc, etc). Then, at this point, when the patient is feeling like they just wasted their $20 co-pay to come to the urgent care for nothing.... I dive into my tailored and very specific patient education speech, equipped with patient education handouts and little personal tid-bits. It's here where I hope to re-win their support and show that I really do care about their illness....but I think we should tackle it in a different direction.

2) Get a good over-the-counter cough suppressant to use....anything with dextromethorphan in it. Robitussin or NyQuil at night is good because it will also have some alcohol in it to help you sleep. It's important to suppress the cough at night so you can get some much needed sleep (if the patient as tried OTC cough suppressants without success prior to coming in, then I might give then a prescription for a more potent formulation).

3) If you feel like there is mucous caught in your chest, then get a cough/cold combination with guaifenasin in it...this is a "mucolytic" and will help thin out your mucous secretions, so when you do cough, you clear the mucous better. Mucinex is a good OTC product.

4) Take Tylenol or Ibuprofen for pain relief.

5) PUSH THE FLUIDS... this is especially important if you have stuff to cough up. If you are hydrated, then the mucous in your airways is hydrated and more viscous and will be easier to cough up.

6) Give it time....viral infections can sometimes take 7-10 days to totally clear up.

There's my speech to patients. I think it's pretty good. Some patients are content with it and understand (sometimes I send them home with a prescription for stronger symptomatic treatments - cough suppressant, decongestant, etc), others just want an antibiotic to fix something that will usually get better on it's own in 2-3 days anyways. Sometimes I do still give those people the stooopid antibiotic they want, just to appease them because they are sitting there bitching at me (even though I know it won't fix what they've got going on). It totally depends on the situation. There was one time where I actually wrote in my medical note, "antibiotic given to appease patient".

So that's what I've learned in my outpatient rotation thus far on treating patients with upper respiratory symptoms. Now back to my symptoms....my throat is still a little sore, but much better when drinking hot liquids. I think I'll stick home at this point and skip the throat swab. It's very unlikely that I have strep. If my throat is still screaming tomorrow, then maybe I'll reconsider. :)

In the mood.....

...to BLOG!

Maybe this is the beginning of the end of many-many-many months of a blogging hiatus. I suddenly have the urge to write, contemplate, vent, whatever! Who knows! All I know is I'm going with it for now. Hopefully there are still people out there who read this thing.... :)

Let's talk about marathon training. I don't think I announced to y'all that Drewbie and I signed up for the Ogden Marathon in Utah. We signed up several months ago, when the race date was way off in the future, and seemed totally feasible at the time....doesn't that always happen?!?!

Anywho, race day is Saturday, May 16th --- just a little over two months away now. I've been doing my best to follow a training plan that Drew found on the internet. It's what I would call a "training plan for an individual with almost no time to train!". It only has me running 3 times a week, sometimes 4, with another day of cross-training (basically exercising without running) thrown in there. For the most part, I've been able to keep up with the schedule --- except for the whole cross-training part...does walking the dogs count?!?!

In the past 3 weeks, I've just started to move into double-digit mileage on the weekends. I've hit 10+ miles twice now, and have felt surprisingly great during/after the runs. It's been well over 2 years since I've willingly ran 10+ miles on a training run. Even last year when I was training for the Robie Creek 1/2 marathon, I never went over 8-9 miles except on race day where I grunted through the 13 mile event --- AND the last 4 miles were completely down hill so gravity helped immensely!

I now find myself going into these long runs with a determined attitude and an excitement to actually RUN. Not to get ahead of myself, but maybe I'm finally rekindling that "endurance flame" that used to burn so brightly inside. HOWEVER, this time it feels different. I'm running with new reasons, new motivations, and most importantly, I'm really DOING IT FOR ME. No one else. Just me. It's a great place to be again.