White House

Leaving Sunday for my trip :)

I'm so excited! I will post everything on the 19th. Remember, it's women's History Month. Here is a good website to check out:http://womenshistorymonth.gov/

Many mentors inspire me. Who inspires you?

March is Allergy and Asthma Month

March is Allergy and Asthma Month

Allergies and Asthma

Here is a recent article I wrote for my new job. Enjoy

The Ides of March are rapidly approaching and with them the dreaded allergy season. Even saying the words make my eyes start to water and images of my sneezing in rapid succession come to mind. Allergies also referred to as seasonal allergies, such as Hay Fever and Allergic Rhinitis occur at certain times of the year. Most are caused by pollens from trees, grasses or weeds. At times mold spores can grow and cause additional problems for those who suffer from allergies. Common allergens in Albuquerque include: Arroyo willow, black willow, box elder and ash-leaf maple, annual ragweed, biennial wormwood, coyote brush and Bermuda grass to name a few. Pollen counts change daily. My go to spot to review the daily pollen count is www.pollenlibrary.com.

Most people breath in allergens and have no problem or minor symptoms but as many as 20% of people in all age groups have allergic rhinitis. Symptoms can range from nasal itching, discharge, sneezing, sore throat, hoarse voice, and itchy red eyes all of which are not conducive to having a great day.

The first thing everyone is cautioned about is to avoid their specific allergen. However, short of wrapping yourself in a bubble, it is difficult to go about your daily life and enjoy the great outdoors and avoid allergens. My suggestion is to do a little detective work. Try to identify what is your specific trigger. Is it the pollens (trees, grass, ragweed, tumbleweed) and insects in your local area (house dust mites, cockroaches, or ladybugs)? Are there animal allergens (skin, fur, feathers, saliva) or even molds in your home you were unaware of?

Your primary care provider will work with you to help identify triggers and can often suggest one or more medications.  These can include nasal glucocorticoid sprays, and antihistamines.  Your provider can also work with you to help find the best treatment, taking into account not only your allergy symptoms and severity, but also keeping in mind any other preexisting conditions you have that may exacerbate your symptoms such as asthma.

If symptoms are severe or persist, patients can be referred to an allergy specialist for further testing to identify the specific agent or agents causing the allergens. Allergy Shots can also be helpful for a certain group of patients. Allergy shots are injections that can make you less likely to have allergy symptoms. They are generally made to order, for each patient’s allergen triggers. They contain tiny amounts of elements that trigger and your allergy(s). Allergy shots are most effective for allergies to:

• Pollen from trees, weeds, and grasses
• Mold spores in the outside air
• Tiny insects found in dust also known as dust mites
• Tiny Flakes also known as dander from the hair, skin or fur from dogs or cats
• And stings from bees; honey , yellow jackets, hornets, wasps and in some cases even fire ants

It is important to know that Allergy Shots are NOT used to treat allergies to Latex, Medications or Food.

For many people Allergies and Asthma go hand in hand. Asthma is a disease that attacks the bronchial tubes. These tubes are responsible for carrying air in and out of the lungs.  Irritants and allergens can trigger these spaces to become inflamed, spasm and produce mucus.  These irritants can cause the airways to be narrowed and result in difficulty moving air in and out and subsequently breathing more difficult. Common symptoms of asthma include:

• Frequent cough, especially at night
• Shortness of breath
• Wheezing

• Chest tightness, pain, or pressure

While not everyone with asthma has the same symptoms, it is important for patients to know their “triggers” and keep them to a minimum if possible.

Keep in mind early signs of an Asthma Attack:

• Losing your breath easily
• Shortness of breath
• Feeling very tired or weak when exercising, in addition to wheezing, coughing, or shortness of breath
• Decreases or changes in peak expiratory flow; a measurement of how fast air comes out of the lungs when you exhale forcefully
• Signs of a cold or other upper respiratory infections, or allergies
• Frequent cough, especially at night
• Difficulty sleeping

Mild asthma episodes will usually respond to use of a rescue inhaler. More severe symptoms, or episodes that last longer require immediate help and you should be treated in the nearest urgent care or emergency department. 

I hope everyone goes outside, reads some Shakespeare and enjoys the day.

2013 is a Great Year

It’s 6:35 am, and after a long week I should be hidden deep under my comforter sleeping, but I am awake and happy so I thought I would catch my friends up.

Last year after graduating and completing the dreaded “Boards” I settled into what I thought would be a perfect job, working in a family practice clinic. I originally thought that was the environment I wanted to be in. That initially seemed comfortable to me. My goal was to have my own panel of patients and grow with a mentor. Unfortunately my ideas may not have been the goal of the clinic.

But, we are ultimately responsible for the doors of opportunity we open and close in our lives. My friend Beau turned in my CV/Resume and as if serendipitously, I was officially offered a new challenge. And as one door closed another amazing door opened.

This week was my first week in my new job, working in a wellness clinic and urgent care setting. It’s funny (in my mind) how I am drawn back into the urgent care setting, keeping in line with my Army Emergency Medicine roots. The office is filled with various personalities, all very driven in their own ways, eager to teach and grow. It’s funny how your personal challenges in life can change. I had previously felt somehow stuck in my previous job decision, and even though my commute was less than 5 min, it felt long and dreadful. I would leave work happy to have small opportunities to see patients, eyes sore from completing other people’s labs and responsibilities, ultimately feeling out of place.

This week, however, is completely different. My commute is longer, but I no longer dread driving to work. I have new challenges each day, I have read more on uptodate , journals, and prescribing guidelines, and had the ability to present a few challenging cases to my peers who are genuinely interested in teaching. Even our “Provider” meeting was a collaboration of presenting cases and reviewing x-ray films (We have old school films and I LOVE IT!).

Each night, I have come home tired, even to the point to falling asleep at 7 and 8 pm. That fatigue is great, and I feel like I am getting my groove back.(Insert Michelle doing her goofy, white girl, I’m happy and I don’t care who is looking "groove"). The best feeling of all is seeing my patients smile, feel comforted and sometimes even laugh. My last patient of the day said “I haven’t laughed in 2 months, thank you”.

2013 seems to bring other blessings as well. My friend Kellie submitted me for an award with the Albuquerque Junior League http://www.jlabq.org. I had the opportunity to attend one of their meetings and meet interesting and motivating women. That in and of itself is truly inspiring, however, I am grateful to have friends like Kellie who motivate me to be the person I am. Mountain Man and I are doing great and are planning for great things this year. My family is doing well. My friends are amazing. And now at 7:00am, I am going to tackle my to-do list from this week I have neglected. Here we go…

More than a Nurse: I passed my ANCC Board Exam

More than a Nurse: I passed my ANCC Board Exam: Well today has been an exciting day! I promised myself as soon as I finished I would write a blog for all of the other Family Nurse Pr...

I passed my ANCC Board Exam

Well today has been an exciting day! I promised myself as soon as I finished I would write a blog for all of the other Family Nurse Practitioners (FNP) in the world who have finished school and are prepping for their board exam. 

What’s on the test?

Well, I can’t tell you questions, and even if I did it would give you false hope that you would learn that one question and get that correct one out of 175 questions. You are smarter than that you don’t need that. But ANCC does give you a generic list of subjects, and the test is a mix of every single thing listed.

How did you study?

I made a plan. I work as an Emergency Room nurse so working and studying is hard to do, but I tried to make a plan and stuck to it.  I Bought three study guides: 
1. The Fitzgerald CD review Course 2011
 2.  Nurse Practitioner Certification Examination and Practice Preparation, 3rd Edition By Margret A. Fitzgerald, DNP, FNP-BC, NP-C, FAANP, CSP, FAAN, DCC 
3.  Adult and Family Nurse Practitioner Certification Examination: Review Questions and Strategies, 3rd Edition By Jill E. Winland-Brown, EdD, MSN, FNP.

1.       I listened to the review course CD’s after graduation when I had spear time: at the gym, while in the shower, on road trips, etc.

2.       I took my down time (ha ha ha) and did the free on-line tests while at work.

3.       I gave myself one full month and set a test date. I told my family, my friends and Mountain Man that I needed this time to myself to study and that I loved them for supporting me in advance.

4.       In that month (when not working) I took it one section at time. I listened to the Fitzgerald CD’s, referenced my ANCC Yellow/Black book (my friend gave me) and my Physical Exam/Bates book as needed to refresh the brain. Then I would do the practice questions for that subject/section from both books. First Fitzgerald’s book, she has questions and answers with long rationales and I thought of it as a further refresher. Then I would take one of the 100-120 question tests from the Winland-Brown book. Here is another suggestion: I googled a free bubble test worksheet and made copies so I didn’t have to look back and forth and could treat it like a test. I kept a spiral notebook and wrote out why I answered a question wrong, what I needed to know, etc.  For example if it was a prostate questions, I read the rational and wrote down the evidence based guidelines.  One section a day, then that night, I would review later once again. Only one section a day. Then repeat.

5.       The week before the test, I listened the CD’s daily. Wrote out information that I wasn’t remembering so well (Anemia it’s my Achilles heel, etc.) a dry erase pen on mirrors in my bathroom and in my guest room. Then I could review, even while brushing my teeth.

6.       Four days before I re-did the free questions from ANCC, the last two review tests in the Winland-Brown book, the questions at the back of ANCC’s black and yellow book and the questions you could purchase on line. (A little overboard yes). All the while I scanned the review spiral I made and the Fitzgerald workbook that accompanied the CD’s.

7.       The day before the exam, I reviewed my notes again. Then I took a break and got a facial and some spa time. I needed to relax. I also drove to the testing center to make sure I knew where it was. Then I went out to dinner with Mountain Man.

8.       The night before the exam I took a warm shower, used my lavender lotion, took a melatonin and went to sleep.

9.      The  Morning of the exam I ate a good breakfast, spoke to Mt Man about the random things I was having trouble with (Rubella, Rubeola, what happened, when, for who, and how many pennies?). He thought I was speaking a foreign language and that’s okay.

1.   Arrived early and took the test.

How was the test? 

Long, short, and basically a roller-coaster. Some questions I knew, so easy that I re-read them twice to make sure it wasn’t a joke. Others I was absolutely in the middle of the road. I marked the ones I spent longer than a minute on and decided to revisit them. There were times I felt over prepared, other times felt like I should have covered more of that theory stuff. The therapeutic communication and NP role questions easy, the Veracity, Transference, counter transference were a little more difficult.

I took a break at about hour and half, went to the bathroom stretched and then went back in. I went over all the questions I marked. Some I changed, most I didn’t. Then I sat back took a breath and pushed end.

And I passed. 

 Fitzgerald has a free power point on her website about advocacy, legal and ethical issues (and the info is also in her CD’s) valuable information. Don’t skip over that.

Some things to mention:

 I had a few sleepless nights and I read about people not passing. At one point I almost bought another study guide. To be honest, don’t do it, you don’t need to. I also read one great blog and she said what I am saying YOU WILL PASS.  I felt as though there needed to be more positive blogs so that’s why I’m writing today. The study course I took from Fitzgerald was great, stick to that.  Don’t read negative things and make sure to take care of yourself.  Spend time each day to review a section and review what you don’t know. You are smart. You finished your  FNP, took tests, wrote papers, even did hours upon hours off free work (Clinicals right?) and now you take one test. Prepare before hand, and tell you friends and family you’re a hermit till this hurdle is over and they will understand.

By the way: I PASSED and SO WILL YOU!

My Round Table with Secretary of Veterans Affairs, Retired General Eric Shinseki

On Thursday May 24th, 2012, I was invited to a round table discussion with the Secretary of Veterans Affairs, Retired General Eric Shinseki.  There was considerable build up for this meeting. Various individuals representing the Albuquerque VA as well as Veterans Resource Center representatives from the University of New Mexico called to confirm and re-confirm my attendance.  Delivered by mail was a list of events as well as a flyer discussing the recent changes at the Veterans Resource Center. To prepare for my meeting I reached out and asked for advice or suggestions on things I should discuss. My request was met with replies ranging from benefits to disability claims as well as problems with education allowances and the GI Bill.  I noticed lots of confusion in regards to resources as well as examples of problems with the “system”; the big brother black cloud that has delayed us all at some point in our lives.

My friend Michael Wissemann, an a Army Nurse Corps officer and my company commander in Germany, suggested I say “Sir, I deeply admire the honesty you displayed during congressional hearings. It took a moral courage rarely displayed by senior DOD officials to state that we would need significantly more troops than projected by then Sec Rumsfeld. So I need to ask you sir, boxers or briefs?" A link to that is here: http://youtu.be/a_xchyIeCQw - I had to laugh at his response.

My friend Eve said “Discussing Education and Benefits seems all encompassing...Really what the VA can do - is take care of the claims backlog…It takes claims reps months to get veteran's files/records so that they can make an accurate determination of disability. Turn it around on him, Mika. Ask him what he thinks the biggest issues are and where and how can we apply pressure on the Hill to facilitate change. I never just complain or bring up issues... I always offer solutions. Ask him specifically for me, what would he have vets advocates do to help the VA?”

What Eve said struck me. I needed to come to the table prepared with solutions, not just a list of complaints. Everyone knows there is a backlog of VA claims, there is a desperate need for more manpower and that while the post 9/11 G. I. Bill is amazing, there are still problems. My friends Shawn, Kellie, Genna, Heidi, Andrea, Myke and Rachel had all outlined problems and I owed it to them to find solutions and present them. So I did my research. I talked with Patricia, a VSO representative from DAV whom I think is a very educated individual, and I spoke with UNM veterans center representatives who understood all the rules to the 9/11 G.I. Bill and Chapter 33. Then I read speech after speech and every news release I could in regards to the both disability claims and education benefit challenges.  I typed up four pages of broad based problems and 4-5 possible solutions for each.

I have to admit I was excited and slightly nervous about attending the round table discussion. I showed up on time (15 minutes early, some things never change).  I sat outside the conference room with a few other veterans I knew. Of course we waited an hour for a meeting between Shinseki and the University representatives to be completed, and then we were ushered to our carefully placed nameplates.

As I tried to take a seat and organize my notes I was greeted by VA officials asking if it was ok for my picture to be taken with Shinseki and if I would be available to be interviewed by reporters after the round table. I agreed and noticed that others were not approached. It is times like this I think that my face or positive demeanor is mistaken for one that won’t discuss tough topics.  I can only laugh; they obviously don’t know me very well.

The meeting started with Shinseki greeting us and shaking each of our hands before starting the discussion. I scanned left and right and saw that there was a wide range of veterans present. I think there were 14 total in attendance. Around the outside of our table there were seats for the representatives of various senators not in attendance as well as different VA officials and university representatives.  As I scanned my peers I noticed that only a handful brought paper and only I had prepared notes.

Shinseki opened by discussing the GI Bill (also known as the Servicemen’s Readjustment Act of 1944), the various degrees obtained by using this benefit and the challenges he faced when returning to college after Vietnam. He discussed the ability for veterans to have an unspoken communication and added in the 4 rules Army service members live by: I will always place the mission first, I will never accept defeat, I will never quit and I will never leave a fallen comrade. He then discussed the Post 9/11 G.I. Bill and the goal of that legislation for veterans today. He said, “If I were to give a speech it would be one word. Graduate”.

With that he opened the panel for discussion. My friend Patricia had recommended letting someone else start. Sure enough, a question was raised about the accessibility of class rooms for individuals with disabilities. Another veteran answered by informing him that when applying for the class there is a section to request ADA accessible classrooms.  One veteran discussed vocational rehab and internships available for veterans after gaining their degree. He stated that even after veterans do obtain their degree an internship is often required before starting into a new career field. However, those are hard to find and they often provide less pay. That can be hard for even a single solider let alone one with a family.

Shinseki discussed hiring fairs held in DC with the sole purpose of hiring veterans. He said the difference between Job Fairs and Hiring Fairs is that employers are required to have jobs available and to hire employees. An interesting concept. Many veterans groups are approached in regards to Job Fairs and advertising that the job fair is for veterans or veteran friendly. At times I personally feel as if it is just a publicity stunt to give the impression of working towards helping the veteran.

I then took the opportunity to talk to Shinseki. I opened with, “Secretary it is an honor to meet you and be here today. I do not have a specific complaint but rather would like to say that I am a success story of the post 9/11 GI bill. 13 days ago I graduated from the University of New Mexico with a Master’s of Science in Nursing and I am now a Family Nurse Practitioner.  However, after discussing with various veterans and peers there are some challenges that veterans face in terms of gaining a degree. Currently education benefits are capped at 48 months, a challenge for many. Another challenge is that when re-entering college many need refresher courses on materials like math and English, however if they do take these courses it counts towards the 48 months. In addition, many degrees take longer than 48 months; some examples are engineering and nursing schools. However, you should come to any meeting prepared with suggestions. (I picked up my typed list and Shinseki’s eyes momentarily widened). I’m an Army Nurse at heart and I come prepared.”

·         While on Active duty each service member has the opportunity to use tuition assistance to further educate themselves while serving their country. However, with so many being deployed this benefit is not being used. If this benefit is not used while on Active duty it should be transferred on top of their Ch 33 benefit.

·         Allow for refresher courses that do not count towards the 48 month allowance. 

·         Universities can give back to those who have served by providing FREE refresher courses. Universities that participate in this program can be listed in magazines or advertised through social media outlets.

·         If working towards the degree and in good standing benefits can be extended to help the veteran complete the degree. This can be helpful for any veteran working to obtain the bachelor's or advanced degrees.

I’m not sure at how many people were staring at me but I know that Shinseki was. He talked about volunteering to tutor other veterans or being a paid tutor at the university. I explained that in my case when I worked as a TA I was given a discount on the tuition that actually decreased the benefits I received with my GI Bill and it was better for me to tutor without working for the university. After I spoke three other veterans stood up and said that they actually did have problems graduating because their benefits would not cover the amount of time needed to graduate even when taking full time coursework. A gentleman working for Shinseki discussed the recent change to allow for $2000 towards tutoring for veterans and representatives from the University of New Mexico and Central New Mexico College discussed that they had free tutoring available. It struck me how quickly everyone wanted to defend their educational institution. I agree that the University of New Mexico is excellent and I could not have asked for a better place to go for graduate school. However, the problems that veterans face in the classroom are not limited to one campus or educational institution.

Another student from Muskogee, OK, discussed his difficulty with work study payments and an interesting thing happened. The vocational rehab representative echoed the difficulty in retrieving payments. Shinseki turned to a VA representative from Muskogee and asked if this was his area, to which the man replied basically “it’s not my job.” Shinseki replied he didn’t want to hear that. Instead he wanted to know why students were not getting paid and how he intended to fix the problem and asked that the solution be emailed to him by Monday morning. The room was in a state of uncomfortable silence for awhile. Inside I did a little victory dance. I loved the fact that a widget worker saying “not my job” was basically stopped in his tracks. That is true leadership.

The discussion next centered on the need for more providers at VA hospitals and outpatient centers as well as establishing rapport with patients. One veteran discussed that her husband preferred seeing a homeopathic physician and not the VA due to the long waits and short visit times provided. Shinseki talked about the expansion of outpatient veteran’s centers, the new proposed budget for the VA, increased numbers of mental health providers as well as the use of mobile VA mental health centers especially in rural environments like New Mexico.

Shinseki ended the formal discussion by addressing the difference between Post Traumatic Stress and Post traumatic Stress Disorder. He said it was unnatural for soldiers today to go to war and experience what we experience and not have stress. A truly legitimate statement. How many deployments have we experienced, how many friends have we said goodbye to, how many fallen comrade ceremonies do we participate in, how many hands do we as nurses hold before it wears a spot in our souls?  

After our discussion Shinseki presented us with coins, a gesture familiar to many of us. Then the seats and tables were rearranged for the press conference, Shinseki was led to another room to review topics discussed and again I was asked “How do you pronounce your last name.” I was given directions on where to stand next to the podium as camera men positioned themselves and reporters took out paper and pen. I stood in silence, the only student veteran in a line of VA officials. My eyes did glaze over as picture taking began. Shinseki started fielding questions from reporters attempting to address issues regarding the backlog of claims (a subject not discussed in our round table) as well as for-profit universities targeting student veterans.

As the questions came to an end and people started to disperse I walked to my bag with papers folded neatly and prepared to leave. Shinseki walked away for the busy “yes men” that surrounded him, walked up to me and once again shook my hand thanking me for being there. I thanked him and said, “I know that you recognize the need for change. People still talk about the congressional hearings and how you discussed the need for more troops. I hope you know that as a veteran and member of American Women Veterans we want to help facilitate that change.” He briefly if not slightly smiled (he is not a man of many smiles) and said “thanks, that makes my job easier.” The “yes men” looked anxious to take him back so I smiled and released his hand. I was cornered twice more by reporters asking questions about school and veterans benefits and what I saw as the need for change.  My answer: “Veterans work hard, we are leaders and we help our communities, let’s change the stereotype of what a veteran looks like and show what we really do.”

It was an interesting day to say the least. More topics were discussed and I would have to say it was a genuine learning experience. Being a voice that is heard versus being just a voice are two different things. I have come to appreciate that as a veteran I still want to serve my community, but finding that voice is something I am still learning. At the end of the day, I have to remember I am more than JUST a nurse; I am a veteran.

Another Step Forward

I realized at lunch yesterday that I haven't updated this blog in a while. Why at lunch? Well, my grandmother whom I haven't spent time with in 16 years contacted me and I found out that she reads my blog. Humbling for me. However, since I get to enjoy time with her, I think I am the lucky one. And with that a quick update and the past few months:

1. Got carbon Monoxide poisoning from the apartment I was staying at in Farmington. That was no fun. Luckily I came back to Albuquerque and finished up my clinical with two amazing Nurse Practitioners and a Physicians Assistant, all of whom taught me a great deal.

2. Cuidando Los Ninos is making great changes. Tony Pino is an AMAZING leader. He along with his development team put on a breakfast event that did well in terms of bringing the community together and raising funds for the non-profit.

3. The Youth Creating Change Film and Art Festival was a success! And lots of fun. These students really took on an incredible amount of determination and responsibility to spread the word about childhood homelessness.

4. Got nominated and choose for the top 40 professionals under 40 by New Mexico Business weekly. A Big thank you to my family, friends and  Mountain Man, for being in my life and motivating me. Emily, Erica and Tony thank you for nominating me and writing letters of recommendation on my behalf. The Celebration is June 21st.Check it out here: http://www.bizjournals.com/albuquerque/event/64991

 

5. I GRADUATED! It is official I have a Masters of Science in Nursing and am now a Family Nurse Practitioner. I will be taking my national boards this summer.

6. With my plate less full I have decided to take a wonderful opportunity and become a Board member for American Women Veterans. I have much to learn and much to do but I am motivated and excited for this next stage in life.

and 7...

I met with Secretary of Veteran Affairs, Retired General Shinseki today and discussed veterans education and benefits. More on that later. And with that I hope you enjoy the wacky pictures. More soon. ~m