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It’s called Chorea

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A man in his 70s with a history of diabetes mellitus and myasthenia gravis presents with severe, involuntary movements of both upper and lower extremities coupled with uncontrollable nausea, vomiting, and diarrhea. It looked like this man was having a never-ending grand-mal seizure while remaining conscious and not foaming from the mouth. He was brought into the ED after sustaining multiple falls while at home, and was treated with increased doses of Mestinon which caused the vomiting and diarrhea.. we tried to fix the movements, while causing fluid volume deficits.

Myasthenia gravis is a neuromuscular disorder that results in easy fatiguability of muscles, whereas this man was having excitability of all muscles. The neurologist coined these involuntary movements as chorea and attempted to treat with Olanzapine (antipsychotic), Keppra (antiseizure), and pyridostigmine/Mestinon (anti-myasthenia gravis) medications. The MD thought the chorea could potentially be caused by hyperglycemia (I have never heard of this as a cause), which was also a problem during this admission.

I do not know what the ultimate cause of the choreic movements was, but after sleep and medication therapy, the patient was discharged from the hospital with vastly reduced movements and was working with physical therapy the next day.

Until next shift,

Shania

COVID Update: Are we really heroes?

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Over the past couple of months, the world was forced to adapt to a new normal. Businesses were shut down, jobs were lost, jobs were deemed essential or nonessential, healthcare workers became heroes, and people appreciated the importance of science. There are two extremes: those who believe the coronavirus is a government-created fake to steal our rights, and those who remain isolated in his or her home. People either wear masks or continue to hang out in public crowds. Hospitals are either overwhelmed and under-resourced, or nearing shut down as revenue has dropped so drastically.

I have been affected by the latter. The rural organization that I am apart of recently furloughed and laid off several hundred workers due to a continued low census/revenue. We have tested several hundred individuals with a majority of them either negative, or positive with mild symptoms and instructed to remain isolated at home. I have yet to have any known exposure, nor have I cared for a true COVID-19 patient. I consider myself very fortunate and lucky. We have at most one positive COVID patient in the hospital per week. Census remains to be so low that many nurses are put on stand-by or cost-containment at least once per week. The so-called heroes are unable to work or make money. Many essential workers are given hazard pay, however at an organization where the usual salaries are difficult to come by, we are eliminating positions and praying that we continue to have a job as a new week begins.

So, am I really a hero? The Oxford dictionary defines a hero as someone who is idolized, shows courage, and noble qualities. By this definition, nurses and other healthcare personnel can be considered heroes. However, I do not search to go into harm’s way. I wear my cloth mask, adhere to crisis guidelines, educate the public (who many do not listen), and #stayathome despite the world starting to reopen. I go to work every shift with the mission to practice compassionate, evidence-based care while providing for the specific needs of each patient and family. And my reward? The personal satisfaction of helping others and the risk of getting called off on the next shift.

I absolutely love my profession, my hospital, my coworkers, and my patients, however I do not consider myself to be a hero. My mission is to educate, treat, and inspire people to do good and to remain healthy. My wish is that this pandemic has encouraged others to never take life for granted. I hope that the day we…

  • Hug our friends/family
  • Visit our grandparents
  • Be a support in the hospital
  • Go to a restaurant
  • Return to the theater
  • Shake someone’s hand
  • Go shopping
  • Fly on an airplane
  • Talk to our spouse and children…

Remember the year that these things were not safe and appreciate every moment.

Closing thoughts: This pandemic will not end until there is a miracle drug or vaccine. Even with the city opening up, please continue to social distance, maintain respiratory etiquette, wash your hands, wear a face mask, and be sensitive to others’ emotions.

Until next shift,

Shania

A Faith of Thorns

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I recently had a patient encounter with an elderly woman and the conversation is as follows:

“Do you think God is creating this virus to destroy the world like he has done in the past? Like he is wanting us to learn something?”

(Me) “I think God is good and would not create this kind of destruction. He has said after the flood that he would not destroy the earth like that again. He said that he works everything out for good. He did not say that everything will be good. The enemy is present to kill, to steal, and to destroy. I believe this is not God.”

(Patient) “I grew up in the Church of Christ and do love God. I have lived for over 70 years and never in my life has something like this happened. I just can’t wrap my head around why. Where is God in this?”

I didn’t really know what to say at this point, other than to listen and ponder with her. I know God did not send this pandemic, but I will never know why it has occurred in this lifetime. I have tried to focus on only positive thoughts such as having more time to learn a new hobby, catching up on Netflix, spending time at home, and enjoying the presence of immediate family; however, the energy of the world is filled with fear, anxiety, and isolation.

Jesus describes the purpose of parables in Mark 4 by defining three different foundations of faith:

1. Rocky soil= hear the word, accept the word, but have no root and when tribulation comes, the faith falls away.

2. Thorns= hear the word, however the desires of the world overpowers the faith.

3. Good soil= hear the word, accept the word, and spread fruit (joy, faith, success) in multiples.

I would like to think that my faith has a foundation of good soil. I like to think that my optimistic persona will radiate and disperse the fear that is all around me. However, as I write this post, I feel like my faith is grown in thorns. The stresses and worry of current life are drowning my joy and hope I have in Jesus. In the words of my sweet lady, “where is God in this?”

I don’t know, but I do know that I will find out one day. For now, I will hope for the future as I know this too shall pass. I will continue to find joy in the little things. And I will continue to trust that God is with us.

Until next shift,

Shania

“And these are the ones sown on rocky ground: the ones who, when they hear the word, immediately receive it with joy. And they have no root in themselves, but endure for a while; then, when tribulation or persecution arises on account of the word, immediately they fall away. And others are the ones sown among thorns. They are those who hear the word, but the cares of the world and the deceitfulness of riches and the desires for other things enter in and choke the word, and it proves unfruitful. But those that were sown on the good soil are the ones who hear the word and accept it and bear fruit, thirtyfold and sixtyfold and a hundredfold.””
‭‭Mark‬ ‭4:16-20‬ ‭ESV‬‬
https://www.bible.com/59/mrk.4.16-20.esv

Things I’ve Learned in Quarantine- A Personal Retreat (part 1)

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  1. Staying positive doesn’t mean you have to be happy all of the time. It means that on hard days, you know that there are better ones coming.
  2. Take every day to count your blessings. I have a healthy family, a paying job, a home, etc.. Social isolation began about 3 weeks after the Nashville tornadoes. There were families who lost everything and now had to remain inside a stranger’s home until it was safe to rebuild. 340 employees were furloughed at my hospital, I am very fortunate.
  3. Being alone with my thoughts sucks. My anxiety exacerbates when I am isolated. This led to phone calls, video conferencing, among other activities to stay connected without complete social distancing.
  4. Joy and tragedy can coincide. When I run through the neighborhood, I see positive quotes from children written in chalk. Countless videos have been posted about people placing thank you signs around the hospitals for front-line staff. One of the most memorable videos is from a city in Georgia who stood on their balconies and congratulated nurses as they changed shifts at a highly populated hospital. Volunteers have made masks and donated food to essential workers and those in need.
  5. I love Yoga! A friend introduced me to online Yoga videos and I do at least one every day I am off work. It’s a relaxing work out, forces me to stretch, and allows me to be present in the moment.
  6. I love community. Before all of the forced social distancing, I willingly social distanced myself. It is easy to want to stay home and relax alone without having to worry about the schedules of other people. It is easy to text, call, or FaceTime a friend for social interaction. It is easy to choose to be virtually present for a race, meeting, etc rather than physically being present. But now that virtual interaction is the only safe means of connection, I realize that relationships and community are so important for a healthy soul. Being engaged in the lives of your friends, coworkers, church, group hobbies, and family creates a sense of self-worth. I may not be fully willing to go out of my comfort zone and seek connection, however when I do, I always feel so much better after. The conversations that can be had with people with common interests and those in my daily circles improve my life. Connections and experiences are what is remembered for years to come, not what I gift or create myself.
  7. The rise of telemedicine.
  8. Homemade peanut butter cups are easy and delicious. Not to mention they are great with afternoon coffee!
  9. I have grown more in love. This “staycation” with my fiancé has allowed us to do all of the things we enjoy for multiple days in a row.. morning coffee while reading on the couch, yoga, running, netflix marathons, cooking, and just being in each other’s presence. I was worried about our October wedding (we have been planning for 2 years) not happening, but just going on a big adventure together wouldn’t be so bad.
  10. I have revamped my acting career.. more info to come.
  11. I am the 2020 nursing preceptor of the year.
  12. I ran my first half marathon in 2 hours, 14 minutes, and 32 seconds.
  13. I enrolled in a clinical trial to test the use of plaquenil for COVID prevention.

To Quarantine or not to Quarantine? This is Corona.

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I have debated on posting about this topic for several reasons. First, I am already tired about hearing about the coronavirus. Second, the world is in a state of panic over this pandemic and I do not want to add to the chaos. However, I am now writing because some facts and concerns need to be clarified using reputable sources.

What is the coronavirus?

There are many different strains of the coronavirus, of which 7 cause human illness. The one in concern today is the COVID-19 (coronavirus disease 2019), previously known as SARS-CoV-2.

What are signs and symptoms?

The most typical signs and symptoms in order of prevalence are fever, cough, and shortness of breath. The incubation period (time in which the disease creates symptoms) is anywhere from 2 days to 2 weeks. A majority of cases are mild and DO NOT require hospitalization. 1 in 5 people develop serious illness and around 2% of the cases have been fatal.

How do we test for the COVID-19?

Testing is increasingly becoming more available locally using respiratory specimens. Most testing is done officially by the CDC, taking 3-5 days for final results. If other respiratory pathogens are positive (influenza), then the COVID-19 is ruled out.

How is it treated?

There is no specific medication, cure, or vaccine approved for the COVID-19. Antibiotics are not effective because this is a virus, not a bacteria. Treatment is supportive- Tylenol, decongestants, rest, hydration, etc. People are advised to call the doctor’s office and if not severe, to remain home. Anyone who exhibits symptoms, but would not normally see medical care should remain home, even if they suspect the virus. Serious cases are those that require breathing tubes or assistance, and need trained hospitalized care.

Let me reiterate. Patients who present to the ED with mild symptoms are sent back home. Patients who cannot breathe are admitted into the hospital. These patients are placed on airborne and contact isolation in a negative pressure room. Health care professionals are required to wear a gown, gloves, N95 mask, and face shield when performing medical care.

Though no current medication has been specifically approved for the COVID-19, China has trialed the medication chloroquine phosphate (an anti-malarial) which was successful for SARS.

Who is at risk?

Currently, the risk for transmission is still low for the general population. High-risk populations include older adults, males, hypertension, diabetes, obesity, lung disease, and an elevated D-dimer (lab shown to be elevated in blood clotting disorders).

How to prevent the spread?

Handwashing and sanitization are the most important… why are we out of toilet paper and paper towels?

If you are sick and do not need hospitalization, stay home. The closures of schools and businesses is a way to “flatten the curve” of transmission. Large, crowded areas allow the reparatory droplets to spread through the air and infect multiple people. That is why avoiding crowds is important.

The COVID-19 is an airborne virus, so surgical masks are not effective. Surgical masks are only useful for very large particles, such as to prevent a surgeon from sneezing or coughing directly into an open wound.

Warm weather has not been proven to halt this virus.

What is the current situation?

As of March 14, 2020… Globally, there are 142,539 confirmed cases and 5393 deaths.

Final thoughts…

Yes, this is a serious pandemic. No, we do not need to panic. No, we do not need to stock up on unnecessary items like toilet paper and paper towels.

It is important to respond, not to react. Wash your hands, avoid large crowds, stay home if you are sick, and have peace over panic.

Resources

https://reference.medscape.com/slideshow/2019-novel-coronavirus-6012559

https://www.who.int/health-topics/coronavirus

https://www.cdc.gov/coronavirus/2019-nCoV/index.html

Until next shift,

Shania

Terminal Agitation

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Terminal agitation. I have never heard of this term before until my last shift. A patient I had a week ago, who was admitted with a fall, died today after being placed on Hospice care. The previous week, the patient was not oriented to person, place, time, or situation, and was very restless. She was able to communicate, however inappropriately. She constantly wanted to get out of the bed, and never went to sleep. She had dementia and I thought this was a progression of her dementia. I found out on this past shift that this agitation was actually her quick decline to the end of her life.

Another nurse on the floor worked in Hospice care for several years and had a hint that this was terminal agitation. The patient was seen to be picking at the air and stated that she was seeing her late husband. I have never encountered these signs before and contributed them to hospital delirium and her baseline dementia. I could not believe that the next shift I had, was this same patient who was now comatose and passed within 24 hours after transitioning into Hospice care.

Until next shift,

Shania

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