Save the date

August 19, 2009

This conference sounds interesting. Anybody wanna go? Huh? Please feel invited to purchase a plane ticket for me as well. Also, I’m going to need someone to spot me the registration fee… takers?

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A Cooking Egg

August 14, 2009

Although I don’t want SEMI to go the way of KevinMD with superficial news blurbs lacking any hint of personality and hawked from other blogs or the Associated Press, I am short on time this week and thus unable to provide anything other than content-poor headlines right now. I must leave it up to my dear reader(s) to discuss.

This week in wealth care reform health care reform:

Hey, Obama, everybody knows that secrets don’t make friends. Money, maybe, but not friends.

Ralph Nader and Amy Goodman should just make a baby already. If Amy’s concerned that she’s past her prime, I’m happy to offer my youthful womb as a surrogate. Anyhow, I think Nader is using the term “harmony ideology person” as a euphemism for “pu**y.” (No, not puffy! Or puppy! Or puddy! Or pushy! Or pully! Or pukey! Or pudgy! Ok, maybe pudgy.)

Someone over at T.C. wags a finger at the left for its failure to keep its eye on the prize. To any regular ol’ nurses (as in, not published numerous times over in academic journals) interested in policy advocacy out there, can you name your state’s senators and congress people AND their voting records on issues related to health care reform like T.C.? I’ll just go ahead and take one for the team by admitting that I can’t either. Let’s get crackin’. Stay tuned for a piece I’ll be posting next week on policy advocacy within nursing.

Jon Stewart spearheads public health campaign raising awareness of ideology-associated amnesia (IAA). John Oliver combats national health care discrepancies by advocating for equal access to death panels.

U.S. Dept. of Health and Human Services attempts to bolster support for health reform with a report on how Big Insurance leaves millions behind. A more comprehensive report on health disparities may be found here. Guess what? People living at or below the poverty level and racial/ethnic minorities receive the shittiest care! I am shocked. For those of you who think they deserve it, perhaps you need a little work expanding your social consciousness (by the by, anybody who is actually interested in that article can “borrow” my copy if you send me an e-mail address).

I’ve encountered a lot of provider disillusionment regarding a public option or universal coverage via expansion of Medicare/Medicaid because many of us in the biz know that reimbursement is a big hairy ugly issue with lots of twisting dark tunnels in which to descend without hope of rescue (For example, I sat down with utilization review a few weeks ago in order to understand how much money our hospital loses because of services that would not be reimbursed by Uncle Sam.) I know providers and patients waste endless time, engergy, money and lives strugging with Big Insurance too, but anybody who wants to see quality improvement of Medicare/Medicaid before a “public option” goes live may be interested in venting your opinions here. I’m no expert on this stuff, so I’d love to see a little lively debate going here on SEMI as well.

Business man Dr. Andrew Weil does a bad job of making a decent argument about the misdirection of the health care industry and the medicalization of socioeconomic problems here. I sure hope we see more “wrong diagnosis” puns in the debate over health care reform!

And finally, a few random tid bits:

Ever wonder how much vaccines cost?

Anybody want to meet in Chicago on Sept. 22 for a sexy weekend of healthcare-associated infection debate (see above section on Medicare/Medicaid reimbursement)? Fellow nurse friends, I’m talking to you.

As an RN and an FNP student, it only makes sense that I don’t have health insurance. I’m due to get my cervix scraped, Pap-style. Any fellow (legally licensed and practicing) med folks out there feel like doing me a professional courtesy? C’mon. I’ll get you back when I’m licensed to hand out prescriptions.

Safe driving, y’all.


Tit for Tat

August 12, 2009

The Department of Health and Human Services is releasing a whopping $13.4 million for nurse loan repayment. $8.1 million will be competitively awarded to nurses who agree to work in one of these facilities with a critical shortage and will be used to pay 60% of their student loans, while the other $5.3 million will go to  schools of nursing to support the training of 500 masters or doctoral students who agree to work as full-time faculty at a school of nursing for four years. The masters and doctoral students will have up to 85% of their loans cancelled. Recipient universities can be found here. My own university is receiving less than $10,000. That’s enough to cover not quite one year of tuition and books for one masters student.

Note that the $8.1 million is intended to help “100 nurses”…. is this a typo? Are there exactly 100  nurses out there with $135,000 in loans? I don’t get this. Still, I’m not sure 100 nurses can really tackle the problem.

Details aside, $13.4 million is a piddly sum to support nurse recruitment and education on a national level. But fine, that’s okay, money is money. We’ll take what we can get. Thanks government. Except these repayment programs lock a nurse into  potentially dangerous situations at facilities in which her or his license is routinely jeopardized. Perhaps this is a fair exchange for a nurse struggling beneath a mountain of debt, but most nurses I know who have signed onto loan repayment programs like this end up regretting it because they find themselves trapped in miserable, unsafe working conditions. If anybody has information or insight to share on this subject, I’d love to hear your opinion, especially if you work at one of the hospitals on the list. I’ve heard good things about Bannar Good Samaritan in Phoenix and Dell Children’s in Austin, but other than that I don’t know about the working conditions at the other hospitals.

I don’t like spitting at money, and perhaps I’d feel better about this whole exchange if the repayment program covered closer to 100% of a nurse’s student loans or if the money affected nursing on a greater scale (which would, of course, require more money.)

Anyhow, the money that will be used for masters or doctoral students seems to be a better deal, at least for students. Nursing faculty earn next to nothing, and perhaps assistance with loans will help some people who want to teach but can’t justify the cost make the decision to pursue careers in education.

C’mon nurse friends. Comments plz.


Hot or Not? MedBlog Edition

August 7, 2009

It’s Wednesday a dark and stormy night. You’re sitting around in your underpants lingerie after a good long workout, enjoying a cup of Dr. Oz’s “miraculous wunderdrug” green tea and lazily browsing the Internet. This is the first time in your life you’ve had anything but dial-up, and the novelty of opening up your browser and being instantly connected to porn the people who really care about you has not worn off yet. Sweet civilization, you sigh contentedly. You head on over to your favorite blog and re-read something so great that it puts you in the mood to remove aforementioned underpants and click your way over to one of those sexy adult websites.  However, you suppress the urge, since you might want to run for office some day and you can’t do anything to compromise that.

Suddenly the phone rings, thus breaking the Interweb’s lusty spell over you. It’s your mother. You answer, and within two minutes of listening to her jump from subject to subject like a crack-addled Robin Williams, you can tell that she’s back on prednisone.

Your  mother asks you a bunch of medical questions. She almost goes into a ‘roid rage when you say you must put her on hold briefly because your sister is calling. Sister is wondering if she has a UTI. She describes her symptoms and you say yes,it sounds like a UTI, provided UTI stands for ugly titty injection. You can hear Sister rolling her eyes over the phone. “That doesn’t even make sense,” she says. You nod thoughtfully.

Later that evening a friend calls, wondering if something “down there” is a pimple or a herpe. 45 minutes and a trip across town later, your friend sighs with unbridled relief when you look up and nod your head definitively. “Pimple.”

It would be a big fat dirty lie if you said you didn’t enjoy dishing out health advice to people who probably won’t sue you for going way outside your scope of practice. If the fact that these people are your close friends and blood relatives isn’t enough to prevent law suits, the fact that you have potentially career-ending blackmail photos of pretty much everyone in your life will. Mua ha ha hahaha ha!

Still, you’re losing a lot of gas money driving around town to look at all of your friends Unidentified Genital Objects (UGO). “I should just start a blog,” you say to yourself.

The next day you receive a text message from Toxic Culture. “You should start a health care blog,” says a member T.C.’s damages award-winning legal team. Your fate has been decided.

You begin your blog career with a post so amazing that you have a difficult time bringing yourself back down to the level of normal people afterwards. Still, your blog is not receiving any traffic, or so claims the evil graph widget necrotizing the lower right corner of your “dashboard” (you wonder if Vanco will kill that thing?). Still, the question remains. Why isn’t anyone witnessing your soon to be posted nude photos brilliant prose? You are so desperate for readers that you briefly consider teaching your mother how to use the Internet.  Then you wonder–the lack of customers couldn’t be because you’ve got competition, could it? I mean, it’s only 2009—the Internet is a virgin landscape like Manahatta circa 1492 and health care is such a fringe topic! Still, you decide to go sleuthing around in search of any leeches squatting on your turf. God, is even the Internet socialist now?!?!?!?!

At first, you can’t decide whether to be dismayed or delighted by what you find. Encouraged or slandered? Amused or moved? Do you laugh until you pee yourself or vomit at the thought that someone like this is responsible for human lives? You can’t help but wonder if Shadowfax is cute. He sounds cute, right? Hell, he could weigh 300 pounds and have zits all over his face and you’d still be interested (no offense to  his lovely wife and three beautiful children. The author of this blog is not an actual person, anyways. She’s a construct of the ether.) You wish that Kim would teach you everything she knows, because you’ve secretly always wanted to be wise-crackin’, EtOHer-regulatin’ ER nurse, and you wish that urethra-diving badass Keagirl would post again already it’s been since April c’mon already geeze! You’re proud of Nursing’s own Amy Goodman, and there are countless others who have already made a major impression on you in the few short days you’ve known them. In any event, you realize that the bar has been set high (except here), and that you’re going to have to step it up and bring your A game–and peer-reviewed journals–and “surgical” lube— to hash it out with some of the good ol’ boys. No more screwing around. Your pocket is full of flushes and you’ve got your Lifesaving Foley in tow….

Welcome to my needle-exchange van clinic, team.


The Beefcake Manifesto

August 3, 2009

A delightful gentleman by the name of Scrawny McSkinny sent me this question:

“For my entire adult life I have weighed 136lbs. Wether I eat more or less, cheese quesadillas from Taco Bell or hearty salads, it makes no difference. I think I am physically incapable of altering my body weight. I believe it is due to my ultra high metabolism. Without radioactive juice and an x-ray machine, I can’t be sure, but sometimes I think I’m pooping out my breakfast just before lunchtime. I would like a hot six pack and some man tits. What should I do?”

My most esteemed Mr. McSkinny, if only you knew the number of unholy acts I’d perform in order to have your problem. Still, as temptingly easy as it is to characterize your inability to gain weight as an “ultra high metabolism“, the truth is that this is a major oversimplification of the many complex processes involved in energy intake, storage, and output. Kick back and relax while I treat you to a very brief overview containing actual science:

Metabolism includes catabolic processes, which break food or bodily components down for energy; and anabolic processes, in which the body “builds up” and synthesizes components like muscle proteins or stores energy as glycogen or adipose (fat). Essentially, your body takes the protein, fat, and carbs from your diet and, through digestive mechanisms, breaks them down into their respective monomers: amino acids, fatty acids, and monosaccharides. Most typically, glucose (a monosaccharide) is used by the cell to generate ATP, which is a molecule with lots of stored energy that the cell uses to fuel all of its other biochemical reactions (or all of the various things that your cells do to make you, uh, live.) Other monosaccharides (like fructose), fatty acids and amino acids may also be used by the cell to generate energy, or they can be used as building blocks to construct needed materials, such as contractile proteins for muscle fibers (hint hint) or phospholipids to be incorporated into the cell’s membrane. The body uses many complex regulatory mechanisms (including hormones and biochemical feedback systems) and metabolic pathways to determine the fate of the substances that you ingest, and if this topic fascinates you then I highly recommend a course in organic chemistry or biochemistry.

My point here is that the picture gets really complicated, and much of this stuff is probably genetically determined. You have your own unique genetic profile, and if you’ve been 136 lbs. your entire adult life, you will probably never look like this, no matter what you eat. But the good news is you can still improve your health, increase your fitness and develop your body’s version of a six pack and “man tits” through lifestyle modifications like diet and exercise (I’d like to add a “duh” and a friendly but pointed eye-roll here).

You mentioned that you’ve toyed with your diet without results, but for you, I’m suspecting that exercise is the missing component. If you have not considered this, then you have bigger problems than the meager size of your deltoids. Furthermore, even if Taco Bell cheese quesadillas did help you gain weight, increasing your caloric intake without increasing your physical activity will only lead to fat gain. If increasing caloric intake alone was sufficient to build lean body mass (i.e. muscle), we’d have a body-builder epidemic here in America instead of an obesity epidemic. Perhaps your body is extra talented at burning energy for fuel, but not so concerned with storing fat or building muscle. This means that you will have to make a REALLY good argument to convince your body to bulk up. The human body, you see, is very energy efficient and is not likely to waste calories maintaining something it’s not using–better to feed glucose to the brain for math problems, or make a bunch of extra sperm for that reproductive edge, or generate lots of heat for those cold northern European nights, or use the your energy doing whatever would serve you better than maintaining accessory muscle, since the body doesn’t really know the difference between something that’s unused and something that’s useless. All of the muscles in your body are being remodeled at all times to match the functions that are required of them, which means you have to engage your muscles in a way that forces them adapt to the new demands being placed on them if you want them to be remodeled into rippling abs and bulging biceps (Guyton & Hall, 2006). Muscles do not grow via cell division (hyperplasia), but rather by increasing the diameter, length, and contractile elements (proteins called actin and myosin) of each individual muscle cell (Guyton & Hall, 2006). This process, in which a cell increases its size, is called hypertrophy. In order for hypertrophy to occur, the muscle must be loaded (either by weight or resistance) during contraction. Though we don’t know the exact mechanisms by which muscles “sense” the demand placed on them, we do know that muscles develop increased vascular supply, increased number and size of  myofibrils (bundles of actin and myosin), and increased enzyme systems that supply energy (like glycolysis, which is a metabolic pathway that breaks up glycogen molecules into glucose molecules to provide a rapid energy source during short-term forceful muscle contraction) during the hypotrophy process (Guyton & Hall, 2006). We know that properly trained muscles can experience noticeable hypertrophy within 6 to 10 weeks, and that contractile proteins will decay in unused muscle and the muscle will atrophy (Guyton & Hall, 2006).

Now, I won’t go and outline a workout plan for you. I used the Body Sculpting Bible for Women by overdeveloped hunks Villepigue and Rivera to help me put together my weight lifting routine when I started strength training five years ago. Here’s a website that provides resources related to the Body Sculpting Bible for Men if you are on a budget and prefer the DIY approach. Start slow and mind what they say about proper form, you hear? If you’d like more motivation and a routine that suits your specific needs, I’d suggest investing in a good, reputable and experienced personal trainer to get you started on your path to healthy weight gain. Other activities like rock climbing may be more appealing to you. And don’t forget the cardio–heart health is more important than looking suave and, besides, extra overlying fat will obscure your hot new muscles and diminish the appearance of your muscle tone. Additionally, you’ll have to fuel your workout with foods that promote lean body mass, so you should choose nutrient dense foods that meet your caloric need. You’ve probably heard all of this before, but unprocessed plant-based foods like green leafy vegetables, root vegetables, and whole grains alongside plant-based proteins or animal-based lean proteins are your best bets. I like a lot of the nutritional and cooking tips in Men’s Health Magazine.

If you commit to a proper weight-training program and muscle-building diet for over two months and see no results, it probably means you’re doing the exercises wrong or not eating enough. If these problems are ruled out, it’s always possible that your thin physique is the result of something more insidious, like a gastrointestinal problem that inhibits your ability to digest or absorb nutrients, or a hormonal imbalance like hyperthyroidism. It’s a good idea to be examined by a doctor before initiating a new exercise program anyways (especially if you’re older), and you should visit your doctor if you experience any complications like exercise-related chest pain or injury.

A few more tidbits to motivate you:

Resistance training and dietary protein help prevent age-related loss of skeletal muscle mass and function (Campbell & Leidy, 2007).

Being underweight or obese at any point during adulthood is associated with lowered cognition in late midlife (Sabina et al., 2009).

Increased lean body mass is correlated with increased bone mineral density, and high-impact aerobics like running combined with resistance training offers the best skeletal protection (Rector et al., 2009).

With this, and the thousands of other studies demonstrating the benefits of  exercise, I rest my case.

References:

Cambell, W. W. and Leidy, H. J. (2007). Dietary protein and resistance training effects on muscle and body composition in older persons. Journal of the American College of Nutrition, 26(6), 696-703.

Guyton, A. C. and Hall, J. E. (2006). Textbook of medical physiology (11th ed.). Philadelphia: Saunders.

Rector, R. S., Rogers, R., Ruebel, M., Widzer, M. O., and Hinton, P. S. (2009). Lean body mass and weight-bearing activity in the prediction of bone mineral density in physcially active men. Journal of Strength and Conditioning Research, 23(2), 427-435.

Sabina, S., Kivimaki, M., Shipley, M. J., Marmot, M. G., and Singh-Manoux, A. (2009). Body mass index over the adult life course and cognition in late midlife: The Whitehall II cohort study. The American Journal of Clinical Nutrition, 89, 601-607.