Dispel the myths, with some facts.

The lack of awareness about Complex Regional Pain Syndrome has led to many myths. These myths can hurt the perception of CRPS that other people have. Here are seven myths about CRPS and the facts to dispel them.

Myth #1: CRPS is a rare/new disorder.

Fact: CRPS has been around for approximately 145 years. Doctor Silas Mitchell Weir and his collegues first wrote about CRPS during the Civil War. Some of the names it has been known by are: Causalgia, Post-traumatic Dystrophy, Shoulder-hand Syndrome and Reflex Sympathetic Dystrophy. In 1995 the International Association for the Study of Pain(IASP)felt Reflex Sympathetic Dystrophy did not adequately represent the whole of the disorder. They changed the name to Complex Regional Pain Syndrome.

Myth #2: CRPS does not spread.

Fact: In 70% of the cases of CRPS, it spread from the original location. It can affect any part of the body, including internal organs.

Myth #3: CRPS will go away in six month, a year, or 2 years.

Fact: Once you have CRPS, you have it for life. There is no cure and at this time, the treatments for this chronic condition do not work for everyone. If you are one of the lucky ones who go into remission, it can come back if there is another injury or for no reason at all.

Myth #4: Opioids do not help the pain of CRPS.

Fact: Using opioid medications can be very effective in lowering the pain level. They are used to help control the pain level in order to allow the patient to go to physical therapy. They also allow a patient to have a somewhat normal life. Without them, most patients would not be able to move or participate in daily life.

Myth #5: CRPS is a psychiatric disorder.

Fact: The pain is very real, as are the symptoms associated with it. No one can see the pain, but there are physical signs such as, color changes of the skin, loss of hair, and osteoporosis. Sometimes atrophy or contracture of the limb is also present. This myth is widespread among medical professionals.

Myth #6: Minor injuries do not cause CRPS, only major ones do.

Fact: The number one cause of CRPS is a minor injury or surgery. A sprain or broken bone are often the reasons heard when asking, “How did you get CRPS?” Minor surgery is a common reason as well. Surgeries for carpal tunnel, or to remove a neuroma from the foot.

Myth #7: If you do not get pain relief from a sympathetic nerve block you do not have CRPS.

Fact: Getting no pain relief from a block only means the pain is SIP, Sympathetically Independent Pain. Patients who get pain relief from a block have SMP, Sympathetically Maintained Pain. A series of blocks may be successful in putting CRPS into remission. It also may result in longer periods of relief with each block. This myth has caused delayed treatment for many people.

“When will you be back?”

So, I have now officially been employed as a LPN for a wee bit over a month. In that month some _______________ things have happened. (The blank is for imagination purposes. Fill it in how YOU see fit.)

In that month, I have had three patients die. One passed on like day three, one was completely unexpected to ME (that’s what I get for taking those two days off). The last, I am proud to say I played a very active role in providing as much comfort and care as I possibly and legally could, not only to the patient, but to her family as I could. That made me feel good. I had decided when in Nursing school, that I wanted to work in Hospice care. However, many of the jobs are for RNs only, in my state an LPN cannot administer Morphine via IV ‘push’. However,  morphine is now generally given in liquid form via a syringe that squirts it into the mouth and is very concentrated, so that BS makes me mad.

With the passing of patient TWO, I do not know what it was that caused her death. Yeah, she was quite old, but she was fine on Tuesday, a bit constipated, for which as per DOCTORS order, I administered the medicines that were to relieve it, much to her dismay, and for some reason,   THAT caused another LPN to get in a boatload of trouble for ME doing so. But anyway, I came to work the following day to a, pardon the pun, shit storm. I had done nothing wrong, I followed the orders given me by the professionals above me. Yes, I threw in some judgement, based upon my education and prior experience with the drug, an evil beverage that  can be purchased over the counter and is usually given to those about to have a camera shoved up their ass to check for cancers and other anomalies of the colon. Magnesium Citrate, its sorta like hell in a bottle. I say hell because once in you, there is a process of cleansing one usually doesn’t forget. I am thankful that, despite my best efforts to soften both the taste and the “blow” for the patient, she told me in her sarcastic 93-year-old, evil eye giving way to “go chase yourself” after having tasted it. It was this med that caused the storm, no one bothered to READ that I noted that the patient had only taken in MAYBE two of the 8 ounces I was supposed to administer. I did the “protocol” expected, initialed the box for the order turned over the page and stated “Patient VEHEMENTLY refused to drink past two ounces”

What we had here my friends, was a real old-fashioned, professional pissing contest. “you shouldn’t have taken that order” “I did not prescribe it, I am an LPN. Even you as an RN can’t do that”  ”You used poor Nursing judgement, you are getting written up” “Try it I won’t sign it” There I stood, asking “WHY the issue, what happened WHY should she have NOT taken the order, I am TRYING to learn here, can someone tell me why she shouldn’t have gotten it? I gave it to her, if anyone was wrong it was ME but I was following a DOCTORS order WHY won’t anyone tell me what the fuck is wrong with that?” Nope, no one had the time to stop for a fucking second, NO ONE could tell me SHIT, they were to busy measuring their dicks at the Nurses station. So fuck the patient, fuck the new nurse. Guess what happens with Mag Citrate the next time its ordered for one of my patients. “Hello, Mr. Plumber” or just a flat-out defiance of a doctor’s order.

And on Easter Sunday, I get to work, the above patient had been sent to the hospital the day I speak of above. She came back two days later on Comfort care. Which means as much morphine and ativan or xanax as any human can take without actually OD’ing so that they are comfortable in the end. The family would not allow testing because whatever they would find would not have been treated. She died just after I arrived back to work on Easter. I was not on her floor that day, and when I heard that someone had just passed on her floor, I assumed it was someone else, I took a minute to go to the floor and find out who, and was stunned to hear her name.

“Lucy” gave me the hardest time while I was there. This 93-year-old, gravely voiced woman would sit there and say “Miss, take me to my room. I want to go to bed” Me-”Lucy its 4:00 p.m. you haven’t had supper yet.” “I haven’t well, OK then. After supper you will take me.” OK. Then she gave the “evil eye”. Her one eye would get the squint that I have, the one that my husband and kids call my evil eye. She had it so reflexively that when she would “throw it at me” I would try to defuse the situation by trying to make her laugh and say that she tossed it around so much that she could no longer control it’s happening automatically. She would either laugh with me, or say something nasty or tell me to “Go chase yourself!”

Thing is though, she is me in about 50 years. Every time I looked at her, I saw ME sitting in a wheelchair, giving the evil eye like that. Wish I knew her in her more “lucid” years. In the time I was there though, we did laugh together quite a bit. I was told to go chase myself enough times that if I started today, I may be done by the next millennium.

I do know that a few days before she passed, the night before the Mag Citrate, I had to go to her and bring her one of her pills that had arrived late from the pharmacy. I mixed it in something sweet. She was so cute, sitting in her bed. She said “Oh that’s good, what is it” “Its a treat”, I said. She wasn’t diabetic, so some sweetness wouldn’t hurt her. I said further, “don’t get me in trouble for this” She wanted me to stay in her room. I said I couldn’t, I had to do my paperwork and go home. “Oh just stay here, I will move over”, and she pulled the covers over motioning for me to stay in her bed. “That’s sweet but I can’t, someone has to go take care of my sick husband and my two kids” She replied in that smart ass way “Oh, they are big enough to care for themselves” She has no way of knowing my kids ages. “When will you be back?” I told her I was off the next two days, but I would sneak her a treat when I came back.

I never saw her again.  I assume it will be a while before I do again.

No one has the answers. What was the question again?

There won’t be many that read this, but I am really writing this more to sort out the shit that is swirling around and around in my head. (and I am actually at this moment picturing the “Tidy Bowl” Man as I write this sentence, gonna make him one of the photos I attach to the post!)  But for those who have braved the waters of my “rantings” before, you know that I have recently begun what is my Licensed Practical Nursing Job ever, at the age of 40. I work in a Nursing Home. I have recently completed my first month of employment there. (I will now direct you to previous posts with tags like HELL and the like)

To understand much of what I am sure to spew here, you will first need to understand the difference between Licensed Practical Nurses and Registered Nurses. LPNs take direction, and work under the auspices of the RN. The LPN is a skills oriented nurse, whereas the RN is more “educated’ as to WHY a blood pressure reading is an important on the body as a whole. An  LPN can take the reading of a blood pressure and know that certain numbers are bad, but not what the consequences are of extended high blood pressure on the patient. The LPN can give you meds, do many direct care tasks, but the RN can ASSESS a patient and have it be trusted that he or she KNOWS what they are talking about whereas a LPN cannot. Example, if you were to be defecating pure brown water, repeatedly for HOURS, I could say basically that you have had “repeated episodes of loose stools” An RN could say that the “repeated episodes of loose stools, put the patient at risk for dehydration”. Many RNs in my state have 2 year college degrees. I as an LPN attended a technical school, full time for a year, I had to pass a state examination and extensive background check to achieve licensure. I basically DO what the RN says I can.

The LPNS where I work, MUST wear professional looking Scrubs. The RNS where I work where business attire.  If I were to get a low Pulse-ox on my patient while taking their vital signs, the RN on the premises, and sometimes there is only ONE for about 120 patients, could listen to the patients lungs with a stethoscope and interpret whether she THINKS the patient has an accumulation of fluid in the lungs, based upon the sounds she hears. I could not. She would be taken seriously if she were to suggest that a patient “appears to be in need of a xray of the hip” because of the fall that the patient took, whereas I as the LPN who found the patient FALLING, would not be.

But, in the MONTH that I have worked under the direction of LPNs with more “work” experience as an LPN then I have, and various RNs,have to say that the whole SYSTEM is so fucked up, that I don’t even know where to begin.  In the past two days at work ALONE,  I think that if I were to count on my fingers the amount of REALLY messed up, ERRORS made on the part of the Nurses that I work with, or UNDER, that I would NEED a few extra hands and that MOST OF THE FINGERS would go to the RNs. But we all have strengths. We all have stuff we can’t do. As humans, we just can’t be expected to keep a ton of specialized knowledge in our brains. I don’t expect that from my PHYSICIAN, I wouldn’t expect that from a nurse. What I expect is a BASIC working knowledge of the condition that you are treating. I would expect that a Nurse LPN or RN working in a facility with elderly people who are infirm, would KNOW that Troponin is a cardiac protein that is tested when a person is suspected of having suffered a myocardial infarction (heart attack). I would also expect either to KNOW that in many patients, women especially, that heart issues sometimes mimic indigestion. Thats why many die. They thought it was “gas”. The above example was about ONE patient and two nurses. One was an RN and one an LPN.

Today, in regard to another patient who is on hospice care at the facility, I was told by one RN to stop what I was doing. I was passing meds, and prepping a patient who had fractured her hip, over 24 hrs before and is also showing every sign of pneumonia there is, to get transferred to the hospital for what will probably be surgery and a long recovery from pneumonia, so that I can help her find the prescription for morphine that SHE misplaced, along with the other LPN that she stopped from her patient care so that the dying man can have the morphine.  The Pharmacy delivery guy is at the fucking door and won’t hand over without the script that the supervising RN doesn’t have because in a matter of hours has been misplaced. And that delivery guy  CAN’T hand it over, by law! It’s a SHIT TON of morphine too. The patient has already been waiting way too long past the last dose too.  There was some available in a emergency kit that we had the permission to give the patient legally, but the paperwork the RN would have to do would have just been too much effort to do. (I already had 90% of ready, per his order)

I found the script while Lady RN was searching through garbage cans, and had the other LPN look in the others. I pulled the chart out, I looked page by page, and I found SOME scripts, not the script in a plastic, see through, pocket in the front part of the chart and while it was not there, when I flipped the page of this see through pocket I see what looks eerily like a controlled substance script pushed in there, behind a paper already in there. WALLA! I rip it out hand it to her. She runs for the elevator. The Man RN steps off she hands it to him. Ten seconds ago all she could say is how “I am a dead woman if I don’t find this!” Yet when I found it and celebrated my victory, she handed it to the Man RN (who is also HER supervisor) She says “I found it”!  I hear this as I am halfway back to where I was working, and shout “WHO found it” She mutters something about how “Well, yeah she found it” She of course did not give herself the credit of “Well, she wouldn’t have found it if I hadn’t LOST it.” SHE is too educated for THAT.

But it was too late. They left already WITH the precious Morphine. But it did come EVENTUALLY but instead of the LABELS matching the order and stupid SHIT LIKE THAT I had to stand there and count 6 bags of ten little syringes with the morphine before I could run it to the dying man.

Then about 45 mins later, after I had already LONG given the morphine, and had ALREADY stopped because the labeled directions did not match the order the RN put in the Med Book, I went to check the chart where it was written, and I checked with another Nurse BEFORE squirting it in the patients mouth, the Supervising RN comes to me with another 6 bags each including ten more syringes, and says. “Count these, sign for them, then I have a test for you.” Without missing a beat, I say “If the test is how many did I give him, you are too late. I already saw the labels are fucked up. So since I am NOT an IDIOT, and since I am NOT gonna KILL the guy, I checked the chart and consulted another nurse, did the MATH and gave TWO for a total of TEN mgs of morphine. I guess I past the test”

“Yes! Good girl thats what you were being tested on” Sure. I think it was REALLY a test of whether he just LOST his License as an RN. NOT my test of “smarts”. So I passed for both of us I guess.

And the RN and LPN is NOT a distinction made by ME. It was made LONG before me. I say we just work as a TEAM, or here is a STRETCH, how about we work for the good of the PATIENT? Remember them, I know I included a few in here SOMEWHERE.

I am NOT an idiot. I know I will have many questions, NO one has the answers, but what was the fucking question again anyway?

Selfless act…one of the first too…

Happy Easter to all! There is a REASON that this day is the most revered in Christianity. Not that DEATH is to be celebrated, but a man who knew NONE of us here today was NAILED to a cross after being betrayed and tortured. WHY? Because his Father said it must be so. WHY? So our sins would be forgiven, and WE could have a chance at Paradise when the day comes for us. We celebrate HIS ascent to his rightful place so that we may one day. What selfless act have YOU performed lately? Doesn’t have to compare to that one, but think about it.

I am not the most religious person in the world. In fact, I don’t care much for “organized” religion. I live my life the way I feel is right and best. I do however believe that many could benefit from thinking about what Jesus did and why. Happy Easter.

Do your WHORING here…

To prevent pissing me right the fuck off with your BULLSHIT spam just to promote your fucking product or fucking useless service just drop your fucking blog name or whatever the fuck you want HERE ok. Save me some sanity. If its gonna be some bullshit that Google fucking translated from Martian all the better, I will have the complete fucking JOY of making fun of every god-damned word-so HERE is where you put what ever it is you want-ok? Lay a big steamer if you want.

All you would have had to do is ask. As pissed as I come off here, I am actually so fucking nice its DISGUSTING! I just can’t STAND when someone plays me for a fucking ASSHOLE.

Whore away…..

It’s a pretty SMART theory…

I have this theory. Since this is my blog, I get to write about it. You can chose to read it or not, but I chose to share it and I will do so right…NOW.

The theory is, are you ready? Adult attention deficit disorder is an acquired survival mechanism of sorts. Just like I know that there are events that WILL change the chemistry of a human brain, even down to the DNA, I am convinced that the same holds true for ADD. If depression can be brought on by events and cause a  change to the chemical makeup of our brain,and drug addiction can too, why not? I am a sufferer so I have PERSONAL experience. So let me explain how I came to this BRILLIANT conclusion.

Those of my generation are GENERALLY the first to be inundated with VISUAL stimulation, the likes that no other before it has EVER experienced. Example, TV. Yes, TV existed before my birth, but many people prior to my birth were not RAISED by it. Then the advent of video games and home computers. MORE to keep the brain going.

Then the stress of the GO GO GO lifestyles we have more so now. Our kids are overscheduled with activities, women that stay at HOME, rather than work are now the exception, rather than the rule. There is TOO much that we USE our brains for and well, I think that it is a juggling act of sorts. They are adapting, to try to keep up with all that we are throwing at it.

About ten or so years ago there used to be a commercial on tv for Stattera. The ad showed a woman at a conference table, at a meeting, and it showed clips like someone was changing channels on a television in her brain, making it impossible for her to concentrate. THAT was me. I swore it was like someone was broadcasting my thoughts, that I frequently experienced and they were doing it to show THAT IS NOT NORMAL.

You don’t know other than what you live. I did NOT know this was not how it was for everyone.

A few years after that commercial, I was overwhelmed by the anxiety that my husband’s illness had caused. I was also in the process of attending Nursing school. I had at that time been taking medication for Major depression. I would have times where I would sink so low that DEATH was something that I welcomed. My life was FOREVER changed when I FINALLY sought help for it. But as I got OLDER the attention issues WERE more of an issue than ANYTHING. It was at this time that I sought out counseling from a psychiatric Nurse practitioner who suggested that ADD was a major ingredient of the soup that is my brain. Made some sense, so I figured I will try the meds and see what would happen. Glad I did.

My work began to suffer. My organization skills, time management, were non-existent. But I do think MUCH of what I have experienced in life has CAUSED the issue that I have always had to an extent to become more pronounced. The being “Every woman” thing. Being two adults, sort of in my marriage and family. Having to adapt in home and work and QUICKLY.I have found that in times of the MOST stress, my symptoms are much worse. It is considered an Anxiety Disorder, like OCD and depression. I suffered pretty pronounced OCD as a child and well into my teens.  I think that it ACTUALLY altered my chemicals to where I NEED them controlled by an outside source.

That outside source being medication, USUALLY prescribed for an affliction thought to be a childhood malady. Nope. I am not a child. Yup, I take Adderall.

Dear Diary: How I, A Medical Malpractice Attorney, Lost Both Parents to Medical Negligence Pt. II--Mom

Reblogged from thebluesquirreldiary:

Christine, My Mother

Her body was betraying her in her 7th decade on this earth.  Scoliosis was ravaging her back and we were told she was probably born with it, but had controlled its eventual development with her extraordinary posture required of all the young girls of her generation.  Pain pills (Vicodin), pain patches (Lidocaine), too late for any surgical intervention. 

Read more… 2,124 more words