Fifty, and counting…

 

Bob at 240#

Bob at 240#

Actually, this image is closer to where I am now…

NurseBob_1

While it is some 15 years older, it’s closer to my current look. The weight is right, but I am MUCH more grey… As Billy Pilgrim would say, “So it goes.”

For the first time in the better part of a couple of decades, when I walk towards the mirror in the bathroom, I don’t cringe; in fact, I’m pleased with what I see. While not at the goal I’d set, I’m on the right side of the curve, and feeling I just may make it back to what I weighed back when a college student. FWIW, that’s still heavier than what the BMI charts indicate are “correct” for my height. However, those charts have wide error ranges. If I get down to 170+, I will be ecstatic. As it is, I am able to see parts of my anatomy that have been hiding for quite some time. And, more importantly, my wife is very, very pleased with my new, reacquired physiogonmy.
In short: On Track.

Stay well,

NurseBob

Educating Future RNs

A new semester begins…

Bob at 240#

Bob at 240#

This is my 4th semester teaching in the classroom, and the first where I’m not doing a clinical rotation. Last Fall I discovered that the challenges of six lectures and a clinical rotation coupled with 150 students. It was definitely a “live and learn – don’t do that again” grind. I find as I age that coupling two days of arising at 0400 with 12 – 14 hour work days is exhausting, especially when the rest of the week is spent in front of the computer for 8 – 10 hours reading papers, writing and proofing lectures, reading and responding to countless emails, trying to keep up with current research and trends in healthcare… I hate to admit it, but I’m getting too old to maintain that level of effort. Further, and this I freely admit, I don’t want to work that hard, nor do I want to work my life away; I have outside interests which have zero connection to nursing, and about which I am easily as passionate.

Yesterday was, and will be for the next 15 weeks, my “long day.” Up at 0400, on campus by 0700 (traffic depending), and then lecturing from 0800 to 1800.  My morning and late afternoon Nursing Pharmacology III classes were spent with the senior nursing students who I had in Spring of 2015 as second semester nursing students.  It was a joy to see them again, observe the increasing maturity and confidence.  Especially I enjoyed their increased willingness to ask questions; they were much more reticent a year ago.

Sandwiched in between were my latest wave of second semester students in Med Surg. It’s intriguing to see the different “group personality” each cohort seems to exhibit, as well as the individuals within the groups. One of my personal challenges, life long, has been recalling names. I’m always a bit embarrassed, but I am perpetually challenged to remember names. As one of my other acquaintances noted just the other day, I can be introduced, shake hands, turn and find I’ve already lost their name. As I approach the middle of my sixth decade, I don’t know if I’ll ever get this aspect of my brain to work properly. Sigh…

What’s new?  I’ve become both increasingly demanding of rigor in their work, and better prepared and organized myself. I think, for the first time, I will have all of my lectures, quizzes, case studies, and tests in place before I’m fully engaged in delivering that content.  Last semester I had the opportunity to take on a couple of new courses and found myself writing lectures and creating presentations in the morning for use in the afternoon.  Not efficient, and part of the reason I found myself continually playing catch-up.  This semester looks to be different.  Not to say the work is done; it’s never done. Just like software development, there’s always a new, improved, enhanced version.  But, just the same, I’m anticipating having time to pursue some of my other interests AND be a better instructor.

So, off to tweak Nursing Pharm II (same students in Med Surg with me), which happens on Mondays.  I look forward to offering them all the support, information, and tools to become the best RNs they can be.  After that, it’s up to them.

Stay Well,

Bob

T Minus 45 and holding…

Bob at 240#

Bob at 240#

Well, if your memory of “T Minus… and Holding” has you recalling NASA’s missions to land a man (uh, person) on the Moon, then you’re likely in my age cohort. If not, well you’re likely a bit younger than I.
Then again, from my current perspective the phrase has nothing to do with Space, NASA, or astronautical adventures. Once again it’s a weight reference. In this moment it’s my hovering around 193 lbs (87.72Kg or 13st 11Lb – I LOVE Scotland and the Scots!!!), which is a couple pounds away from 50 pounds lost. Fifty is neither my goal nor a magic number, but has become significant since I’ve been feeling stuck.

What’s up? Well, I’ve been hovering at that weight for most of the last week. And, “Why stuck?” you ask… Well, I’m struggling to stay on plan; struggling to increase my level of exercise from sedentary to not sedentary. Did I mention struggling to stay on the plan and not exercising enough?

’nuff said. The short, insight-less vision: some weeks are harder than others. This week has been one of the more challenging. In my last group meeting we were all to select a partner we could confide in. While there is an individual I would like to add as an understanding “sponsor,” he’s out of town. Hell, he’s out of country in Patagonia. So, I’m opting to use my other connections as part of my support network. Those would be all of you on FB, Twitter and Linked-in. I appreciate all the wonderful expressions of support I’ve received from all of you. While I may not always adequately acknowledge the support and comments, they are deeply felt and appreciated. Setting out on a more beneficial and insightful path, I have come to realize it’s time to use other additional resources and help. This is not something easily accomplished in state of emotional or social isolation, which is where I tend to go in times of stress.

Thus the work continues. Currently my greatest food/feeding challenge is when I have engagements that have me traveling in the greater Bay Area during business hours. I find I’m near OCD in my newfound desire to eat in places, and have dishes, I don’t normally care much about at all.

Where do these near-overwhelming urges and desire originate? Who knows? Is it just my physiological being, my body, saying, “Eat More! I need FAT! I need SUGAR! Oh, and a bit of protein would be OK too. Then again, is this related to my gut bacteria, my microbiome , calling the shots? Who’s in control, or out of control, here?

Short answer: I don’t know. All I “know” is, at times I am very hungry, and if I’m out and about, the temptation is overwhelming. On the other hand, and perhaps most importantly, I know you are out there on my side; rooting for me; and whether I want it or not, reminding me of the goal.

So, the story, and challenges of my weight loss journey continue, but not without a massive “Thank YOU!!!” to you all. You have no idea of how important and effective your support has been, and will continue to be… 🙂

Stay Well,

NurseBob

Mom’s Stroke – My Dilemma

Bob

On Christmas Eve, about 0900 I took a call from a nurse at the Alzheimer’s/Dementia facility where my mother now resides. At her current age, 94, I was not surprised by the news: “Your mother’s in her bed, unresponsive; her left side is flacid, and she’s not following commands.”

Before diving into the emotional challenges this presented, I want to reassure you that as of now she’s exhibited a near miraculous recovery, with only a minimal residual left-sided weakness, which has left her a bit more at risk for falls.

So, back to the story… Ok, of course if she’s “unresponsive” she’s not following commands, but as a nurse, I saw no conflict in the report. It’s similar to what I’ve reported to physicians regarding patients in the ICU under my care. It’s the jargon…
My in-the-moment analysis – she’s had a stroke, and a significant one. What’s unknown – is it a clot blocking the blood flow to her brain, or is it a ruptured vessel bleeding into her brain.

My sister and I are both designated as decision-makers for her health care if she’s not able or competent to attend to her own needs. And, importantly, my sister and I are in agreement regarding our understanding of how Mom wants life-threatening events dealt with if she’s not able to answer for herself. She wants no heroics; no last-minute efforts to stave off the inevitable as long as possible; she’s DNR – that is, Do Not resuscitate. Further, no intubation (breathing tube driven by a machine to breathe for her), no artificial nutritional support – that is, no tube feedings.

As I dealt internally with the likely impending demise of my mother, I busied myself in gathering and confirming the documents regarding both her health care, and how she wanted to be buried – well, cremated – and her ultimate resting place next to my father. And, of course, I sent off an email to family regarding the turn of events.

For those of you who may not already know, my mother has suffered a profound loss of both long-term and short-term memory, and while not diagnosed with Alzheimer’s, she exhibits many aspects of that condition. For the last two years she’s not recognized me, nor does she remember her marriage to my father. When I last introduced myself as “Bob, your son.” She commented, “How can I have children? I’m not married.” She has, at times, identified me as her late brother, but there is no recognition beyond that.

So, I’m ok. No last-minute life-saving efforts; let nature take its course… Then comes the real-life turn of events. Late that afternoon I get a report: She’s up and walking with assistance; not following commands; and is exhibiting an expressive aphasia – that is, she speaks, but it’s a jumble of words in a non-sensical order – “word salad.”

Prior to this report I was clear about my options, responsibilities and decisions. However, her condition at this point is something unanticipated and damn challenging. She is conscious but unable to understand incoming information and unable to communicate her needs and desires. My dilemma? She’s unable to express her desires; she can’t feed herself and likely won’t submit to any type of external feeding strategies (Intravenous, or, a tube in her nose, or directly into her stomach).

Now what? If I follow her expressed desires there is no feeding by staff, by tube, or intravenously. But… She’s going to potentially experience both thirst and hunger. Furthermore, she can’t say what she wants – remember the expressive aphasia (word salad), nor can she understand any explanation as to why she’d be denied water and food. And, she can’t understand an explanation – the evidence being her inability to follow simple commands.

Back to the present.  As I noted above, she’s back to her baseline.  She still doesn’t remember who I and my sister are, but she is able to feed herself, make her needs known, and move about without assistance.

I remain unsure about what how I might handle a repeat of her event.  What to do for someone who’s unable to understand incoming information, or express their desires, but with a previously laid-out plan for “no heroics” – no rescucitation; no life-extending measures.  We really never covered the scenario briefly experience over the Christmas holiday.

Stay Well

Stroke Resources:

F.A.S.T.
is an easy way to remember how to
recognize a stroke and what to do. Spot a stroke
FAST.
Face drooping.
Arm weakness.
Speech
Difficulty.
Time to call 9-1-1

Stroke – Stanford Health Care

 

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42… :)

Bob
42? Why does that get a smiley? Well, ask Douglas Adams, or read his book… According to his fictional characters, 42 is the answer to to life, the universe and everything. If only…

For me it’s a milestone in my quest to return to a smaller, former self. As a result of my medically managed diet, and my adherance to the diet (well, 98% of the time), I’ve now lost 42 pounds. More than halfway to my goal of 70 pounds. If/when I get there, I’ll be back to my high school weight, which is where I was supposed to stop, but didn’t/couldn’t.
Coupled with that happy achievement my wife and I took a Christmas/New Year’s vacation to Santa Fe, NM, whereupon I not only did not gain any weight, but managed to lose a couple more pounds. Not bad for both a vacation and the Holiday Season.
Other benefits: New/Old wardrobe: Clothes I’ve not fit into for years (maybe decades?) now fit. 🙂

Thus, while I did not strictly adhere to my meal replacement diet while out of state – my cousin’s wife’s New Year’s roast beef dinner with poached and caramelized pears for dessert was too inviting to ignore, it did not stop me from returning home lighter than when I left!!! 🙂

Stay Healthy