Wow! What a year this has been and with each opportunity and
experience I have been able to share, I have the ADVANCE community to thank for helping me to grow and be a better
professional. I have met so many wonderful people who continue to offer support
and challenge me with my every day struggles as an NP working in corrections.
Over the past several months I have had wonderful
experiences attending my local association of advance practice nurses as well
as regional conferences. I enjoy education and learning, and the venues are not
bad either. I look forward to these meetings because I can interact with
like-minded professionals and the education is phenomenal; I strongly encourage
new NPs to join.
While working in corrections and even taking calls for the
60 nursing homes as my second job, I do not have the opportunity to interact
with other physicians and representatives and at times, I feel like I am missing
out. I once heard that NPs are transient, meaning they only stay in a job for
about two years; I really do not know if that is true. I have met several
professionals who were in positions that were not a great fit, and possibly for
some it takes several opportunities before that happens.
There have been some interesting changes over the year: the
ability to prescribe Schedule II medication is a significant one, but I have to
admit the education required is confusing for me, so I have taken the six hour
course and any continuing education I can through the AACN and AANP.
Another change that has come for me is my resignation to the
correctional facility. Initially, this was a great fit for me. It has been a
great first job, but as life goes there have been many changes. First, with the
release of the contract of my collaborative physician and the hire of the current
suggested by corporate that it is not about quality.
While I continue to keep in contact with staff there, it appears
that it has gotten worse. The most recent is thirteen inmates were admitted to
the hospital over three days. This never happened when my first collaborative
was employed, nor when I was there and I do not want to be associated with this
type of neglect. Also, there was a female who had been incarcerated for over a
month. It was reported she became ill after overdosing on an "over the counter
medication." She was rushed to the ER where she died.
The coming year for me will be that of reflection
and hope for a better year; I am starting over. I am approaching my career
optimistically. I know I will find the fit for me, so in the meantime, I have
decided to focus on me, my health and my education. Thank you ADVANCE community for your support. Merry Christmas and Happy New Year!
Time, because of its duplicitous intangibility and
quantifiable nature is, to me, a perennially elusive phenomenon. You can
measure it but you can't hold it and yet it dictates the rhythms of life. While
I reflect on these ephemeral characteristics, the advent of 2013 ushers forth
the commencement of my second year as a Nurse Practitioner.
I still feel every
ounce the neophyte but am pleased to share with any new clinician that as the days
pass a feeling of authority and competence will slowly replace the choke hold of
anxiety associated with the responsibility of diagnosing and treating patients.
From one new practitioner to another, I have included some
tidbits to help surmount the inevitable challenges associated with this work
and ultimately dominate the passage of time.
Happy New Year! May 2013
bring you and yours health, wealth, happiness and much love.
your research and shadow another NP during their routine work day before
deciding to accept the job
for CME funds as part of your hiring negotiations
resources like Uptodate often
your job in the same studious manner that you approached your exams: this means
a lot of reading outside of work
ask for help
up with your patients, their labs and their imagery studies
familiar with the medications you most often prescribe, e.g. dose, drug interactions,
side effects, safety in pregnancy, duration of treatment, frequency of
work to refine and improve your documentation skills
the position if you don't feel well supported
prescience, always think about where you are now and where you want to be in
your practice - set both short and long term goals
forget, nor overlook your nursing background
Every day is an adventure at the correctional facility and
at times it is not from the inmates. Oftentimes, it is from the person I like to call
"The Lovely Doctor." I do not know why I call him that, but maybe it is because
it is the nicest name I can call him...yes! It is sarcasm at its finest.
One of the perks that has been rescinded while working downtown
is our prime parking spots. Due to intense construction and what some call
progress, the courthouse staff and medical staff have been relocated
approximately 2 miles away from the facility. The up side is, we still do not
have to pay for parking and we are being shuttled to and from the parking lot.
I always try to find a positive in a changing environment, and I have. While
we are shuttled to the building, I walk back to the parking lot which is a
great way to unwind at the end of a long, trying day and get exercise at the
Now back to the lovely doctor: One rainy day I decided to
wear a ball cap and I spoke to him when he boarded the bus. When we exited
the bus, I slowed my pace to match his. Clearly, he did not know who I was, so
I hastened my pace and entered the building. While I was preparing to see the
patients, he came to my office and asked, "Was that you in the hat?" I had to
laugh because I did not realize a ball cap was such a great camouflage
My collaborative calls in sick at least once or twice every
other week; he informed me, "I know people don't think I have been sick." I did
not say anything to that. Back in the summer, my collaborative called in sick
because he went to an amusement water park. When needing to use the facilities,
he forgot to wear shoes. He stated, "I burned the bottom of my feet!" I asked,
"You didn't wear shoes?" He is a piece of work.
Two weeks after that call in, he called in and proceeded to
tell the secretary, "I had to pull along the side of the road and throw up." The
secretary said, "Ok, ok, that is a visual I did not need," especially since she
was pregnant. My Health Service Administrator says quietly she hopes this
nonsense won't last much longer, but it will because the corporate office has
not received any complaints. My collaborative states, "I have been waiting all
my life to find a job like this," and unfortunately he will probably be around
a long time.
I wrote a blog much earlier this year discussing the
importance of abstaining from treating asymptomatic UTIs while making a
feeble attempt to include a Harry Potter reference. This past week, a favorite
patient of mine, an older woman who has been hospitalized repeatedly for an
ESBL UTI and bacteremia called our office in a panic.
She was scheduled for a cystoscopy and her urologist
requested that she have a urine culture performed in advance of the procedure.
Her urine culture revealed an Enterococcus species that was resistant to
everything except for Vancomycin. This is a problem.
Vancomycin can only be administered intravenously in the
setting of treating Enterococcus. Plus, she was totally asymptomatic: no
dysuria, frequency, urgency, supra-pubic pressure, pyuria, hematuria, fevers,
rigors, nada. This means quite simply
that her bladder is colonized with Enterococcus. While not optimal, this
is not a problem that warrants treatment.
Do you treat an asymptomatic octogenarian with multiple
comorbidities with a potentially nephrotoxic medication? The answer is no,
unless the goal is to insure categorical antibiotic resistance.
Over the past month I have had some very challenging
patients. I will often question, why and how did someone end up here at the
correctional facility? I believe it is better I do not know. Actually, it is
none of my business; it keeps the care unbiased and pure and it does not impact
how I treat them. If one of the inmates upsets the correction officer (CO) or
even the nurse for that matter, they have access to a program called JMS, which
stands for Jail Management Systems. I thankfully do not have that program on my
computer, but that program lets anyone with a password have access to the mug
shot and the crime.
Do you recall how it is politically incorrect to say, "I am
taking care of the pneumonia patient in room 203." Well, that is what staff will
say at the jail, such as, "The prostitute is back," or, "The heroine abuser has
returned," or worse! I also have seen staff (COs and nurses) bring up the
pictures of the inmates and remark on their mug shots.
There are some interesting individuals at the jail. One is a
24-year-old female who is mentally challenged, legally blind, obese and lives
in a group home. She is one of my chronic care patients; she has type 2
diabetes, hypertension and newly diagnosed hypothyroidism. "Theresa" (not her
real name) is very sweet; when I met her, she was escorted by one of the female
guards. I introduced myself to her and from there on out, I was Miss Beverly.
The curiosity got the better of me - I had to know why she
was there. I asked one of the nurses, who is very caring, and she told me:
Theresa became disruptive over a promise that was made to her. She was told she
would get a snack and the promise was withdrawn and she took the snack herself.
She was arrested for disruptive/unruly behavior to staff and another resident
at the group home. Prior to me seeing Theresa, she was housed in our medical
unit to keep an eye on her. My lovely collaborative physician eventually had
her moved to general population.
When I saw her, she was scared stating, "I think I am going
to die." Well, that's not good; she had also gained almost 10 pounds in fluid.
I moved her back to medical, and put in place orders to weigh her daily, give
her Lasix, compression socks and lab work. Afterwards she asked, "Can I have a
treat?" Here is the problem: I created a
little monster! Knowing she did not have any money on her books, for the next
three days I would give her healthy snacks and every day she would ask for me.
Every day and at least (no kidding) five times per day she would ask for
me. I told the Cos to tell her I was not there; I could walk right past her if
she was waiting for her blood pressure to be measured and she would not see me (remember,
she is blind). I know that is bad all the way around, but her numbers were
improving and she was beginning to lose the water weight. She did however catch
me once while I was seeing a patient and she walked into my office (diabetes
testing is adjacent to my office). I politely informed her that I could not see
her. She of course understood. One week later , I am happy to report she served
her time and she was released. No more hiding!
I was going to write a blog about neuro-syphilis because I just
recently treated a 29-year-old patient for this condition, however, on
reflection it seems more apt to discuss the enormous financial costs associated
with her care. That being said, neuro-syphilis is a tricky diagnosis; I advise clinicians
to read up on it.
Syphilis is commonly referred to as the great imitator. In
the case of my patient, she presented with symptoms of meningitis. As we began
to peel back the layers of her presentation, we had to consider various
etiologies to explain, understand and ultimately treat her persistent meningeal
irritation. Bacterial? Viral? Was this a vascular problem? All of these
considerations necessitated corresponding tests and extensive lab work, not to
mention specialist evaluations (including us - the ID folks - as well as
neurology) and a lot of antibiotics.
She spent nearly three straight weeks in the hospital. That is
costly for any person, but she was without healthcare insurance coverage. Her
condition mandated treatment; failure to do so could have caused irreparable
cerebral damage and possibly death. Nonetheless, I cringe to think of the cost
of her care and the tidal wave of bills destined for her door. Likely the
hospital will absorb some of these costs, but that seems like a totally
inadequate solution. There has to be a better way.
I wonder how many other providers, new and old, find they
are influenced by the cost of providing care to their patients. Is it best to
restrict the quantity of tests in attempts to spare the patient financial ruin?
In the age of CYA practice, should cost be relegated to the lowest rung of
consideration, financial health be damned?
It's ironic that I wrote my last post on October 15, 2012,
the 1-year anniversary of my one and only job as an NP.
What a year! Or, rather, what a year and a half! The worst
of times, yes (the end of a 30-year marriage in June 2011), but also the very
best of times (Duke MSN/FNP in May 2011, certification in September 2011, dream
job in October 2011), and everyday a new adventure of the heart and mind since!
As noted in a previous
post, I've been remiss in submitting posts due to time constraints. With
each new experience I'd think "This is a good topic for the blog," but had
little time to think it, feel it, or write it. So many patient stories - still
mainly uninsured, being seen on the MAP program ($5 paid by the patient, $67 by
the grant), in for establishing care with jaw-dropping blood pressures and
blood sugars. Everyday a new condition presents itself - reflex sympathetic
dystrophy; fibromyalgia; pityriasis alba or rosea, and a host of other
dermatologic conditions; ophthalmic herpes zoster; pancreatitis; cholecystitis;
absence seizures; iliotibial band syndrome; asymptomatic enlargement of
clavicle (more common than one would think). And despite not being the most
dexterous of individuals, I now average 20 to 25 Paps a week, and am certified
in IUD/Nexplanon insertions, with colposcopic exams to follow.
It has been a busy, fulfilling year professionally, and quite
a fulfilling one personally as well. Clichés are often truisms, and as one door
closed, another one indeed opened. I am as happy as I have ever been!
Now, the dreaded "there are so many people to thank!"
Thank you, Bev and Sam, for your
inspiring companionship in the blogosphere. Last but not least, my deepest
gratitude to the faithful readers of our blogs for your always encouraging,
thoughtful and insightful comments. You were often the one bright spot in a
long, hard day! I wish you all every success and happiness, and a lifetime of
fair winds and following seas.
There was a disturbing incident
that occurred a few weeks ago. I also look at this experience as an eye-opener
for me. I have long come to this realization, but it was never more evident
than when the incident happened. First, let me start off by stating, prior to my
opportunity to work in corrections, I was judgmental and biased and I thought
very little of the people incarcerated. I said and thought some very harsh
things. Now, working in this environment, I am glad I am here because I find it
rewarding every day.
Now the incident: My health service
administrator came to me about a grievance that was filed against
medical; she found it valid and asked if I would see this young lady. When I
spoke to the young lady, Ms. J., I found her to be very sweet, soft spoken and
apologetic for having filed the grievance; she felt the medications she
normally would receive were inadvertently left off of her medication list. Ms.
J., I found out, has a movement disorder, which was diagnosed according to her as a pseudo
seizure. This young lady had been to the emergency room numerous times, had
seen a neurologist at our local university, and finally went to Cleveland Clinic,
where the recommendation was to consider a neurostimulator to help control her
I must admit, I was not familiar with a
movement disorder, but the way she described her history, I had no reason not
to believe her. I placed her on the medications she stated she takes at home,
and for the medications we did not have, I allowed her to call her family to
bring in her medication (she takes Zofran sublingual; we do not have this on our
formulary). In order to prevent the muscle spasms and seizure-like activity
from occurring or reducing the incidence, I put in place a clear care plan of
the medications she was to have. One of them was Ativan intramuscularly.
Here is the disturbing part: every day after I
implemented her medication regimen wuth Ativan, the nurses would say, "She is
faking! She has a seizure every day at the same time!" "She is drug-seeking. She
just wants the Ativan shot!" I was very upset by this; I thought, who in the
heck do these people think they are! For Ms. J., stress, I believed, was
bringing this on. The next day Ms. J. asked to see me. She proceeded to tell me
how mean the nurses would treat her, and as she was telling me about the
occurrence, she went into this spasm where her neck had the appearance of
torticollis, and her mouth became very distorted with spasms. Her left arm and
leg would contract and she would have very small tonic-clonic movements. She
could still speak (not well) and hear, but she was struggling. It lasted over
I consulted the mental health physician
whom was very supportive (my collaborative had called in sick...again!). I tried
to tell him what was going on, and I was crying! I felt so helpless, and here
are these ignorant nurses (I am sorry audience)...you cannot fake this...who would
say mean things every day about her when she could still hear them. She would
tell me every day the things they would say. And they call themselves
professionals. Even the corrections officers were more caring towards Ms. J.
when she would have an episode; even they had a plan in place if she would have
I am happy to report two things:
her exacerbations/episodes have decreased since we put the medication regimen
in place, and she is scheduled for release in three days! That entire
experience was an eye-opener for me. I tell the nurses, let's leave the
corrections and discipline to the correction officers, and judges. I am not
here to judge.
I was before, but now I am an even greater advocate of the
pill box. Every patient with a lackluster memory, or taking multiple
medications, or time sensitive medications should own one. There is nothing
better than a physical reminder to keep a body on track.
I was recently confronted with an HIV positive patient on a
cocktail of anti-retroviral drugs that routinely forgot to take them or
sometimes would take them all twice in one day because they would forget if they
had taken them. Needless to say this is a bad habit...especially when the drugs
you take are both life saving and highly toxic if taken incorrectly.
Hence the brilliance of the pill box. I like to think of it
as a classic NP solution: inexpensive and efficient. Pillboxes are super cheap,
but oftentimes if the clinic is open to pharmaceutical reps, it doesn't hurt to
ask the reps if they can schick you some. As I grow, ever so slowly into my
practice, I have come to realize that logistics are an integral part of my
True friendship is a tremendous
responsibility, a responsibility that I do not take lightly. My best friend has
wanted to return to school for many years to pursue her master's in education,
but due to life (married with children, work, financial) she postponed it until
now. She states she has never been a good writer and looked to me for help. While
I want to return to school to obtain another degree, I have found myself
literally back in school helping her. I am not complaining; it feels very good
to help someone and introduce them to the world of an advance degree.
So for the next ten weeks we will
be meeting to collaborate on writing papers, posting assignments and challenge
fellow students' postings on blackboard. Online education is new to my friend
but I really enjoy the virtual connection you can develop with a variety of
nurse professionals. On September 11, 2012 we met at the McDonald's to talk
about a paper on nursing theory until they kicked us out! This may sound
strange, but it was so much fun having the paper come together; we were high
fiving each other and laughing because the words flowed, and I could not be
more happy for her because one week prior she was doubting her decision and
So the cheerleader in me had to
route her on. I truly believe if I can do it anyone can, it just takes the
commitment, determination, goal setting and visualization of the prize. I
decided to share this with my collaborating physician and I may have stated it
like, "Yeah, my girlfriend needs help with writing papers, I guess I am back in
school." His comment was, "Sometimes you just have to tell people no."
Really?! I do not think so; his words
left a bad taste in my mouth. How meaningful is my education if I do not help
someone who needs me. I am so glad when I needed help in school, I was not told
no. There are many nurses who have the drive, knowledge and expertise but not
the degree they need to advance, and if I can bring someone along I am very
willing to do it. My friend was very concerned about the online community and
mastering all that it has to offer. I told her in no time you will be a pro,
and it just takes time and patience.
So as we enter into week two, she is
getting responses and she is accusing students of "stealing her comments and
articles" and twisting them around (to me) and she is having anxiety again, so
the cheerleader directed her on constructive discussions and thoughtful
responses. That is how you obtain a healthy dialogue; that is what makes us
nurse scientists and professionals. Sigh...eight more weeks to go.
Lately it seems a rash (no pun intended) of patients have
asked me how it was that they contracted their Staph infections. Some had MRSA,
others MSSA. Some suffered from bacteremia, others osteomyelitis, and others
still were challenged by skin/soft tissue infections in the form of painful and
unsightly abscesses. Some had recently undergone surgical procedures, some have
a history of IV drug use, and others had not set foot in a medical facility in
years - which is to say, they didn't have any recent, relevant past medical
history that correlated well with their current diagnoses.
Where to begin? Or better yet, how to answer an unanswerable
question? With the exception of the IV drug user, it is impossible to say with
100% certainty where and how patients contracted their infections. This is both
a tough pill to swallow and dispense.
In the event that they have recently undergone a surgical
procedure, likely the infection is the consequence of that procedure, or it was
most certainly conducive to its presence. When I inform the patient of this
reality it is as if they have never, ever heard of any risks associated with
surgery. The follow-up question almost always goes something like this:
"So I got this
infection in the O.R.?"
To which I must answer, "I have no idea, and likely we will
never know, but infections are definitely a risk associated with surgery."
"So if I never had
surgery then I wouldn't have this infection?"
"Again, we will never know, but any time there is a
perturbation of the skin, like when a scalpel makes an incision, you run the
risk of introducing bacteria that exists on top of the skin inside the body and
this can cause various types of infection."
Trying to explain the phenomenon of colonization is cause
for even greater consternation. Thank goodness for the CDC. I often solicit the
website's patient information; why reinvent the wheel?
But moving forward, I do
find that one common denominator and subsequent risk factor for infections is
uncontrolled diabetes mellitus. This commonality is something that makes my
inner primary/preventative care provider's heart beat faster. I eagerly
champion this detail because it provides the patient with some kind of concrete
information and affords me the opportunity to engage in some good old fashioned
While I never say that any infection is the direct
consequence of a patient's diabetes, I refuse to overlook its contributions.
Ultimately, if delivered kindly and intelligibly, this connect the dot exercise
is empowering and illustrative. An NP should never pass up the opportunity to
practice health promotion; it's what makes us great.
"America has spoken" says Nick
Cannon from America's Got Talent and the winner is: The American People! This
is the feeling of many when the Supreme Court ruled that the Patient Protection
and Affordable Care Act (PPACA) is constitutional. Are the American people
really winners? Absolutely!
As the healthcare reform unfolds, nurse practitioners
are poised to meet the challenges of emphasizing health promotion, disease
prevention and effectively managing chronic disease. Approximately 80% of nurse
practitioners provide primary care services by delivering the highest quality, cost-effective
treatments to the population.
This also means more creative job
opportunities for nurse practitioners and physician associates alike. The PPACA offers an increase in
development of nurse practitioner recruitment and incentive programs addressing
the shortage of primary care providers. Hopefully this act will result in less
over-usage of the emergency departments and more responsible use of primary
care providers and clinics.
Working as a nurse practitioner in an Ohio
correctional facility, these individuals abuse the system. The goal while people
are incarcerated is to educate, teach responsibility, and when they are
scheduled for release, provide clinic appointments and prescriptions.
With the passage of this bill,
nurse practitioners will receive better reimbursement by Medicare and Medicaid,
and an increase in prescriptive authority, especially since the passage of
Schedule II prescribing; SB-83 was recently approved in Ohio by Governor
Kasich. Yes, everyone wins when everyone has access to care.
My contact with pain patients was extensive during my
residency in Aurora, North Carolina, a coastal town of about 400, with a
patient population compromising of retirees, commercial fisherman and
above-ground miners from a phosphate mine. I knew from that experience that
even if I never found a job as an NP, I would not choose to do pain management.
Of course, pain management is an invaluable specialty, but in its practice a
few bad apples spoil the whole cart. So much unproductive time is necessary with
these patients, who are tangential by necessity (talking around what they
really want) and, well, manipulative (getting me to give them what they want).
Since I started my job as a new NP at the health department,
I've had many "establishing care" patients whose chief complaint is "pain." The
usual outcome of such visits is that what I can offer for pain syndromes -
NSAIDs, muscle relaxants, tramadol, and/or gabepentin if there is a nerve
component - are inefficacious. When questioned what had helped in the past, the
answer would be one of the opiates. In many instances, all the non-narcotic
pain medications are listed among "allergies/intolerances."
The saving grace at moments like this is to inform these
patients of the "No Narcotics" policy instituted by an MD who was three
providers before me in the last 2 years. It's probably obvious in the small
community that I serve -- word gets out that there's a new provider in town who
may not have heard their stories before. They have no way of knowing, of course,
that the state's substance reporting system contains information on every
controlled substance prescribed for and filled by a patient with a mere entry
of a name and date of birth. We also request prior medical records from one of
the 5 primary care providers in the district and oftentimes these same patients
have been fired from their practices for abusing pain medications.
For those with insurance, a local surgeon whose practice is
a bit slow offered to take on my pain patients, although even he has stopped his open door policy and
will now review a patient's chart, and even conduct a personal interview,
before he will take one on. He has turned down three of my referrals in the
last 2 weeks. He has obviously discovered that even with a pay source it's not
Despite it all, during these "establishing care" visits, I
do manage to divert their attention long enough to discuss preventative care,
and the free programs and discounted labs offered by the health department. Surprisingly,
many of these patients, both male and female (males predominate), have remained
with me for their primary care. In fact, my nurses tell me that I see many more
male patients than any of the previous providers had seen.
If I'm sounding a bit cynical I don't mean to be. It'll be 1
year into my job and I still wake up every morning feeling that I'm the
luckiest girl in the world. I do feel "old before my time" in terms of my
NP-hood, but in a very good way!
I don't know how many of my fellow NPs and PAs have seen and
or heard about HBO's four-part documentary on obesity in America, The Weight of the Nation, but I can't
recommend it enough: it is an awesome and totally relevant examination of
health in the States.
So many of the individuals profiled in this series were reminiscent of patients
whom I have treated for various infections complicated by their obesity and
corresponding chronic illnesses, namely diabetes mellitus and hypertension. The
series thoughtfully, dare I say poetically, illustrates the interconnectedness
of disease states, infections and obesity.
I am confident that most of the information presented in
this documentary is not new, nor novel to many of the NPs and PAs who choose to
watch it, however, the startling extent of the problem may compel you to
initiate more conversations about weight loss and lifestyle changes with your
patients, irrespective of your specialty or practice.
While I appreciate that a documentary on HBO is not
tantamount to staying up-to-date on scholastic research via journals and
conferences, trust me when I tell you that this documentary showcases the
talent. Most of the experts interviewed for this series preside over some of
the most elite research institutions this side of the Atlantic. So it's not
like watching the dumbed down Hollywood version of an excellent novel, rather
it's like watching the authors read their books aloud.
Costs for healthcare are rising. There is not a revelation in
this statement, but as providers, we have to be mindful of the dollars we use
because it affects raises. My former mentor would drive that home for me. When
I would order a test, she would ask, "Will that test change your treatment
plan?" And if I responded with "no" then she would state, "Don't waste the
She would follow with, "I am trying to get a CT machine for the
facility." It would be nice, but it will never happen. Diagnostic imaging (CXR)
has been sufficient and if advance imaging was recommended from the
radiologist, the individual would go to our area hospital for further testing.
But again, if the treatment plan is the same most likely the individual is not
going anywhere. Do you ever feel like you are part MacGyver, Houdini, and
I have said all this
to describe a thought I had while caring for an individual who had used toilet
paper to clean his ears, and now cannot hear. He admitted to cleaning his ears
with toilet paper and the end of a pencil stating, "I think the toilet paper is
stuck in there." Without an otoscope, I could see the foreign body in both ears
and it was hard as a rock! So I decided to make a mixture of liquid Colace and
Debrox and instilled into his ear canals and let him sit for 30 minutes.
After the time had elapsed, I flushed his ears with warm
water and hydrogen peroxide. I thought of all the creative things we as nurses,
NPs and PAs have used to save on cost, time and just to downright get the job
done. For Example, Colace, the stool softener, really works to not only soften
fecal material, but cerumen, paper, and erasers from pencils. I have used
Metamucil for not only a fiber supplement to bulk one's bowel movements, but I
have also given it to my patients as a gentle facial scrub for those
individuals with acne.
Selsun Blue, the shampoo, is a wonderful mild body wash for
individuals with dermatologic issues. Toothpaste has been used for acne
pustules. The condiment mayonnaise was used recently for a lice outbreak we had
in the pregnant population. Calcium carbonate/Tums has been used for a vitamin
supplement in those who do not drink milk, and in this population they are
indoors and they do not get any sun exposure. Tongue depressors are used for
splinting fingers, and topiramate for weight loss and when the individual
states they have migraine headaches.
Even though I do not condone this behavior, individuals have
used the end of a pencil eraser for ear plugs, hence the problem at the
beginning of my blog. I have even used suture material to lace a cracked
plastic slipper; they were not on suicide watch. If there is anything you used
in the clinical setting where you repurposed a treatment or item to help with
costs, will you share it with me please? I love MacGyver!