Once you have decided on a planner, you will immediately start thinking of ways to use the Notes Pages in the back of the planner. Below, I show you pages from my own planners over the years. Some of the other ways I have used my notes pages include:
📝 ✍️ Happy planning!!! 📒📚
I do want you to listen to the podcast, because I think there are some big pearls in this interview, but here are a few highlights:
Find out who is in your circle:
Plan as much as you can ahead of time:
Final pro tips:
-Keep a medical binder of all your paperwork
-Have a designated inbox for all incoming papers (follow The Planning Woman for more on this)
-Apply for intermittent FMLA with your employer
-My personal pro tip: PET THERAPY! 🐶🐱 Charlie the Dachshund makes everything better!
In olden days your last name often described your family’s occupation and reflected your status in the community. The Bakers baked bread. The Carpenters built things out of wood. The Smiths crafted items from iron, silver, and gold. For as long as I can remember I’ve known I was adopted, so my family name was not my own and seemed to reveal nothing about me.
That’s not to say I wasn’t treasured as a longed-for baby adopted at nine months and an adored only child until I was six when my adopted brother joined our family as a four-year-old stranger.
Let’s say my family’s name was Farmer. Although I was unconditionally loved by the whole Farmer clan, I never felt like a Farmer. My mom had a laid-back temperament. Mine was more intense. My mom liked to sew. I had no inclination as a seamstress. Fitting my dresses, she often commented on my wide shoulders and narrow waist, so unlike her own figure.
When I was in fourth grade, I discovered I had a different first name before I was adopted, and growing up, always wondered what was behind that name. Who were my people, and what were they like? (For the details of that fourth-grade episode, see my blog “Carried.”)
Out of respect for my adoptive mom and dad, however, I never searched for my biological parents while they were alive.
But when my adoptive parents passed away, my husband said, “Your bio mother and father are getting old too. If you want to find them, you better hurry up,” so we opened the green metal box always kept in the downstairs closet of my childhood home and dug through official papers to find my adoption agency.
When I read the family history they shared, I discovered a great uncle was active in community theatre, and so was I. Another great uncle was a teacher of foreign language who later became a diplomat to Uganda. I got my masters in language, literacy and culture, and my favorite job later in life was teaching English to brand-new immigrants.
When I finally met my bio mom, she invited me on a family vacation. We walked a Cape Cod beach, and I marveled that her body was shaped just like mine. My husband videoed us chatting, so I could see how our animated mannerisms mirrored each other. She shared my grandmother's favorite flowers were lilacs, my favorite scent, and that my grandmother was a DJ for a classical music and public affairs radio station. I’d just gotten into opera, but when my mom played my grandmother's favorite arias, they were mine. The icing on the cake was when she told me, a writer, that my great, great, great grandfather was Nathaniel Hawthorne.
Recently, my husband urged me to do a 23 and me DNA test, to locate my bio dad's family we’d never been able to connect with. As a result, I found a bio half-brother and subsequently the rest of his siblings. Neither of my maternal half-sibs look like me, so when I saw my paternal half-sibs, I was stunned. Let’s call my father’s family The Jones. There was no denying I was a Jones.
Recently someone told me, “Trauma can be not only something bad that happened to you, but the lack of something you desperately needed.” This average family resemblance flooded a gaping void I was unaware of. In fact, I felt more connected to the half-brother I just met than to my adopted brother who’s felt like a stranger all my life.
All this to say, whether you’re adopted or not, there is power in knowing your name and everything behind it!
My adoption simply highlighted the security of being connected to your family by blood, seeing your image reflected in another, and understanding that the way you’re designed is clearly a gift from God, above and beyond any influence from your environment.
I didn’t realize how much I needed to be acknowledged by my real father. Without a father you are unclaimed, unnamed, and unprotected from the shame that labels you a misbegotten, out-of-wedlock bastard. Harsh, but those words are synonyms for illegitimate, the term that lived just beneath my skin my whole life.
That’s why my most important name is still not my own, but it reveals everything about me.
Under the banner of Christ, no matter my origin or circumstances, I am a chosen, holy, beloved member of the family of God with a blood connection to Jesus, the first born of many siblings. Together may we reflect his image above all others for the rest of our days.
Thank you Ann for your beautiful words and vulnerability. May God continue to bless you and your family.
What's in a name?
I have been married twice. I dated my first husband six years before we got married, and we were married 7 years. We didn't have any children.
I've been married to my current husband for 12 years now and we have raised 3 children together. My step-son was 7 when we got married (19 now and out of the house), and our boys are 9 and 11.
What is bizarre is that neither of my husbands have a very close relationship with their fathers. In fact, I have never met either of their fathers. To take that even further, I have never met a SINGLE person on either of their father's side of the family. So... to put that into practical terms, I have had a last name for 19 of my 45 years that really had no "meaning" to me. My first husband was the only "Smith" (not his name, but just using as an example) I knew but then I carried that name. My second husband is the only Cobb I know other than our 3 children. Let that sink in for a moment.
This has made for some very awkward life moments:
Since I'm really into family in general, and I love old family names and family history, I bought my parents an Ancestry.com kit for Mother's or Father's Day one year. I also bought one for myself and my husband. I love looking back at all of our relatives and heritage, but building my husband's family tree has been difficult.
This has led me into some deep thought (doesn't take much for me to go deep 😜).
In my opinion, a name carries weight. Identity matters.
Having always worked in the medical field, my name is something I sign every single day.
I prescribe medicine so it appears on prescription bottles and insurance claims and lab and imaging orders. Nurses answer the phone "Amy Cobb's office, how may I help you?" I am listed as a primary care provider for about 2000 people. I don't mention this as if I am anything special. I most certainly am not.
But do I feel odd having a last name plastered all over HealthGrades and pill bottles when I have no physical, emotional, or spiritual connection to the name? Yes, I am married to a Cobb. But what makes him a "Cobb?"
I can't grin at my husband and say "you laugh just like your daddy." I can't look at my boys and tell them they have the Cobb nose or the Cobb stubborn streak. I can't say "boys, your grandfather would have loved to see you hit that ball, march that field, fix that jet." I don't know any Cobb recipes or Cobb traditions. I don't know if or where they went to church, what music they loved, or how they earned a living.
And so again, is this how fatherless children feel? What about the motherless child? Is it the name that carries the weight or the connection itself with a parent, a heritage, a history?
For my adopted friends and patients, what does their adopted name mean to them?
Is it a name filled with love, hope, and acceptance or is it a daily reminder of what could have been and what may never be?
Not knowing anyone else with my name is a first-world problem. I realize that.
But it is a thing.
I'm learning to acknowledge my "things." I'm learning to feel those feelings, name what's missing or hurting, and process what thoughts can do to my body.
Is this shame I am feeling? Regret? Did I even do anything wrong? Who is to blame - or is blame even required?
Another ebb and flow in the circle of life, the jagged bonds of connectedness that barely keep us together - sometimes by one single strand of a lineage.
I reached out to my writing group to see if any adopted writers had a perspective about the meaning of a name. Ann C. Averill wrote a beautiful piece about her experience with her name, and I am happy to feature it as a guest post on 10/12/21. Thank you, Ann, for your bravery and vulnerability to share with my readers. ❤️
I was pretty sure an acorn grew into a tree. I haven't been in first grade for a while, but I thought I remembered an acorn grew into an oak tree.
I decided I better look it up before I wrote an entire post about it, and alas... an acorn does grow into an oak tree. Wikipedia expounded upon acorns being used in art, cuisine, customs, and as food for various birds and mammals.
When I took the picture of the acorn in my husband's hand this morning, I wasn't thinking about anything but stored potential.
I remembered squirrels collect and store acorns for the winter. And they eat the acorns. And those eaten acorns never reach their calling of becoming a beautiful oak tree.
There are all kinds of books and stories and even a finance app regarding the acorn as a tool for storage, delayed potential, growth.
Here we are, scrolling on our phones or our laptops or our tablets (thank you, dear readers, and I do mean that)...
Did we write that book we wanted to write?
Did we take that ballroom dance class we wanted to take?
Did we belt it at karaoke night like we'd been rehearsing with our brush mic in front of our bathroom mirror? (Okay, Susie did but that was the bottomless margaritas singing, not her true heart's desire to sing on a stage in front of strangers and have someone's heart beat a little faster and someone's eyes water at the sheer sound of her voice... wait, maybe that's just me)?
Did we finally tell our friend we were sorry when we did that thing that's rolled around in the back of our minds for 20 years?
Did we hold our child close to our chest and tell them everything is going to be okay even though we know it might not be okay and we don't want to be the reason they're in therapy later but we don't want to pretend everything is okay, oh my goodness, what is the right answer?
Did we apply for the promotion we know we deserve or let another opportunity pass us by?
Did we sign up for the race we know we aren't ready for but really, really want to try?
Did we tell the person that hurt us repeatedly that they did hurt us and going forward, did we define what we need from them?
Did we look in the mirror this morning and like every single inch of our bodies and every single fiber of our heart and soul because God designed us as a masterpiece, beautifully and wonderfully made, despite society's measuring sticks?
Or, did we remain on the leaf-covered ground like the acorn... waiting for a squirrel or bird or toddler to scoop us up? Were we stored away for another day? Were we consumed before we ever began our destiny?
An oak tree is a beautiful destiny. She is strong, tall, sturdy, and beautiful, with colors that change with the seasons. She provides shelter, shade, and structure. She never leaves us and she stays the same for the most part.
You know what else is beautiful?
A mother who tells her children she has been hurt too, and that it really is all going to be okay. That she KNOWS it's going to be okay, because she is okay and she will help them be okay as long as she is on this earth.
A wife who tells her partner what she needs from them even if she doesn't know if they can give her what she needs.
A friend who tells the truth when asked if she's okay. And a friend who recognizes her own flaws and asks for patience and understanding.
A daughter who can look at her elderly parents and recognize every line on their face and hands for all its good and bad and steadfastness. She can see herself acquiring those same lines and she knows the toll each one has taken. She knows that her own children will see her lines one day, and she hopes they give her the same recognition.
I'm typing this on the porch of a cabin on a lake in north Georgia and the acorns are literally spilling from the treetops hitting the ground HARD and abruptly and with force and determination. Each one comes down on this cabin rooftop or leaf-scattered ground with a POUND or a BOOM or a SNAP. And my heart is full. For I know the destiny of each tiny acorn. She is yearning to become a beautiful oak. She is waiting for her moment to rise.
Now it is your turn. What path will you choose?
Will you make the hard decisions, let your voice be heard, show up for those who love and need you?
Or will you stay on the ground... waiting... watching... allowing life to happen all around you?
I dare you to stand.
I will stand with you.
State Prints from Jane- White on White Frames from Amazon
These are the 4 states in which I've lived!
LUG Switch crossbody bag - came with free phone holder that you can touch through (though I haven't tried it) and it has that RFID technology that keeps people from scanning your card #s. Ya'll, this was my first ever QVC purchase and I am 45 years old. I love, love, love the bag though for shopping as it's the perfect size for my small LUG Splits Wallet (got it from amazon- will link on my tools page), my phone, keys, lipstick, coupons, mask, and hand sanitizer. I think the QVC chic showed it worn as a fanny pack also, but I haven't been to Disney since I got it. :-). I know I paid under $50, but I would have to look back at the exact price.
I can't find the exact one on Amazon but I linked one very similar in my "tools" page. This bag is still available on the QVC site but the colors are very limited. 👀
Who knew a pen and paper ✍️ could save a life?
I wasn’t actively suicidal. But I was having frequent daydreams of having a wreck that was “bad enough” to keep me in the hospital a few days, off work at least a month, and unable to help anyone else for a while. 😳
I wanted it to be a single-car accident and of course I wanted to be alone. I wasn’t looking forward to the injuries and was praying nothing would require surgery, but I couldn’t wait to have a respite from work, life, and motherhood. Does that sound crazy? Selfish? Or similar to thoughts you’ve had?
Caregiver fatigue 😴 is a real thing, even if you’re paid to care for others. Motherhood fatigue 😴and lemme just say it, full-time step-motherhood 🤷🏼♀️ fatigue is a real thing even if you love your children 🚶♂️👬🏼 dearly. Today’s world 🌎 for women is exhausting:
Toss in a pandemic 😷 and virtual school 📚and BAM, all the therapists are booked!
Fortunately, my mental "breakdown" was pre-pandemic. Thank the heavens I already had a therapist when my regular job got flipped upside down in March of 2020. My crazy started when I was in the throes of motherhood, working full-time and commuting with kids age 2, 4, and 12. I was crying regularly on my way home from work, wondering how I was going to get everything done and actually sleep too...😴
I’ve always had pen and paper near me, but I didn’t start regularly journaling ✍️ until I started feeling that OVERWHELM on a regular basis. I had so many thoughts racing through my head and I didn’t have a system to capture them. I was using a planner, but I might think of something while driving or in the shower and I would lose the idea 💡 or thought before I captured it.
Some internet scrolling led me to David Allen’s Getting Things Done method. By this point I had played around with bullet journaling and list making (List Maker 4 Life right here now!), but again, I felt like my thoughts were fleeting and scattered. I will link the GTD method below, and I do think it's a good system, but that's not the point of this post.
Once I started decluttering my mind from all the racing thoughts, then I had to face my actual thoughts. This was not a good look.
I couldn't remember the last time I had laughed with abandon or woken up with a passion for life. I felt like I was on a treadmill with no way off. Someone was going to have to pull me off, and I didn't have the time or energy to ask anyone to pull me off.
I never felt relaxed. I was in a constant state of fight or flight (or so it seemed). I was alive. But was I living?
Enter the JOURNAL. ✍️
A journal can be so many things:
Happy + Happy = Happy
I was listening to a podcast the other day, and the speaker said he thinks we are all happier when we make others happier. Agreed.
Then he said we are all happier when we are around other happy people. Also agreed.
I went along my merry way and was strolling through the aisles of Home Goods, aimlessly looking at mugs and throw pillows, and those 2 thoughts kept resonating with me. Making others happier and being around other happy people makes US happy.
What does it mean to make others happy?
I know for a fact I've made some people happy in my lifetime. And yes, that made me happy. But did I even know what I was doing? Was me being happy by making them happy even my agenda? Do people even think about that?
Can a person be happy as "an island?"
What about people who choose to remain single or just haven't found a life partner? Those who live in solitude? Are they doomed to a life of unhappiness?
What about solopreneurs and those whose jobs involve them working alone? Does that mean they are unhappy?
I used to have a sign that says "happiness is a decision made ahead of time." I had another one that said "some people pursue happiness while others create it."
While I do think that "our input determines our output" and "we are what we eat" (both in terms of food and the digital content we consume), I just don't think it's that simple anymore.
You see, I can wake up, set my intention for the day, stay as happy as I "want" to be and in the course of one single day I can have the following conversations:
And those are just work examples. What about life examples?
So, how do I continue to make others happy in the above situations?
How do I maintain my positive outlook?
Aren't there times when happy ISN'T the right answer or attitude and staying positive just feels WRONG? In some situations, making others happy devalues their pain and suffering which honestly makes them feel even more isolated and unhappy.
I realize not everyone has a job in the healing field, the medical field, or with the public.
But we are all HUMAN. Almost all of us have friends, coworkers, neighbors, church members, family members, SOMEONE at some point in each day that is going to confide in us and lean on us.
Do we lean in and choose to be a present fencepost or lighthouse for those that need us or do we back off all in the name of HAPPINESS and choosing joy?
Can we even enjoy the good things without seeing the bad? I don't think we can.
I am REALLY starting to pay attention to my body when I meet new people. I don't always count them out if my first impression is less than stellar, but I do remember it. I take note so that I'm not surprised down the road.
And here's another disclaimer to Mr. Podcast's 2nd claim.
Sally may make me feel good but I can't ever see her because our schedules are opposite and she's not good at reaching out. She struggles with depression and anxiety, so I have to let her reach out when she has the emotional space to do so.
Bobby may make me feel like crap, but he's my brother and I love him, so then what?
Susie might put me on edge every day, but she's my boss and I spend several hours a week with her.
So yeah, Mr. Podcast, I like your ideas and they sound great, but then there's life. And after living and working and being in a few families now, I know that we can't always choose who we are around. And maybe that's why I stopped putting my 2 happiness signs out. I realized that I can keep a positive mindset and try to limit the time I spend with people who either make me feel bad or suck the life out of me, BUT... I also realized it takes the bad to see the good. It takes the ugly to see the beautiful.
It takes all those things my patients tell me every day- that are really happening to people I care about- to make me slow down, sip my coffee, exhale at that stoplight, glance at my kiddos in the rearview, pump up the volume, and sing at the top of my lungs with my sunroof open.
It takes being knocked down, run over, and slowly picking yourself up to smile at the exploring, coy toddler vying for your attention at your son's ball game. It takes losing something you love to look at a tree that's been standing outside your window for years and silently thank it for never leaving you. It takes holding someone you love while they shake in fear or agony to appreciate each and every piece of laundry you fold for the 400th time. The mundane is where the magic is... the daily can be the delight.
Today, I choose to live... pretty, ugly, hard, easy, funny, scary, joyful, and unthinkable. Happiness will work itself out. She will make her appearance. And I will nod in recognition each time she does.
To read some of my friends' thoughts on happiness, please click below and support their work. We all belong to a writer's group and I have learned and grown from each of these special women's work and words.
Chasing Happiness By Sharla Hallett
Finding True Happiness and Keeping It By Lisa Granger
Mom Burnout and How to Be Happy By Ashley Olivine
3 Days By MelAnn
Seeing Happiness Right in Your Life By Dianne Vielhuber
The Summer of Happiness Recap of Summer 2021 By Jessica Haberman
I grew up in a family that plays games. My father's family played Rook and Dominos. My mother's mother and her husband loved to play Uno and Skip-Bo with me. My childhood friend and I could then and now beat anybody anywhere in Spades (name the date and time, we will be there). In my first marriage, we hosted game nights pretty regularly since we did not have children and we actually had some free time on weekends. Since moving to Georgia, I have hosted several Girls Nights involving games and a ton of laughter. I can quote some of the crazy things my friends have said from those nights, and I will never regret playing a game with people I love.
Playing games makes us feel connected, engaged, and let's face it - COMPETITIVE. In 2021, our kids don't know a ton about winning and losing. Participation trophies are the norm and handling a loss is not a daily challenge. I even work in a county where a ZERO cannot be given by a teacher even if the child doesn't write a single stroke of pencil on the page. A SIXTY is the lowest grade that can be given. WHAT are we teaching our next generation?
I am the first to admit that not only am I competitive, but I can get carried away. This has improved with each life decade, and I'm now teaching my kids how to win and lose. We love to play the board game Aggravation and now that they are old enough, we have introduced Taboo, The Five Second Rule, Charades, Mafia, Pictionary, Scrabble, Monopoly, and many more.
Along the way, I have created games that we can play at the table during family meals OR on a roadtrip. I have no idea if I am the only one on the planet who created these, so I am not calling copyright and you are more than welcome to use them. I think I made them up, but I am certain I did not. I encourage you to try these with your family. Make sure devices are far away and HAVE FUN!
Anyway, now that you have 5 tried-and-true "invisible" (no prop) games you can play with your family or friends while on a roadtrip or sharing a meal, I encourage you to try it!
Let me know which ones you loved or hated and leave a comment with any "invisible" games you might play with your family.
Have you ever woken up feeling icky?
Or perhaps you felt great, but a certain conversation, text message, social media post, or group of thoughts evaded your mind and body and the icky took over?
How do you know you're feeling icky?
For some people it is a very physical response in the body:
For others, it is a very mental or emotional response in the mind. These might be thoughts associated with your icky:
So, now that I have been in regular therapy for almost 2 years, I asked my therapist about feeling icky:
Me: what do I do when I'm feeling icky?
Therapist: describe icky- what does icky mean to you?
Me: I describe the first scenario since my icky comes out more physically than mentally
Therapist: okay, then we have to focus on your body and reclaiming your body in that moment. If the adrenaline and cortisol have already dumped into your bloodstream from a fight or flight response to a "threat" you have received, then we try to calm that trauma response.
Me: but does it matter what triggered it? what if I don't know what triggered it? don't I have to fix what is wrong in my life or situation to fix my icky?
Therapist: Nope. And that's the beautiful thing. What caused it doesn't matter. I don't even care what caused it. We just need to reclaim your body at that moment.
So, that changed my life.
I repeat. THAT CHANGED MY LIFE.
And I believe it can change yours too!
See below for some helpful links on how to reclaim your body from a state of panic or unrest.
Turns out, we CAN'T fix it with our thoughts.
We literally have to MOVE our bodies out of it. What a relief!
No wonder my brain is so tried from all these years of over-analyzing and overthinking, ruminating, and self-loathing. I wasn't even on the right road getting this *%#@ trauma out of my body!
But now I am, and you can be too.
Find a trauma-informed or trauma-certified therapist.
Your life will change forever.
When a patient presents with hair loss, I obtain a thorough history:
I then perform a thorough physical exam and order the following tests:
That may not “answer” your question but I hope it helps you know what a clinician will be looking for with this presentation of hair loss. 🩺👩⚕️
Personally, I have dealt with hair loss from taking Methotrexate for my sarcoidosis.
It started coming out in clumps in the shower and then in my brush.
I soon had very patchy areas of hair loss all over my scalp.
My hairdresser advised me to stop applying heat to my hair when possible, to wash my hair less frequently, to avoid ponytail holders when possible, and to avoid any hair color or harsh chemicals. I usually got some blonde highlights in the spring put in my naturally red hair, but I went without those for 4 years while I was on Methotrexate.
My rheumatologist increased my Folic Acid dose from 1 mg to 2 mg daily, and I ordered Biotin off Amazon Subscribe and Save. I took the Biotin daily to help with hair growth.
I am finally off Methotrexate and on Humira and am seeing hair growth again.
Losing my hair was very emotional for me. My bright red hair has defined me for so long. I now knew what all of my patients struggling with hair loss from chemo or other medical reasons were feeling, and boy was it a wake up call. My heart goes out to anyone struggling with hair loss. Much love to you and I hope this helps.
I was surprised 🧐 when the vaccine came out for frontline HCW (healthcare workers) in December 2020 and the general public started claiming it caused sterility.
Let’s use common sense. 🧠
It takes 1–24 months 📆 to conceive before most providers start to investigate infertility.
It takes 40 weeks to carry a baby 🍼 to term.
Let’s average conception time to 12 months and add the gestation time of 9 months🤰 to = 21 months.
Covid REALLY started to hit the US hard about 18–19 months ago.
The vaccine was available to some of us 9–10 months ago but MOST of the women of childbearing age could not receive it until 5 months ago.
How can anyone claim infertility at this point in time? 🤔
I never say never because I am constantly learning in medicine. Every day I see something I never thought I would witness.
I have had pregnant women🤰contract Covid and pregnant women🤰receive the Covid vaccine. I have also seen pregnant unvaccinated women with Covid whose babies had to be delivered while mom was on the ventilator. My community just lost a 28 year-old mother of 3 who never got to know her newborn. 🥲
The American College of Obstetrics & Gynecology and the Society for Maternal Fetal Medicine issued a joint statement encouraging the vaccine for all pregnant women🤰 in July 2021.
I recognize that I have the benefit of being "done" having my babies as I navigate this pandemic.
That fact is NOT lost on me.
I know young adults are faced with a very hard decision with such a new vaccine and their entire lives in front of them.
Early in the pandemic, I even advised some of my young, healthy patients to wait until we had more long-term data... that I saw no serious health risk if they were to contract covid.
2021 changed that. I have had YOUNG, healthy patients on the ventilator and near death.
I still believe it is a personal decision, but please be sure you are getting your information from reputable sources and people you trust. Much love...
Those are the 3 phrases that come to mind when I think of intention. And boy do I try to live intentionally. I even chose a name for my blog / business/ alter ego etc with the word INTENT. So why do I feel ill-equipped to write about intention?!?
I have all the planners, techniques, vision, and skills to live a life well-planned. I have mastered and honed the Home CEO, Working Mom, and Grown Adult roles so much so that I even write blog posts dedicated to living with intention, being more productive, and living your best life.
And then I consider the best days and moments I have experienced. They weren’t planned or perfect. Most of them were a result of unforeseen circumstance.
I’m living in a state that never crossed my mind prior to my dad losing his job in 1994 when I was a freshman in college. I’m a mother to a child I never knew existed until he was six. I have AMAZING friends, patients, and coworkers I never would have met had my first marriage not ended. And I’m married to a man who gave me 2 gorgeous, smart, funny, loving boys that never would have known my name if all my plans had worked out. Those that know us would agree we would probably have never been in the same room if it weren’t for someone somewhere creating the internet.
So I will continue to plan, manifest, set goals, and make to-do lists. It makes me happy and I like to think I’m in control. Then I will watch some of it unfold, unravel, get messy, hurt, and burn - I will be better, wiser, and more compassionate in the aftermath of my intention. ❤️
I have a thorough “fatigue” work-up I have developed and honed over my 17 years of NP practice. A thorough history is key to guiding my differential diagnosis but there are a set of labs I run on every patient complaining of fatigue.
if your PCP is not good at taking a history, have the answers to these questions ready and offer them if he/she does not ask:
I order CBC, CMP, TSH, Vit D, Vit B12 on all fatigue patients and add other labs and/or sleep study as indicated.
Hope that helps! 🩺👩⚕️
Fatigue, sleep apnea, and poor sleep quality are linked to a plethora of medical conditions. If you are experiencing extreme fatigue or prolonged fatigue, please consult your PCP. If you do not feel rested after a full night's sleep, please see your PCP. Fatigue can be a sign or an underlying problem - please listen to your body!
These are a few of my favorite things... (insert Sound of Music Julia Andrews here)
Safety 1st AutoSensor Nightlight ($13 for a 2-pack on Amazon)- these stay dark when the lights are on and automatically light up when the room goes dark- they never get hot! These were in a condo we rented last year and I researched to buy them for my own home! I LOVE THEM!
Erin Condren Sticker Album- $10 on Amazon, or you can use my EC Affiliate Link to shop more of her products. This album is 24 pages and holds 48 pages (or more) of stickers. I place my most-used planner stickers on there so I can throw this album in a bag for the coffee shop or the ball field.
Singing my wake up song 🎵 to 2 sleepy-eyed, bed-head boys.
Rocking a baby in a soft onesie wrapped snugly and tenderly in a blanket.
Seeing my parents’ puppies run towards me with wild abandon as I beckon “hey, Littttttttle Boys!!!!”
A brand new journal tight at the spine, crisp at each paper edge, blank as a fresh-fallen snow.
A mug full of barely-used dual-tip markers with a coffee-infused brain and 20 minutes to doodle.
That bass drum, the high hat, a sexy snare, a rumble from a bass guitar, melody from those 🎹 keys, and a voice belting out pain or ecstasy in an outdoor venue. Yes 🙌🏻 I will and I want more!
100k of us squeezed together, sweating, smiling, ❤️ racing, waving shakers, roaring as a collective animal as one 20-something runs up and launches that 🏈 into a fall Saturday reunion of college powerhouse rivals.
Inching into my ✈️ seat and opening a magazine I will never read on my way to something new.
And this. Writing. Typing. Dreaming. Reflecting. Lamenting. Laughing. Crying. Smiling. Feeling. This gives me hope. Meeting you and considering one of my words might tug at your ❤️ or muster a grin. That gives me hope.
As I sit outside to write, I hear birds around me, the gentle breeze in the trees, and squirrels rustling through the leaves. It is a gorgeous late summer afternoon, and I can feel the energy of fall from my toes up through my body and into my smile. Fall is my absolute favorite time of year, only one tiny degree above Christmas. I see a blue-tailed lizard shuffle along my patio and I notice a few dry leaves dancing from the treetops to the creek bed.
God didn't make me to live inside. He didn't make me to sit still or stay in one place either. I have lived in 4 states, multiple homes, and I think I'm on my third lifetime (or so it feels most days). Sometimes, when I'm quiet... when IT is quiet.. I reflect on all I have seen, witnessed, felt, loved, lost, and won. Certain flashes in time come to me, waves of emotions, smells, sounds, and FEELINGS.
When I'm quiet. When my day is quiet. When I'm not moving or doing or thinking...
Cool mornings and crisp evenings. Nice breeze in the air. Green grass, fall multi-colored leaves in the southern oak trees, and the smell of beer, bourbon, burgers, and barbecue surrounds us. Young collegiates in love (or at least like), families with little boys in tiny replica jerseys and little girls in tiny replica cheerleading uniforms, and everyone who likes a good time is invited. Grown men with radio broadcasts on headsets (because watching it live and in person isn't quite enough), decorated RVs with big screen TVs streaming games all day, and the occasional first-timer... jaw agape, taking it all in.
I was one of the lucky ones. I got to to witness this glory every other weekend (or so) for four fall seasons in a row as a student, with a cheap ticket in an amazing seat. Those were the days.
If you are a grown adult with a family or at least a job that offers a 401k, this is what you need to know (if you're an SEC football tailgate first-timer about to witness the good stuff):
Let's take a deeper dive into each one of these tips:
Now that you know what to bring and have some idea of what to expect, please remember to inhale a few deep breaths of that bourbon-infused fresh air and take in the atmosphere.
Look at all the young couples in love, families having fun, and older college friends reuniting for a Saturday tradition. Listen to the drumline of the band, watch the dance team and cheerleaders shake their hips, and feel the excitement in the thousands of people walking the same direction at the same time to witness a good old-fashioned football game. There are a few other ways I like to spend my Saturdays, but this may be #1. Enjoy, my friend.
Reflection is a beautiful thing. It is often overlooked, but when we slow down and DO IT, we can learn and grow. Now that I'm in my forties, I sometimes look back at times in my teens and twenties and try to "hold on" to that feeling. We really can't do that, though, can we?
Frequent reflection allows us to "hold on" right now. To really "feel it" right now... before it passes.
Reflection gives us room to take note, consider future improvements, and relish in current joy.
I'm hoping to start reflecting every quarter here. A public diary entry of sorts. A record of the good and the bad. A glimpse in time.
This is what I'm learning right now, September 2021:
Bonus question: what can I do to help? I feel so helpless!
***as always, consult your PCP for your healthcare. I’m trying to raise awareness. Let’s not bicker and judge over vaccine status. Let’s educate ourselves and let’s come together to get out of this public health crisis!!!***
When to test after known exposure (kid, adult, masked, unmasked, vax, unvax, PLEASE READ):
⁃ are the CDC recs confusing? Yes
⁃ Is your school or work throwing out different recs? Yes
⁃ I say this is when our common sense 🧠 MUST play a role
⁃ This is Sally 🙋🏼♀️ and she was around 🤒Bobby who tested + for 🦠Covid
⁃ I don’t care about Bobby’s 🤒 vax status but I do want to know Sally’s 🙋🏼♀️
⁃ I want to know if 🙋🏼♀️ & 🤒 were unmasked and close to each other for longer than 15 minutes or if something “crazy” happened like 🤒 sneezed or they 🤝 or they were 🍷🍽 together. Maybe they LOL’d next to each other or hugged. How close were they? Maybe they cried together at a funeral?
⁃ Next I want to know if 🙋🏼♀️ has any fever, cough, chills, body aches, sinus congestion, sore throat, loss of taste or smell, joint or muscle aches, diarrhea, nausea, abdominal pain, headache, shortness of breath, wheezing, chest tightness, confusion, or dizziness when standing and if/when she does, I’m testing her regardless of vax status. If neg, I’m testing her again in 2 days. Meanwhile I’m keeping her home because she is symptomatic.
⁃ The only reason I’m testing 🙋🏼♀️ if she never shows symptoms would be:
⁃ the exposure was risky based on above mentioned factors, or 🙋🏼♀️ has someone who is immunocompromised, elderly, young, or unhealthy that she sees regularly
⁃ Work / school requires it
⁃ Peace of mind
⁃ I would test at day 3 or 5 or both
⁃ I’m seeing exposed folks (symptomatic and asymptomatic) test too soon. Then test + a few days later. This burdens the testing sites. So wait until day 3-5 if you can!
***as always, consult your PCP for your healthcare. I’m trying to raise awareness. Let’s not bicker and judge over vaccine status. Let’s educate ourselves and let’s come together to get out of this public health crisis!!!***
This is a great question and one I have seen asked many times on many platforms.
I have 2 autoimmune diseases (sarcoidosis and psoriasis) and take Humira. Prior to Humira, I was on Methotrexate. I took my first Pfizer dose in December 2020, second in January 2021, and I received my third in Aug 2021 since I qualify for the third dose now. I read the pfizer trial and the data is phenomenal. I had zero side effects all 3x other than a sore arm. That is my patient experience.
As a primary care provider, I manage a panel of about 1800–2k patients. I’ve had ZERO deaths or serious side effects from the vaccine in my panel. I have had 2 deaths (age 78 with lung disease, age 49 and healthy), over 225 infections, countless hospitalizations - some requiring ventilation, and I am seeing long-term effects from COVID: stroke, pulmonary embolus, neuropathy, still haven’t regained taste / smell, palpitations & arrhythmias, chronic fatigue, chronic brain fog, and lung damage.
I think the vaccine is being “pushed” because I know I can’t keep up with the volume of sick patients I’ve seen in the past 18 months. I know every ICU in my state is now on diversion. I know we as healthcare workers are leaving the field due to burnout. I’ve never seen anything like it and I’ve been a nurse 23 years, an NP for 17 of those.
***Always consult your PCP for your healthcare. I trust and believe in the vaccine, but I do not think it should be mandatory. Let us not bicker over vaccine choices, but let us come together and try to get out of this public health crisis!***
What can I do at home for Covid?
1. Zoom with your provider
2. Walk around as much as you can- covid causes blood clots
3. Lay on your belly when you’re resting, not necessarily when asleep. We are proning Covid patients (placing them on their belly) even when they are on the ventilator to help move mucus / fluid and drain the lungs.
4. Hot steamy showers. Even if you don’t feel good enough to shower, sit in your smallest bathroom with the steam running to help open up the lungs. If you feel lightheaded though, stop.
5. Hydrate hydrate hydrate - covid is an inflammatory virus and hydration is key!
6. Monitor your pulse and oxygen levels as I mentioned yesterday.
7. What has fallen out of favor / lacked statistical backup and/or caused harm: ivermectin, oral steroids prior to hospitalization, hydroxychloroquine (Plaquenil), unnecessary antibiotics
8. Mucinex, zinc, Vit C, Vit D, Singulair (it’s Rx though) are all in the grey zone- I don’t think they’ll hurt you but they may not keep you out of the hospital.
9. Finish out your quarantine please and thank you.
10. Chest percussion- look it up on YouTube
How do I know if it’s Delta?
1. Big testing centers are batch testing swabs for variants and extrapolating that data to identify geographic variant trends. Your local urgentcare is not.
2. Whatever the variant, we treat based on symptom severity and delta may look good on you and horrible on Sally. Alpha (the original variant) may have put me in the hospital but barely slowed Steve down.
3. I equate it to flu A and B which are always swabbed and tested together each year. Every year I hear “oh Flu B is way worse than A. I’m so sorry you have B.” Etc etc etc when patients’ flu courses can vary regardless of the strain.
4. Anecdotally, my zoom covid visits with this wave seem different than in 2020. Less fevers. Less complaints of crippling headaches. Less loss of taste and smell. More dizziness & confusion (likely from low oxygen levels). Similar diarrhea complaints. Worse shortness of breath and chest tightness. Way more trips to the hospital and ICU. . My only vent-survivor told me all of a sudden they just Could Not Breathe. I should add this person is under 40 years old and is (or was) healthy.￼
5. Speaking of strains, did you know the Gardasil vaccine protects against 9 strains of HPV? Did you know Prevnar13 protects against (you guessed it) 13 strains of pneumonia? Strains have been around forever as have vaccines yet sudden interest persists. Just educating- no judgment on vaccine choices. I’m too tired.
How many times can a child under age 12 have Covid? Will they develop immunity?
Great question. I’ve seen twice so far and I expect more. Their bodies should be developing antibodies but no children have volunteered for my quantitative antibody study yet. Stay tuned.
How soon should I get my vaccine after I have Covid?
I’m recommending one month not 90 days IF you’re truly feeling better. Ask your PCP as they know your health situation.
If I’m + today, symptoms resolve in 2 weeks, and then I’m + in 4 weeks, is it a reinfection or residual positive from original infection?
I would ask if you ever had a negative test. If you did, maybe it is a re-infection but if you did not, I know we saw some folks stay + for 6 weeks or more in 2020.
***as always, consult your PCP for your healthcare. I’m trying to raise awareness. Let’s not bicker and judge over vaccine status. Let’s educate ourselves and let’s come together to get out of this public health crisis!!!***
Taking multiple medications multiple times per day can be overwhelming at best.
Remembering to take them, remembering to refill them with the pharmacy, remembering to contact the provider if you run low, and remembering to purchase or pick them up can be stressful, time-consuming, and somewhat depressing.
I hate filling my 2 pill boxes each month (one for morning, one for evening).
It is a reminder that I am living with a chronic illness and that my body has "failed me."
My rheumatologist told me 5 years ago at the onset of my sarcoidosis diagnosis, "Amy, my goal is for us to get your treatment regimen in line to the point that you only think about having an illness when you see me every few months and when you take your medication. Otherwise, I want you to feel so good that you don't even think about it." I did not know then how important those words would be to me five years later.
I have FINALLY recruited my husband to help me fill these PITA boxes (they are- I spill meds every month and lose count without fail). Now we turn on Ted Lasso or Bloodline and he fills one while I fill the other. It is depressing to accept that my body depends on the very THING I shell out every single day in my profession. I can truly empathize with my patients who say "but I don't want to be reliant on a pill." A few times I have shown them a picture of my med boxes, and sometimes it has provided comfort. One patient asked "oh my goodness- what is wrong with you?" so I decided I might share a little less. Vulnerability is hard.
My best advice is to have a system for managing your medications if you have a chronic illness.
I knew I wanted shelves on all 3 sides of the closet.
I knew I didn't want wire racks.
I knew I didn't want to use shelving brackets if possible.
My husband got creative and thought of a solution.
He notched the wood so he could use wooden slats as supports.
I don't know all the other technical ways he made this happen but I love it!
Mom, wife, writer, lover of books and live music, family nurse practitioner.