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Ancestry.com has become very popular in the past 10-15 years. I decided to join Ancestry.com in 2019. My husband and I took our tests initially and then I bought my parents the tests a few months later. Ancestry can be as public or as private as you like. You also have the option to delete your DNA results at any time. If you have been thinking about joining Ancestry.com but are on the fence, check out a few of the features listed below. I pay a little extra to see the detailed documents because those interest me, but the basic plan also gives you tons of information into your family history. One of the new features of ancestry.com breaks down which parts of your ethnicity you obtained from which parent. The technology allows for this even without your parents' DNA - which as a scientist by trade - amazes me! I love that I have access to so many historical documents through Ancestry.com. I have seen marriage records, birth and death certificates, census records, military paperwork, and immigration records.
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At the end of the day. At the end of my life. When I'm old and gray. When I'm free from strife. I will smile every time I remember your face. And no one can take that from us. Godspeed. photo credit: Oluwaseyi Johnson Was it luck that the young mother of three bumped her head on the bed post and came in to see me? She was picking up a toy that had fallen into the abyss between the bed and the wall but I felt we better not miss an internal bleed in her brain those are rare but not good so I ordered the CT scan and we both went back to mothering our brood When the phone rang that night I can't remember if I dropped the phone It's a brain tumor, and it's big Can you call her at home? Was it luck when the car struck her from behind? Plastic and metal shredded and busted near the yellow line Her head hurt, her neck hurt to the doctor she went And the MRI that was supposed to check bones instead showed a hint of the cancerous tumor that was showing no signs it was in her thyroid, she had no symptoms God was definitely on time Was it luck when she came to tell me she was in pain? Her abdomen was cramping, her bowel movements had changed As the dutiful NP, I pulled up her old scans Has anyone ever mentioned your lungs to you ma'am? My lungs, why would they? My lungs are fine well it says on here that there's an issue - do you mind if I order a CT scan of them just to be safe? God was nudging me, directing me, showing me the way Pulmonary fibrosis? what in the world is that? Well, sweetheart, it's serious, sit down, we need to chat Unfortunately it's the same way my own disease often ends Here's my number, you can call me, I actually do understand Was it luck when she looked at me with frustration and contempt? Ma'am I'm sorry I just met you, let me see if I can help You can't help me she thought, they've already run all the tests God tapped my shoulder, I looked a little deeper, there was one thing left I'm sure it's nothing, but let's check this one last thing It's an ultrasound, I know you're frustrated, but let's do it, okay? Okay, she said, and I wasn't sure she would actually do it But days later the phone rang, there's an issue, there's fluid The young colleague who sent her to me called me for advice What do I order next? What do you think it is? I'm not sure what to try. So I made my suggestions and prayed I was wrong. Come on Lord, let's let this young patient just move along. But He couldn't and she couldn't and my colleague and I cried Another cancer, a bad one, it's not fair, it's not right Was it luck that I've found some of these things at the craziest times? Or was it God this whole time leading me with His light? I'm no saint, I'm a sinner, I get fired up, I have faults, I get loud But when I slow down and I pray and I look up to those clouds I can feel Him, sometimes it's so strong I just weep Like right now as I type this, and all those nights I've lost sleep These are a mere few of the miracles I have watched unfold in my tiny little town with my regular little folks Are we special? am I special? I don't claim any of it as mine It's His, I'm a vessel, I'm a sparrow, I'm a scribe Dear Lord, there have been so many times I have seen You. Why me? Am I doing it right? I sure do try, but I need You. When the going gets tough, and my stethoscope seems too much My alarm goes off again, and I feel Your gentle nudge You'll tell me when it's time. When my service is up. It wasn't luck, God. It's been You. Knowing that is enough. Amen. Author's note: Age and any identifying factors have been changed due to federal privacy laws. Please help support my fellow hope*writers by visiting their pieces using the prompt work LUCK:
You are Not Lucky You are Blessed by Lisa Granger https://lisamarcelina.net/you-are-not-lucky-you-are-blessed/ Luck by Dianne Vielhuber https://simplewordsoffaith.com/wp-admin/post.php?post=10672&action=edit What Does Luck Have to Do With It? By Lori Shoaf https://www.lorishoaf.com/inspiringstories/what-does-luck-have-to-do-with-it Luck of an Evacuee by Ashley Olivine https://ashleyolivine.com/luck-of-an-evacuee/ In my 24 years of nursing / NP work, I have seen countless cardiac events either in action or the ramifications of such events. On a personal note, three of my four grandparents had strokes. I lost my paternal grandfather when I was only 4 and he was 55 due to a massive stroke. My paternal grandmother had stents in cardiac and non-cardiac arteries as well as "open heart surgery" CABG (coronary artery bypass graft). I have been affected by heart disease on a personal and a professional level, and I want to help patients understand the true risk of death and debility associated with cardiac events. Here are the top 10 reasons I refer patients to the cardiologist:
Let's talk a little more about each of these 10 conditions and how a patient may actually present to my office with these symptoms.
I have had patients in their thirties suffer from strokes and heart attacks. I have seen heart failure, cardiac arrhythmias, and high blood pressure in patients from childhood, young adulthood, and beyond. I doubt there is anyone in America who does not personally know someone who has been affected by heart disease. In honor of America's Go Red for Women Month (every February), I encourage you to schedule your wellness exam with your primary care provider and to start paying more attention to your heart rate, blood pressure, water intake, weight changes, and dietary choices. Your heart matters to me! Godspeed. When I sat down to do my YEARLY REVIEW at the end of 2021, I was literally drained. I was exhausted: mentally, physically, emotionally, and spiritually. I could barely even form a sentence in my head. As I started PLANNING MY YEAR AHEAD as I usually do each holiday season, I started to see just how many things were already on my calendar. I am not sure if I felt disbelief, disgust, or disenchantment. "That will be cancelled. That won't happen. I doubt we actually do that." After two years of cancelled, postponed, and rescheduled plans, I almost reached for a pencil instead of a pen. I am eternally optimistic, but I am TIRED. You know those days where you sit down in the evening and you feel like you've been to DisneyWorld with 2 toddlers and 2 strollers and a newborn? Those days where you are driving home from a busy day in family practice and you aren't even exactly sure what your own name is (much less a disease or dosage of medication)? I feel like we've all had TWO YEARS of those days. So I decided to just boycott goals altogether for 2022. I wasn't going to make goal(s) for Health, Finance, Education, Personal Growth, Career, Family, Marriage, Spirituality, Home, etc like I usually do every year. The thought of doing that after I wrote my GOAL SETTING post was just as insurmountable as climbing Mount Everest (for this girl who already battles a chronic lung disease). Choosing a word for the year? Meh. And usually I am ALL OVER THAT!. But the only words that have come to mind lately (that don't include mild profanity) are flexibility, change, resiliency, and stamina. And I realize all of those words are entrenched in what I have LEARNED FROM THIS PANDEMIC as a frontline family NP. So I haven't chosen a word just yet. And I'm not sure that I will choose one for 2022.
And what I'm finding is that wearing ACTUAL CLOTHES (no scrubs, no standard mom "leggings and a tee" uniform) makes me feel better. It makes me feel better about myself, my life, my marriage, my work, and my day. I never thought I would be typing this, but it's TRUE. I choose healthier foods and move more when my pants have a zipper and a button. 👖 I try to have healthier emotional reactions when I don't look like I just rolled out of bed. 🧘♀️ I am reminded of my passion for medicine when I am dressed the professional part. 👩⚕️ I am even nicer to my husband when I like my reflection in the mirror. 👩❤️👨 I feel better about spending all the money I have spent on clothes now that I am actually wearing them. 😜 So there you have it. I set one goal for 2022. It is simple and it used to be automatic. What happened to the girl who loved shoes and purses and dressing up? Where did she go? Who and what took her from me? I feel her trying to emerge again. She is ready for this new year. She has no idea what's going to happen and no control over any of it. But she is showing up. And she looks and feels AMAZING. 👗 *** most of the time
*** except on Mondays *** or on days when her kids are off the chain *** but she is trying ☀️ 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. 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.
Pros:
Cons:
I have worked as a family nurse practitioner since 2004. As with any career in medicine, I have had peaks and valleys. Burnout and frustration countered by personal reward and gratitude. Humility for sure. In nursing school, I liked every rotation. I wanted to do "all of it." My faculty advised me to go into med-surg. I guess my love for "all of it" carried into my choice to primarily stay in family practice. I have done some moonlighting in GI and Pediatrics. GI was interesting, a challenge, and a break from a full family practice panel of patients. Pediatrics was fun, repetitive, and just a different pace. I think any career in medicine comes down to a few things:
In the words of Thoreau "It's not what you look at that matters. It's what you see."
How to have an effective office visit with your provider: There are some tried and true ways to have a productive, meaningful visit with your medical provider. As a patient with a chronic illness AND a family nurse practitioner, I have the inside track.
If you need more frequent office visits, ask for them. Your provider is PAID to see you. Your insurance is billed for those visits where as most providers do not bill for phone calls or portal messages. If you end up needing them before your designated 3 or 6 month follow-up and you have more than 1-2 simple questions, PLEASE schedule an office visit. As a provider with complicated patients of my own, I would much rather have that patient in the office with me to have a discussion than to do multiple back-and-forths over the portal. It’s better patient care. AND my time is used wisely in my employer’s mindset. Medicine is a business. Although so many of us really do care!!! Healing people is wonderful. It’s challenging and rewarding and exhausting and sad and scary and exciting and mundane. It’s refills and phone calls and charts and labs. It’s insurance authorizations and having the same conversations with the same patients over and over and over again.
But it’s also seeing progress and growth and determination. It’s witnessing families come together and sometimes fall apart. It’s being a steady presence in the lives of what starts as strangers and ends as friends. Can we be friends? Am I your friend? I like you. I’m cheering for you. I want you to do well! I think of you and I pray for you. I laugh and I cry with you. I love seeing your pictures of your babies and your successes. My heart hurts when you hurt. Where are the boundaries? I don’t want you to have my cell number, but I want you to tell me when you need me. How does that work? What are the rules and who makes them? I don’t want to think of you as just a name or a number. I am invested in you and you in me. Working in a small town feels like home. It’s likely that I know your mom, your neighbor, your hairdresser, and your child’s teacher. I wouldn’t want it any other way. At the end of our time together, I want you to smile when you think of me. I will always smile when I think of you. Even if you didn’t heed my advice. Even if you missed too many appointments. Especially then, because you made me work harder. I want you to know I looked forward to walking in your room and seeing you just as you are, whatever you were going through. I am thankful you put your trust in me. I know you made me laugh at least once. I saw you, all of you. I think you saw me too and I’m okay with that. |