Sudden Cardiac Death in Student Athletes

This morning as I peruse the daily news with my coffee to start my day off, I come across an article about a 14 year old young woman died during a track meet.  Her autopsy revealing an undiagnosed congenital heart defect, a tragic death.  Working with congenital heart disease, stories like these and ones I have seen personally about the impact of undiagnosed CHD will follow me the rest of my career.

One thing I always like to do is to look for other peoples perspective, I live in the world of congenital heart disease and sometimes I forget what it’s like to not understand a disease process or just someone elses point of view about CHD.  I went to check out the comments left by people and some of them were quite frustrating for me to read.  Before anyone gets upset or angry, let me say, everyone is entitled to their own opinion and to be respected for their own opinion!  If you’re a comment gawker like myself, you have seen the comment wars erupt, insults flung, and the comment trolls, I’m sure.

Anyways, back to the comments that got me thinking and were quite frustrating.  Parents were commenting how they were going to demand an echo at their next visit with their child’s pediatrician, no matter what! Their child has no symptoms but is an athlete, so they must have an echo to play sports.  One mom went on to say her child had a disease that is usually diagnosed by EKG, her child’s diagnosis was not seen on EKG (this is EXTREMELY rare) which this mother shared and then the comments really got going into

-EKGs are useless (don’t even order one-just order an echo)

-doctors are useless and can’t do their job, parents should just google any concern they have, go to their doctor and demand these tests and they will be ordered or their manager will be called and a formal complaint will be filed since the doctor ignored our concerns.

-And don’t even send a nurse practitioner or PA near my child!

-Send me to a cardiologist when my child has no risk factors just to be sure

Now, I’m a educated adult and trained professional with a medical background so I know to take these comments with a grain of salt but what about everyone else reading these comments?  There was over 300 comments  and counting on this article that was two hours old of people listening to non health care professionals on what screening test should be done on their student athlete with no evidence to back it up.

The number on cause of death is student athletes is sudden cardiac death.  This statement is terrifying to me and to many other people in the community.  Do you know what percentage of the population that is? This varies widely based on the resources you use but according to the American Heart Association it’s between 0.6-6.2 per 100,000 people.  Is this enough to warrant an EKG and echo on every student athlete?  If you ask the family of a child with an undiagnosed CHD that passed away or a family whose child’s problem was caught by a screening you will hear a resounding yes, understandably so.  There is a debate in the medical community in who should be screened and what that screening should include.  When a screen shows something abnormal, when do you restrict sports, if at all? When communities provide screenings, how many issues are diagnosed, if any? What’s the cost? How many referrals were sent based on a false positive? Was undue stress created for families if there was a false positive?

Things to keep in mind is your child’s pediatrician knows you and your family, it’s ok to talk to them and voice any concerns you have.  Have a conversation with them of your concerns and discuss if any diagnostic tests are warranted.  Your child’s primary care provider went through rigorous training to provide this care, they didn’t get their diploma out of a cracker jack box! Also your primary care provider has probably known your family for some time and knows your family history.  A thorough history and physical is the MOST important part of any screening, diagnostic tests can compliment a good H&P if warranted.

Google is a wonderful tool, I love the fact I don’t need to go to the library to look up every detail for a project and the most up to date info is right at my hands and late night online shopping.  Googling medical conditions can be deep, dark hole.  If you google stubbed toe, you can walk away with the idea you have bone cancer, not just a stubbed toe that needs some ice and will feel better in a day or two.

Googling medical conditions CAN be a great resource for patients and family members if you use reputable websites and you discuss you concerns with you primary care provider.  I think it is great when families come in with a list of questions they have found in their research, but sometimes a support group full of people you don’t know on the internet is not the best place for a medical diagnosis and treatment advice.  It’s a great place for caregivers and patients can come together to talk about daily life, networking with others who have some understanding of their condition, how they cope with their symptoms but diagnosis (as in the group diagnoses yourself or your child when you provide a list of symptoms) and medical advice not so much (answering questions like my child is having chest pain, what should i do?).

Every child who is going to play a sport should have a physical prior to participation.  Discuss with your child’s primary care provider if further testing is needed based on exam and history.  Even if diagnostic tests are done, false positives can occur leading to denial to play sports.  Screening tests aren’t cheap either, the average price for an echo is $2500 in my neck of the woods.

Their is no perfect answer or test  to end this debate yet when you look at the whole picture, sadly.  If you are looking for more opinions or the latest research articles, the American Heart Association and Screen across American are great resources in addition to your primary care provider.  My hope as the world of congenital heart disease continues to rapidly expand and more research is done, a screening tool will be there to detect any CHD at birth so no child has to die from an undiagnosed congenital heart defect.  1 in 100 children are born with a congenital heart defect.

This article is not medical advice, it is just my opinion.

Finding my Zen

When New Years Day rolled around this year, I didn’t really want to make a resolution.  They can be so cliche and they are often broken with in weeks.  The next week a friend asked me to go to a yoga class with her, I agreed and went to sign up for the class.  Their New Years new client special was a fantastic deal and much more economical than purchasing one class (I can never resist a good deal!)  I paid for the month and joined my friend in class.  I’m not the most graceful person but I did the entire class and loved it without making a total fool of myself and falling over and into someone else creating human dominos!  When I was walking out to my car, this sense of calm and peace came over me out of nowhere and remained with me.  I felt great and quickly signed up for more classes.  I continue to love to practice yoga and share this new passion of mine with others.  It has been a wonderful method of stress relief for me.

Everyone has stress in their lives and everyone copes with it differently.  Stress can be related to work, family, friends, bills, a busy schedule and so much more.  I never realized how much stress can affect my daily life.  After leaving work I’m usually tired and need to de-compress after a 12 hour day.  This can be difficult some days because I go straight home, eat dinner and go to bed to do it all over again in the next 8-10 hours.  I love my career but it can be very stressful, even on the best days, as I’m sure many other careers are.  I started to eat more junk food to cope some days and I quickly started to notice myself gaining weight and not feeling great.

I have tried many things to help me de-compress, meet new people and add culture to my life.  These include running (not my forte!), photography, yoga, reading, coloring, cooking, meditation, shopping (not always the best thing for my budget!), and vacationing (again with the budget!).  These have all been fun for me but not always the most practical, I have to work (which I love by the way) so I can travel and sadly do not have unlimited time off!

Yoga by far has been my favorite providing both exercise and zen to my daily life.  I am no where near perfect at yoga and I never will be, this is one of the many beautiful things about yoga.  Everyone’s practice is different-how it’s approached, executed and incorporated into your life, it allows for each individual person in the class to take away something special and enrich their lives every day.  No one is expected to be perfect and everyone is there for themselves, not to impress anyone else.  Yoga is a beautiful practice that enriches my life in every aspect and helps me to decompress after a long day at work.

Don’t get me wrong, I have tried yoga before and hated it! I sure loved my yoga pants but I sure didn’t love the practice of yoga! Trying to coordinate breathing, stretching and twisting myself into a pretzel; I was like how is this fun or helpful and I’m paying for this??  After going into a class with an open mind and knowing yoga is not a competition and everyone is there for their own reasons did I truly embrace the meaning and practice of yoga.

Peace, love and zen

The New Graduate RN Job Hunt

Advice I wish I had as a new graduate RN- When it rains it pours

Last month, I attended a career fair for the sole purpose of networking, this being my year 6th year as a RN and 2nd year as a nurse practitioner.  I ran into several students there I have taught in past years who will be graduating next month.  They all said they were looking for an ICU position  and were discouraged and disappointed many ICUs were not hiring new grads.

I clearly remember applying for new graduate nursing jobs all those years ago and feeling defeated and rejected.  At the time of my graduation, the financial climate was very difficult and there were hardly any new graduate RN positions in my area and the country.  Many hospitals in the area and in other states were on indefinite hiring freezes (including the hospital I had aspired to work at for years).

I quickly abandoned the idea I would land my dream job as a new graduate RN (pediatric intensive care). After I passed my N-CLEX, I started frantically looking for a job while moving back into my parent’s house (good-bye, college!).  The few jobs out there usually said experience required, no new graduates.  I applied for over 100 nursing jobs in a month and used every connection in the health care world I could think of to no avail. I rewrote my cover letter, triple checked my resume for errors and to make sure my phone number and email address were correct.

After countless job applications I received 3 requests for interviews at 3 different hospitals in 2 days!  Interviews pouring out of the air, I was so excited. One position was at an inner city hospital in the cardiac ICU, the 2nd another inner city hospital in a stroke/rehab unit and the 3rd was on a cardiovascular step down unit in a suburban hospital.  I quickly made lists of pros/cons of each employer and patient population and ranked my choices accordingly.  I pressed my new suit, bought new pantyhose, and printed out copies of my resume and nervously drove to my first “big-girl job” interviews I had worked so hard for.

Leaving the interviews, I decided the cardiac ICU position was the one I wanted the most out of the 3 and prayed I would be offered the job.  The unit was small but busy and they offered a very comprehensive orientation program.  A large portion of their staff were planning to go to CRNA school (I was too at the time) and the manager was happy to support that.

The cardiovascular step down position, my interview lasted 6 hours! I was shocked.  I interviewed with human resources, the unit manager and charge nurse.  The manager was great and he was very encouraging and assured me new graduates do very well on the unit. I still hoped for the ICU job though!

I ended up canceling the stroke/rehab unit as I found it they were not considered an acute care unit and thought I would take my chances with the other two jobs.

About a week later, my phone rang with an inner-city area code, I nervously answered the phone hoping for good news.  Sadly, I was not offered the ICU position as “I was just too green” but to try again when I have some experience.  I was devastated.

The next day, I was offered the step-down job which I accepted.  Don’t get me wrong, I was grateful to have a job but I couldn’t shake the feeling that meant I wasn’t good enough to find an ICU job as a new grad like many of my classmates who left my home state did.  I anxiously counted down the days to my start day and continued to look for an ICU job anywhere in the state.  Fortunately, I failed at finding that magical ICU job.  Looking back at my career, working in a step down unit for my first RN position was the best decision I have every made.

My advice to my former students and to any new graduate nurse:

-Working in a step down unit where I would care for 4-7 patients at a time has given me fantastic time management skills

-My history taking skills were much improved.  I always felt awkward in nursing school asking patients personal questions, that flew out the window very quickly!

-I grasped a much better understanding of practical pharmacology, I did not have to learn drips at first and was able to become very familiar with the medications we gave frequently with out the high pressure learning environment in the ICU with inotropes (IV medications that affect your blood pressure)

• Many of my classmates who had boasted about their ICU positions prior to graduation were miserable and overwhelmed- several leaving or being asked to leave within the first three months of employment
• I became very comfortable calling physicians and APPs at all hours of day and night for my patients.  I quickly learned to never apologize for waking a provider at night- this is their job and their responsibility to answer questions and to listen to your concerns
• When I did switch to PICU a year later, I was able to focus on drips and ventilators while feeling comfortable with basic nursing care and time management.  I was overwhelmed but no where near as bad as if I started in ICU as a new grad
• I don’t know if I would have enjoyed PICU as much as I do now if I had started as a new grad and been extremely overwhelmed
• Even though I’m a pediatric provider, I still to this day call on knowledge gained in the adult world
• It was an honor to care for the older adult generation.  I received some great unsolicited life and love advice.  I also heard amazing stories of struggle and survival first hand including Holocaust survivors, WWII veterans, people who should not have survived their condition but were thriving and so many more
• I met some wonderful people and I do miss working with them

You will be ok if you don’t find your dream job immediately after you graduate, I promise! Find a nursing job to start gaining experience and do whatever you can to build your resume.

-Reach out to the manager of a unit you were not hired for or where you would like to work and ask how you can become a more competitive applicant or if you can shadow.

-Take certification classes that you will need in your dream job! I took pediatric advanced life support when I was an adult nurse and paid for it myself.  At my PICU interview, they complimented me on my drive to succeed

-Join an organization in the area your are interested in, for example AACN for critical care.  Memberships usually include continuing education credits, journal articles and opportunities to network on discussion forums

-Network!  Keep in mind many hospitals will consider internal candidates after a 12-24 month period over external candidates!

-Never burn a bridge- EVER! Nursing and health care is a surprisingly small world, it is amazing how many physicians, nurses, APPS, and managers know each other!

Peace, love, and job hunting

Potlucks: The good, the bad and the ugly

Potlucks- The good, the bad and the ugly

Every hospital I have worked at has always had pot lucks.  Large groups of nurses, doctors, NPs, PA, RTs are known for bringing in large amounts of food to celebrate any occasion you can think of.  Typically pot lucks are great and I’m more than willing to bring a dish to pass.  After I’m particularly stuffed from a potluck, I sat down to write out thoughts on these delicious spreads and how they can make working days you would rather be with your family a little more enjoyable.

When I’m going to a friends for a party, it is almost always requested to bring my buffalo chicken dip like it’s fine cuisine.  It’s no where near fine cuisine but it’s a delicious combo of cream cheese, mozzarella, hot sauce, ranch dressing and chicken (the great American diet staples) all melted into one crock pot of gooey deliciousness.  Where did I get this recipe, do you ask? One of the countless work potlucks I’ve been a part of.  The first time I tasted this dip, I wanted to sneak in to the break room and steal the crock pot full of it to take home later when no one was looking!

The Good:

Makes working holidays more tolerable- sometimes even fun (who doesn’t love a themed potluck)

My work friends are excellent cooks and bakers

There is always tons of food and options

You never leave hungry

Great time with your co-workers

Team building

There’s always someone willing to bring the plates, napkins and eating utensils

You can eat as much as you want and have your waist band expand (scrubs are great)

The Bad:

Your favorite dish being eaten before you can take your break

When doctors or house keeping staff or staff not involved in pot luck comes and eats a large portion of the food without contributing

Never enough serving spoons or plugs for crock pots

Way too many desserts

Totally not diet friendly

The Ugly:

By the time you can go to break, all the food is gone or worse- sitting out for the past 8 hours

The plate you made and saved for yourself in the fridge gets stolen

Dragging home your dirty crockpot

Dropping that said crockpot on the sidewalk and having it shatter on the way home

Forgetting to bring your assigned salad dressing when the theme is salad potluck (I think my co-workers are still mad about that one!)

As another delicious pot luck concludes, I’m thankful for my wonderful, generous co-workers who help produce full Christmas and Thanksgiving dinners and meals for any celebration you can imagine, for each other while we have to celebrate these holidays with our co-workers and patients.  I refer to my co-workers as my work family and I couldn’t do the job I do without them.  Pot lucks are a wonderful way of showing appreciation and love to our work family and work wouldn’t be the same without them.

What’s your go to dish to bring to pot lucks?

Peace, love, and food

How do you do it?

How do you do it?

This is the questions I am asked most frequently.  Why am I asked this? I’m a pediatric nurse practitioner focusing on cardiology and cardiac surgery.  Translation: I work with people of any age who are born with a heart problems I most frequently take care of babies under 1 years old.

I never know how to answer this question.  I love what I do but I don’t want it to come across as if I want the child to suffer so I can have a career in this area.  Or I’m a martyr (I’m not).  I’m also no different from any one else.  Yes, I understand working with sick children is not for everyone but it is what I have made my career on and I understand this specialty is not for everyone.

When I was growing up, I was the youngest in my family, I hated baby sitting and I didn’t particularly like children.  I wasn’t shy about admitting this, either. I was dreading my required pediatrics clinical in nursing school. The first day of class, the professor asked us to raise our hands if we didn’t want to do pediatrics and my hand was one of the first in the air.  I grudgingly signed up for clinical and put my scrubs and headed the hospital on a fall afternoon.  My instructor assigned me to work with one RN that day and said she would check on me later.  5 hours later, I was working on my charting and my instructor came to discuss my day.  I then realized, I had loved every minute of it.  I don’t know if it was the 13-year-old with Flu-A, the gastroschesis baby, carrying a cranky baby around with us because he wanted to be held or the trach vent baby who smiled at me and pulled on my hair that made me enjoy the day, it was a feeling I had deep down that this is what I was meant to do.

When ever I heard people say their career is what they were meant to do, I would nod my head and think internally “yeah, right”.  Well, I was wrong and all those people were right.  This feeling continued through the semester and through my career.  I called my mom the day after my first day at clinical and when I told her I might want to go into pediatrics, she didn’t believe me.  Luckily she has always supported me in everything I do.

All these years later, here I am, working with critically ill children every day I work and I couldn’t be happier.  I still don’t have an answer for the question “how do you do it” but I can say I love what I do and it just feels right.  I sincerely hope every nurse finds this feeling.

I’ve made this blog in order to share my passion for my career with others and to also share some of the crazy days, random thoughts, frustrations, tears and happiness that come with being a nurse practitioner.  It’s been a wild ride and can’t wait to share it with you.

Peace, love, and nursing