Yup, Still Alive

 You'd be surprised how much time pursuing a Bachelor's degree in nursing can take. Paired with holding down a job and dealing with a young one with health issues, it really does just make the pages of the calendar fly by. I was certainly surprised when I wandered over to my poor, neglected blog to find that over two years have passed since my last post. Whew! Well, I'm still alive.

So what have I been up to in these intervening years (apart from the afore mentioned adulting)?

Well reading and writing, actually. With a little crafting thrown in for some spice.

I'm (finally) starting to query agents for the Tree Mage story. It's exciting and scary at the same time. 

I finished the Vampire Story a while back. Originally I thought it'd just be a guilty pleasure piece that I'd eventually post for free on-line. The Hubs thought it was original enough, though to try to get it published, so I'll be trying to query that one once I get a good flow going for the Tree Mage tale.

Very recently I wrote a Dresden Files fanfic, which was a big departure from my usual work. I've written a fanfic before, but the main characters were all original. This one literally just plunks me down in the Dreseden-verse and lets things fly. It was a bit of a therapeutic piece. Again, another one that I felt would never see the light of day, but now I'm thinking to maybe throw it up on FanFiction.net. It was so much fun to write and I hammered out around 33,650 words in a little over a month (which for me is pretty impressive!)

I've also starting picking away at another draft of "The Kai'us Planet" (as always). I'm trying to get out of my rut by "flipping the script" (changing where and when things happen, and who responses to what situations at certain times). It seems to be working, but there's a lot of story to go. 

And of course there's those little cultural details that pop up and side-track me. Earlier this year I spent several days developing the housing and village construction for three of the Kai'us races. Just a few days ago I realized that beings who are pyrokinetic and are surrounded by sand would be pretty epic glass-smiths, so now I'll be incorporating intricate glassware into the story. Also earlier this year I revamped the Kai'us alphabet (again!). I really like it this time and, like the latest number system, it's something I'd actually be able to remember.

Still along the Kai'us vein, I've started making a "census hoop" which is what the village chiefs would use to keep track of who marries who in their village. To keep things specific, I'm making the hoop for the first Grand Chief's village, since I know who would be in that village. I've only gotten the first two rings done however, (encompassing 16 families). There'll be four rings total, covering 48 families and several generations. After that, the hoop becomes more a of "net"; and it's really that stage that I'm more interested in. It's a project that requires a fair amount of time, space and concentration though; so I don't get an opportunity to work on it too often.

My Regency-era outfit is still right where it was when I last wrote about it. I've also started an 1840's mourning gown for my niece. I've gotten the shift and two petticoats done. Still need to finish the corset and then move onto the actual gown. (We'll get there!) 

I've just started to feel well enough in recent months to give martial arts a try again. Have only gone to one class so far and I hurt for days after, but it was so much fun. Can't wait to go back!

Curing (What I Thought was) IBS: Part 3

If you're coming to this post in the middle, go here for Part 1 or here for Part 2. 

The (Final) Solution

My goal for the next few "IBS" attacks was to pay close attention to the sensations in my body during an attack to divine just what was going on and when. This wasn't terribly difficult as I'd been practicing mindfulness and meditation for years, I'd just never applied it in this particular way before. 

I did quickly ascertain that anxiety was indeed a pretty big element, but the techniques I used to deal with it only lessened the symptoms, it didn't dissolve them completely. Apart from simple breathing exercises and assuring myself that I was safe, I also adopted a concept called "embracing the suck". This basically means instead of resisting the present situation, one simple acknowledges that it's pretty darned unpleasant and just accepting it. It doesn't mean rolling over and dying - anything you can do to improve the situation, by all means do it; but do it with an attitude of "it is what it is". It means being okay if you throw up or have to dash off to the bathroom for a possibly painful evacuation of the bowels; just don't fear those potentials. Accept that they may happen and plan accordingly. 

At this juncture I vaguely recalled that I had tried to deal with the anxiety aspect of these attacks in the past as well; obviously it hadn't really worked then either (maybe that's why I had stopped calling it "Travel Anxiety"). There was clearly something else going on here, so what was it?

The answer was tension. My guts were tightening up in knots; and it just so happened that I had stumbled on a way to deal with it just a few years earlier. I felt like a pretty dense idiot that it had never occurred to me to use the technique here!

But let me backtrack a moment as this realization came in two, very different parts. The first was a statement made by my Karate instructor a while back in regards to self-defense techniques. His comment was that the population is split fairly evenly into two groups: one group tenses up when they feel pain and the other relaxes/collapses. Unfortunately there's no way to know who's in what group while they have a hand around your throat, so the first part of any self-defense technique that inflicts pain on your attacker is to first protect anything on yourself that's delicate (like your throat).

The second half of my "aha moment" was a simple relaxation technique that I'd been playing with for the previous five or so years. When I first started messing with it, I thought I'd stumbled on something new, amazing and different. I later realized that it's something every yoga instructor worth their salt teaches (have I mentioned I can be a bit dense sometimes?)

The "new" technique built off of exercises I'd been doing for close to fifteen years: While sitting or laying in a relaxed position, be mindful of any muscle tension anywhere in the body. It's best to focus on small sections at a time, so it's generally recommended to start either with your toes and work upward or your head and go downwards. It really doesn't matter though; you can start with your belly button if you want to; just find the tension in your body and consciously relax it. Do it again and again because it's very likely that once you've made it through the whole body, something near the beginning has tensed up again. It can feel like an exercise in futility until you've been doing it awhile. And I'd been doing it for quite a long while.

Nursing school opened up another aspect of this time-honored technique for me. There's lots of muscles in the body and thanks to anatomy and physiology class, I was learning them all. I could now imagine all the different muscle groups with all their varied layers. I'd start with the big, outer muscles and work my way "inward" to the deeper muscles. There were also different levels of tension to be found. So after going through and relaxing the "gross" tension, I'd go through and relax finer and finer levels of tension. (Who knew so much "hidden" tension could hide in one's feet?)

Now here's the thing (also thanks to nursing school), there's three types of muscles in the body: there's skeletal muscles - these are the ones we use to move about and create facial expressions. We have conscious control over skeletal muscles (for the most part); and these are the ones we typically focus on when doing these types of relaxation techniques. But there's two other types: smooth muscle - which lines the digestive system, lungs and some blood vessels; and cardiac muscles (that surprise, surprise make up your heart and do their own thing). Though these two other types of muscles are not subject to our conscious whim, they do response to our emotional state, and so with some clever mind games you actually can consciously control them to a certain degree. And this is the technique I had stumbled upon.

In fact I'd already been using this technique to stop menstrual cramps for a while already. It's pretty easy really: menstrual cramps are typically caused by the uterus tightening up as it expels all that nice, bloody lining it no longer needs. You can just as easily "tell" it to not tighten up so hard. Just imagine the sensation of a tightened fist and then relaxing that fist. You can apply that sensation to a grumpy uterus too. Works like a charm, but you have to be awake to do it (so night-time cramps unfortunately need a Tylenol to be gone away with, sadly). Also, the cramps can come back pretty quickly as soon as you lose focus, so some persistent crampies need near-constant attention; but it is doable.

Now lets go back to those two types of people: the "tensers" and the "relaxers". Image if you will two people who just ate a big meal. One leans back in their chair, unbuttons their pants and with a big sigh says, "Aaah, I ate too much!" The other person clutches their belly, arching forward and moans, "Oooh, I ate too much!" I'm sure you can imagine who's the tenser and who's the relaxer. The tenser likely feels nauseous because he's tensing up; there's nowhere for the food to go. Our relaxer might have some heartburn from an over-stuffed tummy, but otherwise he just feels really full. Tension inhibits the digestive process. Makes sense.

It was not difficult at all to marry these two concepts together and I have no idea why it didn't occur to me sooner (did I mention I can be a bit daft at times?) I now had a pretty solid hypothesis that tension was the source of my woes and that conscious relaxation was the solution. On my next IBS attack I was mindful of any tension in my gut and I consciously relaxed it while making sure my anxiety didn't get out of hand, and you know what? It worked like a charm. I could literally relax away my "IBS" symptoms. Stop it right in its tracks. That was it?

Apparently it was. After only a handful of attacks handled in this way, it really no longer became a problem. No matter what I ate at whatever time, I could deftly stop it before it started. Oddly enough I did end up having a "symptom-less IBS attack" a few months back. I don't remember the exact situation, but I do remember the sensations. IBS (or whatever the heck was plaguing me) has a unique sensation in the body, even sans the tension. I can't even explain it; it's just "IBS-y". So I felt "IBS-y" with a tender belly, but with the anxiety and tension removed, it never escalated. I remember clearly the thrill of being able to go to bed that night and lay down comfortably with the light off. No shakes, no ragged breathing. No chills, sweats or drooling. It was incredible! I was free.

Here's the thing though: Because I've been meditating for nearly half my life, I have no idea if this technique is one of those things where once you understand the concept, you're good to go; or if it's like learning to swim or ride a bike where you can "understand" it all you want, but you won't be able to do it until you find your own way. Try it and see.

I think this technique would work for any tension-based ailment, not just digestive issues. I feel there's many medical problems that have tension as a root cause, even if it's not initially obvious (like high blood pressure or inflammation issues that aren't allergy-related, etc); but of course I have no way of proving/testing that as yet.

Resolution
So what changes have I noticed since finding my cure? Well, I'm happy to report that I gained ten pounds in the span of just a few months. Believe me, in my case this is a good thing. I had always considered myself underweight and always had a hard time putting on and keeping pounds no matter what I tried. Now that I can relax my gut and let all those nice nutrients in, I've achieved a weight that's perfect for me. Your results may vary.

Travel has become far less an exercise in strategic planning around meal times, sleeping accommodations and locations of toilets. It truly doesn't matter now. It's a level of freedom I had never before thought possible.

Note that meds never came into play here. Though I'd been to a fair amount of therapy (which I highly recommend by the way), as mentioned at the beginning of all this, I was never diagnosed with anxiety. I'm not in the least advocating to handle anxiety issues (or any other mental health issues) without meds. I had never realized just how debilitating my anxiety was until I started writing up this whole series.  

"It's all in your head"
I used to hate that phrase, and I've heard it a lot in life. It implies, "you're making it up," "it isn't real," "you're just looking for attention". It was so demoralizing because my symptoms were absolutely real and problematic; but because there was no detectable medical cause, it was "obviously fake".

Part of my healing involved "flipping the script": if it's "all in your head" then the power to getting better was completely within my control. No external source was going to fix this. No tests, prescriptions, weird treatments, special diets or rituals. It was all on me. 

Claiming this inner power can be difficult for some, especially if you have a passive temperament (like me in my younger years) and just expect the answer to be in doctors, medicine or some external source. As odd as it sounds, another hurdle can be that some people identify with their illness/condition, it's a part of who they are. If it goes away, they'll lose a piece of themselves and that can be scary. This of course is usually unconscious, and requires a good long, honest look within. It is possible that whatever the problem is is serving some purpose in your life. Certainly there's nothing wrong with that, but know that if the problem is "yours" (not caused by an external problem), the solution is yours too.

And so that's my story. I hope it helps, or at the very least provided some interesting reading.

Speaking of reading, here's a short-ish list of books that have been helpful for me and may be for you also (if you haven't read them already):

"The Untethered Soul: The Journey Beyond Yourself", by Michael Alan Singer (2007)
I'm a late-comer to this book, but it's a wonderful read and very insightful. It does touch on tension and its role in the body.

"The Power of Now: A Guide to Spiritual Enlightenment", by Eckhart Tolle (1997)
This is a great book, and really lays out the concept of how to "embrace the suck".

"Energy Anatomy: The Science of Personal Power, Spirituality, and Health", by Caroline Myss (1996)
I can't recommend this and her other books and audio offerings enough. Myss presents her information in a no-nonsense way that invites the reader to take a good long, honest look at their own thought patterns and habits.

"Waking the Tiger: Healing Trauma", by Peter A. Levine (1997)
This one actually deals with healing trauma, but it does hint at tension being the source of many other problems. It also mentions that trauma can be "trapped" in the body in the form of tension and that releasing that tension may bring up buried, traumatic memories. It's something to keep in mind if consciously releasing tension is new to you. 

"Autobiography of a Yogi", by Paramahansa Yogananda (1946)
Okay, I'm recommending this one more because it's just an awesome book (I've read it through twice); but I was reading the part about him gaining weight right when I started putting weight on, so there's that.

Curing (What I Thought was) IBS: Part 2

If you're coming to this post in the middle, go here for Part 1.

(Failed) Attempt at a Solution

I saw no point in seeking out a medical doctor. I might have mentioned my problems in the past to one doctor or another and just gotten shrugs. Certainly the trip to the ER in my senior year had stuck with me when they found "nothing wrong with me". Since I now believed that this was a food issue, I went to a nutritionist. The person I chose though practiced some form a quackery that relied heavily on herbal supplements that could only be procured through his office (of course); but I was desperate by that point and did whatever he prescribed. His treatment plan (which included numerous capsules taken multiple times of day to bolster my immune, digestive and nervous systems) included giving up all sugar and wheat-based products. Meats, fruits and veggies were fine and (despite the fact that I knew even by then that I was lactose intolerant and told him as much) he insisted that dairy products could stay.

So I cut pasta from my life and switched to spelt flour and sprouted breads. I made other dietary changes and took the prescribed pills that even then I felt were next to useless, but if there was even a chance that they'd make me better, I'd take them. And you know what? It actually helped! Over the course of a year my symptoms improved greatly and I could again eat without getting sick so frequently. Travel still caused problems, but it wasn't as bad, especially if I was mindful of what I ate, and at what time of day.

After a year of faithfully following the plan he had laid out, I slowly distanced myself from the nutritionist's practice, which wasn't easy since I was still very passive and had issues with offending others. The practitioner and his staff were not at all supportive of my leaving, and laid on the guilt pretty heavy when I started buying fewer pills and coming less frequently. "It must be nice being healthy," one secretary said in a snit when I confessed I was feeling better and so didn't need all these pills (lol wut?!). I finally had to cut ties completely in a fit of anger at their snide comments and manipulation (I was young and naïve, be kind). I should note that I have no issue with herbal supplements or vitamins, they have their place and serve their purpose, I just felt in this particular instance they weren't all they were cracked up to be.

Considering myself to be as better as I was going to get, I slowly started reintroducing previously forbidden foods. I'd reached a point where I could eat pretty much anything, to a point. Had to go easy on the dairy products, no matter what, but the richer and creamier it was, the more likely it was to cause problems. I was also bound by the sun when it came to my digestive system: I couldn't eat pretty much anything past 7:30, 8:00 at night (except maybe toast with a little butter) lest I be up late feeling miserable. Dinners and meals while traveling and at friend's houses needed to be handled with care. Strenuous exercise was also problematic (see previous posts about Karate rank tests). But this was my life now and I just accepted it.

It was my late 20's, early 30's that I dropped the "Travel Anxiety" label, somehow forgetting that anxiety had anything to do with my issues, and redubbed my affliction "IBS", as by now I had it firmly in my head that my problem was strictly food-related. Again, no doctor was involved in this decision as there continued to be "nothing wrong with me" medically. And I will admit, by this point I could link each and every instance of illness to something I had eaten earlier in the day as the trigger; but then we can make anything make sense under the right conditions. 

Gradually, as the years wore on, my condition slowly worsened again. Then two things happened that gave me a new outlook on my tummy troubles and clued me in as to how I might be able to fix it. The first thing was about seven-ish years ago when I starting to get dry heaves as part of my attacks. It wasn't with every attack, but it was new, most unpleasant and slowly increasing in frequency with no apparent rhyme or reason. A bulb started to go off: if food was the cause of my problems, then shouldn't I be bringing something up with these dry heaves? Hmmmm.

Event number two was Thanksgiving of 2017 or 2018. I'd gone to my brother and sister-in-law's with my mother for dinner. They had chosen a late dinner time, which I knew was an almost guarantee for disaster, but I ate lightly and hoped for the best. Alas, the inevitable sour stomach started to rear it's ugly head and I parked myself on the floor off to the side in the living room after dinner (there were other people in the chairs and on the couch); and I tried to distract myself by playing with their young son on the floor (my spot was also closer to the bathroom; work smarter, not harder). Despite my best efforts, I was feeling steadily worse and I asked my mother if we could head out.

Mom was having none of it, she was socializing with her daughter-in-law in the kitchen and helping with dishes. I'd have to wait. Which I did, but I wasn't terribly happy about it. I returned to my spot on the floor and attempted to chat with the other guests, but I really wanted to go home! After another half hour or so, I had to give an ultimatum: I'd either go outside and pace in the driveway (fresh air and walking tend to be helpful) or we head out now. My frustrated mother decided it'd be far less embarrassing if we just went home (she could also see by this point that I was not holding it together very well). 

Of course on the drive home she wanted to wax poetic about the meal while I begged her not to. Just the thought of food made me want to hurl. This only raised her ire further; what else was there to talk about after a lovely Thanksgiving dinner? Once we got home, I propped myself up against a stack of pillows on the couch (I lacked the ambition to open the hide-a-bed, plus there'd be no point as I'd be unable to lay down comfortably) and attempted to settle in to endure the next couple hours of suffering I knew I had ahead of me.

Mom just stood over me annoyed, and said the words that turned my life around. "This isn't IBS, this is a panic attack."

Not terribly helpful at the time, but it did strike a cord. Since I'd already started suspecting food wasn't truly the source of my troubles, it got me wondering just what could this be then?

Find out what the final resolution was here.

Curing (What I Thought was) IBS: Part 1

I had to split this up into three pieces just because it ended up being so long. There'll be links to take you to the other parts at the end of this post.

Disclaimer: this post is not meant to diagnose or treat any medical conditions. Though a Registered Nurse, I am not a doctor and cannot diagnose. This post is merely anecdotal with the intent that my personal experiences may resonate with others who experience similar symptoms. Also note that I've never been formally diagnosed with IBS, panic attacks or even anxiety. 

I should also preface here that this post isn't going to portray my parents in a positive light. Know that there were plenty of aspects in mine and my brothers' lives in which our parents were perfectly involved with and supportive of; this was not one of them and I don't in the least hold that against them. My condition (because it had no apparent physical/medical origin) was only a source of annoyance for all involved because it couldn't be "fixed" via "regular" means. It meant that I was left to my own devices to deal with it.

The Problem
So to start: IBS is short for "Irritable Bowel Syndrome". The Mayo Clinic defines it as: "a common disorder that affects the large intestine. Signs and symptoms include cramping, abdominal pain, bloating, gas, and diarrhea or constipation, or both." Its root causes aren't wholly known, making treatment difficult. 

You can read more about panic attacks here if you're interested, but I'm running on the assumption that most people know what they are. Here's also some interesting information from VeryWellMind.com about the connection between the two conditions.

So, if I've never been diagnoses with either IBS or panic attacks, why do I think I have one, the other or both? Well, I can say that I've always had a "nervous stomach" going back for as far as I could remember. I never dealt with new or stressful situations well and that nervousness/anxiety almost always manifested as an upset stomach. I rarely threw up during these episodes, but it was most definitely uncomfortable. I wanted nothing more than to huddle in a quiet place, clutching my stomach. My parents suffered my nervous fits with nary a comment. It was simply an inconvenience when I'd beg to go home from school as a small child for an upset stomach that never amounted to anything; and half the time my requests to go home were denied. These nervous attacks only got worse as I got older.

A couple notable events that particularly stand out from my youth: One time in late elementary school, a spring storm blew in from the west. The approaching leading edge of the storm cloud was pitch black. I've never seen a cloud so thoroughly dark before or since. This instantly threw me into a panic even though I intellectually knew it was "just a thunderstorm". Still, thunderstorms can harbor tornadoes and that threat was a recurring source of worry in my younger years despite my parents always assuring us kids that we had a plan to go to the basement in the event of such an emergency. (A tornado has never touched down anywhere near my parents' house by the way, though I've seen scars from past ones near where friends of the family lived.)

With this fear, I hid up in my room, in bed; trembling, breathing heavy and trying my best to deal with awful nausea as I listened to the storm approach and break overhead. Wind and rain pelted our drafty farm house for hardly more than fifteen minutes; and then it passed with no harm done. The power didn't even go out.

Another time, likely in middle school, I was staying overnight at a friend's house (a friend I'd stayed with many times before and after with no problems) and out of the blue I had a sudden sense that something terrible was going to happen; perhaps the furnace would explode or the house was going to blow up for no good reason. Either way, I couldn't shake this awful sense of dread and laid in bed for well over an hour (maybe two), trembling and fighting back waves of nausea while my heart pounded in my ears. At last I couldn't take it anymore and I asked her parents if they could take me home (her parents seemed to never sleep and they were still awake when I wandered into the kitchen to make my plaintive plea). Just an fyi: the house never did blow up and still stands to this day.  

The worst was when I was a senior in high school, I had taken on a babysitting gig for a couple I hadn't met before, but whom were family of a classmate of mine. I had put out an ad in the local paper hoping to raise extra funds for college. I felt nervous and queasy the whole day of school leading up to my first time babysitting for perfect strangers . I'd met with the parents just a few days prior so they could get to know me before leaving their infant daughter and preschool-aged son in my care. I had seemed dependable enough and I tried my best to put on a brave front when showing up that evening to watch their kids. I was given thoroughly detailed instructions on what to do in various situations and then the parents headed out for a childless evening. I loved kids (still do) and my original plan had been to play with the boy and watch TV with him until bedtime while keeping a loose eye on the baby, who I'd been assured would sleep the whole evening - which she did. Instead my stomach just became increasingly sour and the shaking wouldn't stop. I rushed to the bathroom twice to throw up, which rather distressed the little boy (and myself! I was now convinced I had a stomach bug and I was going to get the kids sick). When I wasn't puking, I had diarrhea to contend with too.

I ended up calling the children's' grandparents to take my place in watching the kids and the grandfather was perfectly fine driving me the half mile home. There I parked myself on the couch with the "barf bucket" (a cleaning bucket that served double-duty for the gastrically challenged) and trembled from head to toe while breathing heavy, and was utterly unable to doze off despite feeling exhausted.

This was the first time my parents expressed any concern (that I noticed anyway) about one of these fits as it was so much more severe than anything previous. And I was convinced that it was utterly different from my other nervous episodes; certain that I was physically ill. When I expressed that I was dizzy, had a hard time forming complete sentences and my hands were starting to seize up and form claw shapes (in hindsight, that was all from hyperventilation), they decided it was time to take me to the emergency room where I got my first ride in a wheelchair because by then I was having a real hard time walking straight. 

The staff ran some tests and hooked me up to a bag of fluids, but they couldn't find anything wrong with me. After being there for an hour or so I was suddenly feeling better and so was sent home. No one even mentioned the possibility that this was actually "just" a panic attack. It never crossed anyone's mind until much later. 

I tried babysitting for that family one more time after that, and though I did make it through the whole time they'd hired me for, I was utterly miserable. My stomach just did flip-flops and my body shook so much that I couldn't play with the boy and he was sent to bed early while I watched TV to try to calm my nerves. I had to give up on my babysitting aspirations after that. I just couldn't handle it.

By the time I went to college, I had been around enough between trips through school and Girl Scouts  to know that my first night sleeping in a strange place wasn't going to be pleasant (as symptoms typically only arose after dark). Those symptoms included: intense nausea (with no vomiting); uncontrollable shaking; heavy breathing; pounding heart; tender belly; and usually diarrhea/loose stools (though pooping sometimes made me feel worse, so I'd often try not to go to the bathroom). Sometimes my mouth would water and I'd have to spit into a tissue, or (gross!) just let myself drool because swallowing would only sour my stomach more. Laying down would make me feel far worse, so I'd have to sit up or walk around. I could typically doze lightly in this state (while sitting up of course), but I'd have weird dreams and wake often. Having the lights out would exacerbate symptoms, so lights needed to stay on for the duration. Stomach remedies like Pepto Bismol didn't really help, but they typically didn't make it worse either. Obviously I had no interest in food during these attacks and the smell, sometimes even just the thought of food was a big no-no; though I found nibbling of something very bland and simple, like lettuce wasn't a bad thing. I usually had no interest in drinking anything other than light sips of water. Symptoms tended to come on suddenly and leave just as quickly; the whole ordeal lasting several hours. Once it passed though, I'd feel perfectly fine. I could lay down again and sleep soundly. The dark posed absolutely no problem.

This pattern continued through college and then into living on my own. Around that time that I started calling my affliction "Travel Anxiety" because it seemed to only happen when traveling. This of course didn't stop me from taking trips, it just meant I had to plan for these inevitable inconveniences. The real problem arose when I starting having troubles eating at restaurants or at friend's houses. This is where my anxiety issues started getting linked to food in my head. If at a restaurant, I'd have to pay attention to where the bathrooms were in case I had an attack and have to rush off with a bout of diarrhea (which was becoming more frequent). I'd have to warn friends that my stomach may take a turn for the worse and I may need to go home early or just live in the bathroom for a half hour.

This affliction became more than just irritating or annoying, I was starting to lose weight (which was a bit of a problem as I've always been on the skinnier side). I was also starting to become afraid to eat because by this point in my life (early to mid-20's) it seemed that I was getting sick about every-other time I ate. This was becoming a real issue.

Click here for Part 2, or if you want to skip to the end, here's Part 3.

COVID Update (And More)

I'd be remiss if I didn't do some type of COVID follow-up after my last post; so here's a quick recap: I'm happy to announce that the Coronavirus did not effect my region nearly as badly as it did some others. "The Bubble" was dismantled in early April and all the patient rooms on the floor where I work were equipped with fans to turn them into negative air pressure rooms (so long as you keep the patient room door closed). We still get the occasional COVID-19 positive patient here and there. Happily there's no longer the underlying nervousness about caring for these patients. We have a better understanding now of how to treat COVID patients and what to look out for as warning signs that they may need a higher level of care (i.e. transfer to the ICU).

It does make people outside of the hospital setting nervous when they ask, "So what do you do?" and I out and out reply, "I'm a COVID nurse." They take a step back and tend to keep their distance. They often have questions, which I'm happy to answer. I try to relieve ignorance where I can. This is a nasty illness and it can take down the strong and weak alike, the healthy and the sick. At this point we have no way of predicting who will develop complications from contracting the coronavirus, and who will just have passing symptoms that don't even need hospitalization; so we in the healthcare field advocate doing what can be done to avoid coming down with it in the first place. Frequent hand washing, and mask-wearing while in poorly ventilated spaces where one may be within six feet of another person are still the best precautions.

 I know everyone is sick (no pun intended) of COVID-19. People in the future will likely look back on this brief span of time and be amazed at how much air-time this virus has received. I can't wait for this illness to become a thing of the past; but for now it's still here and it's still real.

*  *  *

On a happily unrelated note: I've been up to more than "just" nursing. I recently started work on a Regency (Empire) Era outfit (pics in future posts that will feature more of the outfit as it's completed). This project will be a hybrid of hand-sewn and machine-sewn. Though I'm shooting for as historically accurate as possible, there will likly be liberties taken based on my whims. So far I have the chemise and stays finished.

I continue to pick away at the Vampire story. It's nearing the end and as of this writing was sitting at just below 68,000 words. I've mentioned a lot on social media that this one will likely never be published as it's too much like other already-existing works; so we'll call it an "homage piece". Happily this means that it'll be available to all who ask (for free) when it's finished and gets squeezed through a couple beta reads. (It may be free, but it's going to be proof-read and edited!).

I've been putting off agent-scouting the Tree Mage story, waiting for the fabled "Right Time™". Of course now would be a great time since we're getting into NaNoWriMo season and submitting right before then would be ideal.

Speaking of which: I have no intention of participating in NaNoWriMo this year, but in past years I've jumped in rather last minute, so anything can happen.

Lastly: I was recently interviewed by Andrea Harkins for her Martial Arts Woman podcast. Link for the accompanying blog post that also has the podcast link here.

The First Three Days as a COVID-19 Nurse

"May you live in interesting times"

                ~ Joseph Chamberlain

Quick backstory: I graduated nursing school in May of 2019. Was hired even before graduating at the hospital where I had done my clinical rotations. Took and passed my boards in June and started working as an RN that July. I was hired to the Med-Surg floor. Med-Surg being short for "Medical-Surgical"; we take care of people with stable medical conditions: usually COPD, complications from diabetes, pneumonia, dehydration and electrolyte imbalances, just to name a few. We also help alcoholics take their first tenuous steps towards sobriety (quitting drinking cold turkey can cause numerous health problems including seizures; we have a treatment pathway to help ease the transition). On the Surgical side, we care for knee, hip and shoulder surgeries/replacements as well as spinal fusions.There's also a variety of abdominal surgeries: appendectomies, removal of gall bladders, colon resections, etc.

I was eight months into my first year as an RN when the Coronavirus started affecting my region. Because the Med-Surg floor at my hospital is centrally located - the ICU, ER, OR and medical imaging suites are all on the same floor - we were selected to have half the floor cordoned off to be the COVID-19 isolation unit, staffed (at least for now) by volunteers. I was quick to raise my hand to volunteer since my family and myself are all in the low-risk demographic to experience complications from the Coronavirus. Plus I wanted the opportunity to see and experience first-hand how COVID-19 was being treated and what measures were being taken to protect healthcare workers.

Sectioning off half of a hospital ward was no easy task: the new unit must maintain negative pressure, meaning the air in the unit cannot circulate throughout the rest of the hospital, and it must be at a lower air pressure than the air outside the isolated ward. Air from the COVID-19 unit is filtered and sent directly outside. This involves a lot of fans and hoses that look like drier vents. The integrity of this isolation unit is maintained by water-proof plastic canvas airlocks held in place with industrial-strength tape. The airlock is accessed through heavy duty zippers. There are clear plastic windows so you can see in and out of the airlock. The airlock is just large enough to fit a hospital bed. I call this isolation unit "The Bubble".

With The Bubble being its own self-contained unit, the next problem was the supply logistics. Because there is an obvious need to limit what comes through the airlock, everything needed for patient care needs to be kept within The Bubble. Patient meds are stored in a large computerized locked cabinet called a Pyxis (pronounced pik-sis). Ours looks like this:

https://www.bd.com/assets//images/international/our-products/medication-supply-management/pyxis-medstation-system_2_DI_1011-0002.png

The Med-Surg unit has two of them, so one went into The Bubble and into a room that's usually used as a conference room. This conference room also became the supply room for IV bags and tubing, linens, diabetic testing supplies, a refrigerator and any other supplies/equipment needed to care for our patients. All in a room that was cozy with just eight people before; it now is tight with three or four.

Computers were also a tricky thing to figure out. At our hospital, we use COW's (Computers on Wheels) to document med distribution, patient charting, monitor test results. etc. We have a fair number of them on our floor, but how many should go in The Bubble? Then it became: where to plug them in to charge? In normal times they get plugged into an outlet in the hallway, and there's a fair amount of outlets...or so we thought. Remember all those fans we need to maintain the negative pressure? They need outlets too. As do the chargers for the walkie-talkies we use to talk to folks outside of The Bubble. As do the small handful of other electronics needed to keep things rolling on the inside. So power strips joined the party.

Keeping things clean comes next. Those COW's have a lot of surfaces. Glucometers for checking blood sugar also have to come in and out of patient rooms. They all need to be wiped down after every use. Thank heavens for disposable stethoscopes! There's one for each patient, so they don't need to be cleaned as often. Even so, one becomes pretty obsessive pretty quick about bleach wipes.

So now how to keep the nurses safe from catching this? How to keep them from spreading this virus to each other, other patients, their families, the general public? Enter PPE (Personal Protective Equipment): Gowns, gloves, goggles and masks.
Ah, masks. The polices keep changing on masks due to supply issues and that's a real sticking point. It partly comes down to the question of Droplet vs Airborne precautions. Here's a quick breakdown:

Droplet precautions: according to the CDC, they should be in place when "pathogens [are] transmitted by respiratory droplets that are generated by a patient who is coughing, sneezing, or talking". The pathogens hitch a ride on water droplets which are heavy and don't stay in the air for long. They can only travel about 3-6 feet before dropping down. This from of precaution is used for the flu typically and other catchy respiratory ailments. For these situations, a surgical mask provides perfectly acceptable coverage because water droplets are relatively big. We also wear disposable gowns just to be safe.

Airborne precautions: "pathogens transmitted by the airborne route". Okay; and that means....? This means the contagion can stay in the air for far longer because it's not hanging out on just water droplets. It can travel farther too because it's not drifting back to earth as quickly. In nursing school we learn the acronym MTV for "Measles, Tuberculosis & Vericella (chicken pox)". These are the three most common diseases that are transmitted via the airborne route. Airborne bugs need a more heavy-duty mask to be filtered out. Enter the N95 mask. These need to fit tightly to the face and we're tested annually to ensure the size we've been assigned still works for us.

So...is the Coronavirus a droplet or airborne pathogen?
According to the CDC, Coronavirus is "only" a droplet baddy so a surgical mask should be fine at stopping it. However if a patient is receiving a nebulizer treatment; or a nurse must handle intubation equipment, the virus is considered airborne and an N95 should be worn.
That being said, most hospitals are taking no chances and staff treating patients who test positive for or are suspected of having COVID-19 are instructed to wear N95 masks.

Here's the problem, because we rarely encounter airborne pathogens on a regular basis, hospitals do not have vast stocks of N95 masks. Pair that with the fact that panic-buying has depleted the supply and Coronavirus took a while to come to the US, these masks are in short supply. Surgical masks are also limited presently partly due to the aforementioned panic-buying, but also because we're just coming out of flu season; so rationing has been put in place. When and how masks are used is certainly a point of contention and guidelines and policies are changing day to day (sometimes hour to hour!).

That all being said, what does a day look like in the life of a COVID-19 nurse?
I get up at 5:30 in the morning, get myself together. Put on my regular work scrubs (just in case I'm not needed in The Bubble that day for some reason) and head out a little after 6:00. It's a 25-30 minute commute for me; very little traffic at that hour and with quarantining in place, traffic is even lighter. Lately I've been listening to Lindsey Stirling's album "Artemis" in the car because her music makes me so happy.

Once at work, I'm greeting by two people: one to take my temperature and one to ask if I have symptoms of Coronavirus and/or have been tested for it. Once through the checkpoint I head up to my floor, clock in and go to the locker room. I've really paired down what I take with me into The Bubble - just a four-color pen, a flashlight, my bandage scissors, some alcohol swabs and IV tubing caps. A small handful of individually wrapped hard candies helps keep the blood sugar up throughout the day.

As soon as I know I'm going into The Bubble, I slip into the patient room that's become the COVID nurse break-room. I leave my water bottle on the table, grab a set of hospital-provided scrubs, hop into the bathroom and change, leaving my badge with my work scrubs (one less thing to clean). The clothing I wear coming in goes into a plastic bag. I make sure my hair is pulled back tight, set my stuff off to the side, and into the airlock I go.

I don a rewashable yellow gown, a pair of gloves and a surgical mask and then step through the airlock and into The Bubble. I receive report from the nurse coming off shift, make sure I have enough N95 masks for the number of patients I have (we try to keep it to no more than three patients per nurse); and off I go! Because policies are always shifting, things are a little different from one day to the next. Maybe our aid(s) will do all the vital signs on the patients in The Bubble, sometimes we're supposed to as we're assessing. We pass meds, we get things for our patients, keep an eye on test results and imaging (X-rays, CT scans, etc). We do EKG's ourselves - something other people did before; to limit the number of people in The Bubble, we're doing more ourselves. We keep the doctors abreast to changes as things can change quickly with a patient. We're mostly Med-Surg nurses; we're used to taking care of "healthy sick" patients, so this is a little new to most of us.

Because our hallway garb is considered "clean" we can go right into a patient room if we have a mask for that room. Once we're done, we stop at the doorway, take off our gown and gloves. The N95 goes into a brown paper bag clipped to the doorframe. We wipe off our goggles, wash our hands and put on a new gown and set of gloves and our hall mask. We're now considered "clean" and can wander around freely until we go into another room. 

What does COVID-19 look like? Well, as of this writing I've only cared for one confirmed case. That person had a low-grade fever (100°) that didn't come down with Tylenol, they had chills and needed supplemental oxygen via a nasal cannula. They remained alert throughout all this, but felt weak. Though their pulse oximetry reading looked fine, their ABG (Arterial Blood Gas) report wasn't so great and their chest x-ray showed a deterioration in condition. For these reasons that person was transferred to the ICU (which has also become a negative pressure Bubble).
But we have discharged COVID-19-positive people who were perfectly stable, with the instructions to self-quarantine.

The vast majority of patients inside The Bubble have tested negative; but that can cause a false sense of security. To get a positive test, one has to have enough of the virus within their body for the test to detect the viral RNA. Easy-peasy. But if there isn't enough virus within your system, it may come back negative even if you actually have it, so we're telling everyone we discharge from the COVID-19 unit to self-quarantine for two weeks even if their test comes back negative. [source]

We're encouraged to leave The Bubble periodically for food, water and rest. We're usually pretty good about lunch and dinner, but we rarely remember to take breaks. When you leave the Bubble, you go into the airlock, take off the gown, and gloves. Your goggles and mask go into another brown paper bag. Squirt some sanitizer onto your hands and you're good to leave the airlock for fresh air and food. (We have a staff bathroom within The Bubble, so we don't need to leave for that). We have been instructed to take our temperature at least two times per shift.

At the end of the shift, after leaving the airlock, I grab my bag of clothes and another bag with shower flip-flops and a hair brush that always stays at work. I hop into the bathroom and shower real quick - someone has lovingly provided shampoo, conditioner and body wash for communal use. After which I put on the scrubs I came to work in, toss the hospital-provided scrubs and my towels and washcloth in a linen bin and chill for a little bit before heading home.

I'm the one getting groceries for the family, so if we need something, I stop at the store on my way home; careful to maintain an appropriate amount of social distancing, but also being as friendly as possible because people are nervous right now and a smile here and there never hurt anybody! I get to chill at home for about an hour and a half before getting ready for bed so I can do it again the next day.

I've had two glorious days off since those first three days in The Bubble and tomorrow I go back for another two days. Likely things will be a little different tomorrow; and things will continue to change and evolve as the presence of the virus changes and evolves in our area.

While things are going on inside The Bubble, the rest of the Med-Surg floor is waiting and holding its collective breath. Patients that usually go to our floor are being sent to the other Medical floor in our hospital. All elective surgeries have been cancelled; so there's very few patients outside The Bubble on our floor at the moment. There's been talk off turning the whole Med-Surg floor into a negative pressure COVID-19 ward. If that happens, we'll go from 10 rooms and 14 beds to 20 rooms and 30 beds.

Who knows where this will take us. In a year one might reread this and think, "Oh, my sweet summer child. You knew nothing." or they may go, "Welp, that was overkill." Right now though, we just don't know where things are headed. Current quarantine measures may successfully flatten the curve and we'll all come out of this just fine; or things can go to hell in a hand basket very quickly and hospitals will become overwhelmed in a matter of days. We're doing the best we can with the information and supplies available to us. Our goal is to keep people safe and healthy.

I absolutely love the outpouring of public support and the desire multiple people have had to make rewashable fabric masks for healthcare workers. Unfortunately, according to this study, fabric masks are not terribly effective and most certainly won't replace those N95's, but I very much appreciate people's desire to help where they can. Right now you can help best by staying home as much as possible and washing your hands. Buy only what you need; but by all means buy a little ahead so you don't need to go out as frequently. Eat well. Love your neighbor and stay safe!

Where Have I Been: Part 2

I assure you, this blog isn't abandoned; I actually come back here fairly frequently to double-check dates on writing projects and life events. It's been a crazy few years (As you might have guessed from part 1 of the post with the same name).

All I can say is nursing school absorbed a great deal of my time. Once my pre-req classes were done and nursing school started in full, I quit my job, dumped all extra-curricular activities and hankered down for a two-year program that only got harder and more stressful as the semesters went! I have significantly more silver in my hair now than I did before nursing school and I can tell you that I wear it as a badge of pride! I worked very hard for my degree and then passing my boards. I was hired right out of clinical and have been working as an RN for nearly six months now.

I'm continually surprised at how well I'm handling the responsibility, occasional "ickiness" and energetic requirements of this noble profession. Turns out I'm apparently very well-suited for being a nurse and that's been a great relief!

But y'all aren't here to get caught up on my real-world pursuits. What have I been doing in the artisic/writing realm?

1) That King George costume I'd been drooling over in the last post has been created. And despite my best efforts to NOT rush it, the fates conspired against me and I was working right up till the last minute making it (yes boys and girls, I got to see Hamilton in person and it was amazing!)

I immediately followed that project up with a rushed Viking Era garb project that I (ironically) haven't worn yet; but I can assure you that those two back-to-back projects have quelled my need for sewing for quite a while! (tee-hee)

2) As far as writing goes: that WIP I mentioned was indeed completed and run through two or three beta readers. I've been wanting to agent-scout it for a year or two, but haven't managed yet. One more beta reader got their hands on it and I haven't incorporated their edits/suggestions yet. I want to get out of post-NaNoWriMo season before giving it a 2020 go.

3) Two summers ago I had a weird dream that sparked an idea for a vampire story (I've been wanting to write a vampire story for a very long time, but felt there was nothing I could add to the genre). This story may not be terribly original, but it's been a delightful guilty pleasure that I started typing up this past summer. I'm about 75% done with it and enjoying it immensely; though it may never see the light of day.

4) "The Kai'us Planet" is next on the docket once that vampire tale achieves a satisfactory level of completion. I'm always noodling on it and making mental tweaks here and there so once I actually sit down and put fingertips to keys, it should go fairly quick (famous last words!)

5) And all those blog topics I hinted at so many years back?
They're still floating around in ye ol' noggin; and on a list on my desk somewhere. I may indeed kick out a series of them to share with you all at some point. It depends a great deal on my general ambition level. I may just start afresh with something else I haven't even thought of yet.

We'll see how it goes.

In the mean time, I just wanted to check in and let you all know that I am indeed still alive and being creative. Thanks so much for stopping by and I'm hoping to pick this back up again and be lexically active again.