Monday, July 28, 2014

In for a penny, in for a pound

When I applied to Nurse Practitioner schools this spring, I had a school that was a guaranteed admission. For twice the standard application fee, no requirement for the GRE, and no need for references, all it required was a solid B GPA and the high application fee and nearly everyone is admitted to the program.

I almost applied to the school as a back-up. Then, I realized that I would never be happy to go to such a school. Yes, it will graduate a functional NP, but it won't satisfy my yearning to truly learn, and it won't make me proud to hold the degree. If I'm going to do this scary step for my future, what purpose would it serve to just have a piece of paper. The tuition at that school was actually slightly higher than the other schools I looked at, and they appeared to give no assistance for finding local preceptorships--the backbone of all NP programs.

I did not do it. At the last minute I decided to value myself and have enough confidence in my abilities to not apply for a fall back school. Instead, I only applied to schools that were top notch, had high academic standards, and were ranked very highly amongst NP schools. I only applied to 'reach' schools, the kind that would be my dream but might be shooting a bit too high and prove to be unattainable.

It was a gamble to make that choice, but I decided it was a gamble worth taking. II asked me what I would do if more than one of those programs accepted me and I refused to even consider it. I was so focused on getting just ONE program to accept me, that I refused to make any decision about what I would do if more than one did so.

By June, I had been accepted into the state program that was highly ranked and highly recommended to me. I had also been accepted into my absolute dream school, one that is arguable Ivy League of NP programs and one of the oldest and consistently top ranked programs in the country. Tuition was nearly identical for the two programs.

For nearly two months, I have wrestled with the decision on which program to attend. With the fall semester just a stone's throw away now, I knew I had to make a final decision yesterday. Then, I had to do the appropriate thing of notifying the other school that I was withdrawing my registration in their program.

There were a few differences. One program starts clinicals before even making a dent in the dydadic work, which makes me nervous. However, that program also has better opportunities for independent research projects. Both have high pass rates for the certification exams. Both have strong repuatations. Everytime I thought I had made a decision one way or another, I questioned my decision.

At the end of the day, the state school only offered the MSN, which will not be sufficient for my career. My dream school, the one that I dreamed of since I first entered nursing admitted me to the DNP program. This will mean I don't have to re-apply for DNP programs once I finish the Master's coursework. Their pass rates for the national certifications is 100%, and you simply cannot do better than that statistic. While the other program was in the top 100 nursing programs, they were in the top 25. Yet, the bottom line was the DNP versus the MSN.

I have notified my academic advisor for the state program and have mailed an official withdrawal letter to the program director. So it seems a decision has been made. As a dear NP friend said to me, choose the program that in ten years will make me smile to see it on my degree. I believe this is the right program.

I'm working hard to finish all of my orientation, registration, and financial aid requirements so I can move forward. I am setting up an office area in my bedroom and a computer dedicated to just my graduate studies. It all comes together and I finally pass a threshold that has been before me since I was 20. In a few short weeks, it will be behind me and I will be in the final three years before I can finally settle into a career for my future.

Thursday, July 24, 2014

Six weeks and forty pounds

That is my statistics after weight loss surgery. Until last week, I was on a liquid or pureed diet since the day before surgery. As a dear friend says, what goes in....comes out. My energy levels were low for the first month. Weight loss sugery is a significant surgery. It's not a quick nor easy procedure, like the surgeries I had last year are considered (and ironically both of those were part on in part because of my increased weight). So, recovery felt very slow. I was exercising as soon as two days after surgery, but sometimes thirty minutes of walking slowly around my house in ten minute increments was all of the exercise I could manage.

Today, I am nearly recovered from the surgical procedure, which is what I was most focused on getting through. I am slowly rebuilding my core strengthening exercise routine daily, and I am up to walking a mile a day as well. Four and a half months of non-stop sick this spring made me lose almost all of the ground I had gained in two years of consistent exercise, so while I have the pattern of a habit, I am starting over with building endurance.

However, there are things that are dramatically different already. I put on just over twenty pounds in those four and a half months of non-stop sick. By the time I was no longer sick and tried to talk, my entire body hurt and I was gasping for breath. I went from walking two miles per day to gasping with half a mile. That changed instantly after surgery. First, I lost that twenty pounds in the first week after surgery, and the other twenty pounds have come off in the last five weeks. That twenty pounds were not familiar to my body and it wanted them gone. As soon as they were gone, my body did not hurt as much anymore. I was able to move, and to walk again. I still have to build my cardiac endurance back up, but I was able to start at half a mile and in a month have built to a mile. Eventually, I intend to build to three miles, which is what I walked when I was in peak physical shape in college. I'm not a runner and I'm not interested in jogging or running, long, endurance walks are my style. I might attempt to retry speed walking, but that would be the most intense joint impact I would attempt.

Immediately after surgery, I was able to discontinue my maintenance asthma medication. I have only needed even my rescue inhaler once since surgery, and that was due to an allergen exposure, not an exercise induced attack. I had forgotten how great it feels to truly breath, it had been four years since I had been able to do that. I love filling my lungs with oxygen and being able to again.

I had to go off my Humira in order to have surgery, and I had to go off all NSAIDs as well. It was the first time since the joint symptoms started at Micah's death that I was off *all* treatments for them. We were able to confirm that I do, indeed, have Psoriatic Arthritis. My Dermatologist is fully aware of this and feels that since I started treatments prior to joint degeneration, he can manage this without having to send me to a Rhuematologist. He is not only board certified (unlike the guy in New England) but he spent a decade practicing Dermatology with the Navy in Betheseda Navy Hospital. He is top notch for the field, and I have high confidence in his skill. My surgeon also cleared me that I can take NSAIDs if necessary for the athritic pain, provided I use chewabale or liquid and I put something in my stomach with them. Once I restarted my Humira, the joint pain is back under control (but now it's not mysterious and I *know* where I have arthritic pain to watch for now) and my intimate psoriasis is cleared up. I still have the two patches on my head and one ear stubbornly keeps having small breaththrough patches. But, this is the most controlled my psoriasis has been since I developed it. The two patches on my head rarely bother me, though the ear situation can be painful but I continue to use ointment on it and I am hopeful that it is simply a stress response from surgery and will clear up soon.

The only medication I have been taken off of is the cholesterol medication. My surgeon felt that since I had just started it, and my cholesterol had not been elevated long-term, it was best to discontinue it prior to surgery. I am still on my blood pressure medication. However, the physcian who treated me when I first went on blood pressure medications felt I needed to lose to a certain level before I would come off blood pressure medications and I'm still forty pounds from that marker still. It seems to be common that most patients come off blood pressur medication around six months post-op.

I am down a size in clothes, and approaching a second size rapidly. It seems that despite my decision four years ago to remove all smaller sized clothes as not mentally healthy for me, I still have some in my closet. I'm wearing clothes I haven't work for a decade, and I look good in them. When I go for my on campus orientation for Nurse Practitioner school next month, I will need to buy some pants in what my actual size is. For now, I'm about to buy a belt and stubbornly wear baggy clothes, simply because I know I will end up smaller than this and I hate to spend money on clothes I will get less than four months of wear out of before I outgrow them.

I started solids in the last week. Yes, it's different than what I did prior to surgery. Unlike many patients, I am not on strict dietary requirements. I am required to take multi-vitamins, and to maintain a minimum of 60 grams of protein per day. However, beyond that I was cleared to simply eat balanced and healthy. For me, the surgery was about a metabolic reset more than anything. The reset is definitely working. I have noticed that if I consume less than 500 calories in a day, I do not lose weight, and I feel shakey and weak by evening. I typically hit around 500-600 in a day, but sometimes go as high as 800 calories. Long-term, as my body recovers, I will likely end up back where I was previously in calorie consumption, but that typically takes about three years to get there. I will have to pay attention to calories as I move into that maintenance phase, especially given that I was not getting sufficient caloric needs previously. I will need to find what calorie range my body will maintain weight now and then keep my lifetime caloric intake at that level.

The biggest dietary change I have made is my breakfast. Because I have to maintain such a high protein consumption, and have such a low volume capability, I need to consum protein rich foods prior to anything else I eat. However, I still need all of the daily requirements of fruits and vegetables. Those who maintain healthy and not suffer malnutrition after surgery accomplish that from getting a real food, balanced, healthy diet. Furthermore, I had this surgery to be healthy, not dependent upon supplements and gimicky foods. So, how do I fit in 5 servings of fruits and vegetables a day when I can only consume just over 500 calories and need 60 grams of protein? I drink a green smoothie for breakfast. I use protein powder and unflavored greek yogurt to ensure that the smoothie still gives me 20g of protein for breakfast, but then I blend at least 3 of my daily servings of fruits and vegetables in my smoothie that I drink. I can drink liquids far better than I can eat food options, so I can get a smoothie down for breakfast, though it generally takes me an hour to accomplish that. Truthfully, they are foul and disgusting--and I love fruits and vegetables normally. However, I don't drink them to enjoy them. I genuinely hope that I will acquire a taste for them, because they are really hideous right now. I drink them because that is how I get the majority of my fresh produce into me. On that front, they are priceless. There are days I only get one other serving of produce in the day due to my protein requirements. However, I figure four servings is still a strong start to meeting my daily nutrient needs.

When I was being discharged from the hospital, the Bariatric nurse coordinator informed me that I would absolutely regret surgery at some point, and that is normal. Thus far, she was wrong. I have absolutely no regrets for having taken this step to reclaim my health. Furthermore, at only six weeks out, I am seeing exactly the progress and positive response from my body that led to my decision that this was the drastic step I had to take to reclaim my health. It will take two to three years to see the full changes of this surgery, but the majority of them will be visible by the one year mark.

Saturday, July 19, 2014

Suffering and powerlessness

I completed all of my requirements for my BSN last month. However, my school will not actually confer the degree until mid-August. So, I figured I would take an elective course this month. I have never actually taken a nursing elective, so I figured it couldn't hurt and might help. I am taking a spirituality and healthcare class.

The good news is that I'm taking this course with a professor who I took a course under last summer. The better news is that she was aware last summer was the first anniversary and remembered that this summer is two years. Fortunate, since the class has at times been gut wrenching for me to engage in.

This week took that to a whole new level. There is nothing quite like having to academically discuss suffering and powerlessness in the week that you already reliving your own. Simply put, it is impossible to maintain your participating at a strictly academic discussion when it becomes such a personal process of unpacking and reliving your past suffering.

I cannot remember that I have outright cried in school, since probably my elementary years. However, twice in class discussion this week, which I had the fortune of being a voice discussion rather than the written word where I could disguise the flowing of emotions, I have in fact cried.

The only thing I can hope that this week has brought is not some greater understanding on my part for what suffering is like, as that is not possible. I hope that by exposing my own pain, I have made it more real and more personal for my classmates. That was all I truly had to offer to the discussion at the end of the day.

Furthermore, I broke my own rule. I quoted one of my posts here about the last days of Micah's life in the paper I submitted. While I referenced myself sa a journal, I imagine if my professor chooses to search, she will find this blog. I can hope that she does not, as I deeply crave my privacy to journal in a manner that my words are present should someone else need to hear them, but without exposing me personally. However, if she does, then the best I can at least accept is that this is my final BSN class and I move onto a different University this fall so I will fade into annonimity just the same.

Yet, when the week's lessons are over, I am still left with the fog of my own suffering still spread across my psyche. It will fade. The emotions that I keep locked in their box except when I deem it safe to unpackage them will slowly over the next day or so be shoved back in and the lid slammed back down. Still, having had to not only open the box but examine those feelings for a week, they linger now, mocking my life I have created in the last two years, haunting me that on my horizon that suffering is ever present, ever capable of crushing me. It leaves me exhausted.....and all for the sake of allowing others to learn from my experiences for a week.

Friday, July 18, 2014

Another year passes

I have had tremendous trouble getting blogger to cooperate so that I can compose anything again, unfortunately. I'm not even sure this one will work as I attempt it now.

This has been emotionally difficult for all of us this month. Of course, we passed the second anniversary of Micah's death last weekend. Last year, we went camping, but we were still greiving hard. I decided then that we should not face this anniversary alone. This year, we extended an open invitation to all of our friends and family to join us in camping.

Not surprising, not one person in my family even acknowledged this anniversary. They didn't acknowledge it last year. Frankly, they barely acknowledged it when he died. I had low expectations for them, and they delivered in spades.

However, our friends and community which we left when we moved to New England, was there to surround us this last week. Seven friends came with their families. At least that many more wanted to come and simply could not make it. Of those families, three of them were in the circle of friends who were the most steadfast to support us during Micah's life.

There was something so much different to connect with those who loved Micah and came to remember him with us. Rather than the tears and isolation we felt last year, we laughed, we sought joy, and when we remembered it was with fondness and laughter. Micah was one of a kind, of that there is no doubt. These were the real, tangible community that knew him and loved him in life. It felt right that they stood with us to remember him now.

As I embraced one of my closest friends Saturday at the picnic, I realized that I hadn't seen any of these friends in at least two years, most for two and a half years. Moving to New England was so isolating for me, even though the children were happy there. I left my community in the south when I moved there. I have come home now.

Sadly, one of my children is not handling their grief, no more than they are handling other deep-seeded struggles from before the grief. We have some very tough decisions to make and this child has an entire team helping us navigate these waters. Even annonymous in my blogging, I am simply not comfortable sharing details about this child's struggle, for the sake of that child's privacy. However, we traveled to vacation with only seven children, and we continue to navigate with this child's needs for as long as we must do so.

We continue to focus on healing and progress for the entire family, and I'm terribly grateful that we have navigated the anniversary once again without breaking--even though it often feels like we might break as we grieve. So, we focus on moving forward. In one month, all but one of my children will be in public school. It will be my oldest child's last year at home, and my youngest child's first year of school. I will start graduate studies this fall, and II continues to do phenomenonally at his new position. Children are involved in sports. They have friends. We have a grieve center where they get support groups and individual therapy as needed. I have not secured a paying job, but given that I will be in graduate studies full time for the next three years, I am no longer looking for a paying job and have choosen to focus on my non-paying job at the low income clinic. I do intend to put my name in the substitute nurse list for the public schools. Otherwise, I am going to focus on homeschooling my last homeschooler and doing well in graduate school so I can learn all that I need to learn to be a Nurse Practitioner by the time I am done.