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cyclicallife · 5 years ago

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dépression nerveuse

Traveling does wonders for the mind and spirit. Each traveler has such a unique and individual experience, this, to me, is where the power of exploration lies.

It has always been a way for me to reflect. I can step back and observe my life from a different perspective. It has a sort of meditative quality in that I, from that place of outside observer, can sit with choices made or actions taken or even, more importantly, choices at hand. Perhaps it is because when traveling I can just be. I can strip away the layers and titles and personas and simply be. In doing so it is easier to stand back and look at one’s life and look at the past, look at one’s present. Without the smothering layers of what one is, what & how one should be, etc., things become a little clearer.

My mother, the sweet and generous lady that she is, lumped together not only my graduation gift but my Christmas gift and birthday gift as well so as to allow me to travel a bit. she would say that my graduation gift, when all was said and done with my illness and things stabilized enough, would be a ticket somewhere - anywhere. I think we both held onto the idea of future travel to also hold onto the idea that I would one day return to the carefree, vagabond lifestyle I once lived. Her gift allowed me the chance to rekindle a sense of independence I was unsure if I’d ever have again.

I felt so fortunate; there was this sort of giddy, childlike joy rising up in me. I have a thirst for traveling and, after three years of a life revolving almost entirely around medical appointments and clinics, my great thirst was finally quenched. Naturally, because of said health issues, panic, stress and anxiety, etc. were never too far behind. Mostly, this anxiety and stress issues revolve around my seizure activity. If a place is too busy or overwhelming I become anxious and in turn stressed that the anxiety will trigger a seizure… it’s a bit of a downward spiral unless I can catch it before hand and keep myself calm. At times the anxiety levels were rather acute, though certainly a small price to pay for the ability to travel once more.

However, there was also this other feeling, too. Something that had yet to present itself sent a different swell of fear and anxiety through my being. I felt a nervous tingling that was running alongside the feelings of glee and gratitude. It was emotion thus far unfelt and one I could not label.

My favorite way to travel is walking. City walking is great, but I’m referring to setting out on foot and just… walking. A lot of the paths I choose are well worn footpaths that often pass through many small villages and cities that are well off the tourist itinerary. These, to me, are where the real culture lies.

During this Trip I set out from a small city in southern France along a footpath used by pilgrims who were walking to Santiago de Compostela, a city in northwestern Spain. On other adventures I have walked different parts of this same route, however those were within Spain.

The term pilgrim might have been used at one time to denote a monk or other such religious devotee trekking hundreds of grueling miles to reach a small shrine or holy site. The modern “pilgrim” however is trekking for a number of reasons and not solely those of spiritual devotion.

I initially went to Le Puy en Velay, a city in southern France, because I had heard about in 2006 while traveling in Spain. A Frenchman told me, “you have to go to my hometown, it is beautiful!” I thought, ‘if anyone speaks highly of their hometown I should probably visit.’ While there I came across a symbol that has guided pilgrims for hundreds of years across various parts of Europe to a city in north western Spain. It was the same symbol, a scallop shell, that I used, that I followed rather, during my many treks to the same destination. The saying “all roads lead to Rome” can easily be said about the numerous footpaths across Europe, all paths lead to Santiago de Compostela.

I believe in such events and other serendipitous occurrences in one’s life. So, with very little hesitation, as per usual with my travels, I packed my rucksack and started out walking.

Walking is all about allowing the mind to enter that previously mentioned meditative state. The reflection, at least for me, begins with the rhythmic movement of the physical being. After this it seems as though the mind follows suit and the pattern begins to move in a spiritual direction. It is also about passing through quaint little towns and cities, many of which aren’t yet jaded by the onslaught of tourists. I think this is really why I love it.

It is also very hard. I’m not talking about blisters and a sore back, I’m talking about the mental and emotional side effects that the simplicity of walking stirs up. In the past this is precisely why I would walk. To me it is sort of purge. After a long hard semester – walk! After a shitty break up – walk!

However, this time the difficulties were beyond those of a sore back and blisters began to emerge. The darker emotions that ran alongside the glee and gratitude, that which had yet to present itself, the emotions that were thus far unfelt … These are inescapable and they too were in my rucksack.

Somewhere neither here nor there as these treks often go, those things crawled out of and stood before me, blocking the path, blocking any forward movement, any advancement of mind and body. Literally, I was unable to take another step. I could feel everything within me shifting and pulsating as though I had spent the last several miles ascending a peak. I wasn’t sure how to react or what to do. I began to think I had hit a wall. Considering the deconditioned state I was in from my years of relative inactivity, this would make sense. I removed the water bottle from my rucksack’s side holder and took a long drink. After which, I removed my hat so as to run a little fresh water over my head thinking this might revive me and allow me to set out again. As I did so my fingers ran over the scar, the wrinkled creases and little divots where my brain had been operated on. I paused, then I began howling and screaming, “I had fucking brain surgery! I had fucking brain surgery!”

I cracked. I broke down. Right there, right there between somewhere and nowhere in southern France, along an ancient footpath upon which I had spent the entire day briskly walking, I broke. I crumbled slightly and then came crashing down! That which hadn’t presented itself stepped forth, looming over me

The weight of three years fell upon me; fear, pain, both emotional and physical, anger, and despair…

The weight of spitting into the sink and seeing blood.

The weight of the first seizure in Chicago and subsequent diagnosis.

The weight of my MFA studies being disrupted just a matter of weeks before graduation.

The weight of endless nights full of fears, of waking from nightmares, of waking up both enraged and saddened simultaneously,

The weight of looking at myself, at my reflection in the mirror, when I was bald and bloated, a gray form with sunken eyes stood there looking back. A figure trying to come to terms with life, trying to put the pieces together in hopes of making sense of everything.

The weight of my girlfriend at the time looking at me with loving and compassionate eyes, but also fear and longing for me, for us, to begin something that we had barely just started.

The weight of being told that the cancer had returned only six months after initial treatment, six months after my life was gaining stability.

The weight of postponing a course I was set to teach only days from the new of my recurrence.

The weight of a stroke and the brain surgery that followed.

The weight of an entire summer spent in a hospital room, cut off from the world, spending each day and night in a chemo induced nightmare, praying I’d make it through two, back-to-back transplants.

The weight of the seizures returning shortly after my transplant, rendering me a fear filled recluse, scared of walking down the street without being full of Ativan.

Right then and there, I fell apart in every way imaginable.

I cried. I cried so hard and wailed so much that my throat hurt. I don’t know for how long I cried. I heard myself screaming but it didn’t sound like me, it was deep and guttural, animal-like and completely unnatural. I don’t know how long I remained in this state. I was shaking, both from the fast approaching night, but also from the overwhelming emotional release, from crying so much.

After that I must’ve been in a state of delirium, because things are very hazy and not really adding up, time seems very distorted. There are many gaps that will fill in with memories over the coming months I’m sure. I remember an older French couple, Louise and Clément, who must have found me while trekking along. I remember Louise was giving me tea and cookies but I couldn’t hold either one down and kept getting sick. Evidently we had made our way to one of the many hostels that are along the route. There they had wrapped me in a blanket and dressed me in a thicker, woolen shirt. Eventually I was able to slowly sip tea. It began to warm me but I couldn’t yet manage the cookies. I just kept hugging Louise and crying. She must have known that I spoke sufficient French to maintain a dialogue and proceeded to tell me that they had found me only a short distance from the hostel. I was kneeling on all fours, pack still on, in the middle of the path crying and screaming. Through her hand movements and gestures, I could tell it was a little bit more than just crying.

The tea was warming my body and my head was becoming a little clearer. Things started to make a bit more sense. I remember the invasion of emotions and thoughts and how it felt as if they were choking me; I remember physically gagging.

I remember having this desire to tear opened my own body, to open up my chest cavity and remove something, to get it out– to pull out every last bit piece by piece of it, I envisioned strands of hair like substance. Though what it was exactly I didn’t know.

Perhaps it was due to my crying but it seemed I had reached a sort of hallucinatory state where strange and nightmarish events were happening. I felt as though I was falling but never reached the ground, it was this continuous feeling of vertigo and the constant fear and uncertainty of when or if I would make contact with the ground. In another Hallucination I could just barely move my legs, but they were stuck, being held back by something. These hallucinations were broken up by my sobbing, as if my crying was holding them back.

I was lost in a terrifying, daydream,-like state recalling all these events, when Clément Sat down beside me and said, in English, “we go now to the hospital.”

They put me in the backseat of a car, to whom it belonged I did not know, then they covered me with blankets. I drifted in and out of sleep, only waking now and then to hear them speaking softly. The warmth of the blankets and the sound of French, which I always found soothing, pushed and pulled me from consciousness.

My sleep was tormented by nightmares however, again they were filled with strange hallucinations: of being in a room where my thoughts were echoing, reverberating within the space. I was not speaking aloud but could hear within the room my stream-of-consciousness- like thoughts.

Again I had this desire to break open my chest and pull forth some substance. This was the strangest of all my hallucinations. I could feel my hands both upon my chest and moving within it. I don’t know what I was seeking or what I was hoping to find therein, I just knew I was looking with a frantic desperation for something.

I deduced later on that The Louise and Clément found me just outside of Golinhac. So it would make sense that we went to a hospital Rodez. At the time however, I didn’t know where I was.

They sat with me in the emergency department until I was admitted. I kept holding Louises’ hand. Now and then she would give mine a gentle squeeze so I would know she was there.

Nurses drew several vials of blood and the doctor ordered an MRI. Several doctors came in, shook all of our hands, and then proceeded to ask various questions. Throughout it all Louise held my hand and continued to gently squeeze it now and then.

The psychiatrist introduced herself as formally as everyone else had. We spoke at great length about all that had happened, the feelings and thoughts, my health history, life and family dynamics - it seems the questions were endless.

At this point I was close to tears and had already broken down a number of times during the conversation.

Evidently I didn’t pose a threat to myself or others so they allowed me to stay in the room I was in. After she left I heard her speak with Louise and Clément Just outside the door. When they came in they too said they would be back in the morning and hoped I would be able to rest. Clément had family in Rodez, so they wouldn’t be far if I needed anything.

The following day, one of the doctors entered the room. He said the MRI was fine, which I knew as I had one recently in conjunction with my CT scan for routine cancer screening. The bloodwork was also normal. I knew this as well, but I also knew they were screening for illicit drugs. That didn’t surprise me considering the state I was in upon arrival. Even though many things were becoming clear, I wasn’t entirely sure of what state I was in or how I was acting when I arrived the night before. How was I acting? How did I look upon arrival — how did we look upon arrival? This older French couple bringing in a foreigner into the emergency room sometime in the dead of night. A foreigner who was sobbing and describing surreal, nightmarish like events. A bleary eyed foreigner undoubtedly speaking mixture of gibberish, French, and English… It only makes sense that they would order toxicology screening.

I drifted in and out of sleep. Louise and Clément arrived and also looked tired, nonetheless, their eyes held such compassion.

Louise Brought in cups upon cups of tea. I’m not sure if she just really enjoyed tea or if she was still concerned that I needed to be warm.

The Psychiatrist arrived sometime later and, as formally as ever, as though she were just meeting us, said good morning and shook our hands. She asked how I was feeling and nodded understandingly when I mentioned how tired I was. She spoke at great length about her theories regarding the night before and the state I was in upon arrival. Much of it was lost on me as my head was still fuzzy both from the events of the previous night and also from the tiredness that seemed to be intensifying. She described it as a nervous breakdown, a dépression nerveuse. She studied me as though looking for an understanding of her words. I just nodded. I tend to do this, I just nod when the subject of my health, mental or physical, arises. She nodded as well and this became the language we shared.

With that she began asking logistical questions regarding my stay in France. When I told her I was leaving from Geneva on October 23 she looked relieved but also a little concerned. Then she proceeded to ask a number of questions regarding my travel plans. It was evident her feelings were mixed both about my upcoming travels as well as the fragility of my mental health. She kept her gaze fixed upon me. I remember looking away several times only to look back to find her still staring at me with such intensity. This unnerved me. Though, each time my eyes met hers it seemed as if she was trying to understand something, it was a questioning look more than anything. There is so much haziness around my stay in the emergency department, but I am certain about the depth of her attention on me.

Louise and Clément lived in Lyon and invited me to stay with them until my departure. They were also comforted to hear I would be leaving from Geneva opposed to Paris or some other airport that would require a lengthy journey.

Breaking her formal manner, the psychiatrist placed her hand upon mine, which was resting in my lap, and said, “It is no wonder this has happened, I am surprised it is just occurring now.” Perhaps that is why she held her gaze upon me with such unwavering intensity, maybe she was trying to find the words, any words, that would help explain all of this to me.

Oddly enough this seemingly simple comment made me feel better. It validated something inside of me. Though still very much unclear, it began dragging things out into the light. Not everything, of course. Events and emotions will present themselves over time, but they will do so nonetheless. Not only will they do so about this particular incident, but in terms of the illness as a whole and the life I have constructed around it. The wall has been breached, this breakdown was the catalyst… it only took a horrific experience and the guidance of two strangers who bravely stood-by never once questioning my emotional or psychological state. Two guardians who seemed to understand the screaming, sobbing and guttural language I was speaking. Two caretakers who continuously brought me an insane amount of tea!

Her comment let me touch down; the continuous fall, the constant vertigo, began to come to an end. The multiple voices within the room - my own unspoken voices — began to speak clearly, presenting as one, solitary voice with which I would one day learn to communicate with. My legs incapable of moving, those being held back, shifted slightly - ever so slightly - a barely perceivable amount. The unknown thing I desperately wanted to rip from my chest... this will take more time to understand and come to terms with. I’m ok with that, I’m patient and am certainly not going anywhere.

She was tagging them, defining them, placing a label on them.

Perhaps when we put a label on something we are forced to recognize it. It is no longer some-thing, but rather, in this particular context of the psychiatrist’s comment, a matter of permission. I am permitting this to happen. I am allowing this to take place. I am relinquishing control. I am letting go.

I’ve always perceive letting go as weakness, the antithesis, of course, being strength. I would stubbornly hold on, I would not be weak, I would hold on and fight to the bitter end to prove it!

Well, my stubbornness led me to emergency room in Rodez, France.

She could have just as easily said, ‘It is no wonder this is happening, I am surprised you’re permitting it to do so now.’

I want labels. I want to define things in order to recognize, grow and heal from them. At least then, when I fight to whichever end comes for me, I’ll know what I was fighting for.

My return… How would I make the journey back to the states? Who would I turn to for help and comfort? Who would watch me and allow me to open as Louise and Clément had? Now, just two days until my return flight was set to depart, with the recent events still very present and raw in my mind and soul, I felt frozen with fear. I felt alone. I felt alone in so many ways. In the presence of Louise and Clément I felt safe and comforted knowing, not only that they were there with me at present to protect me, but that they had seen me in the state in which they had found me just a few nights before.

I wrote to my older who, thanks to the gods, was also in Europe at the time. She had seen me in tears many times over the course of my journey with illness, she had never seen me in my current state. Though the dépression nerveuse allowed for the wall to be breached, I was presented with yet another wall. Advancement is happening, but the process is slow.

Within 12 hours she was in Geneva. She had changed our tickets and arranged everything to ensure our journeys home would be the same. There is no way I would have been able to make the trip alone. The entire way I held her hand; from Geneva to Heathrow and onward to Boston, I held her hand.

This is a form of letting go. This is relinquishing control. Another part of the wall, or perhaps a wall in and of itself, is permitting others the ability to offer assistance. I am stubborn, as mentioned, it is hard for me to accept this. I have always relied on myself to manage various situations in life as I find others to fall short when called upon. Louise and Clément showed me that self reliance isn’t always possible, there are times when help must be accepted. They showed me that help and care come from a place of unconditional love, too.

Just as Louise held my hand throughout the dark night, gently squeezing it now and then so I would feel her presence, so too did my older sister when she guided me home.

#dépression nerveuse #nervous breakdown #life #cancer #growth #cancer recovery #spiritual #spiritual development #personal #personal growth #jeremiah ray

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mypetshopworld · 5 years ago

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Keep Your Pet Safe On Halloween. The Hidden Danger Behind Halloween For Your Cat Or Dog?

Halloween is just around the corner, we are now already into the middle of October and parents prepare for Halloween the costumes, for the kids, and themselves, and of course the treats.

Do our pets like the celebration of Halloween? What is the danger behind Halloween for your Dog?

If you are answering now, there is no danger for my Dog you are wrong. Read on and understand the things that can harm your Dog on Halloween. It might sound simple and normal. Be aware and better safe than sorry.

1.The Trick and Treat Bowl. How dangerous is Candy and Sweets for your Dog?

If you think your dog can’t reach the Trick and Treat Bowl filled with chocolate, sweets and Candy, Think again". Dogs are intelligent, and you know when they want something they go for it.

If you think your dog can’t reach the Trick and Treat Bowl filled with chocolate, sweets and Candy, Think again". Dogs are intelligent, and you know when they want something they go for it. Halloween is a time where kids can indulge in sweets, chocolate and candy. Kids and Adults running around with the trick and treat bag. No doubt it is fun for young and old. It is also a potential danger for our dogs. If you have a dog like I have who is munching and eating on everything, that smells like food, then you have to pay extra attention to where do you keep the trick and treat bowl.

1. Why Candy, Sweets and Chocolate are dangerous for your dog.

Chocolate and Candy are not for dogs, and if you want to keep your Dog safe than keep them in a locked container. Sweets, Candy and Chocolate are toxic in a high dose to a dog. Their dog body is not made to metabolise those kinds of foods.

It does not mean that you can not feed your dog treats, get proper dog treats for your Dog. There are pumpkin, apple, banana, cranberry treats available. Click here for dog treats. There are dog chocolate and dog candy around, and you can bake special dog treats or dog cookies for your Dog. Apple slices and Pumpkin make a great dog treat and on top of it, there are healthy and delicious. ( just in case your dog likes it... my dogs do not like the treats to healthy ) I tell you a story, I have seen a video on Instagram and let me tell you it was scary and I could sympathize with the dog owner how she felt.

When Halloween goes wrong and you have an S.O.S Emergency...

Two years ago there was a video, and it did go viral on Instagram where a dog had eaten 20 or more of the chocolate bars it was Halloween. The Lady panicked and was asking what she should do now, so she rushed with the Dog to the vet emergency clinic.

When the doctor checked the Dog, he decided to induce vomiting, and a few minutes later, a big pile of eaten and uneaten chocolate came out. It looked terrible, and I am not showing you the picture because it is not a beautiful view. It was a big brown mush, and unfortunately, some chocolate still had the wrapping around them. Think about how dangerous is that. I guess the Dog was so excited to have gotten into the Bowl of chocolate and he just swallowed all the chocolate and candy and forget to chew it. That is so dangerous, please keep an eye on your trick and treat container. Keep an eye on your Dog when kids throw candy and sweets on the floor or throw away that your dog is not picking it up and eats it.

2.Halloween Decorations and your Dog. Yes, your Halloween Deco can be a danger to your dog.

One thing I like to mention is the Halloween decorations. If you create your Halloween decor by yourself you will mostly use carved pumpkin and corn stalk. I love putting pumpkins and cornstalk around my home outside and inside as they make excellent and beautiful decorations. Be careful where you place them and when you have nosy dogs like me, who like to put there nose and mouth on everything that smells like food you have to be quite careful where do you place your decoration. Especially Pumpkin what is one of their favourite foods. ( Pumpkin treats) Coming back to pumpkins, they are perfect for dogs, but at the same time, they can also be dangerous to your Dog. Especially when your dogs start to chew your Pumpkin, and they swallow too big pieces, those pieces can cause blockages and your dog might need surgery to remove them, besides that they can also choke on them when they get stuck in their airpipe.

My carved pumpkins have candles inside and when I lighten them they look so good and beautiful. If my dogs knock them over, the pumpkin will catch fire. Happen twice to me and believe me I got a bit scared not much burned but the fact that it can happen made me more cautious. Want to know my solution now? I use the LED candles that are powered by batteries and they are so cool they even flicker and they look real. You can get them in any DIY store or sometimes in the supermarket. Another problem what happens if you use real pumpkins is that the pumpkin when it gets old, depends on the environment can get mouldy. When your dog is eating that mouldy pumpkin it can give him an upset stomach.

Halloween and Cornstalks Deco

Corn Stalks are a beautiful decoration, and the cornstalks when dried are really nice and dogs love to chew them. The problem starts when the dogs swallowing the stalk and you do not discover it. It can cause severe damage to your dog inside the body. Besides causing a blockage in the colon it can also not be digested and that itself can cause pain and damage to your dog. You would not easily detect it, and by the time you do, it might be too late.

Do yourself a favour, and your pet keep your Halloween Deco where your pets can not get to it so easy if you can not consider using alternative decoration that can not cause harm to your Dog.

3.Halloween costumes for humans and dogs.

The tradition is in nearly all countries the same, that you use costumes for Halloween. The scariest the better. Said this as People we understand what is going on, but our dogs do not understand why everyone is wearing a scary costume and masks and people make a lot of noise. Believe it or not, but some dogs do not think this is fun, and they start to hide or run away because those dogs are scared. You must think of your Dog, especially if you just have gotten it or adopted it from a shelter.

https://mypetshopworld.com Your Dog will be quite disturbed when a bunch of kids walk around with masks, and he can not see their faces. Masks are scary for any dog to avoid surprises be aware and keep your Dog safe.

Costumes and Dogs.

When you dress up your Dog in a costume, please do not force it on your Dog. If he doesn’t like it, don’t do it anyway just for the sake of it or for your enjoyment. Accept that your Dog is not a Halloween dog. You know when your Dog is uncomfortable when he stops moving. I have three dogs, and 1 of them is ok with the costumes the other two hate it. When Charly wears the costumes, the other two want to tear it off from him. For me, I do not use the costumes anymore for my Dogs, as the other two come a bit aggressive towards Charly when he wears the costume. Read What is the reason that Dogs behave aggressively towards each other. On the other hand, when your Dog loves wearing a costume make sure it is safe and when he chews on it, he is not tearing or rips it off and is eating it, or worse swallows it. Any costume that restricts a dog’s movement hinders them in breathing. Such a costume is dangerous and can be a health hazard for your Dog.

Yes, there is anxiety in dogs.

It is a real thing. Some dogs, when you restrict their movements with a costume, they can get under stress that can cause an anxiety attack.

4. Why you should keep your Dog inside your home on Halloween?

For me, I have three dogs and three cats. On Halloween, I usually have my cats and dogs inside the house. The reason for it is that one time at Halloween one of my cats and one of my Dog got missing or better say run away totally scared. The kids who around our house, obviously thought it is funny to use some firecrackers and throw them at my pets. My youngest Dog, Bonnie and our youngest cat Minka got so scared and ran off. All the other pets run in the house hiding. I thought first they will be back but after an hour they did not return we decided to look for them, and we were looking for long 6 hours calling their name, but there was no sight of them. Believe me, I would not go to sleep when they are not home. I started to paint all the bad things that could happen to them in my mind, and even I was sure they come back, I was worried sick.

We searched 6 hours for them, and we finally found them hiding under the bushes 3 km far from our home. Minka and Bonnie both shaking and scared looked at us with really big eyes. When we went home both of them would hide for 3 days only coming out for food, then back to hiding. Our cat Minka still today, when she hears a loud clap or something that sounds like firecrackers she will go into hiding. Since that incident, our pets stay on Halloween inside the house. Just to be safe and sound. A piece of good advice from my side if your dog loves Halloween keep him on the leash so you have control over your dog. If your dog does not like Halloween keep your dog inside the house. Your Dog can easily be startled by a strange noise, the scary mask or the blinking lights or costumes. People play pranks on others, and your Dog might be surprised, scared and stress out by it.

Halloween black dogs and black cats.

When you have a black dog or a black cat, people do stupid things to those animals during the time of Halloween. A lot of shelters do close adoption for black cats and black dogs around Halloween time. You never know what can happen to black cats and black dogs on Halloween. Keep your Dog on Halloween inside the home, keep them cosy and safe. One more advice is if your Dog loves Halloween than keep an identification tag on him, and better have your Dog microchipped. That way, in case they get lost, you can easily find them, or the finder will easily understand and check where the Dog belongs too. ( Read GPRS Collars for dogs) Keep an eye on your Dog when you open the front door to trick or treat the kids that come by your front door. I do not want to sound bad or negative, but when our cat and Dog got missing, it was an experience that was not pleasant, and I was worried as I would have lost my kids. After all, our pets are family.

So in short how to keep your pets safe on Halloween Keep the trick and treat basket out of your dogs reach. Spoil him with healthy dog treats. Make sure the Pumpkin and Corn deco or any deco is out of reach from your Dog. Do not force the costumes on your Dog. Make sure the costumes do not restrict your Dog in movement or breathing. The costume has no loose ends or accessories can be easily torn, chewed, or ripped off. Keep an Id tag on your Dog when you trick and treat with your Dog. Keep your g inside the home, and give him dog treats made for Halloween. Play some soothing music to keep him calm. Watch the door. Last not least, keep electrical wires, lights and candles out of the reach of your Dog. You know your dog best and know what your dog likes and what he is scared, or easily afraid off. I hope you have a happy Halloween and both you and your Dog enjoy the trick and treat. I hope you enjoy reading "Keep your pet safe on Halloween.The hidden danger behind Halloween for your Cat or dog?" Please like and share with friends and family who have pets. All yours Melanie https://mypetshopworld.com/the-3-most-common-allergies-for-your-pets/ https://mypetshopworld.com/turn-your-passion-into-a-business/ Read the full article

#anxietyindogs #chocolateandsweets #cornstalk #Halloween #halloweencandy #halloweencostumes #halloweenmasks #Halloweentreats #happyhalloween #lovefordogs #pumkin #pumpkintreats #scary #trickandtreat

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drokelley-blog · 6 years ago

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Okelleys in Tenwek 2019

Since returning from Africa, my wife Dana and I have found it difficult to respond when asked how our trip was. “Good” or “great” is the usual one-word response but many more adjectives come to mind, as it was a trip filled with a mixture of different encounters, experiences, and emotions. And somehow just one or two words do not suffice. It would definitely be accurate to say that it was eye-opening.

We came to this particular place because of the Many family. Most folks know of our long-term friendship with them, so I won’t elaborate here, but it was wonderful to visit them and experience what life is like for them at Tenwek. I believe they are where the Lord wants them to be, but like life anywhere, Tenwek has its share of happiness and hardships. We had learned what we could ahead of time about Kenya and Tenwek from materials provided by Samaritan’s Purse who took care of all the logistics of our trip, as well as from conversations with the Many’s and also from our daughter Claire, who had visited with them for several months in 2015. But nothing really could prepare us for a place that is so different from our everyday experience back home.

Our drive to Tenwek hospital took us 4-5-hours from the airport in Nairobi on a rough road that had become paved only 5 years prior. Tenwek is located in the rural highlands of southwestern Kenya which has no large or modern cities nearby, yet the population in the general area is quite large. In addition, patients are referred from long distances for treatment at Tenwek which is one of Africa’s largest mission hospitals. As you might expect in a developing country, the people there do not have most of the things we take for granted. Clean water, reliable electricity, passable roads, and adequate sanitation are still hard to come by there, and there would be no access to adequate healthcare without Tenwek Hospital. It is a 300-bed teaching facility with a long evangelical-centered mission to provide the best healthcare possible. 72 of those beds are designated to the maternity service, where I spent my time working as a member of the “OB service”.

Most women in this area give birth at home. There are smaller clinics in the area which provide very basic care but lack the ability to handle most emergencies. So, women who come to Tenwek either arrive from their village, or are referred by these smaller clinics with little or no prenatal care and are either high-risk or suffering some sort of complication related to pregnancy or childbirth. The maternity service delivers about 3-400 babies per month, and also receives a large number of patients who have delivered elsewhere and are experiencing complications. The single delivery room holds 3 delivery beds or “couches” and is used for deliveries, triage, and labor exams. There is a 5-bed “labor” ward for laboring patients, inductions (of which there were usually 4-5 daily), and any high-risk antepartum patients. Of course, this ward stays full and often spills over to the other rooms on the unit, which normally accommodate lower risk antepartum, postpartum and post-operative patients. Healthy newborns stay with their mothers. Mothers whose babies are in the neonatal intensive care unit (NICU) stay until their babies are discharged. The NICU has a capacity of about 45. So, the halls are normally crowded with patients, visitors, and staff, and it is not unusual to have 2 mothers assigned to the same bed or 2 babies assigned to the same isollete due to overflow. There is one O.R. in maternity for cesarean sections, or other minor procedures, but it is only available from 9 AM to 4 PM. Outside these hours an emergency cesarean section must be done in the main O.R. or “theatre”, which is in another building.

To say that the conditions in the hospital are different than what I normally have available at home would be an understatement for sure. That being said, Tenwek provides excellent care for maternity patients considering their limited resources. Nurses manage all labor patients and perform all uncomplicated vaginal deliveries. They have medications such as Pitocin and magnesium sulfate for inductions and treatment of preeclampsia but do not have infusion pumps. They also have available the usual medications to treat postpartum hemorrhage. There is no continuous fetal monitoring available including for patients on Pitocin or with other high-risk indications. There is no epidural service available. Intermittent fetal monitoring and a vaginal exam (VE) usually are performed by the nurses every 4-6 hours on all labor patients. Inductions are performed with misoprostol, Pitocin or Foley balloon. Patients are not screened for group B strep but antibiotics are available to treat infections and are given preoperatively. Patients with one previous cesarean are allowed to “TOLAC” (trial of labor after cesarean). Everything is in short supply, and items we normally consider disposable in the U.S. are “repurposed” until they are no longer usable, such as Bovie pens and laparoscopic trocars. O. R. packs included cotton drapes and towels, which are sterilized and reused.

2-3 nurses cover active labor patients and inductions in 12-hour shifts, and 2-3 to cover postpartum, gyn post-op, etc. There are another 2-3 in the nursery caring for the newborns who are sick or premature. As I mentioned, the nurses perform the labor checks, non-stress-tests (NST’s), and routine deliveries and call the intern or physician for complications. The only patients directly under the supervision of the OB team are antepartum admissions, post-surgical patients, and patients with complications. During my time there were 2 medical officers (completed one year of post-medical school training), and 1-2 Ob- gyn’s, depending on who is available on a given day. The Ob-gyn doctors are currently Americans including Dr. Cheryl Cowles and Dr. Angela Many, but there is a new Kenyan Ob/Gyn starting soon who had just completed residency training in Uganda. There were also 2 clinical interns and 3 medical interns. Clinical interns have similar training and background to physician assistants in the U.S., whereas medical interns have completed medical school and will be medical officers at the end of their internship. Night and weekend call are divided among the Ob gyn doctors, medical officers, and family practice residents; however, the Ob doctors are always on the hook if needed to help with complicated cases. The interns take call also, and work pretty much like interns in our training programs back home, which is to say “hard”. On the OB service during my visit there was also a 1st year family practice resident and a 2nd year surgery resident. The daily rounding list included post-op, antepartum, ICU, and any other patients with complications and usually had 40 or so names on it. There were usually 10 or more new admissions every day. Many patients presented with “LAPS” (lower abdominal pains) and were full-term or post-dates based upon their last menstrual period but had no prenatal care and no ultrasound to confirm their due-date. There is one portable ultrasound machine on the maternity ward used by OB physicians and medical officers for performing scans. Typically, these patients would receive an ultrasound, NST, and a VE and were either induced, kept in the hospital for observation, or discharged undelivered and given a follow up appointment in the clinic in 1 week with the prayer that they would keep that appointment or return in labor and deliver a healthy baby.

So, between daily rounds, clinic, scheduled surgeries (non-emergent surgeries are booked on Tuesdays and Thursdays in the main theatre), new admissions, and emergencies, the OB service kept very busy. In fact, the number of patients and seriously ill patients was more than I had ever encountered in one place. The diagnoses on our rounding list resembled the contents section of an obstetrical text book. Tenwek mothers are also chronically anemic and that is a bad thing in obstetrics, where the potential for rapid blood loss is high. We ordered more blood transfusions during my 2 weeks than I have in over 10 years and possibly my entire career. Family members were required to donate, and nursing students, medical staff and missionaries were also called upon often to give blood in order to address the critical need. OB patients occupied 3 out of the 6 ICU beds in the hospital the first week I was there. Unfortunately, 2 of the 3 did not survive their illnesses. We also had several babies born premature and several stillbirths and most of these outcomes could have been prevented if they had gotten to the hospital earlier in their illness. I often thought of how back in Knoxville I would transfer such seriously ill or preterm patients somewhere else for their care, but at Tenwek there is no such thing as “somewhere else”. I took call 4 nights in 2 weeks including an entire weekend. I lied awake at night waiting for the beeper to go off and it usually did. I was able to take call from “home” (our small apartment at the guesthouse which is a 5-minute walk away), but they were not particularly restful nights.

Tenwek is a teaching hospital. So, we would begin “teaching” rounds every morning between 7 and 8 am, just like back in medical school and residency. This took some getting used to since I had not done this in 30 years, but I did enjoy the interaction with clinicians in training. Of course, acting as first assistant and helping an intern learn to perform a cesarean section requires patience, but this is critically important at Tenwek as the goal is to train more Kenyan nationals to provide for the healthcare needs of their country. There were daily conferences such as grand rounds, and “M&M” (morbidity and mortality), just like in any traditional academic setting. But there is also a clear spiritual emphasis here that cannot be missed; one that is related to the spiritual well-being of the interns, residents and ultimately the patients. The motto at Tenwek is, “we treat, Jesus heals”. Prayers are said for the patients before rounds and before every surgery. These prayers became a great source of comfort and strength to me personally as we cared for many seriously ill patients. In addition, a morning team devotion preceded rounds each day, and there is a devotional meeting for the entire medical staff every Wednesday morning in the hospital auditorium. In the evenings there are small group meetings for Bible study and fellowship in the homes of the missionaries for medical staff, interns, and students.

As you might gather from my description, the daily conditions, work load, and severity of illnesses which I encountered during my time at Tenwek was almost overwhelming. And yet I was humbled and amazed by the ability of the medical staff and missionaries to carry on tirelessly with great compassion and concern for their patients. Before the trip, I read a book entitled “Miracle at Tenwek”, which describes how the mission of Tenwek began and has since remained focused on seeking God’s leadership in sharing the gospel through medical missions. I believe that the success of Tenwek is due to the fact that the focus is still the same today. “They still do it right”, was an assessment I heard from a returning missionary in describing Tenwek in it’s mission to train individuals to provide compassionate care for the physical as well as the spiritual need of their patients.

So, to find one word to describe our trip to Kenya is difficult. It was a trip filled with joy, kindness, and beauty as well as suffering, sorrow, and poverty. But if I had to choose one word, I would use the word that another visiting physician kept saying: “amazing”. It’s a good word to describe Africa, Kenya, the Kenyan people, and the missionaries who work at Tenwek. But it is also a great word to describe God, whose hand we saw in every aspect of our trip.

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janeykath318 · 7 years ago

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Christmases With Bones

This is my Star Trek Holiday Fic Exchange gift for @bubblegum-star-trek

Hope you enjoy!! (Bones x Reader)

Five Christmases with Bones 1. (first meeting) You were spending the winter break at the academy when you first met Dr. Leonard McCoy. It was your second year and you had no way or desire to go home for the holidays, so you worked extra shifts in the small campus cafe to pass the time. Most of the human and about half of the alien student body had gone home and you were left with a fairly peaceful campus, though not really quiet due to the amount of winter holiday parties going on and overall relief of getting a break. You were working in the cafe late one evening, when a tired looking man came in. He was wearing medical scrubs and you judged he’d finished a shift at the hospital. He had scruffy brown hair and a face that was handsome, though lined with exhaustion.

“Can I get a decaf coffee?” He asked. “Sure! Anything else?” You asked, as he slumped onto one of the stools. “Nope. Just need to wind down before I crash. It’s one of those days.” “Ah. You’d think there’d be less injuries with the holidays and less people around,” you commented, as you poured his cup, not envying the stressful hospital environment the man likely worked in. “Yeah, you’d think so, but unfortunately the holidays also bring out the idiots and over enthusiastic partiers,” he informed you. “Also a lot of Stress induced heart trouble from the craziness and drama that happens this time of year. Me, I’d rather work on the holidays. It’s all one big commercial racket, anyway.” He sounded rather bitter and you felt a pang of sympathy for him. You weren’t the only one not enjoying the season. “Here you go!” You said, handing him the steaming cup. “Hope it hits the spot.” He took a sip and a look of bliss smoothed out the stress lines on his forehead. “Yes, it does. Haven’t had a brew this good in weeks. They making you work over break?” “No, I’m avoiding family drama,” you replied, feeling safe talking to this guy. “I’m staying on campus and volunteering at a shelter Christmas Day. In the meantime, I’m working here. It’s kind of peaceful right now and I can actually unwind during the break from class.” “You sounds like a woman who uses her time well,” the man smiled, taking another gulp. “I try,” you said modestly. “You sound like a man who has a heart for fixing people.” “I try,” he echoed, with a half pained smile. “Some days are better, others, well....you just gotta survive.” “Hmm,” You hummed in agreement. “Well, it’s time for me to close things down here, much as I’ve enjoyed talking to you....” “Leonard McCoy,” he supplied, draining the rest of his coffee and tossing the cup in the trash. “And I’ve enjoyed chatting wit you too.....Y/N.” (He read your name off the tag on your navy blue uniform shirt.) You started wiping down counters and tables as he gathered his things to go. Pausing in the doorway, he stated, “I’ll definitely be back. Best coffee and service around.” You stared as his tall, broad shouldered form disappeared from sight, already anticipating the next encounter. 2.On a xeno archaeological dig. As fate would have it, you never really had time to really get to know Leonard McCoy well. He was usually in a tearing hurry when he came by the cafe and barely had time to grab his drink and pay before scurrying away. Evidently, that first night had been an anomaly. You didn’t end up seeing him again until after the Nero crisis and the World saving done by Jim Kirk and the Enterprise. His face was all over the news along with Jim’s and you were secretly very proud of having met him. The man had broken a load of rules to smuggle Kirk on board, which ended up saving the world, and performed an emergency surgery that saved Captain Pike’s life and and kept him from being permanently paralyzed. After graduation, which you thanked your Stars you’d loved to see, You shipped out to your first archeological assignment on The desert planet Thyra. Three months in, You were deep in the study of the ancient culture of Thyra and loving your work, when it was announced the USS Enterprise would be bringing more supplies and scientists within the week. A couple of them were good friends and you made plans to hang out together over the holidays. As you were hanging out in a popular club, talking about the dig, you saw a familiar face walk in beside the famous Captain James T. Kirk. Your heart skipped a beat as you recognized Leonard McCoy, the coffee shop regular. “It’s him!” You hissed to your friends. “Who?” “Leonard! The hunky Doctor I served at the Academy cafe!” Sadly, your friends were more interested in the smiling presence of James T. Kirk and abandoned you to flirt with him. Seizing the opportunity, You sauntered over to the Doctor, who was scowling at the loud throng and looking very out of place in the flashy club. “What’s a nice guy like you doing in a place like this?” You asked suavely. “My idiot best friend dragged me here—-wait, Y/N? Is that you?” His griping was interrupted by the shock and disbelief of recognizing you so far from earth. He hadn’t seen you since before Nero and had suspected you hadn’t survived. “Yes, it’s me,” You said cheerfully. “Long time no see, Leonard McCoy.” “You too. I’d thought you might have died in one of the ships that first responded to Nero,” he admitted, accepting your offered bear hug. “I was sick that day and got grounded,” you said, face growing sad at the awful memory of finding out so many of your classmates were dead along with billions Of Vulcans. “I still deal with feeling guilty about it sometimes.” “I know the feeling,” he replied sympathetically. “But I’m extremely grateful you’re still around. Speaking of which, what are you up to nowadays?” You happily explained the Xenoarchaeology dig and the ancient city you were currently studying. Unlike others, his eyes didn’t glaze over during your long winded explanation and he seemed genuinely interested. “That’s pretty interesting,” he said. “What do the locals think?” “They’re very invested,” You explained. “They want to learn more about their history, but just didn’t have the resources and enough trained scientists. Being in the Federation means they can get plenty of both. How are you finding space?” He shuddered visibly and did that cute scowl again. “As nasty, dangerous, and unpleasant as ever. Aliens keep trying to take over our minds, Jim keeps tryin’ to give me heart attacks and grey hairs at every opportunity and I’m always dealin’ with idiots trying to stick stuff where it was never, ever, EVER meant to go!” You covered your mouth to prevent the giggle from coming out. Starship crew did have a reputation for reckless experimentation at times and you’d heard your fair share of stories. “Oh, dear. Sounds like you deserve some nice quality shore leave, Doctor. I can show you some cozier spots if you want to escape from this madness.” The doctor glanced over at Captain Kirk, who was surrounded by giggling beings, including your friends. “Don’t think Jim’ll miss me much,” He said, turning back to you with a pleased grin. “Lead the way, darlin.’” You ended up spending Christmas Eve cozied up to Leonard in a cheery little pub, reminiscing about Christmas traditions, and bemoaning family angst. “My stepmom is a nightmare and she’s turned my dad against me,” you admitted. “I look for every reason to not go home for the holidays.” “Thus, the cafe job when I first met you?” “Yep,” you sighed. “And since then I’ve only spent one Christmas at home. I love how you happened to show up just as I was starting to get wistful.” “That’s me, Mr. Perfect Timing,” Leonard teased with a bow. “Thanks to you, I won’t be stuck being Jim’s wingman.” 3.Five Year mission It would be another three years before you saw Leonard in person again, though the two of you made efforts to keep up communication. The Enterprise was on a Deep Space Mission And you were busy traveling about going from dig to dig, so messages were unfortunately few and far between. You were staying on the Yorktown during the Krall crisis and were crushed at the news the Enterprise was lost. The thought of Leonard dying before you’d had a chance to have more than a long distance relationship was crushing. You couldn’t find any information for days and resigned yourself to the worst after the terrifying invasion that was finally thwarted by Captain Kirk. Then you were distracted by cleanup efforts until one day you heard a familiar voice arguing loudly with a calmer voice nearby. “I still say you shouldn’t be up yet, Spock! For Pete’s sake, man, you almost died!” “Your concern is noted, Doctor, but I assure you, I am adequately healed to allow light activity. The Yorktown physicians and Vulcan healer have assured me of that fact.” “Hmmph! I’m still not letting you out of my sight.” Whirling around, you couldn’t help yourself from yelling his name. “Leonard McCoy!” He started and looked around, eyes lighting up when he saw you coming toward him. He hugged you so tightly your feet left the ground and you clung to him almost in tears, gently scolding him for scaring you so much and the lack of communication. “I’m so sorry, darlin’” he apologized. “It’s been a crazy couple days with Spock’s injury and dealing with the aftermath and getting locked in long meetings with the Fleet. Let me make it up to you and I’ll tell you the whole story.” “If The Commander doesn’t mind me stealing you away,” you replied, looking at Spock. On the contrary, you thought he looked relieved. “I do not mind. I am quite capable of seeing myself around the starbase without Dr. McCoy’s presence.” Len rolled his eyes, but waved the Vulcan away and soon the two of you had found a cozy little cafe to do your catching up in. And boy did you catch up. By the end of the day, you’d heard his whole story and were thanking your stars he’d survived. “And you managed to fly an alien ship, swoop in to save Jim and land it? What a hero.” He shuddered. “If you call a near crash landing, that is. Jim’s in the doghouse for the next twenty years for tricking me into flying that. I’m a Doctor, not a pilot.” “I’m thankful you’re still around,” you said quietly. “I was so terrified.” “Me too, darlin. When I heard they were aiming at destroying Yorktown, I just about had a heart attack. That was too close for comfort.” You and Len dated quite regularly during the time on the Yorktown and when the new Enterprise left on its maiden voyage, you were on board as a ship historian and cultural expert. There would still be digs when you got back, you reasoned. The long distance was just too much to deal with. That next Christmas, you and Leonard were enjoying a raucous party thrown by Jim and Scotty with food and booze and goofy games aplenty. Also: mistletoe, which you didn’t notice until you were standing directly under it and your sneaky boyfriend was pointing it out with a gleam in his eyes. “I do believe that’s mistletoe, darlin’. You know what that means right?” “It means you want a kiss, you scheming rascal,” you told him with a grin. “Got a problem with that?” He challenged, leaning closer to you. “None At all, babe,” you said with a pleased smirk. “Merry Christmas.” Seconds later, your lips met in the best kiss of your life. Leonard was a master and soon you’d completely melted against him. Holly, Jolly Christmas Indeed. 4.After the memorable way you and Leonard tended to spend holidays, it was only natural that you decided to have a Christmas wedding. Despite still being in space, the Enterprise A did not lack for suitable venues and enthusiastic friends who helped put the event together. Sulu supplies greenery and flowers and Carol and Christine added red and gold ribbons and drapery and arranged everything to make a breathtaking Christmastime backdrop for the ceremony. Jim was pleased to be able to perform the ceremony—Spock standing in as the groomsman. You’d heard plenty of Leonard bickering with the first officer in your time on the ship and thought it was hilarious how much they actually liked each other, despite both denying it vehemently. Thanks to the replicators, the quartermaster, and a genius friend who happened to be very gifted at sewing, you had a lovely dress to wear, rather than your dress uniform. There was a touch of red at the floor length hem to tie it in with the Christmas theme and you were stunned at how lovely it turned out in it’s simplicity. There wasn’t any train to deal with and you could happily dance the night away without getting tangled. Len seemed to appreciate it, judging by his face when you made your grand entrance and the many, many compliments he gave you during the course of the wedding festivities. The Captain, resplendent in his own dress uniform, couldn’t stop smiling the entire time he officiated the ceremony and he led the cheers when Len kissed you. “Best Christmas Ever!” You breathed, after he’d left you properly weak in the knees. “I can’t disagree with that statement, Mrs. McCoy,” he said low in your ear, causing you to giggle and go hot with delight at the term. You’d make sure he never griped about celebrating the holidays for the rest of his life. @outside-the-government

@yourtropegirl @star-trekkin-across-theuniverse

@medicatemedrmccoy

@southernbellestatues

#its beginning to look a lot like Star Trek 2017 #leonard mccoy x reader #bones x reader #holiday fic exchange #the fluffiest fluff to ever fluff

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xtruss · 5 years ago

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Covid-19 Patients Sharing Ventilators Is Possible—But Not Ideal

The science of coventilation for coronavirus cases illustrates a complicated dilemma.

— By Alissa Greenberg | Tuesday May 12, 2020 | NOVA

Less-invasive ventilators use a mask rather than a tube inserted into the patient's throat.

On March 20, as severe cases of COVID-19 spiked in northern Italy, emergency medicine doctor Marco Garrone paused during a chaotic shift to tweet a photo: two patients, next to each other in hospital beds, with arcs of tubing connecting them to the same ventilator. “This is what we are down to,” he wrote. “Splitting ventilators, and facing serious dilemmas like choosing who will be actually ventilated when everybody should Take This Seriously”

A month later, as caseloads skyrocketed across the pond in New York City, Columbia Presbyterian Hospital hurried to draft protocols for ventilator sharing. And around the same time, an emergency medicine doctor in Michigan named Charlene Babcock posted a YouTube tutorial featuring step-by-step directions on how to modify a ventilator so it can accommodate multiple patients. That video racked up nearly a million views in the ensuing weeks.

“Here’s my disclaimer,” Babcock says to the camera. “This is off-label use of the ventilator.” But, she adds, extreme circumstances may call for measures that otherwise would be deemed too risky. “If it was me, and I had four patients—and they all needed intubation, and I only had one ventilator—I would simply have a shared discussion with all four families and say: ‘I can pick one to live, or we can try to have all four live.’”

The appearance of ventilator sharing (or “coventilating”) this spring in places where the novel coronavirus has hit the most severely prompts a number of questions: How does a ventilator work? Why is it possible for more than one patient to use a ventilator at once? And if it’s possible, why aren’t more doctors in hard-hit areas doing it? Good news: This is the first in a NOVA series answering burning coronavirus questions just like these.

How Do Ventilators Work?

Treating a patient in extreme respiratory distress is “like staring out the window and seeing people free fall,” says Albert Kwon, an anesthesiologist at New York Medical College. Doctors don’t know how long their patients have been “falling” or how long they’ll continue to fall without intervention; they must make an on-the-spot assessment about whether a parachute is necessary.

In that case, they can choose from several options, ranging from less to more invasive. All ventilators provide oxygen and promote its absorption in the bloodstream while also helping rid the body of the resulting carbon dioxide. The ones you’ve probably heard the most about during the COVID-19 pandemic provide a stream of air into the lungs via a tube inserted into a patient’s throat.

This stream of air exerts positive pressure, which is the opposite of how breathing usually works. When we breathe in on our own, our diaphragm muscles move down in our chests, increasing available space and creating an area of negative pressure that causes air to rush in. (There is one ventilator that works on negative pressure, which you’ve probably heard of: the iron lung.)

High-magnification images show the surface of alveoli in healthy mouse lungs (left) and lungs with ventilator-induced damage (right). Image Credit: Kate Hamlington Smith, University of Colorado School of Medicine

One reason COVID-19 patients need to use ventilators is because their lungs become so stiff that the diaphragm isn’t strong enough to complete its normal movement, causing breathing to slow or stop. Ventilation also keeps the lungs inflated while they heal. That’s important because inflamed capillaries in sick lungs can leak a protein-rich fluid, increasing surface tension in the liquid that normally coats the lungs and making them vulnerable to collapse.

But even healthy lungs are at risk during this process, because their tissues are not usually subject to positive pressure. That means that getting pressure levels wrong during ventilation can be dangerous. Too low, and a patient doesn’t get enough oxygen. Too high, and the lungs can become overinflated, causing their tissue to tear.

At first glance, the ventilator used in the most severe COVID-19 cases looks fairly simple: a tube that goes down the patient’s throat, two hoses that connect the tube to the machine itself (one for pushing air into the lungs and one for bringing carbon dioxide back out of the body); seals, valves, and filters to keep gases moving in the right direction; and a central case. But inside that case lives a much more complicated device, replete with pressure, flow, and oxygen sensors, and sets of circuitry and alarms associated with each element. A standard hospital ventilator has 1,500 parts, features several layers of fail-safes, and can cost around $30,000.

“The number of safeties that have to be on a medical device like this is amazing,” says Nevan Hanumara, a research scientist in MIT’s Precision Engineering Research Group. “This is second only to aerospace.”

A medical ventilator.

Why Isn’t Ventilator Sharing More Common?

Ventilators have such complicated inner workings in part because ventilation is much more involved than just turning on a hose. The process requires doctors to consider myriad disease factors and patient measurements, making it almost an art rather than a science. "Tidal volume," for example, refers to the amount of air in each breath, "resistance" to the ease with which air moves through the lungs, and "compliance" to how stiff or flexible the lung tissue itself is. Clinicians can also adjust how fast patients breathe and regulate air pressure at each stage of those breaths.

All this means that while setting up coventilation is relatively simple—in her YouTube video, Babcock simply uses a cheap plastic adaptor to make space for more hoses—that doesn’t necessarily mean it’s safe. The first problem, Hanumara points out, is that coventilating requires using the same pressure with two very different sets of lungs. The healthier lungs receive more air because they inflate more easily, while the sicker, less flexible lungs won’t get as much.

Secondly, he adds, sensors calibrated for one person’s measurements may not work for two, meaning the appropriate alarms might not be triggered if there is an emergency. Some COVID-19 patients, for example, experience sudden, catastrophic changes in their lung health; without alarms, it’s much more difficult to catch these changes in time. And finally there’s the matter of cross-contamination. Although two coronavirus patients sharing a ventilator can’t give each other their infections, they might still swap pneumonia microbes, or even tuberculosis.

Given these risks, research on coventilation has divided the respiratory care community. Among the more recent studies, Assistant Director of Research at SUNY Downstate Department of Emergency Medicine Lorenzo Paladino successfully coventilated four sheep for 12 hours in 2008. (Garrone, the Italian doctor, looked to that study when setting up his coventilated patients in March.) Paladino and his coauthors chose sheep for their study because adults have similar respiratory physiology and weight as humans, and aimed for 12 hours because emergency protocols allow for delivery of equipment from the Strategic National Stockpile anywhere in the continental US within that time.

The study was prompted by the 2001 anthrax attacks and 2003 SARS outbreak, Paladino says, and was meant to provide a stopgap “bridge” measure for emergency physicians with inadequate supplies waiting for backup in a disaster situation—not to replace single ventilation in the long term. Before COVID-19, the technique was most famously used after the 2017 Las Vegas concert shooting, when a single ER saw a huge surge of gunshot patients and coventilated them to keep them alive while they waited for surgery.

Paladino compares the technique to a life vest. “We don’t condone crossing the Atlantic in a life vest,” he says. “But if I’m in the middle of the Atlantic, I would rather have a life vest than not. And I would hope that a boat is coming to pick me up soon.”

The Future of Coventilation

Not every patient is a good candidate for coventilating, Paladino stresses. Patients with active asthma should be excluded, as should those who tend to “fight” the ventilator, trying to draw a breath when the machine is expelling air, or vice versa. But even with these caveats in place, in the wake of the COVID-19 pandemic, six major organizations—including heavyweights like the Society of Critical Care Medicine and the American Society of Anesthesiologists—have made statements against coventilating, judging it too risky and ethically questionable to be worth considering. “There’s a very legitimate concern that instead of saving two people, you just highly increased the risk of mortality for two people,” says Bradford Smith, a biomedical engineer at the University of Colorado Anschutz Medical Campus.

These serious risks point to the urgency of the recent situations in Italy and New York that have led doctors to try coventilation. Smith, who recently published a “preprint” (a not-yet-peer-reviewed preliminary study) suggesting an algorithm to match patients for safer coventilation, runs down the list of options he would try before resorting to the technique: fixing old, broken ventilators; using available machines normally used for surgical anesthesia; attaching endotracheal tubes to similar but less-invasive machines used for sleep apnea. “This is so rife with problems that the first time I heard about it, I thought, 'This is the stupidest thing I’ve ever heard,’” Smith says. “But people are taking steps to mitigate all those issues.”

Coventilating practitioners can use filters between patients to help prevent cross-contamination, for example. And protocols drawn up by Columbia Presbyterian and the Department of Health and Human Services (HHS) this spring suggest workarounds to allow for some adjustment of ventilator settings, better monitoring of both patients, and use of some built-in alarms.

As in Paladino’s case, most research on coventilation stems from a drive to prepare for the worst. Smith says he was initially inspired to work on his algorithms because he was afraid he would have to use them. (“With the news coming out of Italy, I was on these chain emails of critical care physicians, and things sounded pretty dire,” he says.) And the fact that HHS thought it necessary to convene a taskforce in Washington D.C.—which included Paladino and Babcock—to produce coventilation guidelines for future use speaks to the severity of both the pandemic and predictions for global health over the next two years.

Smith hasn’t had to use his algorithms, but he fears fall flu season may provide another opportunity. He also wonders if they may be of use in other places around the world where ventilator supplies are meager, to give physicians and respiratory therapists valuable context about how different types of patients may react to coventilation.

“This is not how nations, or even states, deal with a ventilator problem,” Paladino says. Instead, he sees coventilation playing an important role for communities that are rural or isolated, or lack access to medical care. Imagine a small hospital that owns just three ventilators and then receives six desperately sick COVID-19 patients in one night. Then what? “One night you see a spike, and you ask for help from the neighbors,” he says. In the meantime, coventilating just might keep those patients alive.

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artofpeacelove · 5 years ago

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https://ift.tt/eA8V8J

When Alyssa*, a 30-year-old infertility patient, began fertility treatments last September, she discovered that on top of her endometriosis, she had a low ovarian reserve (meaning that she has fewer-than-normal eggs for her age) and low-quality eggs. After four egg retrieval cycles, she was left with only one healthy embryo—aka just one shot at getting pregnant with her own eggs. Her doctor suggested moving on to an embryo transfer (where the embryo is implanted into her uterus) in mid-April.

To prepare for the procedure, Alyssa took a shot of the synthetic hormone Lupron in early March. It temporarily put her body into a medically-induced menopausal state that caused hot flashes, night sweats, and headaches. She also went on a strict anti-inflammatory diet to help manage her symptoms and increase her odds of a successful transfer. But after all that, and just five days away from beginning the official prep for her embryo transfer (a new round of hormone shots to help her uterus prepare for a baby), all fertility treatments at her clinic were postponed due to COVID-19.

This isn’t a one-off situation: On March 17, the American Society for Reproductive Medicine (ASRM) called for fertility doctors to suspend most new, non-urgent fertility treatments, including ovulation induction, intrauterine inseminations (IUIs), in vitro fertilization (IVF), and egg and sperm freezing to preserve resources and prevent the spread of the new coronavirus. Many states have also issued orders forbidding elective surgeries and procedures during the COVID-19 outbreak, a designation that applies to most fertility procedures as well as things like cataract or joint-replacement surgery.

But being denied fertility treatment right now feels more personal than having to delay your annual physical or eye exam, because it’s your chance at a future family hanging in the balance. “This isn’t an elective surgery. Fertility patients have no choice,” says Alyssa. “Every time we’re given a little bit of good news, it’s taken away. It feels like that all over again, and we were so close to the end.”

“Patients feel that infertility is not being treated like a disease right now. Many feel it’s unjust…[and] are frustrated,” says Brian Levine, MD, the founding partner and practice director of the fertility clinic CCRM New York, who is board-certified in reproductive endocrinology and infertility as well as obstetrics and gynecology. But as the epidemic continues to grip the U.S. and most of the world, fertility patients will have no choice but to put their plans on hold indefinitely.

The complications of family planning during an uncertain time

The pandemic is also causing many people who are not experiencing fertility issues to put their pregnancy plans on ice, so to speak. A survey of nearly 2,000 women released by Modern Fertility and financial startup SoFi found 31 percent of respondents were changing their fertility or family planning decisions due to COVID-19. One reason? It’s unclear what effects a COVID-19 infection could have on a mom or developing baby.

Thankfully, the World Health Organization says that pregnant people don’t appear to be at higher risk of contracting a severe case of the disease, a conclusion echoed by another small new study and statements by the American College of Obstetricians and Gynecologists and the Society of Maternal-Fetal Medicine. But for those who do contract the illness, fever (which is a symptom of COVID-19) in the first trimester of pregnancy may cause birth defects and miscarriage. These groups also add that pregnant people may be more likely to have potentially life-threatening complications from respiratory infections like the flu or COVID-19. Dr. Levine points to two New York women who had asymptomatic COVID-19 infections and didn’t know they had the virus; they were admitted to the emergency room soon after delivery because they got very sick very quickly.

Amy, mother of a 3-year-old and founder of the blog The Postpartum Party, says she and her husband had been trying to conceive but may put their plans on hold for other reasons related to the pandemic and lockdown. “Being stuck at home all day with a toddler has definitely made us question if we want to keep trying for number two,” she says. “I’m also worried about getting pregnant and having to go out more for care and doctor appointments.” Similarly, 46 percent of the Modern Fertility-SoFi survey respondents say that they’re worried about access to prenatal care during COVID-19. (For the record, care is still available for pregnant women; the American College of Obstetricians and Gynecologists (ACOG) recommends that OB/GYNs providing care to expectant mothers should take appropriate precautions to limit unnecessary contact, including transitioning some appointments over to telemedicine and staggering the amount of patients in the office.)

Aviva Romm, MD, a midwife, herbalist, and internal and family physician, says stress and uncertainty are taking their toll on many people who are planning their families. “Most of my patients and quite a few friends have decided to wait a few months and let ‘the dust settle’ a bit before [trying to conceive],” she says.

“Even though I’m just 30 years old, my reproductive system is saying otherwise. Time is of the essence.” —Alyssa*, infertility patient

However, for fertility patients, delaying a pregnancy indefinitely is a bitter pill to swallow, especially since these treatments are a huge investment of time and money (to the tune of tens of thousands of dollars). Mary Sawdon, ND, says that planning for a frozen embryo transfer IVF cycle in March got her through her darkest days after her miscarriage in December. However, her fertility clinic has closed indefinitely to ride out COVID-19—a conundrum that 18 percent of the Modern Fertility-SoFi survey respondents are facing, too.

“I know in my rational brain that cancelling all new cycles in light of the pandemic is a necessity for public health and safety, but it still doesn’t make it any easier for my emotional heart to grapple with,” Sawdon says. “I feel like I’m in limbo. There are a lot of things out of my control.”

Many patients also feel like they can’t afford to just “wait.” Alyssa is deeply concerned that the longer her embryo transfer is delayed, the less likely it will lead to a healthy, successful pregnancy. “Even though I’m just 30 years old, my reproductive system is saying, ‘Time is of the essence. I can’t really wait much longer.’ This is my life, and I’m ready to start a family.”

“I do think we will need to re-address [the guidelines] if [the pandemic] goes on a long time,” says Molly Quinn, MD, an OB/GYN specialized in endocrinology and infertility at the UCLA Medical Center in Santa Monica, California.. “There’s no data that a month or two of delay will impact success [of fertility treatments]. But six months will have an impact.”

Getting through the COVID-19 pandemic when conception plans are delayed

Despite the necessary limitations to fertility treatments right now, many health-care providers have shifted their practices to serve their patients remotely as best they can. Both Dr. Quinn and Dr. Levine have moved their consultations to telehealth for all fertility prep work, including initial consultations, lifestyle optimizations for diet and exercise, treatment plans, and orders for future diagnostic tests.

Dr. Levine says working almost exclusively online actually allows him to consult with more patients in a day. “As frustrating and sad as this is on a daily basis, we have an even greater reach and can go deeper into the patient population that we wouldn’t have had access to before,” he says.

People who want to pursue pregnancy are finding other ways to manage their time and handle disappointment with delays. Fertility patient Cassie Lando says her clinic recently allowed her to start a timed intercourse cycle with medication that stimulates ovulation since her IVF treatment was delayed. She’s now giving it her all from home, monitoring for ovulation with LH test strips, basal body temperature charts, and the at-home progesterone test kit Proov. “It’s giving me great peace of mind,” she says, to feel that she’s making some kind of progress on her fertility journey right now.

Otherwise, patients are being told to focus on what they can do to hit the ground running when treatments can resume: eating a healthy diet, exercising, and reducing as much stress as possible. In addition to telehealth consultations, people who are struggling to conceive can try the app Fruitful Fertility, which pairs them with mentors who’ve already been through fertility treatments, or other online infertility groups for comfort and support. RESOLVE, an infertility advocacy organization, also offers information and resources. The ASRM will also revisit its guidelines every two weeks as the pandemic continues, with the stated goal of “resuming usual patient care as soon and as safely as possible.”

It might feel like little comfort to people who have tried for so long to conceive, but doctors want their patients to know that they’re doing everything possible to support them during this extremely difficult time. “Patients are not being left alone. Providers are doing whatever we can to bridge the gap so patients know they’re being supported and set up for success to hit it out of the park once we get that green light,” Dr. Levine says. Hopefully that comes sooner rather than later, for everyone’s sake.

*Name has been changed for privacy reasons.

from Good Advice – Well+Good https://ift.tt/3eDvZSj via IFTTT

#COVID-19 is forcing hopeful parents-to-be to put their family dreams on pause #Good Advice – Well+Go

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gaiatheorist · 6 years ago

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Four years.

Four years today, I left hospital after a brain haemorrhage. I usually refer to my ‘discharge’ in snark-marks, and I’m trying very hard to consign the rage to the imaginary file ‘That happened, accept it, and move on.’ There were systemic failings, and personal ones. The last four years started with the ex bringing me some uncomfortable boots, that I didn’t wear often, but he liked, and, once I was in his car, telling me that I might need another operation. That information shouldn’t have come from him, and I shouldn’t have spent the next few days pecking away at Google, trying to figure out what had happened in my brain, and the likely prognosis for the repaired aneurysm-rupture, and the two remaining ones.

It was, in part, his coercive control. He wanted me ‘home’, and he was going to ‘look after’ me. I accept that my near-miss was terrifying for him, he saw the 10 days I have missing from my memory, he had the medics take him into a quiet side-room, and explain that I might not live through the surgery. I wasn’t ‘there’ for that bit, and nobody knew how much of ‘me’ would make it back.

I’ve just checked my Facebook ‘memories’, it’s routine now, I originally started doing it when I went off work sick, deleting anything derogatory or inflammatory, it’s as purged as it’s going to be now. I’d posted some confused babble about having been in hospital, but being home, and there were 41 comments, mostly “OMG! Get well soon!” from people I’d not seen for decades. Posting that status update, after two weeks of nothing at all was very important to me, I’m not a particularly sociable animal, the light-touch of social media suits me, I’m also a sarcastic git, so “I’m not dead!” amused me. What didn’t amuse me was feeling that I ‘had to’ make that announcement. I have almost two weeks of my life missing, between the initial brain-fail, the induced coma, the drug-fog, and the ex having my phone. During the two weeks I was MIA, I have no idea who knew what. I do know that the ex bought a charger for my phone, the “Let me know you’re OK?” messages were on the lock-screen when he eventually allowed my son to hand it back to me. Unread, unopened, not-responded-to, the ex didn’t have my pass-code. He’d told me I “wasn’t allowed” my phone, and, when I asked him to bring in my Kindle, he told me there was no WiFi in the hospital. He lied, there was WiFi, it just didn’t occur to me to ask the staff how to access it, I spent ages trying to work-around it myself, on the Kindle, and on the over-bed TV screen, round and round in fruitless loops of ‘information for patients’ and details about pharmacy and laundry services.

I know he was confused and frightened. So was I. I expect some of ‘my’ people were, too. He deliberately cut me off from the outside world, and then took two weeks off work to ‘look after’ me. The man can barely look after himself, so, as well as suffocating me with his presence, and threatening to ‘strap me to the roof-rack’ and take me to hospital if I deteriorated, he ate lots of toast, and made lots of mess, which I ended up cleaning up. SNAFU. The hospital had told him there might be some personality changes in me, and I genuinely believe that he hoped I might go all ‘Stepford’, and forget my side of the conversation we’d had early in February, about ‘trying’ to make the marriage work. Flogging a dead horse, there, we’d had multiple discussions about ‘staying together’, for our son, for the father-in-law. We hadn’t been ‘together’ for years, when he asked me to ‘try’, I’d explained that I had done nothing but try for the biggest part of 20 years, that I’d bent over backwards to please him, for nothing in return. I’d been cold-clear and he didn’t like it, he wanted tears, and capitulation, and me to suddenly become his subservient shadow again, his housemaid-with-holes. No.

After the brush with the Reaper, he started referring to me as his ‘warrior woman’, and proclaiming loudly to anyone who would listen that I was ‘too stubborn to die.’ He was half-right, I wanted to live, but I hadn’t been ‘his’ anything for a very long time. I pushed him away, physically and emotionally, I started to conceal my pain, because I couldn’t stand his fussing, and I decided I’d go back to work as quickly as possible, despite him suggesting I should sue my employers on grounds that the haemorrhage had been stress-induced. Control-issues, almost two decades of him deciding where I could go, what I should wear, who I could speak to, culminating in him buying me rotten pink ‘shortie’ pyjamas to wear in hospital, knowing perfectly well how much I hate having my skin exposed.

I misjudged myself, and my capacity for recovery. I was going to ‘get better’ through sheer force of will. Brain injuries don’t work like that, it’s not like a broken leg, you don’t ‘get better’ as such, you just get better at covering up how unwell you are. The ex’s threat about taking me to hospital by force if I ‘got a migraine’, and then, back at work, the feeling that I was inconveniencing other people, not pulling my weight, this year’s Oscar for ‘acting normal’... (Stop laughing, this is my normal.)

Four years of constant headaches, vertigo, visual disturbances, fatigue, sleep disruption, emotional lability and enormous sensory overload. Four years of muscle tics and tremors, sporadic episodes of weakness in my limbs, and that weird ‘Alice in Wonderland’ thing (Which may or may not be Todd’s Syndrome, I’ll ask at the hospital next month.), where my perception of where an object is in relation to myself goes all hall-of-mirrors wrong. Four years of ‘you were lucky to survive’, and ‘that might ease in time’. For almost two of those years I’ve been wading through DWP/PIP systems and processes that first assumed I was fully-fit, and then decided I was faking being ill. Guilty until proven innocent, 300+ pages of “As she can ‘x’, it is reasonable to assume she could ‘y’.” ‘Reasonable’ goes out of the window with some brain injuries, and I saw a Facebook post the other day of “People with chronic conditions aren’t faking being ill, we’re faking being well.”

The formal referral for Mental Health support was a little over a year ago, MH didn’t want to take me on until neuro-psych assessment of my functional capacity was complete. Fair point, there wouldn’t be much point allocating me therapy if I was just going to dribble, and eat their leaflets. Neuro-psych assessed me as functional-with-reasonable-adjustments, so MH had no get-out-clause. The poor practitioner was very apologetic about the way the system worked, in order to access provision, I’d have to attend a three-week ‘class’, they don’t say ‘group’ any more. Three excruciating sessions of death-by-PowerPoint, lowest-common-denominator information on anxiety, that I already knew, because I used to be a Learning Mentor. Back for a review, and the therapist doesn’t see any value in referring me for any further therapy, stating that I lack the emotional vocabulary to articulate myself in a meaningful way. (That’s not the case, I’d already answered her question at the start of the session, I shut-down on her because she kept repeating a question I’d already answered.) Next week, I get to explain myself all over again to someone new. I’ll take a note-pad, with bullet-points.

Next month, I have an appointment with neurology. Four years I’ve been living with the after-effects of the haemorrhage and emergency surgery, and almost three years with the after-effects of the second, elective surgery. Statistically-theoretically, there’s a plasticity-plateau 24 months after brain injury. This might be ‘as good as I’m going to get’, but it might not. I’ve compounded the NHS-negligence with my obstinacy, years of no-response and “That might improve over time.” led to me stopping asking for help, there didn’t appear to be any, so I got-on-with-it. There is the potential that some of my symptoms could be relieved with medication. (Not the Nitrazepam in the kitchen drawer, that’s for absolute emergencies, and will probably expire without me ever using it, the ‘common’ side-effects are too similar to the brain-fog I’m trying to avoid.) I’m not naive enough to think it’ll be a quick fix, there’s the possibility of trial-and-error ahead, the somewhat co-morbid existence of physical brain injuries and Mental Health issues are going to take some balancing out, anything MH want to try me on is likely to impact on my lucidity, and anything neurology want to prescribe could well impact on my emotional well-being. Vicious circle, but I’ve tried to self-manage the ‘vicious’ in me for four years, I can’t do it alone.

I’m deflated, I’m not defeated. I know this is going to be a difficult phase, being ‘under’ 3 different hospitals that don’t communicate with each other, permanently on-edge in case I have a bad spell, and can’t complete my Universal Credit commitments. The PIP-award expires a year tomorrow, and I’ll need to re-apply 14 weeks before that date. I’ll still have brain damage, but PIP/DWP/ATOS might well shift the goalposts of disabled-enough. I was ‘lucky’ to survive, but just-surviving is no kind of life, four years of adapting to life with brain injuries haven’t been pleasant, I’ve done all I can by myself, and now I’m asking for outside help. If they tell me I’m ‘Doing really well, considering.’, I’ll eat their leaflets.

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mypetshopworld · 5 years ago

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Keep Your Pet Safe On Halloween. The Hidden Danger Behind Halloween For Your Cat Or Dog?

Halloween is just around the corner, we are now already into the middle of October and parents prepare for Halloween the costumes, for the kids, and themselves, and of course the treats.

Do our pets like the celebration of Halloween? What is the danger behind Halloween for your Dog?

1.The Trick and Treat Bowl. How dangerous is Candy and Sweets for your Dog?

If you think your dog can’t reach the Trick and Treat Bowl filled with chocolate, sweets and Candy, Think again". Dogs are intelligent, and you know when they want something they go for it.

1. Why Candy, Sweets and Chocolate are dangerous for your dog.

When Halloween goes wrong and you have an S.O.S Emergency...

2.Halloween Decorations and your Dog. Yes, your Halloween Deco can be a danger to your dog.

Halloween and Cornstalks Deco

Do yourself a favour, and your pet keep your Halloween Deco where your pets can not get to it so easy if you can not consider using alternative decoration that can not cause harm to your Dog.

3.Halloween costumes for humans and dogs.

Costumes and Dogs.

Yes, there is anxiety in dogs.

It is a real thing. Some dogs, when you restrict their movements with a costume, they can get under stress that can cause an anxiety attack.

4. Why you should keep your Dog inside your home on Halloween?

Halloween black dogs and black cats.

#anxietyindogs #chocolateandsweets #cornstalk #Halloween #halloweencandy #halloweencostumes #halloweenmasks #Halloweentreats #happyhalloween #lovefordogs #pumkin #pumpkintreats #scary #trickandtreat

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thenightisland · 7 years ago

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next installment of the fuck you 2017 series:

this is becoming like its own series but idk how else to explain this awful year i don’t even feeling like properly linking so here’s just the URLs of the other ones in the series: 1. http://thenightisland.tumblr.com/post/161087786689/explanationsupdates-under-the-cutmore-i 2. http://thenightisland.tumblr.com/post/161920216354/additional-updatesexplanations-under-the-cut 3. http://thenightisland.tumblr.com/post/163767959805/updates-under-the-cutmore-post-one-post-two-on 4. http://thenightisland.tumblr.com/post/164398486219/on-the-fourth-edition-of-what-the-fuck-is 5. http://thenightisland.tumblr.com/post/166385890224/side-note-for-last-nights-update-postmore

since my friend’s mother died, 2017 has continued to fuck everything up so literally in the last what two weeks since i did one of these??? it’s just getting to be a list of bullshit

-one of my nurses found out halfway through her shift that her dad had been hit by an eighteen wheeler and had to be choppered to the trauma center and was in icu several days and has three of his four limbs shattered -one of the nurses on days who used to be part of my 11-7 team had to leave work one day because her brother in law dropped dead at random -my friend who’s mom died? yeah they had the funeral last saturday. and the next day one of their oldest family friends fucking died too -one of the nursing directors, who also used to be part of my 11-7 team is off for a while given that her fucking husband also just fucking dropped dead -the second in command nurse on day shift was /also/ hit by a car and has all these broken ribs and had to have emergency surgery and had to have her spleen removed and was in icu for several days and needless to say will be out of work a while -i now have to work without /my/ right hand for the next three weeks because she’s having surgery on monday yay -and today. today we found out that our /fucking boss is resigning/. which like. idk if you realize how horrific that is because she was not like other bosses in the slightest she knew what was required for our unit to run she knew to leave us to our own devices on some things she’d fight admin on our behalf constantly she was the best goddamn nursing director in the fucking hospital. she’s the one who hired me when no one else would when i was fresh out of school. we all thought we’d at least have a few more years left. but nope. she told us all today during shift report and like if you need to know just how devastating this is for us when she told us /four different people started crying/. and we’re all terrified of who might replace her because the thing is, we always said that the day she leaves there would be a mass exodus from our unit. and depending on who replaces her, that may very well be true. our unit is different than the others. it has to be run differently. and so everyone is trying to think of who might take the job or whatever and there are no good options. if they hire someone who doesn’t already work at our hospital, there’s a high chance they’ll be too Regular Army for our unit tbh, at which point we’ll lose several staff members to quitting several to being fired, or we would all have to find a way to drive them away entirely. if they hire in-house [which they love to do], we stand a better chance of having someone who understands how this unit operates but like. the people who would be best at it are also people who would never in their right goddamn mind take that job and all the stress that comes with it. which leaves us in a really terrible limbo. the only two people we can come up with who might conceivably take the position is the aforementioned one with the dead husband [which means there would be no director for the other adult unit] or this nurse who used to work days on our unit [which would leave two other units without a director] like a fucking game of musical chairs. and the number of people not just from our unit but all over the hospital who immediately assumed /i would be taking our boss’ position/ has been ridiculous. like look i didn’t even want to learn how to charge or be a permanent charge nurse to begin with why the fuck would i willingly become the director of a whole goddamn department with all the extra stress and misery that comes with it like fuck it i don’t want the money that bad and also like it drives me crazy that there are already people wanting me to take this position like i have been a nurse for three goddamn years it is not normal to become a fucking nursing director with that little experience. i’m already sick of people telling me i should take the job or assuming i would be her successor. like why???????? why don’t they think the day shift charge nurse would be just as plausible a candidate as me????? are they out of their fucking minds???? and so like if we get a bad boss, so many people will leave including people from my team and like all 2017 has been is people dying and people leaving me and i’m about to have basically nothing in this city except my parents and my work team and the very thought of losing my team too is just panic-inducing like i can’t lose the only thing i have left i can’t watch them leave too.

so. things have continued to be. less than ideal.

#karen's adventures in trying to sort her life out

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theladysmith · 8 years ago

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Reboot.

Hiya. Happy new year. It's 2017.

After a few years of trotting out my social media efforts out as a website presence, I’ve decided to rethink, revamp and relaunch my blog. 2016 was quite the year for me, so much so that I think I might need to write about it, and I’m just delusional enough to think that as my jewelry and design and life-as-a-human work evolves, people might want to learn a bit about my process and the life that insulates it.

So I suppose this post represents a relaunch (or a messy new launch) of my blog. I generally prefer to photo document life, and so spend a lot of time on Instagram, which in turn feeds my Tumblr, and for a long while I’ve felt that this is enough social media presence for me, that my images and captions speak enough about my art-life and my life-life. Until recently. Life-life this year has been challenging, and photo-captioning it doesn’t really allow for the deeper dive that I might want to allow myself every once and awhile. My desire to discuss what’s going down without the threat of caption limits grows daily. I can’t keep my expectations to myself anymore. I guess that’s where you come in: I’m asking for witness.

I had originally written a long, hand-wringingly dramatic post about how I lost my J-o-b several months ago. I was aiming to be concise, but emotions got the better of me and it just started to get whiny. I may post it eventually, but I dunno. I wrote and rewrote this post over the fall, and am now revisiting it 5 months and a New Years later and I realized that I've simmered down some. I feel like telling the story now for historical context, as the lay-off and its repercussions has completely changed my life for the better, and as result has fired up my art-life so much that I can no longer deny that my art-life is in fact my real and true life-life. I can no longer function as a human without working as an artist. That has been the biggest, hardest and most joyful lesson to come out of the shit-show that was 2016. (Full disclosure: I had secured legal representation after my lay-off due to several human rights violations that I experienced as an employee of Sotheby's International Realty Canada's Oakville office, but a change of situation has now freed me to talk about it. I offer this as a cautionary illustration of what a skilled, experienced and friendly employee can experience working for woefully ignorant and shockingly under-qualified management. You know, 'cause the world needs another tale like this...

I started a new job with the regional Sotheby’s International Realty office in August ’15, and I was crazy-excited to be working with a world-class marketing team and historically significant brand in a new (to me) field with a short walking commute. Walking to, but mostly from work soon became the best part of the job, as the management direction became abusive, the expectations were never communicated and the high-school-level office drama emerged just a few weeks after starting the job. At lunch with my brother in mid-September I casually mentioned that I wasn’t very happy with how things were going, but maybe it was just growing pains. By our trip to NYCC in early October, I was depressed each and every night (especially Sunday nights!) knowing that I would eventually have to go back to work, and was planning a pie-in-the-sky escape plan out of self-preservation. I also wasn’t feeling very well, but I figured it was my annual late-in-the-year energy slump and the Monday-Friday frustrations feeding stress-related illness . I told myself to hang on, that the job would improve. It did not improve. Let’s cut to the beginning of 2016, shall we?

After indescribable work stress, a suspicious lymph node infection, a total immune system crash, and 5 and a half months of unending illness (head colds! sinus infections! gastroenteritis! the flu! another cold!), I was diagnosed with papillary thyroid cancer in February, just a week before I turned 40.

To illustrate the degree of shit to which the job had gone, I offer this story: I spent my 40th birthday sick as a dog, yet in a compulsary meeting at work where I was scheduled to make a 1/2 hour presentation with next-to-no voice, which was interrupted by the perfunctory cake and happy birthday song delivered with the energy of a funeral dirge. I finished my presentation to discover that they had eaten the entire cake without leaving me a slice while I was talking! Totally defeated, I spent the evening nested on the couch in my pjs with a head cold so terrible that I was unable to taste the lovely chocolate cake that Mike had gotten for me. I was miserable, scared and angry, and I didn't know what to do. I can't ever remember feeling more hopeless. I wish that was the only horrible story I could tell of this recent job, but there are about 3 dozen more, most far more depressing, including the one where MY BOSS INFORMED MY COWORKERS OF MY DIAGNOSIS BY EMAIL WITHOUT MY PERMISSION. But let’s not go there right now...

By the end of March, I was finally “healthy” (in that I was no longer actively sick with something, except for cancer), and I was feeling a little more optimistic because the multiple doctor's appointments, nasal endoscopies, CT scan and biopsies had determined that the cancer was isolated just to my thyroid. I had a great new family doctor and surgeon who had managed to answer most of my many questions and my surgery had been set for early May. The daily personal bullying at work had even simmered down a bit, but this was just temporary because of yet another massive drama regarding another coworker, so my issues were briefly off the radar. Emphasis on briefly.

I had been working with an amazing therapist (and friend) out of Ottawa via Skype for a few weeks while I navigated my treatment options, and with her support I made the decision to move to working 4 days a week for awhile, to give myself a bit more time to schedule doctor and therapy appointments. The 4 day work week, while definitely no shorter in terms of hours, felt like one of the most adult and freeing decisions I had ever made in my professional life. I was starting to feel very well prepared and almost excited for my surgery. My health was improving (as was my outlook) and it felt good.

My total thyroidectomy was on May 5. O5/05 - I felt like the numbers were auspicious, and I guess they were. The surgery, while a little longer than expect, went perfectly. When I woke up in recovery, high as a kite on morphine, I knew a moment (albeit drug-induced) of pure gratitude and love for everyone and everything. I had never experienced that before - it was lovely. Memorable. I still think of it daily. Propped up with a massive bandage on my throat, I squawked a little 'hello' to myself and beamed that the surgery hadn't taken my voice (there is a small chance of permanent change or loss of voice with all thyroid surgery, as the vocal cords run through the thyroid.)

I had some trouble with my blood calcium levels that kept me in the hospital a little longer than the overnight that I had expected, but by 8 pm the next day I was home, happy and relatively comfortable. I healed like a champ. Work benevolently (can't roll my eyes hard enough here) gave me my 4 remaining sick days to recover, and I worked from home the following week because my voice had still barely recovered and my incision line was periodically sore. I even managed to get to the Ottawa Comic Con a week after my surgery so that I could visit Mike and our friends who were exhibiting. After my stitches were removed (which was the creepiest physical sensation I've ever experienced) I spent a few days recovering at my family home. All of this time felt like such a gift.

My return to work was tough. My voice was weak and would give out mid-sentence, which was weirdly exhausting, and my energy levels were a little all over the place because my body was still getting used to the new Synthroid thyroid medication that I was now on for life. I felt overall that I was doing pretty well, but work quickly reminded me they thought otherwise. The prevailing attitude was "wow, your illness was such an inconvenience" or "actually, we got along just fine without you." I had started a job search during the dark days of deep winter, but after my diagnosis I just let it drop. I started to reconsider. But I I felt like I had really survived something, so the trials and dramas of work should've seemed like nothing in comparison, right? As spring continued, the job environment worsened. The brokerage manager (henceforth to be referred to as Terrible Manager/Person, as she really was both a terrible manager and a terrible person) continued to throw me under the bus, cc-ing emails where she blasted me for non-issues to the entire national management team, wasting everyone's time. I went far and beyond my job description on a few special projects, but my efforts weren't even recognized with a simple thanks. The few actual design-oriented projects that came across my desk were promptly taken away from me and weakly completed by the Toronto office, which was frustrating because my position had been advertised as a graphic designer position but had flattened into a straight coordinator position, leaving me increasingly upset with my decision to leave my former job (which hadn't been the best, but at least they had respected my skills and input.) The professional criticism was unending, and totally unnerving - was I going crazy? Was I actually terrible at this job? You know, the same kind of job I'd been doing for 10+ years, with glowing reviews from former employers? I felt completely lost...however, when the criticism started to involve how I looked and what I wore ("hey, did you know you can lose 10 lbs just by cutting out bread for a week?" "Wow I like your blouse, oh wait, you got it at WalMart? And you wear it here!?" "I heard of a medical trial on the radio for people with skin issues and I thought of you immediately..." THOSE WERE ALL SAID TO ME WITHIN A WEEK'S TIME), I realized there was no fixing this shit show, no matter how long I stayed or how hard I tried. (Honestly, apart from a shitheaded misogynist manager once telling me "you know, you'd be a lot prettier if you smiled more!", I have never, ever been subjected to as much criticism regarding how I looked as I was at Sotheby's. I was always dressed office appropriate with professional hair and makeup and boring shoes, but nary a week went past without someone making some kind of comment about my skin, my weight, my illness, my clothes, the frequency with which I wore some things, or my boring shoes. And it's worth mentioning that it was almost always women making these statements...

We went to HeroesCon in Charlotte in mid June and had the best time (as usual) and I came back to work high on art and our amazing friends, only to be deflated and sluggish 2 days later, looking forward to the next long weekend, con or event. Something at work had changed too, I could feel it. I was left out of or uninvited to trainings and dealings with the rest of the national marketing team. My long-promised raise that had been due in November (per my contract, but withheld by Terrible Manager/Person who never felt inclined to complete my 6 month review) suddenly arrived unceremoniously by email. I was told that a new agent was taking my office and I would need to move the contents of my office to a barren corner of an unused board room where a new office was going to be built for me by mid-July. That plan got fast-tracked, suddenly I was given 2 day's notice that my office space was moving, and it was literally taken down around me as I tried to finish up work before I was due to leave for a long weekend in Montreal at the end of the first week of July. My long-developed filing system was destroyed, my organization systems were hastily thrown into boxes, all of it was moved to the empty board/storage room. I was incredulous as I left work for my long weekend - what a mess that was going to be to come back to.

While I was away, there was the usual monthly general office meeting for all the Oakville and Niagara on the Lake agents, Terrible Manager/Person and office staff. Terrible Manager/Person and 2 agents (who I had rarely worked with but who had always been terrible to me when I had to work with them) spent considerable time during the meeting slandering me to the rest of the group (which I heard about the day I was laid off.) One agent who had exhibited an absolute hate-on for me from day one (and who was tight friends with Terrible Manager/Person) apparently stood up and declared "why should my business suffer because someone is sick!?" It's worth noting she had only come to me twice in the space of 6 months for actual help, and I kept her advertising initiatives on track when she had dropped the ball...anyway... The day I returned back to work from our Montreal weekend, I was knee-deep in sorting out an issue between an agent who was away in Eastern Europe on vacation, the agent who was looking after her affairs in the meantime, and the printer who had dropped the ball on their job. I had it sorted out, and had emailed both the agent and my manager that everything was copacetic, but because of a 6+ hour time difference between here and Croatia, and the fact that Terrible Manager/Person was rarely timely in checking her emails or reading email threads, she bitched me out to the national team once again. That was is, I lost it. That afternoon, I confronted her about it, explaining that every time she cc'd the team about some issue she had with me or my work instead of speaking directly with me, she cost everyone time, especially me, and seeing as how I was constantly over-my-head busy, I was done with that kind of unprofessional bullshit. Her face went blank, and she said ok, and walked out of my office.

I was laid off the next morning. They called it corporate restructuring, as they always do, and told me that the Toronto team was taking over the Oakville and NOTL office marketing needs. They reposted my exact job description (the same one that I had applied to the year before) the next morning - there it was sitting in my inbox at 7 am. I still find it utterly hilarious that they didn't think I'd see that...but considering the very first thing that Terrible Manager/Person asked me to do when I came on board was "to change everyone's emails so that they could somehow look like they were written in cursive handwriting font on a parchment paper background, because it's just so much nicer and elegant", I'm not fucking surprised...(for real, that was the first request that I received as a Graphic Designer/Marketing Coordinator for Sotheby's International Realty Canada. Elegant indeed. I should've run right then and there...)

So, five months later! Where's my head at? I'M SO HAPPY I DON'T WORK FOR THE RICH AND ENTITLED ANYMORE! SO HAPPY I DON'T WORK FOR A TERRIBLE MANAGER/PERSON ANYMORE! SO ABSOLUTELY SURE THAT I AM DONE WITH CORPORATE CULTURE FOR MAYBE EVERRRRRR... All caps screaming aside, I'm at a bit of a loss to describe how life changing last year was. I feel like the creative girl that I was when I was in college, full of ideas, making art on the daily and feeling happy, hopefully and resourceful. The messy breakup feels that the lay-off brought are dissolving - I can't help but note that I don't really have any lingering friendships from that job; I've had them from every job I ever had, but this one was different. I am really aware that people were only friends with me when they needed something. Human nature I guess...or real estate agent nature. Who knows(/cares)? I don't know what the next year is going to look like, but right now it looks like planning, making, organizing, selling and promoting. I may have to take a part time job eventually, I may not, I may find lots more freelance (was doing ok with it in the remainder of 2016), I may not. I truly have no idea. But considering that everything that I held as concrete and permanent this time last year has completely changed and I'm thriving in spite or because of, I'm feeling pretty ok about it all. I wish you a very happy new year. I am very happy to be here to do so.

(If you're working a job that involves you feeling terrible about yourself and your abilities on a daily/weekly basis, if you have to deal with a Terrible Manager/Coworker/Person with no one to back you up, if your job was promised as one thing but has backslid into something undesired, or worse, health-threatening, please make every effort to free yourself. I know how it feels to be locked in, desperate, scared and seemingly without options. You can at least talk to someone, be heard, and vent your frustrations, and through that you can find a path and resources to find something better. I am happy to lend an ear and/or shoulder to anyone who needs to decompress from their workplace tension, and more importantly, brainstorm ways to get out of an abusive job. It is absolutely not worth your health or peace of mind - it is time spent that none of us will ever get back.)

#new year #job #work #layoff #cancer #thyroid #thyca #recovery #art #terrible bosses #life lessons #reboot

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mypetshopworld · 5 years ago

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Keep Your Pet Safe On Halloween. The Hidden Danger Behind Halloween For Your Cat Or Dog?

Halloween is just around the corner, we are now already into the middle of October and parents prepare for Halloween the costumes, for the kids, and themselves, and of course the treats.

Do our pets like the celebration of Halloween? What is the danger behind Halloween for your Dog?

1.The Trick and Treat Bowl. How dangerous is Candy and Sweets for your Dog?

If you think your dog can’t reach the Trick and Treat Bowl filled with chocolate, sweets and Candy, Think again". Dogs are intelligent, and you know when they want something they go for it.

1. Why Candy, Sweets and Chocolate are dangerous for your dog.

When Halloween goes wrong and you have an S.O.S Emergency...

2.Halloween Decorations and your Dog. Yes, your Halloween Deco can be a danger to your dog.

Halloween and Cornstalks Deco

Do yourself a favour, and your pet keep your Halloween Deco where your pets can not get to it so easy if you can not consider using alternative decoration that can not cause harm to your Dog.

3.Halloween costumes for humans and dogs.

Costumes and Dogs.

Yes, there is anxiety in dogs.

It is a real thing. Some dogs, when you restrict their movements with a costume, they can get under stress that can cause an anxiety attack.

4. Why you should keep your Dog inside your home on Halloween?

Halloween black dogs and black cats.

#anxietyindogs #chocolateandsweets #cornstalk #Halloween #halloweencandy #halloweencostumes #halloweenmasks #Halloweentreats #happyhalloween #lovefordogs #pumkin #pumpkintreats #scary #trickandtreat

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