Wednesday, February 13, 2013

Our Trip To Woodbury....Walking With The Zombies

By Chiqui Raveloski

Shifting this blog's gear to a territory where gore becomes glorified and the dead are really walking amongst us, I stumbled upon photographs my husband and I took last summer. The idea of a TV show about zombies did not amuse us at first. Yet, as the show started gaining momentum, where different groups of survivors from a zombie apocalypse are faced with the horror of the "walkers", ever twisting plots in every turn, and new characters "coming to life", curiosity started gearing its head up and inquiring minds then took over.

So off we went, with the Jeep Wrangler, top down, drove to where it was said the set for Walking Dead was being filmed. The scenic 45 minute drive down from where we lived, brought a child like anticipation of going to a secluded town where "The Governor" rose as a fair and strong leader among a group of survivors. In this town, they took refuge and barricaded it from the "walkers". The Governor eventually became consumed with power and greed, becoming almost deranged due to his "zombified" surroundings. Thoughts of Sheriff Deputy Rick Grimes started running through my imagination as his own small group of survivors annihilated zombies who devour any living thing they catch, and whose bites are infectious to humans.

We finally got to our destination that Wednesday and we noticed signs everywhere saying "town closed Thursday, Friday, Saturday". Good... we said. At least we can roam around the area and snoop. We saw several people walking around with their cameras clicking away, trying to capture a glimpse of the semi - blocked town of Woodbury. Here is our collection.

Am I late for the bus?

Zombies will never get us!

Any zombies out there?

Zombie left-overs are placed here!

As the Zombies become the new hit in town, I cannot help but think about how "zombies" had evolved since their introduction in the 1980's. Walking Dead had brought them back to life like never before and they are unstoppable. This leaves me curious as to how this series is going to end. As a nurse, discharge planning upon admission of patients in the hospital is vital. The same goes to every task I encounter in life. With this in mind, there had been so many scenarios going through my mind on how each and every character will contribute to the success of humanity, zombies to slowly rot away in existence, and happily ever after into the sunset.

We all know too well, that it couldn't be that easy. Remember how the LOST series ended? It was confusing to many leaving them more "LOST" than they were. The idea of an afterlife, limbo, purgatory, for many is non existent, making it hard for interpretation. Sheriff Rick Grimes' state of mind and location upon waking up from his "coma" can be interpreted in so many ways. There are no restrictions. Just pure thinking.

With this said, I think this is all a dream. Everything we see in the show are manifestations of Rick's own life. Zombies represents his insecurities, failures, and fears that are constantly coming back to life to engorge his  flesh and blood. Figuratively speaking, zombies are robbing him of the freedom to be the person he truly yearns to be. Each group of survivors represents the different stages and milestones of his life that he had accomplished, while others waiting for resolution.

For the meantime, let's enjoy the series as it unfold each week. 


Sunday, February 10, 2013

To Inject Or Not To Inject

By Chiqui Raveloski

Having type 1 diabetes for 41 years, I believe,  had given me a valid insight on what works when it comes to insulin therapy - MDI ( Multiple Dose Insulin Injection) vs. Insulin Pump therapy. The answer is - they both equally work. Both therapies will ultimately depend on how dedicated you are when it comes to keeping up with your personal health as a diabetic. 

A closer look at insulins:

For those who prefer tables ( me ):
Action Times for Insulins
InsulinStartsPeaksEndsLow most likely at:Usage
Hum/Nov/Apidra10–20 m1.5–2.5 h4–6 h2–5 hdesigned to peak, covers meals and lowers high bgs
Regular30–45 m2–4 h5–7 h3–7 h
NPH1–3 h4–9 h14–20 h4–16 hintermediate, less peaking, larger action
Lantus1–2 h6 hr18–26 h5–10 hdesigned for flatter and longest action, background insulin action for keeping your BG flat when fasting
Levemir1–3 h8–1018–26 h8–16 h
I used the NPH/Regular insulin for a long time. Mainly because those were the only 2 insulins available in my early years as a diabetic. It was a lot of work and felt like I was "chasing" my blood sugars and trying to fix highs and lows. If you look at the table, you'll notice that between the 2 insulins, you will have 4 different times that you need to watch out for the peaks. Blood sugars tend to drop at this point, that is if you did not eat enough and gave yourself more insulin than you should. Additionally, after 7 hours, the Regular insulin would have subsided and another dose of Regular is necessary to cover you for the whole day. This therapy seemed like I was more subjected to more highs and lows. Checking blood sugars regularly is essential for this combo to really work.

Then came Lantus and Lispro ( Novolog and Humalog). I remembered my endocrinologist saying "this is the closest you can get to an insulin pump". Referring back to the table, Lantus lasts for 26 hours, it's a "background" insulin, one peak, that's all. I injected Lantus at night only. Novolog/Humalog lasts for 6 hours, peaks at 4 hours. Combining the two, you will have less peaks. The key to this therapy is the carbohydrate counting. 

Carbohydrate counting is very essential in managing diabetes. Carbs = sugar = hi/low blood sugar. When I started the Lantus / Novolog combo, my endocrinologist and I had to set a Carb to insulin ratio. My ratio was 1 unit of Novolog = 10 grams of carbs. So, every time I counted the carbs  I consumed, I would calculate the amount of  Novolog I would have to inject. A lot of work, but it works. The beauty of this therapy for me is I feel like I have more freedom if I do not feel like eating. The only time I injected Novolog was when I ate. Again, checking blood sugars regularly is essential for this combo to really work.

Then came my insulin pump. I started using the insulin pump 10 years ago and I love it. I tell the nurses I work with that an insulin pump is so much like the PCA pumps -  a basal rate, then a demand dose - without the "lockout". Insulin pumps work the same way. It uses one kind of insulin - Lispro (Novolog/Humalog). My endocrinologist and I had to set my basal rate (which actually changes several times within a 24 hour period).  Then, when I eat, using the carb to insulin ratio,  I bolus to cover for what I ate. Again, checking blood sugars regularly is essential for this combo to really work.

If there is anything else I had learned in years of being a type 1 diabetic is that checking blood sugars regularly is very essential in managing diabetes. I check my blood sugar as soon as I wake up in the morning, before meals and 2 hours after each meal ( so I can make a correction dose ), before going to bed. and last but not the least, before driving. Checking blood sugars first thing in the morning gives me a better idea of "where I am" for the day. Blood sugar checks before driving prevent the occurrences of the "unwanted" hypoglycemia while driving.

MDI and insulin pump therapies are both effective in controlling blood sugars. As a matter of fact, when I need a break form the insulin pump, I revert back to the Lantus/Novolog combo for a while....and vice versa. Every insulin dependent diabetic has their own insulin therapy that they follow. Please talk to your physician regarding questions about your insulin therapy.The key is knowing and accepting the fact that both equally require work and commitment. Yes, I do have my moments of discouragements when the going gets tough. But like what they say, "When the going gets tough, the tough gets going". Take responsibility. Having diabetes is not a death sentence. It is a way of life.

Important links:

Information in this post is for informational purposes only. It is NOT intended to replace the advice of your physician. If you have questions about your diabetes, please call your physician. If you feel ill, please seek medical attention immediately.

40+ Years Of Living With Type 1 Diabetes

By Chiqui Raveloski

I remember waking up inside a white painted room with a window to my left side. The unfamiliar bed and that "medicine smell" gave me a feeling of insecurity. My mother had a sad and worried look on her face and I did not understand why. Mom told me I was sick and I have to take shots every day. I don't think I even asked why. And that "medicine smell" became all too familiar very quickly because it became a start to my journey as a type 1 diabetic for the rest of my life.

I was diagnosed with Type 1 Diabetes at the age of five years old back in the Philippines, the year 1972. Back then, very few or it seems like I was the only kid I knew with Type 1 diabetes. I ate differently, lived differently, seemed like was treated differently. Mom always had to talk to my teachers during the first day of school to discuss my condition and warn them of what they needed to do if I acted "funny". Mom also wanted me to wear a "diabetic badge" which was attached to the back of my school badge.

There were no disposable syringes and needles back then. I remember using a glass syringe and  hypodermic needles. Both had to be boiled with hot water to sterilize and re-use for many times. Checking for glucose in my urine required what I remembered a test strip called Tes-Tape. Insulins back then were made out of pork and beef.

Diabetic supplies and treatment options had changed so much in the past 40 years. Literatures back then did not give me any hopes of living a long life.There were so many restrictions on what I can and cannot do. But, Mom did everything she could to provide me and with all the gadgets and trips to the endocrinologists office every month to keep me well. Mom kept everything together for me and my 2 younger sisters and my younger brother. None of them have diabetes.

I migrated to  the USA in 1986 and the rest of my family followed one year later. Mom had told me several times that America would be full of opportunities for me, my health, and have a better life for the rest of the family. We just have to start working, earn money, and enjoy the fruits of our labor. We had been working ever since and we had done pretty well.

I am not sure how my life as a diabetic would be different from any other. I wouldn't know how to live any other way otherwise. Just like everyone else, I had my teen-age rebellious years. I had my personal battle with weight, and it took a long time to figure out what I wanted to be when I grow up. The only difference is I had to take insulin shots everyday, watch out for hypo and hyperglycemia, check my blood sugars, which are all normal part of living for me.

It has been 41 years since I was diagnosed with type 1 diabetes and I had learned so much about myself and diabetes. The lessons learned became an inspiration on why I wanted to become a nurse. There's so much to share and still more to learn. I will be periodically posting insights, ideas, and personal experiences with diabetes. This page will serve as a medium to let other diabetics know that it can be done. "Maganda pa rin ang buhay kahit may diabetes", "We can live a substantial life with diabetes". 



DIABETES RESEARCH - research for diabetes treatment with the umbilical cord blood cells they collect and have a wealth of information on their site.

Sunday, February 3, 2013

The "Second Victims"

By Chiqui Raveloski

Tears rolled down my face as I came across an article written 2 years ago. A veteran pediatric nurse took her own life several months after administering a fatal overdose of an electrolyte to an infant. After investigations and undisclosed reasons, the hospital terminated the nurse's employment after 27 years of service and dedication to the profession she truly loved.

To further satisfy the state licensing disciplinary actions, she agreed to pay a fine and  undergo a four-year probationary period. She would be supervised at any future nursing job when she gave medication. She even successfully completed a course to qualify as a flight nurse. Yet, countless efforts did not produce any job offers, increasing her despair and isolation. A friend said, "She cried for weeks. Not just because she lost her job, she lost a child".

No one knows all the details which led to the nurse taking her own life. The reality is, the healthcare industry, I believe is not set up to provide personal, psychological, and social  support to the "second victim" of medication errors. The first victims are the patients who were harmed and their families. Nurses are the providers of care and support for  patients. But who supports and advocates for nurses?  I had a post about this.

Nursing, as noble as this profession may be, can also be a lion's den to those who unfortunately had experienced it. When mistakes happen, we are urged to "write it up", appear in front of a committee, get judged, and God only knows what else. Then, labeled as "incompetent" , an unseen force can immediately make the second victim even terrified to go back to work, adding to the feeling of desolation.

My heart goes out to the family of the child. I am a mother and I cannot even imagine or do not want to imagine how it would make me feel. I don't even have words to describe it right now as I write this post. My only hope is that the family was able to and continues to find the strength to overcome their tragedy.

My heart also goes out to my fellow nurse who must have felt so alone. The emotions she went through, and to choose the heartbreaking decision she made. I feel terrible that after all the years of dedication to nursing; no one was able to provide her with accessible and effective support when she needed it most.

As the culture of patient safety continue to be a focus in the healthcare scene, the culture of isolation and abandonment of the second victims need to stop. We, nurses are morally and ethically obligated to provide care for patients regardless of their social status. We are also equally obligated to protect and nurture our fellow nurses who became, and hopefully will not become the second victims.

Supporting each other is vital while we maneuver through this highly stressful profession we chose to dedicate our lives to. We can achieve this by giving fair judgment to second victims and realize that their intentions are good. They deserve respect and should not be ostracized for human imperfection. Instead, we should understand the psychological impact of medical errors to all the victims involved. In doing so, we can make referrals to professional support services uniquely tailored to this kind of situations. Finally, in order to avoid future occurrences of fatal errors, we need to realize that there is a potential for growth. We can start by learning from our mistakes and watching out for each other’s safety.