Tuesday, October 16, 2018

Wrinkle Relaxers do just that!

Do you know what neurotoxins do and will they meet your expections? Many people think that drugs like Botox, dysport and xeomin will erase wrinkles.  Truth is they will not.  They are fabulous medications to help slow the aging process, but if there is a wrinkle they will only slow the progression and prevent new ones.  Many times after injecting someone new, we will get a phone call in a day or two or even a week that the medication is not working because the wrinkle is still present.  The medication works just fine.  I injected correctly, I reconstituted properly and it is impossible to erase a wrinkle.  This complaint is, of course, after an extensive consultation of setting expectations and thoroughly explaining how the medication works.

So, what happens when our clients go home?  Did they forget?  Did they listen? Do they think I was not truthful?  What do neurotoxins actually do?  They freeze the muscle to prevent a repetitive movement that will cause or deepen a wrinkle.  If you fold a piece of paper in half 100 times, there will be a crease.  If you stop folding the paper there will still be a crease.  If you stop folding the paper the crease will no longer deepen.  The crease will always be there.  Luckily we have skin, and it is different from paper.

So, if you inject the muscles to paralyze them, the wrinkle will soften over time.  Eventually, the crease will be barely noticeable, but only if you inject on a regular basis.  The recommendation is every 3-4 months.  The medication will not work if you only inject once every 3 years.  Lotion will not moisturize your hands or face if you apply it once and never do it again.  Neither will Botox or Dysport soften a wrinkle if you only do it once. Not even if you do it twice.  You must keep up on it to see the benefits of this wonderful product.

Thursday, October 11, 2018

Back again...again.

What a journey this has become.  Last blog post was in regards to my transition from private practice to retail in corporate to private consultant.  Funny how things work out.  I went on a journey of a lifetime, learned a huge amount and took a bit of a left turn, and have settled nicely.  I attempted to start up a business as an independent nurse practitioner.  I learned about functional medicine, IV hydration, anti-aging treatments and the harsh reality of business.  I made friends, unveiled fake friends, and networked my butt off.

In this state of Florida it is tricky becoming a nurse entrepreneur.  First of all, Medicare doesn’t recognize you as an independent provider.  Once you have finally completed all the hoops to jump through to get paid by Medicare you only get 80%.  Secondly, collaborating physicians can charge you as much as they want.  Rent is expensive.  Products are expensive.  Advertising is a mystery. Oh, and liability insurance is expensive.  Investors are plentiful, but they want high percentages and it leaves you with little profit.  Hats off to those who have over come!

I, on the other hand, put on the brakes, put it in reverse and changed directions.  With all the training that I was getting in aesthetics, I decided two work for a business that was already established.  I am again an independent contractor and I think this is where I like to be.  There are places for everyone and thank goodness for that.  So, now I am an aesthetic nurse practitioner. I am committed to blogging about aesthetics in this world of mine.  Continue to follow me and stay tuned for my new series of posts in the aesthetic industry.

Tuesday, December 6, 2016

I'm Baaaaack

Hello world!  I decided to stop blogging and focus on other things.  What I have learned in my time away from here is that I missed blogging!  I have transferred from private practice to corporate convenient care.  It's nice enough and it pays the bills.  I get to have some regular patients and build a small rapport, but it's not private practice.  There are many perks of working for a giant corporation, like benefits, matching 401K and paid time off (which I haven't had in 10 years!).  It is very reminiscent of hospital nursing with shifts, trading and competing time off and lots of paperwork.  However, there is no, I mean no office politics(love!love!love!).

A new demention I have ventured into is the front office.  As a retail nurse practitioner, you are the front, middle and back office.  I now get to check in, assess and treat and collect the copy at the end.  I take vitals, which I never have to question or ask to be repeated.  I don't have to wait until my patients are checked in by the front, and while checking in I can start screening.  I have been able to learn how to basically run my practice with the outline layed out for me.  I wouldn't recommend this position to a new grad, although many of my collegues have only worked in retail.  I feel like the experience I gained in private practice has helped me to develop my skills working in the retail clinic on my own.  It makes me a better practitioner recognizing the warning and danger signs and knowing when to refer to ER versus, urgent care, versus we can handle this over the weekend until you get into your primary physician on Monday.

Retail gives you guidelines, but having practiced in other settings, they truly are guidelines and not the holy grail of practicing medicine.  However, many nurses have also developed these skills in their previous settings as well, not just being an NP in private practice.  But, for me I think that helped.  I want to start consulting and branching to other fields of nursing now and I thought blogging would be a nice way to get some attention and make some more headway.  Hope you enjoyed this one and there should be a steady stream to follow.

Friday, August 16, 2013

A Nurse Practitioner's World: Things they never teach you

A Nurse Practitioner's World: Things they never teach you: Now that my collaborating physician may be going VIP, this gives me the opportunity to learn how to do my own marketing.  These are the thin...

Things they never teach you

Now that my collaborating physician may be going VIP, this gives me the opportunity to learn how to do my own marketing.  These are the things they never teach you in school, whether you graduated from nursing or medical school.  I have been researching and reading websites like never before.  I have been taking blogging classes and reading tips for free and cost effective advertising.  Just when you think you can't think of anything else you find out there is more.  Take a few deep breaths, collect yourself and keep going. Here are a few things I picked up along the way.
1.Facebook is free, connect with your friends and hopefully they will tell their friends and so on.
2.There are free websites out there and you don't have to know computer language or codes.  It will do all the work for you and you fill in the rest to customize.
3.There are blogs for people who are trying to start a business and they have done more research than you.
4.Get people's opinions and have them proofread your stuff.
5.You are a nurse practitioner or other professional, a spouse, and probably trying to raise your kids, and you are not an expert at everything. It's ok to get a little free help from family and friends.
6.Everything is better after a good night sleep.

Tuesday, May 21, 2013

Who's guiding the guidelines?

How does everyone feel about guidelines?  I have recently started working with a physician who disputes these guidelines.  He has some very valid points and he has been in practice for many years, so these points are intelligent and well thought out.  The problem comes in where my training is based primarily on following the guidelines.  If you don't follow the guidelines, then you may be held accountable in a law suit.  I was trained, if you follow the guidelines, they will set you free (with in reason).

 As I look at the hard data, the guidelines also make sense.  I feel that the future of medical care in America has to look at the risks and benefits of having or not having certain tests done.  They also have to look at cost effectiveness.   Is educating the patients regarding the guidelines enough to allow them to make their own decisions? Is an expected life span of 10 years or less enough reason to encourage people to stop screening?  I would think that if I could get 10 more years with the people I love, that would be a good thing, but is it good enough for the government to approve payment for your testing?  Is a lifetime worth more than a healthcare spending budget or the other way around?

From a medical standpoint when the numbers are showing that testing 100, 000 we will catch only a small percent, then why bother, it doesn't sound so bad.  However, when you are sitting across from a patient that landed in the 1-10% and you have to tell them that they are going to die because we didn't screen for this, it doesn't seem so rational now.  My employer has some stories like this.  He has tested patients outside the guidelines and caught quite a few prostate cancers in the early stages in men under the age of 45.  He has many years in Medical Practice, looks at the research and the numbers, but he has been in that chair across from patients that would otherwise not have been screened.

My collaborator and I are constantly debating about the new gynecology guidelines and whether to pap or not.  He disagrees with the 21 and up first time pap smears for sexually active women and young girls.  Should they be subjected to a screening exam because they are being responsible and seeking birth control methods?  Does the birth control effect the changes in cervical cancer or the progression of HPV into invasive cancer enough to withhold until further testing is sought and that would include further invasive procedures?  Furthermore the guidelines never suggest discontinuing OCP usage in women who do test positive with HPV high risk or otherwise.

As I struggle with the decision to base my practice on guidelines or not, I wonder who will be "set free."  I started this article 2 months ago and as I struggle to get tests ordered for my patients and insurance companies are arguing with me. They insist on negotiating to get more tests done instead of just covering the test that I am ordering, now I begin to see the light that is "guiding" my collaborating physician.  I know better than to challenge him on most subjects, because he has 25 years of practice over me, but that doesn't mean that I'm going to stop trying.

Latest research on mammograms and late stage
http://www.cancer.org/healthy/findcancerearly/cancerscreeningguidelines/american-cancer-society-guidelines-for-the-early-detection-of-cancer


Thursday, February 14, 2013

Thank you Senator Bill Galvano

There is a new piece of legislation being worked on to keep nurses from using the title "doctor" even if they are graduates of a doctoral nursing program.  A Florida Senator is trying to make it a 3rd degree felony.  A charge up next to burglary, elderly neglect and animal cruelty ending in death.  Sure, that makes perfect sense.  Hey, because I am might be  PhD and say "I'm Dr. Jones" I should share a jail cell with someone who tied a pit bull to a fence and lit them on fire.

I have met Medical Assistants and RNs who call their selves "nurses" and "PAs" and they are not even close to having completed an educational track that could be mistaken as such.  They were not bad people, and they were not trying to pull the wool over someones eyes.  They were simply saving a lengthy explanation of what their actual job entails.  Anyone who has an occupation outside of the doctor seems to need to carry around a job description in order to get patients to understand what their role is.

The hardest position I have ever held is one as a Nurse Practitioner.  The one of the hardest parts of my job is trying to explain to the patient that they don't have to consult with the doctor after seeing me.  I'm not there to take their blood pressure and I'm not going to get the doctor to come in and check up on our plan that we just established for treatment.  I'm not a student doctor, a helper or an assistant.  People who don't work in the medical field (and even sometimes people who do) just don't get what we do.

All that being said, should we make it a 3rd degree felony for saying that we hold a title that was rightfully earned?  We are not ashamed of our titles and we actually want you to understand our roles, but it is really difficult to do in the small time frame which insurance companies and government allot for us to spend with each person.  I actually haven't met a Nurse Practitioner yet that doesn't correct patients or other practitioners when referred to as a medical doctor. I have not met a nurse who has complained when others who do not hold the same level of education refer to their selves as "nurses."  People throw around the title "nurse" constantly without a second thought.  I don't see a law being discussed to make that a felony or any other penalty for that matter. https://www.change.org/petitions/senator-bill-galvano-stop-sb-612-the-doctor-title-bill#share.