INTERESTING TIMES

John Hahn DPM ND speaking
Podiatric Medicine-Naturopathic Family Practice
notes include nice overview of common foot conditions
( original presentation on 2/8/10, moved forward )

for next week: there's a case to do and a self assessment quiz, no reading
cystitis video online is same as what he will present today
( week 6 lecture )

Finally it is done. I shook when putting in my final IV today, just as I shook when I put in the first one. But now I can remain calm and get the job done, even though my hands are shaking. They don't start shaking until after I have stabbed the vein, and usually not until after I have inserted the catheter into the vein. It is when I am taping the catheter in that the shaking really gets bad. But I've learned. I can do it anyway. I dreaded this class. I do not like needles. But I have come to enjoy the challenge. I have gotten good at palpating veins. My lover has great veins; he is fun to palpate. I look at people on the bus, people in restaurants, people on the street, and I am assessing their veins. I never knew I'd see people in terms of their veins. Saw quite a few injection drug abusers in the clinic---those are some tattered sclerosed veins, surrounded by abscesses. The damage done by needles is nothing next to the emotional pain.

It is a relief to be done with this part of my education. Drawing blood, injecting nutrients, numbing tissues, doing IV pushes and drips..... all these needles. Somehow I made it without sticking myself. My lab partner today stuck herself trying to pull saline from a bag. It is easy to do. The first time I did an IV push was in the clinic--on a patient with Hep C--and I told the doc I hadn't had the class yet but he didn't care, said just do it, so I did. The patient had poppers for veins so it was no problem. No active injection drug use. I think I have scars in both of my antecubital veins now, from repeated venipuncture. By rookies. Some missed, some stabbed all the way through and out the vein to the back. Some yanked upward and tore the vein. Some caught the outer edge of it and stretched it. I have experienced many of the mistakes that one can make when playing with needles. I suppose that is the purpose of this education. I know the story from both sides now. I have scars on my veins to prove it. And I will leave fewer scars as a result.

This class was supposed to be taken in the 3rd year of this education, but I dropped it. I had started out drawing blood in second year with great confidence, but lost my confidence when I began to shake. I didn't shake at first. The shaking started after a few blood draws. I still don't know why. I started having trouble just keeping the needle in the vein while I plugged in the various vacutainers. I did better with a regular syringe; something about working the plunger helps me not shake as badly. I have learned to drink less coffee--or none--on days that I must work with needles. And I seem to do better when I support my endogenous acetylcholine. I often will shake less on subsequent punctures, when I do several in a day. I think if I did it all day long I'd get to where I wasn't bothered at all. It is also possible that my adrenal response to being stuck contributes to my shaking while sticking. Maybe if I didn't have to get stuck so often, and were able to dissociate sticking from being stuck, I'd have less bodily agitation.

Excellent basic rundown of EMT procedures when working a scene:
http://people.vanderbilt.edu/~akshay.shah/ems/notes/notes2.html
notice, all ye from NCNM, that on this page a normal oriented person is A&O x4
ONLY at NCNM is normal x3. =-/
( review notes swiped from another student, somewhat updated, I know this material better than the teacher and have improved on his notes in places )

1) Increase L hip extension using PIR stretch: what ms group is stertched?
2) Using PIR corect a hypertonic R quad.
3) Increase L hip adduction with PIR strectch (which muscles?)
4) Perform a grade 4 mobilization to correct a L tibia internal rotation restriction
5) Correct a R calcaneus anterio glide restriction using grade 2 mob.
6) Correct a L navicular superior glide restriction.
7) Use strain/counterstrain to correct a hypertonic R piriformis.
8) Use s/cs to correct a L biceps femoris hypertonicity.
( notes need cleaning up )

diarrhea is not a disease, it is as symptom
( notes )