horsin around

IDEA and Autism and Nursing School, oh my.

2009-03-23T22:41:00.000-07:00

I was once a big opponent of the no child left behind law. I felt that the only way it could work was by redirecting funds to the bottom end of the bell curve and cutting programs for the gifted. Since both I and my husband were considered gifted, it concerned me that our children wouldn't have the resources they deserved to do really well in school and not be bored to tears like I was.

In regards to no child left behind, I must now eat my words and retract that opinion. Not because my opinion was wrong, but because I've had to re-evaluate no child left behind from a new perspective. IDEA, no child left behind, is the guiding laws behind everything that is being or is not being done for my son by his school.

As a result, I am being forced to learn the ins and outs of that law very, very well. It's not in the school's interest to educate the parents in regards to their rights or their child's rights. IDEA forces them to evaluate the kid (Child Find) and construct an IEP (Individualized Education Plan) but when you get to the IEP meeting, the school wants to provide the minimum amount of services that they can get away with.

When Vasili was diagnosed as autistic, it was an unpleasant, unexpected surprise that I had barely begun to come to terms with when I had to meet with the school to discuss his education plan. I didn’t even know what the education plan meeting entailed when I walked into that room. There were six of them and one of me. Guess who won? I didn’t even know what questions to ask, and I’m the medical professional of the family.

Due to my own colossal, but now rectified, ignorance, Vasili is receiving a minimal amount of services by the school. A couple hours of group speech therapy per week, and the occupational therapist is barely involved. He is being mainstreamed, but has a visual learning aide/schedule to go by.

While I agree with mainstreaming Vasili, since he is not at all retarded, I am not sure that his current IEP is serving his interests as well as it could. It is adequate, however, so I will let it ride to the end of the school year. When he is starting 1st grade, however, and the annual IEP meeting is held, there will be... changes. Because I know his rights now, and I have the support of groups like the Autism Society of America to back me up and provide all the paperwork, advocacy, etc, I need to fight the school.

One of the more interesting side effects of Vasili's diagnosis is that it has changed my approach to nursing school(RN to BSN program, I am already a nurse) assignments. With each new project, research paper, and presentation due in school, I am delving deeper and deeper into the cutting edge of autism law, genetics, biomedical research, and so on.

My BSN capstone project will be on autism, too. And it wouldn't bother me to go into research on this topic. It is an epidemic, and the loosening of the DSM-IV-tr criteria alone *cannot* account for what is nearly a 1000% increase in prevalence! Nor do vaccines alone account for it, in case you wondered.

But between work, kids, writing and revising, and homework/research, the only free time I have these days is really late at night. So now I email everyone, and blog. Sometimes, I tweet.

Back to Basics

2009-02-26T14:19:00.000-08:00

My five year old son had a seizure recently.
With luck, he will never have another.

But during the course of this event I learned that a lot of otherwise sensible people have no idea of what to do in a medical emergency, even if they have had CPR training.

So here are some basics to keep in mind:

First, remain calm. Panicking serves absolutely no use and is counterproductive.

Second, if in doubt, call 911. Paramedics would rather respond to a false alarm than have someone not call and die as a result of their hesitation.

Third, ABC! This simple mnemonic, used by every nurse, doctor, and EMT is apparently not as well known as I thought it was. My parents, both CPR certified, had never heard of it. Nor had my son's teacher.

A. B. C. stands for Airway, Breathing, Circulation. This is called primary assessment by ER types and anyone can check them.

First: Airway. Is the victim able to breath or is something obstructing the airway, like a tongue or foreign object? Opening the airway is the entire point of the head tilt, chin lift you are taught in CPR training.

Second: Breathing. Is the victim breathing? Can you feel or hear the breath? Are both sides of the chest expanding? This is where rescue breathing comes in, though that is now thought of as more optional than required.

Third: Circulation. Does the victim have a pulse? Check for the pulse by placing your first two fingers on the wrist, in the inside hollow just back from the pad of your thumb. That's the radial artery. Once you find it, you can assess quality: strong or weak, slow or rapid, regular or irregular. If you can't find it, start chest compressions.

There are few things in life as simple as ABC. Or as life-saving.

Just for Fun

2009-02-03T13:23:00.000-08:00

Entirely for the fun of it:

http://tinyurl.com/akd6ro

I can't say how long that post will be up. Depends.

Odds & Ends

2009-01-30T21:32:00.000-08:00

Okay, it's 2009 now. That means... it's Derby Trail Season. Yipee! I love the three-year-olds. Mary Forney's Blog http://maryforney.blogspot.com is doing a good job of keeping me updated on the west coast contenders. Thanks. :) I'm growing fond of The Pamplemousse despite the name.

Sorrow: Curlin is retired. So is Big Brown. Hopefully in a few years we'll be seeing their colts on the track.

In a complete change of subject: The Holy Revision of the Dark Servant continues. If anyone is interested in proof-reading the ms, let me know. My eyes are starting to cross when I stare at it for too long, and the Workshop is sooo slow.

Someone suggested I go ahead and write the Hybrid as YA and someone else that I write the Dancer as erotica. That made me wonder... YA and Erotica in the same series?! With a murder-mystery in the middle?! Am I insane? Is that how I've managed to come up with this stuff?

The Future of Bookstores

2009-01-18T02:11:00.000-08:00

"In looking over the F&SF shelves, there was a very clear pattern. All that was left were the most recent paperback releases of name authors." L. E. Modesitt, Jr. http://tinyurl.com/2f9wdd

I've seen this pattern in most bookstores myself, including independents, Barnes & Noble, and Borders. I've even told management in these stores that I would have bought more if they'd bothered to stock Books 1 & 2 of so-and-so's trilogy. But they probably lack the power to change that. By not stocking the backlist, they reduce their own sales. But if they did stock every author's backlist, arguably, they'd soon run out of space.

Because of this trend, however, I am buying more and more books online. Amazon has better prices anyhow, and I don't have to spend another $25 for their discount membership. I've never quite gotten how I save money by spending the amount of a hardcover to get a savings club membership card. Waldenbooks Otherworlds Club discount card was free. With Amazon, I not only get a free discount, I can be pretty sure that they'll have the author's backlist.

The downside to Amazon is that there is far less impulse buying. The consumer is far more likely to only buy the book by the author that they're looking for and not pick up the book on the next shelf because it looks interesting. Amazon doesn't have shelves. And sometimes I wonder who decides on the books that show up at the bottom of the screen that proclaim "People who liked X also liked A, B, C, D."

But I remain aware of new and mid-list authors, and I look for them a couple of ways.

The used bookstore is my first stop there. I don't spend as much on the book, so I'm a lot more willing to take a chance. If I like the book, I'll add the author to the list of who I'm looking for at Amazon.

Another method is to read the reviews on Locus. Not 100% foolproof, but they have turned me onto some great books over the years.

I don't know what the solution is for the brick and mortar bookstores, but if I had to guess, it's going to be POD. Problem is, there's not much difference between shopping online and browsing POD titles. You can't pick up the book and skim a few pages. I've heard that it will soon be possible to have a POD kiosk inside a bookstore. You select your book, pay for it, and the machine prints and binds it while you wait.

This might be the solution for backlist. Put the newest offerings on the shelves to attract customers, then have the other books obtainable through the POD. One stop shopping that's actually competitive.

ICU eavesdropping

2009-01-12T07:24:00.000-08:00

Our redoubtable night shift charge is fond of challenging us to think outside the box. On the question of patient/family complaints about noise, he had this to say:

Pretend you're not a nurse. Walk down the hall, stop and listen outside of each room for a moment, then move on.

Some results:

1. "Don't put that thing in there!"
2. "Squeeze!"
3. "Work it!"
4. "Suck it in harder!"
5. "Blow blow blow blow blow!"
6. "Yes, you do have to do that."

There was nothing inappropriate going on in any case, but feel free to guess what the actual situation is. I'll post the real answers tomorrow.

Works in Progress Eternal

2009-01-08T23:30:00.000-08:00

Works in Progress (as of 1/8/09)

Fantasy

Ydron Chronicles (510,549)

1. Dancer (Rak 1) (55,098)

2. Novice (Rak 2) (55,726)

3. Priest (Rak 3) (33,405)

4. Dark Servant (Rak 4) (210,474) (Complete, in revision)

5. Thearch (Rak 5) (87,062)

6. The Hybrid (Stand alone) (68,784) (Complete, in revision)

7. The Temple (Stand alone) (Outline only)

Science Fiction

Rovanis Chronicles (61,648)

1. Yeri 1 (10,650)

2. Yeri 2 (15,919)

3. Yeri 3 (8,491)

4. Yeri 4 (6,404)

5. Yeri 5 (20,184)

6. The Forest (Stand alone) (Outline only)

Dark Star Chronicles (157,051)

1. Razorback (39,000)

2. Ghost Fleet (Outline only)

3. Last Stand (66,513)

4. Masquerade (86,638)

Total Word Count: 729,248

Happy New Year

2009-01-02T07:46:00.000-08:00

Courtesy of the night shift ICU charge nurse comes the best New Year's resolution I've ever heard.

"This year, I resolve not to make any resolutions."

2008-12-09T04:53:00.000-08:00

This is originally from The Big Read - they think most people will only have read 6 out of the 100 books listed.
Instructions:

1) Look at the list and bold those you have read.
2) Underline those you intend to read.
3) Italicise the books you LOVE.
4) Reprint this list so we can try and track down these people who’ve read 6 and force books upon them.

1. Pride and Prejudice - Jane Austen
2. The Lord of the Rings - JRR Tolkien
3. Jane Eyre - Charlotte Bronte
4. Harry Potter series - JK Rowling
5. To Kill a Mockingbird - Harper Lee
6. The Bible
7. Wuthering Heights - Emily Bronte
8. Nineteen Eighty Four - George Orwell
9. His Dark Materials - Philip Pullman
10. Great Expectations - Charles Dickens
11. Little Women - Louisa M Alcott
12. Tess of the D’Urbervilles - Thomas Hardy
13. Catch 22 - Joseph Heller
14. Complete Works of Shakespeare
15. Rebecca - Daphne Du Maurier
16. The Hobbit - JRR Tolkien
17. Birdsong - Sebastian Faulks
18. Catcher in the Rye - J D Salinger
19. The Time Traveller’s Wife - Audrey Niffenegger
20. Middlemarch - George Eliot
21. Gone With The Wind - Margaret Mitchell
22. The Great Gatsby - F Scott Fitzgerald
23. Bleak House - Charles Dickens
24. War and Peace - Leo Tolstoy
25. The Hitch Hiker’s Guide to the Galaxy - Douglas Adams
26. Brideshead Revisited - Evelyn Waugh
27. Crime and Punishment - Fyodor Dostoyevsky
28. Grapes of Wrath - John Steinbeck
29. Alice in Wonderland - Lewis Carroll
30. The Wind in the Willows - Kenneth Grahame
31. Anna Karenina - Leo Tolstoy
32. David Copperfield - Charles Dickens
33. Chronicles of Narnia - CS Lewis
34. Emma - Jane Austen
35. Persuasion - Jane Austen
36. The Lion, The Witch and The Wardrobe - CS Lewis
37. The Kite Runner - Khaled Hosseini
38. Captain Corelli’dolin - Louis De Bernieres Mans
39. Memoirs of a Geisha - Arthur Golden
40. Winnie the Pooh - AA Milne
41. Animal Farm - George Orwell
42. The Da Vinci Code - Dan Brown
43. One Hundred Years of Solitude - Gabriel Garcia Marquez
44. A Prayer for Owen Meaney - John Irving
45. The Woman in White - Wilkie Collins
46. Anne of Green Gables - LM Montgomery
47. Far From The Madding Crowd - Thomas Hardy
48. The Handmaid’s Tale - Margaret Atwood
49. Lord of the Flies - William Golding
50. Atonement - Ian McEwan
51. Life of Pi - Yann Martel
52. Dune - Frank Herbert
53. Cold Comfort Farm - Stella Gibbons
54. Sense and Sensibility - Jane Austen
55. A Suitable Boy - Vikram Seth
56. The Shadow of the Wind - Carlos Ruiz Zafon
57. A Tale Of Two Cities - Charles Dickens
58. Brave New World - Aldous Huxley
59. The Curious Incident of the Dog in the Night-time - Mark Haddon
60. Love In The Time Of Cholera - Gabriel Garcia Marquez
61. Of Mice and Men - John Steinbeck
62. Lolita - Vladimir Nabokov
63. The Secret History - Donna Tartt
64. The Lovely Bones - Alice Sebold
65. Count of Monte Cristo - Alexandre Dumas
66. On The Road - Jack Kerouac
67. Jude the Obscure - Thomas Hardy
68. Bridget Jones’ Diary - Helen Fielding
69. Midnight’s Children - Salman Rushdie
70. Moby Dick - Herman Melville
71. Oliver Twist - Charles Dickens
72. Dracula - Bram Stoker
73. The Secret Garden - Frances Hodgson Burnett
74. Notes From A Small Island - Bill Bryson
75. Ulysses - James Joyce
76. The Bell Jar - Sylvia Plath
77. Swallows and Amazons - Arthur Ransome
78. Germinal - Emile Zola
79. Vanity Fair - William Makepeace Thackeray
80. Possession - AS Byatt
81. A Christmas Carol - Charles Dickens
82. Cloud Atlas - David Mitchell
83. The Color Purple - Alice Walker
84. The Remains of the Day - Kazuo Ishiguro
85. Madame Bovary - Gustave Flaubert
86. A Fine Balance - Rohinton Mistry
87. Charlotte’s Web - EB White
88. The Five People You Meet In Heaven - Mitch Albom
89. Adventures of Sherlock Holmes - Sir Arthur Conan Doyle
90. The Faraway Tree Collection - Enid Blyton
91. Heart of Darkness - Joseph Conrad
92. The Little Prince - Antoine De Saint-Exupery
93. The Wasp Factory - Iain Banks
94. Watership Down - Richard Adams
95. A Confederacy of Dunces - John Kennedy Toole
96. A Town Like Alice - Nevil Shute
97. The Three Musketeers - Alexandre Dumas
98. Hamlet - William Shakespeare
99. Charlie and the Chocolate Factory - Roald Dahl
100. Les Miserables - Victor Hugo

Publishing vs Nursing

2008-12-03T19:34:00.000-08:00

I freely admit that I am an aspiring author who would very much like to leave my current career to write full time. But isn't that the dream of every aspiring, unpublished author? I am at least realistic. I know the odds are against me.

And after today's news of publishing houses laying off, restructuring and possibly placing freezes on acquisitions, now is clearly not a good time in the publishing industry. Publishers Marketplace dubbed it 'Black Wednesday' and bad news seemed to come from every direction.

Agent and editor bloggers that I follow and admire seem beside themselves as they worry about what's going to happen next. My heart goes out to all of them, and I hope they all weather this crisis in good form with their careers intact.

It's at times like these that I reflect upon my day, er, night job. As a Registered Nurse in a cardiac ICU, I don't have to worry about lay-offs. I have to worry about mandatory overtime and whether or not I'll get Christmas off.

There's a nursing shortage. If the hospital I worked for went under, I could find a job within days if I wasn't picky, a month at the utmost if I was picky. And given that sort of job security, I'd be crazy to want to leave the field.

And yet, as an author, I'd be able to set my own hours, eat like a normal human being, use the bathroom on an as needed basis, and see more of my family. But I'd be at the mercy of the economic climate and how well my books sold.

For now, I shall remain a CVICU RN. Yes, it means I'll have to work Christmas and New Year's, but at least I'll get holiday pay on top of the overtime.

Blog Reading Levels

2008-12-01T13:08:00.000-08:00

TV Reviews

See Janet Reid's most excellent Blog for an explanation of what this really means.

NaNoWriMo Winner!

2008-11-26T19:19:00.000-08:00

Well, I did it. Sort of. The novel isn't quite done, but I got impatient and went ahead and uploaded what I had. 52,725 words in 26 days. NaNo is an impressive motivator. I just hope and pray that I didn't write pure crap. My new goal, of course, is to finish the story by the end of the month. However many words that may turn out to be. Then I can happily revise it, create a query letter and synopsis for it, and send it out to every agent I can think of. The only question remaining, in my mind, is whether this novel is more suited for the YA or the general adult fantasy market.

Stoned Responder

2008-11-26T00:55:00.000-08:00

It is my opinion that after having oral surgery, you should not then catch up on all the blogs you follow while stoned half out of your mind on Vicodin.

To those bloggers that I did, in fact, respond to, I officially apologize.

:)

2008-11-21T21:31:00.001-08:00

The Mom Song- LIVE from Northland Video on Vimeo.

Screamingly funny.

2008-11-18T02:59:00.000-08:00

Great book. Go read it.

Even if you don't like SF&F.
(how can anyone NOT like SF&F?)

Even if you don't like to read.
(You poor soul.)

Go.
Read.
Anathem.

2008-11-16T00:04:00.000-08:00

Am-I-Dumb.com - Dumb Test

I am smarter than 99.81% of the rest of the world.
Dumb Test

Apparently I am bored tonight. Actually, I think I am procrastinating actually doing any work on my NaNo story. Even though it's getting good.

2008-11-15T23:52:00.000-08:00

Free-IQTest.net - Free IQ Test

And I was not exactly awake or concentrating on it, either.

It was an okay test, a little tricky in places. But the really annoying was the end. It takes nearly ten minutes of clicking 'skip' to get get past all the ads and products they want to sell you.

A Review of Anathem

2008-11-13T00:46:00.000-08:00

Anathem, by Neal Stephenson
A book review

From the word “anthem” meaning “a piece of sacred vocal music” and from the word “Anathema” meaning “a formal ecclesiastical ban, curse, or excommunication.”

This is the title of Neal Stephenson’s latest book. Now, I usually read science fiction and fantasy. I had never before read Stephenson because he is not a pure genre author. Most of his work falls under the category of historical romance. Some of his work is alternate history/near future. And his earliest work has been described as cyberpunk. None of these are genres or subgenres that hold any interest for me.

Then Stephenson wrote Anathem. The pre-release work-up in Locus was interesting, and I thought, “I might give it a read once it’s out in paperback.” But as the release date grew closer, I found myself thinking about the concept of the novel that I’d read about. And if I am thinking of a book I haven’t even read, well, I take that as a sign. I bought a copy, in hardcover, which I am loathe to do if it’s an author I don’t know, trust, admire, love, etc.

The first thing I noticed was that the book was 900 some odd pages long. Long books don’t scare me. I read Hubbard’s Battlefield Earth because it was a long book. I read very fast, you see, and frequently run out of book long before I’m ready to leave the story. My favorite authors, who by sane standards are prolific, don’t write fast enough to suit me. So long books don’t scare me.

I settled down to start reading Anathem. I thought it would take me several days to read it because I lack the time to devote to intensive reading right now, what with NaNoWriMo, the revision of my own book, school etc. Nuh-uh. Just over a day. Why?

Because Anathem is a complex book with many themes and concepts interwoven and I was afraid that if I put the book down for any great length of time, I’d lose the thread of it. At the same time, I found the book insightful, funny, and absolutely brilliant. And more importantly, it was an awesome read. I read a lot of books. This is the best book I’ve read in well over a year.

From the beginning the concept grabbed me. The plot took two hundred pages to show up, and I didn’t care. The concept, the background, the sheer detail of the fascinating world-building held me spellbound. Then when the plot did show up, it got even better! It alternated between philosophy and action and politics and science and math and religion. Any concept you can name was probably thought about at some point during this novel.

Anathem is what science fiction used to be. It is what science fiction should be. This is not a rehashing of the typical sci fi plot involving rockets and space colonization. It isn’t thinly veiled socio-political commentary. It isn’t space opera with nothing but lip service paid to the science aspect of sci fi. No, it’s innovative. It’s like 40s sci fi writ anew, based on modern science. Not Newtonian or Einsteinian physics, but sciences like quantum mechanics.

The science is dazzling, well researched, and logically presented in such a way that the average reader probably can understand most of it. Ditto for the math. And the characters are human, believable, and likeable. They make you want to keep reading to find out what happens to them next. All the way to the end of the novel. At which point, I heaved a huge sigh and said, “I wish there was a sequel.” Of course, the odds are slim, I think Anathem was written as a stand-alone, but still, what a wonderful, wonderful book.

Here’s hoping that Stephenson considers writing another book in the same world.

Horses in Writing

2008-11-08T23:29:00.000-08:00

As a writer of fantasy and a lover of horses, this blog post was pretty much inevitable. The following is a primer for those people planning on putting horses into their novels in any way, but particularly as a form of transportation.

1. The horse is not a machine. It needs to rest, it needs to eat, it needs to sleep. It drinks lots of water, very messily. And then the horse smears it’s wet, grain-and-dirt-and-snot coated muzzle across the shirt you’re wearing.

2. The horse has a mind of its own. It can get cranky. Or frisky. And they startle easily. The horse is a prey animal and wired that way. Its instinct says run away first, then wonder if that flapping thing is really trying to attack. So sometimes the horse goes sideways because a leaf flips over in the wind. Sometimes, the rider doesn’t go with the horse.

3. Some horses will hold their breath while being saddled so that the girth is too loose. And some horses will try to scrape their riders off on trees. And then there is propping. Propping occurs when the horse stops suddenly, usually at a gallop. The horse stops by planting its stiffened front feet to the earth. Propping them, see? The problem with that is simple: the rider rarely sees it coming and ends up flipping over the horse’s head.

4. Horses have bad habits, too. They need mental stimulation. A bored horse who has been in a stall too long picks up vices. Cribbing, for example. Cribbing is when the horse starts biting and chewing on the stall itself, and swallows air as a result. There are a whole host of stable vices that the budding author can look into.

5. The rider. The escaping princess leaps onto the back of a horse in her silk dress and gallops off into the night? She falls off after ten paces because silk is slippery. So are the bare backs of horses. Okay, she has a saddle. Ever try mounting a horse in a full length skirt? And side-saddles aren’t well balanced, so no cross country, which makes it easy for the guards to catch her. Dress sensibly: boots, long pants.

6. The characters ride all day long, hand their horses over to the stable boys, and saunter into the inn. Riding all day long is hard physical work. It’s exhausting. After a full twelve hours or more in the saddle, even given stops for nature-calls, the character shouldn’t be able to stand up straight, much less walk, much less saunter. And both people and horses can get saddle-sores.

There is plenty more to think about when using horses in a novel. The best recommendation I could give you is to find someone who owns horses and will let you experience the joys of riding AND taking care of their needs.

Art and Personality

2008-10-23T14:42:00.000-07:00

Your result for What Your Taste in Art Says About You Test...

Conscientious, Fulfilled, and Spiritual

20 Renaissance, 14 Islamic, 11 Ukiyo-e, -23 Cubist, -27 Abstract and 2 Impressionist!

The Renaissance was a cultural movement that profoundly affected European intellectual life. Beginning in Italy, and spreading to the rest of Europe by the 16th century, its influence affected literature, philosopy, religion, art, politics, science, and all other aspects of intellectual enquiry. Renaissance artists looked at the human aspect of life in their art. They did not reject religion but tended to look at it in it's purest form to create visions they thought depicted the ideals of religion. Painters of this time had their own style and created works based on morality, religion, and human nature. Many of the paintings depicted what they believed to be the corrupt nature of man.

People that like Renaissance paintings like things that are more challenging. They tend to have a high emotional stability. They also tend to be more concientious then average. They have a basic understanding of human nature and therefore are not easily surprised by anything that people may do. They enjoy life and enjoy living. They are very aware of their own mortality but do not dwell on the end but what they are doing in the present. They enjoy learning, but may tend to be a bit more closed minded to new ideas as they feel that the viewpoint they have has been well researched and considered. These people are more old fashioned and not quite as progressive. They enjoy the finer things in life like comfort, a good meal, and homelife. They tend to be more spiritual or religious by nature. They are open to new aesthetic experiences.

A Blog Suborned

2008-10-13T12:31:00.000-07:00

I stopped following a blog today.

The owner of the blog, a literary agent, started to use the blog to express political opinions. Now, there is nothing wrong with expressing those types of opinions. But it would be better to start a new blog for that purpose than to use your pre-existing blog about being an agent. That's rather underhanded, in my opinion.

And even though the agent had previously been on my list of those to consider querying, I now have doubts. Does it matter that she sounds like a good match? Does it matter that I seem to write the sort of fiction she seems to like? Can I trust her, given her dishonesty in regards to her own blog?

Even if I had agreed with her political viewpoint, which I don't, I would have stopped following her blog. I simply don't like politics. I don't want to hear about it. On election day, I will go to the poll and make my own choice irregardless of what anyone else on earth thinks about the candidates or issues.

So by using a blog as a vehicle for political preaching, this agent not only offended me, she may have gotten herself removed from my consideration as an agent. I know, she doesn't care. Neither do I.

Rant complete.

Musings about MRSA

2008-10-07T05:42:00.000-07:00

A friend recently asked me (yet again) about the "MRSA thing" and what can he do to prevent it?

Okay. MRSA has been around, and known about, since the 1970s at least. It stands for Methicillin Resistant Staphylococcus Aureus. It is a variant of the normal Staph A that every one of us already has on our bacteria-laden human bodies. What makes MRSA special is that R. Resistant. Bacteria gain resistance by several methods.

1. Antibiotics. In the good ol' days, patients could pressure their docs to write antibiotic prescriptions for viral issues like the common cold. Placebo effect, to be sure, for the cold. But the bacteria, they learn.

2. Antibiotics. Again. Patient is sick, takes antibiotics, feels better, stops taking antibiotics even though full prescribed course is not done. Patient may think 'I'll save these for later, in case I get sick again.' Uh-huh. By not finishing the antibiotics, some bacteria are left alive and kickin'... or actually, dividin', and they learned a lot about surviving that particular antibiotic. And what they know, so do their neighbors and offspring.

3. Bacterial communication. Okay, I know, it's strange to think that a bacterium, a simple single-celled organism, can talk. But it does. At least, it talks to other bacteria. They swap DNA frequently. We shake hands when we meet, and bacteria rub their membranes together and trade DNA snippets in lieu of discussing the weather. As a result, your new resistant friend set up from #2 doesn't keep the resistance a secret.

4. Darwin. Darn that man, it's all his fault. Whether you agree with him or not, life does adapt, evolve, and change. And with bacteria that change can be rapid. If they weren't microscopic, I'd have said visible. E. coli, for example, can divide every 20 minutes. This is exponential growth. 1, 2, 4, 8, 16... and so on until the bacteria run out of nutrients. The only growth curve in all of nature that can match the bacterial curve is ours. We are also reporducing exponentially. (I wonder if we'll die off when the nutrients are all consumed?) But because of that rapid growth, adaptation can occur at a high rate. Like all life, it appears to be imbued with a will to live. So the bacteria can learn resistance from natural selection processes as well.

But there's good news. Really. Because of #4, resistant bacteria do not reproduce as well as non-resistant strains. So take all of the antibiotic prescribed, even if you feel better. Invest in hand sanitizer. And eat that activa yogurt to re-establish the good bacteria before another resistant strain sets up. Resistant strains can't compete with the normal strains in a non-antibiotic laden system. And yes, that's why antibiotics cause diarrhea. They're not very specific about which bacteria they kill.

Furthermore, the bacteria is cultured out and then resistance-sensitivity tests are run on your personal infecting bacteria. The antibiotics you are given are specific to that strain of bacteria.

I laughed a lot when the media fastened onto MRSA like it was the next pandemic. MRSA is small potatoes in the hospital setting these days.
It's community acquired.
It's been around for decades.
And...

Vancomycin kills it.

What the media failed miserably at noticing was the bacterium that scares even the ICU staff.
That would be VRSA.
Vancomycin Resistant Staphylococcus Aureus.
MRSA has a new family member.
Be afraid.

Brevity

2008-09-28T06:33:00.000-07:00

As an aspiring author, my work is often critiqued as being too detailed. I am told that I need to keep it short and sweet, giving only as much information as the reader can handle. Okay, I can see that. We don't want to bog the story down unnecessarily. But if you're too scant on the detail, the reader ends up confused, and puts the book down in frustration. Me, I err on the side of abundance.

Perhaps it's a knee-jerk reaction to work. I spend a lot of time writing a lot of things as briefly as is humanly possible. For example:

'9/26/08 1830 Nsg. Report rec'd, assumed care of pt. Assessment per flowsheet/path plan. VSS, afebrile. Pt NPO 2400 for LHC in AM. SR on monitor. BP, HR WNL. Will cont. to monitor pt.
2030 Pt c/o CP. CP protocal init. EKG shows no changes. Pain relv'd nitro tab x 2. Physician updated, orders rec'd and noted.
9/27/08 0130 Pt c/o CP. See flowsheet/code sheet. Physican notified, orders rec'd. Vent settings: PRVC 16, TV 450, Peep 5, FiO2 100%. Pt to OR.
0430 Pt back from OR. Vent settings unchanged. MT & PL CTs to LWS. Pacer wires taped. VSS, afebrile. SR on monitor. BP, HR WNL. Assessment per flowsheet/pathplan. Will cont to monitor pt.'

Now, from this, can you tell what happened?

Here's the translation. 6:30 pm. The patient is fine, and going for a cardiac catheterization in the morning. Because of that, he can't eat or drink after midnight. At 8:30 pm, the patient had chest pain, which was relieved by two nitroglycerin tabs. The EKG was fine, the doctor was updated, gave a few orders, which were done.
At 1:30 in the morning, the patient went into cardiac arrest, was given CPR, drugs, and several shocks. He was also sedated, intubated and placed on a ventilator. Since he was already in the ICU, he wasn't transferred, but the Cardiothoracic surgeon came in (yes, at 2 am) and took the patient to surgery for emergency bypass surgery. (guess the cath got cancelled).
Patient came back at 4:30 in the morning, with chest tubes hooked up to suction, pacing wires attached to his heart, and many other new wires and tubes. And yet, stable once more, by nursing standards for a fresh post-op open heart patient.

Is it any wonder I rebel and give the detail?

Curlin

2008-09-27T19:34:00.000-07:00

Today I watched a racehorse set a new record. Curlin has now earned over ten million dollars in purses on the race track. For those of us who followed his Triple Crown run last year, and came away disappointed, it is vindication.

This is why racehorses should continue running so long as their health and soundness permits. Curlin as a four year old is superior to Curlin as a three year old. And I was a loyal fan of Curlin at three.

Like most racehorses, he's won some and lost some. He even lost the Belmost Stakes to a filly, in what really was a beautiful race. To those who think Eight Belles should not have been in the Kentucky Derby because of her gender, I suggest you check the NTRA video archives of the '07 Belmont Stakes, when a filly named Rags to Riches defeated Curlin in a stretch duel. In the '08 Derby, that same sort of courage was present, but with different results.

And none of that detracts from what Curlin has accomplished in his career. Truly, Curlin deserves to be ranked among the modern greats. And if he meets Big Brown in the Breeder's Cup Classic, well, I for one will be glued to my seat for the two minute duration.