Dinner tonight: delicious salad! (all from Trader Joe's grocery store- my fave!)
I buy all the ingredients in advance which makes it quick and easy to put together.
Mixed baby lettuces
Chopped endives
Green onions
Chopped pear
Blue cheese crumbles
Candied walnuts
Micro greens
Champagne Pear Vinaigrette

Every day at work I do gynecological exams, and many of these visits are the patient's "annual exam" or "well-woman exam." During this visit I like to check in with patients and make sure they are doing well, see how they are doing on any medication, screen for disease, etc. Many of these visits it is the first time I am meeting a patient, and I know nothing about them other than their name, age, and hopefully a completed history form and a quick scan through old scribbled notes from previous exams. I generally walk in the door with a smile on my face and greet my patient and ask them deliberately vague questions like "How's life?", "Tell me about yourself" or "What's new?" to leave the door open to hear what's on their mind. Some people look at me with a blank stare...

If you would like your visit with your OB/GYN to be of more benefit and to really get the most of your 15 minutes with the practitioner, I'm going to let you in on a secret on how to do so...
BE FORTHCOMING!

Volunteer information about yourself that you think might be of use to the person who is trying to help you promote your health (this generally does NOT include information about your friends or neighbors, which oddly sometimes people tell me about...). It is our job to ask about these things but we only have so much time, and we have less time to help you if we spend much of it trying to figure out what it is you need. When I was in NP school my instructor told us "90% of the diagnosis is in the history", meaning that the patient will tell you what the problem is if you truly listen. Doctors and nurse practitioners and other health care providers are not mind-readers- so help us help you!!

Think about it: you are at the gynecologist's office. What are some things that this doctor/nurse practitioner might want to know about you to promote your health? Here's what I'm looking for:

• Are you married? single? in a relationship? how long have you been with your partner? are you monogamous (only one sex partner)? (*If you've cheated on your partner- TELL ME! you should be tested for STDs and if you're over 25 years old we generally don't routinely test for many of those things. If you're 30+ and tell me that you're married, I'm going to assume you're monogamous unless you tell me otherwise.)
  
• What are you using for contraception (birth control)? Do you use condoms? Would you like to leave here today with a method of birth control?
  
• Are you trying to get pregnant? If so, for how long? Do you have any children? How old are they?
  
• Do you have any gynecologic problems or concerns (ie- are you having pelvic pain or unusual vaginal discharge, pain with sex, urine leakage?)
  
• What are your periods (menstrual cycles) like? Any bleeding in between periods? Pain?
• Would you like to be tested for STDs? Are you concerned you may have been exposed to a STD? (and please tell the practitioner that you want to be tested for vaginal infections or STDs BEFORE we do the pelvic exam!!)
• What medications are you taking? Do you have any problems with the medications that your OB/GYN has prescribed you?
  
• Do you have any mental health problems? (ie eating disorders, depression, anxiety, bipolar, etc)
• Do you have any major medical problems (now or in the past)? (ie diabetes, cancer, heart disease, transplants, surgeries)
  
• Have there been any changes in your family medical history- specifically anyone closely related to you with breast cancer, ovarian cancer, colon cancer?
  

I hope this list will help you have a more productive visit with your OB/GYN Remember, we're there to help you, but we can't do it alone!

This is so funny. Actually a great idea, although not sure I'd want to put this in my purse after using it...

GoGirl

So it was Halloween day, and I was walking around the town square in Healdsburg with some friends. I was decked out in my Swine Flu costume (great idea, right?!?), wearing a pink robe, piggy ears and a curly tail, a pig nose and a surgical mask, adorned with a box of Tamiflu, a box of Kleenex and a bottle of "NyQuil" (aka pinot noir). People are everywhere on the street, kids and adults in costumes. I hear someone say "Nurse Coco!". I look up and a man with a baby is standing in front of me, he says are you Coco? Nurse Coco? I said yes... how do I know you?? He says that I taught him and his wife their "Newborn Care" class at Day One!

How random and also hilarious is that this guy recognizes me, while I'm in a sick pig costume (is that bad???), and that he remembers me as Nurse Coco! I don't even refer to myself as that in my classes except that I give patients info about my website at the end of the class. It was awesome!

I bought a new pair of sandals the other day and unhappily discovered that there were a few areas (like between the toes) that they are painfully rubbing against the skin. I bought some band-aids but they didn't work so well-they kept falling off, didn't cover the right spot... Later that day I came across some "Liquid Bandage" in my medicine cabinet. Ah-ha!! I don't know why I didn't think of this before! I applied the liquid bandage to the irritated areas, let it dry, and when I put my sandals back on- they didn't hurt anymore! I've been applying it daily while I break in my new shoes and with time the skin will become slightly calloused so the shoes won't hurt anymore. I plan to do this in the future with painful (but always beautiful!) high heels. Let Nurse Coco know if this works for you!

Hello friends-

Today I had a frustrating phone call that I am still upset about, and I would like to share it with you (this is not the first time I've had this type of phone call).

A woman in her mid-20's was calling to obtain a sample of her birth control, the Nuva Ring. She had been fortunate enough in the past to receive samples of this product at our office, so she had not yet had to pay for it with her insurance. Apparently her insurance did not cover Nuva Ring or it was considered "non-formulary", so her out of pocket cost for 1 Ring would be about $60. Our office happened to be out of stock of our Nuva Ring samples, and we did not know when we would get some more. The woman became very upset, saying that she needed her Ring NOW and if she didn't get it on time then it would be MY FAULT if she became pregnant. I reminded her that she had a prescription for the Nuva Ring- she countered that she "didn't want to pay that much" for it. I informed her that she could use condoms or practice abstinence- apparently that was out of the question too. She seemed to feel entitled to get her birth control for free. Has this woman ever heard of PERSONAL RESPONSIBILITY???

There is very little reason for someone nowadays to get accidentally pregnant. Guess what- if you have sex, even if you use protection, there is ALWAYS a risk that you could become pregnant or contract a sexually transmitted infection (STD)- who doesn't know that???  Just because you didn't want to become pregnant when you had sex, does not mean that it's not your fault that it happened. Even in horrible situations of rape or forced sex, you can take Plan B afterward, which significantly reduces the risk of pregnancy if taken soon after sex (<5 days, but the sooner the better). It doesn't always work, but taking Plan B is much better than looking back 6 weeks later and wishing that you had taken it.

Condoms are cheap and available at pharmacies and retail stores practically everywhere. Hormonal birth control methods (pills, patches, rings) are available by prescription only, but there are cheaper generic versions available for most pills, and your health care practitioner will almost always give you a prescription for a full year. Free or low-cost clinics have these birth control methods available at reduced or no cost to individuals who cannot afford them. Plan B, the "morning after pill", is available over-the-counter at pharmacies if you are over 18, and is also available by prescription for people of all ages. THERE ARE MANY OPTIONS!!!

Good thing to remember: Lack of preparation on your part does not necessarily constitute an emergency on my part. Your healthcare provider is there to help you, but you alone are responsible for your own actions and behavior, even when you make bad choices...

Be safe and plan ahead,
Nurse Coco

Hello friends-

So I hurt my foot a couple of months ago-I have no idea how I did it, it just HURTS. When it didn't get better after a couple weeks, I went to a podiatrist who instructed me to wear this lovely black walking boot (I hate it! and everyone who saw me in it who'd worn it before and looked at me pitifully and told me their story of their hurt foot and how they too despise the boot) for 2 weeks. Done. 2 weeks later, foot still hurts. Options: $1000 MRI to find out why it hurt (gotta love those high deductible insurance plans, right?) or cortisone injection in the area of pain... um, that sounds like the most horrible thing ever.

Thinking about it made me nauseas/feel lightheaded/horrified... My foot hurts on the top of the foot, on the bony ridge. My podiatrist was telling me he was going to stick a needle between the joints and inject cortisone (a steroid anti-inflammatory medication) into the top of my foot. Excuse me while I vomit/pass out/shudder...

The only thought more horrifying than having this injection* was paying whatever amount my insurance was going to charge me up to the amount of my insanely high deductible* for a MRI of my foot.
*yes, it's called an injection not a shot. an injection puts a liquid agent into the body, a shot is what you need at the end of a long day at work. just kidding. kind of...
*had no choice- insurance through job

I am a nurse, thus I am not generally squeamish. I regularly perform intramuscular (IM) and subcutaneous (SQ) injections and paracervical nerve blocks. So why was I being so anxious about this particular injection?? I definitely don't like being on the receiving end of healthcare, which is why it is so important for practitioners to be sensitive and empathetic.

So I finally got over the idea of the injection since my foot was already hurting so much that I decided it would be better just to get it over with. The doctor was very nice and understanding about my anxiety. He numbed the skin with a freezing-type temporary anesthetic (numbing medicine) to dull the sensation of the poke... but it FREAKING HURT!!! It is now about 10 hours later and I can still feel that sharp/shooting/burning sensation throughout my foot. It was about as bad as I imagined, maybe a little less, but NOT FUN. My foot has been completely numb since then. It is like dead weight, it feels so heavy! My podiatrist said the numbness is from the compression of the fluid onto the nerves, cutting off sensation. It doesn't hurt when I walk anymore, but it doesn't feel good and I hope I get sensation back soon!

Wishing you all a healthy holiday season!
and remember, "even nurses with needles are nice" (sometimes!)

nurse coco

Have you all heard about the "pregnancy pact" among a group of teenage girls in Massachusetts??

http://www.msnbc.msn.com/id/25272678/from/ET/

This is so crazy/sad. These poor girls have no idea what they have gotten themselves and their families into. They have thrown away the possibility of experiencing one of the rare times in one's life that one may be fully responsible for only oneself (and if they do get to experience that, they they are not raising their own child, which might be better for the sake of the child).

I used to work in a family planning setting and typically the teens I worked with fell into one of three categories (or somewhere in between):
1) Strongly desiring NOT to become pregnant
2) Ambivalent about becoming pregnant
3) Wanting to become pregnant

The easiest patients to work with (obviously) in getting them to use contraception was group #1. If someone is highly motivated to do something that will prevent a negative or undesired outcome, and I can provide the means for that patient's prevention, that's what I'm going to do. There will always be naysayers to argue that teens shouldn't be having sex, so providing contraception is enabling a negative behavior. I say, history has proven that teens will have sex whether or not contraception is readily available, so it is a public health issue to provide contraception to those who desire it.

People are always surprised to hear about #3 but this news story has brought this scary reality to light. This was a small percentage of girls I saw in my practice who obviously lacked self-esteem and parental involvement. I once had a 17 year old patient come to me saying that she'd been having unprotected sex with her older 20-something boyfriend for a couple months and couldn't understand why she wasn't pregnant yet. It gets better- she wanted me to help her get pregnant! I gave her a serious talking-to (but felt like my words were hitting a brick wall), tested her for STDs, and she left with condoms, educational pamphlets and a referral to a psychologist. I wish I knew a better way to handle these girls...

I was more disturbed by the high numbers of teenage girls who were ambivalent about becoming pregnant- these girls are too often the teens who get pregnant because ambivalence is a HUGE factor in teen pregnancy. Answers to questions such as, "Are you trying to get pregnant?" and "Do you feel you're prepared to raise a child?" are met with shrugs, blank stares, and responses such as "I don't know", "Whatever", and "I'm not worried about it." Sometimes I would want to shout at them, "Well you SHOULD be worried about it!", which I know would be very productive since adolescents LOVE to be told what they should and should not do.

Unfortunately I don't think there's any good answer to this problem. Let's hope this story from Massachusetts is an isolated event and not go the way of Columbine and have similar situations plague high schools throughout the country...

Hello my friends-

Nurse Coco has been bad and not blogged for many moons... so sorry. I am busy with work, but I love my new job (hardly new anymore, I've been there 4 months now!) I am excited to say my website has had more than 8 thousand hits in 2008! That's more than 1000/month! Spread the word, amigos...

It is summer in the city, but here in the city of fog, San Francisco feels more like winter... Here's to hoping for warmer days.

Calling all nurses! I want YOUR story! In my effort to educate the public about the vast opportunities in the career of nursing, I want to feature REAL nurses and nurse practitioners and their stories. Interested? Email me! (nursecoco@gmail.com) Briefly describe your job, what you do, where you went to school, why you became a nurse, why you love what you do, etc... Responses may be featured on my website and serve as an inspiration to others!

Hope to hear from you soon!

Nurse Coco

This is horrible. The city of Berkeley has decided that the Marines are not welcome there (article link here). Excuse me??? That is so hypocritical! Do they not realize that they are protesting the organization that fights to protect their right to freedom of speech? In America, we can protest the government without fear of being killed or imprisoned because brave Marines and soldiers have fought for over two hundred and thirty years to protect our country. The Marines do not choose where they are sent or what mission they are given- they just do what is asked of them. The Marines should not be persecuted by the public for doing their job. If the city counsel members in Berkeley have a problem with the war and our country's foreign affairs, they need to address it with their elected representatives. Code Pink is a brown smear thanks to their despicable involvement in this. There needs to be a protest against Berkeley for this! Support the Marines!