Disney Conference for Four

We have recently returned from our annual (at least) venture to the land of childhood. I have a conference for my continuing medical education that I like to go to in Orlando that just so happens to be held in Disney World.

The conference is great, casual and refreshing

I primarily woke with pediatrics but like to keep my hand in with family medicine plus there is a lot of overlap with adolescents.

I use Skin, Bones, Hearts and Private Parts for CME. It is exactly that. Dermatology and Msk have been my favorite this time. Last year it was Cards/Urgent Care and Dermatology. There have been different topics and speakers every year that I have come.

Coranado Springs is where we’ve stayed and where the conference is hosted. It’s great. The only other conference I’ve attended was an NPACE conference in Boston and while we loved Boston, especially in October, the conference felt long and a little stiff. I did learn a lot but it was just less fun. They also did not have speakers and topics listed very far in advance.

This year there’s a lot of construction going on at Coronado but I think the visit has still been a good one.

We usually get about an hour or so for lunch so I met the hubby and the girls who of course came to Disney with momma and made a vacation out of it. The pool is awesome and we had a great lunch at just the little pool bar (the restaurants inside the resort are good as well they just tend to get crowded and the weather was nice.

I feel like I get my money’s worth at this conference. They allow you to get the savings from the conference at the hotel a few days before after the conference. It’s a good value. Especially with the early bird discount. My family enjoys the stay with me, and being on Disney property has its perks as well—you don’t have to drive, you can easily get most whatever you need without having to get back in your car.

I have not received anything from SBHPP conference or the like I am just giving my opinion.

Feel free to ask me any questions about the conference or any previous one I’ve attended.

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A Short Guide to Breastfeeding Part 1

New to breastfeeding or looking for help with challenges? Want to be a better provider for your patients and their families? Look no further!
We all know that breast is best (human milk for human babies), however, let me just go ahead with a disclaimer that I tell my own patients who are struggling or have conflicting reasons both medical and personal–if you are feeding your baby with formula and  both of you are happy and healthy, you are doing the right thing. I will never belittle a mother or parent for doing what you feel is best for you and your family as long as it is safe and you and your child are healthy.
Moving on…
A Little About Breastfeeding and Why It’s Considered “Best”
So what’s the big deal with breastmilk? The CDC (Center for Disease Control), WHO (World Health Organization), and AAP (American Academy of Pediatrics) all have guideline recommendations in for why we should breastfeed our babies. It’s great for baby AND MOM (physically and emotionally)! It’s great for disease prevention. Hell if you want to get down to the nitty gritty of things, because it does so much good it reduces money spent on healthcare. I’m not going to list all of the things it helps prevent (which when you look at the reports they make it seem like it is prevention rather than formula causing problems but let us not go there…) because I said I would make this a SHORT guide.
beautiful-sitting-mama-breastfeeding-gioia-albano
(Pic courtesy of fineartamerica.com)
Getting Started 
Pregnant? Planning on getting pregnant? Rather or not you think you want to breastfeed or bottle feed (or a mixture of the two) it never hurts to get more information!
  • Take a class!
    • Many local hospitals and Le Leche League chapters hold free to low-cost breastfeeding classes
  • Read a book!
    • My personal favorite is The Womanly Art of Breastfeeding which I had read cover-to-cover (borrowed) as a floor nurse prior to having children because nursing school had taught me very little about breastfeeding and I wanted to be a great resource for my patients. I bought the book when I became pregnant and read it again, passing it own to a friend shortly after my daughter was weaned.
    • Breastfeeding Made Simple I didn’t care for this one quite as much and basically skimmed it. That being said if your library only carries this one or you want more than one choice, it’s not a bad one and is in fact a bestseller on amazon.
  • Ask Someone! Talk with your friends who have kids, talk with your mom (and then back all of this up with one of the above)
  • Keep in mind everyone’s experiences are different and that even amongst themselves, each baby can be different!
 
Vitamins and Supplementations
Vitamin D
Long gone are the days for the majority of the civilized world where women continue to work in fields or roam nomadically across the plains to scavenge for foods with their babies strapped or carried with them. In fact we know sunburns are detrimental for our skin in the long run and thus we avoid or use sunblock which prevent production of vitamin D.  Humans need sun for vitamin D production and we need vitamin D for bone growth (and new studies suggest that it may help innate immunity and play a role in prevention of diseases such as diabetes and certain cancers).  As such mom nor their babies tend to make enough vitamin D. Therefore the AAP and CDC recommendations include either baby receiving supplementation of 400IU daily or mom taking an extra 5000 to 6000IU daily so that baby receives enough through breastmilk.  Commercial formulas contain vitamin D so supplementation is not generally needed.
Iron
Breastmilk does not readily contain a large amount of iron and healthy, full-term (born at 38 weeks or later) infants generally have used up their stores by 6 months of age and iron-fortified infant cereal, other iron containing foods or supplementation with iron drops/vitamins are recommended.
Challenges
Breastfeeding is not easy for everyone and can hold many challenges. I once had a physician friend tell me that some women were just meant to be wet nurses. She said this semi-jokingly but also as reassurance to me that I was not the only working mom struggling to keep my supply up (it did not help I was not only working full-time but in graduate school for the entire stent as well). That being said here are some of the things that I have not only found helpful for myself but have in my practice also found helpful for my patients and their babies.
Latch difficulties
This often becomes difficult for my patients before they ever even reach my office. Once the baby is born, most hospitals are now trying to follow recommendations that babies go straight to mom’s chest. This helps regulation baby’s body temperature, blood glucose levels and helps with breastfeeding initiation but not all moms have a baby that just latches on with ease, nor do all mom have “optimal breastfeeding nipples” or even the nursing staff with knowledge about breastfeeding.
  • Asking for a lactation consult is always a big help as well as either forgoing modesty or kicking all of your family out of your room until you and baby get things figured out. If a lactation consult isn’t available and you and baby aren’t quite getting the hang of it consider
  • Nipple shield
  • Pumping for about 5 mins and then trying to attach baby
  • Multiple positions (football/rugby hold is great for new babies, craddle-hold, side-lying, australian crawl or biological hold)

breastfeeding positions

(Pic courtesty of mama-milk.co.uk)
Don’t be afraid to do what you need to do!
Decreased Supply
There are many many reasons for decreasing supply:
  • hormonal (starting menses, thryoid issues, pregnancy)
  • medications (antihistamines)
  • poor-latch
  • pumping (not all women respond well to the pump)
  • stress
  • infrequent feeding and/or bottle feeding (ladies our breasts are supply-and-demand responders)
so what can we do about it?
  • more frequent feedings/pumping sessions
  • stop medications causing decrease if possible (consult your physician!!)
  • seek help with latch issues
  • make pumping as comfortable as possible with a good pump and a good-fitting flange, warm blanket, cup of tea, comfie spot in which to pump, relaxing music, an item that smells like baby
  • de-stress! (i.e. with postnatal yoga, getting a massage, seeking medical care if your are over-anxious or depressed)
  • take a nursing holiday (you and baby cuddle skin-to-skin all day and nurse on demand while taking it easy and eating well, taking in plenty of fluids)
  • consider supplements (Mother’s Milk Tea, Fenugreek capsules (it may take up to 3200mg of fenugreek for some women to see results but start low and go slow, avoid it altogether if you have thyroid or pituitary issues))
Just a reminder that this a SHORT, very abbreviated guide. I hope you enjoy and find it helpful and informative. The second part will explore more challenges and weaning.

MSN/FNP Graduate School Prep: Part One

I found it hard at first to look back and remember graduate school and specific things about practicum and studying for boards even though it has not been THAT long ago. Call it PTSD or repression of traumatizing events, haha. I’m only half-joking and I think mine was so rough because I was either pregnant or with a newborn for the majority of it and working full-time (yikes) and still vaguely unsure of how I survived. I made the most of my practicums and was lucky enough to have had a lot of family support for help with the baby. My husband took on an extra part-time job so that I could go part-time for the final portion of my clinicals. It was still exhausting and I wanted to go to bed every night by 9pm if not earlier.

I had to document each encounter in our school’s system using IC9 codes (now ICD10) and CPT codes for all the visits. As annoyingly time consuming as this was, it was worth it in the end because I had exact numbers for the different types of patients I had seen and procedures completed. The reason that this practice was so valuable was because it made that information readily available when applying for hospital privileges. I was lucky in that my school provided a program from which an excel sheet could be extracted but if yours does not I would recommend keeping track as it may save you time in the long run.

 

funny ICD10

(Image courtesy of heathcarenews I believe…I can’t remember where it came from so forgive me, I had saved as a joke but thought it to be funny)

 

EMRs suck. That’s the long and the short of it but they are also a necessity for the majority of practices. They slow you down compared with paper but very few practices are eligible to use that anymore. Fortunately, most nurses have already had some experience with EMR (electronic medical records) prior to grad school and therefore have an idea of the layout. Ours is in the form of (very detailed) SOAP notes, which from what I gather, is the current standard for most NP programs. So if you haven’t already familiarized yourself with this format then go ahead and start.

Soap note

Another extremely free and valuable resource I used was Evernote (for both desktop and my phone). It made it easy for me to do studying on the go during small downtimes I had (waiting for an appointment, riding in the car, etc). I would copy and paste study plans there especially as I was getting ready to study for boards. I was not aware of how valuable this resource would be when first starting, but had I known, I would have started using it with each didactic course at the beginning of my program. You can arrange different notebooks for each course like I did then have individual “notes” for each topic.

 

Screen Shot 2016-06-11 at 10.41.01 AM

 

When I was ready to study for boards (and pre-boards we had to pass a comprehensive final at my school which I found to be more difficult than boards) I took practice tests then focused on my weaker areas or areas I was less familiar with in my past clinical experiences.

 

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I just used the free version and have never tried the paid for version but it might be worth looking into if you find you need more storage space. I believe the free is now 60mb limit. However, I have many notebooks and it has not yelled at me yet to upgrade. Again, I have yet to receive anything from any company unless I otherwise mention so this is all just personal opinion.

As silly as it may sound, set yourself out a study plan and make it realistic. Most people in graduate school have the added weight of balancing family time, work, etc. Where are you going to squeeze in textbook reading assignments? Papers? Research? I did this for boards and wish I had created such a schedule for papers and didactic work. I’m pretty “Type A” anyway but I was forced to be even more so with all that was going on with life. Trying to fit in some study-time when I had a sitter on non-work days or when my hubby was going to be home was difficult and required preparation. We were on a tight budget especially at the end when I had to drop down to part-time so I went to Target, bought a large dry-erase calendar and skinny dry-erase markers and color coded our schedules. Even the Moose’s schedule (my hubby) who was begrudgingly standing in the kitchen acting put-off as I asked him day after day what his plans were so that I could schedule everything.

I try to save helpful things I find on Pinterest if you want to follow me or any of my boards you may find them helpful. I’m under Everyday Empress and have a board E2NP where I try to put helpful advice/sites as well as posts if you’ve missed any. Recently I have been adding equipment I have found helpful (some that I just like 🙂

Until next time!

EE