Happy Christmas Morning!

As Ralph and I sit here, away from home on a frigid ( 0 degrees F ) Christmas Morning watching the wind and snow through the window, we realize how much we have to be thankful for. We are warm and dry, have more food than we can eat, are healthy, and have a family at home that loves us.

Unfortunately, many of our acquaintances, friends, and neighbors can't say that:

My wife was out before 5 am this morning helping feed the homeless in Memphis, yet I have more than enough to eat.

Many people need warm clothes, yet I have dry boots, gloves, a hat,  and a warm winter coat.

There is someone, somewhere at this very second fighting for their last breath, yet I am healthy.

There are fire and EMS workers, at this very minute, exposed to the elements as they care for others. Yet I have a nice warm emergency room to practice my trade in.

There are emergency workers spending the day away from home with their "second family", yet I have the ability to FaceTime with mine.

Somewhere there is a soldier sitting in the sand, or maybe a wet ditch, standing constant vigil so I may enjoy the things I do and provide for my family. Yet so many things I seem to take for granted.

Somewhere there is a person that has no family, they may be in a strange land with no friends, yet Ralph and I have been befriended by many here and have several invites to visit this afternoon so we "won't be alone on Christmas".

As a christian, today is my celebration of the birth of Christ. Yet somewhere, someone is being persecuted because of their religious beliefs. And even more unfortunate, we may only have to look across the street to see it taking place.

So how do we change things, how do we make the world a better place? We do it just like we do everything else, one breath, one step at a time, and one smile at a time. But most importantly, we do it everyday and we don't just talk about it, we take action.

As we approach the new year, the time for resounding resolutions, let's focus on one thing:
Let's try to make everyday like Christmas. Be thankful for what we have, help those that have not, and most of all, "Let's be good to each other".

Merry Christmas from Scobey, MT

T and Ralph

Good morning from frigid Scobey, MT!

Ralph and I are back on the road, healing the sick and observing life!

It has been two years since Ralph and I have shared with you, but life has a way of both getting in the way and changing your perspective on life. In my last posting, my plan was to blog more as I settled into an academic life. I was not going to work locums so I could be home with a blossoming teenage son.

Well, you guessed it, life sent in a 100 mph fast ball that totally changed both my plans and our family life. BG (our son) suffered a severe closed head injury 2 years ago and has suffered from post concussion syndrome since. Initially, he had a continuous debilitating headache that was uncontrollable with multiple medication therapies. Additionally, he had severe spatial vertigo so he was unable to walk without assistance. And if he attempted to read, after one to two minutes his headache became so severe he would vomit. We obviously could not leave him alone, so our family became home bound. Either Kat or myself stayed with BG continually, he was never alone. There was "no quick trip to get a gallon of milk". Kat and I rearranged our lives so we could care for BG.

This period was the most depressing, frustrating, maddening, and horrendous time in my life. Imagine your teenage son vibrant and active one day, and the next he is afraid to try and walk because he is afraid he will fall down. He doesn't want to go outside because his vertigo gets worse. He learns to compensate for the vertigo by crawling on the floor and sitting down to go up or down steps. He has a totally flat affect, he never laughs or smiles and he has no interest in doing things because he is afraid it will make his head hurt worse. Heck, a teenage boy that won't play video games? I am a healthcare provider, I take care of people, I "fix" people, yet I could not make my son better. Both Kat and I know people, we are respected in our local healthcare community, but we could not get appropriate help for our son.

There is a sports concussion program at one of the neurology groups in town. This program deals with concussions and the residual effects, BUT only if they occur during a "sporting event". It seems that the program is funded by research money, and BG didn't fit their research inclusion criteria. Now being the realist that I am, I know you can not truly imagine the emotions that that information produces, but try. What if that was your child? Well, I think you are getting the picture. The 6 ft 275 pound "papa bear's" redneck-country boy  personality moved expeditiously to the forefront! What do you mean "he doesn't meet your research criteria"? He is sick, you have the knowledge, information, and resources to potentially make him better, FIX HIM! Fortunately, this is one time Ralph's logic prevailed and I was neither arrested nor sued for inflicting severe bodily harm to the concussion program folks, even though I think it would have improved my state of mind (at least for a few minutes).

We finally found a program and facility in Atlanta, GA that provided information, resources, and support. Almost one year later BG's symptoms had improved enough for him to return to school, by the way, did I mention that he lost his entire freshman year of high school? He still has a continuous headache, that he rates daily as a 2-3/10. He occasionally has an increase in his headache that will put him in bed for a day or two, but he has learned to compensate and adapt remarkably well.

BG has returned to school and has made the honor roll his last two semesters. He has resumed most normal activities that teenagers participate in, including back to shooting competitive trap. He smiles, he laughs, and we have our BG back. We will help him deal with his headaches and pray that one day his head won't hurt (there is still that possibility).

Now that he is better, I have left the academic world and am back to doing what I love. Providing healthcare in rural and frontier areas!

Until next time,
Me and Ralph

The journey begins

As some of you know, I began a new journey into academia on November 3^rd. I have assumed a full-time faculty position at The University of Tennessee Health Science Center College of Nursing in Memphis, Tennessee. I will be teaching in the Adult Gerontology-Acute Care Nurse Practitioner concentration. I will still be doing some “rental assignments” but will be staying closer to home due to my son’s health condition and trying to get him through high school.

Hopefully, I will have more time to post my ramblings and share some educational information with you on a more frequent basis. I will also continue to inform you of the “WTF” moments I observe in my everyday life.

As I sit here typing, a commercial comes across the radio taunting “free pancakes for our veterans today”. What does a “free pancake” have to do with acknowledging the sacrifices that have been made by those who have, and are currently, serving in our armed forces? Does this “marketing plan” not tend to shift the focus from the veterans to the “restaurant”?  Also, why do we just want to acknowledge the veterans today? Should we not be thankful and appreciative every day?

The very fact that I am able to blog is a direct result of the freedoms I have enjoyed for nearly six decades to rant, rave, ramble, and comment on my life, politics, and the general state of the world. I do not fear “political consequences” for my postings because my country men and women have sacrificed so I may experience these and many other freedoms.

Throughout my travels I have: given my seat on a flight to a soldier headed home from deployment and taken another flight, paid for a sailor’s cup of coffee, and thanked many service men and women for their service. Does this make me special, not at all, it makes me an American. So while we celebrate and honor our veterans with parades and accolades today, let’s continue doing it the other 363 ¼ days of the year!

To the Veterans and those that will become Veterans, know that you are in my daily prayers. For those that have served or are serving now, THANK YOU FOR YOUR SEREVICE! Because you choose to serve, my family and I sleep better at night.

Joint Injection Course in Memphis, TN November 8, 2014

I will be teaching a joint injection course in Memphis, TN November 8, 2014. There are only a few spots left, if you are interested sign up now at: http://www.injectioncourses.com/

Hope to see you there!

12 Different Injection Approaches:

• Glenohumeral joint injection
• Subacromial bursa injection (2 approaches)
• AC joint injection
• Medial/Lateral Epicondyle injection (tennis/golfers elbow)
• Trochanteric bursa injection
• Knee joint injection (4 approaches)
• Trigger Point injection- lumbar paraspinous muscles
• Synovial fluid analysis
• Viscosupplementation knee injection discussion

Plenty of Hands On Practice for each injection discussed included

Memphis, TN Injection Course
Date: 11/8/2014
Time: 8:00 AM - 5:00 PM
Where: Memphis, TN

Hyatt Place Memphis/Germantown

9161 Winchester Road

Germantown, TN 38138

(901)759-1174

http://germantown.place.hyatt.com/en/hotel/home.html

NPs: This program is approved for a maximum of 8.5 contact hour(s) of continuing education (which includes 2.0 hours of pharmacology) by the American Academy of Nurse Practitioners.
PAs: This program has been reviewed and is approved for a maximum of 8.50 hours of AAPA Category 1 CME credit by the Physician Assistant Review Panel. Physician assistants should claim only those hours actually spent participating in the CME activity.
See Registration & Cancelation Policy.

Who the heck is Ralph?

 

Thanks to you wonderful cyber friends, this blog has had over 12,000 views. This means that someone must enjoy my ramblings and better than that, some of you are telling your friends about it. So as the readership grows and we have a new group of readers, it seems that a lot of folks want to know who Ralph is so I will try to explain.

Ralph is the “voice in my head”. He tends to live on my right shoulder so he can whisper in my right ear. When I can’t find him on my right shoulder, it is because he got tired of the scenery and is over on the left shoulder. Conveniently for him, there is an ear on each side so he can always “whisper in my ear”. Some of you are probably thinking about now that I am totally insane. The reality is that each and every one of us have a “Ralph”. I just choose to acknowledge his presence and existence. I first acknowledged Ralph many years ago as a paramedic. I learned that if Ralph was whispering that “something is WRONG!” there usually was, whether I had identified it or not. We have had quite an interesting relationship through the years, some days great while some days he is just a royal pain in the butt.

 Each of us usually have three things inside our heads. Obviously a brain, “that little voice” and a filter. How these three distinct entities interact can vary from person to person as well as from second to second in the individual. I will let some neurologist or psychiatrist attempt to explain the brain thing, but I will give you some insight into the filter and “THE VOICE”.

First, let’s look at the filter. The filter is present to keep the words that come out of our mouths and our physical actions from embarrassing us or worse, harming and maiming other human beings and ourselves. Unfortunately, filters do not always work. In order for them to work, one must first turn them on (sometimes I forget). Additionally, for the filter to work the input cannot be greater than output or the system overflows. And lastly, things like human emotion, alcohol, genetics, drugs (both recreational and therapeutic), and our friends can have a seriously detrimental effect on the functional capability of our filters.

Now on to “THE VOICE”

As stated above, each of us have a “voice in our head”. While yours may not have a name, it is definitely there. Some of you describe him/her (after all this is a gender neutral blog) as a “narrator”, some choose to ignore them, and some have yet to discover their existence. Ralph is a mixture of morals, ethics, life experience, situational stress, and occasionally all of the above mixed in a big pot that boils over totally exceeding the filter’s capabilities. Most of the time Ralph is mild mannered and serves as the voice of reason.

For instance, Ralph usually won’t let you say things that make your co-workers cry. However he may facilitate you explaining to them that their entire brain function is comparable to that of an amoeba. He has told folks that they were dumber than floor tile adhesive. The worst events occur when I forget to turn the filter on and Ralph is feeling “really frisky”. Ralph has been known to spend hours at a time sitting in an airport throwing fashion flags. On the other hand, Ralph and I have sat in the floor consoling a child whose doll has a broken arm. When a relative calls and asks for money, Ralph is the one who blurts out,” OH HELL NO!” I hope this sheds some light on Ralph.

Till next time!

I did it, I did it!

Well it is official, Ralph and I have completed the Jurex PLNC certification course! We have made some great new friends and were able to extend our networking into a new arena. Elizabeth Randolph’s approach is to “keep it simple sister”, which does NOT insult mine or Ralph’s masculinity. Her explanations of the legal process, Latin terms, and ability to allow the students to realize how much they already know is amazing.

Here is a class picture (notice that I am surrounded by a sea of estrogen, but it is really good for mine and Ralph’s reputation):

Till next time!

“Well if you’re gonna do it, do it right!"

Several years ago an attorney friend called and asked me if I would do him a “favor” and look at some medical records. When I asked him “why”, he informed me that he needed someone to explain items in the records in “layman’s terms”. Ralph said,” hey what are friends for?” So, being the good friend, I went to his office and broke down all the “official medical terminology” into common terms for him. Now this wasn’t too hard, it involved things like telling him that the “femur” was “da big bone it the top of the leg”. Really it wasn’t quite that simple, but you get the idea. A few days later, I received a check from him in the mail. Interestingly enough, on the memo line it said “nurse consultant”.  

Ever since then I have had attorneys contact me, not for “favors”, but to inquire if I would be available to review medical records and what my “rates” were. Now being a fairly prudent business person, I did some checking and spoke with my attorney friend who helped me figure out what the going rates were in this field and came up with a “rate sheet”. Interestingly enough not one of the attorneys early on ever asked me if I had a clue about what I was doing. They contacted me because my attorney friend told them what I had done for him and he, evidently, was happy.

So why are Ralph and I bringing this up now? We all know how Ralph gets when he gets something on his mind. Ralph kept saying; “if you are going to do this, you need to really know what you are doing. You know they teach this stuff and have certifications and everything….” So about six months ago I began to seriously start researching Legal Nurse Consultant training and certifications. I found everything from Community College classes to private firms that, for a large fortune and your first born child, will train you to perform Legal Nurse Consulting. I researched all the opportunities I found, weighed the cost, student satisfaction feedback, locations of the courses, and several other things while I was trying to decide which offering was the best fit for me.

I finally decided on the program offered by Elizabeth Rudolph, JD MSN RN (and Ralph thinks I have a lot of letters after my name) for several reasons. The first was her reputation and credentials, everything I heard about her and her program was positive. Secondly, she is a “Memphis Girl”, so if it wasn’t what I thought it would be it wasn’t long distance to make those annoying “unhappy customer” phone calls. And lastly, I could afford it both in time and dollars. It is a two day program with a certification exam at the end of the final day.

So today was day one and even Ralph liked it. The class represents a variety of clinical experience and it seems everyone is there to learn and absorb knowledge. Questions are welcome and all the legal mumbo jumbo and terminology is explained in terms that even Ralph can understand. Topics other than the finite legal items include helpful tips on everything from advertising and marketing to billing. I am looking forward to tomorrow’s class and I might even become a Certified PLNC tomorrow on my birthday!

I will definitely post a blog tomorrow with a subjective review of the second day of class. Ralph and I are sure we won’t be disappointed.