more letters on my business card

So last week I officially became a certified hospice nurse, I passed the Certified Hospice and Palliative Nurse exam (150 questions, 1 hour, 92% correct). It wasn't too hard...I studied for maybe a total of 8-10 hrs over a couple of weeks, just read the curriculum book and study questions and reviewed a bit with another hospice nurse who took the exam the same day. All this gets me is a few extra cents an hour and the right to add these letters, CHPN, after the RN on my name tag and business card. The main reason I took it is just because it says, "I care about what I do so I took some time to prove it."

In other business of dying news, I'm changing my position! At the end of the month, I will move into an RN float position and out of my current RN case manager position. I'm pretty excited about it. While my 1+ year as a case manager has been an invaluable experience, the thing it mostly taught me is that I enjoy the nursing part more than the manager part of that job.  Our patient load is exploding, which means hours of overtime and often unexpected events or phone calls leading to looooong days. I've worked a few weekend triage shifts, where I just see patients with emergent needs. I get to swoop in, meet the patient and family, assess the most urgent issues or problems, and attempt to provide a solution. So that's what I'll  be doing as a float nurse. No more pages, phone calls, re-certifications, discharges, care conferences, etc. Just see my assigned patients for the day, chart on 'em, ensure appropriate follow-up from the care team is in place, close the computer, and DONE. Sure, the OT is nice on the paycheck but it's just not worth sacrificing my nights and evenings to charting charting charting. Plus, I'm really looking forward to the variety and new challenges of this new position. I perversely enjoy the challenge of "difficult" patients or "interesting" family dynamics when I know that it's just for that one shift. Also, after a year or so of learning a new thing, I tend to get a bit squirrelly...I start thinking, okay, this stuff is no longer terrifying or overwhelming, what's NEXT? That's a pretty cool perk about my job, and nursing in general, is that there are so many different opportunities, positions, educational chances, etc, that's there's really no excuse for boredom or stagnation.

and then I almost died..

Ok, so this "headache plan" of mine... Hm. The verdict is still out. The diet itself is kind of a pain in the ass to follow...I'm having a really hard time eliminating onions, citrus (esp lemons and limes in my cooking!), yogurt, and aged cheeses. I mean, life without cheddar? Are you kidding me? I even sunk so low as to Google "substitute for parmesan" because God knows nothing livens up a salad, veggies, or pasta like a kick of parm. It may be that none of those things are be a "trigger" for me, but the migraine book guy advises to cut all possible triggers out of your diet before adding them back in slowly, and individually. Which of course makes a bit of sense...but has HE tried cooking without lemons, limes, onions, yogurt, feta, etc? Obviously he must enjoy a rather bland diet. Other sources I've read on tyramine in foods advise limiting quantities of those items to small daily doses. Which is sort of what I've been doing, since I cannot find things like onion-free salsa and I drank half a bottle of "citrus zest" flavored sparkling water before realizing what I'd done.

But the diet modifications are like a trip to Disneyland (or in my case, a yarn store) compared to the caffeine elimination. I thought I was ahead of the game, tapering off my coffee habit over the course of two weeks. I cut down from about 16 oz each morning (with the occasional tea or soda here or there) to about 6 oz per morning, and then...NOTHING. Yesterday, Day 1 of the Great Caffeine Withdrawal, went sort of okay. I felt icky and foggy in the morning, took three Aleve (yes three, yes I know what the label says, trust me I'm a nurse) and actually made it through the day. I was a bit irritable and drowsy and had a mild lurking headache but all in all, I thought, hey, not so bad! Until this morning. I woke up with a vague headache behind my right eye (yesterday it was my left eye), feeling a little foggy and muzzy. Had a cup of peppermint tea and three Aleve (stop judging), and went about my day. Only today, the headache and irritability only got worse and worse. I made it home by 1:30, had some lunch, and had to lay down for a nap. I woke a few hours later with the same headache but worse, tried to eat dinner, but nothing helped. Finally Matt convinced me to take an Imitrex and I even took a couple of Excedrin Migraine too. Obviously they helped because I'm sitting in front of a glaring computer screen typing somewhat coherently at the moment and not sobbing and moaning in a dark room.

So yeah. Caffeine Cold Turkey plan aborted. On to Plan B: tapering caffeine slowly. Tomorrow I will try to switch to tea and see how that goes. After all, I have an unopened box of PG Tips and it would be a royal shame to let that go to waste.

Oh my aching head.

I hate it when there's a long pause between blog posts on a blog that I read, and when a new post finally shows up, the blogger spends an inordinate amount of time making excuses and apologizing for the silence.  So, I'm not going to do that. I haven't blogged in a while. Now I'm back. Make of that what you will.

So I'm trying out this new migraine plan, based on this book by David Buccholz, Heal Your Headache: The 1-2-3 Plan for taking charge of the pain. I can't remember where I heard of this book, just that I kept coming across references to it on various headache sites and finally thought I'd see what all the fuss was about. Thankfully, there was a Kindle version available because I am both impatient and lazy.  Keep in mind that I am full of snark and skepticism, and am the first person to mock "self-help" books and whatever diet plan is the flavor of the month. But I also have chronic headaches and migraines, and it sure would be nice to not have them control my life anymore. So I read the book. And, despite being soap-boxy and arrogant and overbearing, it pretty much makes sense. The author explains the three steps to taking control of your headaches: Stop taking "quick-fix" abortive migraine meds that are causing rebound headaches, eliminate dietary triggers, then try a preventative medication to raise your migraine threshold. The premise, while the author doesn't delve too deeply into the physiologic explanation, does make sense: you can't control external headache triggers (stress, sleep, barometric pressure), you CAN control internal triggers, such as diet and caffeine. And triggers are cumulative, so while peanut butter may not give you a headache one day, on another day when other triggers have accumulated peanut butter will be enough to hit your threshold, and BOOM. Headache.

I'll give this plan a try, since it can't hurt, and maybe it will even help. The diet is kind of hard to stick to: no caffeine, no citrus or bananas, no hard/aged cheeses, among other things. Eventually I'll try to add things back in on a trial basis, since I can't fathom an existence without onions, garlic, yogurt, parmesan, or lemons. So far so good, but it's only been about a week. I'm down to about half a cup of coffee in the morning, and I plan to taper that to nothing by the end of the week. I haven't had any headaches but it's early days yet. I have "cheated" a bit, but in tiny amounts. Like tonight I had caesar dressing on my salad, which usually contains some "forbidden" ingredients: anchovies, lemon, parmesan.

I'll try to post updates with my progress and results on here. I'm having trouble finding recipes for this diet, so maybe I'll post some of my attempts to modify recipes to fit the diet on here.