Patrick's left knee injury

He told me he experienced it again. A classmate helped re-align his left knee. This is the fourth time it happened in the past 3(?) years.

Hives again part 2

Yesterday, after stopping my clindamycin and taking the first dose of prednisone 60 mg, I had high hopes the hives would subside. However, the apparent improvement on my chest was short-lived. Last night, despite my Benadryl (both before bedtime and at 330am), I found it hard to sleep. I itched everywhere. That same itch that prevented me from sleeping good. I got up at 530 am to subject my arms to hot water treatment. I had a few hours of relief after that, although my legs kept itching. My skin was sensitive everywhere even to cotton clothes. When I got up this morning, my neck and my face were red again. I took a hot shower to "scratch" my skin without traumatizing. It dawned on me that I could possibly be allergic to prednisone as ell. Good thing I blogged about my first bad case, wherein I was also just treated with cephalexin and prednisone when I developed very itchy rashes. I could rule out it was not cephalexin that caused it because I had no history of allergy to cephalexin, and that a second treatment course of cephalexin without the prednisone actually led to resolution of the swelling I had in my arms that time. The remainder of my skin healing depended on keeping it moist and applying vaseline petroleum jelly for barrier.

So, now I am thinking, after discontinuing my clindamycin yesterday, maybe I should hold off on the prednisone for now and see if I get better without it. I will continue with Benadryl instead. Type here

Hives again

Rarely a year comes without me suffering from some form of skin allergy manifestation. Usually it is something environmental, and would happen anytime from spring to fall. This time it is winter, and the only culprits I can pinpoint were possibly (1) the colossal shrimps I got from WalMart and ate for supper on that night the rashes appeared or (2) the clindamycin which I had been taking since 1/1/11. That was the second time I ate that brand/type of shrimps. The only other things I ate that supper were fruit cocktail (canned, plus fresh apples and kiwis, with the dressing made with condensed milk, cream cheese and mayonnaise -- nothing suspicious and nothing new to me), and a Knorr brand fetuccine alfredo which I cooked with bacon. I doubt that the pasta and the flavoring that came with it caused my hives. No new soaps or shampoos or perfume that would correlate with the appearance of this rash.

1/11/11 first night of rash on torso

So, since 1/11/11 (10 days after my first dose of clundamycin), I have had the hives, which has rapidly spread now all over my skin that you will only see pinpoints of normal skin amidst the red skin. I feel tight and, of course, itchy, although the itch this time is nothing compared to my itch that happened in 2008. It was not that itchy so I could sleep okay. In fact, with Benadryl's help, I can sleep very well.

1/14/11 fourth  day of rash on torso

I am just worried that the hives keep getting worse even after 3 days already, despite taking benadryl and zyrtec. I decided to visit my PCP for a prednisone prescription perhaps, and I did get that prescription. The doctor thinks it is the clindamycin that caused it. Now, if this subsides by Monday, probably I can proceed with my CAT scan on Tuesday, and my follow up appointment with the surgeon on Wednesday for a possible FNAB.

1/14/11 rash on my left arm

It's a good thing my allergies manifest only on the skin and not on the airways.

Neck Mass = Lymphadenitis

I have been suffering from body malaise since Christmas, with some lymph nodes enlarged. However, on the day of the blizzard, 12/27/2010, my lymph nodes enlarged suddenly to this size after I slept for about 4 hours from 8am-12nn.

So I went to my PCP and was seen by Dr. Lambke. He did some tests (CBC, sed rate and cat-scratch) and basically found nothing. I was scheduled to see Dr. Shankar for assessment (he's the head of surgery at RFGH) on 1/5/11. However on 1/1/11, after my 12-hr duty, I had fever, and another set of CBC, sed rate, plus chest AP-lat were done. I was started on clindamycin. I had ato see Dr. Forster on 1/3/11 for increase in my clindamycin dose because it was prescribes as OD when it should have been q6h. She increased my dose and even extended the treatment to 10 days.

My lymph nodes are better now, and I was supposed to have the CAT scan done, after Dr. Shankar saw me last 1/5/11. However, because of rashes that started yesterday, it was postponed for 1/18, hopefully by the time I would have no more rashes.
Type here type the rest here

Dear Hubby: Happy Father's Day!

Make a Smilebox scrapbook

Mother Nanny

I was delighted to see Tagalog movies on Netflix (I have unlimited account). Last night I watched the very first Tagalog movie I got from Netflix - Mother Nanny. A yaya torn between taking care of her own daughter versus that of a rich couple whom she raised since infancy. My stepd and younger son both sat with me through the whole movie, so I had to translate from time to time for them to catch the gist. My stepd even appreciated it well. My eyes were boggy after the movie from the crying I did. I told my stepd, "Tthat situation is something you will never see in this country. I can relate to it, though, knowing the plight of many children in the Philippines.

I recall having worked a whole weekend in Makati then going home to Bulacan to my kids during the weekend. Of treating sick kids while one of mine was sick as well, but was taken care of by my Nanay (and sister on some occasions). It was not a good feeling at all.

I may not be working now as a doctor, and consequently I am earning much less than my potential earning as one, but the time I get to spend with my own kids is priceless.

Firefox Crashes and IE7 freezes - enter Chrome

Lately my firefox crashes on certain websites (including my kusina)...it was very exasperating. So even if I do not want to use IE (since it is so vulnerable), I had no choice but to resort to it to browse my site and answer comments. However, tonight even IE just could not even open up google.com (my default homepage for both browsers)....I so wanted so much to answer comments (long overdue!), and was getting kinda hopeless...I searched for same problems, but the latest I saw was way back in Dec 2008. Is it just me, or my website apps? I read about incompatibilities with add-ons, as well, but I wanted a quick-fix...

Then I saw someone mentioned chrome comparing its popularity with IE and google and opera. Of course, it is way below as it is new...But I thought I'd try.

Well, so far, so good! It has not crashed on any of those sites that used to crash on firefox (including my kusina). I have updated my slides (baking and cooking) and answered comments.

I think I will be able to post some in kusina (but I have to sleep first and continue with my spring cleaning...rewards will be my playtime on blogging at night tomorrow.



Type here



type the rest here

US Immigration: Medical Examination - What do they look for?

I thought I'd post it here for quick reference when someone asks me what do medical examiners actually look for when they are examining immigrants/aliens prior to going to the USA for immigration purposes.

Below is a set of guidelines that tells the medical examiners specifically what to look for:
http://www.cdc.gov/ncidod/dq/pdf/ti-alien.pdf

If you are planning to immigrate and are having medical exam, having a high BP is not a reason for you to be banned from immigrating to the US, although the doctors will feel safer to "clear" you if you are being managed appropriately, taking your medications, and your BP is controlled. That way, even if you suddenly suffer from a stroke on your first day upon setting a foot on the US soils, the medical examiner will not be apprehended for "clearing" you.

However, the major concerns are:
1. Communicable diseases - Tuberculosis is easily transmittable. However, if just diagnosed, based usually on x-ray (presents as nodule at the apex), then you will be required to have treatment for 9 mos, but they can clear you, I believe, as early as after two weeks upon starting treatment, but you have to continue treatments.
2. STDs - HIV, AIDS, syphilis, gonorrhea, etc. Of course, there is no treatment yet for HIV or AIDS so don't bother if you have this. With other treatable STDs, have them treated first.
3. Mental or Psychological issues - No to drug abuse! Psychological problems that will pose threat to the public safety or yours (e.g. suicidal, homicidal tendencies), or will be a burden (I believe mental retardation used to be a factor to prevent one from coming to the US since this will be of so much burden to the government, but I did not find that anymore in the guidelines, probably it is now acceptable unless there is homicidal/suicidal/violent tendency).

Of course, vaccination requirements must also be met as part of preventive measures of the government, especially for minor immigrants.

For a full set of information, check out http://www.cdc.gov/ncidod/dq/panel_1991.htm


Now, if you are already in the US and is currently applying for permanent residency, you will probably need another medical exam (or not; I believe it depends on how long you had the last medical exam done by panel physician), here is the link to the guidelines that medical examiners use to examine the applicant:
http://www.cdc.gov/ncidod/dq/pdf/ti-civil.pdf

DEFINITION of TERMS in my simple words:
Panel physicians are the medical examiners in the Philippines designated by US embassy to conduct your medical screening prior to immigration
Civil surgeons are the medical examiners in the US designated by US embassy to conduct your medical screening prior to approval of your application for permanent residency or citizenship(?)

Got on sale!

 

Got this from JC Penney last week (it's almost spring! This light winter coat = shearling = was the last piece, size small. I was very hopeful it would fit me, and IT DID!
Original price: $200.00
Sale Price: $9.97

mas mahal pa yung panties na binili ko...on sale din at 3 for $21.00

Citizen Eco-Drive Watches

 

I got this Citizen Men's Eco-Drive Perpetual Calendar Chronograph Watch #BL5250-02L
as Valentine's gift for hubby. He was not expecting it, and he is not used to having "expensive" watches (only wore something like $10 worth of watches). He loved it. Of course, I had to get Citizen Women's Eco-Drive Silhouette Crystal Accented Gold-Tone Watch #EW8842-57D
for myself as well (he gave me a different toy as his gift for me).

 

I had been eyeing these Citizen Eco-Drive at amazon.com and they sound so high-tech, not requiring batteries; only exposure to some light, sun or artificial.
However, after two weeks from purchase, mine had scratches all over. It was supposed to be scratch-resistant! My husband's had no scratch whatsoever (he was impressed!), and he had been subjecting his to more "trauma." I rarely wore my watch.

I made a phone call to amazon. They had me return it for a full refund. I got my money back. Too bad. I wanted it so much. I want to make another purchase of the same watch, but it was a disappointing experience. Should I trust Citizen again???

My New Toy

We finally got a family plan for our cellphone needs now that our kids are into adolescence. The kids are going to more games, and keeping in touch via cellpones with reliable network is a must.  I was the only one who got a cellphone with features more complicated than just being a phone and a cam. They all got the same motorola phone with cam feature, and it can be used also to send email. But I chose to have this blackberry curve not only because I have internet with it, but mainly for the PDA applications. I had been using the PDA Palm TX before, but I felt so limited with that in that I could not use it for internet purposes unless I am at home, and I do sometimes need internet while at work.

I was thinking that with this blackberry curve as my cellphone/PDA, I probably will be more inclined to study for USMLE. :)

I did not realize ER can be boring at times

Yeah, we all heard about ER nurses being adrenaline junkies...I was quite anxious I would be too tired every time I come home from work. However, lately, I realize that the norm here where I work is that we get slow during the hours from 2am to 5am...usually.

Not that I do not like that. I actually enjoy that extra time because now I can make blog posts during those hours. And for those blogs that usually require photos, I just upload the photos to my picasa web album then later embed them as I make a new post during work hours.

My charge nurses do not care as long as our work is done. Or in cases where we have patients, we should make sure we have done all that we have to do before we "play." They themselves play online games when they get bored.

I used to do my online ENA training. But right now I am caught up with all online trainings. I should also try to make use of the time for reviewing for NCLEX...but how do I hide from my co-workers about me planning to take the USMLE?

It is not that concrete yet. I am just trying to see if I can actually find the time to prepare, and if I will indeed be prepared in a year to take the step 1...So far no luck. I have had my Kaplan reviewers for 2 months now, and I have just finished chapter 1. Pathetic...

Pediatrics

I might have said I never wanted to be in Pedi. I still feel that way.

But I had a child patient tonight accompanied by mom who is a med asst somewhere. Child was shy but cooperative with a little coaxing. MD and PA did their stuff. I did mine with some PE as well. After administering a PO med, she was ready to go. MD came for the last time while I was there, to hand me the discharge instruction. Mom said, "[Child] is usually shy, but she did great tonight. She (referring to me) must have done something right at the start, that made her comfortable enough to do good with all of you."

I said, "I connect." with a smile. Child smiled back at me every time I winked at her. Cute.

I still do not want to be in pedi.

The story of B

It's not the book by Daniel Quinn...It's about the charge nurse I worked with one night (I was still in my orientation). Let's call him BAH.

Scenario: 10 year old patient who came in with abdominal pain, diffuse, persistent. Nausea. Patient vomited once in the ER. Given GI cocktail. No relief. IVF NS 600 mL/hr.

Easy IV start. Prominent veins on AC.

I used regular tube, and ran it around 2-3 drops per minute (600 ml/hr divided by four equals 150 drops per minute. Or 150 drops per 60 seconds. Or 15 drops in 6 seconds. Or 5 drops in 2 seconds. Or 2-3 drops in 1 second. And I am talking about MACRO drops.

BAH later on calls me into the med room and shows me a pediatric buret. Told me to use that on Pedi pts to avoid overloading. I'm an orientee, so I said...."Okay."

Okay convert that 600 ml/hr to microdrops and it turns to 600 microdrops per minute. Or 600 microdrops per 60 seconds. Or 10 microdrops per second. Can you count that fast? I cannot convert that to smaller units. So I made it fast drip using microdrop. Who can count 10 in 1 sec???

Both parents of this kid were MDs (physiatrists). They should have an idea of what's going on.

Later on, BAH, while seated behind the ordering MD, was lecturing me about how given the rate ordered, I should get the idea that MD did not want to overload pt with fluid (Duh....that's even a faster rate than what we give to many adults. I kept my mouth shut.). MD seemed ready to chuckle...

Anyway, later on, IV antibiotics was started. My fave co-RN started it for me but told me she would use a regular tube. I told her about the incident with BAH. She said, "Oh, BAH is stupid." So we were on the same footing there.

An introduction

I used to work as a general medical practitioner in the Philippines before coming to the US. Having said that, I can safely say I know very little in everything medical. I am not a specialist, so I do no really know much. I admit that.

Now allow me to brag some. I graduated with BS Biology degree from UP Diliman, had 97%ile ranking in NMAT, got a scholarship for Medicine in Fatima (my parents were very happy!!! Free tuition, books, board and lodging, including free review books for boards), got pregnant at age 24, struggled to finish Medicine despite having a baby and a husband afflicted with CHF, graduated 1st among 200++ Med grads but without honors, had my internship at EAMC, passed the boards without landing in the top 10 (my school would have wanted me to land in top 1 so they subjected me to 1 yr of (useless) review classes.

Despite some friends (and other patients I had later) who would have wanted me to go through IM residency because of "my brains"m (what brains they were talking about, I have no idea), I wanted to be in OB-Gyn. Less morbid. Less problems with patient compliance. Less headaches. More surgical skills. But at the time I was going to apply, the QUERT (qualifying exam for residency training) came into effect. So the powers that be in the DOH now had a say where their babies could get into for residency training. I did not know anyone in DOH. Can you guess??? That's right, I ended up not going into residency. Later on I got pregnant again and became a widow, so that now I had two kids to support, and I was alone (save for my Nanay and sister, that is).

I practised in a very busy clinic in Makati that was like urgent care type serving patients from annual/pre-employment medical exam types to common community illnesses to NSDs and D&Cs. Nothing medically/surgically complicated. Some of the consultants working there have actually offered to back me up if I applied for residency in the private hospital they were affiliated with. But with two kids to support, the salary I would get just would not cut it. So I stayed moonlighting for 5 years, with Quality Assurance Management on the side. (If you are familiar with JCAHO, you must know about quality assurance.)

I got to the US with a BSN from Philippines. Got a job as a Medical Transcriptionist and saved some money for NCLEX. Passed NCLEX and got a job at a nursing home. Stayed there for barely two months (never enjoyed it) and got a job at a hospital. Rehab unit.

It was a good introduction to the hospital culture here, with all the high-tech equipment and the new people, new set of policies and rules.

I got bored after a year, applied at the ER and got accepted. Now on my 5th month. First two months were spent during day shift I applied for night shift) and it was like hell...I got rattled because, even as I was still trying to learn the ins and outs of flow of patients here, the rules and policies, etc., they were throwing Category 2s and 1s at me, and I got too busy I was ready to scream when they would tell me I had another patient to get (uhhh...can I chart first on my other two patients?). Finally, against my first preceptor's recommendation to prolong my orientation on days (for purposes of exposing me to more cases), I was started on my orientation on night shifts. After a week there I was really considering applying for another job (even medical transcription), but as I was slowly released to be on my own with only a resource nurse to go to for questions, I became more comfortable and the clinician in me re-surfaced. My doctor-thinking came into play in trying to predict the management of patients, so that I easily got into the flow of when to start IV's and EKG's etc., without fear of being scolded by the MD for doing so without an order. Well, actually, the reason I was hesitant before to just jump into action was that I was not sure what my limitations were as a nurse. Apparently, the nurses here have enough autonomy, and even if the MD did not order, let's say, an IV line, it would be pretty safe for me to start one and draw blood (then dispose of them if they would not be used anyway). No big deal.

Because of being more comfortable, my resource nurses (usually the charge nurse) have observed the marked improvement, that everyone now says they are hearing good things about me from other CNs. Even my clinical manager and ED educator told me, "Finally, it has kicked in! I told you so."

So now I am enjoying the ER. It is quite a good exposure in my plan to pursue the MD license. Somehow, I am getting an idea of their treatment protocols, how the ED MDs proceed with consulting for possible admission. I am also getting a chance to review things indirectly, and I find myself doing the critical thinking again. Interpreting lab results mainly, in correlation with the presenting symptoms/complaints. However, my main disappointment is that I do not see the imaging results (the MD's see the images and make their "wet readings" then wait for official reading from offshore -- Australia, I heard). The official results usually come up the next day when the Radiologists of our hospital are able to officially read and sign electronically to make the report available on the computer.

I will be off orientation by the end of August. Some patients are quite needy, but most of the time it is the usual abdominal pain, chest pain, altered mental status that I see. Sometimes those brought by EMS are not really high categories. I have learned once again the art of being cool in the middle of this chaos.

Behavioral patient

I inherited AF from an outgoing nurse. I went in and introduced my self. Patient wanted some medication before going to the BH hospital ce. MD did not want to give her any as she was not anxious when she came in. Then she began saying things like, "Ok, I don't even want this lady in my room. Please." in front of her mother. I did not even get a chance to do some therapeutic communication.

I swear, if this was my child, and she does this to me, I am gonna slap her on the face and ground her for at least a week. More so if she does this to a stranger who is trying to be helpful.

Glad the EMS personnel came right away.

Brat.

That's why I never considered to be in Pedi.

On my First Month of Orientation

One thing I love about my hospital is that we have a very good orientation program. Having been exposed to Quality Systems Management while I was in PI, I could see my hospital addressing the elements of a quality system. And knowing so, I have the confidence to voice out any dissatisfaction in a constructive manner, for purposes of quality improvement (it is always a good reason) which will have patient satisfaction as an end-result.

First week of my training was spent working on my competencies, mainly the paperwork. Second week, I had my Basic EKG interpretation training, a prerequisite (aside from BLS- Basic Life Support) for ACLS, which I took and passed yesterday (yehey). Of course I have been going on duty with my wonderful preceptor. Whoever told me ER nurses here ate their young, well, I do not see that happening. I have the most wonderful preceptor (even better than the one I had in rehab, I would say). I'd say we do have a good chemistry. I had exposure in the triage room, and I actually am contemplating on sending copies of the triage flow diagram back to the Philippines for nurses to learn. I had a case of AMI (acute myocardial infarction) on my first day there, which was the highlight of my day.

Next I should sign up for PALS (Pediatric Advance Life Support), then sometime before the end of my first year, I plan to have the TNCC (Trauma Nursing Core Curriculum, if I remember it right) at least.

I have been trying to involve my kids to at least know how to do basic CPR...I gave them a lecture before, along with video viewing, several months ago. Yesterday, I kinda gave them a quiz, asking them what to do if they see me on the floor unconscious and unresponsive...Ben gave the best answer, then I recounted to them how they should approach it.

I told them they might someday consider ER nursing, but then I said they might not like seeing blood and what not, but both the boys seem not to fear that at all...hmmmm...we surely need more male nurses...

I will sign up for ENA (Emergency Nurses Association) on the next payday.

Emergency Department - my new area

OK, I dunno why I looked for new openings in other departments...maybe because at the rehab, we usually would be RIF'ed (reduction in force when the census is low), or maybe because I was getting bored with the routine no-challenge type of work there (the only challenge was physically because we RNs also needed to help the techs prepare the patient for the rehab day -- i.e., bathing and dressing of patients, which could mean from the independent hip replacement patient to the bedridden stroke patient).

In any case, I looked in the employment opps in our website -- OR nurse. I guess I applied too late. One of my co-workers applied ahead of me and got accepted I guess even before I got the chance for my resume to be reviewed...OK...on to other opps...

Behavioral Health...nah...I always fear for my own sanity. I believe there is a very thin line between sanity and insanity, and that can easily break when you are surrounded by pathologic personalities.

CCU (Critical Care Unit)...too morbid for me...I have never liked taking care of very sick people...that would be too stressful.

MCH (Maternal Child Health)...I would have loved to be here but they required current OB-Gyn experience in any of the areas in L&D and Nursery. I have experience, but whether they are current per their standards, I don't know. I don't even know how to use the fetal monitor, but I can do it manually, including manual monitoring of labor. But they do it here with machines. I heard from another Pinay nurse (old-timer) that they wanted the experienced nurses because they were desperate to find ones who needed minimal training, as they were expecting 400++ deliveries for the month of May. Oh well...

ED (Emergency Department)...well, it's not exactly the kind of stress you would have in CCU, but the kind of cases, the variety, the surprises, the critical thinking, the more practical applications towards my own life...the similarity with my past experience while I was a GP in the Philippines, I guess I don't have much to fear. There may be different equipment that I needed to learn, but I am quite a gadget junkie so equipment do not intimidate me, nor computers. The one thing that almost stopped me from trying that one was the circulating reputation of the ED personnel: that they eat their young. Well, I guess that is not entirely different from the scenario I suffered in the hands of senior nurses when I was undergoing my clerkship and internship rotations before getting my MD license in the Philippines. Given the past circumstances of my life where I have had humbling experiences, and have come to accept that whatever I know now or understand now just made me realize how little I actually do understand (as in, God's work is just so amazing I cannot pretend that I understand exactly how He designed the human body), I have learned to get along well with people, and have converted several toughies into softies when they interact with me. Not that I suck up, I just make them realize I am not someone who will challenge them or intimidate them, that I will willingly accept whatever they can and will teach me and I will be very appreciative of that, because I know I DO NOT KNOW EVERYTHING.

Well, despite the warnings I received from friends and co-workers, I went ahead and applied. Not sure that I would like it. But I did think that if I would get stuck in rehab for another year, I would get stagnant mentally and skills-wise. ER, on the other hand, is such a very good experience to have, because after a year or so (or even less), I can find work virtually anywhere. One thing that attracts me to nursing is the TRAVEL NURSING opportunities, and the per diem rates. The hospital closest to me always have ER openings, both for per diem and regular positions. ALWAYS. And since ER nurses are in demand, I will never fear of becoming RIF'ed. Rather, I might always be called to fill in for one who calls out. Plus, I want to get all those certifications that are a requirement of other in demand departments -- ACLS, EKG interpretation, PALS...

I got an interview, and there was instant feeling of being at home. I had positive vibes with the two interviewers (manager and educator). I got the job (well, according to one of my co-workers, ER's are always desperate for nurses). After learning more about my past experiences, they even went as far ahead as me probably being a mentor, taking the TNCC and other higher trainings. (I was thinking, hey...slow down...one at a time). Anyway, maybe I looked confident enough that they became confident about my abilities, although I was quite upfront about the lack of abilities for the more complicated cases that really warranted a hospital (not clinic) visit, but they knew I could be trained. Ain't that the most important trait anyway? --- trainable. Another area they were concerned about was the use of the new computer system. I assured them I was, as a matter of fact, a superuser back in rehab. I was one of the few who had to walk others through the new system, simply because training for that was a breeze to me.

I started 1st week of May, when I was suffering from severe allergy that I almost feared I would be very vulnerable if I worked in the ER because my skin was so damaged (and on this very day I am posting this, is the first day I saw and felt my skin come back to an almost normal state that now I can expose it to air without sloughing skin and itching). It was a nightmare allergic attack-turned to atopic dermatitis event. Luckily, today I realized I am not that immunocompromised, and I can continue to enjoy the ER.

Why I like it: some days are busy, some days are not. Never boring. Variety of cases and people. Critical thinking developed. My clinical skills will be put back into practice, and they will probably benefit from skills I gained in IV insertion and blood draws (I used to stick even neonates without much problems). What I hated when I was a GP in PI was that I did not develop the skills needed to respond to emergencies such as stroke and acute MI (heart attack), and that I did not really learn much beyond treating common community acquired illnesses, etc. I wanted more...although I would not be the one who would actually treat (doctors would be) at least I would be exposed as to how they do it here...I can easily learn the why's. I can easily follow the rationale for the treatment because of my background, but learning their protocols will be great. I might in the end consider taking the USMLE, or maybe become an NP, who knows?...But this ER experience will surely be a gem in my resume...

Contact Allergic Dermatitis that turned into a NIGHTMARE!!!

Are you like me, who, after having immigrated to the US, have encountered a lot of new things to which you react (i.e., allergic to)?

During my first year in the US, it was the year of exposure to new trees, new bacterial/viral strains, etc. That first exposure made my immune system create a counter-attack force for future re-exposures...

On my second year I had a brief episode of urticaria, which lasted 3 days. I could only think of having eaten Chinese food as a culprit. I used Benadryl and Aveeno oatmeal baths to help soothe the itching.

On the third year, I suffered another episode of urticaria for almost two weeks. Aveeno oatmeal did not help much to soothe. I was glad it was over by the end of the second week.

Fourth year here, I seemed to have succeeded avoiding re-exposure to whatever triggered my urticaria (I avoided gardening).

This year I attempted gardening during the first nice weekend of spring, and suffered from a new type of allergy that led to the nightmare depicted on the photo. As of this posting, the whole event is now on its 5th week. Yap! That's how long I have been suffering from this predicament.

As I mentioned in my previous post, I was suffering from dishydrotic eczema and was on prednisone treatment. I was at the last days of my prednisone taper when my allergic dermatitis started.

See my slide presentation for the series of events explaining the whole thing. I will keep updating this slide show as I progress.



UPDATE:
The flare-ups of my skin inflammation apparently was caused by my alternating use of petroleum jelly then lotions (which I would dare use once I felt my skin was getting better). Upon my derma's suggestion, I stopped all lotions or special soap for sensitive skin and stick to petroleum jelly, soak for at least 15 minutes in shower or tub (to engorge my skin cells and close the cracks), then slather a thick layer of the petroleum jelly to trap the moisture. Also, he prescribed desonide lotion which I had to apply to affected areas twice a day. I did that, and the desonide use had immediate effect on inhibiting the itching and inflammation of my arms/hands, and with showers twice a day at least, using the (self-prescribed) hot water treatment (counter-intuitive, the treatment regimen was effective for me. I believe that the increased rush of inflammatory chemicals like histamine, bradykinins, interleukins, etc. overload the receptors so that after the initial sensation like that of being scratched when in fact it was heated water, comes pain, then relief from itchiness for at least 4 hours (so finally I would get at least 4 hrs of straight sleep). Increased sleep boosts health and immune system. Less irritation (use only petroleum jelly) and more hydration of my skin (showers soaks)...finally my skin was back to normal after 6 months. When I mean back to normal, there is no longer that thin layer of skin with fast turnover, which was very very prone to losing moisture.

Well, during the first few months when I thought I would never get my pre-morbid skin, I was getting depressed because not only could I not wear tank tops/shorts without being so self-conscious, I also was not sure if there was ever an end to that suffering. I also felt so vulnerable since my skin was not intact and I was working at the ER (skin is the biggest organ of defense, so I felt defenseless). I even recorded songs for my hubby (although I did not tell him then that those were in case my skin issue would lead to my early demise eventually).

Now, I am happy with my skin, even if I still suffer from itchiness and cracks every time I go on duty at the hospital and have to wash my hands often.

Dishidrotic eczema

It all began when I started working as a nurse in April of 2007-- the soap (I thought) irritated my skin so that at the end of my shift, I would drive home constantly scratching on my hands. I developed maculopapular rashes by May 2007 and sought an appointment with the Employee Health for an alternative soap (upon my Manager's suggestion). Okay, so I used a gentler soap, but continued to use the hand sanitizer (which seemed to be better despite making my skin red; it did not cause itching).

However, I did develop dryness, flaking, and eventually cracks on my skin. Once you have skin cracks, washing (especially with hot water) was agony. I almost was quite phobic of handwashing, and was using the sanitizer more. I also decided to use an OTC soap that was moisturizing, without the approval of the Employee Health. My symptoms were controlled, although I still got dried flaky hands on duty days. I also went to my family doctor and asked her to write a note that I can show at work that I was to avoid the hospital soaps to control my dishidrosis (aka pomphylox).

Then I was contacted by EH, and was asking if I was doing ok with the soap, to which I said yes. And that they would send a whole box, which I received that week. My manager told me to keep the used up bottles in the utility room so they could count. Oops...so I started using it again. My condition worsened again, and I would get cracks during duty days, which would heal during days off. It was torture every time I washed my hands or used the sanitizer because of the cracks! Despite use of lotion, I could not help the progression of my condition.

Then our manager started implementing a handwashing program, targeting 50 handwashes per shift! I tried to stick to it as much as I could, which led to soreness and swelling of my fingers, it was just too painful to even bend them because of too much swelling, and forcing to bend led to cracks and bleeding. Too thin because of flaking, my skin would also bleed at the slightest touch of a side of a paper...That bad. The EH nurse arranged for me to see the Workplace Health doctor. Nothing new prescribed aside from what my family doctor did. Nothing new suggested; just keep trying new soaps until I found one that would not exacerbate my condition. I did, but I still had the problem. After a week, I called the EH nurse to arrange another visit, because I could no longer sleep straight with all the itching and pain and severe dryness, and this time, even 5 days off did not result to healing. I knew the soreness/pain was due to infection already. I felt like amputating my fingers...

A nurse practitioner saw me the next time, and I liked his approach. He listened well, suggested specific creams/soaps, treated the infection and gave me prednisone and topical steroid. As expected, it cleared up. I was quite happy, but he had reservations, because he knew (and I knew) that eczema can flare up again, and is a chronic condition. We would have to see whether once off prednisone, the use of mild soap and cream would help control the issue.

These are before and after shots (not all have corresponding photos, though.)

row 1, cell 1
row 1, cell 2
row 2, cell 1
row 2, cell 2
row 2, cell 1
row 2, cell 2
row 2, cell 1
row 2, cell 2
That crack was extremely painful!!!
day 3 of commencing antibiotics
row 2, cell 1
row 2, cell 2

I was happy to be finally free of pain, and during the final followup, I had no problems anymore...but then at the end of my shift, when the EH nurse called me to remind me to have follow ups with her, I told her it was starting again...but then I had some more prednisone tabs to finish, and one more week of topical steroid cream plus the barrier cream to apply...

I was hoping the problem would go away, especially that I would have one week off before I make the transfer to ER...