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For those who don't know, I am a student nurse practitioner (NP). This is the main reason as to why I am not able to post as much to support my husband's website. The other reason is partially due to the fact that nursing school has sucked the creativity out of me so much so to the point that the only creative juices I am able to produce are through the means of a power point presentation. But, I digress. The point of this article was for me to point out how hard NPs have it in the healthcare field. It does not start in practice, but rather, in school. Since I am in the Family Nurse Practitioner (FNP) program, I am required to complete a total of 750 practicum hours before I graduate. Practicum is basically where I practice in a clinical setting (with real patients and real problems) as a student NP underneath the direction of another NP or MD. This amount of hours is fine with me since I am going to be working with other NPs and MDs who will consider me to be their colleague. Also, I will be making important life and health decisions with many families which requires much training. However, in the program that I am in, I have to find people who will be willing to precept/take me under their wing in this process. My practicum placements are totally made up by me in my free time between going to school full-time and working my 3 separate part-time jobs. This results in several rejections from people (because a student would decrease their productivity) and many calls and e-mails that are unanswered (they are too busy to call me back or they just don't have the time). I can understand why some NPs do not want to get back with me for one reason or the other, though. NPs are not paid extra to precept student NPs. So this means that their productivity decreases AND they are not paid extra. On the other hand, MDs are paid extra to precept physician assistants (PAs). PAs do essentially the same duties as an NP does. It's just a different discipline of thought when it comes down to it (medical vs. nursing). Okay. So now I'm a bright-eyed and bushy tailed NP in the world excited to conquer new things. I accept the first job that comes my way. A PA who has just graduated from a 2-year community college with an associate's degree (vs. me, who has graduated with BA and 2-years of masters training) has also just landed a job in my same place of work. This person, on average, is going to be making at least $20,000 more than I am based on the fact that 1) he/she was physician-trained and 2) this person is most likely male (I'm not even going to go there at this present time.). It's bad enough that NPs have been around for over 100 years and they're just starting to get recognized in 2006. Next year will officially only mark the 40th anniversary of PAs. Unfortunately, the reason that NPs are more recognized now, is not because MDs want to promote collegiality, but rather, because MDs want to specialize. They are willing to pass many of their regular patients on to NPs now in order to make more money for themselves in specialization. This is not the case for all MDs...but they all know who they are. It saddens me when a patient demands to see an MD. Then when he/she is told that the MD is unavailable, they'd rather settle for the PA than the NP. These patients freely admit that they would rather see a PA opposed to an NP just because of the name "physician" in "physician assistant." They claim that they have got to be the next best thing to doctors. Haven't us nurses paid our dues already? We're not in the old-school days of hospitals being places to go and die and the healthcare professionals they label as "nurses" are really the town prostitutes. Do your research. It's true. I just feel that for a profession that has been around for so many years, I don't feel I should fight for everything that I've already worked so damn hard for. It's just ridiculous.

Hooray! After 27 years of suffering through being Really Really Fat I have FINALLY been given the answer I was looking for - it is NOT my fault and my fatness is a disease with a name! No, it's not diabetes or hypothyroidism. Those have been around for many years and all Really Really Fat people have been tested for those at least twice in their lives. The new disease is Metabolic Syndrome. It's symptoms are:

• Obesity (particularly around the waist)
• High blood pressure
• High cholesterol
• Insulin resistance

OMG I am so stoked. The Mayo Clinic says if I have any one of these symptoms, I'm totally in the running for Metabolic Syndrome. Now my obesity can be attributed to my high blood pressure and high cholesterol and not the other way around! This Syndrome was brought to my attention by the latest issue of Wired magazine, which usually just tells me about science I can't understand, technology I'll never be able to afford and biological & environmental achievements the government can never get behind. So why are they talking about my Fatness? Well, this new Metabolic Syndrome is a big hit with "Big Pharma" (and Wired loves to write about Big Pharma). Give a group of symptoms a fancy name and the pharmaceutical companies will find a miracle drug for it. Apparently the old name for Metabolic Syndrome - obesity - was just not.....selling. In the Wired article, they cite business owner and Kentuckian Karen Cunningham who gained weight after her pregnancy. She "couldn't shake the weight" and went to "various specialists" to tell her what was wrong. Apparently "lose weight and you won't feel like shit anymore" was NOT the answer she was looking for. Her answer was "Metabolic Syndrome."

The breakthrough came last December when her new endocrinologist diagnosed her with something called metabolic syndrome. She'd never heard of it. As she Googled to learn more, her chronic ailments – the weight, the high blood pressure, the lack of energy – started to make sense. They even seemed treatable. She's now on Glucophage and Avandia (which both regulate blood sugar) and has lost 20 pounds by cutting out carbohydrates. "Getting a diagnosis was a relief," Cunningham says. "I have hope now, whereas I didn't have any before."

Wow ok so you have....the beginnings of Type II diabetes and eat too much sugar and starch. That's pretty much what Dr. Robert Atkins was telling the world for 30 years before he died in 2003. Some people - not all people, but a good chunk of them - have bodies that just can't deal with insulin-raising carbs. Some are diabetic, some are just plain fat. People went berzerk over this claim. Doctors yelled and screamed, scientists wagged fingers. Me, I lost 90 lbs. But fuck all of that healthy eating stuff. I mean, "going on Atkins" means cutting our sugar and starch, eating more low-sugar fruits and veg, and eating whole grains. Yeah, and eating meat too (but not gobs of butter rolled in bacon smothered in cheese). Why should I have to eat like that if there's a PILL that will "cure" me of my new-found disease? You bet your sweet bippy there's a pill, too. Now that Atkins has died things have gotten awful skeevy on the "low carb" frontier. His company is pretty much a manufactured crap food warehouse now. Doctors and scientists are taking his ideas seriously now. But instead of having to claim he was right while he was alive and giving people the non-pharmaceutical way to fight your body's stupidity, they waited until he was dead so there'd be no one around to tell people "just stop eating sugar" so they could instead say "try this magic pill." The new pill is rimonabant. So far, human trials have shown that the only side effects are depression and anxiety. But those also happen to be side effects of being Really Really Fat. So what's the harm? It doesn't quite matter, because now Big Pharma has a disease and a pill to combat this disease. Without a disease, HMOs aren't likely to let you get the pill. And like any drug, doctors are going to be eventually pushed into prescribing it - to quell the pushy pharm reps and to quell their fatass patients who say "nothing I do works." I will come clean and say that while I did lose 90 lbs, I am still fat. I lost 90 and put back on 50 (truth be told, I was still fat after losing 90). Why? Well my body sucks. It's high maintenence. And I am too lazy to maintain it. It's my lot in life that I have a high maintenence body. Some do, some don't. I'm living proof that "get up off your butt and move" doesn't really mean the same for everyone. I could eat and move the same as someone else and probably still be fat. But I recognize the difference. I do have to watch what I eat and I do have to bust my ass. C'est la vie. I didn't gain weight because what I did didn't work for me. I gained weight because I stopped doing what worked for me. Duh. So now it seems that I have a choice. Get back on that high-intensity workout regimen again, or go with the "Metabolic Syndrome" wave and get a pill to fix me. I don't think I'm ready to give up the fight just yet. Maybe it's the Puritan in me that feels like I should be punishing myself for my "failing" instead of taking the insta-cure. The lack of serious side effects (such as bleeding from the eyes and exploding diarrhea) is pretty tempting if you consider some of the side effects of previous "fat" drugs like uh...speed and phen-phen. All you get is some depression (which, like I said, most of "us" already have). But the side effects of ass-kicking exercise are lack of depression and a good night's sleep. Perhaps some weight loss along the way. For now, I'll stick with that and not let myself be pigeonholed into some "disease" which has caused my "affliction." What would you do it you could take a pill and cure your "fat"? Would you do it? Would you even believe it could be possible? Check with me in 20 years, though. If I'm in my late 40's and still fat and single, perhaps I will have changed my mind.

Fellow interneters, imagine with me if you will: You are in a group, either that you know or you don't, it doesn't matter. The subject turns from something innocent about the upcoming elections to, dare I say it, sex. Not just 'hey, that's sexy' but 'oh my god, there is sex everywhere and my/someone's children could possibly hear about where babies really come from and now I am super offended'. Now, everyone is in a giant debate over their personal views of sex. Some are offended and leave, some yell and scream and don't listen to what anyone else has to say, and some never get their point across. . So, now you have this visual. Someone please tell me why it's such a hot topic? Personally, I think that we are way to hung up on it. We can't have our children finding out about sex! It's immoral. It's disgusting and dirty and better just not to think about. The question I pose to you is: Why are we still like this? If we just taught our children about sex, then it wouldn't be a big deal. I know it's cliche but knowledge is power. I feel like we shelter our children from way to much. Bike helmet obsessions, not allowing children to play outside alone, fear of generally everything and an overwhelming fear of our children seeing a naked breast, or godforbid, a penis; when are we going to stop bubble wrapping our children? Americans are afraid of sex. Why is that? Why is America so hung up on it's own fear of sexuality that we have to persecute Janet Jackson for a slip of a pasty covered nipple at the Superbowl for years to come? Why is that more important then any other topic, just about? If you want to have the American public's attention turned away from important matters, why just say something that involves children and sex. That'll start some new fires and leave your fraud/political mishap/whatever bad thing you were doing to die in peace with out the American public even knowing it was there. American priorities are in shambles. Who cares if there is nudity? Some people used to think that the human body was beautiful, not shameful. When did my vagina become shameful? Why are we teaching our children to fear their own bodies? It's not just Hollywood that teachs girls to hate their own bodies. It starts with their own mothers and fathers telling them about that special private area, you know, the one that's dirty and ugly and never to be looked at much less touched unnesessarily. Hmm... And so, this overwhelming fear of our own sexuality is spread like an insecure disease to our children in an unending cycle of self hatred and obsessive insecurity with the topic of sex or sexuality. How can we change this?

Would you choose to give a child a disability? The question seems preposterous, but as Slate pointed out, a recent academic paper reports that parents at three percent of U.S. fertility clinics did just that.

Are you planning on having a child? Worried about your family's history of cystic fibrosis, or hoping to protect the next generation from Tay-Sachs or spina bifuda? It is now possible to do genetic testing for a number of diseases well before birth. Genetic screening of embryos at fertility clinics is becoming popular – since the clinics create a number of embryos and only implant one, it is relatively easy to test and select the healthiest of the lot.

But as Slate bluntly points out, not all parents are looking to prevent their children from suffering a debilitating disease. Many parents simply want to balance their families, adding a girl if they already have boys. But in a more shocking twist, deaf parents are asking to have deaf children, and the blind may be purposefully giving birth to the blind.

My immediate reaction is that this just seems wrong. How is imposing a lifelong limitation on someone else, even your own child, before birth any different from imposing it afterward? Surely it's illegal and immoral for a deaf dad to jam an ice pick in his son's cochlea.

But the more I've thought about it, the more I wonder about why the parents are making these requests. Are they just really, really committed to the notion that there is a deaf culture? That doesn't seem likely.

I can think of two lines of thought that might lead down this path. One is that two deaf parents might worry that they would not be able to properly assist in the speech development of a hearing child. Many deaf people can speak well without being able to hear themselves, but it might be more difficult to teach a child. I don't have any case studies or evidence on this point, but it's a possibility.

For the second line of thought, I try to put myself in their shoes, at least through analogy. I always did well at math in school, but I'm no genius. There are otherwise normal human beings all over the world who are geniuses – people who have a deep, intuitive understanding of math, or music, or chess that I will never have. If tomorrow scientists isolated the math-genius gene, and a clinic offered me the chance to chose the math-genius positive embryo, would I? In this case, my wife and would be the “disabled� ones, lacking this sublime understanding of math-if we chose instead to have a “normal� child, would we be doing the same thing these deaf parents are?

It is not a perfect analogy (as my wife pointed out when I posed the question to her). For one thing, being a math genius is not the usual baseline case, and in that way it is similar to blindness or deafness. But is this majority rule enough to make a moral judgment?

I'm not going to go down the slippery slope of employing a “slippery slope� argument, but it is interesting to consider the gray areas – for example, some diseases shorten lifespan and induce so much suffering that nearly everyone will agree it is good that they can be avoided. But what about genes that only statistically increase the risk of a disease? Is it good to avoid a gene that increases breast cancer risk by 80%, but a bad idea to screen for a gene that represents a 7% increase in heart disease?

I'm usually a staunch supporter of the “crippling children is wrong� camp, but the more I think about this the more I wonder – where will we draw the lines, and how will we make these moral decisions, as the technology improves and becomes less expensive and more common place?

Some people make a point of learning a new word each day. This web site does not teach you a new word each day, but time to time we will point out a fun new word that would make a good addition to your vocabulary.

Today's word is Foley. Foley has exactly two possible meanings, which you should never mix up. I repeat, do not mix up the two meanings of Foley.

The first meaning is sound effects, for a film. When films are shot, it is often difficult or impossible to clearly record sounds and dialog, and often a director will want to add additional sound to emphasize something, to create a mood, or to foreshadow something sinister. This is where Foley comes in. Monty Python's Holy Grail illustrates Foley by banging coconuts together instead of using real horses. If you didn't really pick up the joke before, but just giggled because of the word 'coconuts,' that's okay, it works on many levels.

The second meaning of Foley is a type of urinary catheter. This Foley is inserted through the urethra in order to drain the bladder. A Foley is not a truck; it is a series of tubes. Patients may be catheterized because of chronic urinary tract infection, prostate problems, or during surgery and long periods of recovery.

Do not underestimate how embarrassing it would be to confuse the two meanings of Foley. If you are a nurse in a hospital, and you are told to hook a patient up with a Foley, do not search for a metal sheet that sounds like thunder when shaken. This will only torment the patient, who is already having a hard time peeing and feels like the whole world knows about it.

If you find yourself on a film set in Hollywood and the director asks you to provide Foley for a scene, do not insert a tube into his urethra. What is wrong with you? Why would you even consider doing that? I don't even want to know what you thought the official duties of the Foley artist were when you signed up for this job.