Monday, December 6, 2010

Why Do Bad Things Always Happen to Good People?

"God protects drunks and fools", that was taught to me early on in my nursing career in the trenches of a "charity" emergency department. Through those years I recall time after time this point seemed to be true.

Then on the other hand you see really good people struck down with horrible illnesses in the prime of their lives- seeing them deal with the pain, doubts and fears of a uncertain future and you have to ask yourself why? Now I'm not writing this to bring us all down but to share a story that really helped me come to grips with "why do bad illnesses seemed to always happen to good people" and more importantly provide to patients my thoughts when they ask: "Why am I having to go through this?"

For the last seven years, I have worked as a NP in an interventional pain clinic. Many, many times when talking to patients they would ask me that question "Why me?" And my only response was the most honest one I could give- "I don't know, but we are gonna keep trying to fight it."

I liked to tell you this story I heard awhile back that really made sense to me:
A patient presented one day, just like any other day. As the NP & patient were talking about his pain problem and how he couldn't do anything like he used to- the pt. abruptly asked: Does Mr._______ come here? Well, of course with all the HIPPA laws and everything the standard line of: "I have no idea, we have several thousand patients and I couldn't tell you yes or no anyway." was given.

A minute passed and the pt. responds "Well, I know he does, and I know he is alot worse off than I am." Now this struck the NP as odd for them to say and before a response was given the pt. went on: "And I see him at church, around town shaking hands with people, smiling... happy. And I know he is in more pain than I am. So, I said if he can do it- what's my excuse?"

When I heard that story, it helped me make some sense why bad things seem to always happen to good people. A patient living with chronic pain, debillatating condition or incurable illness usually just see their situation- as they should. Those of us on the other side of their fight see despite this horrible situation they are still pleasant, gracious- good. Their true character remains- no matter what. In a sense, seeing how they respond to extremely difficult circumstances with continued peace and joy greatly helps others with their "lesser" problems of life.

I have said all this to make this point- patients living with chronic pain need hope and a sense of purpose. If they can see a reason, a purpose for their lives, other than just living day to day to hurt until they die- I have seen how this can change their whole outlook on their life.

So, the next time a patient asks you "Why did this have to happen to me?" Tell them this story, and encourage them to understand that although they don't see it- their struggle is showing others what true character and grace really is. That people they love or hardly know them see how they are dealing with their struggle and are asking themselves: "If they can be happy despite all their pain & problems- what's my excuse?" These type of people you never forget them.

(This was a story told to me some time ago- I don't care if this was a true story or completely fiction, to me it doesn't matter. Any patient similiarities are unintentional. The purpose is this story has helped patients living with chronic pain gain some understanding about the part they are playing in the "bigger picture" and in the lives of others around them.

I hope this helps you and your patients.

All the best-
Andy Austin FNP-C, FAAPM

Monday, October 4, 2010

Live Joint & Trigger Point Course

We are scheduled to present our Hands On Injection Course in Jackson, MS- March 5th, 2011
12 Different Injection Approaches Discussed- Hands On Practice for Each!
AC Joint
Glenohumeral Joint
Subacromial Bursa
Medial/Lateral Epicondyle
Trochanteric Bursa
Knee Joint
Trigger Point Injections (Lumbar paraspinous)
Viscosupplementation for OA Knee
Only 30 spots available- Some are already gone!
CE's approved by AANP
More Info/Registration :
We are Looking for additional locations- we want to hear from you!

Tuesday, August 17, 2010

"Shoulder" Injections

Shoulder pain is a very common complaint during the summer time- people are active, working in their yards, etc. So when you are considering performing a shoulder injection for your patient. Where & What are you actually trying to treat? Is it bursitis, tendonitis, osteoarthritis flare, etc.?
Ok- so you get an xray.. Results: mild OA found.. now what? Well, how is the patient presenting? Is the shoulder their chief complaint- new or chronic pain? Did it present after trauma, activity, etc. ? Where is the pain located anterior, lateral shoulder? All these clues are extremely important in determining the exact condition of the shoulder pain in order to have the proper diagnosis and proper plan of care and what type of injection to perform.

Many providers (MDs, NPs & PAs) use the term "shoulder injection" to usually mean subacromial bursa injection- which is a different location than performing a (glenohumeral) shoulder joint injection- Seperate areas with seperate clinical indications (adhesive capsulitis is shared)

How bad would that be if you did everything correct, complications arouse anyway- the case went to court & was found that where you injected the shoulder had no clinical indication (wrong diagnosis). Your documentation with the wrong diagnosis would be blown up so big in the courtroom that people in China would see it. Your counsel would politely try to settle the case- the whole while muttering something about @#$% mid level providers...

So, it goes without saying- knowing the indications for each "shoulder" injection you perform is as important as where you are going to insert the needle.

All the best,
Andy Austin FNP-C

Sunday, August 8, 2010

New Procedure Course

Hey Folks,
A special Thank You for all the support- especially area NP groups have been wonderful- our post course surveys have been excellent! We rely on your input to continue to provide the best Hands On procedure learning opportunity possible. That is and will always be our goal.

Special announcement: another NEW inoffice procedure course will be available soon- with the HANDS ON PRACTICE and the convenience to learn when its right for you!

Email me or visit our website for more information coming soon!

Saturday, July 31, 2010

Triggerpoint Injections

A question that has been asked on several occasions is which medications to use while performing a triggerpoint injection? The combination of medications clinicians use for triggerpoint and joint injections can be quite a complex mixture at times but it boils down to the individual clinicians judgement based on previous experiences from which combinations of short/long acting corticosteroid along with whichever "flavor" of short and/or long acting anesthetic works for them.

As far as my previous experience, I see no difference in sustained analgesic effect using corticosteroids in triggerpoint injections vs. using anesthetic alone. Now, I'm not saying NEVER use corticosteroids along with an anesthetic but one needs to remember why triggerpoints are being performed: 1. to provide relief of pain in the specific muscle and 2. to promote circulation of the triggerpoint area by active needling during the procedure. I know some clinicians that perform triggerpoint with a dry needle (no medications at all) with good results- however, I'm concerned about patients pain level while performing the procedure- especially in those with chronic myofascial pain (Fibro) that would require additional injections in the future.

Including corticosteroids in triggerpoint injections does pose a chance of hypopigmentation of the skin as well as atrophy of surrounding tissues that could cause scarring in that area. If you choose to perform triggerpoint injections with corticosteroids- Please discuss with the patient in rare occasions patients do experience these complications and have this on your consent form.

I'd love to hear from others who perform these procedures and what medication combinations work best for your patients?

All the best,
Andy Austin FNP-C, FAAPM

Wednesday, July 28, 2010

Joint Injections for Arthritic Pain in the Elderly

As I currently work in an interventional pain management- many of my Nurse Practitioner colleagues in Rural Family Practice ask "I have this old patient that has severe arthritic pain, the patient does not want to have replacement surgery, they have been on NSAIDS for a while but now it just not helping their pain as much as it did before. I don't want to start them on opioids right now either due to: NP wanting to avoid treating chronic pain- as in our state NPs cannot prescribe narcotics for chronic pain, potential side effects of opioids (constipation), poly pharmacy or future dependency issues. But, the patient can't drive to another city for a specialist to treat their arthritis pain."

When conservative treatment of arthritic joint pain fails (i.e. weight loss, exercise/PT, NSAIDS, etc.) the nurse practitioner should consider performing corticosteroid joint injection for symptomatic relief, usually in conjunction with previously mentioned treatments. Joint injections have longed been consider an appropriate treatment for arthritic joint pain. My personal experience with joint injections is that these simple in office procedures decrease patients' joint pain and improves their functionality and mobility.

Down and Dirty on Joint Injections:
A patient with less arthritic knee pain as a result of an injection is more likely to increase their activity of daily living- thereby, maintaining or improving lower extremity strength. Improved lower extremity means better stability and hopefully less likely to fall- we all know what happens when they fall.

As the current number of aging patients with mild to moderate OA is staggering with the number only increasing- Learning joint injections is an important skill necessary for the Nurse Practitioner treating our aging population.

Andy Austin FNP-C, FAAPM