Catching up! End of 2011

Okay, I am a terrible blogger. I'm now going to play a bit of catch up and post a few pictures.

By the end of November I was completely off of the prednisone and I started back to full time work (having been on modified duty for several months). In December Martin I got to fly to BYU Idaho to see Skyler and Sarah graduate, and Skyler be commissioned into the US Army as a 2nd Lieutenant. We spent several days enjoying the various festivities in Rexburg and then shortly thereafter Skyler and Sarah drove down to Calabasas. They stayed with us for several weeks before they took off to Germany to visit Sarah's sister. By the end of January, they were off to their new home in Sierra Vista, AZ at Fort Huachuca where Skyler began his training.

While we were not fortunate enough to get Nick, Jamie and the kids here for Christmas, it was the Onken Christmas this year and we had a lovely holiday. I should also mention, that my sister Ellie got married and brought her new hubby out to meet us at the end of December.

We also got a chance to celebrate the birthday of my nephew Riley! Riley is my brother Todd's son and we are enjoying getting to know this young man.

 I'm also posting one of the great photos Sarah took of the Nick Onken family last August. And of course our adorable Walker needs a picture in here, too. I think this was from October.

Support Your Nurse Practitioner

I know I haven't blogged in forever. And I will update with personal info soon. But today I'm just posting a letter I've sent to my legislators. For all the moaning and groaning and hollering over health care, our system still has some ridiculous and wasteful practices that inhibit free competition, appropriate resource utilization, and quality controls. My personal, professional, biggest issue now is admitting privileges to skilled nursing facilities. I had some colleagues at a local Kaiser (different from the one where I work) lose their jobs over this issue, because, bottom line, there's a turf war here. Here is my letter.

I am writing to ask for your help with a serious problem that we are having with the limitations set on nurse practitioners regarding the Medicare Conditions of Participation for providing services in skilled nursing facilities (SNFs). Even though we have been authorized to provide Medicare services to patients in SNFs for 25 years, according to those rules, nurse practitioners are unable to conduct admitting physical examinations or alternating monthly-required medical visits for patients entering the SNFs.

While we are able to admit patients to ambulatory practice, nursing homes that are not SNFs, and hospitals, and are authorized to certify and recertify patients for Medicare long-term care, the Conditions of Participation prevent nurse practitioners from functioning at our full scope in a SNF.

Nurse practitioners are high quality primary care providers who work successfully with elderly patients in all settings including SNFs. We are specially trained to manage the problems of chronic illness in the aging population. Studies have shown that nurse practitioners working in SNFs improve the quality of care in those facilities and reduce readmission rates to the hospitals. The inability to conduct these examinations has serious ramifications for patient care in the SNF. In my case, I work directly on-site, however I am not permitted to see a newly admitted patient coming in from the hospital. Instead, the patient must wait as long as 72 hours to be seen by a physician. With patients coming from the hospital to the facilities sicker, due to shortening lengths of stay at the hospital, it becomes crucial that these patients be seen quickly upon admission. Furthermore, since the nurse practitioners are generally driving the discharge planning for these patients, continuity of care is improved when the same clinician has been seeing the patient from time of admission. Finally, due to the dearth of geriatricians and primary care physicians, there are fewer physicians available to meet the needs of the elderly, a very under-served population. It is simply not logical that nurse practitioners, who can conduct these very same services in a variety of other settings, are not allowed to conduct an admitting physical examination in a SNF. I believe the rule is truly an anachronism in the Medicare COP rules that has simply been overlooked. In an era of ever greater need to control costs and improve quality in healthcare, this oversight must be corrected.

I would appreciate your assistance in taking steps to adjust this rule so that nurse practitioners may perform admitting examinations and follow up oversight visits on patients in skilled nursing facilities.

Anyone interested in this topic should take a look at AARP's white paper on this issue regarding advanced practice nurses and admitting privileges. And check out the Institute of Medicines report on The Future of Nursing. To really understand the absolutely political and financial aspect of this turf war between physicians and non-physician providers (such as NPs, PAs, ODs, etc.) check out Appendix H of the IOM report. It's a great read and very enlightening.

Miscellaneous stuff

When we went to my nephew's wedding a couple months ago, the caterer served this amazing cheese and cranberry appetizer that had most of us gorging ourselves on it. I decided to recreate it and it came out pretty good, if I do say so myself.

2 8 oz boxes of cream cheese softened
8 oz of goat cheese
16 oz mascarpone cheese
1 package (approx. 10 oz) of Craisins or other dried cranberries
1 package pecans
3 Tb sugar

Cream the cheeses together in a food processor, layer half of the mixture into an 8 inch springform pan that you've sprayed with pan spray. Cover with cranberries and layer the remainder of the cheese mixture. In a saute pan, melt the sugar over medium heat. Add pecans and stir until they are nicely glazed. Cool and then top the cheese with the pecans. Refrigerate for several hours before releasing from the pan. Voila, a cranberry, cream cheese and glazed pecan torte!

In the sewing room I put together another baby quilt top for a friend of ours. It's at the quilters:



I got my other baby quilts back from the quilter. One is for Walker and the other is a gift. Since they are the same quilt, I'm only showing one photo :)




I'm just about ready for the holidays. The house is decorated, the tree is up, most of the shopping is done and I even got quite a bit wrapped. The Christmas letter went out in the mail today. Because we are leaving for Idaho next week, the last weekend before Christmas, I really have to be a bit more prepared than usual. Skyler and Sarah are graduating and Skyler is receiving the Newel K. Whitney award, giving a commencement address, and commissioning into the Army as a 2d Lieutenant. He also received a Distinguished Military Graduate award from the Army. I know this is a bit "braggy" but he really seems to have hit it out of the ballpark this year!

October already?

I haven't posted much because up until about a month ago I just didn't have the energy. When Martin gave me that blessing so many months ago and I was told that I would eventually be better but that it would take awhile, who knew it would take 6 months? The good news is that while it has been a long and difficult 6 months, I AM finally almost back to normal and it looks as though the Crohn's is in remission. I still have chipmunk cheeks from the steroids and it will be another month before I am completely off of them, but so far I am tolerating the taper (the slow reduction of dosage) and that's what counts. I thought I'd try and play a little catch up on the blog.

First, I promised a report on our May trip to Washington, DC. We went to DC so I could present my research poster and receive my doctorate degree. Because this was such an event for me, we wanted to try and bring the kids to be there with me and to enjoy Washington, DC. Unfortunately Natalie was not able to join us and Nick was only able to come for the actual graduation as he was in the middle of finals! But we had Jamie and the kids, Trenton & Chelsea, and Skyler and Sarah with us. And, much to my delight, my sister Sherry and her husband Dave also came and joined us for a few days. We rented a house big enough for all of us and walking distance to the Metro. My very smart husband insisted on renting me a wheelchair which turned out to be a blessing. Me in a wheelchair and the kids in the stroller - can you picture it? LOL! At one point we rented a wheelchair for a very pregnant Chelsea, soo. We were quite the sight. We did manage to see some sights too - enjoyed the Holocaust Museum, the Smithsonian (well, some of it), the memorials, Arlington Cemetery, Ford Theater and we got a personal tour of the Capitol courtesy of a friend of Jamie's. The weather was fabulous, and we had some good food (ask me about the toasted marshmallow milkshakes!!) I dragged the kids to all the graduation related activities and they were good sports about it. I just love spending time with my kids and DC is one of my favorite places so in spite of my physical problems it was a great little vacation.

In July our little Walker was born. He just keeps growing bigger by the minute and smiles his little dimple smile - they don't get any cuter. Mom and dad are adapting to sleepless nights. Trenton started his master's program at CSUN; Chelsea still picks up a few hours at Expedition here and there but mostly spends her time being mom.

Nick, Jamie and the kids came out for 6 weeks during the summer. Nick had an internship in Torrance. They stayed at their old apartment building but they made the effort to spend lots of time with us and I enjoyed every minute of it. Then, we got lucky enough to have Skyler and Sarah come out and spend several weeks with us, too! It was a full and fun household.

In the middle of September, I took a trip to Boston for a palliative care conference, but mostly it was an excuse to visit the kids. At the end of September, Martin, Chelsea, Trenton and I attended my newphew's wedding in Paso Robles. It made a nice long weekend for us and a mini family reunion with my sisters Ellie and Sherry and my brother Joe and his family in attendance. Then just last week Martin and I took a long weekend trip to Albuquerque for our friends' wedding. The wedding was great, but even better we took advantage of the spa and the fancy restaurant and had a great weekend together.

So that's my recap, dependent upon my poor memory; we are looking forward to one final trip this year, which will be to Idaho for Skyler and Sarah's graduation and Skyler's commissioning into the Army.

Seeing as how I'm very poor about taking pictures, I don't have much to show, but here are a few:

Welcome to the world Walker Ace Pierson!

Born 7/7/11, an auspicious birthday I think! 7 lbs. 1 oz. 19 inches long. Mom had a very hard and fairly fast labor and delivered this little beauty!

Quilt photos

The husband of a good friend of mine threw her a surprise birthday party. I wanted to give her something special so I quickly whipped up a small wallhanging - hopefully one she can use for all her family's birthday celebrations to come.

Chelsea and Trenton's tiny apartment could only accommodate a mini-crib. Bedding for a mini-crib isn't easy to find. That is okay, it gave me an excuse to make a tiny crib quilt and bumpers and a bed skirt, too. You can see a tiny portion of the polka-dotted bumpers in the lower left corner.

Life on the other side

So yes, I've been to DC and back and graduation is past. I will shortly write about that if I can get any of my dear family members to send me photos to share! But tonight I write about something else entirely.

You see, about the second week in April, I got hit by a bus.

Figuratively speaking.

And the bus was my own immune system.

It started oddly, with a red spot and pain in one ankle and quickly spread to the other. Then both feet became alarmingly swollen. Within about two weeks of this, I could barely walk at all. Then the fevers hit - chills, then burning, then breaking. Yes, I went to the doctor who ran many, many lab tests which mostly showed that somehow I was malnourished (not absorbing my nutrients properly) and that I had quite an inflammatory process going on. Within a few weeks of this starting, I began to have GI symptoms (I'll spare you the details) and more painful nodules on my wrists, etc. I have had more doctor's visits with various specialists and more blood taken in the past 6 weeks than probably in my entire life. This past Wednesday I got "scoped" up and down and I now have a diagnosis: severe Crohn's disease. This is a chronic autoimmune disease (which means my body is attacking itself) and the goal of treatment is to try and beat it into remission and pray that I do not have any flares. The rheumatologist that I saw before I left for DC had blessedly put me on prednisone which has helped make me somewhat functional, although I did spend my DC vacation in a wheelchair (bless Martin for that idea!) The gastroenterologist who will now manage my disease has increased that prednisone for now and will start me on a biologic called Humira. It is a bit scary (those are scary drugs), but I'm prepared to do what I need to do to get my life back. It's an amazing thing to go from running your life at the usual 65 mph, and suddenly smack into a brick wall.

But I've learned a lot being on the other side of the patient/provider relationship:

I have learned how frustrating it can be to be a patient and to deal with specialists who have forgotten basic medical training (80% of the diagnosis is in the history) and don't bother to ask you (the patient) what the story is.

I have learned that "come back in two weeks" is an eternity when you are sick and not functioning.

I have learned how life becomes very narrowly focused when you can only manage to lay on the sofa and be in pain and feel crappy and be frightened of having a chronic illness.

I have learned that a little compassion goes a very long way.

I have learned how blessed I am to have a compassionate and loving husband who takes such good care of me, and children and children-in-law who are thoughtful and kind and care about and support me.

I have learned how blessed I am to have colleagues and friends who care about me and are willing to support and help me.

(I'm kind of hoping that I've learned all the things He wants me to learn and will now "fix" me - LOL!)

So, a new chapter in my life. Keep your fingers crossed that the Humira does the trick when I start that in a few weeks. I know I will get a little bit better every day! And I promise to write about DC later. It was great!

Time Flies

Just realized it has been awhile since I've posted here - not that I have much of interest to post. We've been staying busy with the usual work. Nick, Jamie and the kids were here and gone in a flash. Sadie turned 1 year old two days ago! Andrew is getting better with his talking, and just today he and his daddy sang the Alphabet Song to me over the phone before Andrew went to bed :)

Chelsea is sick of school, and feeling the tired effects of being pregnant. She's now registered at Babies "r" Us, and the crib is purchased. Of course Nana now has to work on bedding! Trenton has an invitation to interview for the graduate program in social work at CSUN next week. I have no doubt he'll be accepted into the program. Chelsea, on the other hand, will have to take a break in the fall semester because it will be pretty hard for her to do student teaching with a very tiny newborn at home.

Skyler and Sarah just completed their next to the last semester. Skyler will be contracting with the Army this summer and so will be spending about a month this summer doing army stuff.

I finished my paper and my poster project. I just need to get it printed and shipped to D.C. It's hard to believe that our trip to DC and my graduation is only a month away.

My job is wearing me out these days. I look forward to having a break. I sure wish California was a plenary state for Nurse Practitioners (like Utah, Arizona, Oregon and 13 other states in the union) so I could just start my own business and break free of some the politics!

Checking in

Just realized I hadn't posted in a while. The biggest news today is the news from Egypt that Mubarak has stepped down. I think this is such an exciting time - reminiscent of the fall of the Iron Curtain - I am both nervous and optimistic about what this means (starting with Tunisia) in the Middle East.

In the Onken household the biggest news is the confirmation that Chelsea's pregnancy is going well and that we will have another grandson! The happy parents are trying to think of "place" names since both of them have "place" names. Suggestions are welcome! Other good news in the Pierson household - Chelsea and Trenton moved into a darling apartment in Reseda, not 10 minutes from school. They are so happy to be back into their own little place and they have been warmly welcomed by their neighbors. Trenton has also filed his application for graduate school.

Great news from the Boston kids - they are flying home for Spring Break! I can hardly wait to get my hands on Andrew and Sadie!

My schooling is fast coming to an end. I have to turn in the rough draft of my capstone paper on Tuesday. The final will be due on March 15th. Then I have to prepare a scientific poster. The statistical analysis was done for me by the Kaiser statisticians, but it's all in "geek speak" so I have had a challenge trying to understand it. Overall, it appears that my study turned out like I had hoped. Just a little bit more for me to do and I can be done. My application for graduation has been filed, my regalia has been reserved, and we found a house to rent in DC. We'll be booking flights using all the "points" we've been saving for just this purpose. Chelsea and Trenton, Skyler and Sarah, and Jamie and the kids (with Nick just for a day) will be able to join us in DC for all the celebrations and a little vacation too. The last time we took the kids to Washington DC, Skyler was maybe 6!

Hope everyone has a great Valentine's Day.

It's a New Year!

2011 - so futuristic! I wonder how many months it will take me to remember to write 11 instead of 10.

I notice that I did not write anything about our Thanksgiving trip to Cambria. I don't really have many photos from that trip but we had a great time. Martin rented a really beautiful home with an ocean view and an open floor plan. The kitchen was well appointed so cooking the big meal was a breeze. Everyone was there except the Boston crew. We had some rain while we were there that dampened a bit of the activities, but we had a beautiful day when we toured Hearst Castle and we did go take a look at the sea lions. We ate and rested and generally enjoyed being together as a family.

Christmas was spent in Boston with Nick, Jamie and the little ones. We took a red-eye out of LAX on Wednesday the 22nd. The flight was delayed and we didn't actually manage to get to Nick and Jamie's until a little after noon. From there we all headed down to Mr. Bartley's in Harvard Square for burgers (and raspberry lime rickeys for some of us). This gave us an opportunity to show Natalie that area. Christmas Eve was spent playing with the little ones, eating a delicious dinner prepared by Jamie, and attending a special presentation at the kids' Ward. Christmas morning was loads of fun and I think all the gifts were a big hit. Christmas mornings are just so much fun when there are children! We were scheduled to return to LA on Sunday late, but Boston took a hit from a blizzard that closed down the airport. It gave us an opportunity to spend one more day with the family and Natalie, Nick and Jamie went out into Boston proper to get some sightseeing done and pick up cannolis from Mike's Pastry. We had a very long day of traveling home on Monday. Unfortunately, by the time I got home I had a full blown cold, probably the same one Natalie had been battling while we were in Boston. All in all a really lovely Christmas that Nick and Jamie made special effort to make very special for us. I just wish Boston wasn't quite so far away.

Being sick the week between Christmas and New Year is a bummer. I have all this time off, but can't really enjoy it. New Year's Eve was quiet, just the two of us watching movies and eating soup, chips and quacamole. Today I will make the annual oliebollen, because it just wouldn't be New Years without it! It will unfortunately take me a month to get rid of all these excess holiday "baggage" I have accumulated. LOL!

Hope that your holidays were wonderful and here's to a very good 2011 for all of us!

Pre-Christmas

It's been raining like crazy here for days and I really love it. Lots of people are complaining, but not me. I wish I could stay home and warm and cozy with a good book and a warm cup of herbal tea and just listen to the rain with Scooter curled up in my lap!

We leave for Boston in two days. It will be a very quick trip with red-eyes there and back; sure to leave us exhausted. But when Nick invited us, it is hard to pass up an opportunity to see those little ones - and the big ones too! We're taking Natalie along with us. The other kids are sharing Christmas with the in-laws.

For the first time in 30 years I have not decorated the house and there is no Christmas tree. I thought I would miss it, but honestly, I don't and I am surprised by how stress-reducing it was to not decorate.

Our Christmas letter announced (with permission) the little July 4th blessing that Chelsea and Trenton are expecting. She's feeling well and we are all excited.

Skyler's team at school won the Dell competition at BYU-I (designing a software for the Streak) and he's hopeful that they will also win against BYU, which should result in a cash prize.

Everyone is happy to be done with finals and enjoying the holiday break. In the meantime we're trying to stay warm and dry.

Blessings of the season!

Quilty things and a bonus baby photo

You may remember that last July when I went to Long Beach with my friend Lynda for a quilting "getaway" I worked on 4 baby quilt tops. I finally got them back from the longarm quilter and last Saturday I got them labeled and bound. These are baby gifts (some LONG overdue), including one for my sweet Sadie. I got them out in the mail to the various recipients on Monday and heard today that Sadie already received hers! Here are the photos - I made two of each colorway but I only photographed one example of each. And I'm posting a picture of Sadie because she is so stinkin cute and because I love the photo.