April - VA-CA-TION!

Yippee, a real vacation. And where else? Boston. We picked a perfect week to go with Nick only having to be in school two days during the week we were there and the weather was unseasonably warm. We celebrated sweet Sadie's 2nd birthday; we spent time on Battle Road/Minuteman National Park - walking along the same road that Paul Revere rode. We spent some time in the charming village of Concord, right in the seat of the American Revolution.

Jamie planned some other wonderful side trips. We took the ferry to Martha's Vineyard and enjoyed some time on the beach, shopping in some of the small towns, and visiting this cool little "camp" of old Victorian gingerbread cottages. Originally a Methodist church camp, this wonderful site in Oak Bluffs on Martha's Vineyard is quite charming.Click here to see some photos of the cottages.

Another day we spent down in Newport, Rhode Island. First we visited an area known as "the Point" which is the highest concentration of colonial homes in the US. It is completely charming with house after house built in the 18th century, many before the Revolutionary War. None of photos I took completely captured the charm of the area. We visited a wonderful artist, Ilse Buchert Nesbitt, who has a home and a gallery there. She works on an old press to create her art. She's lived there for 45 years. She said the only reason the neighborhood survived was because it had been too poor to tear it down. Later, through Operation Clapboard, the area was preserved. We also took a tour through The Breakers which was the Vanderbilt "summer home." Quite amazing.

Our last side trip was to Kennebunkport, Maine. We stopped in Cape Elizabeth at the Twin lighthouses, where we ate at this outdoor eatery and had the most amazing lobster rolls and fried clams! We spied the Bush (41st) compound and then spent time walking around Kennebunkport, shopping. I must admit that I feel like we found "THE" Hallmark town in Kennebunkport. We took the scenic route slowly down the coast of Maine for awhile before heading back to Boston. I totally loved Maine!

I'm also posting Nick's "rebuttal to Skyler's movie"! Who knew my boys were both "stars!"

January to March 2012

In February, Jamie flew out with the kids for a few weeks to visit. That was SO fun. I took a day off of work just to spend time with Andrew and Sadie. We went up to Oxnard to the Gulls Wing Children's Museum and then from there to the Santa Barbara zoo. They were scheduled to fly back home the day after our 32nd wedding anniversary. To celebrate, we took everyone to Buca di Beppos for a big family style dinner. Later in February, I flew up to Sacramento as a House of Delegates member for California Association of Nurse Practitioners (CANP). I am making an effort to get more involved in professional advocacy. March was rather uneventful except that we had a great time taking Walker and his parents to the Santa Barbara Zoo for a fun outing at the end of March. We also discovered that Skyler was a YouTube star. I'm also posting some of the beautiful family photos Sarah took of Chelsea's family when she was out here.

 

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!