Friday, October 19, 2007

The ups and downs of freelancing

A post about writing today – they sneak in every once in a while. When I came back from vacation near the end of September, I had anticipated a very busy week. A regular client had work for me, as did a new one. A return client, who pulled a project August due to internal issues, contacted me again to work on a different project. Since work had been a bit slow before my vacation, this made me happy knowing I had this work ahead of me.

However, as we know in the freelance life, we don’t count on upcoming projects until they’re in your hand and you have the contract signed and delivered/faxed/emailed.

The regular client’s work went on as continued, but the new client bailed (no explanation given). The return client gave me a wonderful project to work on but after I did a few hours on it, I got a call that this project was also pulled because of – you guessed it – internal issues.

It’s times like this when you just want to bang your head against the nearest wall. As luck would have it, another client, who sends me work from time to time, provided me with a few good hours of stuff and then I found another new client to fill in the gaps. This new project is great and it’s something I really enjoy working on. The client is an absolute pleasure to work with and I hope that this will develop into regular work. I also picked up a few smaller projects along the way so, things do ultimately work out in the long run. But this up and down is enough to drive the most secure person a little batty sometimes.

A few people have asked how I get my work. One word: Marketing. Fairly regularly, I send out letters of introduction to anyone who may be able to use my services. I comb the Internet for prospects and send off tailored letters to my target companies. What happens most of the time is I don't hear back, but every once in a while, there's a return message that they’ll keep my information on file, and again, every once in a while, someone calls with work. And, you never know when the call will come. In the spring, I emailed a company and that very afternoon, I got a phone call from them. I now have a very regular client out of that letter. This past June, I sent out a slew of LOIs and didn’t hear back from any of them – until September. Just before my vacation, someone contacted me because her boss, to whom I had addressed my LOI, passed on my email to her and now they had work for me.

So, other than applying for jobs as they come up, the LOI route does actually work. It just doesn’t work with lightening speed most of the time. If you’re looking to be a freelancer, don’t give up if you don’t hear from the people you are targeting. Work on it, keep it up, and don’t give up. It will happen if you put enough of yourself into it.

News for Today:

Ban cold medicines for kids under 6, U.S. pediatricians tell FDA
Strategy needed now for future pandemics: experts
FDA to warn Viagra users of hearing loss
Effectiveness of most PTSD therapies is uncertain
Early intervention dramatically improves outcomes for new dialysis patients
Services for patients with BPD need to be improved say psychiatric nurses

Thursday, October 18, 2007

Everything old is new again

Yesterday’s news had two pieces about labour and delivery. Having just read the book The Birth House, by Ami McKay, these stories stuck in my mind.

For those of you who don’t know the book, it’s a good read. The story takes place in the early 20th century in a rural village in Nova Scotia (in the Canadian Maritimes). Dora, the main character, takes on learning midwifery from the village midwife when a doctor arrives, very sure that he has the latest to offer the suffering pregnant and labouring women of Nova Scotia. Along with the battle of wills that occurs, we follow Dora’s life.

The news stories yesterday reminded me of the book. While we can’t ever forget that maternal and fetal deaths are a very real part of life where medical care is unavailable or substandard, we also can’t forget that pregnancy and delivery are not illnesses. Most women have uneventful pregnancies and deliveries and would do well without medical interventions, with the guidance of an experienced midwife.

Now the medical community is beginning to realize that maybe some of their approaches aren’t as necessary as they insisted they were.

I’m all for improving labour and delivery. I think epidurals are a great thing for women who want them. I wanted them. I had them for each of my three but they didn’t work. Go figure. I’m all for having special places to have babies, be it a hospital or birthing center since you would be closer to medical care if an emergency were to arrive. There is so much about the available medical care that can and does improve maternal and fetal health, but one thing that we always have to remember is that healthy and normal pregnancy and delivery doesn’t have to treated.

News for Today:

Multiresistant bacteria that cause kids' ear infections discovered: study
HPV test beats Pap in detecting cervical cancer
Experts issue warning about egg freezing
Obese children show early signs of heart disease
Patients should ask surgeons about using honey to heal wounds
HIV Linked to Increased Risk of ESRD in African Americans

Aspirin -- just for men?
U.S. agencies stick to pregnancy fish-eating limits

Wednesday, October 17, 2007

Wednesday's news

I love Wednesdays for news because so many stories come out on Tuesdays. There is so much to choose from. I try to pick things that are not as clinical as interesting as they may be, but what I think my readers may find applicable and interesting.

Blood test predicts onset of Alzheimer's is interesting because Alzheimer’s is such a devastating disease. Of course, detecting it doesn’t mean that there is a cure, but it is a good step in that direction. Plus, researchers are finding ways to slow down the progress of the disease, so early detection would be a great plus.

Canada approves first new HIV drug in 10 years and Study examines AIDS patients in Africa seem ironic, to me, that they show up in the same week. It’s known how difficult it is for people in so-called Third World countries to get HIV medications and now we learn (although it’s not surprising) that many don’t take them as they should. Very sad.

This story A low prevalence of H pylori in HIV-positive patients was just interesting to me.

Now, I guess we shouldn’t be surprised with this story: Severely mentally ill at high risk for cardiovascular disease. I’m thinking of it from the point of view that a psychiatric illness must be stressful on the body – that was always my amateur take on this type of thing. I believe that psychiatric illnesses have a much greater impact on the physical body than the medical community has realized.

Potentially deadly staph superbug spreading faster than ever is an important story. We hear a lot about some problems that may never affect us, but this is a biggie. We need to be more aware of this. Interestingly, this story also appeared at the same time: Simple measures can reduce spread of respiratory viruses. Handwashing is our number one defense against spreading germs and getting sick ourselves.

Sometimes, the stories hit home because of issues that I’ve gone through or had. I’ve had a few gastroscopies so this story definitely caught my eye: Patients may have sweet and effective way to prepare for upper GI endoscopy: an anesthetic lollipop. I can do a lot of things without freaking, but I just can’t tolerate upper GI endoscopies. I have a very strong gag reflex and it’s not easy for me to imagine one of those scopes going down my throat.

A few others that were interesting because of professional or personal experience were these ones: Chinese herbal medicine may help relieve painful menstrual cramps, No evidence that insoles prevent general back pain, Stretching out does not prevent soreness after exercise, Don't routinely use enemas during labor, and Don't 'break the waters' during labor without good clinical reason, concludes Cochrane Review.

Most women who have had painful menstrual cramps can definitely understand the interest in such a finding. If you don’t get a good effect from the available treatments, it really is miserable having to experience that cramping every month. The story about insoles is interesting. As a nurse, I have that age-old nurse problem, a sore back. I never thought of trying special insoles though.

Now, the stretching story really caught my eye because I’d read that before. And you know what? Even though they have the findings, I have to disagree with them. I know that if I do any type of exercise, be it on my elliptical, raking leaves, shoveling snow, or golfing, and I haven’t stretched first, my muscles hurt. However, if I stretch before (and after if I think of it), there is minimal, if any, muscle pain.

The next two stories about labour are also interesting. I thought that they didn’t do enemas to labouring mothers any more. I guess I was wrong. As for breaking the water – that one makes a lot of sense because we really should be limiting any type of medical intervention in labour and delivery unless it is really necessary, in my opinion.

And that is the news for today!

Tuesday, October 16, 2007

Shingles vaccine available

A vaccine for shingles: People over 60 should get shingles vaccine: CDC – do I ever wish we had that two years ago and that I was targeted for it, even though I'm still a good number of years away from 60. In May 2005, I was 44 years old and I had the unfortunate experience of having shingles. I didn’t even know what it was until it was too late to do anything about it.

Luckily (?) for me, the shingles were around my belt line. I know people who have had them on the face and suffered severe consequences because of it; all I had was a horrible itchy, painful, awful rash on the waist. I also didn’t realize how sick you could feel with shingles. I thought it was just a rash thing, but it really does affect your whole body.

There are some misconceptions about shingles so let’s see if we can clear up some of them.

First, the medical term for shingles is herpes zoster. The virus itself is from the chicken pox. If you have not had chicken pox, you can’t get shingles. This is why so many people are proponents for the chicken pox vaccine, particularly from those of us who have had shingles.

Once you have had chicken pox, the virus lives in your body for the rest of your life. For most people, the virus lies dormant for that entire time. For some, it flares up, particularly in times of stress – either physical or psychological. This flare results in shingles. It used to be that if someone younger than 60 had shingles, doctors worried about cancer or some other immune deficient illness because it does happen if your body is under stress.

Although having shingles more than once isn’t common – it can happen.

The signs of shingles are very typical. The rash starts with tiny round plaques, spots that can be itchy. Some people feel a burning or itchy rash along the area before the spots begin. The virus follows the nerve path as it leaves the spine – therefore you have will have the rash on one side of the body, but not on the other. The plaques begin to blister and then crust over.

Shingles is and isn’t contagious. If you haven’t had chicken pox, someone with shingles can pass the virus to you and you will develop chicken pox – not shingles. If you have had chicken pox, you cannot catch shingles from someone who has it. However, once you have had chicken pox, you always have the potential of developing shingles. The contagious period covers from the time the blisters start to form to when they are crusted over.

People who catch shingles early enough may benefit from anti-retroviral medications, but otherwise there isn’t much that can be done. Standard pain relievers may be recommended by your doctor.

The strong push towards vaccination against shingles has more behind it than just wanting to prevent the discomfort of shingles. Some people who have shingles develop post-herpetic neuralgia after the rash has healed. This is a painful, deep, nerve pain that continues along the route of where the shingles rash was, although there are no longer any lesions or signs of a rash. This pain can range from bothersome to debilitating.

I have to admit, I never really thought about shingles and how it may affect someone until I had the misfortune of having it. Oddly enough, once I had it, I learned of so many more people my age who also had it.

News for Today:

Omega-3 foods differ in health benefits: experts
People over 60 should get shingles vaccine: CDC
Online autism videos used as guide for parents
Racial and ethnic differences in colorectal cancer emphasize importance of screening
2 studies highlight the risks and significant health-care costs of NSAIDs injury
Researchers warn that gastric bypass surgery may cause post-op nutrient deficiencies
New studies reveal that night-time acid reflux can impact sleep
Obesity strongest risk factor for colorectal cancer among women; greater than smoking
Once-a-day epilepsy drug is effective for partial seizures

Monday, October 15, 2007

Using pain scales to rate pain

Ever wonder how some people can walk on a broken ankle while others feel the slightest bump and bruise? Why some people can manage without many pain killers after surgery, while others can barely move around without as much as often as they are allowed? Pain is very subjective. Pain is how everyone perceives it to be, and we all perceive it to be different.

Those differences make it very difficult for nurses and doctors to assess a patient’s pain. Not only do they have the differences among the patients, they have their own interpretations of pain. So, how can we tell if a patient is having severe pain and if the pain is relieved or not? We use pain scales.

If you've recently been in the hospital or visited an emergency room with severe pain, it's likely you were asked to rate your pain on a scale of 1 to 10 or 1 to 5. Usually, a response of 1 means virtually no pain and 5 (or 10) is the worst pain imaginable.

Let’s say that you rate your pain as an 8, quite bad. You are then given some pain medications and after the medication has had time to work, your nurse asks you again what your pain scale is. If you answer "8," then we know the medication hasn't helped you. If you answer "4," there was some effect from the medication. If you answer "1," then the medication was fairly effective.

Because you are using numbers instead of descriptions (pain is awful, pain is better, pain is getting worse), every nurse or doctor reports it back the same way, with the number. This gives the whole staff a good reference to work from.

Scales can also be used for children. The Wong-Baker Faces Pain Rating Scale uses facial expressions for children to indicate what their pain level is. Other scales use numbers of items like balloons - 1 balloon means little pain, 10 balloons means severe pain, for example.

News for Today:

FDA approves anti-AIDS pill from Merck
More than 90,000 products pulled in U.S. for unsafe lead levels
Childbirth deaths down slightly: UN report
Cigarette Smoking May Accelerate Disability in Those with MS
Kidney Disease Treatment May Harm Patients
Drug Derived From Chili Peppers May Reduce Acute Pain After Surgery
Expecting an afternoon nap can reduce blood pressure
1 in 5 bariatric surgery candidates not psychologically cleared for surgery
People overestimate their self-reported sleep times compared to measures by a sleep test
Study: Modafinil is effective in treating excessive sleepiness
JCSM: CPAP therapy improves symptoms of depression in OSA patients