Closing Time

It's time to go.

NewFNP has really enjoyed this blog over the last almost-six years, but it's time to move on. The blog will stay up and the email address will stay active so if you have a question for newFNP, she will happily respond.

Thank you all for reading and writing. Keep fighting the good fight.

Boola boola motherfuckers!

NewFNP out.

POP!!

NewFNP has previously discussed the lady scourge of urinary incontinence. Kegels, ladies, kegels!! But what newFNP hasn't talked about is the sister scourge of pelvic organ prolapse.

NewFNP is super content to leave her lady-junk all up in there, where it's supposed to be. Except the parts that are supposed to be outside. They can stay there. NewFNP is just saying this -- a reasonable expectation for aging is to keep all yo junk in its O.G. spot. Let's get Suzanne Somers to work on this one with her team of experts!

Because when innies become outties, that is not so good.

What makes newFNP think of this on a lovely Sunday is a patient who came in with a chief complaint of feeling something falling out of her vagina. This is the second CC of this nature, but as this patient was in her 50's and was not in the post-partum period, newFNP was certain that she would not find any form of placental treasure upon examination.

What newFNP did see was a fairly obvious cystocele-rectocele combination platter. As newFNP's patient had mentioned that the sensation of fullness was more pronounced when she was using force, newFNP went ahead and had her patient give her a little Valsalva while in the lithotomy position.

Had newFNP been wearing 3D glasses, she might have had a heart attack. "Okay, stop!" she told her patient, fearful that she would deliver her uterus into newFNP's hands.

NewFNP quickly completed the OB/GYN referral and was ready to end the visit when her patient asked her, "Is that happening because I'm not having any sexercise?"

"Did you say 'sexercise'?" newFNP replied.

She had indeed.

Not so much a lack of sexercise, no, but her four >8 pound babies delivered vaginally might perhaps be a more likely culprit. (Or, in other cases, family history. Or obesity. Or hysterectomy.)

And swallow

The Friday before newFNP's grandma died, newFNP was scheduled to see a GI specialist to find out just what in the hell is up with her stupid esophageal pain. Of course, she cancelled that appointment and rescheduled it for yesterday.

NewFNP's handsome, young and friendly gastroenterologist didn't think that newFNP is having diffuse esophageal spasms at all. No, in fact, he thought that she is having eosinophilic esophagitis (EE).

Fucking allergies! This one newFNP blames completely on attending fancy grad school on the opposite coast from whence she hails and where she developed mother-effing food allergies.

Dr. Handsome thoughtfully wrote down a list of foods that commonly trigger EE: corn; gluten; dairy; shellfish; peanuts; and soy. Great. It's like the most anti-patriotic elimination diet ever! No corn? No wheat? No dairy? What's next? No Pledge of Allegiance? And no soy? How is newFNP going to get her salad protein??

Stating that he wasn't entirely certain, Dr. H offered to provide newFNP with an esophagogastroduodenoscopy -- biopsies and all -- to find out just what is the damned problem.

Now, newFNP generally doesn't let a guy put his tube down her throat at their second meeting, but for this guy, newFNP is going to make an exception.

End of an era

NewFNP said goodbye to her grandma this past Sunday. What a wonderful gift to have had her all these years and to have been able to take care of her in a way that honored her life and the extraordinary role that she played in newFNP's life. NewFNP and her brother were by her grandma's side as she took her final breaths and slipped away.

A very special lady, who taught newFNP the fun of shopping and girl time, who indulged newFNP's love of middle school reading with the entire Sweet Valley High collection, who slaved over newFNP's prom dress with her, who loved newFNP equally during her darkest hours and when she was shining her brightest, she will be missed and she will be treasured.

And she will always, always be loved.

Ho no she didn't

NewFNP was driving to work early this morning and it's possible that she didn't entirely have her senses about her. She was driving through an area that is known for being up to no good, but that's pretty routine for her so it was no BFD.

Readers of newFNP know that newFNP considers shopping to be as essential to her life as oxygen, George Clooney and the Sunday Styles. So when she saw a sign for "hoe-tique," she did a double take.

Hoe-tique?! Shitty neighborhood or not, it doesn't seem right that one could just walk in and buy a ho like that! Or maybe they just sell ho accessories such as short-shorts and thigh-high patent pleather boots.

Upon closer inspection, newFNP realized that the store was, in fact, a Shoe-tique but that the "S" had faded over time. Now, newFNP does love herself some new shoes, but she was a little happier when the store was the hoe-tique.

After all, new shoes are a dime a dozen. New hos are harder to come by.

Broken safety net

NewFNP has no problem with HMO's. This is quite likely because newFNP is generally healthy, is in the know, and -- in true newFNP fashion -- has her primary care provider through one of the best medical groups in the nation.

When newFNP went to her PCP and told her that she has been having diffuse esophageal spasms for two years and finally thought it was high time to get that mother-effing upper GI and quite possibly some esophageal Botox, she received her referral before leaving the office and had a specialty appointment twenty minutes later. The system is connected and coordinated.

If, however, you are newFNP's patient and you have a state-insurance funded HMO and you need specialty care, you are jacked.

Take, for instance, newFNP's 31st patient of the day last Thursday. Three months ago, she was told at another clinic that she was HIV-positive. She was told to get HIV care. Where to get that care? Apparently that was not a part of the discussion. Thus, this 32-year old woman showed up at newFNP's clinic stating that she heard we did HIV care.

We do not. Yet.

So newFNP picked up her cell phone, dialed a nearby clinic and handed her phone to the patient who proceeded to make the appointment. Only that clinic doesn't take her HMO.

Son of a bitch.

Yes, newFNP could have gone through the regular old system of giving the referral to the referral coordinator who would get to it as soon as she could given the extraordinary amount of work that she has. Then she would mail the referral to the patient. But the patient wasn't "trying to get no mail from an AIDS doctor" so that option was out. And frankly, this woman had been wandering around for three months out of care and that is just not acceptable to newFNP.

The patient got all of the details regarding the insurance switch she would need to make and then spent some time talking to newFNP about how she doesn't want the HIV meds to make her crave drugs again, about how she can't get state financial aid because she committed a felony while crack addicted and then cried for her diagnosis, for her situation, for her frustrations. NewFNP listened, acknowledged, supported.

She left the room forty minutes later -- five minutes before the clinic was scheduled to close -- and was told by a member of the support staff and HIV planning team, "I thought you were taking care of this!" To which newFNP replied, "What the fuck do you think I'm doing??!" As though taking the time and providing the care to this woman was unacceptable.

NewFNP was livid. And then she went and saw patient number 32.

Bootie-licious

Some things never change with newFNP. For instance, she will never stop looking for the perfect shoes to wear to clinic that are both stylish and comfy.

She found a near bulls-eye on a recent trip to Dolce Vita with her BFF but remarked that she would not want to wear her perfect suede wedge boots if her had to do an IUD insertion. One drop of betadine and that luscious beige suede would be ruined!! She swore that she would remove her new boots rather than take the chance at their being destroyed. After all, there are no surgical booties to cover newFNP's fashionable booties in her clinic.

So of course she headed to clinic last week with her super cute booties and was greeted with the news that the room was all set up for an IUD insert.

Balls!!

At first, newFNP felt a little awkward at the thought of removing her shoes for a procedure and, of course, she shouldn't take off her shoes at work. It's gross, for one, and her shoes offer her some protection from sharps and fluids and god knows what, for two. But fuck that! These boots are brand new and beige suede.

At first, newFNP followed that path of correctness and safety and kept them on, but tucked them under a drape. But she was nervous and couldn't go through with it.

When her patient was in the lithotomy position, newFNP quietly removed her booties and scooted them out of harm's way. The IUD insertion went smoothly and newFNP replaced her boots once the betadine was out of sight.

Thank goodness newFNP was wearing cute argyle socks that day! She would have hated for her medical assistant to have seen some of her B-list socks!!