Happy CRNA Week 2024

Happy CRNA Week 2024

 

A lot has happened

The last two months

I moved to San Diego

Oh what joyous fun

 

A lot of changes 

for my family and for me

New preschool, grandparent help,

New workplace

 

A lot of things to learn

“Reprogramming” I’d like to say

Each NORA (Non-Operating Room Anesthesia) location

Different than the next

 

A lot of new people

More than double the CRNA staff

Plus anesthesia residents and attendings

So many new names to learn

 

A lot of new equipment

And locations of the equipment

And drugs. Where is it? Where is it?

Ah, it is over there

 

A lot of preops and postops

More digging through charts

Some healthier and some sicker

Like those with LVADs and single digit EFs

 

A lot of blood

Type and screen, type and cross

Pre-checked PRBCs, FFP warmed

Hourly ABGs

 

Since I’ve been ‘on my own’

It is getting better

With texting my attending

The first thing in the morning

 

It is so nice to get help

To start my ‘big’ cases’

Another CRNA to start my second IV

And another arterial line

 

No matter where you go

It is a work in progress

You try to find a better way

Everyday

 

As they say

You’re only as good 

As your last anesthetic

Keep striving, keep moving



Happy CRNA Week 2023 and the Importance of Previous Anesthetic Records

Every year in January, we celebrate CRNA week. Most people don’t even know we exist, what we do, or what we are capable of. Let me illustrate a story of how we make a difference everyday and the importance of the previous anesthetic record.

Last week, I encounter a patient that I’ve taken care of twice before (how likely is it amongst 30 CRNAs at the hospital that I get to take care of him 3 times in a row?). I was able to connect with this person and spouse quickly and go over the previous anesthetic record. Since I remembered how it took much longer from him to recover from anesthesia, I adjusted my anesthetic and he recovered much more quickly.

Another patient had a history of postoperative nausea and vomiting so I performed a Total IV Anesthesia (TIVA) and the patient wasn’t nauseous postoperatively.

Another patient had a true history of a difficult airway so we were able to perform a spinal for this particular case.

Another patient had a history of requiring a lot of vasopressors so a drip was used throughout the case and led to a smooth and stable anesthetic (otherwise known as railroad tracks, one of our favorites).

Another patient required extra TLC, explanations and a calming presence prior to the induction of anesthesia. Frequently how you feel going to sleep is how you wake up.

Another patient had a history of emergence delirium and that allowed me to provide additional medication to reduce its occurrence.

Many patients state that their previous anesthetic went well so you can repeat a similar anesthetic and expect it to go well, especially if it is a similar type of surgery or procedure.

As they say, you’re only as good as your last anesthetic. Every case, you find ways to improve your anesthetic technique and tailor the anesthetic based on the individual.

My One Month Postpartum Food Photo Journal: Day 3

Breakfast was oatmeal, goji berry tea, and a tea that helps with getting rid of lochia. We waited until 4 days postpartum to start the red blood cell production and decreasing anemia first. This tea is taken for 7 days daily.

For lunch, I had leftover soup from last night and added pork in.

For dinner, I had pork, eggs, bok choy, noodles and goji berries soup.

I started to feel more weak today compared for the first couple of days. I am resting quite a bit and I have to thank my mom mostly for making all this delicious food. This one month postpartum period is an important time for healing.

We are entering day 5 of life for my son. Colostrum has transitioned to milk. He gained 3 ounces in from day 3 to 4 reaching a low weight of 7 pounds. He does eat and poop a lot and his latch has been great so I really cannot complain. Since our first son had high bilirubin levels (thus his jaundice was above 20), he needed to go to the hospital for phototherapy. So far with the second son, his bilirubin levels are lower so it is unlikely that we will need phototherapy this time around!

My One Month Postpartum Recovery Photo Journal: Day 2

For breakfast, I had oatmeal again. There are berries, nuts, apples and banana. Great for milk production. There’s also a goji berry tea.

For lunch, I had a soup. It’s made with lotus root…

山藥 (shen yao) translated as yam but it’s not the same as a sweet potato.

Sparerib soup with red dates and seaweed.

For dinner, we used the same soup base and added lamb, tofu, and udon noodles.

My One Month Postpartum Recovery Photo Journal: Day 1

Dear journal,

I haven’t updated this website in a long time. Earlier this year, I got pregnant with my second child and I just had him a couple days ago. The labor and delivery took 12 hours from when my water broke and I had such a wonderful team of midwives and nurses to help me through the process.

From my first birth, I wanted to write about my first month’s postpartum recovery period where my mom prepared intentionally selected foods to help with recovery. A lot of things I never knew and thought it would be interesting to share. I plan to show pictures and the rationale for the foods I eat throughout this important recovery period.

Today was my first full day home with my newborn. For breakfast, I had oatmeal, eggs and zucchini. Oatmeal is a good source of iron and help with red blood cell production. It is also good for increasing milk production. My mom added in some nuts (almonds, cashews), dried fruits, banana, and blueberries.

For lunch, I had sea bass soup. My mom went to the Asian grocery store and bought a pound of live sea bass. Sea bass is good for healing wounds. For me, I had a first degree tear and received 3 stitches. This will help heal my wound faster.

Also, there’s tofu for protein and goji berries. Goji berries have several benefits including it is high in antioxidants, improved vision, more energy, lowering of bad cholesterol, increased energy, better sleep, weight loss, improved hair thickness and luster, and less dryness. Goji berries also may help fight depression. It is also great to put goji berries into some hot water to let it open up and drink it like a tea. It is slightly sweet.

My mom also added white cabbage for vegetables and less “flavorful” so it does not taint the taste of the breast milk. It is also advised to not add too much spices (including pepper).

For dinner, we continued to use the same fish soup base and added lamb. Lamb has heme iron, which is easier to absorb and help with the anemia associated with childbirth. Lamb also has zinc, which is vital to maintain an optical immune system, wound healing, DNA and protein synthesis.

If you noticed, everything is soup based. Hydration is incredibly important to maintaining breast milk, which is the primary food for the newborn.

Today I felt great. I’m not sure if it’s because I got stitches this time for a first degree tear so I’m not nearly as painful in my perineum area. Or maybe it’s because I’ve had experience and systems in place at home already. Or if it’s because I’m so glad that my newborn is able to latch well today (and not cause a bleeding nipple). Anyways, see you tomorrow.

Happy CRNA Week 2022

It’s 2022 and we are entering our third year of the pandemic. Omicron is ravaging the country. In Michigan, it’s currently plateaued at 1600 new cases a day. At my hospital, we haven’t completely stopped surgical cases. We are canceling cases due to the nursing shortage. There aren’t enough nurses to watch the patients after surgery overnight. There aren’t enough nurses to monitor patients in the ER, med-surg, ICU and PACU. There are overtime mandatory hours. Nurses are asked to work 20 out of 24 hours. How can that possibly be safe? Is it simply getting out of hand.

What we need to have is an appropriate nurse to patient ratio. The frontline nurses who have too many patients are bound to miss something in the patients’ care and that could be your mom, brother, child. In California, it is mandated at every hospital to have a certain nurse to patient ratio depending on the type of care rendered. The result of this is having more nurses hired who can provide the care necessary for the patients. Why can’t that be in every state?

Some may argue that would close down more hospitals because there aren’t enough nurses. However, that is furthest from the truth. There are more registered nurses now in the USA than ever before and yet we still have this nursing shortage.

Proposed Federal RN to patient safe staffing ratios https://www.nationalnursesunited.org/ratios

This nursing shortage exists because nurses are burnt out and the hospital doesn’t want to pay for more nurses. The hospital administration knows that nurses cannot take care of too many patients and yet they ask them to. They keep hoping new nurses come to replace the retiring nurses. There are more people applying for nursing school now than ever before. When you are chronically overtaxed with patients, you know you aren’t providing the best care that you can. You start to perform sub-optimally, and that eats away at your soul. It gets to you emotionally and physically. It happens to the nurses who want to provide great care but they aren’t able to because there is just too much to be done in a safe manner. If you’re constantly being asked to provide care that isn’t up to standard, you will become demoralized and burned out.

If there is less burnout amongst nurses, more nurses would stay in their career and continue to care for patients. It is satisfying work to care for patients but when it starts to negatively affect nurses, they will make a jump to retire early or go into another career.

Just remember, when you enter a hospital, you are depending on the care of the watchful nurse to ensure your treatments and monitoring for changes. Without appropriate ratios, the nurses can no longer do their duties to the best of their abilities and things will get missed. And that can be the difference between life and death. Is that really fair if it was your loved one?

I think this is the year to ask our state legislators to make a change to get safe staffing ratios. This will make a life and death difference. Thanks for reading.

This last 8 months of 2021 has been difficult, polarizing, and changing. At the beginning of this year, I got the Pfizer COVID-19 vaccine and thought everyone would eventually get on board with getting the vaccine and ready to cull the pandemic to its end.

People were going across state lines where less people were getting the vaccine. The rush to vaccinate began in the USA.

Then I heard chatter amongst my colleagues. People were scared to get the vaccine. A lot of misinformation was and is still out there. They hear about the cases where people got bad side effects. They weren’t going to chance getting the vaccine. They would rather get the virus and brave the disease process and treatment. While many survive, many also maintain “long covid” symptoms such as the loss or reduced smell or taste.

Finally, the rush to vaccinate had subsided and those hesitant to get vaccinated began to say “how could you want an experimental drug, I’m not a guinea pig.” The institutions were not to be trusted— only their “sources” would reveal the “actual truth”.

At the end of June, my hospital decided to implement a vaccine mandate by September 10th, based on the belief that the vaccine would pass FDA approval (and no longer under emergency use authorization). Of course there are medical and religious exemptions.

Since then, protests occurred in the name of freedom. People quitting, going into a different field away from healthcare. Others quit to become a “traveler” where in healthcare you could make 2-3x your regular wages. Nurses becoming jealous of those with big sign on bonuses and thinking of wanting some of that too.

Many religious exemptions were made. Personally, I’m not sure if it is to keep the staff or if there are truly that many religions that are against vaccines. What religion promotes transfer of diseases? When you know a way to protect yourself, adding a layer of armor against something, wouldn’t you want it to help yourself fight?

About a week ago, the FDA approved the Pfizer vaccine. The excuse to not get the vaccine changed again. Did it really encourage those people who were hesitant to get the vaccine to get the vaccine? I hear many say the government pushed them too fast to get it approved. Basically, why trust the government.

Right now in Michigan we are lucky to not have a big surge, unlike in Florida. We are lucky to be “business as usual” without delaying surgical care to patients. We don’t have a huge influx of covid patients and for that I am thankful. We are starting to get a few more covid positive cases compared to the last few months. I sincerely hope with the start of the new school year that everything stays the same. But I highly doubt that. More people will get sick. Sure there’s treatment for it but isn’t it better to take measures to prevent getting a disease?

Starting in September, we will see what will happen. Until then…

As for my little one, I feel fortunate to have pumped /breastfeed for one year. But I am also happy that he readily accepts whole milk and doesn’t mind (too much anyways) that it’s only bottles now.

I can’t believe he’s already 15 months old. He’s running around, bounces up and down to music, climbs furniture more readily, goes up and down the stairs, understands quite a bit of what I say to him (even in Chinese!), points where he wants to go or do or eat, and says a few words. He loves the water and can’t wait to jump back in the water again. It is such an amazing journey.

The storms are getting bad, with my parents losing power for 5 days. I am seriously considering getting solar with a battery backup.

That’s it for now.

Happy CRNA Week- How to have a happy breastfeeding and pumping CRNA

Disclosure: I share some affiliate links below of products that I personally use. If you purchase I may earn a commission. I only share products that I really enjoy using and hope that it’ll help you too.


First of all, happy CRNA Week. Today I’d like to talk about how to have a happy pumping CRNA.

Before I became a first time mom, I really had no idea what breastfeeding and pumping entailed. It’s not really talked about anywhere online especially regarding those working in healthcare and how they managed to work and pump. Now that’s been more than 8 months, I’d like to share my experience to encourage new moms to continue their breastfeeding journey once they return to work.

It’s good to share than the American Academy of Pediatrics reaffirms its recommendation of exclusive breastfeeding for about 6 months, followed by continued breastfeeding as complementary foods are introduced, with continuation of breastfeeding for 1 year or longer as mutually desired by mother and infant. Personally, I set my breastfeeding goals to the first month, then 3 months, and then every 3 months to one year.

What I’ve discovered that the breast pump represents freedom from the baby and the ability to still provide the best and complete nutrition for your baby. You don’t need to have your baby attached to your hip to be a good breastfeeding mom. The breast pump gives you freedom to express milk whenever you want and it is not dependent on when the baby is ready to eat or if the baby has trouble latching. Also in the beginning, nipples take a beating (boo… I highly recommend Motherlove Nipple Cream and Lansinoh Hot/cold pack and Ameda gel pads especially for the first week or two) from breastfeeding so pumping gives your nipples a break.

Ever since I got back to work, I’ve had the support of my colleagues and family and the opportunity to continue feeding my baby breast milk. I have to be thankful for the positive nursing culture and a built-in system in the surgical department. That really is key!

It is super helpful to have supportive CRNA leadership, especially from someone who’s done it before. It’s also helpful to have an understanding from all the other CRNAs who can give me a little extra time to pump (getting a 20 minutes break instead of the usual 15 minute breaks).

For me, I take 10 minutes to pump. 5 minutes to clean my pump parts and use the bathroom. 5 minutes for walking to and from the pump room and getting my cooler bag. However, some moms may take more time to pump, usually up to 20 minutes.

My cooler bag from RTIC includes:

In addition, I just wear my nursing/pumping bra to reduce the time that I have to put on and take off a specific pumping bra. I love the one from Kindred Bravely.

When I get to work every morning, I write down my pumping times on the assignment board so that someone can get my pump break at those times. Breastfeeding is a matter of supply and demand and requires you to pump at least every 4 hours to maintain your supply throughout the day. It is extremely helpful to try to maintain this. It is ok to seldomly miss it but not on a regular basis. Otherwise your supply will take a hit.

Anyways, I try to pump at 5am, 9am, 1pm, 5pm, 9pm. However I do adjust my schedule and move it one hour earlier to accommodate the OR schedule. For example, at 5am (at home), 8am, 12pm, 4pm, 8pm. Many moms will try to pump around the same time she would feed her baby.

Having a dedicated private pump room that is close by to the OR is extremely helpful. When the pump room is far away, it takes so much more time to walk there and back, which cuts into the pump time (and every minute counts!). Also, when there are more than 2 pumping moms in the same unit, it is extremely helpful to have additional pump rooms available nearby. The reason is that frequently, pumping moms will have a similar pump schedule. Our unit has multiple pumping moms. We started with one room when I returned to work 5 months ago. Now we have 4 private pumping rooms near the OR. This will ensure timely pump times.

Here are “must haves” to a private pump room:

  • A lock to lock the room or curtains to separate the space in a large pump area
  • Private room with no windows or a screen if the room has indoor windows so no one can peek in
  • A table large enough to put all the pump bag and supplies (for example, a bedside table typically found in hospitals)
  • Chair where your feet touches the ground
  • Trash (housekeeping should empty this daily)
  • A whiteboard and a dry erase marker for the outside of the door when there’s more than one pumping mom to indicate the estimated “out” of the door time so the next pumping mom knows when the room will be available. It’ll help her decide to either wait for the room or try to find another room.

Here are “nice to haves” (but you can have workarounds):

  • Sink to wash parts
  • Paper towel to dry parts, clean off sink and pump area
    • Workaround: Use the wipes from above
  • Mini-fridge to keep the milk/breast pump parts cold
    • Workaround: get a cooler bag and place an ice pack in there. Or put the whole pump bag or just the milk bottles into your work refrigerator (but it may take more space)
  • Nice ambiance conducive to a relaxing environment. Stress decreases milk production so thinking or looking at pictures of videos of the baby helps
  • Extra pumping supplies. If the hospital already has a mother/baby unit that has a hospital grade breast pump, having this extra set is extremely helpful when something breaks (your own breast pump, parts) or is missing (you forgot to pack it!).
    • I always keep a manual breast pump (the hospital gave it to me after giving birth before I left for home) in my locker for those “just in case” times. I’ve used it several times and I could actually empty one breast in 5 minutes but it definitely requires using one hand to pump and the other to manually pressing the breast towards the nipple to empty the milk ducts.
  • Snacks such as lactation cookies- breastfeeding requires an additional 500 calories a day. Moms are feeding for two!

Whenever possible when I’m home, I’ll directly nurse the baby. Once you get the hang of breastfeeding, I find it to be easier than exclusively pumping. However, there are definitely pros and cons to both.

In conclusion, having a happy pumping mom at work is so vital to prevent burnout and help moms do great work and feed her little one. Having a private pump room close to the OR and a respected pump break time helps immensely.

If you’re a potential or current pumping mom, what would or has made your pumping journey easier?

If you’re in management, what can do you to implement a better pumping culture to reduce burnout for new pumping moms?

One week after the 2nd COVID-19 Vaccination

It’s been one week since I received the second Pfizer COVID-19 vaccine. I didn’t feel as fatigued compared to the first shot. However, the injection site became red, swollen, hard, warm, itchy, and painful starting on the second day.

On Day 4 after the 2nd Pfizer Vaccination Shot

It peaked on the 4th day where you could see red streaks and it got to be about 2 inches in diameter. After work, I went to my primary care physician to have her take a look at it. She said it was unlikely to be cellulitis since they clean off the site with an alcohol pad and used a clean needle. She said it looked more like a strong local immune response to the vaccine.

That same day, I started taking Tylenol, iced it, and rubbed some hydrocortisone 1% on it. I just went to my local CVS to purchase some. I also rubbed some Nature Republic aloe on it.

By the fifth day, the injection site started to decrease in size and became less tender.

Day 8 after the 2nd Pfizer Vaccination Shot

Today is now day 8 and while it is still slightly tender, it is in much better shape now.

Even though I had some side effects, it beats the unknown effects of COVID-19. While I’m unlikely to die due to my age and comorbidities, there is still a possibility of getting sick and worse– passing the virus to my loved ones.

I hope when the vaccine becomes available to you, you make the plan to get it. If you’re concerned about it, chat with your doctor about it or feel free to reach out to me. Do your part and get vaccinated!!

Happy New Year 2021

I’m so glad that it is the new year and that 2020 is over. We have two approved, highly effective COVID-19 vaccines and vaccinations are on their way.

Next week I’m getting the second of two vaccine shots. I felt fine the first day besides a little arm soreness. The second day I felt fatigue, a slight headache and my arm was still sore. By the third day I felt much better. Since then (2 weeks now), I’ve felt fine.

It was a tough decision especially since I’m still breastfeeding and there were no clinical studies on that population yet. While there is unknown data for nursing women for this vaccine, there is plenty of data for providing immunity for our babies through our breast milk and it’s partially due to vaccines. Currently my baby is still doing just fine and progressively developing.

After weighing the risk vs benefits, I believe that the benefits of getting the vaccine outweigh the risks of getting COVID-19.

After speaking with some skeptics, I’ve countered some of their arguments below.

While we may not know the long term consequences of the vaccine, I do know possible long term consequences of COVID-19– neurological changes, difficulty breathing, and death for already over 330,000 Americans. I’m ready to have a 95% effective vaccine protect me from getting COVID-19.

While we may not know how long the immunity will last, I’m ready to take another booster shot if it means protecting my loved ones and anyone I come in contact with.

While we may experience worse side effects from this vaccine compared to other vaccines, I’d rather get known side effects than the potential unknown of how COVID-19 would affect me or others around me.

While this new vaccine development seemed rush, I also know scientists have been studying mRNA vaccines for YEARS, this vaccine has gone through rigorous testing, and the mRNA does not enter the nucleus of a cell and change the DNA. The mRNA provides the blueprint to make the spike protein found on the virus so our body can start making antibodies against this virus.

While there is currently no data due to a lack of studies to suggest a reduction in transmission of COVID-19, most vaccines do reduce the viral load buildup since you are much less likely to get sick. With a decreased viral load it would ideally be more difficult to pass the coronavirus. To suggest that getting the vaccine still would not protect those who haven’t or can’t get the vaccine is just unfounded.

I feel so relieved to be at the beginning of the end. I can’t wait for the pandemic to be over. I can’t wait to experience freedom from masks again. To go back to seeing friends and family, to traveling, and to eating at an indoor restaurant again.

While I know getting the vaccine seems scary, for me, NOT getting the vaccine is even scarier. If you’re ready to go back to any resemblance of normal again:

Be part of the solution, not the problem.

Protect those who cannot get vaccinated by getting vaccinated when the vaccine is available to you.

So here I am. I decided to borrow a book called “Dare to Lead” by Brene Brown. In there, the author discusses how on the flip side of courage is fear. And I definitely feel that. Fear that other people will judge me or think negatively towards me due to me speaking out. Sometimes it just feels easier to stay quiet and not make any waves.

But while we can’t be right 100% of the time, we can try. And we can keep trying to do the right thing. Just like in Frozen 2, when you’re feeling sad, you just have to do the next right thing.

The next right thing is to make a plan to get vaccinated when the vaccine becomes available to you. Let’s end this pandemic.