Alpha-gal syndrome

I learn about new disorders all the time here in MRI. Normally I’ve at least heard the name of the disease or disorder before, or I know a teeny bit about it.

I have never heard of alpha-gal. At least, I’ve never heard the name.

Turns out, I have heard of the disorder before. I had a patient once tell me he was allergic to pork because of a tick bite.

Alpha-gal is a “sugar molecule found in most mammals (except in people, apes, and monkeys)” (CDC.gov, 2019). Turns out there is a tick (lone star tick) that can transmit the molecule in blood from the animal to humans. We humans don’t normally make the molecule but apparently we can make an immune response to it. If we develop an allergy then we can no longer eat meat from cow, pork, rabbit, deer, lamb, essentially the animals work hooves! The odd thing about it, and what makes it kind of hard to diagnose, is the fact that the reaction tends to take place 3-6 hours after the ingestion of meat. It’s hard for a lot of people to make the association between meat and their allergic reactions.

I found a good podcast about the disorder. Lots of information about how it works and the ongoing research around it.

One of the things I realized while looking further into the disease is how important it is to ask your patient about allergies. Alpha-gal is uncommon, however, patients with it can’t have certain medications. Heparin is typically derived from pork. Some insulin is derived from pigs and cows as well. There are quite a few medications that have porcine or bovine derivatives. A nurse would have to make sure to take this into account for their patient with this particular allergy.

Then again, when is the nurse not taking safety into account, right?

DiGeorge Syndrome

Have you ever heard of DiGeorge Syndrome?

I hadn’t until I had a pediatric patient with the diagnosis. So what is it?

According to the Mayo clinic, it’s a genetic disorder caused by the deletion of a section of chromosome 22. Patients tend to exhibit heart defects, cleft palate, weak immune systems, developmental delays, and behavioral problems.

I had the most adorable little 7 year old with DiGeorge. She didn’t have the cleft palates that is common with the disease but she did have cardiac issues. In fact, one of her ventricles was huge! She already had cardiac surgery before and it looked like she would need to have it again. Apparently she would be dealing with this for the rest of her life.

Working in radiology I come across at least one disease a day that I have never heard of. I like to look up the disease just for my own medical knowledge. Any diseases you’ve run across that you knew nothing about?

Preceptor behavior (how not to be an asshole)

I have been the orientee and I have even done a little precepting. I lucked out so far and had wonderful preceptors (except for one but anyway…) but I have seen some TERRIBLE preceptors.

One thing that I noticed from a few of the preceptors that I would definitely label as “assholes”, is that they take pride in being intimidating to their orientee. I have witnessed this behavior and have had other nurse confide in me about their preceptors after they were out of orientation. Some of the things I heard were appalling.

It is NEVER okay to make your orientee feel “dumb” or “stupid”. You were a new nurse at one time and you didn’t know everything when you started, you had to be taught as well. You know what else is not okay? It’s not okay to just leave your orientee to fend for themselves. You are not on vacation, you are responsible for teaching this new employee the ways of your unit. Get up and check on them, make sure that they are actually alright. STOP USING THE AMBUSH TECHNIQUE!!! For those of you that don’t know what the ambush technique is, let me fill you in on this bs. Basically what happens is the preceptor ambushes the orientee when they aren’t prepared for it and starts hammering them with questions of “things they should already know” in the eyes of the preceptor. Do I know the normal range for a CVP? Yes, I do. Do I know the normal range for a CVP when you show up out of nowhere, while I am catching up on charting on a patient that I just had to start on norepinephrine and give two units of blood? No, absolutely f*****g not! This does not mean I am less intelligent than you, it means I was focused on my charting and not expecting a nursing ambush! The ambush technique neither proves nor disproves someone knowledge, it just makes you look like a douche. While we are at it, stop making your orientee feel like they are bothering you when they ask you questions. They don’t know. You do. Spread the wealth of knowledge. Learn how to give constructive criticism and praise. A lot of preceptors seem to miss that last part. Your orientee is already paranoid and trying to be a close to perfect as possible. Let them know you notice the good things they do along with the things they may need to work on. Your orientee will be much more receptive of your criticism, trust me.

Look, i’m not asking for a lot. I am simply asking you to remember what it was like when you were orienting. Remember how stressed you felt. Remember how confused you were. Remember how intimidating it was. Remember that you aren’t perfect.

n00b

So you’re the newest person on the unit. You may not be new to nursing but you are new to this place. Don’t let that freak you out.

As the newbie I was always really quiet and reserved. What I didn’t realize was how off-putting that was to others. It never failed, once I got to know my coworkers they would all say the same thing “I thought you were so mean when I first met you!” For the longest time I didn’t understand why that seemed to be the case. You know me though, if I don’t know then I’m going to ask. That is when I found out that I sort of appeared unapproachable because of how I tended to distance myself from my new coworkers. I changed that once I started the new position I am currently in. This time I made a conscious effort to get to know my coworkers.

Here are a few steps to transition into your new work environment:

  • Introduce yourself to your new coworkers. If you know of a good ice breaker then use it (having the name Shaunelle but being called Fred is one hell of an ice breaker, everyone loves the story of how I got my nickname.)
  • If you are an experienced nurse understand this: your experience is much appreciated but you are the new nurse on the unit. Don’t walk around like you already know everything there is to know. You may know cardiac ICU but you don’t know how they run their cardiac ICU. Have a little humility (ran into this with a new coworker, she didn’t last long).
  • Don’t be afraid to ask questions. It is safer to ask than to assume you know what you are doing and then do it wrong. Your new coworkers will remember that screw up, trust me.
  • If you are a super proactive person, join one of the committees. You are bound to meet your coworkers that way.
  • Become familiar with your physicians and introduce yourself to them. Let them know you are new to the unit, I mean you will be working with them too.
  • Know that not everyone is going to warm up to you immediately and that’s okay. They may still be “feeling you out” so to speak. That is not your problem, that is theirs. They’ll either come around or they won’t. It’s not the end of your world. However, DO NOT allow bullying behavior towards you. You may be the newbie but you deserve respect and if they want it from you then they should earn it. Forget that “nurses eat their young crap”!

Those first few weeks, hell even first few months, are a weird time. You’re trying to adjust to a whole new setting. Things may feel off and that is normal. You may feel a little out of place at first, and that’s normal too. Give yourself time to get acclimated to your new surroundings, you are going to do great!