The Goeckerman Program

While I'm at break at work, I thought I'd explain a little bit about what I do. In our outpatient dermatology department, we work primarily with psoriasis and dermatitis patients. In a nutshell, I work with tar, ultraviolet lights, and maggots (more on the maggots at a later date!) Our psoriasis patients go through a rather rigorous 21 day treatment program called the Goeckerman Program. They are typically admitted as an inpatient and receive 24 hours of wet dressings. We put steroid creams on their body which help to reduce the itching and inflammation. Then we wrap their body with wet gauze (the solution can be medicated) and then we cover the wet gauze with soft dry blankets called bouies. At the end of our "wrapping session," they look like mummies. The patients stay in the wet dressings for three hours when they are an inpatient, and we decrease the length to two hours when they are transitioned to outpatient. Once they are an outpatient, these patients are tested to a small amount of tar on their body to make sure they don't have a reaction. They are also tested to 5 different doses of ultraviolet B light (UVB). Here is a typical schedule for them for the day:

7am - Oil - We put Wesson cooking oil over their body and wipe it off with soft paper cloths. The oil helps to moisturize their skin and remove the tar in preparation for lights.

7:15am-7:30am - UVB lights - We have a special lamp called a Hot Quartz lamp to emit the light. When I work in the light room, I wear a 65 SPF sunscreen and usually have to reapply after lunch because we are exposed to quite a bit of light. Depending on their skin type and their light tests, we generally start their light treatment dose anywhere between 2 seconds and 13 seconds. We expose each body part separately in order to maximize the benefit of the light. At the beginning of the 21 days, they are only in the light room for 15 minutes, but at the end of their treatment program, some patients can be in the light room for over 2 hours!

7:30am -8:00am - Tub bath - After the light treatment, the patients soak in the a tub with a special bath oil for 30 minutes. Patients really enjoy this part of the day because they finally feel clean!

8:00am-8:15am - Shampoo - Psoriasis can often times affect the scalp, so we shampoo their hair to remove scaling.

8:15-8:30am - TAR!! - After their shampoo, we put tar which is mixed in a petroleum base (Vaseline) all over the patient's body. The tar is black and has an odor, but all of us nurses are pretty immune to the smell. Since the tar stains clothes and is very messy, we provide cotton pajamas and a sweat suit for them to wear.

8:30am - 8:45am - Scalp Treatment - Once the tar has been applied and the patient is dressed, we put a medicated solution in their scalp to decrease the scale, inflammation, and itch. This is a typical schedule for the psoriasis patient's in the morning. They will return again in 4 hours for a "Tar Smear," where we will again do another application of tar. And then they will return again in 4 more hours for another tar smear and another scalp treatment. This completes their day and they will return the next day for the same routine.

Dermatology isn't covered very much, if at all in nursing school. Maybe I missed that day... I've learned so much and I've really come to love this patient population. The patients are absolutely wonderful and because they are here for 3 weeks, we become their "second family." They are appreciatve of anything we do, especially on a day like today - Thanksgiving - when many patients are away from their families. Today, one of my patients bought Amaya a beanie baby turkey - "Gobbles" - to celebrate her first Thanksgiving. Working on the holiday makes me thankful for my job and also thankful for my health.

Happy Thanksgiving!

What I'm most thankful for is that Amaya's fever is officially gone! After 5 days of giving Amaya tylenol and ibuprofen like candy, snuggling her to no end, and lots of naps, she's finally recovered. And just in time to celebrate her first Thanksgiving with her Grandma and Grandpa Horning, her Aunt Debbie, Uncle Paul, cousins Emily and Brian, her Great-Grandparents, her Great Aunt Janet and Great Uncle Chris and more! That's a lot of love to go around!

We're so thankful our families. While having dinner last night, Grandma Horning looked around the dining room table and said, "We started off as a family of four. Now we're 1-2-3-4... 9! Amazing! The Gustafson clan is now... 16! AND... (Carol - now that you've sent out your Christmas cards and made your announcement, I can finally blog about your exciting news!) ... We're expecting another NIECE OR NEPHEW in MARCH!! (Actually we know the gender, but we're sworn to secrecy). Steve and I love being an aunt and uncle and can't believe that we will have 10 nieces and nephews! That's pretty amazing! We have so much to be thankful for!

We hope everyone has a wonderful Thanksgiving!

Two Babies!

A couple weeks ago or so, when the Gatzke and Gustafson families were visiting Grandpa and Grandma Gustafson, Jan took this picture of me holding Amaya and Miles (Amaya's cousin).

It was pretty funny... whenever I would hold one baby, the other would crawl over and want to be held too!

Mirror, Mirror, On The Wall...

Amaya LOOOOOOVES looking at herself in the mirror, putting her mouth on the mirror and smacking the mirror with her hands. I think she likes seeing the smiley baby in the mirror!

In all 3 pictures below, Amaya is standing on the counter in the upstairs bathroom while holding on to my (Steve) hands.

Grandpa H. and Amaya

It was actually Grandpa H.'s birthday, but we spent most of the time being entertained by Amaya. In the first three pictures below, Grandpa H. is showing Amaya how to rip off the wrapping paper from one of his presents. Once she got the hang of it, she enjoyed it immensely.




These next two pictures are after Amaya tore all the paper off the present, opened the box (with Grandpa's help), and began playing with the tissue paper that was in the box.

Grandma H. and Amaya

For some reason, Amaya likes mouths. She has always been fascinated with them. Maybe all babies are this way at some point in their development?

As Promised...

...here are the pictures of me raking earlier this fall.

Poor little girl...

Last Thursday night, Jan's mom called us and said that we probably shouldn't bring Amaya over the next day because Paul (Jan's dad) was not feeling well. He had a fever...

...the next morning (last Friday) when I lifted Amaya out of her crib I noticed that she felt really warm to the touch - almost hot.

I took her temp - yes, there - and it was 102! I took it throughout the day, and at its highest it was 104. Jan called the Mayo nurseline (when Amaya's temp was still hovering around 103.7) and the nurse said that we should take Amaya in if her temp ever reached 104. It did, so off we went to the ER at about 6 p.m. After a nice long wait, we saw the doctor and she ruled out an ear infection or a UTI. The doctor said it was viral, and it would eventually pass on its own, but to keep an eye out for other symptoms.

As of today, her temp is hovering around 100. It's been a little difficult to get her to eat solid foods, but she nurses fine and drinks from her sippy cup just fine... so we're not too worried - yet.

It's 4:00am!

When I'm scheduled to work the 6am shift, my alarm clock typically goes off at 4am. What I realized this morning is that I absolutely CANNOT hit the snooze button. This morning, I hit the snooze and because of this, I nearly missed the shuttle bus! Thank goodness Dave was driving this morning because he waited for me!

I've been at Mayo for 8 1/2 years and still don't have downtown parking privileges. I was told that after 10 years of service, I should be able to park downtown. (I'm not holding my breath.) So, I have to be out the door by 5:15am to get to the shuttle lot at 5:25am to catch the 5:30am shuttle. He comes around again at 5:45am, but then I'm a few minutes late for work. What should be a quick commute to work since we only live a few minutes from the hospital, ends up adding nearly an hour to my work day.

Now that I've griped and complained about being up so early, I also get to leave work at 2:30pm! I love this part of working the 6am shift! And, the doctors don't show up until 10am, so I'm able to get so much more patient care done before they arrive. I can get our unit and patient rooms organized the way I like and ready for the day. It's a little eerie walking around the Mayo and Gonda Buildings because I'm literally the only one around, but I walk right past our friendly security office.

I really enjoy the variety of shifts and also being able to work between two different areas: Outpatient Dermatology and the Ultraviolet Light Phototherapy Unit. Well, I suppose... back to work...

The Bjorn Again Experience

For those of you who are thinking "Bjorn who?" or maybe even "ABBA, what's that?" when reading the previous post, here is a link:

The Bjorn Again Experience

And a link to ABBA

Enjoy!

SURPRISE!

Yesterday afternoon, after a frustrating hour and a half, Amaya absolutely REFUSED to take an afternoon nap. I had Bible Study in the morning, so she got a shortened morning nap, and I thought that she would be wiped out this afternoon. When I put her down, she was stomping her feet in the crib - of course screaming at the top of her lungs. I tried rocking her, I tried laying down with her on the couch, tried walking her around. After 30 minutes of frustration, I thought we'd give up on the nap and play. While playing, she was whiny, rubbing her eyes, yawning... grrr... So, back to the crib - more stomping and screaming. Back to the rocker, the couch... that's it! Mommy is not a happy camper and neither is Amaya. Daddy to the rescue!! Steve arrived home and I told him that he was on "Daddy Duty" for the rest of the evening and that Mommy just needed a break.

After we ate supper, I thought we'd do some retail therapy and shop for Christmas presents (we're halfway done!). Somehow it was taking us FOREVER to get out of the house! At 5:55pm, I'm ready to get our coats on, buckle Amaya in her carseat, and with shopping list in hand, Steve says, "We have to wait five more minutes for a surprise." Surprise?!? I looked out the window and see Grandma and Grandpa Horning to the rescue!! Yahoo! Surprise date night! (How sweet of Steve to call his parents and ask them to watch Amaya after I had a rough afternoon with her.) Little did I know, Steve kept this night SECRET for TWO WEEKS!!!

We said our goodbyes, and while in the car, I asked Steve a billion questions - where are we going? Do I need my shopping list? Are we going to a movie? Are we going to the Cities? Am I dressed appropriately? Are we going out for dessert? Are we going to see Bjorn Again (an ABBA tribute band)?

I was fairly certain we were going to the Civic Center to see a concert, but I couldn't remember when Bjorn Again was coming to Rochester. When we got downtown and parked, there is a sign outside of the Civic Center listing all of the upcoming concerts. I saw Oakridge Boys run across the screen and said, "Oh, please not the Oakridge Boys!" And then "Winnie the Pooh" flashed across the screen. I never did see the listing for Bjorn Again, but when we got inside there were signs directing us to the concert.

We had a blast! Steve did an amazing job keeping it a secret and it was a great surprise! It was amazing how similar they were to the real ABBA - not only in voice, but in mannerisms, dance routines, humor, and costumes. Bjorn Again sang all of my favorites: Fernando, Mama Mia, Take a Chance on Me, SOS, Waterloo, and Dancing Queen. I shouldn't have been surprised concerning ABBA was around in the 1970s, but there were people in their 50s, 60s, and 70s! I felt like I was the youngest one there! Anyway, it was a great date night and a much needed break! Thanks Steve and thank you Grandma and Grandpa Horning for being co-conspirators!

Climbing Stairs and Hide-and-Seek!

I've broken my record! I shocked Mommy today and climbed all 20 of our stairs! I started out in the basement after watching Baby Einstein World Animals, and worked my way all the way to the top! Yay me! I was panting pretty hard when I reached the top, but it was worth it. I wanted to go back down the stairs, but Mommy wouldn't let me (maybe tomorrow).

Mommy also taught me a new game: Hide-and-Seek! To play Hide-and-Seek, Mommy gets down on her hands and knees just like I do and hides behind the bed, or behind the couch, or in the bathroom and I crawl after her to find her. After I find her, then I crawl away and she comes and chases after me! I giggle so much that I get the hiccups A LOT! I haven't figured out how to hide yet, but I will! Mommy told me that she LOVES to play Hide-and-Seek and that this game is also a favorite of a lot of my cousins. Maybe when they come to visit for the holidays, they will play with me.

--Amaya

Welcome to Winter!

From the NOAA website:

"A WINTRY MIX OF PRECIPITATION IS EXPECTED ACROSS THE AREA THIS MORNING AS A LOW PRESSURE SYSTEM MOVES NORTHEAST TOWARD THE REGION.

THIS PRECIPITATION MAY BE IN THE FORM OF LIGHT SNOW...SLEET... FREEZING RAIN OR DRIZZLE. THERE MAY BE A LIGHT GLAZING OF ICE WITH THIS. AS A RESULT...A WINTER WEATHER ADVISORY WILL BE IN EFFECT UNTIL NOON.

BY THIS AFTERNOON...THE PRECIPITATION SHOULD BECOME MAINLY SNOW... AND THIS IS EXPECTED TO CONTINUE INTO TONIGHT. SNOW ACCUMULATIONS OF 1 TO 3 INCHES WILL BE POSSIBLE."

I know that there are those of you who do not like snow, or cold, or who wish it were summer all the time. I like the winter! One of the great things about this part of the country is the four distinct seasons - as opposed to 2 or 3 in other places.

In the winter, I like waking up on a Saturday morning and seeing 6 inches of snow on the ground - call me crazy, but I like shoveling. It's fun to be outside even in the cold.

I like listening to the rain on the roof in the spring. The sounds of thunder that make you jump out of bed at night are fun too.

In the summer, I like going outside without a coat, and walking, riding bike, playing basketball at the hoop by the garage and quite a few other things that are more difficult to do when it's cold out.

Living in a part of the state that is pretty densely forested (especially in and around Rochester), it is very enjoyable to watch the trees change from green to yellow, red, orange and brown. I enjoy getting the yard ready for winter - the pile of leaves this year was about chest high and maybe 10 feet across at the base. I'll post pictures soon.

-- Steve

Amaya's Eye Appointment

Amaya was an absolute trooper yesterday. Amaya had her consultation with the pediatric ophthalmologist for her blocked tear duct. Despite being overly tired, she did great while the nurse dilated her eyes and the doctor examined her. After nearly two hours of patiently waiting (Amaya did better than Steve and I did), the doctor decided that he would like to have Amaya go through with the surgery. We've scheduled it for January 30th - it's not emergent, but they'd like to get it done sooner rather than later. She'll be put under with anesthesia for about 5-10 minutes - the actual procedure will only take 6-7 minutes. The doctor will put a probe in her tear duct to open up the membrane that's currently blocked. I was surprised that they don't even touch the eye at all! She'll have the procedure done at St. Mary's Hospital and will keep her there for a total of 3 hours. There are minimal risks and complications of the anesthesia and surgery, so we are both relieved. Thanks so much for the prayers!

My First Halloween!

Trick or Treat! Yesterday, after my nap, mommy changed my diaper as usual, but instead of freeing me off the changing table, she proceeded to put this fuzzy looking outfit OVER MY CLOTHES! I'm used to mommy putting strange things on me like tights, but this outfit, I've never seen before. I got really nervous when mommy put a fuzzy thing on my HEAD - it wasn't like any other hat I have! Mommy tried to explain to me that I was going to be a little lamb for Halloween and we were going to visit both of my grandparents and great-grandparents and they would put candy in my pumpkin bucket.

Mommy took a bunch of pictures of me outside... I really liked the pumpkin bucket (but I like it even better with goodies inside.)





We went to visit Grandma and Grandpa Gustafson first. They took a bunch of pictures of me and then let me pick out some candy for daddy. I guess I'm still too little for candy.


Then Grandma and mommy took me over to see some friends - Jim and Jean. They put a lot in my pumpkin bucket! Candy for my daddy and animal crackers and goldfish crackers for me! I can't wait to try them!

Our next stop was my Great Grandparent's house. They feed my parents and my Grandma and Grandpa Horning every Friday night. Great Grandma let my mommy and me pass out candy to the other kids. I can't wait until I can go door to door and get candy of my own! I saw a horse, a couple princesses, a knight, a pirate, and an Amish girl. We ran out of candy so we had to turn out the outside light.

It was a really fun night. The best part was making everyone laugh and smile! I can hardly wait until next year!