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Meds quit working

Has anyone else had meds just quit working?  I can't use inhalers, and that issue flows over into the too self conscious to use nebs at work.  

I just can't seem to get over being very self conscious about the nebs.  I would give anything to be able to use inhalers, but the propellant in them is what my lungs don't like.  I can use inhalers for some steroids but all we can figure is the steroid itself combats the reaction to the the propellant. 

When I was originally diagnosed, my doc said there was nothing to control my type of asthma-it was in the pipe, but it was at least a decade away-so we threw everything but the kitchen sink at it until we found something that would work as well as anything would-but she said the chances were that it would only work for a while-and then it would quit.  She said we would just have to start all over again every time and hope we could keep finding something that worked until the meds in the pipe were out. I'm  using a COPD med off label because of reactions to all of the asthma meds.  Slowly, one after another inhaler quit working-including all of the albuterol ones on the market. I knew when the inhalers started to fail on me, what was happening.  I've been scared to death recently that all of my meds are starting to fail on me, just like my doc said they would.  Now, 3 doctors later, I'm afraid that's what is happening and I have no doc to help.  All of the docs I've seen that are good have left the area or are no longer seeing pulmo patients-sleep apnea patients only.  I had to cut my main med back to 1/2 dose months ago-I just can't afford the almost $900/month price tag for 1 med and then almost $300 for the steroid inhaler on top of that. My lungs are more twitchy because of I've had to cut back, but it is what it is.  Nothing will ever control this mess, but with full doses, it was at least not as twitchy.

I know you guys probably think I'm stupid about the nebs and work, but I've had too many bosses humiliate me in front of others about my asthma or when I needed a neb, and I just can't get past it.  My new clinical director is amazing-very caring, family oriented, strong Christian man, but I've just been burned too many times to feel comfortable-or to forget.The smart side of me knows better and knows I need the nebs, but the hurt side still wins out.  I guess also, part of me thinks and hopes that if I don't use the nebs unless I absolutely can't go any longer, maybe it will be longer before they quit working as well.

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  • K8sMom2002

    Hugs, hugs, hugs. I do NOT think you are stupid. I think you are an amazing woman who has been put through unnecessary grief by people who can't understand and empathize. 

    Pljohns posted:

    I guess also, part of me thinks and hopes that if I don't use the nebs unless I absolutely can't go any longer, maybe it will be longer before they quit working as well.

    I know you're between pulmonologists now. But is there anyone else on your medical team that you can talk to about this strategy and whether it's the best one for you? 

    I ask because my allergist/doctor has warned me in the past that if I wait to use my inhaler (and I'm assuming a neb as well), that my lungs will have a harder time moving air and the meds with it into all of my lungs. If I wait, then my meds don't work as well.

    Your issue and fears with nebulizers and work are what they are — it's a real thing for you, and we just have to help you figure out a work-around. Let's brainstorm about what makes this nebulizer so hard for you and what we can do to help you work around that. 

    I'm asking the following to see if I can help, not to be nosy.

    There are no wrong answers, no stupid answers, no silly answers. Your feelings are your feelings, and I can understand about comfort zones. You need trust before you can become vulnerable, and you don't have that complete trust with your boss … yet. Eventually maybe, but for now, it is what it is, and THAT IS OKAY.

    • Is it because you have to do it in a public space?
    • Is it because it's loud or noticeable?
    • Is it because it takes up so much time?
    • Is it because you think you have to continue working while you neb?
    • Is it because you fear your boss will think you're weak or sickly?

    If you could have the PERFECT situation where you could use your neb and feel comfortable, what would that be? (Okay, granted, the perfect thing would be if you didn't have to use it at all.)

    If you had a staff person come to YOU and confess, "Hey, I have failing kidneys, and I have to do a mid-day peritoneal dialysis procedure, but I can do it at the office," or "I'm breast feeding, and I need to do a mid-day pump, but I can do it at the office," how would you make that work for them? What would you say to them to let them know that it is okay? What parameters would you set up so you would know they weren't abusing the situation?

    Once you figure that last one out, can you go to your boss and say, "Hey, boss, I have this situation,"  and explain it just like you would want the kidney dialysis patient to do for you? And then suggest reasonable accommodations?

    We are here for you. I promise.

  • Pljohns

    Cynthia-thank you.  You bring up some good points for me to think about and some that I have actually had to deal with.  I pumped for a year with DS#1 and #2 and my bosses were WONDERFUL.  They allowed me to use part of my lunch time when I needed it, to pump.  We had a corp. gym and, although it wasn't great, had private dressing rooms with showers and a place to sit.  I could go there, relax and be back at work in just a few minutes.  I've also had an employee that had the same situation.  I had no place, really, for her to pump and no matter how clean you try to keep them, restrooms-even staff ones-are not the best places to pump.  I mean-who wants to pump sitting on the toilet????  So, I went to one of my doc's and ask if she could use their office a couple of times a day to pump.  They were happy to share and we put a sign on the door knob that was a tasteful "do not disturb" sign.  She never tried to hide what she was doing, but it provided her a comfortable chair and a clean environment.  

    My old job wasn't too bad-I had finally gotten to the place that I would close my office door and do a neb.  If people needed me, they would barge in and then act like I was doing some terrible thing in there and turn and leave.  With this job, I don't have a private office or a room and even if I did, I have to cover the front until we hire additional employees.  That puts me square in the face of everyone that walks in, everyone in the gym doing PT as well as the clinical mgr who I share an office with and any of the tech's etc that are fill ins now.  So, to answer your question, yes, it's that I'm in a public place, yes, it is loud and isn't something I can do quickly.  When I'm having problems, nebs every 1-2 hours adds up.  I do have to neb and keep working so I've gotten to be a pro at holding it between my teeth and keep right on going.

    The perfect world would be someone that could cover(which will eventually happen) and a place that no one could see me-other than in the restroom.  I'm not sure how I would handle making sure an employee wasn't abusing the situation.  For some things, something from the doc would be great to have in case anyone said anything missed work. I'm sure if I talked to our HR lady,  and the clinical mgr, they would say of course there's no problem but the HR lady has never been in a clinic to see how much it would affect my work and I don't know my clinical mgr well enough to know if he would then regret hiring me.  It's just a big mess-thanks to my lungs and not being able to use inhalers.  I've gone almost a year without landing in the hospital-mostly from lifestyle changes-and have only had 1 bout that was REALLY bad.  I probably should have been in the hospital then, but wouldn't give in.  I did manage to to neb and work then and the clinic mgr was understanding  but I could tell it was a problem.  Why can people just understand???

    Any suggestions or help anyone would offer would be greatly appreciated-

  • K8sMom2002
    Pljohns posted:

    If people needed me, they would barge in and then act like I was doing some terrible thing in there and turn and leave.  

    You are NOT doing a terrible thing. You are taking care of yourself, and your lungs. I know it's easier said than believed, but if someone has a problem with you following a doctor's advice and treatment plan, it's their problem and not yours.

    Pljohns posted:

    With this job, I don't have a private office or a room and even if I did, I have to cover the front until we hire additional employees.

    When will you hire additional employees? Is it a question of funding or finding the right person? And do you get to participate in the selection of that person? Because if you do, that could help your problem in two ways:

    1. An additional person could give you the time and space you need for a neb in private — how long do your nebs take, anyway? Remember that you get 15 minutes twice an 8 hour work day, plus at least a half hour lunch. You may be like me and forget to take them, but it is your right.
    2. You can feel prospective employees out about how they feel about people with disabilities. That goes two ways — how will they react to you, and how will they react to patients who are disabled?
    Pljohns posted:

    That puts me square in the face of everyone that walks in, everyone in the gym doing PT as well as the clinical mgr who I share an office with and any of the tech's etc that are fill ins now.  So, to answer your question, yes, it's that I'm in a public place, yes, it is loud and isn't something I can do quickly.

    The "everyone in the gym" might not be something you could control, but how scary would it be to talk to your clinical manager and the techs? Would you feel comfortable explaining it this way? "Hey, you've noticed I have to neb a lot, but this is because I can't use inhalers. I'm hoping science will get a move on, but until then, it's a neb for me."

    Also, could you shop around for a quieter neb? is pricey, but it's billed as being very quiet. Or could you put something around your unit to muffle the sound? A blanket? A pillow? A box designed to muffle the noise?

    Pljohns posted:

    The perfect world would be someone that could cover(which will eventually happen) and a place that no one could see me-other than in the restroom.

    Is the issue that

    • you don't want people to see you actually using the neb?
    • you don't want to have to explain to people why and what you're doing?
    • or you don't want people to see how OFTEN you're using your neb?

    If you just need some privacy while you work, how about a screen or a room divider in part of the room? Or how about asking for a work station to be set up in another portion of the office so that you can work there while you neb? It could also be used to handle super sensitive work or conversations to do with patient privacy, so it wouldn't be just for you. 

    Or is there a break room or a storage room that you could co-opt for some of your nebs? (Yes, I understand that when you're having to neb multiple times and you don't have anyone to cover you, that wouldn't work, but I'm thinking toward the future and your ideal solution.)

    Pljohns posted:

    I'm sure if I talked to our HR lady,  and the clinical mgr, they would say of course there's no problem but the HR lady has never been in a clinic to see how much it would affect my work and I don't know my clinical mgr well enough to know if he would then regret hiring me.

    How much DOES it really affect your work? You sound like a hard-working, extremely talented, super organized, team-oriented person that anyone would be lucky to have on her team! If you've been at this job for any length of time, I would hope that your clinical manager has seen that and recognized it. 

    Does your boss or your boss' family have health issues? Sometimes when you know that, it's a bridge to understanding. I know that in the past, when I've had employees under me (I used to be an editor for three papers with a staff of about a dozen people), and they needed to be off, I totally understood. They didn't have to ask twice, and they never got grief from me — because while I didn't have kids, I did have a mom who had a chronic illness, and I had health issues myself. You can't help being sick, you can't help your kids being sick, and as long as you're pulling your weight, then that's all anyone can ask.

    What I have found is that if I were not honest with people about my or my DD's limitations, it caused me/her more problems in the long run. Expectations minus reality equals disappointment, and people can come up with all sorts of explanations that aren't true to answer questions my behavior may be raising.

    For instance: my DD has a bleeding disorder. There are times during the month when she will need longer than the three minutes between classes for a bathroom break. Naturally, a high school girl (and before this a middle school girl) does NOT want to explain that she's on her cycle to a teacher in front of her class. But if they didn't know, they might think she was trying to get out of class or do drugs or Lord only knows what. So we came clean and we explained to all her teachers and the staff in a closed meeting that, hey, it is what it is. She won't abuse it, and if it becomes a problem, then you can talk to me, but she needs to be able to get up and leave the classroom without any explanation sometimes. 

    You know, after that, we never had a problem. They got it. They understood and appreciated our honesty, and they have seen she was a hard working student who doesn't abuse this accommodation. 

    I surely hope that you can work something like that out with your bosses, but I can understand your fear and your hesitation. If they are GOOD bosses, then they will understand.

  • Pljohns

    Cynthia-thanks for the great suggestions-I do have an ultrasonic neb that I can use BUT I can't hold it and work at the same time AND it apparently looks like a vape pipe  I've had more than one person ask me if I was vaping. We should be adding additional employees shortly-we had to have the volume to support it-and we do now and yes, I will have some input into their selection.  We do have a break room that I can use as long as someone can cover for me.  I agree the best solution is to talk to my clinical mgr and then he can take it into account when he interviews.

    As for the time from work-it takes 0 time right now or most of the time-even with nebs every hour.  I've gotten to be a pro at holding the neb mouthpiece in my teeth and keep right on working.  The neb has a battery pack (Pari TrekS) so at home, I tuck it under my arm and run all over the house-I could do the same here so it wouldn't take any time from work and Lord knows, I give them enough time now that I don't bill out. I guess that's part of the root of the problem-I don't want this to negatively reflect on my work.  I work my tail off and will go 110% for my clinic and company and I feel like that's what they expect so anything less than that is a poor performance-at least in my eyes. 

    My clinical mgr said yesterday that he's the type of person that will run through a fence, and another and another with arms and legs dangling until someone says enough-time to stop and take care of yourself.  Guess what-I'm the same way and as stubborn they come too.  If taking care of myself means slowing down on my work, I would rather take a beating.

  • Kathy P

    Careful with the ultrasonic neb – there are meds you can't use in those. I don't recall which ones but that fact was what made me choose a regular compact one. 

    Remind me, have you tried the dry powder inhaler with the same issue? This don't have propellant, but do have other potential issues like containing lactose as a carrier. There is DPI albuterol version. 

    One thing I've noticed about some inhalers is that, once the package is open, they seem to loose strength over time. I've noticed this with both my MDI and DPI albuterol. It's made me think the med stopped working, but if I go open a "fresh" one, it works. 

    Is the main issue at work using rescue meds or are these scheduled preventative meds? 

  • K8sMom2002
    Pljohns posted:

    I guess that's part of the root of the problem-I don't want this to negatively reflect on my work.  I work my tail off and will go 110% for my clinic and company and I feel like that's what they expect so anything less than that is a poor performance-at least in my eyes. 

    My clinical mgr said yesterday that he's the type of person that will run through a fence, and another and another with arms and legs dangling until someone says enough-time to stop and take care of yourself.  Guess what-I'm the same way and as stubborn they come too.  If taking care of myself means slowing down on my work, I would rather take a beating.

    A couple MORE questions.

    Could you start with asking your clinical manager for a performance review or a talk on how he sees how you're doing your job?

    That may ease your mind about how he sees you. He may say you're giving two hundred percent and he's worried about burnout. In that case, he'd probably appreciate you dialing it back and lasting longer — marathoner vs. a sprinter, if you know what I mean.

    Does your clinical manager view that go-until-you-can't style as a badge of honor or as a personal failing?

    I've had some supervisors with health issues who didn't take care of themselves, and they considered it a badge of honor that they ignored their doctor's advice and worked when they shouldn't. I've had others who said they viewed people disregarding medical advice as foolhardy and a sign that a person isn't willing to follow directions.

    If he's a "you need to follow directions and be a good role model" kind of guy, then a frank talk probably WILL help. If so, could you approach it like this: "How about we keep each other accountable in a friendly sort of way? I'll tell you when your arms are dangling, and you tell me."  

    I like Kathy P's reminder to take care in choosing inhalers — that's a definite concern. And fingers crossed that perhaps one of the DPIs will work! This WILL work out!

  • Pljohns

    I think the "go until you drop" mentality from my clinical mgr is more his personal style-he said it takes his wife to dial him back-DH has given up on dialing me back but that's a whole different issue-I like the idea of asking how he thinks I'm doing-I do believe he is very pleased as he's told our big bosses in front of me what an amazing job I'm doing and things that I track for the financials of the clinic, no one else does, so he told me that's what he hired me.  It's funny that you said "marathon vs-sprinter" because thats the same analogy that he used yesterday reminding himself to pace himself as establishing a clinic was a marathon-not a sprint.  

    thanks for the reminder on the ultrasonic nebs-yes, there are meds that can't be used in them-my maintenance med is one of them but this one handles albuterol fine.  I also thought about the nebs loosing their potency and when I had issues with the albuteral inhalers(at the time, I was carrying ventolyn, xopenex and proair because sometimes one would work and sometimes it wouldn't but one of the others would).  I always made sure they were relatively new.  I have found with inhaled steroids, after a period of time, the propellant isn't as strong so you don't get a good puff. I got the ultrasonic because it runs on 2 AA batteries and is small enough I can carry it in my purse, which is a requirement for me.

    I think a talk to my clinical mgr is the first step.  there is no way today or tomorrow-we are slammed and he is out of town all next week.  At least that will give me some time to sort of think through it and figure it out.

  • K8sMom2002
    Pljohns posted:

    I think a talk to my clinical mgr is the first step.  there is no way today or tomorrow-we are slammed and he is out of town all next week.  At least that will give me some time to sort of think through it and figure it out.

    Thinking it through is a great first step! 

    And when you do get in with your new (hopefully GREAT pulmonologist), perhaps you can talk over these problems with inhalers and the doc will have another suggestion? I'm really hopeful that the dry powder inhaler might be different enough to help you. 

    And pssst … I think your boss probably thanks his lucky stars that he found your application and resumé in his inbox! You just seem like that kind of worker!

  • Pljohns

    Thank you Cynthia-I just found a new pulmo-she runs the severe asthma clinic at UAB-her first appt is Oct/Nov and she requires a physician referral but I've already sent my PCP a portal message to please refer me.  Hopefully she is good and I hope i can get in!

    I've not had a lot of choice today with the weather-had to go to the car and get my neb and use it-everyone was so busy only the temp tech noticed and she just stood here and stared at me.  Of course, she was part of the cause-I swear she bought out BBW!!!

  • K8sMom2002

    Oh, yay on the new pulmo! Fingers crossed that this is a great fit — sounds like it may be because if she runs the severe asthma clinic, then she's seen tricky cases. 

    Bummer on the BBW starer — do you think she was just looking at something that was not in her ordinary experience? Or was she being obviously nosy? Or openly malicious?

    If it were the first, how comfortable would you be with smiling and and a simple explanation? Something like, "This is my asthma medication. Your perfume has set my lungs off. Please overlook the noise."

    If it's a malicious and demeaning stare, sometimes I'm hard pressed to keep from uttering a snappy comeback. But in the interest of taking the high road, I try to let it roll on past.

    DD is adopted from China, and when she was a baby, we got all manner of stares — and really, really stupid questions. But I found that understanding that it was not usual to see a 4'10" Caucasian woman holding a beautiful Chinese baby went a long way. A short and cheerful, "Yes, she's adopted, and no, she doesn't have any trouble understanding English," served to snap dropped jaws shut.

    I think it's harder for us southern women to endure stares. Our mamas taught us that it was wrong to stare and even worse to point.

  • Jen

    Lynn – I have read some advice on how moms of special needs kiddos deal with staring, etc and I think some of it could apply here.  Polite smiles back, a short but sweet explanation could go a long way.  Then, if they're still staring, let them ask questions/have a back and forth.  I think that when people see something that isn't within their norm or realm of experience, it stands out to them and they are curious.  Of course, it is totally ok to not say anything to them and go about your business.

    Just yesterday, I was at the doctor with ds (we both have the same primary).  He was doing his usual thing  - running around the waiting room, laying on the floor, staring at the air vents, etc.  There was one other patient in the waiting room at the time and I saw her quietly looking at him.  I couldn't quite read what she was thinking.  After a while, she starts talking, tells me how she works at a special ed school, deals with kids like him, etc.  Super nice and friendly.  So….sometimes people stare because you remind them of something and they are just waiting to strike up a conversation.

    As for those with the vaping comments, I'd say something like, "Yep…just vaping my asthma meds."

  • Pljohns

    Thank Jen-those are very good suggestions.  I'm just not at a spot yet where I am willing to try and explain it when people stare.  I did get in a lengthy conversation with one of our patients(she saw my med alert bracelet and ask why I wore it)-she has asthma too and we were talking about nebs an doctors. My clinical director was just standing there listening-said it sounded like we were having a bonding moment and he didnt' want to interrupt. She told me which doc she see's and that's he's just "ok" and I had already heard that about him-and he's almost 70 so I'm sure he will be retiring soon. Anyway, I was comfortable talking to her because she has asthma too-along with a TON of other issues-but she was easy to talk to.  I'm working on it-baby steps-I have a week without my mgr to think about it and try to decide how I want to talk to him-and then I just hope I can.  Once I do, there is no turning back-no matter how he takes it.

  • Jen

    It does sound like he's a really great manager, so it seems likely he will be receptive.  *fingers crossed*

  • Shea

    PLJohns, it is scary feeling like your meds are not going work, and that others will judge you negatively for needing neb breaks. I do not like to neb in front of others. I like to be in my room, I have my machine set up there on my nightstand. If I was at work, I would want to do it in my car I think. I think if you can schedule them at certain times then people would know, " PLJohns has medical leave break at 10am, 12pm, and 3 pm every day for 20 minutes" or whatever it is. I am also not a fan of inhalers.. They mess with me and do not work as well. I love my current neb mix: budesonide, and albuterol-ipatroprium bromide. I never had my meds stop working per se, but I have definitely flared up to the point that the NEB's were not cutting it, and I had to get a steroid shot and to do a taper, and I also have a maintaence dose of prednisone that I take on top of my nebs. You definitely want to feel like you have a plan for each situation and a doctor to call to manage.  My primary handles flares, whereas my immunologist and rheumatologist handle the disease itself and keep up with research. 

  • Pljohns

    Thanks Shea-I do try and work the work nebs so most of them fall during my lunch break so i can go to the car and do them.  Right now, in a new clinic, there are no lunch breaks, but that's won't be forever.  I've used the same neb mix you do and yes, it works very well.  I've hit a point that the nebs aren't cutting it too and I do the same thing you do.  I'm use to that but my concern is during regular times-no flare-my LABA sometimes just doesn't cut it or I reached for the albuterol inhaler and got no relief AT ALL, but an albuterol neb took care of things right away.  It's scary but it is what it is.

    Glad to have you back!

  • Shea

    Thanks, I always do better with my asthma when I check in on here.  And, I am glad the albuterol neb worked right away… Gotta be able tyo rely on that! I have had the same thing with the inhaler not hitting it, but the neb getting it. I am going to mom you now, lol; I really do think you should not work through lunch, no matter the state of the clinic… It got crazy where I used to work too, I was doing that at the beginning because my old office manager quit and I got promoted and it got crazy busy all at the same time… I eventually got more help, we would set timers on our phones and tag out in pairs to have lunches… And that was basdically after sn employee of mine told me NO SKIPPING lunches.. It was hard for me do I am glad she did. I skipped lunch a lot, but I would totally not do that if working again, I do think it contributed to a health decline… And you KNOW its just not worth it to let your health go for any work, because they are not gonna take care of you (I hate to easy it, but in our past experiences, it is just true, businesses cannot and don't at least at the level I was at). Even temporarily, a good boss would not make her or his employees skip lunch, or meds, if regular ones fall there. It would be worth a small "putting my foot down now", with doctors notes for the neb needed if you want but at least your human legal right to lunch break, nive quick conversation, your boss will not fight it, and they obviously need you badly right now in their state, so you will get it.  Even if it is two 20 minute breaks, there needs to be breathing/eating/checking in with yourself breaks, and it is the law too. It is never fun to have that conversation, but simple and nice: I haven't been getting my lunch in, I need it, even if we close the phones with a message for 30 minutes (some drs offices do) until we get more staff.)

  • Kathy P

    Well said Shea. It's important to take care of ourselves first. There's a reason why the emergency procedure on airplanes tells people to put their own oxygen mask on first. You are no good to others if you don't take care of yourself first! It can be really hard for those of us who are perfectionist people-pleasers.  But it's so important. 

  • Pljohns

    Thanks guys-you are right and I don't usually skip eating-just taking a break to do it.  Mostly I eat and work at the front desk and keep right on going.  I've been working on a "speech" for the clinical mgr to try and get on the same page taking care of me.  This week has been WONDERFUL-he's on vacation and we have only had PT's 1/2 days so I've had 1/2 day each day to get caught up.  I've still got to clean the clinic before the end of the week (we don't have a cleaning crew yet either) and with the load we've been having, I'm having a hard time finding time to vacuum and mop when patients aren't there.  That's my plan for Thursday afternoon-PT leaves at 12 so I'll have all afternoon. At least by doing the cleaning, I've gotten to pick the products so I've gotten ones that don't bother me-NO BLEACH and no strong smells-and I intend to make sure that keeps up (and since I'm the one that buys them, it's my choice what to buy)

    I think I've figured out what to say and how to bridge it with him but I want to run through it a few times before he gets back and I actually have to talk to him.  At least I have a game plan and good bullet points to bring up.  I plan to push the issue on hiring some help AND a cleaning crew.  I know he's talked to the company owner but I don't know what they decided on.

  • K8sMom2002

    Lynn, I have to at both what Shea has said and what you've committed to. 

    You can run that practice speech by us any time you'd like. And you don't have to address everything at once. I would bet you'd free up more time if you got the cleaning crew hired first.

    Could you say this, "Hey, I've drafted a help-wanted ad for a cleaning crew. Can you approve it?" or if you're doing a contract-bid, how about, "I've drafted a bid request for area cleaning crews, and here are all the reputable janitorial services. Can I go ahead and send it out?"

  • Pljohns

    Well I found out late this afternoon that some of the clinic allow their staff to clean after hours for $50/cleaning.  My real boss (not my clinical mgr) ask if I was interested and to think about it.  Well guess what-NO WAY.  It's contract labor so I would have to put back taxes because they wouldn't hold it out, I can only charge it 1 time a week and the before and after hours for $35 after taxes-just not worth it.  I have enough going on BUT she said when the clinical mgr gets back from vacation, have him get with the VP and figure out what we need to do.  Can you say CLEANING CREW???

  • Shea

    Cleeaaning Crewwww!!! lol. There are a lot of green cleaning crews around these days too, so if you google one snd send it to him, well, it cant hurt. And, yeah, to what Kathy and K8Smom said, your oxygen first, please yourself first, and yes feel free to run a speech draft or email by us.

  • Pljohns

    OK-here's the first draft-it needs cleaning up but first pass-opinions please!!!

    1. Cleaning crew-we need one NOW.  I can't find time to clean when we don't have patients.       * steam mop             * Savings on cleaners             *  Wont' be swiping dirty water all over floors with a reg mop floors dry faster so can mop and not have to worry about pt slipping             * mop covers can be washed with bleach to save month/no sour mop heads/kills germs on the mop.

            *  No fragrances in garbage can liners/cleaners/air fresheners.  I've found a bleach that doesn't bother me to use or be around.

    2. Tech/PT What thought did Nathan/Steve have about hiring them (these guys are the owner of the company and the VP that is mentoring my clinical mgr because he is new with the company.  All hires have to have their approval)

    3. Lunches    *I need a break-even 30 min.-how do you want to handle it. I will make every effort to schedule new patients at times other than lunch to ensure no paperwork needs to be completed. We have an answering machine that will catch calls if I'm at lunch.    *I can't turn in OT so I'm "volunteering" my time. I don't mind doing whatever needs to be done for the clinic but 6+ hrs a week is a bit much. I know you are working much longer hours than I am and I feel badly that you have so much to do and that is part of the reason I've kept pushing and put this clinic ahead of what i need to do to take care of me

    4. Personal concerns     *NO FRAGRANCES in the clinic on techs/PT's/cleaning products    *I have personal issues being OK using a neb in front of others-my solution has been to just not do them, which isn't really an option. I can easily do a neb and continue working and will make every effort to keep nebs on a schedule that matches up to a lunch break so I can use them in the car or at time other than the top of the hour when we have patients checking in, but there are times I need to use them every 1-2 hours. I keep a neb and meds in my drawer all the time because I can't use inhalers.    *Right now, I have no pulmonologist so I need to be extra careful. Having said that, I have a referral to the severe asthma clinic at UAB but I can't get in until Oct/Nov. I was seeing a doctor at Grandview so appointments wouldn't have me out of the office long as they are 5 min away, but that pulmo is retiring and I have not been happy with the care from that practice. B'ham has a shortage of pulmo right now that will see asthma patients, most of them are only seeing sleep apnea patients now. They want the primary care docs to take care of asthma patients but my PCP has told me my asthma is so severe that i need to see a pulmo.    *I will continue to make every effort not to miss work but in order to do that, I need to take care of myself, which I haven't always done in the past and it's had serious consequences.    *I put everything before me-my family, my job, everything and whatever is left over, takes care of me and I need to make lifestyle changes to fix that. I can't be an asset to the clinic/company if I'm too sick to work or if I'm in the hospital.    *No major changes in my job performance-I need to make myself use my nebs when I need them-no matter what and keep the scents out of the office. There may be times (after we get help that can answer the phones and take care of patients) that I have to use nebs so frequently that I am more comfortable going to the break room to use them. Some of them make me shake uncontrollably for several minutes when I'm done and back to back ones will frequently leave me in tears but that isn't necessary very often and passes quickly.    * You will soon learn to tell the more horse my voice is or the worse my laryngitis is, the more my asthma is acting up. That is the one outward symptom that I can't mask.

    I am very nervous that you will regret having me as your office manager or that you will have concerns about my abilities to do this job. I want to assure you that I will make every effort not to let this interfere with my work and job performance. I made the lifestyle change to this job for less stress and better working environment and it has helped tremendously but I need to take a few more steps to properly care for myself. I'm not great at doing that but I need to change that-especially with no pulmo to fall back on for help.

     

    Tell me what you think-he will be back on Monday and hopefully next week I can get a few minutes to talk to him.  Thanks for all of the help and opinions

  • Shea

    You might not have much time, and you have a few requests I would focus on keeping it clean, quick, easy, and sweet, mentioning the quick problem and solution.

    1. I haven't been able to take lunch breaks. I need 30 minutes to eat and do my nebulizer, and two 15 minute breaks to neb as needed (do not mention not having a pulmo now, you have a primary doc and have been directed by doctors to neb at these times).

    We will either need a tech, or I can use the following timers to put the phones to a message and take these breaks:  (list times)

    2. I have a printout on a no scent policy in the workplace that other hralthcare HR departments use (you may have to internet search for one to bring) Because I do have this sensitivity, I was wondering if you could sign off on it as a policy, and include it in new hire paperwork for employees and contracted workers, especially would like cleaning crews to be made aware. 

    3. Speaking of cleaning crews, we need one. I cannot volunteer the extra hours any longer, nor work contracted hours to clean. I would love to help you find one that uses green products and steam mops that is within budget. 

    What do you think?

     

  • Shea

    Here is a good scent-free policy: 

     (You might want to edit it not to included visitors, just employees, but you might ask to have a sign up somewhere with the policy)

  • Pljohns

    Thanks for the help and info.  I already used the link to the educational info in the e-mail to HR this morning.  I forwarded the e-mail on to my service director so he already had a heads up on a big part of it.  A much shorter version of above can now happen and be short, sweet and to the point.  I think he will be very receptive-he has been out of town all week and checked in every day.  I got a text from him this morning thanking me for being someone he could rely on so hopefully now that he's seen I can handle things even after going to the ER, he will be very receptive to me taking care of me.

  • Shea

    Yes, good luck. That educational link was … wow… so i am like gonna have a list of chemicals to check next time I go shopping. I did not realize I shouldn't inhale limonene.. my beloved bathroom spray! I have to find a different one I guess. Ay ay ay. But I like the policies, at least they aadress fragrances and have a system that seems good for workers in an organization. I think the other two policy links would be helpful to any HR ddepartmen.

  • Pljohns

    I agree and thank you for posting the links.  That list was AMAZING-going to definitely pay attention to that one!  Now I guess the ball is in their court-I sent it not only to HR but to my clinical mgr and my direct boss so we'll see what happens.

  • Pljohns

    Shea-I printed all of the policies from the links above and one of them has some SUPER pages with questions that employees might pose if a fragrance policy was implemented.  I'm going to send it to HR as well so hopefully they will see how it can be handled and they will move on it.  Thank you again!

  • Pljohns

    Just found out that they are in the process of updating the policy manual and writing some new ones-including a dress code.  Hopefully they will add the fragrance one too-at least for once in my life-sounds like I timed it right to ask!

  • Shea

    Yaaay!!! It really is perfect timing, I think it fits in great with the dress code policies, and it is nice that you got it in before too many people are hired. This should make life a lot easier for you, as a person with a serious asthmatic sensitivity to scents (and everyone– for really most of those chemicals negatively effect people to one degree or another). 

  • Pljohns

    I still haven't heard from HR so I don't know if they are even considering it BUT our HR lady isn't the greatest about replying to e-mails and she only works like 15 hrs a week (super small company).  I still haven't heard from my boss either so I still don't know if there will be backlash or if it is something they are considering-at least I know my clinical mgr has my back.