Thursday, December 25, 2008

The Healthy Weight Network and The Slim Chance Awards 2008.

John and I have been seeing a registered dietician for about 2 years now, and with her help we've lost a combined weight of over 160 pounds. No special tricks, just good old fashioned nutrition and exercise. It was important for us to not only lose the weight but to learn better health habits. Over the years we've encountered a lot of get-thin-quick schemes and have been asked at many a party what our "secret" was, and when we've told people we simply stopped shoveling food and ate more veggies and got up off our asses thirty minutes 4 to 5 times a week, the reaction was a bored "oh." (John says there was one time where he encountered a woman who walked away from him almost defeated. "It was as if I'd punched her in the stomach.")

Skepticism and nutrition pretty much go hand and hand. Two of my favorite fitness magazines have good advice mixed in with ads for pills or mixtures guarenteed to "get ya cut." It seems you have to have good critical thinking skills to take care of yourself properly. Frances M. Berg, M.S., who operates the Healthy Weight Network has issued the 20th annual set of "Slim Chance Awards" to weight-loss scheme promoters. Freakin hilarious! Special thanks to Dr. Steven Barrett from Quackwatch for the link and the story!

Tuesday, December 23, 2008

The JREF announces AB Kovacs as Director Of Operations

Woot. Whadda cool Holiday present for skeptics worldwide:

AB is an energetic skepchick who will serve the JREF well!

Saturday, December 20, 2008

Pooh Bear Knows Best...

"People who don't Think probably don't have brains; rather, they have grey fluff that's blown into their heads by mistake." A.A.Milne.

Friday, December 19, 2008

Sci-Fi Loses One Great Nurse: Jamma Party and A Doubting Florence Remember Majel Barrett Roddenberry

In the hubbub that has become my unfortunate existence known as the holiday season, I completely missed the connection when John told me last night that Gene Roddenberry's wife had passed away from leukemia that he was indeed speaking of Majel Barrett Roddenberry, one of the stars of the original Star Trek series. Star Trek is a good show not only for the delightful spirit of one-man show Leonard Nemoy, but for the groundbreaking idea that both men AND women (of any race, creed, or color) could boldly go where no man has gone before. Majel Barrett portrayed the voice of the computer, but more importantly (in my humble nurse opinion) the provocative Nurse Chapel, who, along with Major Margaret "Hot Lips" Houlihan from M*A*S*H, made me wanna become the R.N. I am today. After Gene's death, Majel made a point of being a presence at many Star Trek conventions, keeping the legacy alive, and, maybe secondarily promoting science to future generations of kids. Live long and prosper in our hearts and memories, oh great healer of the Starfleet!

Monday, December 8, 2008

Skeptic Jenn's Favorite Things for 2009...

...Because Oprah shouldn't have all the fun....(especially since she helps promote that crappy Secret book and Jenny McCarthy's antivaccination prattle)

Criteria: Things that, when I think of them, I smile. Honorable mentions are going to things I really don't know so much about them to call them favorites, but they are off on a good start. (View the whole list on my blog, Jamma Party)

Skeptic Jenn's Favorite Things for 2009

The Flu Shot Props to "Big Pharma" for making a bad arse flu vaccine this year. At a rate of 70 percent to 90 percent effectiveness, it's one of the things we need to stay healthy and not pass flu boogers to those who may not be able to fight it off- the elderly, babies, and people with weak immune systems. They are predicting a nasty flu season this year folks. And, contrary to urban legend, getting the flu shot does not give you the flu. It's a deactivated version of the virus that is in the vaccine. It should be avoided if you are allergic to eggs. Don't forget also to wash your hands before and after you go potty, and use hand sanitizer to combat germs as needed. You don't wanna kill babies and grandmothers, do you? DO YOU?????

Death From The Skies by Phil Plait The book came out in 2008, sure, but the buzz will still be going strong in 2009. Phil Plait, who I like to refer to as The Jonas Brothers of skepticism (three times the awesomeness in one package), has been newsworthy for a few reasons in 2008- In late summer/early fall of this year, Plait accepted the very honorable position of President of the James Randi Educational Foundation. There's also an online petition circulating a suggestion for Phil to be Obama's science advisor. Most importantly, he was interviewed in a recent issue of Geek Monthly. Although I have yet to read Death as well as it's predecessor Bad Astronomy (yeah, I know, I know), I already feel it's going to be a bit hit in many skeptical book clubs.

The Skepchick Podcast Sigh. So good for so many reasons. Here are a few: Rebecca. Bug Girl. Elyse. A. Stacey. Carrie. Maria. The girls dish candidly to each other, and although it's a podcast where in reality everyone is sitting in front of their computers and communicating via the 'net, the vibe is so cozy you almost can convince yourself that they are all sitting in one room together sharing a bottle of good tequila and a few laughs (in my image there are bean bag chairs and some knitting going on as well- but that's just me) about crap based medicine, Sylvia Browne, and creationism. Smarter than Cosmo, a bit more entertaining than Bitch, and always about the truth. Brainsbodyboth!!!

Nursing Students I started precepting clinically about three months ago, after a fluke encounter with a frazzled student turned into something very cool. Since then, I've precepted three very cute, intelligent and professional future nurses. I try to work on stress management and critical thinking along with home health skills and the importance of time management. Projects have included flu shot saavy and transitioning a patient from home health to hospice. Nursing students are really awesome and they don't get enough cred. Hug a student you love today!

Playing Gods with Ben Radford In the day, I was an amazing board game player. I could accuse Miss Scarlet of bludgeoning Mr. Boddy in the Billard Room with the lead pipe and whooped when my oppponent landed on my hotel laden Marvin Gardens. Back in the days, I could give you Trouble, catch a mouse with Mouse Trap, and could always retrieve the funny bone without The Operation Patient without the nose of defeat lighting and honking loudly. But the sixth grade ended far too quickly, and then the teenage years gave way to collecting makeup tips vs. chess moves. My gamer skills are rusty at best. But I'm ready to play Ben Radford's newest game, Playing Gods. Ben had a great low key marketing campaign at TAM 6 (we still get comments on our "My God is Better Than Your God" bumper sticker. The game came out in September, and with predictions of a wicked winter in Virginia, we are looking forward to many a snowy evening battling as powerful dieties. My husband, a hardcore gamer, calls this a great beer [or mer-faux] and pretzels game. But we're ready to get tough if we need to! Be prepared to be God-served in many fun nights over at Casa De Feefer and Bob. We're waiting for your diety to bring it.

Honorable Mention
Baxter Infusor Portable Elastomeric Infusion System (known here as the INFUSIOR)
Why it makes me smile: The BIPEIS main purpose is to help make the crappy regimen known as chemotherapy a bit easier for the patients at Big Bad Cancer Kickin' Doctors Practice (not it's real name, obviously), one of our newest group of doctors using our home health services. With their practice came the INFUSOR, which is a portable medication delivery system that uses a balloon resivoir that is designed to very very slowly push medication (or chemo) into your body at a specified rate, which is controlled by a flow restrictor. It resembles a small baby bottle and is made of pretty tough plastic. The tubing connects to the patient's IV catheter and is kink resistant. They're portable as heck (I got to discreetly troubleshoot one at a patients office).
Why it didn't make the Big List: Like any medical procedure or medication, there are pros and there are cons. At times, the rate is sooo slooow that at times, it doesn't look like it's working, which results in some false alarm calls for troubleshooting for the agency (it's okay though- better safe than sorry). And if your math is off, you could end up at a patient's home a few hours too early to remove the INFUSOR, which is not a happy feeling on a busy day. Also, I don't want to Big List something I have only worked with a handful of times. This might be a future topic for A Doubting Florence.

Sunday, December 7, 2008

A Doubting Florence Presents: Vaccines and Autism- A Skeptical Nurse Perspective

"I was nine when my childhood mother had taken me to a number of doctors, but they could find no reason for the fatigue or the insomnia that now plagued me...[at my ninth birthday party] I pushed myself off the wall [where I was sitting] and a surprise pain, a bad one, shot through my legs, back and neck as I dropped straight down onto the pavement...I was mortified. It was my birthday and I couldn't even get up...I forgot which nanny carried me to bed, where I lay flat and quiet, listening to my party outside my window...After entering the hospital, I was abruptly taken away from my parents, without explanation, and wheeled into an elevator. That was when I came apart. I screamed all the way upstairs to a big room where there were curtained cubicles and lots of children, all on gurneys, all screaming, just like me. A nurse wearing a mask over her nose and mouth hissed, Be quiet you're only making things worse for everybody, but I was beyond terror. I threw up. Everything hurt- my back, neck, legs, arms, and chest; it even hurt to breathe...It was 1954 and polio was sweeping the country. Nobody knew how it was spread, so you didn't go to movies or swim in public pools because of was supposed to be a children's ward, but the iron lungs that lined the halls must have contained some adults too. I could hear men's voices wheezing and shouting in the night. When my turn came to be in the iron lung, I kept calling out, I'm okay, I feel fine now, please. But nobody came, and you can't even scratch your own nose...[in my room there was] a crib in which lay a little girl about two years old with brown curls, a quiet little thing who never made a sound, except for an occasional soft whimper, but I don't remember seeing her move. One night the lights went on and the curtains were pulled around her crib, and doctors and nurses all crowded into that corner in a hurry, talking loudly. I pulled the covers over my head and tried to pretend I was somewhere else, but that's not so easy when terrible voices fill the room. The next morning the crib was empty, and then I had to put that quiet little girl out of my mind."
This quote is from Chapter One of Mia Farrow's autobiography, What Falls Away. Farrow was nine when she contracted a mild case of polio, from which she made a complete recovery after several months. According to the CDC, polio has had a 100 percent reduction in morbidity as a result of adminstering the polio vaccine to children.
I admit that I just committed a logical fallacy. I used an appeal to your emotions verses a rational argument to try to explain why you should vaccinate. This blogpost was originally going to be about how disappointed I am about the recent coupling of World Wrestling Entertainment and autistic parent group Generation Rescue (board member Jenny McCarthy will be a guest on the WWE broadcast of Saturday Night's Main Event). But I realized that I'm too high-strung on this topic to look at it objectively.I love pro wrestling. The banner on shows the attractive McCarthy, and her cherubic smiling son Evan. At the same time, Mia Farrow's story also breaks my heart. Either side of this debate involves kids and the potential harm that could come to them. Needless to say, it's very easy to latch onto emotion. I don't have any kids, nor am I in any hurry to procreate. But I live next door to a couple of 'em and they seem really likeable. I don't wanna think about them having to deal with the scary diseases that Evan and Mia dealt with. There were appeals to your emotions all over the nine or so revisions I've been working on since 9 yesterday morning. I'm done. Instead, I would like to focus on how nurses are involved with the adminstration and safety of vaccines. That is a lot easier on my psyche and most likely will be a bit more informative for you, gentle reader. Part 2 will appear in the next blogpost.
Resources for this blog entry
1) Farrow, Mia. 1997. What Falls Away. New York: Nan A. Talese Doubleday
2) Shermer, Michael. 1997, 2002. Why People Believe Weird Things. New York: Henry Holt and Company.
3) Judelsohn, Richard G. Vaccine Safety: Vaccines Are One of Public Health's Great Accomplishments. Skeptical Inquirer 31, no. 6:32-35.

Saturday, December 6, 2008

A Doubting Florence Presents: An Oldie But A Goodie: The Rosa Study On Therapeutic Touch

TITLE: A Close Look At Therapeutic Touch
AUTHORS: 11-year-old Emily Rosa broke a Guinness World Record for the youngest person ever to research and be published. She was assisted by her mother, Linda Rosa, an RN and member of the Questionable Nurse Practice Task Force. Also participating in this study was Larry Sarner and Dr. Steven Barrett of
THE STUDY Therapeutic touch involves the practitioner placing his or her hands about 5 to 10 cm (about 1 to 5 inches approximately) over a patients body to detect "energy fields" which they claim can be manipulated and can be used to treat medical conditions, including acute pain, nausea, thyroid imbalances and others that the study touches on briefly. Emily designed this study herself and originally presented it as a science fair project. She wanted to know if therapeutic touch practitioners could detect her energy field. She had 21 practitioners place their hands through holes at the bottom of an opaque screen. She flipped a coin to decide which side she was to start. She then hovered her hand over the practitioners hand on the side in which the coin toss determined. The hypothesis was that if the TT practitioners could detect an energy field via Emily's hand, then they should be able to determine which of their hands was able to indicate/pick up Emily's energy fiend and correctly identify the placement of Emily's hand about 60 to 75 percent of the time.
THE RESULTS The Rosa Study showed a score of 44 percent correct answers by 21 practitioners which is very close to random chance. One most likely would get similar results if one were guessing.
WHY I THINK THIS STUDY IS IMPORTANT FOR NURSING AND SKEPTICISM There was a collective giggle from skeptics nationwide when this study appeared in the April 1st 1998 issue of JAMA: The Journal of The American Medical Association. The fact that a 9 year old kid could debunk what appeared to be vaild research of an alternative therapy with one very simple study was, in my opinion as a then-nursing student, awesome. Therapeutic touch is a questionable nursing practice. Its validity has been challenged multiple times, and the research to support it has flaws. Despite studies like this one, Therapeutic Touch has been given support by national nursing organizations such as the American Nurses Association. In fact, in this month's issue of Alternative Therapies in Health And Medicine has a research study on healing touch for post op coronary artery bypass (my review of that to follow later). I could wax poetic about the numerous atrocities that occur with questionable nursing practice, but for now, I'd like to give credit where credit is due- to Emily Rosa, the designer of the study. I'll end with a quote by JAMA Editor George Lundberg:
"[JAMA's statisticians] were amazed by its simplicity and by the clarity of its results...Age doesn't matter. All we care about is good science. This was good science."

Emily and Dr Barrett have both appeared on a recent episode of Penn and Teller's Bullshit! Emily is just as adorable now as she was then. Dr Barrett has gotten much more adorable with time. He's like a fine wine, you see.

References for this blog entry:

Courency, Kevin R.N. Further Notes on Therapeutic Touch

Rosa, L, Rosa E, Sarner L, Barrett S, A Close Look At Therapeutic Touch. JAMA 279:1005-1010, 1998.

Friday, December 5, 2008

A Doubting Florence Presents: Cool Stuff Nurses Do--Negative Pressure Wound Therapy

The most popular advice given to novice writers is "write what you know and where you come from." I come from a home care nursing background. The patients I work with are stable enough in their conditions to have most of their health monitoring done at home. The purpose of home care is to keep patients stable and avoid re-hospitalization. Wound care is a huge part of home care. The nurses are primarily responsible for teaching the patients and their caregivers how the wound originated, what can be done, as well as signs and symptoms of wound infection to monitor for on a daily basis. There are many many many types of wound care out there, each one has it's advantages and disadvantages. This post I will discuss one of my favorite types of wound healing- Negative Pressure Wound Therapy (NPWT for short).

WHAAA? NPWT technique involves putting a open ended foam inside the wound cavity, covering it with an adhesive drape, thus creating an airtight seal and a closed wound, and attaching a noncollapsible evacuation tube that is attached to a vacuum which applies a controlled subatmospheric pressure (usually between 125mmHg and 175mmHg below ambient pressure). The vacuum is also attached to a canister that collects the drainage as well as any bad wound spooge (not a clinical term) that the vacuum draws out of the wound. It is also known as vacuum-assisted closure, or wound vac-ing. I will refer to it here as "the wound vac." Studies of the wound vac appear to start to be published around 1997. Dr, Louis Argenta and Dr. Michael Morykwas found that vac therapy in animals increased blood flow to the wound, removed bacteria, and increased the rate of the good granulation tissue (a "good lookin" wound has a wound bed that looks like raw hamburger meat). The FDA started to approve wound vac therapy around 2000. It can be used both as inpatient and outpatient therapy. The goals of wound vac therapy, as defined by Argenta and Morykwas, are to increase patient comfort, decrease patient morbidity, decrease the cost, and decrease the length of hosptialization. There is a second type of NWPT out there, developed by Dr. Mark E. Chariker and Dr. Katherine F. Jeter in 1989. This involved using a Jackson Pratt drain (it's a plastic flexy drain that is inserted surgically. If you've ever seen one, it looks like a clear hand grenade attached to a tube) connected to wall suction in a patients hospital room. It's known as the Chariker-Jeter technique. Unfortunately, I wasn't able to find much on this technique- it started being commerically marketed in 2001. We don't use it at my agency. NWPT is usually discontinued when the foam dressing can no longer fit inside the wound because it is too shallow. Average length of therapy is about 9 to 12 weeks for larger wounds.

OKAY MS. SKEPTIC, WHERE IS THE SCIENCE? Glad you asked!!! There have been at least 300 peer-reviewed studies regarding the effectiveness of NWPT. For this blogpost, I was able to find and review about 7 studies in various journals, including one of the studies done in 1997 by the "wound-vac dads," Argenta and Morykwas (however there are lots more available). I also reviewed a study by Bendwald, that examined the use of NPWT following surgery for complex pilonidal disease (a common type of cyst on the anorectal area). A paper by Jerome outlines the recent advances in NPWT. Bharestani performed a retro exam of clinical outcomes in neonatal and pediatric wounds. One extremely interesting study to read was one done by Leininger, about NPWT and soft tissue injuries in Iraq. Very surprisingly, their group of patients had a wound infection rate of 0 as well as no wound complications. The wound vacs were applied and reapplied in a completely sterile field by one of the surgeons at the 332nd Air Force Theatre Hospital in Balad, Iraq.

PROS Out of 300 wounds of all types (chronic, acute, subacute and nonhealing), Argenta and Morykwas found that 296 of the wound responded favorably to the vac. Jerome adds that NPWT to reduce excess moisture in the wound which reduces burden to the wound bed and surrounding skin, and also prevents growth of toxic stuff. Bharestani's study found that NPWT- combined with antibiotic therapy, surgical debrediment, optimum medical care and optimum nutrition- revealed a 92 percent successful wound closure rate. The foam is designed to have a pore size of about 400 to 600-um which maximizes cell growth. Wound healing tends to be faster with the wound vac. Also, one could take a wound that would require daily dressing changes and decrease visits to three times weekly. That is good in keeping Medicare and insurance claims down. When used properly, it can cut down on wound infection. It also has a very very low mortality rate. The vac appears to be useful for acute, chronic and non-healing wounds. The foam dressing is trimmed at the bedside for the specific size and shape of each wound. It does not have to be a completely sterile process so it can be done in the home (but you want it as clean as possible). Some pain was noted by patients, but most pain appeared to subside after the wound vac had been on for about 30 seconds. The vac is portable and allows for increased mobility for patients. One of the test subjects in the Bendwald study was able to attend high school using a portable wound vac.

CONS Most of the studies I reviewed stated that in order to truly call NWPT effective, more long-term well-designed studies are needed. Weaknesses of the current research include small samples of the same types of patients, lack of hard-core experimental design and lack of sensitive outcome measures, and lack of documentation of pain, length of stay, and cost of treatment. For wounds covered with dead tissue, surgical removal of the dead stuff is required before instituting the wound vac, or else it will be ineffective. Special training is needed, so not all nurses can put on wound vacs. Some patients don't like carrying around a bulky vacuum attached to them by a flimsy tube. And at times the wound vac can be noisy and distracting for some. (I would describe the sound it makes as sort of like a cross between a bull snort and a coffee perculator) Like any treatment, it has the potential to be put on improperly and if so, the vacuum pressure can cause damage to the healthy skin around the wound. Also there is a potential for wound infection if nurses don't practice good clean technique and proper universal precautions (handwashing, gloves, etc.) while performing wound care. And it requires A LOT of adhesive dressing, so if you are sensitive to medical tapes and bandages, you might want to carefully monitor how your skin reacts. There is at least one mention in at least one of the studies I reviewed that stated that a test subject had to discontinue wound vac treatments due to skin sensitivity and the adhesive. The wound vac IS NOT RECOMMENDED for wounds that are the results of tumors or cancers, as they can actually help enhance the tumor growth.

HOW ARE NURSES INVOLVED? Nurses in home care undergo a series of training and re-training classes involving wound vac administration, set up and rountine care. This is usually supplied by a clinician at the company that supplies the wound vac supplies. The nurses monitor the wound multple days on a weekly basis. My agency usually changes the wound vac dressing every Monday Wednesday and Friday, but no less than three times weekly. We are responsible for keeping accurate weekly measurements of the wound's length, width and depth, as well as describing any drainage amount, color and consistency and teaching the families how to care for the vac machine and helping the patient and the caregivers troubleshoot any problems with the machines, mechanisms and therapy. Most physicians who are working with us look to the nursing staff to advise THEM on the protocol and parameters of wound vac use. Plus, many of the research studies on wound vacs are performed by Wound Ostomy Continence Nurses (WOCNs), who are nurses who are educated and certified to specialize in wound care.

SO, IS IT REALLY COOL? I think it is. The vac does a really good job at keeping wounds clean and dry and necrotic tissue (the dead stuff) rarely returns when a patient is on the vac. It's neat to watch a stubborn wound respond to the vac. Our agency has a good working relationship with the manufacturer of the wound vac. It's pretty easy to obtain one for a patient if a doctor orders it, and the clinician that works with us is very available if we have questions. Many patients like it because it really is minimally invasive and cuts down on nursing visits and daily dressing changes...and money, which is why insurance companies like it too. If you are reading this and think that you or someone you know might be a candidate for a wound vac, please first visit the doctor you are working with and discuss it with him/her.

WHAT'S NEXT FOR JENN AND NPWT??? Are you implying something?? ;) Actually, I have been toying with the idea of becoming a WOCN. I really like to do wound care. It's a great type of nursing for a skeptic, as one has to apply their critical thinking skills as well as practice the scientific nursing method of assessment, diagnosis, intervention, results and eval on a regular basis. I could do what I do now, but it would be more focused towards a specific type of patient and...they would pay me more money. So I am definately interested in being a WOCN. But, there are some days I also wanna be a Care Bear. So we'll see.

References for this blogpost
Leininger, B.E., Rasmussen, T.E, Smith, D.L. Jenkins, D.H., Coppola, C. Experience With Wound VAC and Delayed Primary Closure OF Contaminated Soft Tissue Injuries in Iraq. Journal of Trauma Injury, Infection, and Critical Care, 2006;61(5):1207-1211.

Bendwald, F.P, Cima, R.R., Metcalf, D.R., Hassan, I. Using Negative Pressure Wound Therapy Following Surgery for Complex Pilonidal Disease: A Case Series. Ostomy Wound Management, 2007;53(5):40-46.

Verrillo, S.C. Negative Pressure Therapy for Infected Sternal Wounds: A Literature Review. J WOCN, March/April 2004:72-74.

Baharestani, M.M. Use of Negative Pressure Wound Therapy in the Treatment of Neonatal and Pediatric Wounds: A Retrospective Examination of Clinical Outcomes. Ostomy Wound Management 2007;53(6):75-85.

Jerome, D. Advances in Negative Pressure Wound Therapy. J WOCN, March/April 2007:191-194.

Negative Pressure Wound Therapy

Argenta, L.C. and Morykwas, M.J. Vacuum-Assisted Closure: A New Method for Wound Control and Treatment: Clinical Experience. Annals of Plastic Surgery, 1997;38(6):563-576.

Thursday, December 4, 2008

The Slacker Skeptic stops mulitblogging and starts gettin real.

This is Jenn, the resident padawan skepchick of Richmond Skeptics here, humbily groveling at your skeptical feet (nice shoes by the way, where'd ya get em?)telling a somewhat sad tale which hopefully will have a happy ending.

Fresh of the afterglow of The Amazing Meeting 6, I started a blog dedicated to skepticism in nursing. I had high hopes for my blog, which I called A Doubting Florence. As an RN, I have a wonderful oppurtunity to apply and use science on a daily basis, but I've noticed that there are not many blogs out there that address skepticism and nursing specifically. The plan was to use this blog to make people aware of all the good research and critical thinking done by nurses- past present and future. I also attempted something I called the Quest For Knowledge, which involved me trying to tackle a multi-faceted subject pertaining to either nursing science, research, or history, along with the regular weekly reports I planned to post. This fall I focused on a historical perspective on one of the most famous pioneers of nursing- Florence Nightingale.

I haven't posted since August. A LOT of nursing news has passed me by. I'm only on page 200 or so of a 400 page bio on Nightingale, the self-imposed deadline expired about a month ago. TAM 6 was in June. Now as December begins, the honeymoon is, sadly, over.

Sigh. Blogging is ruuuullly hard, y'know? And when I started A Doubting Florence, I'd figure the quickness and clever subject matter so easy to the great Steve Novella would come just as natch to yours truly. But alas, not so.

First of all, Steve is a blogging machine. He has, like, 4000 brilliant blogposts out there in skeptical cyberland- it's almost ridiculous! And in order to churn out the meticulous and well written blog entries that folks like the good docs at Science Based Medicine do on a daily basis, you have to do a lot of homework, have a lot of good resources and perhaps a few essays saved in your hard drive foryour writing block-esque off days. I chose to jump, figuratively, without these very strong nets in place. Also complicating things was around the time I started A Doubting Florence, my husband and I were sharing one computer. The computer in question is one he uses for his job, and since we like it when he works and makes money, that took priority over the nursing blog. And speaking of nursing, my job owns me, (really. They gave me a computer, a cell and most recently, a car. They own me, and I love it!) so that got in the way too. Plus, I am horrendously lazy and at most, I'm only getting the blog bug sporadically at best. Much less than the monthly updates I had promised readers.

Now I have a nice laptop with wireless internet (thank you job! I love you), and few more resources under my belt and a new side gig as a clinical mentor to nursing students. Life is good. I still felt a bit bad about the lack of effort. Even a skeptislacker like me could do more. I felt a little better listening to the long overdue Quackcast, which makes no apologies for their hiatuses (not that they should apologize). And the recent very lovely Skepchick Podcast made me think about the strength in numbers. After all, that was the real reason for The Amazing Meetings and others like it- comraderie. So I figure I would try to salvage what dignity and saavy I had left, and come groveling to the skeptics that love me for the procrastinating mess I am and ask if that would be okay. That was about 24 hours ago. So far, none of the Richmond Skeptics has chased me away with torches and pitchforks, so I am thinking that A Doubting Florence has found a home here! Exciting! Over the next few days, I'll be moving the old entries onto and it, along with Skepchick news and updates, will sort of be my main contribution to the Richmond Skeptics. I'm totally stoked and ready to go. Thanks again to Patrick, John, and my one true love, John Y. for all their support.