Day 10: Breast Health

Today was spent shadowing the Breast Health Navigator, Michelle Wilkes, RN, BSN. She has an office in the general surgery clinic and does a variety of things and works with all breast cancer patients. Michelle does the breast health case management and the promotion/prevention material at the hospital. In October, she does a lot of health promotional type things such as participating and organizing health fairs, creating flyers and banners for awareness and ofcourse coordinating with her stake holders and managing her budget given by the government.

We talked about almost everything today and I am very interested in this field. It’s very rewarding to work with cancer patients and feel that you are providing care and support for them. Michelle has a list of resources along with a Breast Cancer textbook that she gives each of her patients upon arrival. I also learned that there are multiple kinds of breast cancer depending on its location– whether in the fatty tissue, lymph nodes, or ducts. I will be attending a meeting at the American Cancer Society with Michelle on February 5th which she thinks will be beneficial to me. So I am excited about that and feel fortunate to have met her! I learned about a program that the American Cancer Society has called “Road to Recovery” which is for volunteers who help cancer patients by driving them to their chemotherapy appointments. I am very interested in this and want to get more information on participating!

So I also learned all about finding bumps or cysts in the breast and how they do the biopsy and thus remove the abnormal tissue. It is a process, and involves lots of radiology, needles, mammograms, surgery if needed, etc. However, at times a cyst may show up on a mammogram but it can’t be seen or felt in person. To locate and remove this kind of cyst, they do a procedure called a stereotactic biopsy which I found extremely neat and interesting! Basically, since the lump cannot be seen or felt, they use radiation along with a computerized program to locate it and then insert a biopsy needle at those coordinates. Later if it needs to be removed, they perform the stereotactic procedure again however this time the shot inserts a metal wire (similar to getting an IV tube) which then sticks out of the breast and the patient is taken immediately to surgery. The physician is able to locate and remove the lump of tissue by making an incision on the breast where the wire sticks out. Then, they follow the wire until reaching the end of it where a small hook is around the lump and is then cut out. It gets sent to radiology right away to ensure that they removed all of the abnormal tissue and stitch the patient up. Very neat, but also have a heavy heart for those who go through it.
I noticed Michelle receiving many phone calls from patients where she would be consulting with and comforting them. She is great at her job and helps these survivors to be strong– which is crucial!

I learned the anatomy of the breast and had to pick lumps out of a sample breast that Michelle had. At first it was difficult to do, but once she explained the texture of the breast and the texture of a cyst/lump, it was simple. A cyst has harder edges or boundaries and does not move where natural lumps in the breast will move or squish around when pushed on.

I also learned how to administer a breast self exam (BSE). SBE is the #1 form of prevention. Mammograms are another form of prevention and should be done annually beginning at the age of 40 unless instructed otherwise. For those ages 20-30, a clinical breast exam by your doctor should be done every 3 years.

Probably the most important thing that I learned about doing the BSE is to check yourself on the same day each month, preferably the day after your menstrual cycle. This is important because women’s breasts naturally feel lumpy and frequently change throughout each month. Once you perform the BSE on the same day each month, you get a good idea of what is normal and how your breasts feel. It will be easier to catch something unfamiliar when done this way.

Interesting fact: The greatest risk factor for breast cancer is being a woman. One in eight (1:8) women are expected to get breast cancer in their lifetime. Prevention is our best protection!

Overall, a great day and experience! Really enjoyed Breast Health– who knows, maybe one day my career will be in this specialty!

20130128-143850.jpg

Anatomy and structures of breast

20130128-143910.jpg

How to do a Breast Self Exam (BSE)

20130128-143922.jpg

Mammogram

Daily hours: 8
Total hours: 72

Day 9: news & modules

NEWS: This morning I went to the office to speak with Jim and him up on the health fair news. I told him about Andrea Beck’s event on April 20th and we discussed the possibilities of ending our event planned for April 5th and instead, joining the Family Fun and Fitness event. I received a call back from Andrea yesterday and we discussed the opportunity of me co-committing with her on this event. She sounded excited and sent me an email saying, “We respectfully invite NHP to participate at our Family Fun & Fitness Event on Saturday, April 20 from 11 AM to 2 PM.”

So I was excited to share this news with Mr. Sherrard and we are going to have a phone meeting with Andrea on Monday afternoon to further discuss!

MODULES: The rest of my day has been spent doing some of the tobacco cessation modules on my computer that are required for the certification. Each one is 60 minutes long and there are 13 I need to complete. Needless to say, I stayed busy…

Daily hours: 8
Total hours: 64

Day 8: (01/23/13)

It’s wacky Wednesday! Which means today has been a very busy day with lots of running around.

First, I checked in with Mr. Sherrard and got the phone numbers of all the contacts that we emailed regarding me shadowing. In my office, I then called each of them in reference to the email to schedule the time and days to shadow each. After setting up those appointments and speaking with many new people, Mr. Sherrard and I started working on the health fair.

So we’ve pretty much decided on Friday April 5th from 10-1 in the hospital courtyard for staff & employees. We focused on 3 things today. First, getting clearance from the hospital to ensure that there are no conflicting events taking place on the same day, April 5th. He gave me the PAO’s number (Public Affairs Officer) as well as the CO’s secretary’s number, Tina. Second, is securing the courtyard and finding out who is responsible for managing that area of the hospital. Third, we would need to form a committee to work with us to plan this health fair. We have some vendors in mind such as MWR, the NEX and commissary, UWF SHEP club members (Students for Health Education and Promotion), deployment health personnel including some of those I have been contacting to shadow, etc. The theme would be fitness and nutrition so that is why we have thought of these particular vendors to support and provide us with appropriate workout equipment (NEX), food (Commissary), workout plans (MWR), and overall health and wellness promotion (SHEP club).

So, I got busy and called the PAO and Tina, the CO’s secretary. They both checked the calendars for any conflicting events on April 5th and didn’t find anything. However, Tina directed me to Tara Retigg which is the marketing coordinator at Naval Hospital Pensacola. She was a great help and told me about an event going on Saturday April 20th at the NEX called Family, Fun, and Fitness which sounded very similar to the health fair we were trying to plan at the hospital. I began to get very excited as she told me the about Andrea Beck (the NEX Special Event Coordinator) who was organizing this event and that she is interested in Naval Hospital Pensacola working with her, specifically Deployment Health! So she gave me Andrea’s number and I called and left a message with her. So stay tuned on that!

Just when I thought my day was becoming exciting, I got a response from Sheila Jones who is the Infection & Prevention Program Manager and NHP asking if I wanted to come and shadow her right away! Ofcourse I said yes, and after arriving and then spending the afternoon with her, I realized why she wanted me to shadow her today. I cannot share what I learned and observed from her today because it is confidential, however I may be able to later on in the semester… So again, stay tuned 🙂

To end an exciting day, I attend Mr. Sherrard’s 2nd tobacco cessation class at UWF. It was taught again by Amanda and we went over more harm, excuses, and consequences of smoking along with covering all forms of tobacco (smokeless, cigars, strips, snus, hookah, e-cigarettes, etc.). It was a very informative class and I look forward to next Wednesday’s class to learn more!

Daily hours: 8.5
Total hours: 56

Day 7: health fair scheming

Happy Monday & MLK!

My day was mostly spent researching various ideas for a health fair. Here are some possible ideas:

-SPRING into HEALTH or COMMIT to be FIT as the theme
– target audience is hospital staff and their beneficiaries
-Last week of March or first week in April. Wednesday or Friday morning/noon time. During working hours
-5K run/walk held in the back outside gate of the hospital
-Participants receive a t-shirt or wrist band
-vendors set up with tables (still collecting list of possible vendors- should have better idea Wednesday after meeting with Mr. Sherrard)
-promoting physical health & nutrition
-collect food donations (healthy snacks)
-make flyers to post throughout hospital weeks before
-drawing for prizes?

That’s the basics for now. I’ve been brainstorming and trying to come up with good objectives and incentives for people to come. I need to do more research on any previous/existing fitness programs for employees.

Daily hours: 8
Total hours: 47.5

Day 6: (01/18/18)

It’s Friday and week 2 of my internship is complete, yippee! It’s been a great week and experience already, I can’t imagine in 14 more weeks what all I will have learned.

Mr. Sherrard and I met today to discuss more shadowing opportunities for me as well as a Spring Health Fair.We emailed 10 different health professionals within the Naval Hospital Pensacola to ask if I could observe them for a couple of days. Literally, the same email was sent to 10 people. This is what it said:

“Dear–

I have a UWF student intern this semester and I am attempting to support her
learning opportunities by giving her ‘broad’ perspective of prevention and
wellness in our healthcare setting.  Would you be willing to allow her to
shadow you for a full day or two, to allow her to gain insight of your role
in prevention and wellness?  Her name is Breanne Watts and she is a health
education major.  Her husband is a Marine pilot in training aboard NAS.

R/Jim Sherrard”

*I like how he threw in the part about my Marine in training husband 😉

It was sent to:

Michelle Welks, Breast Health Coordinator & Navigator

CDR Hunter, Active Duty Dietician

Lanora Glaze, Diabetes Health Educator

Dr. Skipton, Mental Health

Sheila Jones, Infection Control Nurse

CDR Payne, NATTC Branch Clinic

CDR Dan Swisshelm, NASP Branch Clinic

WIC- Women Infants and Children

Debbie Shell, Case Management

Lactation Consultant/Women’s Health Coordinator

SO, this should give us a good start to my learning experience! We wanted to contact a broad spectrum of health promotion & prevention educators to help further my interest in a specific field one day.

When then discussed a perceptive health fair to be organized in the spring. He got me off to a good start on some ideas and told me that he would like it to be simple, with a specific theme, and targeted towards the Naval Hospital Pensacola staff held during business hours. We know we want it to take place in the beginning of April and talked about the possibilities of a 5K run/walk to draw attention to the event. We brainstormed a small list of vendors to attend and decided to meet on Wednesday to contact those individuals on attending a meeting related to the health fair. The rest of my day has been spent brainstorming ideas and internet research. Stay tuned on Monday for some more information and ideas on my health fair– COMING THIS SPRING!!

Daily hours: 8

Total hours: 39.5

Day 5: (01/16/13)

Hello Bloggers!

It’s Wednesday, and today’s agenda entails two things: PA shadowing of PHA appointments and lots of tobacco cessation material!

So this morning I spent time with both Lauren and Vaun who are the Deployment Health & Wellness Physician Assistants. Some of the appointments were PHA’s but there were also some DD2900’s. A DD2900, also known as the Post Deployment Health Re-Assessment (PDHRA– got to love all the acronyms!), is done 90-180 days after returning from a deployment. A deployment is considered being OCONUS (Outside of the Continental US) for more than 30 days. So, when the service member returns, they must complete this health assessment to ensure that their health and well-being are up to par. Lots of times, this is where you may catch some cases of PTSD, TBI, or depression. If so, the PA will refer these patients to their PCM or Mental Health Specialist. I learned a lot by sitting in on these appointments and also took lots of notes. Attached is a picture of the PHA. Vaun gave me a copy of this and showed me more on how to submit patient information on AHLTA.

Next, I attended Mr. Sherrard’s Tobacco Cessation Seminar to service member’s in the ballroom of the Officer’s Club aka O Club. He put together a power point presentation on tobacco and briefly discussed his 4 week program through AHEC that helps users to quit. The program is actually called “Quit Now” and I found some of his materials interesting. In a class I took at UWF called Changing Health Behaviors, we learned about the Stages of Change using the Trans-theoretical Model. It was neat to see this application applied to a life setting. This is how I know that I am living in this internship what I have learned throughout my college courses. Another interesting fact is that 20-30 minutes of using a hookah is equivalent to 100 cigarettes at 2mg of nicotine each, crazy!

This evening, I attended Mr. Sherrard’s night class at UWF called Drugs in Society. I have actually already completed this course when I attended the University of Georgia, however my professor did not include tobacco cessation certification into the course. Mr. Sherrard wants me to attend this class (as do I) so that I may become certified to teach tobacco cessation to users. I am very excited about this process! The class was very fun, informative, and interesting. It was actually taught by AHEC member Amanda Pavlich, MBA, CHES, CTTS who is a Certified Tobacco Treatment Specialist. She did a very good job of discussing the effects that tobacco (cigarettes, cigars, and smokeless) has on the body.
I will attend this class along with completing modules online that go along with the material. In 4 weeks, I will receive my certificate.

An interesting fact of the day– “Each year an estimated 443,000 Americans die prematurely from smoking or ETS and it is the #1 cause of preventable deaths”

http://www.ahectobacco.com/

Daily hours: 8.5
Total hours: 31.5

20130118-165623.jpg

Day 4: (01/14/13)

My day started by talking with my internship director, Mr. Sherrard, regarding my schedule for this week. Here’s a snapshot:

Mon- shadow Lauren Treven (clinic PA 1),

Wed- shadow Vaun (clinic PA 2), attend Mr. Sherrard’s tobacco cessation presentation at the Officer’s Club, and attend his Drug’s in Society night class at UWF covering tobacco cessation.

Friday- meeting with Mr. Sherrard on contacts to shadow and discussing/brainstorming on a spring health fair for the Naval Hospital Pensacola staff/beneficiaries

So, time to get busy shadowing! I am excited about this because I am wanting to get my master’s to become a Physician’s Assistant. Mr. Sherrard has moved my office down into the deployment health clinic, right next to both of the Deployment Health PA’s (Vaun & Lauren). I am so excited to be shadowing a PA within the deployment health field because it gives me the best of both worlds, really! Below is a picture of my new office. I am so fortunate to have my own space and feel so welcomed by all of the staff here.

Now onto the learning– Like I said, I will be shadowing Lauren Treven, PA today. First, we discussed her educational background, where she attended PA school, and she gave me some great advice on my future career as both a health educator and PA. We then went over her duties as a PA in the clinic and she introduced me to the online health records system that they use called AHLTA. I am very familiar with this acronym after reading the binders full of instruction last week 😉 I am beyond excited to now apply that knowledge and get a visual experience on how the Deployment Health & Wellness Center operates.

The PHA (Preventative Health Assessment) is done each year on the active duty or reservist’s birth month. It is done to ensure part of their IMR (Individual Medical Readiness). I have taken many notes on the PHA appointment process, but will spare you on all the details. Actually, we’d be here all day which is why I am just going to say that basically it entails a lot of medical records, screening, questions, vital signs, immunizations, lab work, and prevention. They want to make sure that the service member is clear and ready to perform their job in a healthy and safe manner.

Overall, it was a busy and informative day of shadowing in the clinic. I enjoyed it very much and feel blessed to have this experience!

Daily hours: 7
Total hours: 23

20130116-155609.jpg

Day 3: (01/11/13)

Today I finished reading two binders of information on the Deployment Health and Wellness Instructions at the Naval Hospital Pensacola. I learned about the following 8 areas that deployment health covers: drug abuse prevention & control, alcohol abuse prevention & control, tobacco use prevention and cessation, overweight & obesity elimination & nutrition education, sedentary lifestyle elimination & physical fitness promotion, injury & illness prevention, sexual health & sexual responsibility, suicide prevention & stress management.

I have taken many classes covering these subject matters and therefore look forward to applying what I have learned!

An interesting statistic I came across today while reading is, “lifestyle-related chronic diseases account for at least 70% of the nation’s annual healthcare costs.” I found this to be shocking and inspirational at the same time. I know that my job as a health educator in our society today is very crucial and demanding. I hope to help change lifestyles and thus lower the risk of chronic disease in people all over the world (as I travel around with my husband who is in the Marine Corps).

Daily hours: 4
Total hours: 16

Day 2: (01/09/12)

Today I am nervous! First day at the internship site, which is actually located at the VA Outpatient Clinic but still a part of the Naval Hospital Pensacola. On the second floor, there is an administration section which is where my internship supervisor and Department Head of Deployment Health is located, Mr. Jim Sherrard. Upon arriving, he introduced me to his administrative assistant, Nancy Parenteau along with the staff downstairs in the Deployment Health clinic, including both PA’s, Clinic Manager, and civilian employees. I will be shadowing some of these clinic personnel as well throughout the semester.

Next, I was given 3 binders full of information to read. The first and only binder I was able to complete today was the Bureau of Medicine and Surgery Instructions for the Deployment Health and Wellness Center. I learned lots of acronyms and information on how the deployment health system works. Some of this process includes the PHA (Periodic or Preventative Health Assessment) and the IMR (Individual Medical Readiness). These tools are very complex and are used overall to assess the active duty and reserve service member’s health and wellness so that they are ready for deployments. I arrived at 9am and left at 4pm.

Daily hours: 7
Total hours: 12

 

Day 1: (01/07/13)

It’s Monday! And Day 1 of the semester. I am nervous but beyond excited to start this internship. First things first, security clearance and paperwork– we are dealing with the DOD here!

So, I attended a hospital orientation held on the 6th floor of the Naval Hospital Pensacola this morning. It included some paperwork, a meeting discussing hospital rules and policy, and then I received my badge. All of this was administered by Thomas Dunn who manages the security clearance.

After this, I went to the Navy Wellness Center and was given a CPR test by Bob Thomas who works for MWR (Morale Welfare and Recreation) and received my CPR certification card through American Red Cross.

My first real day at the internship site will be Wednesday, so stay tuned!

Daily hours: 5
Total hours: 5

20130111-114023.jpg