Baby Steps are Better than No Steps!

Have you ever felt stuck when you were trying to work through something?  Saul Enriquez, a teacher to our future nurses at Rio Grande Valley Nursing School, has over 26 years of experience in caring for people with a multitude of health issues. During his work providing critical care at ICUs, trauma units, and emergency departments, he's seen patients recover from extensive injuries. All of them had one thing in common: persistence. He now teaches future nurses to have patience with their patients. Even when facing tremendous obstacles, survivors found ways to make improvement, even if it seemed insignificant at the time. Future nurses will learn with those baby steps, patients will eventually find themselves further along their path of recovery. So if you feel stuck, remember that any action is better than inaction. Keep going!

Transcript

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Instrumental

Carrie & Kezia: 0:10

Hi, I'm Carrie, a brain injury survivor and a member of BIND. And I'm Kezia, a stroke survivor and member of BIND as well. And today is a very special Thursday and we're super excited to welcome not only our guest, but also for it to be our very first virtual episode. So I really hope you guys are all watching us on YouTube and can see the big difference between this episode and all our other episodes. So today we have Saul Enriquez, who is a registered nurse, uh, in And, wait. Rio, I can't say the right word today. Um, well, he'll introduce himself too, but he's a registered nurse and he is actually a, um, professor at one of the colleges at Rio Vale, right? Rio Vale Grande. Um, and we're super excited to have him here as a guest from Texas and teaching us a little bit more about his point of view as a registered nurse and his very, um, a lot of years, uh, in neurology. Today is not the best of my day with words, guys, but I hope you guys all watch the episode and enjoy it. So welcome. So we're so happy to have you here.

Brian: 1:30

Welcome to BINDWAVES, the official podcast of the Brain Injury Network of Dallas. I'm Brian White, BIND's Executive Director. On each episode, we'll be providing insight into the brain injury community. We'll be talking to members and professionals regarding their stories and the important role of BIND's Clubhouse. We work as a team to inspire hope, community, and a sense of purpose to survivors, caregivers, and the public. Thank you for tuning into BINDWAVES. Let's get on with the show.

Saul Enriquez: 2:03

Thank you, Kezia and Carrie, Carrie Terry. Thank you for having me. I'm Saul Enriquez. I've been a registered nurse, uh, 26 years now. I started, I got my bachelor's degree in Corpus Christi, Texas A& M University, way back in the late nineties. It was like my second or third career, but. I felt like that's where I needed to go immediately on my very last day of clinicals. I was, um, introduced to open heart massage and open heart, um, CPR. And so I went straight into the ICU thinking, Oh my goodness, this was an adrenaline rush. So I've done medical ICU. I've worked in the surgical ICU. I've done neuro ICU. I've worked in the coronary care ICU, trauma unit and the burn unit. And then did two and a half years in the ER. So I have extensive high critical care experience, which really has given me a broad, arena of information. And now for the last eight years, I've been imparting a little bit of my knowledge and experience to students here in the Rio Grande Valley. Uh, I'm currently teaching at a private college called RGV College, uh, in Pharr, Texas. I do reside in the Rio Grande Valley here in McAllen, Texas. Uh, and I'm really pleased to see that the nursing shortage has hit us very hard, especially after the pandemic. And so I'm able to help fulfill a lot of my students dreams in becoming RNs. And so, uh, I'm excited that I'm able to be on here with you and share some of my, some of my experiences with you. Uh, so thank you for that.

Carrie & Kezia: 3:43

Awesome. That's a lot. Open heart massaging sounds kind of scary, but I could see where that would be a rush as well. But so my question for you is in your many years, let's say we're going to focus on neuroscience. That's kind of our little niche here. Um, have you always just been in ICU and CCU? I don't know the difference. I know I was in CCU and ICU. I don't know which one came first. I don't know. Really know the, I know what they stand for. I know, no, I actually, you know, I know CCU is critical care and ICU is intensive care. Did I get it right?

Saul Enriquez: 4:17

right, correct. CCU involves coronary care as well. So one is related to the heart space, like the open hearts. A medical would be more pathology, disease oriented. Then you have the neuro ICU, which is traumatic brain injuries, whether they're external or internal. Then you have surgical intensive care, which is after any type of surgery, Um, they have a, almost like a recovery area, make sure that they stabilize before they go back to the floor. And then we have, um, the ER and the burn unit that I've also worked in. And what I tell my students, Carrie, as many times as when I'm teaching urology, Um, you know, the urology is like the road map of the body. And so if everything is controlled and managed by the brain, then everything will be affected if the brain has injury. And so I've always related that to a map of Texas, for example, and I say there's different ways to get from the RGV all the way to Dallas. But you know, if there's one area that's roadblocked or damaged, or there's under construction, there's other pathways that can be created to get to the final destination. So that that's The therapy comes in, not only the allopathic physicians or the osteopathic physicians, but also nursing care. We come in and try to re establish those alternative pathways that can enable patients to recover back to close to where they were before the trauma began, uh, started, or has happened.

Carrie & Kezia: 5:48

All right, and we call that neuroplasticity. I know more words than I should know as a stroke survivor, but you know, that's

Saul Enriquez: 5:55

That's a

Carrie & Kezia: 5:55

good It's good to learn. Um, I think that I like, I like the way I've always used one of my counselors in my day neuro program that used a like a railroad station, like if, you know, so, but I like that. Texas roadmap better. I think I'm going to start using that. Yeah, I really liked that too. I hadn't heard it that way, but I think it makes total sense. And honestly, Carrie, we learned a lot because we went through this and we learned our recovery and we learned through our actions, so, um, but I liked comparing it to a roadmap that we just have to rebuild, uh, a way to get to our, our next, our next place. I really liked that. Um, and actually. Not only are we patients, or were we patients, um, but a lot of the time between our families, our caregivers, our supporters, it was a way for them to also understand. Um, so how would you be able to, the way you taught us right now, is that the kind of vocabulary you use with the people explaining them what happened?

Saul Enriquez: 7:00

Well, yes, Kezia, because in down in the Rio Grande Valley, we have a high, high amounts of immigrants coming in. And so we have not only the non high school graduates trying to better their life and fulfill their dream, but we also have also Caribbean doctors. educated in the Caribbean and in Mexico, having trouble passing their TOEFL exam and so they cannot pass their board exam. So they, sometimes they alternate and become nurses. And so instead of them, um, restarting all over again, they just go the RN route. And so I've had three or four medical doctors in my classes, uh, along with recent high school graduates. And so I find myself having to challenge. My, the medically trained professional without losing my high school, post high school graduates. And so it's really, it really tough, but I also try to make sure that, that there, it's a learning environment so that they can be stimulated enough to realize that, uh, this is not just a lot of memorization, but this is life experiences. And I feel like when I'm speaking, especially about the brain, the brain, I've been able to not only impart. Knowledge to the, uh, LBN program, but also the RN program here. We have a transition. 10 month program for LVNs to trans, uh, transfer or, um, transition, I'm sorry, over to the registered nurse, uh, level. And, uh, I've been a guest lecturer in that department three times now, and I've been able to impart to them the, uh, how it, what it takes from a nursing perspective, uh, to help a patient get to where they need to go.

Carrie & Kezia: 8:46

Kind of talking about the

Saul Enriquez: 8:47

very exciting.

Carrie & Kezia: 8:48

And on that, I guess one of my other questions that I was trying to ask earlier, um, I don't think I asked it correctly, but so is being a nurse in neuro, ICU, CCU, whatever it may be, different than being a neuro nurse in the acute setting?

Saul Enriquez: 9:04

Yes, big, big, big difference in that we as nurses, number one, the nurse has to be very therapeutic and very understanding what's going on. Most of these treatment plans and recovery plans take months, if not years. And so if the nurse is not patient or sets up a therapeutic trust with the patient, then it's going to be very, very difficult The patient can get very frustrated with themselves. And if the nurse is pushing too far, too fast, and too hard, and, and, instead of encouraging, causes frustration in the patients, then they can cause, it can be counterproductive. So I find that, uh, in the neuro ICU, you know, you would have to be exceptionally therapeutic, very patient with them, let them know that this is going to take time, this is not going to be, you know, seven days of antibiotics and you're going home. Thank you. That type of thing. It's going to be rehab. It's going to require relearning different, uh, you know, activities of daily living and things of that nature. So, you know, we have to make sure that and then on top of that, we have to also make sure that our patients are going to be safe. The top priority, I guess, for any nurse in the neuro ICU, especially after it's like a blunt head trauma or, um, MVC, motor vehicle, uh, uh, collision, then you have sometimes seizure activity that comes on after the fact. And so then we have to make sure that our patients are not going to end up on the floor. They're not going to end up with an additional injury, a hip fracture, arm fracture, because, you know, uh, they were not. Secured properly and make sure that they didn't fall out of bed. So it's a vigilance, observation, meticulous detail, safety, reassurance, and things of that nature. Make sure that the patients are going to be taken care of, watched after, and secured, make sure that they're safe. And that's what I teach my students, is that in due time, we'll see the recoveries. Sometimes it's baby steps, but it's okay. Baby steps are better than no steps. Hopefully that answers

Carrie & Kezia: 11:21

I think what you just said that this is. Oh, yeah. Yes, it does. It does answer a lot of questions. It also asks, now I have so many more questions. But yeah, I mean, I think it's awesome that right now that you're saying that you teach your students and they have so many different perspectives with, you know, where they're from or what they've learned before. But I think that as a patient, that also is almost the same. Like we. We're also learning along the way with our injury and with our experience, um, and also of our, our family members. Um, so I think, I think I related and I'm not a nurse or a student, um, but I think that's where we're at too. So I love that

Saul Enriquez: 12:05

Yeah, so the internal versus external brain injury, you know, can result in the same type of damage. Uh, in my personal life, both my mother had had a CVA, um, about six years. Years and six months ago and she survived and up until this past March and she was bedridden but you know, we did meticulous care with her and she was able to have very lucid days and some days she didn't wake up But she there were times where she would ask and speak up and so we were I was honored to have her in my home And and take care of her but then in 2020. Right as soon as the pandemic was coming into the United States, my wife had a CVA, and so she had a stroke, and she was in the hospital for 30 days, and so we found ourselves At the time, then, you know, having to deal with this on a very, uh, from the RN perspective and the patient perspective, because my wife is an RN as well, and she found herself very impatient because being a charge nurse, being in charge of the whole ICU and the floor, she found herself impatient many times, wanting to get up out of bed and wanting to do this, and then she finally had it come to terms that as a patient, now it was having to take the time to go back and recalculate, re relearn and, and, um, do the baby steps again. Thank goodness they hit her. Uh, it, they, she was at work when the CVA happened, so they were able to immediately take her to the CT scan and it was an ischemic, uh, CVA, that means it was a blood clot in the brain. So they were able to give her, uh, that. streptokinase medication very quickly and dissolved the clot. And so she regained most of, if not all her right sided, uh, abilities to move, I guess, the, the, the, um, lack of movement and paralysis, I should say.

Carrie & Kezia: 14:09

Yeah. That I was

Saul Enriquez: 14:10

then, but cognitively she, she lost her cognitive abilities to remember a lot of the information that she, that she had learned through her 20, also 25 years of nursing. So, she may have had short term memory and long term memory loss and ended up, you know, with full disability. But at the bottom line, she's able to now get back to the point where she can drive. She knows where she's doing. She makes herself daily lists of what she's got, has to do that day. Uh, and so it's, it's very important that from, you know, we have to be a very understanding as, as the nurses and versus the patient. Sometimes we're both. In our situation, we were both. And it was very frustrating for her. But again, I had to be very reassuring. The nurses that took care of her and the rehab, uh, therapists were amazing. They all knew her from before the stroke. So when they saw what had happened, they were very therapeutic. Bedside manners were awesome. And so they, they were very understanding as well. So I guess it's a, it's a whole different paradigm when you start having to change your mindset, going from just a nurse taking care of somebody to being the patient. And now we can understand how the patients feel. And again, like I said earlier, that's how I'm trying to impart to my students that type of therapy.

Carrie & Kezia: 15:33

Yeah. Well, thank you so much for sharing your story. Um, and your perspective as a nurse and As a, as a husband and as a, as a son, I think that's really, it's really important because like you said, we lose, not lose our perspective, but we kind of lose control of it to a certain extent. I mean, I had a stroke and, uh, it, it's hard to be patient with oneself. I was 28. I went to college. I think, I mean, I was really smart. I still am, right? But it's really frustrating when I didn't, I couldn't read. So yeah, it is very, very frustrating. Um, but it's great. It's a great, uh, it's a great process and, uh, success when you can totally understand it. And you're like, okay, that, that, that's what happened. Now let's move forward. So I think it's really important. Yeah.

Saul Enriquez: 16:30

And we, we, we have to be very careful though, Kezia, that as nurses we don't push our patients and, and knowing that my wife was so energetic and she was so, uh, advanced, she was a lot smarter than I am. I will never be. And I had to make sure that I didn't push her too much too fast and that she was also very patient with herself and that let frustration creep in. Uh, and ultimately with depression and whatnot. So yes, it's very, it's baby steps. And if we get back to 90, 95%, that is very, very important. Awesome. If we can get back to 75%, that's, that's awesome as well. The bottom line is that, you know, it's, it's just, everybody has their own story, their own abilities. And cognitive wise, we have to make sure that the brain heals. Um, and that's, sometimes it takes longer for some people, but it ultimately will reach its maximum point and we have to work with that.

Carrie & Kezia: 17:27

Okay. Thanks. So I'm going to take a quick little break and just remind all of our listeners to go ahead and click that like button, that share button and that notify button. Um, I guess he's clicking, um, you know that. And so just to kind of go back to what you were saying, um, I also, I had a hemorrhagic stroke and I also had like, I had a blood platelet transfusion. So maybe that's why I went to both different ICUs or whatever. Um, but I also had some of what I feel like you're describing what they told me. was impulsivity. I had a bed alarm. I had a chair alarm. I had all of that. So, um, and all the different personal, I mean, your family versus, not versus, but in all the patients that you've seen, you think that's one of the greatest challenges with a brain injury survivor? Or what, what do you kind of, I mean, we all have to relearn. We all start somewhere lower than where we, where we wouldn't The brain injury happened or whatever it may be. And again, like you said, we all recover at a different pace at our own pace. Um, I was completely paralyzed on my left side. It's still a little, not so good, but I walk around, I drive, I work, I do everything. But

Saul Enriquez: 18:38

Right. I reassure my patients, Carrie, that the brain recovery is multifaceted in that not only is it physical in that we're trying to get back to activities of daily living. But it's also mental and emotional and it can even be spiritual because people's emotions are affected. Like I mentioned earlier, frustration, depression can lead to suicide ideation. If they're not getting back to where they want, they thought they should be. And so it encompasses all the areas of our lives. You know, the three spheres of our being. And so I, I Try to reassure my students that, that, uh, as a, as a nurse, we have to be very patient, of course, and therapeutic. And number one factor is safety for those patients. They have to be safe. They have to make sure that they are not going to do something outside of their boundaries and or push themselves that they're going to fall and hurt or jump out of bed or accidentally fall out of bed, I should say, and, um, or develop seizure activity and they're left alone and they're not monitored carefully. So yes, it's, it's the brain in the healing process. It encompasses all different arenas, not just physical. And so you have the physical and metaphysical, the emotional, and, and it's, It's very important that, as nurses, we take the time to do, to deal with all those aspects. If someone needs meditation, if someone needs prayer, if someone needs, um, some sort of different therapy, then, of course, we need to be there for them. So again, that's very vitally important as a therapeutic agent, you know, promoting health.

Carrie & Kezia: 20:28

yeah, I just want to give everyone a heads up. We might have some, a little bit of, um, a disconnection for a little bit. Um, I hopefully not, hopefully it's not that bad. Um, but I think right now what you were sharing was just, um, I think we have talked about that a lot in some of our previous episodes about communication and like the importance that sometimes our emotions get affected as well. It's not visual, but it's something that happens that is invisible, um, that it's hard to explain, right? Like, We have a brain injury and now, you know, some, some people cry more than before or some people laugh more than before and have a difficulty explaining their emotions or their needs to people that love us. So, um, it's a very important part of recovery. Um, that might take longer to heal. Um, so I think it's very important and I love that you express that to future nurses, um, because at the end of the day, those are the, the nurses are the people we spend the most time with through, through our hospitalized. Um, so I love that. Thank you so much. Um, I do, uh, would love to hear, um, actually, if you have any advice. Well, right now, you were talking about that, but also like, if you have any, like, things, innovative. I can't say the right words today. Um, but anything that's new that's happening to a brain. Um, I did, you did share it, uh, via email, a new, um, research, but is there anything new that you think is super important to be sharing to people that, um, are going through their new, um,

Saul Enriquez: 22:08

Well, one of the thank you. That's an excellent question because the I find myself, especially down here in the valley, we call ourselves a Rio Grande Valley, and we find ourselves that diet has a lot to do with with not only predispose the predisposed risk factors. If there is a familiar Familial genetic predisposition for let's say Alzheimer's or Parkinson's that we can actually slow down those risk factors by what we're taking into the body. We can also that one of the key things in any med search class and pharmacology class is going to be lowering the levels of inflammation in the body. Number one. Every disease that I've ever studied or come across has, besides, except for trauma, has to do with inflammatory responses. And so what I find is that if we lower inflammation at the diet level, at the rest, exercise level, reducing those radical oxygenation species, then we can actually reduce the pathology in our bodies. If that, we can do that from the brain all the way down to our feet. Number, number one. Uh, one of the techniques that I've actually recently started implementing in my own life because of the amyloid plaque buildup history in my family, realizing that my mom had had CA, a cerebral, uh, amyloid angiography and, um, amyloid, uh, angiopathy. Angiopathy, sorry. was one of these new techniques that we, it is called a photobiomodulation. And where they use the different nano wavelengths of the red light spectrum to, if it's, if it's introduced directly on top of the cranium here, for some reason, now medical journals are, are conclusively saying that the wavelengths at 810 nanometers penetrate way down into the limbic system and actually stop the development of amyloid plaques. And coming from a familial genetic history of having Alzheimer's, uh, getting up there, you know, whatever I can do diet wise, photo bio modulation wise, exercise, things of that nature, then one needs to be educate ourselves. And I bring that up in my classes. I said, research is now showing this, so I'm Oh, constantly in the NIH website looking for peer reviewed journals, double blind studies, sometimes even triple blind studies. And so it's in AI today. Kezia is absolutely changing the world of neurology. It's bringing technology into the world. Point. I mean, for example, look at our new neighbor down in Brownsville, uh, Mr. Mr, uh, Elon. He is now actually working on implementing and has already implemented on trial basis Neuralink. You know, and so there, there are not only the ability to bring your thoughts to reality, but now you can actually bring your thoughts in texting for somebody who's fully quadriplegic or paraplegic. And so you have medications now that are coming to light. Uh, for example, Clostamine. Clostamine is, uh, has been recently discovered as an anti, it's an over the counter antihistamine. And it's helping with MS patients who have problems with demyelination of their nerves. And so again, the technology is so cutting edge that by the time we get our textbooks, they're like maybe two or three years old, the technology is already way up ahead. And so it's a little, as an instructor, we have to continue to research, continue to find things and bring them to light, even though they're not in the books, but you know, they're going to be at work when they hit the road running, you know,

Carrie & Kezia: 26:04

I know, and it's so exciting because if I think about it, like, I've read books since my stroke, you know, my stroke was 15 years ago, and I've read books of people who had strokes 40 years ago, and they were just stuck in a nursing home. Um, Or, you know, an asylum and just a, they had a stroke, they're done, they can't go. And now look at us today, we've grown so much in that, in that amount of time and hopefully we'll just keep growing quicker because unfortunately brain injury is here to stay. We can't, We can't, stop car wrecks, motorcycle wrecks, or strokes. Not yet, hopefully we can figure out how to stop strokes, but.

Saul Enriquez: 26:38

right.

Carrie & Kezia: 26:39

But I love seeing that your excitement to tell us. I am looking forward to this episode to be watched by many. And also it was so much fun to do. Honestly, so we can hopefully have you back to continue teaching us. Yeah, because you're really not only teaching nurses, you're teaching us and our listeners. And there was so much information. I had so many more questions to ask. But thank you so much for being here. Um, honestly, thank you so much to our listeners to sticking through our episode and hope you guys have learned a lot. Thank you

Saul Enriquez: 27:14

All right. Thanks for having me. I appreciate it, Kezia and Carrie.

Carrie & Kezia: 27:17

Sure. And for all of our listeners, again, if you would like to contact us, you can email us at bindways at the bind. org or find us on our website, the bind. org bindwaves. And of course on Instagram, guess what that is?@BINDWaves. Um, so again, if you're interested in becoming a member or volunteer, go there and check us out. And obviously, like Carrie said earlier, just don't forget to press all of those like buttons. And if you would like to see us, you can check it out on YouTube. And again, don't forget every Thursday you'll find us on your favorite platform. So until next time. Until next time.

27:56

We hope you've enjoyed listening to BIND Waves and continue to support BIND and our non profit mission. We support brain injury survivors as they reconnect into the life, the community, and their workplace. And we couldn't do that without great listeners like you. We appreciate each and every one of you. Continue watching. Until next time. Until next time.