Message for hip community

In my medical training I have watched patients and families deal with illness for years.

Over the past several months the experience of being a patient has changed my perspective. It is difficult to deal with pain, physical limitations and new knowledge of undeniable congenital skeletal abnormalities. Like many of you, I liked feeling strong, powerful and invincible. Dealing with my illness has been a struggle. I have been writing about my thoughts in this blog.

Zoom Zoom

Motofino is a Chinese moped manufacturer. A month ago I purchased a retro style scooter for $1200. A practical decision at the time. My husband's truck (1993 Nissan 210,000 miles) was stalling frequently. He drove my car to work (30 min commute) and I rode scoot. The tank fills up with 1.5 gallons, so about $3 a pop. So far 180 miles racked up on the odometer. Now we are the proud owners of a 2007 Honda Accord (4 vehicles now, if anyone is counting). So what happened to the truck? Well it is still parked in front of the house. Sometimes it takes men a while to come to terms with these things. Suprisingly I do not care. Having a husband who struggles to let go is an excellent quality. Besides he has known the truck 4 years longer than he has known me.

Crazy Busy Explodes

I am just sick. Nausea and dispair. Pediatric fellow late for work calls basic science research scientist husband. He comes downstairs to meet her, she runs to work. He drives car 4 blocks and parks it in usual location. She didn't mention the baby. He didn't look in the rear facing car seat. He returns to work. Seven month old little Sophia is found dead in car 4 hours later.

Too close to home, in more than one way.

Loss

My baby was due June 16th. Every time a colleague mentions their children reflexivly I think about the baby I lost. Seven month old baby, four months older than my child would have been. A sense of loss multiplied.

Similar Stuggles

In medical training others control your schedule. You are kept on a short leash. Pushing your limits despite mental or physical fatigue. My friends who have children share thier sense of guilt. Needing more time for work or home, always balancing the two. When interviewing I met a cardiovascular research scientist who balanced her medical career, laboratory, and family. When asked her advice she responded, "As a female physian you learn to juggle, trying not to drop a ball but knowing it will bounce. As a physician mother you keep juggling but the differece is now one of the balls (your child) is made of glass."

Harsh Reflection

Others tell me how lucky I am. They remeber their pre children days fondly. They say, "How wonderful it must be to pick up and go at a moments notice. You are so healthy and productive, these kids just take so much time!" Bitter for me. Waiting to start a family was a concious decision. Baby while protected in the lab was my plan. Infertility, left wrist fracture, hip cartlidge tear and congenital hip abnormality were not part of this plan. Few can understand the way married with children looks from my perspective. Disaster and loss haults the crazy busy life for Sophie's parents. Horrible pain and loss was not in thier plan. Where does that leave us?

Cleveland Update

With time the board review torture course is over, and also part of my wait is over.

The Cleveland Clinic (3rd opinion) also suggests surgery. The first emotion is disbelief, then two tears, then relief. My research mentor's brother offered the opinion. I had feared that he would be the only one to suggest less invasive (non-corrective) surgery. In that case I might have had less support for a long leave of absence for surgery.

Still waiting to hear from Dr. Nashville. He, after all fixed Izzy.

Izzy and me

"Eleven months ago, Isringhausen slumped at his locker, admitting, "I can't keep going like this." Saturday, he could think of nothing better. Isringhausen didn't require a full hip replacement. Instead, doctors shaved bone from the neck of his femur, allowing him greater flexibility with his left leg." -Joe Stauss, St. Louis Post-Dispatch, August 2007

Jason Isringhausen underwent femoral osteotomy for femoral acetabular impingement last year. It was his second surgery. I can only assume his 1st surgery was to repair a labral tear. Now he is playing baseball, can't beat that (for a n=1 non-matched- non-blinded -non-randomized clinical study).

In was in medical school (my friends agree) I never heard FAI. Now the literature suggests it affects up to 60% of patients receiving hip replacements in older age.

In the 1970's cardiologists were newly diagnosing mitral valve prolapse as thought it was a disorder of epidemic proportions. Years of further study revealed that actual morbidity associated with MVP is very low- and the diagnosis has fallen out of favor. Conversely, the first patients receiving the (arterial) LIMA grafts at bypass did not know what the clinical trials would show...... however now it is proven standard of care. Thousands of lives have been saved by this surgery.

A favorite attending in my training program says about new medical techniques and technology,

"Be not the first, yet be not the last."

Impatient medicine

---- Mortality rate increases 2% per hour in ascending aortic dissection
---- 90 minutes door to balloon time for acute myocardial infarction.

Cardiology Board Examination Preparation Course, not for wimps. Lecture 13 hours each day and the Cleveland Clinic has this ridiculous commitment to healthy eating- so no junk food, coffee or chocolate allowed in the lecture hall. Some kind of torture.

What impresses me when reviewing my chosen field is the focus on rapid evaluation and quick, concise treatment. This is contrasted by my experience in outpatient orthopedics.

Symptom onset 4.5 months ago, physical therapy for 8 plus 6 weeks. Wait and see approach, will it get better? Will osteoarthritis develop? What will the long-term outcomes of currently favored treatment be?

Recognizing that being a patient, when trained to be im-patient is challenging.

Puppy update

This morning I discovered a cachet of toys (raw hide bone and 2 fuzzy squeaky animals) carefully arranged atop of the doggie bed. Happiness is an active playful puppy. Wanna go outside? You had better make way or else you'll be trampled as he bolts down the stairs (oops sorry Owen when Smokey knocked you over!) Galloping back into the house he investigates his empty food bowl, only to gaze up at me, as if to say did you forget to feed me? Gobbling up his 2 (plus a little to grow on) cups of Purina Pro Plan before running upstairs to give B some chicken flavored wake-up kisses. Smokey is better, and against my better judgment returned to Doggie-day-care this week. His dad reported he was ecstatic when dropped off, and returned in the evening blissfully spent. So life goes on. The worst possible scenario averted this time. We'll leave the interesting veterinary cases for the academics, we're glad to have our happy puppy back.

Think much

What do I think?
Well, what do you think I should think?
Why do you think I think what I think?
What does it mean that I care what you think I should think?
What would you think if you had to think what I think I am thinking?

God bless my friends, who listen to my thinks.

Just the facts

Xray and MRI images of my hip show: femoral neck deformity, labral tear, and possible poor lateral coverage/dysplasia

Dr. Wash U said that surgery would be recommended unless I am pain free

Dr. Mayo said at this point I am unlikely to improve with conservative therapy

I have pain daily. It is better with less activity, but consistently have discomfort when walking more than 5 min


Plan of action:
1. Study and take my Cardiology Boards October 31st
2. Do PT exercises at 100%, swim and elliptical as tolerated
3. Request AP pelvic film to determine degree of dysplasia
4. Make appointment to see Clohisy in late Sept, early October
5. Accept I will not have a baby in 2007, grieve as necessary
6. Discuss with PI plan to complete this project
7. Explore career options, translational research vs. clinical track

Girls behaving badly

Folding the laundry this morning I had a moment of clarity. Since my beginning cardiology fellowship in 2004 I have made a concerted effort to help other women interested in cardiology, and foster a network among the female fellows. This is necessary because women make up less than 10% of cardiologists. In the office shared with the other (male) fellows, it is not unusual to find porn posted, and many (even attendings) remember fondly the days when a stripper pole was installed as a joke.

My efforts have faced disappointment, as to my dismay there is dissension among the women training behind me. Frustrated and perplexed up until now, the meditation of ordering the white t-shirts and matching socks brought a new understanding.

Faced with challenges each of us found (our own) way to survive. Mine is trying to create a better atmosphere for the future. A close colleague looks out for herself and hates everyone. Another is flirtatious and keeps the guys off balance by being unexpected. One found support in another fellow, they will be married this year.

We need to transcend to understand that we still have more in common that we are different. Referee I am not, yet the mother in me still hopes to see these beautiful, passionate, brilliant women together.... for unified we could be a force.

Please don't be discouraged

In July 2006 I deviated from my medical training to take advantage of protected time for research. I joined a basic science laboratory. Since then I have learned an enormous amount. Western blot, quantitative PCR, immunoflorescence, flow cytometry, the list goes on. The problem is that with my assigned project (picture of cells), actual discovery or understanding has been difficult. As a novice in the lab I require direction. Doing what I am told gets old, yet whenever I attempt to inject my own ideas often I am redirected. I don't feel like this work is my own, it feels more like a burden. Writing a paper feels years away- I must see things through to completion. With my health problems this year I don't know what I am doing anymore- or better said why I am doing this. Misery at work is familiar, but with my clinical training I always felt that I was improving or at least touching the life of others. When I was young I had tons of direction and no skill. Now I have enormous skill and no direction.

Pain Scale

So how do you rate your chest pain, let's say if zero is no pain at all and 10 is the worst pain ever- for instance like a broken bone? Who knows how many times I have asked patients this. It can be useful- but you are always aware that one person's 8 might be another's 5. But who can imagine what a broken bone feels like- what is un-imaginable pain?

Breaking my arm last January clued me in to a great deal. The regular pain meds (the stuff I often prescribe for pain) didn't touch it. I was so grateful when a friend who was working in the ER came to check on me, then insisted that they give me stronger stuff. Honestly the whole experience affected the way I interact with patients. By facing pain and disability I now have a personal place to connect when people share their fears.

It is quite possible that the torn cartilage in my hip occurred with the fall that led to my broken arm.

After months of rehab to get my arm back, I was relieved to resume my training- to have my life back. Things came to a halt when my left hip began to hurt. The news was worse than I could have imagined. A real injury- AND underlying congenital hip deformity. Personally I am still reeling. Professionally I am still pushing forward- investigating and healing.

Beware the testosterone is climbing....

I boycotted fertility meds in April and joined Prozac nation. Metformin for insulin resistance, they told me my anovulation was because of PCOS. Colomid to ovulate- it didn't work the first time (no ovulation but plenty of hormone craziness). Daily temperatures- waiting for the thermometer to beep before climbing out of bed. Not to mention (the unmentionable) pressure for baby making within a 18 hour window. It should be more fun that this!

My lab tests showed triple the amount of testosterone for a woman my age and size. Here I thought all of my interesting qualities (athletic ability, intensity, interest in cardiology- a male dominated field) were uniquely me. So I have been jacked up on male hormone all along. No wonder I couldn't figure out how to play with dolls or make the cheerleading squad in junior high.

As a new member of Prozac nation I wonder if I should have joined years ago. Certainly less crying and moping. Less anxiety for sure. I can feel despair being replaced by anger. It this a modified grieving process- and I am working the stages? Or perhaps it is just the testosterone again..... my old friend.

Feel free to get lost

Family wedding weekend. Hours of driving around the metro Detriot area with my nuclear family of childhood, reunited and packed into my father's Ford (american made) Explorer. Generally such togetherness would bring anxiety, that was before Tom Tom. Excellent gift from the in-laws, the mobile GPS. Navigating the local highways and family discussions were assisted by the gentle direction, and humor provided by this little contraption. So feel free to explore, even get lost the Tom Tom will get us there.

Multi-lobar Pneumonia

Medline search for canine pneumonia reveals reference to Yersinia Pestis (Black Plague of the 1930s). Bordetella causes "kennel cough". But why such a serious illness in my puppy (15 months old)? Certainly a bacterial infection is likely, but no white count or left shift despite his certain toxic appearance. I looked up combined immunodeficiency- and found the canine model is used to understand the disease in humans, but it is not clear that it occurs spontaneously in dogs. Moral of the story- lit review provides no solace when the illness is personal.

Smokey is my labradoodle. He has been spending the days at the vet, and the evenings under my care. In our living room we have administered subcutaneous fluids. We have perfected our pill swallowing technique. My husband has surprised me. When Smokey came home he gagged with picking up poop, but now manages rectal temps and special TLC like he was born to do so.

Excellent sleep

For the past several weeks I have been having vivid dreams, epic in nature. Sometimes nightmares. Each night I wake up frequently, feeling unsettled and uncomfortable. Last night I got some good rest. No nightmares, no pain this morning. I am giving the hip injection the credit. I almost can't wait for tonight- to sleep again!

We spent years sleep deprived. People would ask how in the world do you do it? It is all about the training- or perhaps simply getting used to living life in a cloud. Post- call you ache all over, crave sweets, feel angry and sometimes paranoid. You sense of humor becomes skewed, and reality seems distant. Your mind and body are telling you to rest, but you power through it. Patients, paperwork, and studying must come before any personal needs or wants. Eating and peeing are luxuries. We spent years like that, it becomes a way of life. When you engage, give it your all, and then succeed it changes you.

Some of my friends still live like this. They are better compensated- but with homes, families and practices the demands are greater as well.