Smokey loves being a country dog. The darkness is a stark contrast to the constant buzz of city street lights. And quiet. At night not a sound other than a frog croak or cricket chirp. Gone are the hospital sirens, car doors slamming and occasional gun shot. Our new home has a screened porch overlooking a pond. There are weeping willows along the bank. About 100 yards from our front door is a boat ramp with marsh access. With one small road leading to this area Smokey has the privilege of running off leash. Earlier this week he met two Black Labradors who live nearby. They jumped and ran together..... for a 86 pound Labradoodle life does not get any better than this.
My favorite part of our new life is the in-ground neighborhood pool. It is surrounded by over sized deck chairs, tables with large umbrellas, oyster roasting open fireplace and grill any man would salivate over. The shallow end is zero entry with jets of water that shoot up, indeed fun for the little ones.
If I swim from one end to the other I think it is about 20 yards. Not exactly regulation but you cannot beat swimming under the sun (or moon) walking distance from my house. The water is gentle and healing for my sore hips and back. Almost like magic the sore spots melt away after floating and stretching in the water. I am still wearing a normal swimsuit but the boobs and belly are pulling tight. I wonder if the baby is learning to to love the motion in the water?
Two nights ago my swim was shared with a large frog. Apparently he found the pool most delightful as well. Lap swimming with my goggles on I could see how graceful he moved through the water. A big frog kick, glide, kick, glide, kick, glide. And funny, there were noticeably fewer little critters buzzing over the water surface.
Friday, August 8, 2008
Monday, July 21, 2008
Moving Day
No way to tread lightly here. I haven't blogged, really in months. Those close to me have seen changes, bold but gradual. Don't be startled- the comprehensive update in bullets- I am leaving this city for the beautiful eastern coast, taking a faculty position at an University, uprooting my husband, having a baby in December.
The movers are packing, literally right now. Our life in boxes, the usual order dismantled- including wireless router. I am grateful for an unknown gracious neighbor from whom I am pirating WiFi. With my recent sad goodbyes a good friend told me I need to start blogging again. Especially since I am moving away and leaving so many dear friends behind. So here I begin again.
One big concern, and a reason I have been silent is the veil of anonymity. I really like writing about my life, feelings and relationships. As I leave training and become a real "professional" I need to either write less specific or go deeper under cover. Probably not a good idea for my patients to find my blog. Haven't completely reconciled this yet- but fully intend to post updates and pics of my new life here.
The movers are packing, literally right now. Our life in boxes, the usual order dismantled- including wireless router. I am grateful for an unknown gracious neighbor from whom I am pirating WiFi. With my recent sad goodbyes a good friend told me I need to start blogging again. Especially since I am moving away and leaving so many dear friends behind. So here I begin again.
One big concern, and a reason I have been silent is the veil of anonymity. I really like writing about my life, feelings and relationships. As I leave training and become a real "professional" I need to either write less specific or go deeper under cover. Probably not a good idea for my patients to find my blog. Haven't completely reconciled this yet- but fully intend to post updates and pics of my new life here.
Friday, June 20, 2008
Times are changing.
It is happening all over the hospital. Fresh eyed young students arrive in their perfectly pressed short coats. They have just spent the summer studying for Step I of the boards, and can hardly conceal their excitement to touch real patients for the first time. Bewildered slightly older young interns wearing equally unstained long white coats, with pockets stuffed with crib notes. How to run a code, what dose of sleeping pill to give, normal lab values. Their arrival is like a breeze of fresh air.
Not too long from now the med students will look like hell- suffering their first post call days. When every cell in the body is SCREAMING to lie down and close the eyes, and it seems impossible that such torture will become a new way of life. The interns will no longer look frightened. With long lists of patients, hours of notes to write and endless check boxes to fill they will become engrossed in their daily tasks. They will awaken sometime in next Spring- and realize 10 months have passed.
On the flip side are the dinosaurs. Like me. Ten years ago I first set foot into the hospital. A decade of training. When I look around I remember the hospitals I entered and eventually conquered. Incomprehensible the number of patients I have laid my hands on. And then those who died, whose families I counseled. From the confidence of thinking you know everything, to the painful realization you do not, then pretending confidence (not to worry the patients), gradually evolving to the place where you really do know a lot and can do a lot- competently.
Yes times are a changin'. It is a new beginning.
Not too long from now the med students will look like hell- suffering their first post call days. When every cell in the body is SCREAMING to lie down and close the eyes, and it seems impossible that such torture will become a new way of life. The interns will no longer look frightened. With long lists of patients, hours of notes to write and endless check boxes to fill they will become engrossed in their daily tasks. They will awaken sometime in next Spring- and realize 10 months have passed.
On the flip side are the dinosaurs. Like me. Ten years ago I first set foot into the hospital. A decade of training. When I look around I remember the hospitals I entered and eventually conquered. Incomprehensible the number of patients I have laid my hands on. And then those who died, whose families I counseled. From the confidence of thinking you know everything, to the painful realization you do not, then pretending confidence (not to worry the patients), gradually evolving to the place where you really do know a lot and can do a lot- competently.
Yes times are a changin'. It is a new beginning.
Monday, May 5, 2008
Back in the Saddle
More news actually. Today was my first day back doing procedures- since my hip surgery. I was a little anxious about being able to stand the whole morning- I can remember how grueling these clinics were last year. I would dose up on Motrin before and during the busy schedule. And today, NO PAIN! None. I am so relieved.
An two patients told me after their heart biopsy that it was the BEST one they have ever had. Quite a compliment from transplant patients who have basically had any and every procedure under the sun. So I feel pretty pumped up.... I am good, I've still got it, and I'm back!
On the road
I am officially on the interview trail. Must tell you it is SO much better this time around! They had a limo waiting for me at the airport, then delivered me to the hotel where I was given a suite. A suite! As I stretched out on the king sized bed with the high thread count sheets I called my husband. In remembrance of the difficult interview tours for residency and fellowship. Where I had to pay for every flight and hotel. I think I am still paying.... the cost was tagged onto my student loans... which are no where close to being paid off.
True there were some exciting adventures.... teaming up with a perfect stranger to drive 6 hours from interview A to interview B, then sleeping on no-longer-strangers couch a few day later for interview C. Being snowed in at Raleigh-Durham, forced to stay extra night at a shabby Motel 6, sick with fever and rigors. What misery! No story quite like Dr. G's (my OB/gyne). She came upon a laboring woman at the airport, and delivered the baby into her interview suit coat.
So I am keeping my mind open and hopes up to find the right place.
True there were some exciting adventures.... teaming up with a perfect stranger to drive 6 hours from interview A to interview B, then sleeping on no-longer-strangers couch a few day later for interview C. Being snowed in at Raleigh-Durham, forced to stay extra night at a shabby Motel 6, sick with fever and rigors. What misery! No story quite like Dr. G's (my OB/gyne). She came upon a laboring woman at the airport, and delivered the baby into her interview suit coat.
So I am keeping my mind open and hopes up to find the right place.
Thursday, May 1, 2008
Report from Lobby Day
American Heart Association Lobby Day was Tuesday.
I crawled over Capitol Hill with 700 others, wearing red- and a fancy heart pin with LED lights that flashed on and off.
We lobbied for greater funding for NIH. Did you know that during the Clinton administration NIH funding was doubled, but then cut sharply seeing a flat line over the past five years. Accounting for inflation, we are now at a level of funding lower than we would have been without the increases in the 1990s.
NIH funding supports the majority of health related research. In my mind, this is very important because the alternative is drug company sponsored research. Pharmaceutical development is also important, but always driven in the direction of profits. Who would study the use of vitamins in the prevention of heart disease- the NIH that is who!
Last year only 12% of research proposals submitted were funded. That means 78% of scientists (people with MD and/or PhD) received a failing score- and were sent packing. Can we really afford to lose this much talent?
Furthermore although heart disease and stroke are the #1 and #3 killers in every state in the Nation.... of NIH dollars only 7 and 1% respectively are spent on heart research! We deserve a larger piece of the pie.
So Lobby Day was a success. I got to meet my favorite Senator and our Congressman. I spent the day with grateful patients. Far away from the hospital and research lab, I spread the word about something I care about- and got a little smarter through the process.
In a moment of introspection how did the state of research funding affect my decision to leave science? As generation X-ers we are blamed for being motivated by recognition and always looking out for ourselves. I am sorry, but after 12 years of extra training I cannot accept a job equivalent to what I could have done when graduating college with a BS in Chemistry in 1996. It is because I care that it has be so difficult for me.
Sunday, April 27, 2008
In the District
This weekend an exciting trip to Our Nation's Capitol- where I will participate in the American Heart Association Lobby Day.
My brother (JkC) lives in DC, and works as a lobbiest for a National Health Care Organization. Saturday was near perfect. We headed to Chinatown and had a fabulous brunch al fresco.
Then an adventure at the Spy Museum, where we participated in Operation Spy. JkC and I, along with 8 strangers investigated, decoded, interrogated and cracked the case- saving the world from nuclear annihilation. Highpoints- when I found the secret door to enter the exhibit, as we quickly became better acquainted with stranger teammates as we dove left and right (twister style) in attempt to escape the path of search lights. Near miss- crouching down to evade capture then realizing I was in complete darkness with nothing to pull my self up with (quads just aren't as strong since they were detached at their insertion).
Then drive out of the district the in in-laws house. There we had a delicious dinner and relaxing evening. My friend at work commented that it was weird to visit in-laws without your spouse. My response- well you will think it is REALLY weird then that I am brining my brother! How lucky I am to be so close to my brother- we really enjoy each other. Wondering how this came to be- is it because we were forced to do chores together, "Mom why does he always get the easy part!" or struggled to share a bathroom, "I can't believe my brother takes longer to get ready than I do!" My little brother turned out to be a really fun and interesting person- and now that he no longer fears me pinning him down to tickle him (he is now much taller and stronger) he feels much more comfortable around me too.
My brother (JkC) lives in DC, and works as a lobbiest for a National Health Care Organization. Saturday was near perfect. We headed to Chinatown and had a fabulous brunch al fresco.
Then an adventure at the Spy Museum, where we participated in Operation Spy. JkC and I, along with 8 strangers investigated, decoded, interrogated and cracked the case- saving the world from nuclear annihilation. Highpoints- when I found the secret door to enter the exhibit, as we quickly became better acquainted with stranger teammates as we dove left and right (twister style) in attempt to escape the path of search lights. Near miss- crouching down to evade capture then realizing I was in complete darkness with nothing to pull my self up with (quads just aren't as strong since they were detached at their insertion).
Then drive out of the district the in in-laws house. There we had a delicious dinner and relaxing evening. My friend at work commented that it was weird to visit in-laws without your spouse. My response- well you will think it is REALLY weird then that I am brining my brother! How lucky I am to be so close to my brother- we really enjoy each other. Wondering how this came to be- is it because we were forced to do chores together, "Mom why does he always get the easy part!" or struggled to share a bathroom, "I can't believe my brother takes longer to get ready than I do!" My little brother turned out to be a really fun and interesting person- and now that he no longer fears me pinning him down to tickle him (he is now much taller and stronger) he feels much more comfortable around me too.
Friday, April 25, 2008
New Steps
Reading over at Life of a Busy Little Bee, Jen is approaching a gap. Plans are tight for the rest of the school year, followed by an array of options to be punctuated by a major life event- A Wedding!
Thinking of my summer- the end of my fellowship, an unknown next step. Seems huge. My rather sudden change of plans and fresh job search. Are we moving? Will be in academics? Private practice? Considering the radical re-alignment I do feel at peace. As if saying no that will not work for me, and getting off the train that was barreling in the wrong direction was a critical step. A needed moment of clarification, pause to unify my gifts and desires.
And then there is the husband, "Just try something else for a while, and if that doesn't work move on. It is never the END of the world." Well said for a man who may again be following his bride across the country.
Thinking of my summer- the end of my fellowship, an unknown next step. Seems huge. My rather sudden change of plans and fresh job search. Are we moving? Will be in academics? Private practice? Considering the radical re-alignment I do feel at peace. As if saying no that will not work for me, and getting off the train that was barreling in the wrong direction was a critical step. A needed moment of clarification, pause to unify my gifts and desires.
And then there is the husband, "Just try something else for a while, and if that doesn't work move on. It is never the END of the world." Well said for a man who may again be following his bride across the country.
Sunday, April 20, 2008
Not a mommie blog
In case it feels like EVERYONE is having a baby- you are right. Your sense is correct. They are.
In October of 2006 I had Halloween circled on my calendar. My husband and I were whispering back and forth about our little goblin. My first pre-natal visit scheduled for October 31st. We held hands in the waiting room. My urinalysis showed trace blood. From that moment on my husband and I experienced the visit dramatically differently.
Dr. G is my OB. She and I became friends in 1998 when as she was a year behind me in med school. Dr. D is her partner. D and I met in 1996, our first year of med school. She and I played Volleyball together- we were quite good- winning the intramural league.
For me the blood was foreboding- of course G reassured with her voice but her eyes shared my worry. The ultrasound showed a gestational sac- but measured half the size I expected. Still more reassurance, not received as my concern grew. Outside the room G finished her charting, returned with my US picture. Her hand shook as she gave it to me. June 16 was the calculated due date. Congratulations she said. Everything looks good- but let's have you come back next week to take another look.
B and I spent the week like the one before. Occasionally I would mention my worry- and he would question whether I was being rational. He honestly (bless his heart) had no clue of the trouble. I followed his lead.
One week later we returned and the final diagnosis was made. Missed abortion- miscarriage. This time G had not words, just tears in her eyes. I can remember shaking when getting dressed then stepping out of the door to find both D and G. Across the hall I stood in their office and we made a hug circle. How uncomfortable the med student must have felt that day- a young man wishing he could disappear as three women, two his attendings sharing a very emotional moment.
How alienating (and shocking) this experience must be for most women. For me I had some warning and then was surrounded by two doctors/two dear friends when accepting the news. I was sad, but also felt an agony. Anticipating the time that must pass before returning to this same point, with another chance for life. Little did I know that a broken arm and major hip surgery were in my future, pushing motherhood even farther away.
Life does go on. And as expected for young female physicians in our 30's the baby making goes on too. How many more first birthday cards I will send and baby showers will I plan? No need to seem like it doesn't bother me- no need to hide that I feel left out. Just moving forward.
In October of 2006 I had Halloween circled on my calendar. My husband and I were whispering back and forth about our little goblin. My first pre-natal visit scheduled for October 31st. We held hands in the waiting room. My urinalysis showed trace blood. From that moment on my husband and I experienced the visit dramatically differently.
Dr. G is my OB. She and I became friends in 1998 when as she was a year behind me in med school. Dr. D is her partner. D and I met in 1996, our first year of med school. She and I played Volleyball together- we were quite good- winning the intramural league.
For me the blood was foreboding- of course G reassured with her voice but her eyes shared my worry. The ultrasound showed a gestational sac- but measured half the size I expected. Still more reassurance, not received as my concern grew. Outside the room G finished her charting, returned with my US picture. Her hand shook as she gave it to me. June 16 was the calculated due date. Congratulations she said. Everything looks good- but let's have you come back next week to take another look.
B and I spent the week like the one before. Occasionally I would mention my worry- and he would question whether I was being rational. He honestly (bless his heart) had no clue of the trouble. I followed his lead.
One week later we returned and the final diagnosis was made. Missed abortion- miscarriage. This time G had not words, just tears in her eyes. I can remember shaking when getting dressed then stepping out of the door to find both D and G. Across the hall I stood in their office and we made a hug circle. How uncomfortable the med student must have felt that day- a young man wishing he could disappear as three women, two his attendings sharing a very emotional moment.
How alienating (and shocking) this experience must be for most women. For me I had some warning and then was surrounded by two doctors/two dear friends when accepting the news. I was sad, but also felt an agony. Anticipating the time that must pass before returning to this same point, with another chance for life. Little did I know that a broken arm and major hip surgery were in my future, pushing motherhood even farther away.
Life does go on. And as expected for young female physicians in our 30's the baby making goes on too. How many more first birthday cards I will send and baby showers will I plan? No need to seem like it doesn't bother me- no need to hide that I feel left out. Just moving forward.
Tuesday, April 15, 2008
Upside Down
When babies are very young they have the Moro reflex. It is also called the startle reflex. After hearing a loud noise the throw their little arms out and wave them back and forth. This is an involuntary reaction, and fun to elicit as a med student rotating in pediatrics.
If only there were an involuntary response for the shock that comes with the little surprises of adulthood. My conditioned response includes anxiety and worry- both old friends that I would rather be without.
Sixteen years ago I set a goal. Become a doctor. Four years of college, four of med school, four of residency and now four of fellowship. I made it. I am a doctor. A fairly specialized one at that. So how can it be that I have no earthly idea what I will be doing three months from now?!!
Listening to my heart of hearts. Deciding the bedside is better for me than the bench side. Next tossed out of this "Top 10" medical school on my little bottom. Oh boy. No I will not starve to death. I am certain that I will find a job. It is just difficult to pick yourself up from disappointment, and wrap yourself up into a presentable package to peddle around.
The first step to decide you are on the wrong path. Next step to find the right one? This time I am seeking joy.
If only there were an involuntary response for the shock that comes with the little surprises of adulthood. My conditioned response includes anxiety and worry- both old friends that I would rather be without.
Sixteen years ago I set a goal. Become a doctor. Four years of college, four of med school, four of residency and now four of fellowship. I made it. I am a doctor. A fairly specialized one at that. So how can it be that I have no earthly idea what I will be doing three months from now?!!
Listening to my heart of hearts. Deciding the bedside is better for me than the bench side. Next tossed out of this "Top 10" medical school on my little bottom. Oh boy. No I will not starve to death. I am certain that I will find a job. It is just difficult to pick yourself up from disappointment, and wrap yourself up into a presentable package to peddle around.
The first step to decide you are on the wrong path. Next step to find the right one? This time I am seeking joy.
Monday, April 7, 2008
Out for dinner
It is a warm spring evening. B, Smokey and I walked over to the neighborhood cafe and had dinner on the sidewalk. Then we took the long way home in order to pass through the park. The trees are beautiful with their spring buds, and daffodils have sprouted everywhere. It feels so good to be able to walk without pain. My mind and body take a long exhale together.
Sunday, April 6, 2008
Fateful step
Last Monday. My first day back in heels..... conquered the massive convention center. Back to the hotel at the end of a successful day- change into a cute black dress (and sensible black flats) ready for a fun night out in Chicago. Confidently stride out of my hotel onto Michigan Avenue. Rainy gloomy spring weather, typical of the Windy City. A warm evening, but wet from a day of rain. Three blocks from the restaurant. Thinking about the exciting people I met that day. Thinking of the big events in the upcoming week. Thinking of the nice glass of red wine waiting for me. Thinking of plenty things, except my step.... and whoa, right foot out, left foot back, hands in front, down I go. No, not the hokey poky. It was me, biting it on a wet sidewalk in Chicago.
A deep breath later, surveying the damage. Left hip- still there, no pain, good. Left knee, planted into one of those metal grates, ouch. "Honey are you okay?" a tall lurking man says voice straining to hold back a chuckle. "I don't know" I stammered as I stood up slowly and walked off a little less confidently. Pausing at the next street corner, surveying the damage- deep cuts in the knee. Considering the options, now two blocks from the restaurant I decide to seek the solace of friends- expecting other cards fellows assembled for the drug rep dinner.
I step into the restaurant with blood running down my leg and eyes welled- only to find instead of a group of friends- my program director and the drug rep. Welcome they say.... still not yet ready for complete sentences I get out.... can't- stay- dinner.... and the boss quickly realizes something is wrong. Now quite embarrassed about my state I accept his offer to hail a cab and I am on my way back to my hotel.
I find a Walgreen's. Purchase bandages, neosporine and as any girl would do in that situation- a pint of Ben & Jerry's for dinner. Nursing my wounds bloody and emotional I find solace in chocolate fudge brownie.
So I made it home safely. My knee looks rather gnarly, and my swim and bike routine has been suspended for the week. My hip was a little sore for a few days- but no major damage. Another lesson in humility- so much for big girls don't cry at work- all for sure I will recover from in time.
A deep breath later, surveying the damage. Left hip- still there, no pain, good. Left knee, planted into one of those metal grates, ouch. "Honey are you okay?" a tall lurking man says voice straining to hold back a chuckle. "I don't know" I stammered as I stood up slowly and walked off a little less confidently. Pausing at the next street corner, surveying the damage- deep cuts in the knee. Considering the options, now two blocks from the restaurant I decide to seek the solace of friends- expecting other cards fellows assembled for the drug rep dinner.
I step into the restaurant with blood running down my leg and eyes welled- only to find instead of a group of friends- my program director and the drug rep. Welcome they say.... still not yet ready for complete sentences I get out.... can't- stay- dinner.... and the boss quickly realizes something is wrong. Now quite embarrassed about my state I accept his offer to hail a cab and I am on my way back to my hotel.
I find a Walgreen's. Purchase bandages, neosporine and as any girl would do in that situation- a pint of Ben & Jerry's for dinner. Nursing my wounds bloody and emotional I find solace in chocolate fudge brownie.
So I made it home safely. My knee looks rather gnarly, and my swim and bike routine has been suspended for the week. My hip was a little sore for a few days- but no major damage. Another lesson in humility- so much for big girls don't cry at work- all for sure I will recover from in time.
Sunday, March 30, 2008
Physician Scientist: BUST
So I have news... that I am kinda anxious about. Looks like my days as a basic scientist are numbered. I am looking to make a change in my career plans. Tossing in the hat, there will be no K award application (although it is almost finished!)
I was supposed to get a faculty position last year. The division director was an the phone with the credentialing people- when it fell through. (NIH funding technicality, cannot be on training grant and see patients independently) Before my surgery I was told January 2009. Last week I met with the boss again- and the plan changed again. Now IF I submit a paper by this fall, I will probably be offered a Clinical Instructor position starting July 2009. I will have to do another fellowship year (yes 5th for those who are counting) for a total of PGY-9! None of this will they put in writing, and when finally appointed to faculty my salary will be a whopping $80K- no negotiations! BRUTAL.
Why do they do this? Because they can.
Who will ever go into academic research? Breed facing extinction.
What are they thinking? Fossils cannot think.
Now I am a good girl. I love academics, spent two years doing research- hung in there for the rough cards fellowship. But honestly I think this is my breaking point!
So if you trade the money you could make in private practice- the alternative is supposed to be prestige, security and intellectual interest. This "TOP 3 Med School" policy of continuously whipping young trainees lacks prestige and apparently security. Can you believe that I still cannot see a patient on my own and even if I do another 3 years of training I am not guaranteed a tenure track position?!! The last 2 years have been the toughest of my life- so bliss in the discovery of science is lost on me.
Options are:
nationwide search for academic science training/ tenure track position
local/ nationwide search for academic clinical position, heart failure and transplant
local search for private practice (part time?) general cardiology
I am having a little identity crisis right now. It is pretty scary.
I was supposed to get a faculty position last year. The division director was an the phone with the credentialing people- when it fell through. (NIH funding technicality, cannot be on training grant and see patients independently) Before my surgery I was told January 2009. Last week I met with the boss again- and the plan changed again. Now IF I submit a paper by this fall, I will probably be offered a Clinical Instructor position starting July 2009. I will have to do another fellowship year (yes 5th for those who are counting) for a total of PGY-9! None of this will they put in writing, and when finally appointed to faculty my salary will be a whopping $80K- no negotiations! BRUTAL.
Why do they do this? Because they can.
Who will ever go into academic research? Breed facing extinction.
What are they thinking? Fossils cannot think.
Now I am a good girl. I love academics, spent two years doing research- hung in there for the rough cards fellowship. But honestly I think this is my breaking point!
So if you trade the money you could make in private practice- the alternative is supposed to be prestige, security and intellectual interest. This "TOP 3 Med School" policy of continuously whipping young trainees lacks prestige and apparently security. Can you believe that I still cannot see a patient on my own and even if I do another 3 years of training I am not guaranteed a tenure track position?!! The last 2 years have been the toughest of my life- so bliss in the discovery of science is lost on me.
Options are:
nationwide search for academic science training/ tenure track position
local/ nationwide search for academic clinical position, heart failure and transplant
local search for private practice (part time?) general cardiology
I am having a little identity crisis right now. It is pretty scary.
Thursday, March 27, 2008
One point for the pink team
Watching a professional in action. The men fear her. Stiletto heels, purple business suit and some serious chutzpa. Wow, I have never actually had my picture on a poster before- she said referring to the large advertisement we created for her visit. Yes the poster, the flier for lecture attendees, invite for tea with medical students planned for this afternoon. The details. It is my thing. Chit chat, however for me is a more deliberate effort. Our ride to the hospital from her hotel was casual. I was quite impressed when the people we talked about in the car received props during her talk. She chatted with me, and from my answers... this physician is interested in this, so and so taught me that, etc. This is the business of academic medicine. I suppose you do not become Professor without a significant mastery.
My favorite moment so far- last night at dinner. The indignation from the female faculty members when one of our fellows mentioned that the male fellows undress in our office. They choose to change from scrubs to dress clothes in front of us. Okay I know everyone stands around in their underwear on Grey's Anatomy- but this is real life and the locker room is right across the hall! Perhaps these boys feel more comfortable standing in their boxers surrounded by photos of cheerleaders and women with large naked breasts. Oh yea. This is what is posted in their cubicles.
So I spend time (and talent) fostering mentoring from women in cardiology. Why? Because the more I see of these successful, talented, gracious women the stronger I feel about my career, and life actually. But deeper even- I am out for revenge. Not an ugly kind- but just the type where the underdog good guy (girl) wins at the end.
My favorite moment so far- last night at dinner. The indignation from the female faculty members when one of our fellows mentioned that the male fellows undress in our office. They choose to change from scrubs to dress clothes in front of us. Okay I know everyone stands around in their underwear on Grey's Anatomy- but this is real life and the locker room is right across the hall! Perhaps these boys feel more comfortable standing in their boxers surrounded by photos of cheerleaders and women with large naked breasts. Oh yea. This is what is posted in their cubicles.
So I spend time (and talent) fostering mentoring from women in cardiology. Why? Because the more I see of these successful, talented, gracious women the stronger I feel about my career, and life actually. But deeper even- I am out for revenge. Not an ugly kind- but just the type where the underdog good guy (girl) wins at the end.
Wednesday, March 26, 2008
Brooks Brothers Break-down
Please tell me that this has happened to someone else. This afternoon I cried in the Brooks Brothers dressing room. Idiot. So much for the "not loathing my body" mentality. And for the spiritual balance. Several professional projects coming to fruition, a big business meeting in Chicago this weekend. My larger than normal ass has been in yoga pants for the majority of the winter- and my super cute pant suits just do not fit.
As for the crying, two ladies were helping me. One asked my size, and I said oh I am not sure. I recently had surgery and gained weight, and I am not sure how things will fit. One said, are you on a diet now? Do you plan to loose the weight? Wow that thought hadn't actually occurred to me. Just give me the frickin' size jumbo fitted shirt for me to stuff under my interview suit from 5 years ago and let me get out of here!
A triple latte later I regrouped and boldly entered Ann Taylor. Found a nice black and white woven jacket. Will wear with white shirt and comfortable black pants. Found red jeweled necklace that will pop. Not exactly a suit, but will be passable.
So still reciting the mantra..... I am not my body. Cripes I am almost to the point where I can do enough exercise to get a cardio work-out. In the mean time it is excruciating- I would run and hide- if only I could run.......
As for the crying, two ladies were helping me. One asked my size, and I said oh I am not sure. I recently had surgery and gained weight, and I am not sure how things will fit. One said, are you on a diet now? Do you plan to loose the weight? Wow that thought hadn't actually occurred to me. Just give me the frickin' size jumbo fitted shirt for me to stuff under my interview suit from 5 years ago and let me get out of here!
A triple latte later I regrouped and boldly entered Ann Taylor. Found a nice black and white woven jacket. Will wear with white shirt and comfortable black pants. Found red jeweled necklace that will pop. Not exactly a suit, but will be passable.
So still reciting the mantra..... I am not my body. Cripes I am almost to the point where I can do enough exercise to get a cardio work-out. In the mean time it is excruciating- I would run and hide- if only I could run.......
Tuesday, March 18, 2008
Whenever a tragic loss occurs, you can either resist or yield......Yielding means inner acceptance of what is. You are open to life. -Eckhart Tolle, A New Earth
An awakening has been in the works for some time now. My first glimpse of deep spirituality was in high school. In the midst of teenage depression I somehow found my way to an evangelical Baptist church. I was raised in a home very skeptical of organized religion, so church was an odd place for me to flee. I was saved and baptized. Dunking in the holy water, head to toe, Southern Baptist style. There I sensed for the first time a spiritual connection. In fact one day during a call to the alter (which can last upwards of 20 min) I felt that God spoke to me. I had a clear vision of what I was to do, my purpose in life. Healer.
Then the preacher gave genital herpes to my Sunday school teacher, and the affair became the scandal that split the church. It seemed that perhaps my parents were right all along. You really cannot trust those holy-roller types.
In med school crisis in the mission to become healer led me back to church. This time a campus Lutheran Student Center. I thought Luther was on to something, the act of believing is the way to salvation, sans the guilt. Met my husband there. Believed I was again on the right track.
My dear brother had an awakening of his own. Realization that he was born gay, and strength to live his life congruent to his true identity. Never was there a moment that I (or our God avoiding parents) hesitated to stand with him. Inner conversations with God asking why did he make him this way? Why do the leaders of His church not see God's creation of homosexuals to be as beautiful and wondrous as the creation of any living thing? Couldn't much sit through a church service after that.
There were still moments. Discovering the perfect words to comfort a patient. Connecting with another human being deeply, without words. Predicting a reality with intuition, sensing beyond the physical. These moments I still believed to be divine. But where/what was God?
Blogging about my exile to the periphery. No longer able to connect with myself in the role of triathlete, superstar cardiologist, mother. Reading this New Earth book is interesting because Tolle teaches about an inner consciousness. He draws connections to the the world's religions. He suggests that setbacks like my year of illness is a common way that people connect with this spiritual force.
Suddenly "Turn it over to God" has different meaning for me.
Then the preacher gave genital herpes to my Sunday school teacher, and the affair became the scandal that split the church. It seemed that perhaps my parents were right all along. You really cannot trust those holy-roller types.
In med school crisis in the mission to become healer led me back to church. This time a campus Lutheran Student Center. I thought Luther was on to something, the act of believing is the way to salvation, sans the guilt. Met my husband there. Believed I was again on the right track.
My dear brother had an awakening of his own. Realization that he was born gay, and strength to live his life congruent to his true identity. Never was there a moment that I (or our God avoiding parents) hesitated to stand with him. Inner conversations with God asking why did he make him this way? Why do the leaders of His church not see God's creation of homosexuals to be as beautiful and wondrous as the creation of any living thing? Couldn't much sit through a church service after that.
There were still moments. Discovering the perfect words to comfort a patient. Connecting with another human being deeply, without words. Predicting a reality with intuition, sensing beyond the physical. These moments I still believed to be divine. But where/what was God?
Blogging about my exile to the periphery. No longer able to connect with myself in the role of triathlete, superstar cardiologist, mother. Reading this New Earth book is interesting because Tolle teaches about an inner consciousness. He draws connections to the the world's religions. He suggests that setbacks like my year of illness is a common way that people connect with this spiritual force.
Suddenly "Turn it over to God" has different meaning for me.
Sunday, March 2, 2008
A buzz
Not sure what has come over me. Last week was off to a decent start. Suddenly, around Wednesday afternoon I developed difficulty being upright. Lying down no problem, head up, yep there it is again, cloud head. The room isn't spinning exactly, but I feel off balance. Like when you are drifting off to sleep or sip a martini a little too quickly on an empty stomach.
My husband suggested I embrace the gentle persistent buzz. Okay no problem, but it is a bit unsettling. Especially when trying remember how a patient is answering my questions or behind the wheel of my Volkswagen.
The cause? I am not sure. I did stop my medications. The Lexapro perhaps the culprit however my psychiatrist Dr. SM (aka best friend from college) told me a long taper is not necessary. Perhaps instead is was the psychiatrist's two children who visited last week, each with runny noses and low grade fevers. Being home for the winter has has its benefits, one being skipping out on flu season. I succumbed on Thursday and stayed in bed all day, but no improvement. Maybe with all of this not standing and not sitting (therefore lying) my heart forgot how to get blood to my brain. But then there is the fatigue issue. Could I just be tired? If so I have never been this tired in my life. Anemia, hypotension?
Whatever. I am tired of this listen to your body crap. My body is a freakin' lunatic. There is only so much I can take- so I do not plan to take this little development lying down. I doubt I will actually pass out or anything.
My husband suggested I embrace the gentle persistent buzz. Okay no problem, but it is a bit unsettling. Especially when trying remember how a patient is answering my questions or behind the wheel of my Volkswagen.
The cause? I am not sure. I did stop my medications. The Lexapro perhaps the culprit however my psychiatrist Dr. SM (aka best friend from college) told me a long taper is not necessary. Perhaps instead is was the psychiatrist's two children who visited last week, each with runny noses and low grade fevers. Being home for the winter has has its benefits, one being skipping out on flu season. I succumbed on Thursday and stayed in bed all day, but no improvement. Maybe with all of this not standing and not sitting (therefore lying) my heart forgot how to get blood to my brain. But then there is the fatigue issue. Could I just be tired? If so I have never been this tired in my life. Anemia, hypotension?
Whatever. I am tired of this listen to your body crap. My body is a freakin' lunatic. There is only so much I can take- so I do not plan to take this little development lying down. I doubt I will actually pass out or anything.
Tuesday, February 26, 2008
The humble (limping) protege
It was a nice affair. My boss (fifteen years my senior) is a cardiologist, scientist, mother, and today Professor of Medicine. They gave her an endowed chair..... with all of the pomp and circumstance. There was a medal, a big one, that she wore around her neck as she gave her lecture.The chancellor of the university, dean of medical school, chairman of medicine all said that she is an amazing scientist. They had her mother, father, brother, sister, husband, son and daughter stand up. They all were in the audience. For her introduction, "When a brilliant mind meets excellence in education and enthusiasm for discovery........"
It all-together was surreal. In surroundings familiar, I felt like an outsider.... being away for almost two months. Her accolades seemed to belong to a giant. For a moment seeming more like a coronation than lecture. Today she is the star. Somehow managing to find her way atop a pile of ego-centric, contemptuous, impatient, gender-biased men.
Surreal because I know this woman. I have been known to curse her. When she returns my writing nearly all red with edits, sends me back to the bench feeling my questions were ridiculously stupid, chastises me for spending too much time with patients and casually suggests I should repeat the experiment over the weekend.
But she is also the woman who hand-delivered home cooked meal to my house after my surgery.
What a challenge to be a successful woman. Here I am a critic, sitting in the privileged position to advance under her tutelage. Perhaps it reflects my own struggle. To find the right balance between kick-ass cardiologist, healthy/ fit athlete, and caring thoughtful friend.
A love hate relationship with the Professor. A love hate relationship with myself?
Monday, February 25, 2008
Hip Update
I am reaching the 6 week post-op magical date. This is when I stop taking the medications. Anti-inflammatory to prevent heterotopic bone formation. Aspirin to prevent blood clots. Lexapro because I don't want to take it anymore, and I prescribed it anyway.
Update of wound healing...... this was taken last week.
Compared to POD#5 you can appreciate the improvement!
And the wrist? One year of healing, my scar is white, flat and smooth. Secrets?
Update of wound healing...... this was taken last week.
Compared to POD#5 you can appreciate the improvement!
And the wrist? One year of healing, my scar is white, flat and smooth. Secrets?
- Scar massage, rubbing skin to loosen from connective tissue below.
- Vitamin E/Coca butter lotion, applied daily for first few months.
- The SPF 45 sun-block all summer, if fresh scar is exposed to the sun, it will turn pink or blue
Sunday, February 24, 2008
Mini Medical School 101
Recently I came across the efforts of Fran Drescher (star the Nanny). She is leading the Cancer Schmancer Movement, with the goal of increasing awareness of gynecological cancers.
Her goal is for all cancers to be diagnosed in stage one, when the disease is most easily and most effectively treated. An advocate for women understanding and taking control of their bodies, I applaud her efforts.
In a recent interview she was speaking about screening tests, in particular the use of vaginal ultrasound for detection of ovarian cancer. She was expressing the concern that it is not covered by insurance and therefore not available to women.
Respectfully I would like to clarify this issue. I believe it to be an important one and will be an excellent topic for my 1st Mini Med School Post.
A screening test is only useful if it:
Is capable of detecting disease
Has more benefit than risk
Makes a difference in the outcome of the disease
In the case of ovarian cancer, vaginal ultrasound is not an effective screening tool. The problem is the frequency of false-positive results. False-positive results are when the test suggests an abnormality when nothing is really wrong.
Doctors believe this because in one study (Jacobs Lancet 1988) 5 cancers were found among 5,489 asymptomatic patients who received 14,356 vaginal ultrasounds. In a second study (Andolf et al Br J ObGyn 1986) one cancer was found in 805 high risk women who were screened by vaginal ultrasound, BUT 38 patients in the study had exploratory surgery to follow-up on false positive test results. These numbers (the frequency of disease in a population and complication rate from screening) are used by physicians to determine if screening tests work.
Sometimes people believe that because a test is available it must be good. This is not always true. The well-informed patient should understand this.
Her goal is for all cancers to be diagnosed in stage one, when the disease is most easily and most effectively treated. An advocate for women understanding and taking control of their bodies, I applaud her efforts.
In a recent interview she was speaking about screening tests, in particular the use of vaginal ultrasound for detection of ovarian cancer. She was expressing the concern that it is not covered by insurance and therefore not available to women.
Respectfully I would like to clarify this issue. I believe it to be an important one and will be an excellent topic for my 1st Mini Med School Post.
A screening test is only useful if it:
Is capable of detecting disease
Has more benefit than risk
Makes a difference in the outcome of the disease
In the case of ovarian cancer, vaginal ultrasound is not an effective screening tool. The problem is the frequency of false-positive results. False-positive results are when the test suggests an abnormality when nothing is really wrong.
Doctors believe this because in one study (Jacobs Lancet 1988) 5 cancers were found among 5,489 asymptomatic patients who received 14,356 vaginal ultrasounds. In a second study (Andolf et al Br J ObGyn 1986) one cancer was found in 805 high risk women who were screened by vaginal ultrasound, BUT 38 patients in the study had exploratory surgery to follow-up on false positive test results. These numbers (the frequency of disease in a population and complication rate from screening) are used by physicians to determine if screening tests work.
Sometimes people believe that because a test is available it must be good. This is not always true. The well-informed patient should understand this.
Friday, February 22, 2008
Quiet time
An ice storm outside and husband snowed in in Boston provided the smokerdoodle and I some quality quiet time. Although I am able to be more active, the past two days I have extended my recovery- not too practical to balance on the ice and scrape the car. Before my surgery I had a panicked feeling about my sick leave- how silly I was. It has been the most wonderful month. A few experiences/ surprises discovered that I am grateful for:
Yogurt- cannot beat it, it was what I asked for out of anesthesia, better than ice cream. Packed full of nutrients, calcium, excellent calories. Narcotics and antibiotics can wreak havoc on your GI regularity, gotta love the active cultures
Helplessness (true, not the I'm overwhelmed emotional kind) provides recovery for the type A mind- I actually felt my brain re-setting, in those moments when there was nothing to do, nothing to plan for, nothing to worry about. Looking forward to simple pleasures: hot coffee, someone to turn on the light so I could read, an extra blanket for warmth
PBS (and TiVo)
Jane Austin Collection (all of her stories, one each Sunday night)
Legacy: Being Black in America (high profile black Americans find their mainland African, slave, and surprising white ancestors through public records and DNA profiling)
Local Explore your city shows..... who knew there were live caves beneath the asphalt, special meaning behind statue in my favorite park, new exhibits in the museum worth checking out
NexFlix- In your mailbox every day, oh my!
Public library- online catalog, remote book requests, the library in a century building, weeknight outing to retrieve books, public access computer room, lively with parents online with children, reminding me that the most important things in life: love, family, education are free.... material wealth and the pursuit of it can alienate us from this truth
Yogurt- cannot beat it, it was what I asked for out of anesthesia, better than ice cream. Packed full of nutrients, calcium, excellent calories. Narcotics and antibiotics can wreak havoc on your GI regularity, gotta love the active cultures
Helplessness (true, not the I'm overwhelmed emotional kind) provides recovery for the type A mind- I actually felt my brain re-setting, in those moments when there was nothing to do, nothing to plan for, nothing to worry about. Looking forward to simple pleasures: hot coffee, someone to turn on the light so I could read, an extra blanket for warmth
PBS (and TiVo)
Jane Austin Collection (all of her stories, one each Sunday night)
Legacy: Being Black in America (high profile black Americans find their mainland African, slave, and surprising white ancestors through public records and DNA profiling)
Local Explore your city shows..... who knew there were live caves beneath the asphalt, special meaning behind statue in my favorite park, new exhibits in the museum worth checking out
NexFlix- In your mailbox every day, oh my!
Public library- online catalog, remote book requests, the library in a century building, weeknight outing to retrieve books, public access computer room, lively with parents online with children, reminding me that the most important things in life: love, family, education are free.... material wealth and the pursuit of it can alienate us from this truth
Thursday, February 21, 2008
I am healing
Sitting at the kitchen counter eating my oatmeal with raisins, a searing high pitched tone grabbed my attention. The fire alarm? Cell phone out of batteries? Actually my pager. So funny. I did not recognize the sound. I have been into work twice now. On the second journey I opened up shop so to speak, which included turning my pager back on. There were times on call, especially my first year of cards fellowship when it went off every 20 minutes. Following the beep my laboradoodle Smokey looked at me..... eyes wide open, head tilted slightly, ears raised as if to say what the heck is that.... what have you done!!
I am walking without crutches for short distances. Sitting is more comfortable. The potty chair and shower seat have been sent to the basement. My plastic apparatus for donning socks still is essential. I have PT exercises that I do as frequently as possible, and I can tell my strength is increasing. My hip hurts. Not all of the time, but frequently. It does feel different than before the surgery. Stiffness mostly, but sometimes there will be a pull or cramp when I turn or twist a certain direction.
I also found the courage to get on the scale. My clothes (and bras) don't fit. I have been living in yoga pants for the past month. The damage? Twenty pounds. Ten since November, twenty since I stopped exercising. To my credit when I stare at my naked body in the mirror I do not exactly like what I see, but I seem to have gotten over the loathing. This is kinda huge for me.
Before the infertility, miscarriage, broken wrist, hip problem/surgery there was a sense of control. Focus on success, perfection. Consideration of every move, analysis of each decision as if I held the power, thinking that if I worked hard enough I could make things happen.
This blog is about this experience for me. Now I am healing. I certainly hope the series of terrible events that sent me off track are behind me. But if their purpose was to teach me a lesson, give me a life skill necessary for health and happiness- I get it, finally.
I am walking without crutches for short distances. Sitting is more comfortable. The potty chair and shower seat have been sent to the basement. My plastic apparatus for donning socks still is essential. I have PT exercises that I do as frequently as possible, and I can tell my strength is increasing. My hip hurts. Not all of the time, but frequently. It does feel different than before the surgery. Stiffness mostly, but sometimes there will be a pull or cramp when I turn or twist a certain direction.
I also found the courage to get on the scale. My clothes (and bras) don't fit. I have been living in yoga pants for the past month. The damage? Twenty pounds. Ten since November, twenty since I stopped exercising. To my credit when I stare at my naked body in the mirror I do not exactly like what I see, but I seem to have gotten over the loathing. This is kinda huge for me.
Before the infertility, miscarriage, broken wrist, hip problem/surgery there was a sense of control. Focus on success, perfection. Consideration of every move, analysis of each decision as if I held the power, thinking that if I worked hard enough I could make things happen.
This blog is about this experience for me. Now I am healing. I certainly hope the series of terrible events that sent me off track are behind me. But if their purpose was to teach me a lesson, give me a life skill necessary for health and happiness- I get it, finally.
Saturday, February 16, 2008
Sat Morning at the Y
Surrounded by polliwogs, starfish and eels.... Saturday morning in the pool at the family YMCA. There was also a Baby & Me class, the best part when they played the hokey poky with 10 laughing babies splashing about.
The crowded conditions forced me to do the unthinkable. Walk in the lap lane. No self-respecting fitness swimmer would ever do that. I am so sorry coach (ravenlou) I am sure you are aghast!
The crowded conditions forced me to do the unthinkable. Walk in the lap lane. No self-respecting fitness swimmer would ever do that. I am so sorry coach (ravenlou) I am sure you are aghast!
Friday, February 15, 2008
One Month Follow-up
My office visit this week confirmed that everything is on track. The incision looks good (finished my Keflex), I can increase my weight bearing, I can drive a car, I can get in the pool. All good. A month of recovery behind me, it went so fast.
Celebrated by walking around liberally without my crutches. Later experienced ("My butt's on fire!") muscle spasms in my hip that kept me up until 3AM. My husband not knowing I succumbed to two percocet before sunrise thought I was dead in bed the next morning. Went to PT and got instructions on how to approach the next step of recovery- the rational practical approach. Allowed 75% weight bearing for the next week, then try without the crutches.
I got in the pool yesterday and it was wonderful! I walked back and forth, back and forth, back and forth.... you get the picture. I had the company of a 70 something little lady with a twinkle in her eye. I imagined as she walked next to me she was saying, honey you can do it!
My PT reluctantly agreed that I could try to swim. I did 100 yards, 25 at a time. It felt wonderful. Silence of the water, water streaming past my body, force of forward motion, strength of my stroke. I was never much of a kicker- so my limp legs did not make a huge difference.
Going to work this afternoon. Plan is to check out how taxing the walk from the garage to the lab is. Also to help celebrate my lab-mate's birthday.
My brother is flying in to town tonight! I am so excited to see him.
Celebrated by walking around liberally without my crutches. Later experienced ("My butt's on fire!") muscle spasms in my hip that kept me up until 3AM. My husband not knowing I succumbed to two percocet before sunrise thought I was dead in bed the next morning. Went to PT and got instructions on how to approach the next step of recovery- the rational practical approach. Allowed 75% weight bearing for the next week, then try without the crutches.
I got in the pool yesterday and it was wonderful! I walked back and forth, back and forth, back and forth.... you get the picture. I had the company of a 70 something little lady with a twinkle in her eye. I imagined as she walked next to me she was saying, honey you can do it!
My PT reluctantly agreed that I could try to swim. I did 100 yards, 25 at a time. It felt wonderful. Silence of the water, water streaming past my body, force of forward motion, strength of my stroke. I was never much of a kicker- so my limp legs did not make a huge difference.
Going to work this afternoon. Plan is to check out how taxing the walk from the garage to the lab is. Also to help celebrate my lab-mate's birthday.
My brother is flying in to town tonight! I am so excited to see him.
Wednesday, February 13, 2008
Grazie for not smoking
In January of 2005 indoor smoking was banned in Italy.
Yesterday a group published in Circulation reporting reduced acute coronary events among the citizens of Rome. This accompanied by measurable decrease in indoor air pollution, decreased cigarette and increased nicotine replacement product sales.
The reduction of acute coronary events was greater among men, and those in lower socio-economic groups.
Evidence that smoking bans improve public health.
Indoor smoking bans are in place in many American cities. Still others propose legislation, however it lacks the public support to take hold.
Americans hate to relinquish freedoms. Smoking, over-eating, sedentary activity, lifestyle for many. Criticism of these choices are taking hold, but to take away one's choice to behave as they please is another story. Our economy can only survive with a Universal Health Care system if we contain costs, take advantage of public health measures that may in effect legislate health for the general population.
Yesterday a group published in Circulation reporting reduced acute coronary events among the citizens of Rome. This accompanied by measurable decrease in indoor air pollution, decreased cigarette and increased nicotine replacement product sales.
The reduction of acute coronary events was greater among men, and those in lower socio-economic groups.
Evidence that smoking bans improve public health.
Indoor smoking bans are in place in many American cities. Still others propose legislation, however it lacks the public support to take hold.
Americans hate to relinquish freedoms. Smoking, over-eating, sedentary activity, lifestyle for many. Criticism of these choices are taking hold, but to take away one's choice to behave as they please is another story. Our economy can only survive with a Universal Health Care system if we contain costs, take advantage of public health measures that may in effect legislate health for the general population.
Friday, February 8, 2008
POD#23
Physical therapy this morning. No more CPM machine. Allowed to flex 90 degrees, which means I may sit in a normal chair. Now I am doing exercises against gravity.
My first post-op visit with the orthropod is next Tuesday, and I am hoping I will be able to bear more weight at that time. Additionally my incision will be healed (infection cleared) by then, so that I may return to the pool. My left leg is strong. I think I will be able to walk. It will be wobbly initially but the majority of the muscles are ready to go. I will also ask when I can bike, I imagine a recumbent stationary bicycle would be the first step.
It has been so long since I have exercised. Months. 2007 was pretty much a wash.
2006 was my best year:
Swam 128,925 yards (78 miles)
Bike 378 miles
Run 282 miles
So this is the time for firsts again. Like yesterday, my first email to my PI (research mentor). Sent off an outline of my grant proposal. Time to start writing.
Next week first day back in the pool.
Maybe the following week back to work. Followed by treadmill, cath lab. All in good time.
Thursday, February 7, 2008
Fat Loving Badness Everywhere?
A few posts ago the Bicycling article informed us that conventionally grown food leads to organochlorine (OC) toxicity in our bodies, and when we exercise the harmful chemicals affect our metabolism.
I was disappointed when reviewing their reference, but in that paper however I found the following:
Energy balance and pollution by organochlorines and polychlorinated biphenyls. C. Pelletier, P. Imbeault and A. Tremblay. International Journal of Obesity (2004) 28, 936–939.
This was much more helpful (and scientifically sound). A review:
OSs are proven to be associated with breast cancer, weakening the immune system, decreasing thyroid function and lowering mitochondrial fat metabolism.
OCs are lipophilic (fat loving) therefore are stored in fat. Obese individuals have a larger depot for OCs therefore they have higher total body storage. As the fat is converted to energy (during weight loss) the stored OCs are released into to bloodstream.
Their bottom line- because of this phenomenon, losing weight may not be as good for you as you think it is. Terrific.
Here at this point I need to backtrack and re-group.
Organochlorines are bad for me. But would I recognize an OC if I saw (or tasted it)? Where am I exposed to them? How much can I tolerate? What should I do to avoid them?
The EPA website (http://www.epa.gov/oppfead1/international/pops.htm) includes OCs in a list of the “Dirty Dozen” Persistent Organic Pollutants (POPs). This is news to me. Wasn’t the dirty dozen a movie or something? Anyway from the site a description of POPs
Is this stuff in our food (non-organically grown) too? The FDA regulates this, I plan to look into it.
I was disappointed when reviewing their reference, but in that paper however I found the following:
Energy balance and pollution by organochlorines and polychlorinated biphenyls. C. Pelletier, P. Imbeault and A. Tremblay. International Journal of Obesity (2004) 28, 936–939.
This was much more helpful (and scientifically sound). A review:
OSs are proven to be associated with breast cancer, weakening the immune system, decreasing thyroid function and lowering mitochondrial fat metabolism.
OCs are lipophilic (fat loving) therefore are stored in fat. Obese individuals have a larger depot for OCs therefore they have higher total body storage. As the fat is converted to energy (during weight loss) the stored OCs are released into to bloodstream.
Their bottom line- because of this phenomenon, losing weight may not be as good for you as you think it is. Terrific.
Here at this point I need to backtrack and re-group.
Organochlorines are bad for me. But would I recognize an OC if I saw (or tasted it)? Where am I exposed to them? How much can I tolerate? What should I do to avoid them?
The EPA website (http://www.epa.gov/oppfead1/international/pops.htm) includes OCs in a list of the “Dirty Dozen” Persistent Organic Pollutants (POPs). This is news to me. Wasn’t the dirty dozen a movie or something? Anyway from the site a description of POPs
AHA. My friend the architect was trying to convince me the hospital building materials were killing me! Maybe he was right. I certainly have heard of PCBs, and DDT is the insecticide that saves millions of lives from malaria in underdeveloped countries.
- Certain insecticides, such as DDT and chlordane, which were once commonly used to control pests in agriculture and in building materials, as well as to protect public health, are now considered POPs.
- PCBs, which were used in hundreds of commercial applications, such as in electrical, heat transfer, and hydraulic equipment, and as plasticizers in paints, plastics, and rubber products.
- Certain chemical byproducts, such as dioxins and furans, which are produced unintentionally from most forms of combustion, including municipal and medical waste incinerators, open burning of trash, and industrial processes.
Is this stuff in our food (non-organically grown) too? The FDA regulates this, I plan to look into it.
Wednesday, February 6, 2008
Flabby butt sydrome
It is an epidemic."You see your real problem is that your butt muscles are weak," the diagnosis from 4 independent physical therapists! Describing four different butts mind you.
Subject #1. Early 30's. Previous gymnast, excellent swimmer. Serious running and biking. Chronic knee pain, eventual hip pain.
Subject #2. Early 40's. Serious biker for years, leading to hip pain.
Subject #3. Mid 20's. Running, biking, swimming. Back pain.
Subject #4. 33 year old (me). High school volleyball and basketball. College volleyball. Recreational athlete in 20s. Triathlon training in 30s. Running up to 6 miles, biking 100+ miles a week, swimming 5+ miles/week. Hip pain, femoral acetabular impingement, the rest is in the blog.
A coincidence that PT evaluation revealed weak gluts in all of us? Is it the biking? Is it the running? We are in shape, exercising to be/stay healthy.
Is there something else we should we be doing?
Tuesday, February 5, 2008
POD#20
My husband left town for the week and his mother arrived to stay with me. She is practical, has a relaxed nature and believes in everything in its place (all compliments). She makes hot chocolate with frothed milk and brought a stack of books for me to read. She is the wife of a physician, and I wonder if this has anything to do with the chemistry we seem to have. As a computer tech-y she arranged our wireless so that I can print in the den from my laptop anywhere. Pretty cool. She listens to my observations on life and emotional analysis with eager interest. As a breast cancer survivor and post knee replacement she has an interesting perspective on healing and recovery.
My wound is better. We went to see the doctor yesterday, mainly for peace of mind. Bottom line it will be fine, the antibiotics are working. This is a good thing.
I can do all of my prescribed PT exercises with ease. It feels like my hip is functioning at 30%. My Millenial Crutches are well worth the money- and they are red, which kicks ass.
My elevated commode has indeed come in handy. I purchased 6 pairs of TED hose (compression stockings) on ebay. This adds to the two pairs issued to me in the hospital. Netflix has been great, movies come in the mail almost every day. I burned up my first CPM machine, and am at this moment strapped into my second.Three weeks have passed quickly. I expected to feel frustrated with the convalescence, but feel peace instead.
Monday, February 4, 2008
Digging Organic
Before I dive into my detailed article review, let me start with the conclusion.
In the Bicycling article, the paper Thermogenesis and weight loss in obese individuals: a primary association with organochlorine pollution, Tremblay et.al. (http://www.ncbi.nlm.nih.gov/sites/entrez) was used to support the notion that organochlorines (suggested from conventionally grown foods) are released from fat during exercise and decrease mitochondrial function. I think this particular paper falls short of this assertion. Other papers referenced in this article may have promise however, and I plan to look into them.
I am growing more fascinated in this subject. Vietnam War veterans are compensated for occupational exposure to Agent Orange. They get diabetes. They get cancer. So organochlorines are likely connected to metabolism and certainly cause cancer....... but this doesn't resolve my organic foods question..... stay tuned.
Data in the paper above, was part of a study where the drug fenfluramine was tested. This makes it a secondary study, where the outcomes reported are not what the study was designed to measure. The study was not directed to look at pollution and its effects on the body. Investigators used data from an unrelated study to look for a correlation between pollution and the body’s ability to burn fat. In medical research this is done all of the time. Such research is useful, but is unable to show a cause and effect relationship.
There were 15 obese subjects (average BMI 35.4) who after 12 weeks of dieting had an average BMI of 32. Measurements were taken in these patients before and after their weight loss. Although we know 11 patients received fenfluramine and 4 received placebo, results were lumped together. Incidentally fenfluramine is Fen-Phen, the drug you may have heard on the plaintiff attorney commercials. It was removed from the market in 1997 after patients developed serious irreversible heart disease while taking drug.
Measurements included a sleeping metabolic rate (SMR), reporting calories burned when resting. The expected SMR was determined by measuring it in 86 “normal” people (with BMI 28.7). These people were not obese, not on a diet and not on fenfluramine.
The SMR of patients was recorded before and after weight loss. A predicted SMR was generated for these patients (extrapolated from normal group). Measured SMR and predicted SMR both decreased after weight loss. Before weight loss the measured SMR was much higher than predicted. After weight loss the SMR was slightly higher than predicted. The change (before-after) in SMR was greater for measured results.
The authors wondered why the decrease in SMR was greater in measured than predicted. In my mind obvious reasons (which were not discussed) include #1 because these patients were obese, #2 these patients were on Fen-Phen, #3 these patients were on a diet. All factors were not true of patients used to create generate expected results.
Now for the part we are interested in…. the organochlorine (OC) measurements. The article reviews that OCs are bad, they are in chemicals are used in our home and yards….. but also feared to be present on our food from herbicides and pesticides used by farmers. OCs are stored in fat cells. When fat is lost during weight loss the OCs go into the bloodstream. This has been reported to affect the body’s ability to burn fat efficiently.
The authors measured patient OC levels before and after weight loss. It increased a significant amount. When performing a multivariate analysis they found that the increase in OC concentration predicted the differences in SMR described above.
In the Bicycling article, the paper Thermogenesis and weight loss in obese individuals: a primary association with organochlorine pollution, Tremblay et.al. (http://www.ncbi.nlm.nih.gov/sites/entrez) was used to support the notion that organochlorines (suggested from conventionally grown foods) are released from fat during exercise and decrease mitochondrial function. I think this particular paper falls short of this assertion. Other papers referenced in this article may have promise however, and I plan to look into them.
I am growing more fascinated in this subject. Vietnam War veterans are compensated for occupational exposure to Agent Orange. They get diabetes. They get cancer. So organochlorines are likely connected to metabolism and certainly cause cancer....... but this doesn't resolve my organic foods question..... stay tuned.
Data in the paper above, was part of a study where the drug fenfluramine was tested. This makes it a secondary study, where the outcomes reported are not what the study was designed to measure. The study was not directed to look at pollution and its effects on the body. Investigators used data from an unrelated study to look for a correlation between pollution and the body’s ability to burn fat. In medical research this is done all of the time. Such research is useful, but is unable to show a cause and effect relationship.
There were 15 obese subjects (average BMI 35.4) who after 12 weeks of dieting had an average BMI of 32. Measurements were taken in these patients before and after their weight loss. Although we know 11 patients received fenfluramine and 4 received placebo, results were lumped together. Incidentally fenfluramine is Fen-Phen, the drug you may have heard on the plaintiff attorney commercials. It was removed from the market in 1997 after patients developed serious irreversible heart disease while taking drug.
Measurements included a sleeping metabolic rate (SMR), reporting calories burned when resting. The expected SMR was determined by measuring it in 86 “normal” people (with BMI 28.7). These people were not obese, not on a diet and not on fenfluramine.
The SMR of patients was recorded before and after weight loss. A predicted SMR was generated for these patients (extrapolated from normal group). Measured SMR and predicted SMR both decreased after weight loss. Before weight loss the measured SMR was much higher than predicted. After weight loss the SMR was slightly higher than predicted. The change (before-after) in SMR was greater for measured results.
The authors wondered why the decrease in SMR was greater in measured than predicted. In my mind obvious reasons (which were not discussed) include #1 because these patients were obese, #2 these patients were on Fen-Phen, #3 these patients were on a diet. All factors were not true of patients used to create generate expected results.
Now for the part we are interested in…. the organochlorine (OC) measurements. The article reviews that OCs are bad, they are in chemicals are used in our home and yards….. but also feared to be present on our food from herbicides and pesticides used by farmers. OCs are stored in fat cells. When fat is lost during weight loss the OCs go into the bloodstream. This has been reported to affect the body’s ability to burn fat efficiently.
The authors measured patient OC levels before and after weight loss. It increased a significant amount. When performing a multivariate analysis they found that the increase in OC concentration predicted the differences in SMR described above.
Sunday, February 3, 2008
Organic Fuel: Bicycling Magazine
The March
Issue of Bicycling Magazine (page 101) included an article about Organic foods.
They included a list of fruits and vegetables that are more or less important to be purchased organic (from foodnews.org by Environmental Working Group).
Organic please
Bell and hot peppers
Carrots
Celery
Cucumbers
Green Beans
Lettuce
Potatoes
Spinach
Apples
Cherries
Imported Grapes
Nectarines
Peaches
Pears
Raspberries
Strawberries
Conventional Okay
Asparagus
Avocados
Broccoli
Brussels Sprouts
Cabbage
Cauliflower
Eggplant
Onions
Okra
Peas
Mushrooms
Radishes
Sweet Corn
Tomatoes
Bananas
Blueberries
Cantaloupe
Grapefruit
US grown grapes
Honeydew
Kiwi
Papaya
Pineapples
Plums
Lemons
Limes
Mangoes
Oranges
First an admission. I am not a whole foods or organic food shopper. I am committed to eating healthy, but in my lifetime this has been to the extent of dieting and losing weight. It is time for me to investigate this matter, so I plan to do a series of posts on this topic.
This article got me thinking.
In the article mentioned above, the author states that pesticides contain organochlorines (from fertilizer) that collects in our fat cells. Release of these chemicals during exercise affect mitochondrial function [their source Intern J Obesity 2004, will review article]. They explain that by eating organic, "help keep your body and the earth clean and healthy". The list above represents items with more v. less residual pesticides.
My immediate questions are:
What is the evidence of pesticide contamination in conventionally grown foods?
What is the effect of pesticide consumption?
How is organic food regulated?
I am excited to learn more about this.
Issue of Bicycling Magazine (page 101) included an article about Organic foods.They included a list of fruits and vegetables that are more or less important to be purchased organic (from foodnews.org by Environmental Working Group).
Organic please
Bell and hot peppers
Carrots
Celery
Cucumbers
Green Beans
Lettuce
Potatoes
Spinach
Apples
Cherries
Imported Grapes
Nectarines
Peaches
Pears
Raspberries
Strawberries
Conventional Okay
Asparagus
Avocados
Broccoli
Brussels Sprouts
Cabbage
Cauliflower
Eggplant
Onions
Okra
Peas
Mushrooms
Radishes
Sweet Corn
Tomatoes
Bananas
Blueberries
Cantaloupe
Grapefruit
US grown grapes
Honeydew
Kiwi
Papaya
Pineapples
Plums
Lemons
Limes
Mangoes
Oranges
First an admission. I am not a whole foods or organic food shopper. I am committed to eating healthy, but in my lifetime this has been to the extent of dieting and losing weight. It is time for me to investigate this matter, so I plan to do a series of posts on this topic.
This article got me thinking.
In the article mentioned above, the author states that pesticides contain organochlorines (from fertilizer) that collects in our fat cells. Release of these chemicals during exercise affect mitochondrial function [their source Intern J Obesity 2004, will review article]. They explain that by eating organic, "help keep your body and the earth clean and healthy". The list above represents items with more v. less residual pesticides.
My immediate questions are:
What is the evidence of pesticide contamination in conventionally grown foods?
What is the effect of pesticide consumption?
How is organic food regulated?
I am excited to learn more about this.
Saturday, February 2, 2008
Big Gulp
I am not a big drinker. Sipper mostly. My favorite beverages with coffee at the top of the list, followed by a nice glass of red wine perhaps. On a long bike ride you should drink a water bottle an hour..... how much do they hold? About 500 mL, I imagine.The day of my surgery and the night after I was wicked thirsty. Our hospital issues every patient a pitcher for water, with a huge straw that sits on the bedside table. Our heart failure patients have one. Four liters of water. I drank 4L of water in under 8 hours. I think it is the straw. It got me thinking, how much do our patients drink while they are in the hospital?
Water retention is a big problem in heart failure. Decreased pumping function of the heart, decreased blood flow to the kidneys. Kidneys see less blood, and therefore are unable to filter out excess water. At the same time they secrete hormones that increase blood pressure and stimulate thirst.
These measures are the body's way to stay alive. It backfires as the the weak heart is overwhelmed by the excess water. Handfuls of pills are issued to the patient with a failing heart- all to counteract this cascade. When swelling fills the legs and lungs patients are admitted for even more drugs, directly in the veins. An now as I am aware, a large pitcher of water with a mack daddy straw. Interesting what you can learn about medicine from a hospital bed.
Friday, February 1, 2008
POD#16
Yes the wound is infected. Immediately my mind entertained the worst possible outcome. Again because of the complications I have seen in patients during my training. Hundreds of patients are discharged home and live happily ever after. It is the one or two that stay with a bad outcome. Those you have to see every say, with feelings of guilt and frustration that leave the mark in your memory. But at the end of the day the reality (as my husband reminded me) is that it is just a little infection.
So it took 24 hours from my diagnosis of a wound infection until my first dose of antibiotics. In the last picture posted you can see a little redness at the top of the incision. Later that day I noted drainage (determining infection not just inflammation). It was 9PM. I called the SuperNurse early the next morning. I suspect they were in the OR all morning. I emailed with pics of the wound shortly after lunch. At 3PM I called again, to reiterate how concerned I was, and to share the pictures were available. The called me a little after 4. SuperNurse discussed it with the resident (an individual with 6 less years of training than myself) and they called the antibiotics in to the pharmacy. Viola, 4 hours later my husband brought it home.
Okay I realize patients go through this all of the time. I want to to be a good patient, let go of the urge to direct everything, not obsess about the details. I am trying. But waiting for treatment I could have gotten for myself a day earlier, is that the best ultimately?
So it took 24 hours from my diagnosis of a wound infection until my first dose of antibiotics. In the last picture posted you can see a little redness at the top of the incision. Later that day I noted drainage (determining infection not just inflammation). It was 9PM. I called the SuperNurse early the next morning. I suspect they were in the OR all morning. I emailed with pics of the wound shortly after lunch. At 3PM I called again, to reiterate how concerned I was, and to share the pictures were available. The called me a little after 4. SuperNurse discussed it with the resident (an individual with 6 less years of training than myself) and they called the antibiotics in to the pharmacy. Viola, 4 hours later my husband brought it home.
Okay I realize patients go through this all of the time. I want to to be a good patient, let go of the urge to direct everything, not obsess about the details. I am trying. But waiting for treatment I could have gotten for myself a day earlier, is that the best ultimately?
Tuesday, January 29, 2008
POD#13
I think my incision might be infected a little. It has been burning a little the last 24 hours, and a little drainage from the area on the left side of anterior incision. The steri strip worked its way off, and the wound is not perfectly approximated there. I go to therapy today, so I will see what PepMaster, MSPT thinks.
One of my favorite things about our neighborhood is the public library. Located in a restored century building, it has beauty, presence and is accessible to everyone. We stopped in last night. For a Monday evening it was quite busy, the computer room packed with children and parents (homework assignments perhaps?). Three stacks dedicated to books written in Vietnamese.. their contents a mystery to me, but enjoyed by the large Vietnamese population in our neighborhood. I selected a fun book on Handwriting Analysis, so if you would like to submit a sample for study please be my guest. Otherwise any suggestions on good books to read are welcome as well.
Saturday, January 26, 2008
POD#10
Brief update..... my days fly by most of the time I rest. Six hours a day with my leg in the CPM machine. Walking fairly well on crutches, but am pooped after about 5 min. Have taken outings to grocery store (good for down and back one isle) and drug store (wandered for about 10 min). My husband and I plan to go to a movie today, we have a cool theater where the seats are leather couches. Hopefully at the 1:30 show no one will be upset when I take a whole big couch to myself. Several projects that I planned to do (including blogging) are hard to find the time for.
Thursday, January 24, 2008
The View, a rusted railing
My mom likes to watch The View when she is home from work. Last week Colin Powell was a special guest to celebrate Martin Luther King Jr's life. I do not follow the show, but am familiar with sound bites that periodically seep out into the general media chronicling their more heated discussions.
Elizabeth Hasselbeck in trouble. This time for making the statement, "Well black men were given the right to vote before women." She was quickly and respectfully corrected by Whoopi Goldberg, then the producers cut to commercial. Admittedly confused about the issue I looked into it, what was the deal? Constitutional amendments in order, Blacks then women. Civil Rights fight in the 1960's long after suffrage for women. So I am a white girl who learned American history in a Northern blue state... and I am still confused.
Government gives blacks right to vote following Civil War. Following Lincoln's assassination Andrew Johnson allowed the former Confederate States to create local laws to limit voting rights for Blacks. Congress confirmed the 14th amendment, but then had to dispatch the Union Army to the south to enforce it. Military districts saw to it that black men were registered, and nearly all black men were a part of political organizations. In 1867 more blacks than whites were registered to vote in the south, and former slaves are participating in local government.
The undoing of this progress? President Hayes in 1876 removed the troops, the Ku Klux Klan took over. A generation of hatred and violence. Suffrage for women happens in 1920, but not until the 1960's does the Civil Rights Era begin.
(My source: http://library.thinkquest.org/J0112391/myth_9.htm)
The weekend before my surgery my husband and I drove down to Memphis for the weekend. It was a perfectly timed get-a-way. We stayed at the Peabody, followed the ducks into the lobby, rested at the spa, rode the trolley downtown and danced late in the clubs on Beale Street.
Saturday afternoon we set out for the Civil Rights Museum. As we turned from the main road we were confused, because the address we expected to find it stood an old Motel. Aluminum siding in teal and white, an old neon sign that was no longer lit. As we approached we noticed antique cars from the 1960's parked outside, only at that point did we realize our surprise. The Civil Rights Museum was built inside the Motel where Martin Luther King Jr. was murdered.
The main entrance was a few feet away, and over the next two hours we wandered through the museum. The history of slave trade, civil war, WWI, industrialization/North migration, School De-segregation, Rosa Parks, Walk on Washington, Memphis Sanitary Worker's Strike.... eventually leading us back to MLK. The final exhibit could only be approached in a single file line. I followed a few young people ahead of me, and again paused in reverence as I stood inside the hotel room MLK slept the night before his death. Outside the window was the balcony. On the rusted railing was a wreath of flowers.
Thoughts?
Elizabeth Hasselbeck in trouble. This time for making the statement, "Well black men were given the right to vote before women." She was quickly and respectfully corrected by Whoopi Goldberg, then the producers cut to commercial. Admittedly confused about the issue I looked into it, what was the deal? Constitutional amendments in order, Blacks then women. Civil Rights fight in the 1960's long after suffrage for women. So I am a white girl who learned American history in a Northern blue state... and I am still confused.
Government gives blacks right to vote following Civil War. Following Lincoln's assassination Andrew Johnson allowed the former Confederate States to create local laws to limit voting rights for Blacks. Congress confirmed the 14th amendment, but then had to dispatch the Union Army to the south to enforce it. Military districts saw to it that black men were registered, and nearly all black men were a part of political organizations. In 1867 more blacks than whites were registered to vote in the south, and former slaves are participating in local government.
The undoing of this progress? President Hayes in 1876 removed the troops, the Ku Klux Klan took over. A generation of hatred and violence. Suffrage for women happens in 1920, but not until the 1960's does the Civil Rights Era begin.
(My source: http://library.thinkquest.org/J0112391/myth_9.htm)
The weekend before my surgery my husband and I drove down to Memphis for the weekend. It was a perfectly timed get-a-way. We stayed at the Peabody, followed the ducks into the lobby, rested at the spa, rode the trolley downtown and danced late in the clubs on Beale Street.
Saturday afternoon we set out for the Civil Rights Museum. As we turned from the main road we were confused, because the address we expected to find it stood an old Motel. Aluminum siding in teal and white, an old neon sign that was no longer lit. As we approached we noticed antique cars from the 1960's parked outside, only at that point did we realize our surprise. The Civil Rights Museum was built inside the Motel where Martin Luther King Jr. was murdered.
The main entrance was a few feet away, and over the next two hours we wandered through the museum. The history of slave trade, civil war, WWI, industrialization/North migration, School De-segregation, Rosa Parks, Walk on Washington, Memphis Sanitary Worker's Strike.... eventually leading us back to MLK. The final exhibit could only be approached in a single file line. I followed a few young people ahead of me, and again paused in reverence as I stood inside the hotel room MLK slept the night before his death. Outside the window was the balcony. On the rusted railing was a wreath of flowers.
Thoughts?
Tuesday, January 22, 2008
Monday, January 21, 2008
Beautiful closure
The most shocking dating show moments. Excellent television. I take no responsibility for this- my husband has control of the remote. I am laughing at the ridiculousness just the same.
I feel like my healing is well underway. My surgical wound itches a little, and touching it feels like a bruise. There is a 4 inch incision in the front of my hip, two inches above and below the inguinal ligament (fold of the groin). Two lateral one centimeter arthroscopy port sites. All were closed with sutures (no staples). The SuperNurse informed me that they did a plastics closure. Meaning they used sub-cutaneous (below the skin) absorbable suture. This takes much more time than staples and expert surgical technique. Thank you team. All covered with steri-strips, and then dressed with 4x4's and paper tape. I change the dressing every other day.
Scar massage was part of my occupational therapy/rehab following the broken arm. The purpose to prevent adhesions, since the skin over the carpal tendon needs to slide for normal flexion. They suggested rubbing in Coca Butter/ Vitamin E lotion. I plan to do this when the steri stips are removed.
Below: diagram of suture technique (from: Seminars in Cutaneous Medicine and Surgery
Volume 22, Issue 4, December 2003, Pages 306-316)
I feel like my healing is well underway. My surgical wound itches a little, and touching it feels like a bruise. There is a 4 inch incision in the front of my hip, two inches above and below the inguinal ligament (fold of the groin). Two lateral one centimeter arthroscopy port sites. All were closed with sutures (no staples). The SuperNurse informed me that they did a plastics closure. Meaning they used sub-cutaneous (below the skin) absorbable suture. This takes much more time than staples and expert surgical technique. Thank you team. All covered with steri-strips, and then dressed with 4x4's and paper tape. I change the dressing every other day.
Scar massage was part of my occupational therapy/rehab following the broken arm. The purpose to prevent adhesions, since the skin over the carpal tendon needs to slide for normal flexion. They suggested rubbing in Coca Butter/ Vitamin E lotion. I plan to do this when the steri stips are removed.
Below: diagram of suture technique (from: Seminars in Cutaneous Medicine and Surgery
Volume 22, Issue 4, December 2003, Pages 306-316)
Sunday, January 20, 2008
No pain
I stopped taking the pain meds. I am POD (post-op day) #4. I never felt any pain, which was surprisingly strange. I continued the pain meds a few days, but am now sticking to tylenol. When lying in bed it is amazing to me that my hip and back do not hurt. I guess I was in quite a bit of pain before- much be on the right track since it is better already.
The procedure went well. Arthroscopically they confirmed the impingement and re-shaped the femoral head/neck. I had more cartilage damage and arthritis than they expected. The opened the hip up through an anterior incision. The removed the cartilage and smoothed the arthritis.
This led to favorable hip restrictions. Instead of non-weight bearing, I am able to step with 50% weight on my post-op leg. Instead of swinging each step with the crutches, I walk through which seems much easier than how I practiced.
One reason to do the surgery was to prevent joint damage- so I was disappointed that there was more cartilage damage and arthritis than expected. They fixed the anatomic abnormality, but instead of preserving the joint they "cleaned it up". I suppose there is a greater risk that I will need a future hip replacement, and it increases my concerns about my right hip.
The doctor was pretty clear that I should take it easy on my joint. So my running and triathlon days are indeed behind me. I am glad that I chose a cardiology sub-specialty that is outside of the cath lab. I will not be able to wear lead daily. But probably once or twice a week will be okay.
So today I am the most relaxed and well rested board certified cardiologist on the planet. Not a bad deal.
Friday, January 18, 2008
The other side
I emerge with two eventful days behind me. A couch-on-stilts project is going on in the next room. My husband and mom are elevating the couch on cinder blocks, which with a memory foam mattress will make that piece of furniture comply with my hip restrictions.
So my bed will be my cocoon. I just woke from a nap- surprising how much you can enjoy just lying and resting. They delivered my Continuous Passive Motion (CPM) Machine this morning. It keeps my hip moving, and I will need to use it 6-8 hours a day. I really like it, it feels great so no complaints from me. For Christmas my husband found an electric throw blanket, which keeps me very toasty- hence the cocoon.
The Labradoodle is on watch. He patrols the house observing the increased level of activity with much curiosity. I woke in the middle of the night- and whimpered a little forgetting that I was post-op and bandaged. Smokey was up at at my side immediately. Very cute.
So here we are, the patient, husband, mom and puppy all adjusting to the new life of recovery. I have no pain. Amazing really. Sleep feels so good rest will be my main occupation for a while.
Tuesday, January 15, 2008
Nervous?
People ask if I am nervous about my surgery. The answer is absolutely, but you might be surprised by what I am worried about. There is no anxiety regarding the operative technique, being put to sleep or even pain. I am worried about keeping my composure. Also figuring the right balance between paying attention (which as a MD might actually be helpful) and letting go allowing others to cover all the details. The risk of complication was figured into my decision to undergo the repair. Thinking about it, I want go through the same motions as all other patients. I want the doctors and nurses to be in their regular routine. This I will focus on when I grow impatient or frustrated.
Monday, January 14, 2008
First out of the blocks
I met with the division chairman. The conversation was rehearsed in my mind countless times. My preparation for this meeting- comprehensive. Seriously worried if I could pull it off, the honest truth is that I do not feel so well put together as of late.
The stakes were high. At this stage of training all fellows meet with the boss to discuss their future. This year several fellows have gone before me, all disappointed with the result.
My questions were: 1. Will this division support physician scientists who want to do research and heart failure? 2. Is there a future for promotion for me here (meaning if I stay will you promote and support my career)?
I did pull it off. I felt strong. Laid out my research plan, career aspirations, and described how I stand out from the pack. He mentioned my health problems, I said it was disappointing however I worked very hard despite my troubles- and am proud of my accomplishments.
He offered me a faculty position. My work has been the most productive, I show promise. YES. Slugging along, believing that I was making the right moves... they finally threw me a bone.
Thursday, January 10, 2008
Update 6 days to go
My List
Work
Meet with boss to discuss future- today 3 pm
Teach DO to genotype my mice- today, but where is she?
Get portable hard drive to bring data home- ordered
Finish med student evals- done
Conference call with cards fellows/ ACC program- tonight
Home
Pay bills- Monday
Fire cleaning guy- scaled back to every other week, we'll see how that goes
Dog to groomers- today
Car for tune up- next tues
Self
Take Calcium/VitD- going well, also got Vit C and Zinc wound care nurse protocol
Get list of books to read- have some good leads, started Harry Potter last book, kinda boring
TiVo interesting shows- Matt Damon Actor's studio was cool, collecting History channel stuff
Pedicure- Sat AM
Romantic weekend get-a-way- booked
Pick up hip stuff from friends (potty chair, shoe helpers, grabber things)
Wednesday, January 9, 2008
Results not yet available
Cardiovascular board certification exam. October 31, 2007. Results not yet available. What the heck is up?!?!! Admittedly I have been checking the ABIM website frequently. I am really scared that I did not pass. My life has made unexpected turns, disappointment over this test seems entirely plausible. I would be crushed. Practicing cardiology means so much to me. Or should I say being a cardiologist. Seems slightly absurd writing this as I wait (at 930 PM) for the centrifuge to finish spinning my cells so that I may suck off the serum and wash them with PBS (phosphate buffered saline). Seriously I could teach a 10 year old to do this. The big mystery and wonder of discovery is locked up in the PIs office. A delightful place where questions are met with a patient instructive tone holding slight condescension. Redirection sending me back to the bench where the process of wild guesses and repeated failure is not doing it for me. I am not a post-doc. I am not a graduate student. I am not a molecular biologist. I am a physician who has been training for 8 years since med school. I want to be a leader in academics, in cardiology. I want to learn and gain these skills- but am so tired of working days and nights for years and years, and after all of this time feel like I suck. Perhaps the drug induced coma or forced convalescence will bring some clarity.
Tuesday, January 8, 2008
Penalty time out
In hockey penalties mean sitting in the box. The rest of the team plays on and the opposing team has an advantage. Keeping the speed of the game these players hop on and off the ice, it is difficult for me to keep track. Dr. SMH yesterday suggested my surgical leave is a forced time-out. Fitting. The reality is that I have never had a prolonged break from working. In school I spent my summers either waiting tables doing research or both. Vacations during internship and residency were always a rush either to a wedding or funeral with the rare international adventure. I welcome the new perspective that my time on the couch will bring. Like the hockey player from the bench analyzing the opposing teams strengths and weaknesses, catching his breath, perched and ready to take the ice again.
Monday, January 7, 2008
A chance to cut is the chance to heal
This is what the surgeons say. This came to mind as I was walking the 1/4 mile from the parking garage to the lab this morning. I hate that walk. No anti-inflammatory meds before surgery. Ouch. So I reminisce on how loose and free my hip felt after the lidocaine/cortisone injection and recite: a chance to cut, chance to heal.
Friday, January 4, 2008
My List
It is time to make a list of things to be done before surgery. Countdown 12 days.
My list will be comprehensive to do for work, home and self.
Work
Meet with boss to discuss future
Teach DO to genotype my mice
Get portable hard drive to bring data home
Finish med student evals
Conference call with cards fellows/ ACC program
Home
Pay bills
Fire cleaning guy
Self
Take Calcium/VitD
Get list of books to read
TiVo interesting shows
My list will be comprehensive to do for work, home and self.
Work
Meet with boss to discuss future
Teach DO to genotype my mice
Get portable hard drive to bring data home
Finish med student evals
Conference call with cards fellows/ ACC program
Home
Pay bills
Fire cleaning guy
Self
Take Calcium/VitD
Get list of books to read
TiVo interesting shows
Thursday, January 3, 2008
Pre-op anesthesia
I have my pre-op anesthesia appointment in the morning. Taking a break from admitting patients to the cardiology service I pause to fill out my paperwork. It occurs to me that they are exactly the same forms. Random heart patient presenting with right sided chest discomfort and shortness of breath. Ortho patient (me) presenting with left acetabular labral tear with underlying pelvic dysplasia/ femoral impingement.
They ask if you have ever had difficulty with anesthesia. The truth would be yes. With my miscarriage I was a big girl and did not cry. That was until they dosed me with Versed in holding and then I sobbed all of the way to the OR. Two months later got conscious sedation to set my broken arm. I should have been asleep. Cry I did not, but more embarrassing I babbled about my weight, my calculated BMI and how I would get fat not exercising post broken arm. These experiences leave me feeling very exposed. Emotionally exposed- similar but not exactly the same as the exposure our patients experience in the cath lab while waiting for their groins to be prepped. The thought brings the memory of my hip injection, where I, completely awake was far less embarrassed than the resident who had the duty of preparing my groin for the injection.
These juicy details will not be shared at my appointment in the morning. Because I know what they really need to know is whether I, or a family member ever developed malignant hyperthemia with anesthesia. So I will check the box for no next to "difficulty with anesthesia", but pause to recognize that the physician is privy to only a small part of the whole story.
They ask if you have ever had difficulty with anesthesia. The truth would be yes. With my miscarriage I was a big girl and did not cry. That was until they dosed me with Versed in holding and then I sobbed all of the way to the OR. Two months later got conscious sedation to set my broken arm. I should have been asleep. Cry I did not, but more embarrassing I babbled about my weight, my calculated BMI and how I would get fat not exercising post broken arm. These experiences leave me feeling very exposed. Emotionally exposed- similar but not exactly the same as the exposure our patients experience in the cath lab while waiting for their groins to be prepped. The thought brings the memory of my hip injection, where I, completely awake was far less embarrassed than the resident who had the duty of preparing my groin for the injection.
These juicy details will not be shared at my appointment in the morning. Because I know what they really need to know is whether I, or a family member ever developed malignant hyperthemia with anesthesia. So I will check the box for no next to "difficulty with anesthesia", but pause to recognize that the physician is privy to only a small part of the whole story.
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