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?

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)

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

News! Just found out! I PASSED!

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

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.