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!

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.

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.

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.......

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.

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.

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

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.

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.

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.

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?

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.

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?

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.

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.

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)

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.

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.

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.

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.