Breather

After a month of work/sleepwalking in the hospital, I’m so amazed that I was that stressed out! More and more I feel like I’m living to work, instead of the other way around. I keep telling myself that this is temporary, just a few more years of being a resident (and internship, typically the worst year of being a doctor is already behind me!) And when I’m staff it’ll be better.

It’s funny how people think physicians are so smart but really, if we were smart, we’d probably figure out a way to balance the life/work thing. Individually it’s possible, but working a 40 hour work week is kind of a Holy Grail in medicine.

But since my schedule has become SO much better even in the past week, the difference in my mood, my energy level, my overall well-being has become exponentially improved! How I was able to survive a month of q3 and stay sane is beyond me… I was about at my wit’s end by my last call. Thankfully everyone I worked with was fantastic and that’s one of the few reasons why the pros still outweigh the cons in my career choice!

Willpower of Jabba the Hut

Everybody whines about how they wish they would work out more, eat better, sleep more.

I count myself among them. Then again, occasionally I will achieve these goals- look back on my week and realize that I’ve spent over 60 minutes on cardio each day, ate my perfect share of the 4 food groups, and slept 8 hours a night. This has only happened maybe…. twice in my life?

At times it’s easier, but right now it is REALLY HARD. I am spending every third night sleeping in the hospital. By “sleep” I mean, working 30 hours straight. Straight. Once I got about 2 hours of sleep, but sleep while on call isn’t the nice nap in your own bed. Even in sleep, you’re on edge thinking “was that my pager?? did it go off??? did they just announce a code blue???”

Basically I either 1.) Wake up in the hospital, 2.) Spend the night in the hospital, or 3.) Head to the hospital and then go back to sleep as soon as I can get off work, because tomorrow I’m spending the night in the hospital. My last “night off” I spent nodding off at dinner. I then went to a friend’s house, where I promptly fell asleep. I went home and woke up the next morning to watch football, but then came home for a nap. I went to a friend’s dinner but had to leave early because I had to sleep up for my 30 hour shift the next day.

I don’t know how my peers do it, the ones who have spouses and kids!! My laundry is literally overflowing, I have been eating whatever I can get my hands on instead of planning meals- which has meant frozen pizza and popsicles this past week, and exercise has been nonexistant.

Of course, with no clean clothes, eating high sugar, high fat foods, along with a serious lack of sleep and no exercise, I feel like Jabba the Hut. Mean, sluggish, and fit to be thrown into a sarlacc pit. At least I can spend that thousand years catching up on sleep 🙂

Personal Trainer

I got a personal trainer, she’s fantastic!! Though I didn’t anticipate I’d ever sink money into something like this, my roommate joined a gym, got me to join the gym, and of course the gym offered 3 free sessions with a trainer. I figured, why not?

She was awesome from the start! As a runner, I’m not the biggest fan of strength training. But when Christal and I have our sessions, we chat so much that I forget how hard I’m working, which makes it SO much easier! I’d love to work out with her more often but having that one-on-one attention doesn’t come cheap so we have 30 minute sessions once a week and I try to make it to her fitness classes on other days to keep up abs, kickboxing, bosu, etc.

I noticed a huge improvement in my running time when I added these workouts, an unexpected bonus! I’ve read so many times in Runner’s World how this is true but I didn’t believe it until I felt it myself. My sprints are so much faster and without losing a pound, I was able to comfortably shave 30 seconds off my mile!!!

Getting a personal trainer is sooo worth the money, not only because it’s motivating but makes those hard workouts much more fun. Now I just have to ace my Navy Physical Fitness Test in 4 weeks…

Ames, Iowa – Told you it was great!

No one ever believes me that Iowa could be a great place to live. I actually consider myself a native of both Ames and Iowa City, as I moved back and forth a few times during my childhood. However, I did spend 4th-12th grade in Ames and was a Little Cyclone (though I consider myself a die-hard Hawkeyes fan!! First game of the season is this Saturday!!!!)

So reading that Ames has been called one of the top 5 Best Places to Live the Simple Life was cool, I got a kick out of hearing about some of these places mentioned….
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Ames, Iowa

Vibe: Wholesome Americana
Population: 55,000
Median housing price: $159,270
Average commute: 17 minutes
Average number of sunny days: 202 per year
Most relaxing way to spend an afternoon: Paddling a canoe in Ada Hayden Heritage Park, where you may spot—besides hundreds of common birds—a short-eared owl or a summer tanager
Simple fun for less than $10: Touring Reiman Gardens at Iowa State University, where $7 ($6 for seniors) buys access to award-winning rose gardens and more
Who knew?: It recently ranked as the sixth-smartest city in the United States.
Membership – Join, renew, or learn about exclusive AARP member benefits.

Ames is a gracious town—with broad lawns, leafy neighborhoods, pretty parks and ponds—and its distinctly rural flavor is the key to its urban charm. With its thrice-weekly farmers’ markets, paddling options on the Skunk River, and 55 miles of city-maintained trails for avid bikers, runners, and walkers, Ames is a place for people who like wide-open spaces. “You can drive less than five minutes outside of town and you are really in the country,” says Russ Cross, 53, a bank executive in Des Moines, 30 miles away. The lively downtown area—including a long Main Street, fun restaurants (such as favorite Aunt Maude’s, serving up local meats, cheeses, and produce), and a pub with its own brew—adds to the charm. “I love that when I step outside my office on Main Street, it’s such a clean little town,” says Russ’s wife, Beth, 51, president of a local marketing company. “It’s one of the most welcoming places I’ve ever seen.” The couple, who like to run on Ames’s trails with their golden retriever, say they are a long way from retiring, but when they do, they can’t imagine moving anywhere else. “There’s just so much that I want to do right here,” Beth says.

http://www.aarpmagazine.org/lifestyle/the_simple_life.html

6 days post marathon

When can I start running again??? WAhhhhhHHHH!!!!!!!

My quads are sore- in a really good way though. Sadly, my left calf is still acting up. I can barely climb stairs now. I went to the physical therapist and she wants me to get ultrasound therapy for the next few weeks, stretch at home (first hot, then cold to cool down) and have a clinic visit in 1 month.

When can I start running again??? I missed it since the day after the marathon!!! I was limping for a few days but now I’m much better. Ugh, I cannot WAIT to lace up my shoes again. Guess I’ll swim and kayak till then…

Rock and Roll 26.2!

Yesterday I ran the San Diego Rock and Roll Marathon in 4:31:10!  My first goal was to finish… check… and secondly, to finish under 4:30, but this is close enough!  I have to say that in comparison to my first marathon, this is better in that I actually finished 🙂  In comparison to my second marathon, I -thank God- had no IT band syndrome and so this was MUCH less painful!!  Apparently it’s true that the third time’s the charm 🙂

The day started off really well when I found out it would be a low 60’s degree, cloudy day.  I didn’t sleep all that well, but woke up at 5 AM to get to Balboa Park.  My roommate Frankie brought her dogs to the event, and she took pictures while I stretched, dropped off my gear, and found my corral.  The only concern I had was an old calf injury that started to flare up during my 20 miler a few weeks ago, and was still present on my 13 miler last weekend.

I saw a few people I know from work milling around the start line, but after the race began I put on my headphones and got into my pace.  For the first few miles I ran below my typical pace, remembering that I have to conserve energy over the long run!  The spectator turnout was fantastic, first as we ran up to the Hillcrest area and were awarded high fives amidst Rainbow flags from a big group of men wearing wigs and fake boobs!  Then we turned around south, down past Balboa Park and around PetCo Park.  We looped into the Gaslamp, in which some of the businesses were open and had spectators shouting encouragement to the runners.  By the USS Midway I noticed the first band, for which I turned off my music and enjoyed the Rock n’ Roll experience.

I think around mile 5 or 6 we began running up the highway, which I never noticed was uphill!  My left calf injury had been acting up since the start, and the uphill didn’t help.  I hoped and hoped and stretched many times during the race to make sure it didn’t suddenly cramp up and ruin everything… something I had been anxious about for the past 2 weeks.  Amazingly and by divine intervention, my worries evaporated at mile 14 when it suddenly eased up and I was able to run the race without further calf issues!  Well, maybe once on mile 22 but I was able to stretch it out.

The race took us past the Fashion Valley mall, to Mission Bay Park, looped around to Pacific Beach, and back towards the Marine Corps Recruit Depot.  I felt really good for almost all of the race, and I stuck to my strategy of eating an Accel Gel every 4 miles (one Gu at mile 20 because they were handed out) and never passed up a CytoMax energy drink stop.  The Medic tents were handing out salt packets, of which I took 2 and I’m sure it helped!  Because of this my energy level was faily constant… though around mile 22, then more so around mile 24, I started to think “uh, this hurts… I wonder if I’ll ever do this again?” 

Not that I couldn’t run, I just knew it would be sooooo much easier to walk!!!  In the last few miles there were a lot of walkers that I passed, I envied that they probably weren’t in as much pain as I was but I just thought about how much better my time would be 🙂  Also, I wanted to be able to say I ran a marathon, not walked it.  (I’m not counting the walking as I drank the energy drinks, I end up coughing and spilling it all over if I try to drink and run at the same time!)  Surprisingly, after I’d clear the drink station and begin running again, it wasn’t as painful to restart as it was in my longer training runs.  That was a definite plus!

After mile 24 I did start to think about the finish just a little too much… “am I there yet?  Where is it??”  People without bibs were running in the opposite direction of us, I assume to find their friends and run them in.  I did see one of my friends do this and he encouraged me by saying “Only 2.5 more to go!”  but in all honesty, what got me through those last few miles was just my determination to never quit and push myself to the limit.  If I were to give in and walk, I’d be letting myself down, as I knew I could run.  So RUN I did!

Once inside MCRD I kept looking up for the big balloons that usually signify a finish line, listening for a loudspeaker indicating we were getting close to the spectator stands.  I was sooo happy once I saw the balloons!  As I tried to pick up my pace- at this point, it probably was about 0.15 seconds faster per mile, that’s all my energy had left– I lifted my shoulders, thought about how “hey, I’m finishing now!” and gave the photographer the best smile I could!

Afterwards I ate a bunch of fruit, drank a ton of water, and changed into dry clothes.  Once I got home, I took a loooong warm shower and a quick nap.  My roommate and I went to Arrivederci in Hillcrest where I ate as much bread, fettuccine, and tiramisu as I could fit into my stomach.  I’m counting calories on LiveStrong.com, and I calculated that the marathon burned 4,589 calories!!!!  Try as I did to eat, I could only match it with 5,365 calories of food.  I also tried to keep to the 4:1 carbs to protein, but it was more like 3:1.  Oh well.

Today my left calf is cramped, and my quads are soooo sore!  I’m taking the elevator everywhere and my ortho friends put in a consult for me to get PT so I can adequately recover.  Overall, it was an awesome experience.  Honestly… call me crazy, but I wish I could run again today!  But then I try to stand up from a chair and feel how hard I worked yesterday 🙂  I still can’t wait until I run again… maybe plan another marathon in December?  Anyone interested?

Today

Today I have over 2,000 miles on my bike, will be running a marathon in 4 days (unless my calf cramps up!) am finishing out the last rotation of my intern year, and am planning to move out of my apartment in one month.  In 6 weeks I’ll be an emergency medicine resident and hopefully have upgraded to a 600 cc bike (maybe an R6 or a CBR 600? )  Hopefully I’ll have settled into my new beachside apartment by then and won’t have damaged my joints enough to be able to keep running along the boardwalk.  Yeah that’s my life right now, crazy huh?  Never figured i’d be able able to say any of that!

Now I just have to survive this last month of medicine wards which is already threatening to suck my soul out piece by piece… may sound dramatic but every computer meltdown, stupid page, getting transferred to a dead end phone line, unacknowledged labwork, etc. etc. kinda really gets you down.  Today I was forced to do a senseless pap smear on a scared old woman who was in a wheelchair for a traumatic brain injury… aaaand I’ll just stop my negativity right there or else I’ll never be able to go in to work tomorrow… :p

Motorcycle maintenance

Having been through enough car breakdowns, I realized that on 2 wheels the same thing might be the kiss of death.  So after going to my awesome Motorcycle Safety Foundation course this weekend (FREE for military!!!!!) I’m hoping to make it to the DMV today and get my license.  I got a lot of great tips on motorcycle maintenance, but still feel like I have a lot to learn!

I have over 1,000 miles on my bike now, but I bought it with 300 on already.  I recently checked the tire pressure and had to inflate the back wheel, and also realized my tire pressure gauge sucks for my bike.  Yesterday I was researching what checks to do at different mileages, and as a result I’m going out to buy some chain lube today and probably some rags.  I printed out some info on checking chain slack, but I figure for the rest of the service stuff I’ll take it in to a shop for now.

Hopefully I can get to a point where I’ll be changing my own oil, knowing what lines/electric stuff to check, and making it a routine.  I’m pretty astonished there isn’t a course available out there for this kind of thing, but one teacher from the MSF course is trying to set one up.  Hey, at least I already changed my own busted turn signal!  Oh yeah, also on the “to do” list is to buy mechanic soap.  Girls with mechanic greasy hands, not so cool 🙂

Necrotizing Fasciitis!! or maybe just Cellulitis…

“Nec Fasc” is one of those diagnoses in medicine that makes surgeons sweat bullets, ER docs pump antibiotics like firehoses, and sends interns screaming into phones to set up emergency surgery STAT.  We had a patient where this was a concern, he’d let it go due to the fact he was sooo close to finishing Hellweek as part of his SEAL training- and he made it!  But like most guys I’ve seen from this training, they are so cut up, beat down, and pushed so far past their limits you just have to sit back in awe at what they’ve done to their bodies.  Stress fracture?  That’s nothing!  Pneumonia?  Who cares!  Keep going!

Anyway, I got a few key pointers about telling the difference between nec fasc and cellulitis.  These are just things someone educated me about, I didn’t pull this from the 7th edition of a textbook or a randomized controlled double blinded study,  so take it for what it is.  Cellulitis is MUCH less concerning, though also usually requires hospital admission with antibiotics and can also be devastating in the long run.  So here were a couple physical exam pointers that can either raise your blood pressure or calm those 4 AM frayed nerves:

1.)  Erythema:  Present with both, but in nec fasc the infection in the fascial plane spreads faster than the erythema above it.  Therefore, patients often complain of pain beyond the erythematous border.  In cellulitis, pain is typically only present over the affected skin.

2.) Palpation: If there’s crepitus, think nec fasc.  I’ve felt crepitus before (from a botched chest tube placement) and it seriously feels like there’s crinkled cellophane just below the surface of the skin.  Others have described it as rice krispies, which is also close.  It actually feels like popping and snapping when you press down!  Lack of crepitus doesn’t rule out nec fasc though- it can still be an emergency situation if all you feel is the classic hot, swollen, painful skin.  Remember it depends on the organism causing the infection…

3.) Vital signs: Tachycardia may be the only change.  Especially in young, healthy patients (like in the military population) their body can compensate for infection for quite a while.. until a sudden crash that was unanticipated lands them in the ICU.  On exam, patients can appear to be doing well, but don’t let that fool you!  All that “badness” growing at exponential rates will hit a threshold the body can’t handle… and then you’re dealing with full blown Shock.  No thanks.  Watch your vitals carefully!

4.) Labs: Obviously infection will make your white count go up.  However, in the experience of most residents I’ve spoken with, ned fasc will raise it dramatically and usually above 35.  Of course, it depends on the time of presentation and immune status of the patient but if the lab starts calling you with critical values, that might be a sign that something critical is happening.

With the SEAL I saw, when I evaluated him in the emergency room, I drew a line at where the erythematous border was though he was already receiving antibiotics.  Being on ortho, I was there to rule out compartment syndrome (due to pain out of proportion to exam) but I quickly ruled that out since the skin was pretty soft.  Surgery decided to take him to the OR, where I saw him 1.5 hours later and was astounded at how far past my markings the erythema had progressed!  He had alredy received about 5 different IV antibiotics and still the infection was advancing.  In some places, it was almost an inch.  Holy smoke Batman!!!

The surgeon made an elliptical incision over where some new petechiae had shown up on the skin, often being a clue as to where the worst underlying infection may be.  I heard him teaching the resident that (only read on if you’re a surgeon or have a strong stomach) …. if it’s nec fasc, expect “dishwater discharge” when making the incision.  When palpating the fascia, run your finger up and down the incised areas and if it’s intact, that’s good.  If it breaks apart as you push, that’s bad.  That’s when you being the unzipping process and debride, debride, debride.  Then drink a couple RedBulls and Rockstars because you’re not going to get any sleep on the frequent post-op checks.

My patient did not have nec fasc, in case you’re wondering.  They just did the 2 elliptical incisions, packed and left them open, and kept pumping him full of antibiotics and fluids.  Phew 🙂

Dirtbikes cause fractures: Pelvis and Scapula

This is the second call I’ve gotten about fractures and dirtbikes.  The first was someone I saw who raced up a sand dune only to find the back was not there.. and he fell 20 feet onto his bike, fracturing his pelvis- which is a hard thing to do!

Today I saw a scapular fracture, it was a guy who went over his handlebars and now can’t raise his arm above his shoulder.  Apparently this is expected after fracturing your scapula.  Treatment for a fracture that’s still relatively lined up (non displaced) is to just keep it in a sling for a few weeks, but keep flexing the elbow so as not to lose muscle tone or develop any other disuse symptoms.  After 3 weeks, having someone move the shoulder (passive range of motion) should help regain strength in the shoulder.

Surgical indications are if the fracture is displaced, involves the articulation with the humerus, and some coracoid process fractures.  As I got sent home sick today and am miserably typing from my couch and don’t have the energy to look in my Handbook of Fractures, I can add more later.  Right now I’m going to blow my nose and take a nap instead.

…. The only thing I thought to add is that I’d like to try dirtbiking some day.  Seriously, no sarcasm!  I accidentally got my ninja on some sand, it freaked me out for a sec when it fishtailed and I worried about how junky my chain would get but if I had a dirtbike I bet you could take some badass curves and the lack of roadrash would be a plus!