Tuesday, November 24, 2009

I need a vacation ...

... or smarter patients.

Overweight, 39 year old, stupid female patient (whom I will now refer to as O39S) comes in today for a pre-operative physical exam and clearance for surgery.

Gastric bypass surgery.

I've known O39S for several years. She's an out-of-control diabetic with hypothyroidism who is on disability because she has some weakness in her left arm from a workman compensation accident 10 years ago. She broke her arm in several places because she was too lazy to get the ladder at her warehouse job and she decided to climb the 15 foot shelves, which promptly collapsed under her enormous girth. So she sued the company and filed for disability and some idiotic doc signed off on all of this.

I'm not shitting you.

Anyway, she never does what I tell her to do - lose weight, check her blood sugar, stop smoking, stop sleeping with drug users, stop driving drunk, stop selling your thyroid medicine to your nieces as a "weight loss pill"; the list goes on and on.

So, today, she's all smiles and giggles. She was cleared for bariatric surgery and because she is on medicare, it's covered 100%.

She has not exercised a day in her life. Her version of a diet is cutting down to 2 liters a day of Mountain Dew from 4 liters. She has not checked her blood sugar in over a year. She has not taken any of her medications in 3 months, because she is using the money to buy cigarettes.

She would not even need this surgery if she tried half of the things I've been telling her to do for the last several years.

As we were finishing up the exam, she reports that she's going to get a boob job and a tummy tuck after she loses all the weight. She gleefully tells me that her cousin did it and got it covered by medicare because she told medicare that she was suffering from "mental anguish" from having "extra skin all hanging off her".

"That's what I'm going to do, too! It's awesome!" O39S is absolutely smiling like the cat who got the canary.

I think my mind must have short-circuited at that time because I couldn't mask the look of disgust and revulsion on my face. She didn't care, though.

"Well," she replied, stupid enough to not be offended, "Because I won't be eating as much, I'll have enough food stamps to trade for cash, so I can buy me some of those little Victoria's Secret underwear!"

I could only mumble something like "good luck with that" as I scurried out of the room.

Seriously. I need a vacation.

Monday, November 16, 2009

I like a little junk in the trunk ...




... but usually it's not the front hood crammed into the back trunk like this guy who was in front of me at a stoplight the other day. I can only imagine the shitty day he's having.

Friday, November 13, 2009

There are worse things I could be ...

... than my dad.

I was looking at this picture of my son and I that was taken a few months ago, when we were up in the Brainard area, and it seemed to resonate with me:



I don't know, it has a timeless feel to it. It was taken in 2009 but it could easily could had been taken in 1972. Which would've been when my dad was approximately my age and I was Peter's age.

I look at me and see my dad's half-smirk expression; the placement of his/my hands around his/my son; his haircut and clothes - even his sandals (his were leather, mine are some sort of canvas/microfiber).

Twenty-five years ago, this revelation would've upset me; today, it makes me proud.

I love you, Dad.

Thursday, November 5, 2009

Ok, autumn doesn't really suck ...

... I know I was a little hard on the red-headed step-child of the seasons a little while ago. My SAD can be a bitch.

We did have some snow, but it melted quickly. I was able to get out on the river a few more times. Laura and Peter and I have visited many, if not all, of the orchards and corn mazes (maize mazes?) in the 50 miles radius of the cities. And we were able to enjoy a little color from my little trees:





Most importantly, I was able to help one of my favorite buddies experience jumping into a pile of leaves for the first time this fall:



Yep ... autumn doesn't suck too much. Peace.

Thursday, October 8, 2009

Much better this time ...

... I haven't blogged recently because I've been lamenting the loss of summer, fighting a never-ending cold or have just been busy at work. Or all three.

Anyway, I got to get out on the river yesterday in my single for maybe the last time this year:



I was out for over an hour and logged more miles than I logged in the log book at the club.

I hear we're supposed to get snow tomorrow night.

Sigh ... the fugue state continues ...

Friday, September 11, 2009

Autumn sucks ...

... I used to be a fan of autumn when I lived back east. I have fond memories of raking leaves (and then jumping into the pile of said leaves), tailgating at football games, warm sweaters, trick-or-treating on a brisk night, etc.

Now, living in Minnesota, fall is just a speed bump on the inevitable slide to a dreary, long winter. (which has less than 10 hours of sunlight on the shortest day of the year! no wonder we all have vitamin D deficiency!)

Well, at least the trees are starting to look pretty ...

Wednesday, August 26, 2009

With this ring ...

... you get callouses when you row.

I've been taking my wedding band (my only piece of jewelry, because beauty like mine needs no adornment) off when I row this year. I think it helps my 'blade work' on my starboard oar. It definitely has cut down on the blisters.

I forgot to put it back on this morning (not a usual rowing day for me) and when I realized it a few hours later, it struck me how naked I felt without it on.

While feeling a little off, it was actually a good feeling - I felt a sense of family and knowing that there is more to my life than myself.



Awesome.

Monday, August 24, 2009

Ok, ignore the angle ...

... and concentrate on the fluid movements.



peace!

Monday, August 10, 2009

Thank god for Hanes ...

... and maybe undershirts in general.

I don't consider myself a smelly guy, but let's just say if I had a superpower, it'd have something to do with my ability to manufacture sweat.

It's not a smelly sweat (I think it smells like flowers), it's just there - unless I was drinking the night before, and I'm so lame, that barely happens these days.

I sweat a lot when I exercise and that's expected and good. The process of evaporation of the sweat actually sucks heat away from the body and cools you down. When you're outside in the sun and you stop sweating - you're in trouble.

To dispel your mental image of me sweating like the "weight-challenged" kid to the left here, I don't sweat ALL the time. I'm civilized. I bathe regularly. I wear a pleasant but mild-smelling antiperspirant. Garlic is not a regular part of my diet. And ... I wear an undershirt under my dress shirts at work (and the "wicking" kind under my tshirts when I work out).

For some reason, I have noticed that there are a lot of my contemporaries and younger peers who have decided to eschew the undershirt. Why? Do they want to be smelly and have pit stains? I don't get it.

And, finally, what's the "wife beater"? Do they come free with purchase of large, tacky gold chains? They do, usually, cause the growth of cheesy facial hair.

They aren't very functional. There is no fabric in the area that needs the most absorption. They also are kind of ugly, fashion-wise. Very few guys can pull off the ribbed, stained white cotton look.

Maybe that's why the people who wear them are angry all the time. Maybe they're angry at their wives for not getting them the 95% cotton Hanes undershirt with no tag that feels like a warm hug.

Sheesh, silly misogynists. Everybody needs a (non-sweaty) hug to get you through the day ...

Friday, August 7, 2009

Endorphins are cool ...

... I never understood the "Runner's High".

It's this mythical state where a runner has reached a level of training that, during a run, the bloodstream gets flooded with hormones that the body produces that have opiate, or morphinelike, properties. It's an euphoric state that, quite frankly, can be addictive in the right peron's physiology.

I've never really considered myself a runner (it's waaayyy too much work) but I did run track in high school (110m high hurdles and pole vault, thank you) and did my fair share of some 5k's and 10k's when I was in grad school and early medical school.

But, I never got "the high". I remember seeing it in the face of a high school classmate of mine when we had to run a mile in gym class. She had this big grin on her face and literally sprinted the last 100 yards. It was f'in nuts and a little scary.

(Interesting side note - she had 6 kids and is now a fitness instructor at a YMCA in Tennessee; she DID become addicted to the endorphins! Women get an endorphin rush after delivery and experience a slightly less powerful but more pleasant neurohormone when breast feeding.)

Anyway, today was shaping up to be a crap day.

My two rowing partners were out of town and I was looking forward to taking my single out this morning.

But as I pulled into the parking lot on Raspberry Island, the sky was dark and a little rain was falling. Shit. Not ideal conditions, but do-able.

However, the competitive team was coming in (there are ... like a million of them) because of the rain and some lightning. Pussies - I guess they're afraid of 2 to 3 gigawatts of arcing plasma that can essentially melt your nervous system. (just kidding ;))

Shit, again. So I slogged away on the erg for about half an hour which I love (sarcasm), stopping every 10 minutes to look at the weather channel website on my phone.

I hate erging, so I talked to Linnea and Eric (people that rowed Novice with me, but are infintely better than me now) briefly and then adjusted the length and inboard my oars which I had been meaning to do for a while. Finally, it looked like the little break in the rain was about to cruise through the downtown Saint Paul area, but the worse case scenario was about to unfold.

The Juniors.

Nice kids (who all probably row better than me) but watching them get organized and get off the dock is like watching a Keystone Kops movie ... but more annoying and less structured. I don't know their coach very well, but she's very vocal and loud - which doesn't seem to help the kids too much. Shit, cubed.

I went to my happy place for a brief respite and emerged to find the rain had stopped, the wind had died down and I had exactly 35 minutes to row. Finally.

I got off the dock with no problems and after a few minutes of warm-up drills, I felt pretty good. I went up to the inlet which is nice and protected and did a couple of laps in there. Once again, despite waiting for over an hour, everything felt good. I headed back out into the river and downstream towards the club.

I was rowing a 18 stroke rate and I was able to balance and get my oars off the water.

It's wasn't exactly a "high" but everything felt in sync and I watched my pace get ever so slightly quicker and quicker on my stroke coach iphone thingy. I was breathing hard but I didn't notice. My back was good, the linkage of legs, trunk and arms was smooth and I could feel my (yet unnamed) single surge a little after each stroke. Hmm ... maybe I'm not as bad as I thought.

I turned around under the Wabasha Street Bridge and docked relatively smoothly. It didn't start raining again until I was halfway up the ramp. It didn't start raining hard until I was in my car and speeding up 35E towards work.

I didn't care, the endorphins were still tickling my brain ...

Wednesday, July 29, 2009

When did I get old? ...

(Steve's note: I have been sitting on this post for a while; it took a little time to gel in my mind and more time to make it to my fingers and the keyboard. I'm still not sure I got my words around my concept and then have it expressed coherently, but when you're 40 ... you don't care anymore! Peace!)


... I guess that's not really a question, it's more of a statement.

I came into my office one morning a few months ago to be assaulted by this:

I appreciated the sentiment and the effort by Kathy, my nurse (no, she works for me, not takes care of me ... sheesh!). But ... that particular morning, I was feeling all of my 40 years of living at the same time. I had a whopping sinus headache; I was awakened at 3am by my beeper by a brainless on-call telephone nurse with an idiotic question that could've waited until morning; my morning row was horrible (down on port. the. entire. row.) and I could feel my hamstrings and low back muscles starting to tighten up with each step. And to make it all worse, the caffeine infusion from my 32 oz diet coke was not working.

After my shower today, I got dressed and plopped down into my chair. I adjusted the lumbar support, repositioned my gel pad for the mouse and keyboard and glanced at the "dessert" after my breakfast. Mostly vitamins, but mixed in with my fair share of pharmaceuticals.

Jesus.


I used to look and feel like Steve Guttenberg in Cocoon, but now I was feeling more like Hume Cronyn (or Jessica Tandy! - RIP).



I give advice to people all day long. They usually don't follow it, but that's another story. In order to make an impact, I have to say something that they can remember. It's hard to be original and influential by 4pm on a Friday (hell .. 9am on a Tuesday!) so I do resort to idioms.

Occasionally an adage. A lot of expressions. I've been using some local Minnesota vernacular-isms ("spendy", "that's different") to help me fit in. I'm also a big fan of metaphors. I'll even use a simile in a pinch for those with the protruding brows and knuckle abrasions from walking.

But I try to avoid cliches. Or talking about cliches.

What I really hate ... is being a cliche.

So, instead of participating in the cliche "40 year old guy mid-life crisis" thing, I'm going the other way.

Most guys hit 40 and freak out. They look back at the last 10 years of their life and find that they were stuck in a rut and just going through the motions. Time flew by and they settled into an easy if not necessarily comfortable existence. Then the big 4-0 hits them and they start thinking, "Oh my god, I'm wasting my life ... I never got to (fill in the blank); and if I don't do it now, then I'll die unfulfilled."

Or something like that.

Well, I look back at the last 10 years of my life, and luckily, I don't see that. In fact, I've turned the cliche on it's head.

Since I turned 30, I have started a new career. I was put on the fast-track and after riding that rail for several unfulfilling years, I took myself off that track and have found a nice niche ... for the next few years at least.

I traded in my "newer" model wife for a slightly older but much better, smarter, funnier and prettier model. She's also more dependable and an awesome mother.

My next car will probably be a minivan, not a sports car.

In the last 10 years, I've taken up two new hobbies. One is usually practiced by 50 year old Japanese guys - bonsai. The other is usually practiced by lanky teenagers in college in incredible shape - rowing/sculling.

I can attest that I am neither Japanese or in incredible shape. Or a teenager. I'm certainly never been accused of being lanky.

But, I've enjoyed both immensely and plan on practicing both well into my 80's.

While most guys are thinking about a vasectomy, I'm thinking about fertility and having another kid. I know, too much information. Sorry. Actually, I'm not sorry. Pbbbt!


So ... I'm not trying to sound high and mighty, just telling it as it is. Maybe, because of the retarded social growth caused by medical school and residency, there is a distinct possibility that my midlife crisis will hit when I'm 50. I doubt it, though - I think life will be even more busy as Peter starts sliding into the tweens. Plus, after winning the lottery, Laura and I will be too busy spending his inheritance. We'll be backpacking through the Swiss Alps with some wine and food in the backpack instead of Peter. Or he'll be old enough to carry his own backpack. Now that would be a great mid-life adventure ...

Friday, July 17, 2009

I lost ...

... what I thought was a cool competition.

Sigh ... I guess I won't be immortalized in concrete.

I have unfulfilled dreams of kids hopscotching all over my words or having bikes ridden through my thoughts or having dogs using my witticisms as a bathroom.

Oh well. C'est la vie.

In case you were wondering, here were my entries (you were allowed 2 entries for a $3 fee - paypal-friendly no less):


They’re just like us only better.
Filtered through another’s DNA,
unblemished by life so far.
Unlimited potential and
unconditional love.
The best thing I ever did



Lineage
GTAC begat DNA
which begat RNA
which begat ME and U



I, of course, think they're brilliant. Most true artists are not appreciated in their own time.

(OK, it was hard to type that with a straight face.)

Monday, July 13, 2009

Summertime ...

... and the livin' is easy.

I don't know how high the cotton is or if the fish are jumping, but "me and mine" are enjoying the Minnesota summer (it's the one season that makes the state habitable!).

There's been a lot of good stuff going on and I only have time to live it in the first person, so I haven't posted anything in a while.

However, I have been rowing my single sculling shell a lot recently which is ... awesome; but I'm starting to incur some 'wear and tear' damage. (here's a gratuitous shot of the cockpit after a recent wash while I was up at a lake:)

Being the manly, muscular male specimen that I am, sometimes I don't know my own strength. Out on my last row, I actually caused one of the bolts on the foot stretcher to shear off. The foot stretchers are hardware that connect your feet to the boat; the sneakers are attached to the foot stretchers and the foot stretchers are attached to the hull of the boat.




This is the upside down view of the whole kit and kaboodle. It's hard to see, but the bolt on the lower left is missing. I was just going to replace the bolt, but as I examined the structure more closely, I could see a lot of other flaws: The right foot rest is splayed out to much, the sneakers are shoddily attached in the wrong place and only with a single bolt apiece, the wood is cracked and metal parts are starting to rust. Plus the design is poor - it needs another support between the foot rests to reduce the torque on the bolts on the bottom - in particular the very bolt that I broke.

I could feel my father's energy channeling through me as I thought to myself, "This sucks - I can do better".

So ... I'm making a new foot stretcher. I found some nice oak that is slightly thicker that I cut to size and predrilled holes for the attachment. I'm coating that with 4 or 5 layers of marine varnish. I've sanded and repainted the metal components. I'll attach the sneakers correctly this time (after I've washed the sneakers and bought new odor eater insoles!). I am also going to add a small metal support mid foot for the stability issue.

My goal is to end up with a better (and, well, prettier) foot stretcher that is no more heavier than piece of crap that's in there now.


I know ... I'm a geek. But it keeps me out of trouble.


Hmmm ... the seat casters and the tracks for the seat are looking a little grimy and beat up, too ...

Friday, June 26, 2009

Busy, busy week ...

... and I'm not talking about the demise of Farrah, Ed and Jack-o; or the 3 ring reality show circus of 'Jon and Kate'. Life has been busy this week for us "real folks".

1) "crazies" - a non-flattering term that I use for all my mental health patients who got kicked out of their psychiatrists' or psychologists' offices only to land on my doorstep. Primary Care has been become the dumping ground for bipolars, schizophrenics, demented seniors, sociopaths, drug-seekers and borderline personalities. People that have fallen through (or in most cases, shoved through) the cracks by society and mental health specialists. Some well-meaning, low-paid and under-appreciated county worker rallies to get them medical insurance through MedicAid or Medicare and then sets them loose. They ricochet through ER's and 72 hour holds in the psych ward until some social worker gives them a piece of paper that says "Follow up with a primary care provider for refills on your medications". I have no problem treating their medical issues but I am NOT a psychiatrist or psychologist - If I wanted to be one, I could have gone into a Psych residency and ended up making more money with better hours. But I didn't, and I'd rather pluck out my eyelashes and eyebrows and eat them than deal with their psych issues.

Sorry, got caught up in a rant there for a moment. Anyway, this week sucked because all my worst head-cases came in to see me in a matter of a few days.

Some even came in twice.

2) the kid is all right - Peter had a cold (parents, you know what I'm talking about); and is officially doing fine; in fact, better than fine! That's all I'll say about that.

3) hypochondria solved - the problem with being a diagnostician and a closet realist is that you are going to be slightly hypochondriacal. The worse situation for a hypochondriac is when you're right - you are sick or have a disease.

I'm going to be a little vague here on purpose, but I was having a little problem, so of course I thought the worst, so I had a test and let's just say I got my "B-9" card punched. Whew.

4) the in laws are coming - Actually, they're here. Laura's parents are renting an apartment in St. Paul for a few months. They're escaping the oppressive heat of southwest Florida but are mainly here to see, spoil and spend time with the sole heir to the Mill's dynasty.

There's a saying about guests and fish after 3 days, but I'm glad they're here. My father-in-law helped me shovel about a ton of sand for Peter's new sandbox:



They also can watch Peter for a few hours and Laura can get some stuff done (like golf lessons, yay!) and de-stress a little. For everyone knows, if momma ain't happy, then nobody ain't happy.

I wanna keep momma happy.


5) my new toy - Well I finally go my new iPhone and it's pretty cool. One of the neat things I've done is downloaded an app that serves as my stroke coach and GPS on the water when I row. Here's my row in a double with Bruce this morning all mapped out:


View Larger Map

You should be able to zoom in and out. The breaks in the blue lines show when we stopped for water breaks, etc (it was pretty humid and hot even at 6:45 am). We only rowed about 5 miles because I had to go to a 8am meeting.

This really isn't a bad thing, but it's been keeping me busy. And I have to go to bed early in order to get up at 5:55am to row.



So, life goes on ... for most of us (sorry, Farrah and Jack-o). I just have to keep on reminding myself to stop and smell the roses. Some of them are pretty damn sweet ...

Monday, June 22, 2009

Hmmmm ...

... why is summer so busy?

I think it has to do with the 15 hours of sunlight up here in the northern climes.

Tuesday, June 16, 2009

"What's in a name? A rose is a ..."

"... is a rose is a rose."

True. A rose flower would still smell as sweet but I doubt it'd be as popular with gardeners and florists is it was called "sweaty butt muncher".

So I'm looking for a fitting name for my boat.

It nameless now, but it's generally considered bad luck not to re-christen a boat when it becomes yours. I don't think there's an accepted time-frame, but I'm arbitrarily calling it a year.

The relationship of man (or woman) with a boat is symbiotic. There's a lot of give and take. Well, mostly 'give'. I bought the damn thing. I transported it across the country. I pay to have it stored at my club's boat house.

And I just bought it this snazzy cover so it won't get all dinged up and covered with dead insects when I precariously strap it to the top of my car:



As far as the 'take', well, as I use it more ... I'm becoming pretty fond of quietly gliding across a nice lake at 6:40 in the morning with no one else around.

(Especially when I run into a dock! Like I did this morning; don't worry - no damage to me or the nameless boat.)

So, I'm taking this naming/re-christening kind of seriously. I've always wanted to try to be appropriate and right on the mark with this kind of thing. Hell, they were almost wheeling us out of the maternity ward before Laura and I settled on "Peter". We were seriously thinking that "baby boy Cytrynowicz" sounded OK, but we were worried we were limiting his future career choices.

We took a long time to name our cars, but "Bob" the CRV and "Miles" the Mazda are so ingrained into our vernacular to the point that we forget when we talk about them to non-family members.

I could go with something profound or moving, but that's not my style. I could just call it "Owen" as that's the name of the manufacturer, but I'm having trouble committing to that - it's kind of lazy.

I'm also contemplating "Minnesota Fugue" - ripping off the name of this blog - but that's too wordy. Maybe just "Fugue".

I don't want some corny, pun-ny phrase like "Myassis Dragon". Or something stoic like "Endeavor" or "Fortitude". However, "Sanity" is looking kind of good now.

A friend of mine has suggested the "Flying Wasp" and I'm considering it as an homage to my youth and one of the funniest movies ever made.

I also don't want to get too personal, but the "Bowlegged Sculler" keeps on percolating to the top of the list. I broke my right ankle in college and as a result my right knee wants to flail out on the recovery when I get tired. It's a definite technique "no-no" but maybe my boat name will let others know that, yes, I do know how to scull, I'm just not that good at it sometimes, so shut your pie hole.

Any name suggestions? The boat is red (my boat club already has a "Red Beaver"). It's old (made in 1988). And, it's helping me keep fit and healthy, physically and mentally.

I'll consider all - just as long as it doesn't contain any of the these words in any order: sweaty, butt, muncher.

Tuesday, June 9, 2009

"Hi, I'm a PC ... but I'd like to be a Mac" ...

Apple had their annual WWDC meeting yesterday.

I think it was held in a secret lair on Steve Job's island in the South Pacific that is uncharted and home of an immense energy source that can make time travel possible. Wait ... sorry, that's LOST.

Anyway, they announced the new iPhone yesterday - the 3GS. And it's cheaper than the previous model for the same amount of memory with new bells and whistles.

I have to admit it - I have Mac-envy. Especially every time my PC crashes at work. I was an early Mac follower - in fact, this is what I used in the 'computer labs' (remember them?) in college:



I love my first generation iPhone and I'd buy a mac computer if they weren't so expensive and/or my work would reimburse me. As of now, we're a PC-compatible company - so I'm stuck being a wannabe.

But, I'm going to pre-order the new 3GS phone. It's been a few years since I had a technology fix and I'm jonesing a little bit.

Plus, I need the 3G network so I can use my phone as a GPS on land and when I row - check out this app that I'm thinking of buying. It's a little spendy (as they say here in MN) but it's cheap compared to the real stroke coaches.

Hmm ... maybe I should learn how to row better before I worry about how fast and how far I'm going ...

Monday, June 1, 2009

"Ok, you're ugly too..."

... As a primary care doc, I see a myriad of ailments and complaints from a variety of people who are all shapes and sizes from all walks of life.

But there are a few common threads, observations, demands that pop up enough from my patients that merit some translation through my "Doc, what I'm really saying" translator (coming sooon as an app for your iPhone :)).

What they say: "I'm having trouble losing weight and I'm tired all the time, I'd like to have my thyroid checked out."
What it means: It usually comes from the 30 to 50 year old female wearing too much eyeliner and clothes that are 2 sizes too small - screaming kids are optional. They have a knock-off handbag that is filled with mentos and a 2 liter bottle of Mountain Dew. What she means is "I haven't exercised in years; I still eat like I did when I was a teenager; I like to drink and smoke .. alot. I'm starting to get fat and lonely and I want an easy solution that doesn't require any real work." Trust me, it's not your thyroid. Put down the twinkie and go for a walk.

What they say: "Your nurse said my temperature is 98 degrees; that's a fever to me because my temperature is usually 95 degrees."
What they mean: This usually comes from the mid 30's to mid 60's professional or soccer mom who looks pissed that they have to take a break from their busy day to see the doctor. They're not really that sick, but it usually means "This virus is annoying and disrupting my already too-hectic life. Write a prescription for an antibiotic, you little twit, so that mentally I'll feel better through the placebo effect. And no, I don't give a crap about causing community-resistance to common bacteria, I've got shit to do." Relax, take a day off of work, put your cell phone in a drawer, sit on the couch and eat chicken noodle soup and watch cartoons - the world and it's problems will still be there tomorrow. Yes, I will also validate your assertion, that because your "temperature is normally 95 degrees", you are unique and special.

What they say: "Tylenol and Ibuprofen don't seem to work for me."
What they mean:
The patient will have some sort of pain complaint - twisted ankle, migraine headache and the classic, non-specific lower back pain. He or she is wincing and groaning and being incredibly histrionic - Emergency Room patient identification bracelet optional. Ocasionally will have rotten teeth and may actually be actively 'tweaking'. Their body language is screaming, "Give me oxycodone, hydrocodone, hydromorphone, morphine, tramadol, valium, horse tranquilizers, those frogs that you lick from the amazon-freekin-rainforest - anything that will get me high as a kite so I can get away from my miserable life for 10 minutes." I used to be sympathetic. Now, It just makes me sad.

What they say: "What? Hop along marietta beaver?"
What they mean: This is an elderly couple, usually in their 80's to 90's. She is deaf but refuses to wear hearing aids. He is pleasant but has dementia and always wears a baseball cap too high on his forehead. They are usually being seen for vague symptoms like fatigue, lightheadedness, insomnia and achey joints. This is usually the response to when I ask "How long have you had a fever?" What they really are saying is "We're old and tired and in pain. We want someone to listen to us and take us seriously. We know we're coasting into the 'beyond' but we want to enjoy the trip and remember the ride. Thanks for listening." Besides tweeking (not 'tweaking') their medications a little bit, that's all I usually do and it's that all they usually want.


Avoid saying any of the above and your doc may take you seriously the next time you're seen. Oh, never ask me for a 2nd opinion as you'll get the response (I can't help it) that's in the title ...

Thursday, May 28, 2009

Like a (bad) rower to water ...

... I'm back on the Mississippi in the morning.

I'm going out with Bruce and Jim in doubles at 630am, sandwiched between the competitive team and the junior team. I didn't realize how much I missed it.

However, I'm ... sore.

It seems like the flexibility and the core strength that I built up all winter by going to the Y in the dark and frigid Minnesota mornings vanished in the 2 months of relative inactivity since my trip back east. Damn you, exercise physiology!

See you on the water, I'll be the guy in the annoying tshirt that's sweating twice as much as anybody else ...

Tuesday, May 19, 2009

MI's and Nursemaid elbows ...

... "So, Mr. Johnson, how's the chest pain, now?"

"Better, buckshot, better".

He was still ashen. I glanced over at the blood pressure monitor and it read 90/54. That's not too good. It was 130/80 before we gave him the sublingual nitroglyerin.

I looked at his EKG tracing that the lab tech just handed me. Something wasn't right. I couldn't put my finger on it but he definitely was NOT having an acute inferior or lateral wall myocardial infarction. There were no "tombstones" in the limb leads and V2-V6 looked normal as well.

Mr Johnson looked up at me and forced a wan smile. "Better, bucksot".

I smiled back. I don't know why he had chosen 'buckshot' as my nickname but it was congenial and sincere and seemed to make him feel better.

I felt my phone vibrate in my front pants pocket. I removed it and saw that Laura was calling me from her mobile. While I'll let other family members and friends go to voicemail, I always answer when she calls.

"Hey," I said as I turned my back on Mr. Johnson and the ekg tech and the RN who was getting a repeat BP reading, "Can I call you back in, oh, 10 minutes?"

Instead of the usual "sure thing, babe", Laura replied "Actually, no - Peter hurt his wrist or elbow somehow."

I started to feel as ashen as Mr. Johnson.

"Whaddya mean? did he fall? Is he bleeding, is he all right?". I gave the RN and Mr. Johnson a 'just a minute' index finger wave and stepped outside the surgical room.

I felt sick. My stomach was hollow, like when you take the first drop on a roller coaster.

Laura was talking quickly. "I have an appointment at the Saint Paul clinic at 11," it was 9:15am, "we are at art class and I was sitting on the floor and he came up behind me to give me a hug and he started to fall and he grabbed on to me but he jerked a little. He screamed but instead of shrugging it off after a few minutes, he's still whining and holding his arm funny. You know that's not like him."

My mind raced. Differntial diagnoses cycled through my mind. Fracture, dislocation, muscle or tendon tear. Thoughts grew deeper - Pathological fracture due to a carcinoma?

The RN came out into the hallway.

"Um, Dr. C, his BP is dropping - it's 80/40. We need you."

Shit. I have to triage, fast.

To the nurse - "ok". To Laura - "Um ... I'd take him to the ER; if there is a fracture or something, then they can do more than they can do at the clinic."

"Really?" pause. "OK."

I was worried about Peter but I knew that Laura's maternal instincts were kicking into overdrive. Mamma bear was going to take care of baby bear, no matter what. I trusted her to do the right thing.

"Love you," we said simultaneously.

Click. I slipped my phone back into my pocket.

I went back to Mr. Johnson's room. Still ashen, still hypotensive.

I picked up the EKG tracing again. I couldn't give him any more nitroglycerin with his blood pressure that low. He was defintely having a heart attack by clincal presentation, but the EKG wasn't telling me where.

Wait. V1 looked funny. The 'R' and 'S' spikes were reversed. That's it, he was having a posterior wall infarction.

It's rare type of heart attack that usually is fairly harmless as far as heart damage goes ... unless your right coronary artery is dominant or is the main supplier of blood to the back wall of the heart. Then it could be fatal because doctors do what I just did - treating it like a "normal heart attack". Instead of pushing fluids, I gave him nitroglycerin, causing his blood pressure to bottom out because his left ventricle fails to fill in time with blood - this makes the posterior wall becomes floppy and ineffective. The blood pressure continues to drop and the ventricle fibrillates and stops.

He needs fluids. Now.

I grabbed a liter of saline from the medicine closet and handed to the RN. "We need to hang this. Open it wide".

She was wide-eyed. "But he'll go into heart failure. Shouldn't we start a pressor like dopamine?"

I had to put on my 'hard-ass doctor look' I save for just the occasion. "No," pause for emphasis, "that will kill him. Hang the fluid."

She did. Within 10 minutes, the nitro had worn off and over half a liter was infused into Mr. Johnson's circulatory sysytem. His blood pressure had climbed to 97/60. He went from ashen to pale and he had stopped clutching his chest.

"Let's call 911 and get him to the ER with a stat Cardiology consult." He was doing better but wasn't out of the woods.

"What going on, buckshot?" Mr. Johnson looked a little worried.

"You were having a heart attack but it's going to be ok. We figured it out and stopped it from getting worse ... for now. We have to get you to the hospital to get is all settled down."

"I had faith in you, buckshot. Thank you." He was holding my hand firmly but gently. "Let my wife know what's going on - she'll like you, you're a handsome devil, buckshot."

"You're welcome, Mr. Johnson." Sometimes, I like my job.

I had to go back to my regular schedule of various ailments and personalities. Mrs. Franklin was getting a chest xray to rule out a possible pneumonina and Ms. Rodriguez was waiting in my other exam room - she thinks she has bugs in her rectum - last week it was people breaking into her apartment to rearrange her furniture. All the appointments were full for the rest of the morning.

Finally, at lunch I had time to plop down into my office chair and catch my breath. The RN from earlier poked her head in. "Just thought you'd want to know. Mr. Johnson had a 95% occlused right coronary artery. They were able to angioplasty and stent him open. The wife just called from the hospital, he's doing fine."

Yep, sometimes, things work out okay.

Then I had the sudden realization - "Shit!" - as I remembered Peter and Laura.

Laura picked up her mobile on the 2nd ring. I could hear Peter playing in the background.

"So? How is he?"

"He's great. He had a ... nursemaid's elbow? I think that's what it's called. Anyway, the people at Children's ER were great. He was seen by a Nurse Practicioner and a resident; the NP just popped the elbow back into place and He's been fine since. He yelped a little, but I go him ice cream on the way home. He's playing on the cube since we got home and is no worse for wear."

I was relieved. It's a relatively common injury in toddlers and with Peter being as active as he is, I'm not surprised. He'll be fine.

I'll be fine. Laura hung up and I got back to my charts.

Barely a minute later another one of the RN's poked her head into my office.

"Dr. C - we have another walk-in chest pain. She doesn't look too good."

I grabbed my stethoscope, took a swig of diet coke and raced down the hall ...

Thursday, May 7, 2009

sometimes ...

... after seeing some of my patients, I'll go wash my hands.

Not to use universal precautions to lower the risk of spreading or contracting a communicable disease, but rather to "wash away the crazies".

Work ...

... is seriously getting in the way of my hobbies.

Gotta go play the Powerball ...

Friday, May 1, 2009

Well, it was better than Titanic's maiden voyage...

Let's start out by stating that lake water in Minnesota on May 1st is ... chilly, to say the least.

I wasn't going to let that stop my maiden row in my new single. I had the day off and the planets were aligned just right, allowing me a few hours to get out on the water for the first time this year. (Plus, I had an "ok" from the missus.)

I had thought about this all winter. I had scoped out the lakes near my work and had chosen Lake Josephine for a few reasons - a sandy swimming area I could lauch from, it was 2 miles from my work, and my boss has a house right on the lake with a nice dock (for possible launching and storage of my boat!? - all I have to do is ask him). However, it's the wrong shape and locale for optimal rowing. It wasn't long and thin and protected like Lake Hosmer at Craftsbury, it was more round and open. But, hey, we can't all be lucky enough to live in "God's Country" in Vermont.

But I digress.

The air temperature this morning was in the low 50's at best. And it was windy:



Which sucked.

Because when I got to the Lake, it was choppy.



There were 6 to 12 inch waves lapping the shoreline and the chop looked treacherous especially to a newbie like me. Out for the first time of the year. In a 'tippy' boat (only 12 inches at its widest point). With water temperatures in the 40's. Nice conditions for hypothermia.

I was bummed. I had bought this boat half a year ago and trekked it halfway across the country, only to be stopped by some wind. And bone-chilling water.

Fuck.


I lumbered back to my car and called my wife to leave a message that I was just going to the YMCA to slog away on the erg instead and will be back around noon.

As I hung up my iphone, a thought hit me - this is Minnesota, for gosh sakes! There are 9,999 more lakes for me to try. (actually, 11,842 more lakes)

Also, my iphone has google maps and a GPS built in. So, thanks to Jobs and Woz, within minutes I was following the turn by turn directions to Owasso Lake less than a mile away.

I pulled up to the beach area which was in a nice little protected cove. The cove was only about 100m wide but 400m long. It's not a big space - it's not uncommon for one stroke to carry you 10m or more, so I'd only get 20 strokes or so and then I'd have to turn around. But I didn't care. Most importantly, the water was calmer:




Jackpot! The wait was over.

Unfortunately, I was flying solo, so I wasn't able to take any pictures of me rowing. But I did get to row.

And it was fun.

It was a little touchy at first. I haven't rowed on the water in 6 months and haven't been in a single for close to 8 months. So after I almost flipped just getting into the the boat, I was able to take a few tentative strokes and it all came back to me. So far, so good.

So I got cocky and took a couple of good pulls on the oars and ... I almost ended up in the drink.

Humbled again by this sport, I went back to the basics and did some drills and I felt much more stable.

Finally, after about 30 minutes I was able to put together 10 or so good strokes and the boat set up, took up some speed and for a brief few seconds carved a nice straight line over Lake Owasso.

Awesome.

It was better than the feeling of driving a golf ball to within inches of the cup, or hitting a baseball over the center fielder's head or smashing a racquetball into the back of your opponent (I never said I was an good at these sports!).


I'm not ready for Ole Muddy just yet, but give me a few months. I could imagine myself rounding Pike Island and gliding back downstream.

Then I almost ran into a bouy ...

Wednesday, April 22, 2009

Google Maps says it's only 1159 miles ...

... however, try that with a 27 foot long boat strapped to the top of your car:




(That's my mom and dad at the bow and stern, respectively, by the way. You can click on any photos to make them bigger.)


I finally was able to make the trek back East to pick up my new/used sculling single.

I've been rowing and sculling for the past 4 or 5 years on the Mississippi River out of the Minnesota Boat Club and ... well, I'm addicted.

Or crazy.

Maybe a combination of the two.

I drove 1100 plus miles from Minnesota to Pennsylvania to see my family for Easter; but mainly I had to drop off parts of an indoor sculling machine I sold to a guy in New Jersey and to pick up the shell from another guy in New Jersey, who just happens to know the first guy - small world, huh?.

So, on the Tuesday after Easter, my dad and I braved the rain and traffic in 40 degree weather to make the 140 mile round trip to the Jersey Shore from Philly. The gentleman (a lawyer who started rowing when he went to Penn for undergrad) I bought the boat from was great (well, almost - I'll get to that) and accommodating and everything went fairly smoothly. He rows out of a brand spanking new, multimillion dollar boat house in Ventnor, NJ.

The boat house was an impressive structure that's the home for rowing teams for several high schools and one college, as well as 40 or so private rowers. There were 3 or 4 bays and the boats were stacked 5 or 6 high. Thank god the boat bays were wide enough that I was able to squeeze my CRV into one and load the single on top of my car - out of the pouring rain and almost freezing temperatures! It was such a miserable day, I didn't stick around to take any photos. Plus, it's always a good idea to get the hell out of New Jersey - did ever notice that all the toll roads, bridges and tunnels charge you to get out of Jersey but they don't charge you to get into Jersey? Apropos.

==========================

So, a few days later, my brother and I were getting the boat ready to take the long trip back to Minnesota. We tried to put the cover on the boat (also sold to me (cheap) by the lawyer from Penn) and:



It looked a little funny. The skeg (the black fin looking thing) wasn't lining up with the neat Velcro hole. Also:



It was 10 fucking inches too short!

The bum sold me a cover that didn't fit. And he swore he measured it and promised me that it'd be fine.

After I left a hasty and rather terse message on Ivy League Lawyer's voicemail, we decided to just cut a new hole for the skeg and then duct tape the shit out everything. There is no way that I was going to transport the boat without some sort of covering!




(the guy ended up returning my call - he was apologetic and is willing to refund and/or pay to get the cover altered ... but screw it, I'm returning his shitty cover and I'm going to have a newer more weather-resistant cover custom made. By the way - the cover is needed - look at all the dead bugs stuck to the boat rack. Ewwww)



==========================

Anyway ... The road trip was fun. My brother, Eric, is one helluva great guy and agreed to be my co-pilot on both legs of the journey. He's also the head duct-taper and structural engineer on the whole project - I think we could have driven through an F5 tornado and the boat wouldn't have budged from the top of the car.

It was also fun to stop at divey-motels and eat in greasy-spoon diners along the way. We ate a Texas roadhouse/steakhouse in Elkhart, IN and I felt like something was looking over my shoulder the entire meal:




==========================

The Mississippi River is still fast and high and I don't plan on going out in a single on Ole Muddy until later this summer. I'll still mostly row in a double in the morning for now; but I'm going to be taking my new/used single to a lake near my work one or two days a week for the next few months so we can get acquainted with each other.

But, hopefully, by late summer/early fall, I'll be skimming across the placid waters.


Hmmm ... I still need to re-christen the shell. Maybe "1159 miles"? ...



Tuesday, April 21, 2009

My soundtrack (part two) ...

... While it is going to be summertime soon (hopefully), and the "The Natural" is one of my quintessential summer movies (and soundtracks), I think I found my new anthem.

I stumbled upon it while listening to my brother's ipod while we drove halfway across the country.

So the next time I need to feel heroic or need to be inspired, I'll just turn the volume up to "11" on my ipod, plop my ear buds in and play Aaron Copland's "Fanfare for the Common Man".

(give it a minute or two to load, then turn up the volume on your speakers, etc).

Something about it just gives me goosebumps ...

Monday, April 6, 2009

Waiting ...

... for spring!

Where the hell are you? I made snowmen yesterday with Peter in the front yard and I may light a fire in my living room fireplace tonight while I work on charts for work.

This is April - that is not right. I'm getting sick of wearing sweaters. And snowboots. And wool hats.





Even my bonsai's are confused; this poor maple and cotoneaster are trying to push out new leaves but the occasional snowstorm and freezing temps are holding them back.

I hear birds chirping every morning. The dock at the boat club has been in for a week and the river has thawed. The yuppie down the street emerged from the Starbuck's last month and didn't see his shadow, so there shouldn't be 6 more weeks of winter.

Mother Nature - wake up!

Wednesday, March 25, 2009

Is "brey" a color? ...

... or how about "bran"? Or "greytanandbrown"?

That's the only semi-quantitative thing I can say about the Minnesota landscape this time of the year - the pervasive color pallette of dead vegetation. Everything else that pops in to my mind is more qualitative: drab, dreary, dreadful and my favorite in the alliteration parade, depressing.

I definitely know I have a little SAD in the late fall and early winter, and I think I did an okay job this winter by working out regularly and trying to soak up what little sun was out there to combat it. I even took some Vitamin D to help boost lowered levels caused by living in this northern wasteland.

And, I thought I was doing fine ... until Daylight Saving Time ran me over like a truck full of anvils going 90 mph down an incline. It completely f'ed up Peter's schedule too, much to Laura's (hi, honey!) and my chagrin - he's still not back to his pre-DST bedtime.

Don't get me wrong, the increased daylight is a small joy in my heart these days, but the newest bee in my bonnet is the horribly bleak weather and the dead landscape. At least the snow covered all of the imperfections (like the leaves and trash in my backyard) and made everything look clean and bright. Now, with the snow cover caput, everything has the run-down, weathered and deflated look of a neglected compost pile.

arrgh. Can't even muster a capital "A" these days.

To paraphrase one of my favorite movie lines: "This is our most desperate hour. Help me, spring; you're my only hope."

Monday, March 23, 2009

Jumping the shark ...

... Well, I think facebook has donned it's leather jacket, grabbed the nearest towrope and is sailing over the shark tank with it's new layout.

We're a fickle, ADD society these days. If it isn't either shiny and new or well- used and comfortable, then it might as well not exist because no one seems to care anymore.

Anybody want to follow me on twitter?

Tweet, tweet ....

Monday, March 9, 2009

He who smelt it (part deux) ...

... So, I'm trying to transition back to the erg (indoor rowing machine) from the treadmill in hopes that I'll be able to get back on the water in a month or two and not be too pitifully out of "rowing shape".

The rowing machines at my gym are definitely a step up from the usual fare seen in gyms (I was using one at a YMCA a while ago and the chain was so rusty that it broke while I was using it - and believe me I wasn't pulling that hard) but they still aren't as nice and well maintained as the one that sits sadly folded up in the corner of my office.

So this morning, I decided I could get up 15 minutes later and workout in my office on my rowing machine instead of going to the gym. This is a bonus because Daylight Saving Time is kicking my ass bigtime.

I was surprised how relatively easy the workout was going despite not erg-ing in, oh, 4 to 5 months. Like falling off a bike, or in my case, a treadmill.

However, I have a fiber processing problem. And my office is small. And warm. And I had the door closed. For 30 sweaty, falutelence-filled minutes.

I ... need to get a fan. And maybe some beano.

Friday, March 6, 2009

Well, the service has been pretty good up until now ...

Peter had his 2nd birthday a few weeks ago and, of course, like most 2 year olds, he was more excited with the party balloons than the actual party itself.

Can't blame him.

What I did notice is that some of his playmates his same age - mostly girls, as he is a chip off the ole block and is a ladies man - talk better than most of my patients. Well, they're definitely more polite.

"I'd like some more milk please, Ms. Mills," said the cherub with the golden curls, holding her cup out to Laura as she passes.

"Milk - me, me. pease!" chirped the younger woman of the group.

Peter just looked at me, grunted, made a flapping hand sign with his right hand and then threw his plastic cup in my general direction. It bounced off one of the cats who slinked off but will probably retaliate by shitting in the bathtub later.

It then occurred to me that Peter doesn't need to speak because we are typical older, doting parents of an only child. He grunts and points and we give him what he wants, within reason.

Laura bought some signing videos which he loved to watch ad nauseum when he was 6 to 9 months old - until he broke the DVD player. As a result, he has a good repetoire of signs (which by the way are the same American Sign Language signs) and can get his point across for most of his life's neccessities at this point.

He's also physically pretty advanced - he's tall and strong and amazingly adept at most fine motor activities as well. Most pediatricians note that boys also learn to talk later and there is a trade off balance between the physical and mental milestones. And, with his learning how to sign, I'll be surprised if he won't talk until he's five.

(it probably doesn't help that his current favorite DVD's feature a penguin who speaks a made up language and a monkey that basically points and grunts ... hmmm)

This will probably be a moot issue in several months (in fact, I'll probably wish he'd shut up sometimes!) but for now, as a fairly intelligent professional with a fairly intelligent wife (who regularly kicks my ass at scrabble and boggle), it's frustrating when your offspring isn't at the crest of the development wave.

I should say he does have a handful of words, but most of them sound like something Jodie Foster says in the movie "Nell". (May an tay in the wiiiinnn!!).

I know life's a long ride and he'll probably (hopefully!) do well and contribute to society, but the one thing I wish he'd learn how to say is "daddy".

Then, I wouldn't care if he never learns another word.

Wednesday, February 25, 2009

That stuff will kill ya ...

... I talked to an old acquaintance from medical school the other day. He's a respected cancer researcher in a small but very vital facility back east.

We weren't good friends in med school but we ended up in the same residency program where "batttleground friendships" are soon quickly formed after 36 hour shifts and little sleep. Nothing like defibrillating an octagenerian at 2am to bring out one's true personality.

As it turns out, Jeff (as I'll call him) was a good guy - nice, smart, compassionate - and quirky. He was fun company on call.

We used to hit the vending machines in the hospital cafeteria at 3 am when we'd trade beepers so that one of us could catch a few hours of sleep. We'd grab something unhealthy and sign out to the other person. Then one of us would go to sleep and the other would go back to the floors or the ICU.

I'd usually get an ice cream sandwich or a Reese's peanut butter cup - chocolate would give me energy for the waning hours or fill my belly, allowing me to catch some z's. Jeff would go to the same machine every night but would always get something different. Sometimes he'd happily gobble down some Doritos or peanut butter crackers, but othertimes he'd disdainfully pick through an ancient bag of trail mix or choke down some dry nilla wafers. His choices seemed weird and totally random.

After a year or so, my curiousity got the better of me and I would discreetly stand behind him pretending to search my scrubs for a wadded up dollar while he make his vending machine purchase. He was always deliberate in his choice but always purchased random foodstuffs.

After a month or so, I realized what he was doing. And, for a budding oncologist, I thought it was quirky, endearing and brilliant.

He'd always go to the same machine and buy whatever was in the slot "B-9".

Say it out loud. It seems that the guy who was going into a potentionally depressing field was also a closet optimist ...

Thursday, February 12, 2009

And the Russian judge only gave me a 4.5 ....

I'm not a big fan of the treadmill.

As an engineer, I think it's ingenious - if you can't move relative to the ground due to space or weather etc, then have the ground move relative to you. As a doctor, I love it becuase it can literally be a lifesaver - it's recognized as the most effective piece of exercise equipment to get your heart rate up to "training levels". It's also pivotal in cardiopumonary stress testing, etc.

As a runner, who's more of a plodder, I hate it.

It feels artificial; it's noisy; it's boring. And as a few days ago, it almost killed me.

Well, not really, but let's just say it was a wild ride.

When I run on the treadmill in the way-too-early morning at the Y, I sometimes feel like the 6 million dollar man. I wear my insulin pump on the waistband on one of my hips that has small tubing that snakes under my clothes to the infusion port on the other upper buttock. On the same buttock that the pump resides I have a continuous glucose sensor tegaderm-ed to me that beams blood sugar readings to my pump every 5 minutes. Under my shirt and against my skin, a Polar heart rate monitor fits snugly around my body just under the chest. I wear the heart monitor watch on the left wrist (I hate wearing watches). I put my iPod on the treadmill stand itself and the ear phone cords are plugged snuggly in my ears. I usually wear a baseball hat because I have the worst "bed-head" imagninable every morning. And I occasionally attach the little safety thing from the treadmill to my shorts, in case I fall off - that is called foresahdowing.

About two weeks ago I was trudging along. Thump, thump, thump. Green Day was blasting away through my headphones and the talking heads from Fox news on the tv on the wall were blathering about something - however, whoever was typing the closed captioning obviously didn't have English as their first language.

I started to feel a little lightheaded which sometimes can mean that my blood sugar is dropping. I was wearing my sensor that morning, so instead of stopping the tradmill or straddling the belt, I decided to see what the pump meter display said while I still running.

Instead of unclipping it from my gym shorts waistband, I thought it'd be easy just to twist to the right and glance at it in mid-stride.

This caused me to veer a little to the left but I caught myself and quickly corrected. However, by turning my head to the right, it caused my iPod to pull a little bit off the treadmill stand and it was now dangling close to the edge.

In what was a bad decision, I whipped my head around to try to catch my iPod as it stared to fall and I tripped over my own feet.

Never do that on a treadmill.

While it's going at 6 mph.

I saw the iPod hit the treadmill deck and it was zipped out of sight. I was heading face first into the deck myself but was able to put out my hands at the last instant.

As soon as my hands hit the moving treadmill, they whipped out of the way and I was now forward rolling on to my back (instinctively tucking my head, thank god). I landed on my back, upside down on the treadmill and was instantaneously shot off the back of treadmill onto the floor of the gym where upon landing, I think I yelped like a little girl as the momentum flipped my over onto my stomach where I came to rest, facedown.

I quickly got up and mentally checked for blood and broken bones and despite a little rugburn on my back, I was fine.

I was in the back row of the treadmills because I am very antisocial at that time of the morning - so there is nothing behind me, thank god once again. There had to be 30 other people in the gym at that time, but no one saw it. Or maybe no one admitted it because this is Minnesota after all.

I started to laugh as I picked up my stuff off the floor. The "safety stop" cord was still attached to the machine and was dangling straight down - it had failed miserably in what it was supposed to do, instead of flinging me across the room. I was now fully awake, that's for sure. I got back up on the treadmill and slowed it down to an easy walk. I couldn't help just chuckling and shaking my head - like most people do when they have near death experiences.

After a minute I realized I never got a chance to see what my blood sugar was. I almost instinctively did it again - contorting my body instead of stopping and looking at the screen like a normal person, but I stopped myself at the last minute - I straddled the belt, unclipped my pump and was happy to see that my blood sugar was in the normal range.

I think I'll go back to the rowing machine next week.

Monday, February 9, 2009

crazy ...

There are some crazy-assed people out there.

Friday, February 6, 2009

Brother, can you spare a dime ...

... Well, this recession or correction or whatever is hitting people pretty hard.

I'm not going to pretend that I'm some financial wizard or economic know-it-all; I've always been a selfish bastard when it comes to the vagaries of the economy and the GNP et al. I want to know how it affects me and mine. What action do I need to take to ensure I get to retire before I'm old and limbless or let me buy the flat screen TV without having to skimp of necessities - fast food, "man toys" and Peter's shoes.

I thought that by being in the medical field, I was insulated against recessions. Hell, everybody gets sick - everybody needs health care.

Or so I thought.

My clinic schedule has been anemic the last few months; probably only seeing 1/2 to 3/4 the usual amount of patients. My phone and email "in basket" however is overflowing with work.

While some of my less fortunate patients have lost health care altogether, others can't afford the co pays. So instead of coming in for a cold, the medication refills for hypertension, the "itching down below" and the occasional growing lump - I'm getting deluged with people wanting to be treated over the phone or the Internet.

I understand and I can treat sometimes, but most times, I can't - practically (ever have a patient try to describe a rash over the phone? "It's red") or legally (who wants to be the doc who misses the patients signs and symptoms of a stroke because they aren't able to do a good neurological exam?).

Patients invariably get upset and complain about high-deductible plans and that I'm saying they need to come in because I need to pay off my yacht, etc. Or serve my poodle steak tartare.

I empathize, but believe me, I don't have a yacht and my wife's allergic to dogs. Yes, I make a good amount of money but I'm 39 and still will be paying off my student loans (which amount to a nice sized mortgage payment every month) until I''m 50!

I feel the recession too. Less patients mean less income for me. Most physicians are not paid on salary, then get paid according to a compensation package that is based loosely on seeing patients. So, at this point in my life, I'm getting trickled down upon - or is that trickled up? Who knows? All I know is that it sucks.

Getting back to patients who don't want to come in - I had a gentleman, whom I knew pretty well, contact me to complain about belly pain. This is a big, old stubborn Minnesota man who never complained of anything - ever - even after getting shot in the head in the Korean War. We played phone tag with symptoms for days and finally I told him he had to come in for an exam and there was nothing else I could do over the phone.

He reluctantly showed up for the appointment and bitched the whole time. After a few minutes, it became clear that the "belly pain" he was referring to was actually lower chest pain (I guess he missed anatomy class in high school). I got an EKG and a chest x-ray ("doc - this isn't covered by my deductible!") - it looked like he was having a stuttering myocardial infarction probably due to an aortic aneurysm that was slowly rupturing in his chest. I told him we had to get him to the ER immediately and he needs surgery within the hour or he was going to die.

He sighed, looked at the ground for awhile and finally said, "shit ... this is going to fuck my premiums up."

He had the surgery and didn't damage his heart (too much) and is doing well postoperatively, thank god. But if he didn't come in, he would've died. If he came in sooner, he might have saved some of his heart muscle that infarcted.

As stated earlier, I don't know what's wrong with the economy - but for all my reasons, it's gotta get fixed. Soon.


For now, I'm just waiting on my tax refund.

Thursday, January 29, 2009

He who smelt it ...

Let's just start off by saying that a high fiber diet is good for you. It lowers cholesterol and decreases your chances of developing colorectal cancers.

On the other hand, fiber has been known to increase your chances of ... farting.

Yes. Flatus. Passing gas. Tooting. Pooting. Breaking wind. Cutting the cheese. Or, as my nephews so eloquently put it when they were young, "Making air poops".

Let's also get strainght that I'm not a morning person. I can wake up early if I need to but I don't like it and I don't think my brain starts working until about 8am.

So, I was slogging away on the treadmill at 6am this morning with my iPod on that was blasting my workout music (alot of harder alternative rock and some old school punk, by the way) and I was focusing on not falling off the damn thing (sad story - for another time). After a few minutes, I noticed that the people on the treadmills on either side of me had moved farther away.

Also, remember that walking and running causes the psoas muscles (hip flexors) to "massage" the colon as well.

I didn't think too much of it as first, until there was a little gap in my music and I heard myself "let off a little gas". I realized that the "silent but deadly" farts that I was letting loose for the last 5 minutes - were not "silent" - and obviously everyone else not wearing headphones in my vicinity noticed. Then I got a little whiff of the offending gas as it percolated through my gym shorts after a little spurt of speed at the end of my 2nd mile, and I realized anyone with a snese of smell probably noticed too!

At first, I was a little embarassed (I saw my heart rate monitor increase a little) but that soon passed. Sure, I may become to be known at the gym as the "farting guy with the obnoxious tshirts" but I don't care - it may even work to advantage - I'll always have some space around me at the time of the day when I'm at my most "antisocial-ist".

Peace. I'm going to go have a salad with cucumbers.

Monday, January 12, 2009

Procrastinat ...

Having trouble with motivation these days. Mentally, that is. Physically, I'm surprising myself by getting up early enough to work out on work days.

I "blurbed" that I want to write a book - I still do - in fact, I got some unsolicited encouragement from some old friends - but, I just need a little kick in the ass.

Well, I've been working on my flexibilty - maybe I'll try to kick my own ass ...

Monday, January 5, 2009

It's the bitch of living ...

Ok - I need to rant a little.

Sometimes in life, you can do everything right and still get screwed. Now, I don't pretend to do everything right, but I try most of the time. And believe me, it's tiring.

I woke up at 5:40 am to go to the gym before work (so I can spend time with Peter and Laura after work). I did 26 minutes of cardio on the treadmill, then another 26 minutes of circuit weight training, followed by stretching and an attempt at core work. I ate a relatively healthy breakfast and then hydrated with non-carb fluids all morning. I thought I was living the diabetes straight-edge.

Around 11am, I felt crabby. Not just a little crabby, more like set-a-basket-of-puppies-on-fire-and-then-put-out-the-flames-with-my-urine crabby. It didn't help that I had a run of particularly trying patients that were pushing all my buttons.

I knew I had to test my blood sugar. My CGSM said 110. No way. Uhn-uh. That can't be right.

I pricked my finger and the numbers glared back at me: 399.

Fuck.

I don't test for ketones, because I luckily don't produce them too easily, but I new I had to change my infusion site, put on a new CGSM patch, give myself a shot of novolog in the butt and spend the rest of the afternoon checking and chasing my blood sugars. All while continnuing to perform my job at a high level with intent and compassion.

I'm normally pretty resiliant, but my "highs" have been starting to take the wind out of my sails these days. I think I'm "burnt out" on my diabetes. I spent the next few hours not giving a crap.

But, too f'in bad. Even if I want to give up and take a holiday from my diabetes, I can't.

I can't because the diabetes never takes a holiday from me. If I ignore it, it doesn't ignore me - it slowly breaks blood vessels in my eyes, ruins neprons in my kidneys, causes inflammation and plaque in my arteries, overloads my nerves causing them to short out, messes with my emotions and makes my nights fitful and sleepless.

So, I felt sorry for myself. Then I felt angry that I have to deal with all of this. Then I felt envious of those who can go work out and play and be active without ever having to worry about getting low or wonder if you have a power bar in your back pocket if you do. Then I bargained with God that if he lets me win the lottery, then I'll be the healthiest person he had ever met. I never felt denial, though - I've had this too long and that emotion has been played out and dried up for years.

But, as I always do in these little moments of crisis, I then felt acceptance which brings me some peace. I take a deep breath, give myself a little insulin and figure out what to eat at lunch that won't be too bad for my sugars.

It't the little grieving process that I (as well as others with type 1) go through about once or twice a week. It's brought on by highs, lows, good blood test results, bad test results, good doctor's visits and bad doctor's visits.

It's the bitch of living. But, I guess it could be worse. I have a good job and a beautiful family and that's alot.

So ... rant is over. For now.

Peace.