Thursday, April 18, 2013

Reflection on this week Boston, Steve Arch, and an injury

This school year has been a crazy learning time and personal development time for me. Currently I am recovering from a stress fracture... that I got when I could barely run again after months of injury! What happened is I tried to do my first long run on trails and ended up turning my ankle a few times, avulsing the fibula, a non-weight bearing bone. This means that I can barely walk down stairs without shooting pain. So I effectively have gotten to run less than 10 days since September and my knee injury when running was my #1 stress-reliever, etc, etc. I may be able to run in two more weeks, which will make it six weeks since I last tried to run and eight weeks since the fibular injury.

This weeks news has brought me to an emotional location. The boston bombing is astounding. That could have been myself and my family. It was well after the elites, so in reality it will be professional Courtney 10 years from now once I have fallen out of shape during residency and getting back into shape with my family finally able to cheer me on... as I have a good amount of family in that area. And maybe some little ones also cheering me on (as having future kids may help me be out of shape due to juggling residency/new jobs/motherhood). We are treating it as a terrorist attack because actions such as that are unacceptable and we are going to ensure safe living circumstances for our own citizens. We try to establish it for the world, but we cannot determine the fate of other countries. Then the horrible destruction in Texas. So much destruction.

The most reflective moment comes with the death of my former advisor and in many ways hero Steve Arch. He was a big, lumbering man with destroyed knees who reliably sat in his office many days of the week with a dragonfly lamp lit. He played basketball at noon every tuesday thursday and was renowned for throwing elbows. He taught me so much in our conversations. I was scared to talk science with him as he was a neuroscience genius and could make anyone feel completely stupid if he wanted. He set up seminars that were from 8-10 at night where all the students sat around, drank a beer, and talked about the latest research. That is the life. Waking up your mind as you relax the body, where learning knows no limits.

But what he taught me went so beyond the classroom. I remember one time sitting down with him and him asking me, seemingly out of nowhere "if you're going out with a group of friends to eat, where would you go?" and I thought about all the exotic food I would love to try and started to respond maybe the moroccan restaurant with belly dancers, or a thai restaurant, or... and he cut me off "No, you're going out with friends. It doesn't matter where you eat, what matters is the company." Another time I was upset about friends trying different drugs that I considered completely unacceptable (heroin, etc) and discussed that with him and during our discussion he agreed with me but also reminded me how to be more open-minded. That people's curiosity is what drives us into science and to make the greatest discoveries of all time. What we don't want to do is condemn curiosity or the vision or exploratory nature. A wonderfully contrasted point of view to the narrow one I presented (not that he condoned the use of heroin).

In many ways he embodies for me what it means to be a real man, what it means to be strong in our convictions. In those talks he taught me so much. So much about passion and perspective. The need to explore, be curious, to question and undermine our everyday assumptions, whether they be about health, science, biology, physics, people, etc, etc. I ran my first marathon while his advisee and he was proud, but recommended against doing a second because it takes so much time that could be invested in something else (I also took carpinetry lessons, joined both a flamenco and hip-hop dance troupe, and most importantly spent many many many hours in the laboratory doing mediocre work.... as science takes training and focus and i had inadequate training for good work at that point).  Only after his death did I find out that he had been offered a slot to play professional football with the chicago bears that he turned down to attend graduate school. Because waking up the mind and exploring the world was in his eyes the essence of life, as was his family and love. Sports was just a small part of it all.

As I go forward I will try to remember all those things he did teach me about being strong: forceful yet kind, intimidating yet caring. He wrote poetry that he only let me see once... after I showed him some poetry about DNA replication experiments that I had written. His poetry was not meant to be shared. It was meant to help him appreciate the details and intricacies of the world around us. I am so sure that if more people got to have an adviser like Steve Arch in their lives that the world would be a much better, interesting, and functional place. I know that if I had kept in better touch with him I probably would have made much better decisions about my daily life and choices and time devotion. He told me that to become what I want to become I need to be reliable and predictable. This is one of the hardest traits for me to develop... what something shiny? Yes I do want to go look at it... oh I had an appointment? Yet being predictable is one of the key traits of being a doctor or a teacher. People need to depend on me to take their call and be in my office.

This has been a week of tears and studying and not running. Usually I would process the meaning of all this while running. But I cannot. So I will clean my house, push my vacuum, do some lunges, and think about how fortunate I am to have the people I have. And how I can change the world so that people do not die in needless explosions. Whether it be due to a fertilizer plant or another human being. We need to be strong, curious, and explore to find better answers than the ones we have.

Thursday, March 21, 2013

Where to call home

On my way to the river on Tuesday this song was playing and I sang it to myself as I went into and out of the wave, playing... I realize this song is about men and women, but for me it is about going home. When I left Montana I gave up the place I love and I had decided to call home. I left the first place I have ever truly been able to call home, where I came to fit in, despite being hyperactive and just wanting to play in the mountains, to come to dc.

The hardest decision was to not go back after my mom died. I had always dreamed of being a doctor and with my mom I found that I was truly talented. I had applied soon after coming home and gotten accepted first try. There are no medical schools in Montana, but there are in Virginia and I was just a couple of months from officialy becoming a Montana state resident. So I could still get Va in-state tuition. The timing was perfect. But I still had the option of returning to my program where I was happy.

When I made the decision to leave everyone told me "the mountains will always be here, but your mom won't be." But then after I had been here for a few months and went back to visit my coworkers started to encourage me to go back. "your face just lights up whenever you talk about it." Apparently the only time I really shone was when I talked about going home.

I took my first kayaking lesson the first weekend I was in DC. Kayaking was my consolation prize for giving up my home to care for my dying mother. One day while waiting outside Duke's cancer institute in a meditation garden before going in to meet with a doctor about her case I made a promise. That while she was alive I would do everything to save her. And when she died I would do everything in my power to help others in her honor. But did this really mean that I still couldn't go home? When will it be time to go back home?

Now this spring break vacation my dad had surgery. It is his seventh on his left eye to attempt to recover his vision as he has hereditary glaucoma. It seems that the pressure is up in his right eye and he may need to operate on that soon, his only seeing eye, or else both eyes may go.

I would have loved to go home to Montana and gone skiing and seen my friends and have been in the mountains. But I made my decision to be here and put my family first. Only two and a half more years and then I will hopefully be able to move closer to where I feel most at home. It is crazy how different my life is based on that one decision. All the people I have met and all the things I have done. I would never have won a running race or even known I could be pretty good at running. I wouldn't know how to roll a kayak, much less have worked on flipping it around. I would not be in medical school and never known that I have "world class empathy" and can be "a great doctor" as I was told recently following an exam in my practical application class. And most importantly, I wouldn't have gotten this time with my family. And so I listen to my songs as I play around in the waves for a few hours and reassure myself that the mountains and rivers will still be there when I get back.

Thursday, March 7, 2013

Removing the tube

Yesterday in class we had a lecture about Advanced Life Directives. This brought up a lot of painful memories for me that have made me cry a lot in the last 24 hours. I wrote the dean a letter that I copied below. I have not re-read it because it would be too difficult, so I am sorry for the spelling errors, etc. Today I went for a run and smiled the whole time. This is a good thing to process, but very difficult and will take a long time.

Hi Dr. Babineau,

Yesterday's lecture brought up a lot of issues for me and another student suggested I briefly talk to you about it. I took responsibility for my mom's life and she took chemo for me. In the process of me giving up my previous graduate education and moving back home to be with her I guess I proved myself the most medically capable in my family and the one people would trust with big decisions. I should back up. Before I was born my mom had a dog, Zorba, who was a little terrier or poodle, or something small. It hated my dad because my mom belonged to Zorba. When my mom had to put Zorba to sleep she saw that my dad couldn't handle the decision. So she had advanced directives put into writing that said if after two days on life support she had no hope of recovering to her previous functioning level (i.e. she didn't want to live with depleted mental abilities) she wanted the breathing tube removed. She put her sisters in charge of her breathing tube because she saw how difficult and painful that decision was for my dad, even if it was the right thing to do.

My entire life my mom made us firmly aware of these advanced directives. Especially aware after my sister's friend in middle school was hit by a car, flew 15 feet in the air, landed on her head, and was in a coma for over a year and came back going from the school's valedictorian to being mentally retarded. My mom and I visited her a lot (she learned my name and asked for me when I didn't know her before the accident and yet couldn't remember my sister's name). Caring for Lily after the accident, visiting her in the hospital then at home, was an important experience in my life and in my and my mom's relationship. One that no one else knows about, though I spent much time doing it.

Anyways, when my mom had her final seizure from her brain tumor and was intubated and brought to the hospital, she had already lost most of her capabilities, she couldn't feed herself, she couldn't name the months backwards, she was living her worst nightmare. I had asked her previously if she wanted me to be responsible for saying no to the tube and she had said yes as adamantly as she could despite being unable to say much more. It was horrible that day coming home from the hospital, she was only able to open her eyes, being paralyzed all over other than that, and seeing her blood on the floor with syringe wrappers, and slowly cleaning it up by myself. My heart completely breaking. At the hospital I had grabbed her hand and she had rubbed it with my thumb very soon after the ambulance arrived. That was the last time she ever moved her hand, showing me that she knew I loved her and I was there for her.

My family fell apart very predictably. Everyone was malfunctional. Her sisters came down and were just overwhelmed with the tragedy. My dad was extremely lost as he had been for so long. My sister and I began to have an extremely antagonistic relationship and she ended up punching me in the face when I asked her to leave as she was talking loudly on the phone while I was reading to my mother, making me bleed. My mom's eyes had kept roaming, looking for where the other voice was coming from whenever my sister started talking. For some reason, this was extremely distressing to me that I couldn't just read to my mother. I know how irrational and crazy family can get. When we have to change our lives to watch someone we love so deeply die it makes us unpredictable and antagonistic and defensive and strange.

So no longer rambling, when it came down to it my mother's sisters didn't do their job to remove my mom's tube and kept saying that it was my dad's responsibility. My dad told me he thought my mom was glaring at him every time she looked at him, incriminating him. So I went to find the advance directives to bring them to the hospital and take the responsibility off of everyone's shoulders and put the burden of making the decision to honor my mother's wishes by killing her onto my own shoulders. I know that it is letting her die, but there is something about saying I am removing her life line that feels akin to shooting a horse, it feels like a merciful killing. And I was willing to do the killing because as I took responsibility for her life, I was willing to take responsibility for her death. I left the advance directive out overnight so that people could be aware of my intentions and my family went crazy on me.

I didn't bring it in because they would have never forgiven me. Two weeks later my sister, my dad, and I all sat together as I watched the palliative care doctor persuade my dad it was time to remove the tube. My dad looked sick and his eyes bulged out of his head. He was making the decision that was the most painful and horrible decision to make and was not his to make. Unfortunately by the time we removed the tube my mom was out of status epilepticus and stabilized and lived for another month in a paralyzed-semi-comatose state. For another month she could have died at any second. We were all complete wrecks and spent most of our time with her in hospice. It was hell. I believe I made the right decision by not honoring my mother's wishes because I know she loved my father and fought to live to give him strength. Letting him have whatever modest amount of control he could have in the most nightmarish situation imaginable was what my mother would have wanted. But the amount of pain wrapped up into those memories is immense and difficult. I saw a therapist and still speak with her when I need to. But that doesn't change the painful tragedy of that experience. 

One thing that I didn't say that I wanted to tell the class is that when we had that meeting to remove her breathing tube, the palliative care doctor cried with us. She felt the sheer tragedy that was previously unimaginable. She saw my dad's pain as he had to make the decision to let the love of his life die and that he could not save her, that no one could. Those tears were comforting and kept me in the moment, allowing me to acknowledge that this was a horrible situation. Otherwise I would have put up emotional walls and a whole defense system to protect myself. But this was a tragedy so great that it would make even the strongest person with strong walls break down into tears.

Tuesday, February 26, 2013

Breastfeeding I: Colostrum, Antibodies, diarrhea prevention

Human milk provides protection against disease for a baby. There are many ways that it does this, much beyond what I can delineate in my non-studying time allotted. So I will start at the very beginning and then continue later.

A vaginal birth allows the baby's gut to be colonized by healthy bacteria which will deter disease by preventing the growth of unhealthy bacteria. #2 provide essential nutrients such as vitamin K. The proper colonization of the gut is why adults take probiotics, which will be another post.

The first milk secreted by the mother after birth is called colostrum because it is soooo different from 'mature' milk. It actually selectively facilitates the establishment of healthy gut bacteria Lactobacillus bifidus along with aiding the passage of meconium, or baby fecal matter that is still sterile from being in the mother, or not yet full of healthy bacteria.

Colostrum has less kcal than mature milk that will be secreted a few days later but has a higher amount of protein, fat soluble vitamins, and minerals. Further, it has a VERY high level of antibodies against bacteria and viruses that may be present in the birth canal.

These secreted antibodies are called IgA (immunoglobulin A) and are fascinating because the act like little pac-men for the viruses and bacteria. They are secreted by the adult gut and are specific for the topography of bacteria, viruses, etc. The immunoglobuns thus grab onto the bacteria or viruses and hold onto them preventing them from infecting you. In the adult,  IgA is secreted in the nose, the salivary glands, and throughout the gut along with into the breast milk.

In the second trimester of pregnancy, the human breast fills with inflammatory cells and it is thought that it is for this purpose: to identify and greatly increase the amount of secretory IgA made against any bacteria or viruses present in the environment and therefore protect the baby. Not only that but the degree of protection against organisms causing disease is proportional to the amount of HUMAN milk the infant receives, meaning exclusive breast feeding = greater protection vs diseases that cause diarrhea, nausea, etc. It is well established in the medical community that ingested antibodies from human milk provide gastrointestinal immunity against the following digestive tract/enteric pathogens that cause diarrhea: E. Coli, Salmonella typhirium, Shigella, V. Cholerae, Giardia, rotavirus, C. Diff, C jejuni. Therefore the antibodies in human breast milk in combination with the nutrients that help healthy bacteria survive protect the baby against diarrhea, GI ilnesses, etc.

Further the mother secretes immune cells (lymphocytes, T-Cells) that give specific immunity for bacteria present in the environment to the baby whose immune system cannot yet make those bacteria.

Saturday, February 9, 2013

A Brief Update

It is discouraging and scary to be coming back from this injury. Strange that I say this as I have come back from two ACL reconstructions. But there the injury was fixed. This time I know I have no miniscus and a meniscal tear. It is not "fixed" and it is up to me to change my training accordingly. Also running cannot be my priority. My schooling is my priority and that takes up a lot of time and effort. There is no clear path forward.

I went for a 14 mile run on tired legs on Thursday and really died at the end; my legs felt like lead. That used to be easy and at an easy pace (~7:30). Now it is difficult to brutal. My physical therapist said on Friday that people have come back from worse and that I will be back out there. And I will try. I know I am not alone when I run, I know I have my mom and my cat (who I put to sleep when her kidneys failed the day after my mom had been hospitalized with her final seizure. She sometimes visits me in dreams. She had been abused by previous owners, so I spent a lot of time sitting with her until I was the first person with whom she connected.) But is is hard to have loved something so much and have it taken away suddenly, whether it be a mother, a cat, or running. But hopefully I can get it all back.

I know I have strength in me. But between school and being in the worst shape since my ACL reconstructions, it is scary. I'm going to keep plugging away at my schoolwork and keep going to physical therapy and hopefully soon I will be back out there racing with my friends and comrades. I won't be at the front of the pack. That isn't how the body works. I will have to take some time to earn my way back up there. Wish me luck; I need it!

Monday, February 4, 2013

It's okay to be a chubby runner!

It was around 3 o'clock on what was a Tuesday or Wednesday afternoon when I got the call. I was fourteen and was doing nothing much after getting home from school. It was my dad's voice on the phone:

"I've got it Courtney"
"What dad, what have you got?"
"I've got the sport that will take you to the Olympics"
[pause... I'd never thought about going to the Olympics .. didn't have any idea why I was getting this call out of the blue]
"And what sport is that dad?"
[another pause... thoughts of being like the guys in Cool Runnings going through my head]

"Why bobsledding?"
"Because you can run fast and weigh a lot"

[pause as I get kind of excited, sounds like fun, but then I realize....]

"Dad, did you just call me fat?"

Yes that is the call that no fourteen year old girl wants to receive.... the fat call. I was chubby and kinda short. One guy who tried to date me in middle school ACTUALLY tried to flirt with me by calling me Courtney FAT-man before giving me his nike wrist band and trying to hold my hand! But I could still out-sprint most everyone in a soccer game. One time I remember hearing the parents from the other team commenting on how long my legs were... and I am 5'4" now, probably was shorter then, and weighed probably ~140lbs. So I knew didn't have long legs, I could just run faster then their daughters. And I remember telling my dad about that and wondering how fast I had to be running to create the illusion of long legs...

I think that training as a chubby athlete all my life has prevented a lot of injury. It takes a lot more muscle to run in a 140lb body than a 110lb body. Then as I dropped weight while living in Montana, I could sustain those speeds.

Now after having been injured I'm back up to ~127, which is 10-15lbs higher than my ideal racing weight. It will come back off if I keep training. But earlier today I did 5 mile repeats at a sub-6 minute pace (between 5:56 and 5:39) while weighing about 15 lbs more than most girls that can run like that.... As great as it would be to be a bobsledder, I can just stick with running for now and see how far this woman who was a happy-go-lucky Chubby girl can get in the running world :)

Sunday, January 27, 2013

A woman's best friend

5:00 In the Morning (A true story that I wrote a few years back)

My cat has decided it’s time to eat
She wants a full meal not just a treat
In my back her head she does shove
Reminding me food is payment for love

I curl in a ball and pretend not to know
She cannot wake me back to sleep I go
Meow she screams as she paws my head
Meow, meow: get your ass out of bed

I wipe away her paw and say:
"The sun’s not up, I will not start my day”
Meow she replies “there’s pink in the sky”
Meow: her belly’s rumbling and time is nigh

“An ounce of patience is worth a pound of brains”
Oh kitty, the truth each proverb contains
Meow she responds with a tear in her eye
Meow my belly cannot wait she does sigh

“I love you baby, please don’t cry
But I’m not getting up till the sun’s high in the sky”
Meow, she nudges me “I love you too
But Meow I love food, what do you want me to do?”

Meow: just get up and put more food in my bowl”
Meow, her cry wrenches my very soul
I give up I say and stumble out of bed
But then fall down the stairs and bump my head

Meow she nudges me, you’re still not there
Meow I’m sorry, but my bowl is still bare
I get up and and towards the kitchen I limp
Meow she purrs: I love my wimp

Oh, and Meow: on the chicken you’d better not skimp
But baby, all I own is some brine shrimp
Meow I’ll survive, just give me the shrimp
But baby, not too much, you’ll become a blimp

Meow: my concern is actually becoming too lean
Meow: Now I don’t want to sound very mean
Meow: but bow down and acknowledge what all have seen
Meow: you’re a servant, now worship your queen

I found my cat a starving little tiny kitten, definitely less than a month old, in the backyard soon after moving to Portland. She desperately needed food, so I fed her, and she hung around. Within a couple of weeks she wanted to come inside, but she had fleas. Unfortunately as she was so young this meant she had to get a flea bath. This obviously was painful because while cats don't like baths in the first place, she had scratches all over her little body. She disappeared for three days after that. When she showed back up, she was with me to stay.*

The first problem was that she had a siamese howl and couldn't handle being alone in the house. She would sit in the middle of the floor and howl for the entire time I was out. My upstairs Haitian housemate who was a stay at home pothead computer programmer and said having cats in the house was against his religion seemed to not appreciate her meowing for hours on end very much. So I began bringing her everywhere, the store, to class (she would sit under my chair). After I moved if I tried to leave her at home, she would follow me to class and wait outside. She has gone camping and hiking and driven down the 101 coast with me. The scariest moment was when she jumped out of the car after just after sunset in Yellowstone when we stopped did a quick in the middle of the woods pit stop.... we could hear the wolves howling in the background. She obligingly jumped back in of her own accord, however, when I opened a can of fancy feast. In honor of that occasion her name was officially changed from "Pumpkin Purr-Bucket" to "Pumpkin Wolf-bait Purrbucket."

Being able to live somewhere that I can have my cat has dictated where I could live and whom I met for the last 10 years of my life, arguably changing my life very considerably. Now as I study and isolate myself leading up to the USMLEs, I have my cat right next to me. She meows if I sit still for too long and don't play with her. She meows if I sleep in, as she needs to play by around 5am. Like today, no chance of sleeping past five, it was kitty play time. I have had people ask me if there is such a thing as kitty adderall. But the little girl downstairs loves playing tag with my cat, as do I. I guess I may have made my cat a little ADHD over the years to be quite honest.... But in the end I have a best friend who has stuck with me through the best of times, the worst of times, and many trips all over the United States.

*Note, she does submit to bathing without scratching or complaining now. It seems to be part of the deal we struck when she came back after those three days. She is willing to be bathed as long as I care for her.

Friday, January 18, 2013

About ready to go, my first real speed workout!!!

The last 4 months off of running have been tough and it left the question in my mind, will I come back? I never expected to be as fast as I am now. I never expected to run a sub-6 minute mile, much less 5k, or a 6:11 half marathon or a 6:45-paced marathon. But I have with a year and a half of honest training.... Was it all a freak accident?

My knee feels almost better today, tight on the outside (where there is no cartilage) and a little painful on the inside (where there is torn cartilage). In contrast, my head felt like crap this morning. I woke up with a runny nose, swollen eyes, and a scratchy voice. When I feel like this in general, only one thing makes it go away: running really fast. No joke. I feel like I can't get out of bed, so I get that lymph moving and suddenly the runny nose is gone and I can think clearly. As I had a quiz at 7:55 that I needed to study for before class, I had to wait until noon to try to clear my head the way I did throughout winter last year.

While I don't like talking ad nauseum about the pace of my speed workouts or how hard I try, etc, etc, I'm dang proud of my first speed workout back. (For the record I'm not supposed to do speed for a few more weeks....) So I got on the treadmill, put it to a merciful 0.5% incline. Before I did all my treadmill runs at at least a 1.0% incline, usually more, and pulled off:

1.5 mile @ 6:07 pace (9.8mph)
.25 mile recovery
1.5 mile @ 6:00 pace (10.0mph)
.25 mile recovery
1.5 mile @ 5:52 pace (10.2 mph)
.25 mile recovery
.5 mile @ 5:39 pace (10.6 mph?)
.25 mile recovery
.5 mile @ 5:33 pace (10.8mph?)
.25 mile recovery
.5 mile @ 5:27 pace (11.0 mph)
1 mile cool down.

I'm almost back baby and getting ready to go! Hopefully the knee will keep improving and I can get back to my old speed workout paces, but hey, I'll take this as a sign for good things to come! YAYYYYYYYY!

Wednesday, January 16, 2013

The Runner girl's heretical guide to beginning to swim as an adult

Many people writing about swimming seem to be swimming purists... They think we should just love slogging through the miles. But I don't feel this way. As a kayaker, I have tried to avoid swimming because that means I royally screwed up and came out of my boat. This is about turning around my negative swimming attitude and embracing my inner mermaid.

My #1 tip for beginning to swim as an adult is toys! Toys toys toys! The beauty of swimming is it is about "form" and in order to gain that form people have designed many different toys. People like to play with toys and runners don't like to swim because it feels weird and unnatural. So why not make it an adventure into toyland? The difference between toys and 'gear' is that nothing needs to be top of the line. I like to bring my entire bag of toys and mix it up. I have read several articles about how when you see someone with paddles, etc, you know they are triathletes because they are 'gear-heads.' I say Whatever! The toys are making me a better swimmer AND making it fun.

#2. Get goggles. They help so so so so much. Even though it makes me feel good that I can pass the guy who is swimming laps with his head above the water. Don't let that be you when you are trying to figure out how to enjoy the sport.

#3. Make friends with the lifeguards  Not only will this make swimming more enjoyable, but sometimes they let you play with their swimming-toys. This helps you figure out which toys are your favorite. Over Christmas break the lifeguards let me borrow all kinds of different swimming toys of theirs and would bring them daily for me to use! Also will they tell you "oh, you don't look like a beginner at all" and improve your swimming ego. Until you remember that they are comparing you to the people doing water aerobics and the guy without goggles swimming with his head above water.

#4. When all else fails pretend you are scuba diving and swimming in a school of fish, and there go the turtles! Oh wait, here comes a shark! Sprint, go go go go, zig zag, dive deep and up. Few, made it to safety at the other end of the pool now back to checking out the buried treasure in the sunken ship in peace...

My toys:

I use a waterproof ipod nano and listen to PharmRecall while I swim. The repetitive nature of swimming is perfect for memorization. It would also be a great opportunity for learning a new language. My pharmacology grades have improved since I began swimming!

I use flippers a lot! As a runner, my legs like to go wild. Flippers restrict their movement and make them move 'correctly' so I am kicking effectively. Also they make me go a lot faster. And I like going fast... But can't yet without the flippers, so flippers here I come, vroom vroom!

The forearm fulcrums are one that the lifeguards lent me while I was home over Christmas. They have completely changed my stroke and I can feel the water now. I can actually FEEL when I am stroking effectively, instead of just not knowing why I am going so slowly.

Finally, I use paddles now that make my shoulders stronger (once again supplied to me by the lifeguards that compliment me on my non-beginner stroke). They help a lot with my breast stroke that seemed to just take FOREVER and was brutally slow.

These are all the toys I have so far, though I use the pull buoy and kick board supplied by the Y.

Next student loan check in July I will get a snorkle, which I am excited about. This will absolutely help me fantasize that I am snorkling in somewhere crazy amazing instead of in a chlorinated pool at the Y in Grandpa's AND Junior's urine.

And when some swimming purist comments on all your toys just tell him/her... yeah, I have a lot of toys, but at least I'm not a stuck-up jerk. Just say it in Urdu and all other of the twelve languages you have managed to learn fluently while practicing swimming back and forth and back and forth and back...

A reaction to the shooting: Why I first wanted to be a doctor

When I first heard about world war II and the Nazis was when I first decided that I wanted to help people on an emotional level. What happened horrified me, because everyone involved was human, these were people hurting people. I was five and wanted to be a psychologist. I wanted to help people that no one else could help and I believed I could. I believed I had special powers to see beauty, pain, and good in people that no one else could see. I believed that all people are inherently good and have the capability for incredible evil. So I could stop evil if I could just reach the good in each person.

Since getting into medical school and becoming an elite runner, I feel as though many people look at me differently and think I was always successful, one of those people that fit in. People don't see or know that for many years I was the family screw up. A big part of that is that I am ADHD and make people angry no matter what. Another big part is that my parents were both horribly horribly abused. While they did their best, when my mom lost her temper she would get incredibly violent and mean. And I would make her lose her temper. My dad would get distant/withdraw/go to work/ and occasionally get angry, but usually just disappear.

Yes, social services were called. Yes, we had neighbors threaten to call social services on top of that. Yes, I moved out of my house and slept in a park and friends' houses because my mom got so angry that she came close to killing me. And yes, that is all water under the bridge because I LOVE my family and I am one of the most fortunate people you will ever meet for having such smart, kind, hardworking, generous, and honest people as my family even if we all have our issues.

However,Yes, I was incredibly depressed and different and hid it all away and no one knew that I was broken inside. I didn't let anyone know how broken or suicidal I was. How much I hated myself for who I was and what I created in the people around me, most importantly my mother. The truth is years later, after I moved across the country to Oregon to find and define myself as something positive, to work through all that crap, my mom apologized. I forgave her. That is what made it imperative that I spend her last months with her when she was diagnosed with terminal cancer, so she knew that no matter what had happened, she was deeply loved. That she was still my hero for how hard she struggled to be the best person she could be. That I knew she was just an abused and hurt herself, but still very lovable. I knew that she tried her best all her life to be an amazing mother. That she gave me the gifts of learning and education and opportunities, even if she had the limitations of a fiery temper and impossible standards. I needed her to know that I forgave her for the years of abuse because that whole time she loved me and was being the best mother she could be. That makes her my hero. My tragic hero. That her struggle and many gifts define her as a person and mother, not her mistakes, not her anger.

This experience, these experiences, have made me privileged, have helped me develop a gift for seeing a different side of people, a beautiful side, that they may not feel as though anyone else can see. For example, over the years I have connected with several schizophrenics despite the idea that schizophrenics lose the ability to connect with people during their meltdowns. One time when visiting old housemates I met someone who had moved into one of the rooms and chatted with him for about 20 minutes. ~1/3-1/2 year later he had a schizophrenic meltdown that lasted about a week and was arrested by cops after having broken into some random person's car and was just sitting in the backseat. From jail he wrote my previous housemates a letter and about half of it was addressed to me. Another guy I met on campus and chatted with him during dinner. That night he broke one of my neighbors' windows trying to get someone to let him in to talk to me. My neighbor delivered the present... a bag of chocolates with his cell phone because he was being tracked by the cops, and needed to get rid of it, a strange present... I must make the disclaimer that this was not sexual, he was not hitting on me, he had mentioned a girlfriend in our earlier brief conversation, and it did not strike me as sexual. I have many other strange stories as well.

As a kid I used to have nightmares about my elementary school. One repeated nightmare is that there were aliens invading the school. One by one they were pinching those around me, my teachers, my classmates, my friends and family, making them into automatons as well. That one by one everyone else was losing their humanity, losing their ability to feel and love. All I could do to not get pinched, my only defense against becoming an alien like everyone around me, was to pretend that I, too, was an alien with no emotions. I always woke up barely having escaped being pinched and made into an alien like everyone else around me, but always retained my humanity.

My  secret struggles have defined who I am. They have defined my ability to look into people's eyes and see their humanity. To understand what it is like to go to school with a smile on my face and try to make everything okay then return home to either a warm happy family or to running away and hiding and crying because my life may have depended on it. My mom always called me her sensitive little girl or her tender little girl. The shootings remind me of this and my vow to return as someone with the power and gift to help others who feel that isolation and alienation and searing pain and shame that I have felt most of my life for being different. Of my promise that I would help others, less fortunate than I, by seeing them, and helping them find a way to succeed despite their differences and disabilities and inability to fit in with society. That I would use my greatest gift, my ability to retain my humanity when it is too easy to feel completely broken and alone.

Sunday, January 13, 2013

PTSD & Survivor's Guilt: My Worst Nightmare

I have incredibly vivid dreams. The Friday night before my mom died (the night after Thanksgiving, 2010) I had a dream that I was sitting by her bed in the hospice center. She was in her comatose state and I took her hand and laid it on my thigh, keeping my hand on top. Then she started breathing quickly, showing that she was in pain. I screamed for the nurse to come, but the nurse didn't come. I kept yelling and yelling but before anyone came she just stopped breathing. She had died in pain. And I couldn't stop it.

That Sunday night she was still alive and I left the hospice center near midnight. Before leaving, I asked the nurse whether she thought my mom would die the next morning. I was supposed to meet with some radiation oncologists from the Bethesda Naval Hospital and I had my heart set on becoming a doctor with the Navy at the time (this was before I realized the difficult of joining as I have exercise-induced asthma). My mom had been in hospice for a month now teetering on the edge and I had been pulling quite short work weeks. And not just for the last month had I been unreliable at work, but since she had been hospitalized with her final seizure on the 19th of October (two days after my birthday). And really for the last 10 months it had seemed like she could die at any second and it was scary, so scary, to go to work because what if I missed her last breath? The nurse told me that my mom would choose how she died and with whom she died. I should go to work with a clean conscience and just come back as early as possible the next day.

As I drove into work that day I called my dad and asked him how is mom doing, how is her breathing? He said she was fine. She had been breathing quickly about two minutes ago, but he had grabbed Barry (my favorite nurse, he had been deployed with the army several times), and Barry had given her morphine and she was breathing normally again. I hung up the phone. On the radio, Michael Franti's song "Say hey (I love you)" was playing, strangely enough because that was the only time I have heard it on the radio. My dad called back a minute later and I dropped the phone because I knew what it meant. When I pulled over and called him back he said that after he got off the phone with me, while he was watching my mom, she stopped breathing, and she was dead. Just like how I had dreamed, but she had gotten the morphine and was not in pain. I take comfort that she spoke to me through the song and she is still with me, especially when I am dancing, as we took dance lessons together for about 5 years :) I would highly recommend watching the video.

I had a dream last night that my sister had a stroke and that I did not see the warning signs. That she was in the hospital and it was so much worse because I had not adequately studied to identify her symptoms. It is difficult to be in school when I made a promise on my mother's grave that I would help others in her honor and that I would never out of laziness miss a diagnosis. It makes it difficult to have friends and hang out or relax. But I am working at it. While I may not be ready for big parties, I am slowly making friends both in school and out and sometimes I can open up with them and joke around again. This is real progress. I know my mom would want me to be happy and have friends, but the implications of not studying scare me. A LOT. But baby steps.

Side note. I met with the men at the Naval hospital that Friday instead and had a blast. It was fascinating and exciting. They were mildly impressed for some reason when I said sorry I cancelled, but my mom died Monday morning. And then moved on with the conversation.

EGCG/green tea, Prevention of Encephalopathy, and Alzheimer's Disease in Down's Syndrome

I had my first concussion in second grade. I was playing soccer in the beehive league (where all the girls run after the ball like a hive of bees). For that quarter of the game I had been stuck as goalie. So I was staring off into space when all of a sudden this girl who had been held back a year or two in school (much bigger than the rest of us) had a breakaway and kicked the ball really hard at the goal, smacking me in the head and knocking me out. I remember later asking my dad if he thought that the other girls would have stopped the goal....

Since then I have had several other concussions including once hitting my head very hard against the pavement after falling off my bike while going too fast and not wearing a helmet. Hence, when I hear about chronic traumatic encephalopathy (CTE), it scares the living daylights out of me. And there has been increasing amounts of evidence regarding its profound effects including the latest published research on Junior Seau who shot himself last year. There is further evidence that even veterans exposed to roadside bombs have CTE. Here is a nice picture show of brains of athletes with CTE:

What can I do about it? It is difficult to say because the current literature doesn't say very much regarding successful interventions. Therefore, instead of relying on statistically significant interventions in the general population, there are a few things that I am trying out based on my knowledge and logic. These include preventing chronic hypertension and atherosclerosis from my endogenously high cholesterol (which compromises the brain vasculature and architecture), exercising regularly (which increases neurogenesis, or the birth of new neurons in the brain), taking fatty acids like Omega-3s, and drinking green tea.

Why green tea? Well, I am just so glad you asked! First of all, tau is being found in the brains of people with alzheimer's disease along with traumatic encephalopathy. Chronic traumatic encephalopathy further includes compromised vasculature. The flavonols in green tea are potent antioxidants that may limit the build up of oxidative damage throughout the cells. These means no oxidants to further compromise the integrity of my vasculature, my neurons (main thinking cells), or my glial cells (support cells whose function is just as important as that of the glial cells). For this purpose I also take omega-3s and phosphatidyl serine, but that is another post.

An interesting model of Alzheimer's disease (AD) is in Down Syndrome (DS) where behavioral evidence of AD begins in the 40s and 50s. According to our teacher, who is a medical pathologist and identifies causes of death for a living, ~100% of DS patients she has autopsied have neurological evidence of AD by the age of 50. It is not uncommon to see evidence of AD as early as thirty. This early onset AD is thought to be at least partially, if not fully, due to the increased expression/concentration/activity of a protein (Dyrk1a) that modulates the activity of many many other proteins including ones responsible for brain development and ones responsible for homocysteine levels. Dyrk1a is thought responsible for the increased risk of leukemia in children with DS along with a decreased risk for solid tumors in adults with DS.

EGCG from green tea has been shown to lower the levels of Dyrk1a in lab animals that have the genetic mutations of DS (trisomy21). These animals have neither the biological changes of AD on autopsy nor the behavioral/reduced mental functioning of AD in memory and behavioral tests. There are currently ongoing medical trials looking at whether EGCG could make a similar improvement in humans. But I say who cares, the evidence is adequate and the treatment (drinking a cup of green tea a day) adequately benign that why wait and see what happens to the average person with DS to see whether it will help me? Drinking green tea is much better than the alternative, which is reading about the problems that all these people are having from brain damage and doing almost nothing.

Oh, and GOOOO RENEE HIGH who is running in Disney marathon right now (1/13/2013 Sunday morning at 8am)! She won last year and we are looking for a good solid run this year! YAYYYY Renee!

Friday, January 4, 2013

An update: Not going to do surgery

Going into the second surgical consult, I knew that I needed to make a decision between running and medical school. Basically, the first surgeon told me I would need to take two weeks off of school. I don't think I would need this much recovery time, but during the second semester of my second year of medical school to do surgery with that possibility would be VERY risky. So my heart was breaking. I further discussed this decision with the dean, who had a similar opinion. I was guaranteed that the school would support me as best they could academically, but with the number of exams and all the information, to have surgery on Martin Luther King weekend would be very risky.

I entered the second consult with the plea that we need to find any and every non-surgical options. The second consult said that I *may* get by without surgery IF I find the best physical therapist around and he specializes in elite athletes. I have been getting better slowly, so as long as I adequately strengthen my leg before returning to running, it may not matter that I have both a torn meniscus medially and no cartilage laterally. 

So I had my first appointment yesterday at the physical therapist recommended by Dai Roberts, my triathalon coach. My left leg is now significantly weaker than my right due to extensively babying it these past few months. This is strange, because since I tore my ACL on my right leg in 2008, my left leg has been the stronger leg. And over the summer I was told by a sports specialist that I need to focus on strengthening my right leg because it is so weak.

The PT said I should be able to start running next week and gave me several exercises for my hamstrings and lateral rotators. And so rehab begins and the process of avoiding surgery at all costs. I will continue triathalon training and make this the year of triathalons... But I had a dream the other night about racing. Right before the (running) race began up this exceptionally steep hill, I looked at my teammate next to me, a girl. I told her "you have this, but don't slow down, because I will try my hardest and be right behind you. If you let up I will pass you." And so I will return to running, weaker, slower, but with no less heart or determination to be the best I can be and make the races that much more difficult for everyone else!