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!