Good News and Caution

Back in New York, I have now finished my scans, tests and seen my favorite ortho onc, and I'm still healthy. Yep declared to be in excellent shape. No sign of any recurrent or metastatic disease. She was amazed by how much I can do, how strong my ankle. Everyhting is good. We went through the usual discussion of my recent athletic pursuits and she gave me that look. That look I remember from when I asked if I could get out of the wheelchair because I wanted to exercise by using crutches. Well, not quite the same but still I knew the look. She is happy about what I can do, happy about how strong I am, proud that I have focused on getting healthy and strong, but worried about me starting to run long distances. She is OK with the triathlon, but warned against pushing myself to hard. As she says the constant banging on a post radiation heel and ankle can be hard on the ankle. Further, apparently the radiation weakens the bone and makes stress fractures more likely and post radiation stress fractures might never heel. So, Be Careful is what she said. She wants a picture of me crossing the finish line. She was not so subtle about pursuing any longer distance running- that got a serious negative.

Ok, I can deal with all of this. I'll listen to my body. I'll be careful, I promise. I worked too hard to keep my ankle and to get in shape to let anything derail that.

Train of Tranquility

For the past two and a half days I have been at the Pediatric Academic Societies meetings in Baltimore, MD. For two and a half days, I have had to be “on” from pretty much the moment I wake up until I go to bed (which has been well after midnight every night). I discussed a paper I’m working on while on the elliptical, connected with old colleagues in line for coffee, etc., etc. My brief respite was dinner at my Aunt and Uncles on Saturday night, a meal of great hilarity as we participated in what my cousin calls “full contact dining- bring your armor and your wit, or you’ll be either torn apart or left behind” I love my family. Anyway, point being- I’m exhauseted. The kind of exhausted where you are on sensory overload and a little amped on caffeine to get through my 7 am breakfast meeting today. The kind of exhausted where you’ve been rushing from point A to point B for so many days, you forget how to stop.

So, when I arrived at the Amtrak station to get on my train to New York for my biannual check up and saw there was a quiet room, I made a beeline. The trip from Baltimore to NYC aboard the express train took slightly less than three hours. For three hours, I sat in blissful silence broken only by the conductor announcing the next city. I napped, I read, I wrote, I stared out the window. Ah, such bliss before the sensory assault that is New York City.

Tales of my Own Stupidity

Before this morning, I had missed two flights in my life.

The first one was totally my fault. I was in Nicaragua and misread the departure time of my connecting flight as the departure from Managua (this after I’d checked my luggage mind you). When I returned to the airport two hours late for my flight, I learned of my mistake. I made it home 24 hours and fair chunk of change later without my bags in the same clothes I’d worn for 48 hours. I ultimately got my bags back a month and a half later. Not one of my best maneuvers ever, clearly.

The second, I was flying to DC for my cousins wedding. I left my house two hours before the flight, but hit traffic, and delays getting the shuttle from the parking lot found me in line to check in and check my bag 42 minutes before the flight. The two people in front of me were on the same flight, they checked in- then the flight attendant lady said- nope you missed the “40 minute window.” But, but… I stammered, no luck. She rerouted me to a later non-direct flight, I made it through security before they even began boarding my original flight. I tried to sweet talk my way onto that flight, but nope. Defeated, I accepted my fate.

Then there is the flight I tried to get on 24 hours early, but THAT story’s already been told.

So, this morning… I found myself once again heading to DC on a direct flight. (I believe this might be the first time since that last ill-fated journey.) I was ready to leave my house two hours before my flight. My car was loaded, I’d eaten first breakfast, left my dog crying on the stairwell when I realized, I’d forgotten my sweater. I ran upstairs to the chair said sweater had rested on yesterday, but my ever efficient cleaning lady had moved it. Oops, I ran around the house for 10 minutes looking for the stupid sweater, never found, pulled down a replacement. OK, 10 minutes late, but I should still be fine. Checked sigalert.com, bad traffic on the freeway I was headed towards, I took a detour- Bad Idea. Worse traffic there. Oh well, I was still OK. More traffic on the freeway, now I’m beginning to panic. Arrive at the parking garage, 45 minutes before my flight, need to wait for shuttle. Woops, I try to get on line on my phone and check in, but nope- you can’t check in from the internet within 1 hour of your flight. This is looking bad. OK, I don’t have to check my luggage, I’m fine, right? Shuttle guy finally pulls up several minutes later. I arrive at the electronic check-in thingy with 29 minutes to go to departure time. No dice, I can’t check- in. URGG.. Long day at the airport ensues. Cancel plans with my family for tonight, flight rescheduled. I prepare to become passive and just go with it, while internally screaming at myself.

Morals to the story-
1- check-in to your flight from home before you leave it so you don’t have to deal with arbitrary time cut offs
2- If you can’t find your sweater, chose a different one immediately, or just buy one at the airport, anything
3- Or better yet, put stupid sweater away where you know where it is before it is mysteriously moved by said cleaning lady.
4- Maybe for a 9am flight from LAX leaving your house at 7am is really just too late. Maybe

Simple Things That Make Me Happy

As many of you know, I have been in a little bit of a funk lately. I'm out of it now thankfully, but it got me thinking about the simple things I do almost every day that make me smile. Here is the most recent.

When I first moved into my house, I immediately tore out all of the iceplant on the hillside in front of my house, and replanted it in a Tuscan/ Califonia themed, water conscious garden. I chose every plant myself for its shape, color, smell etc. It occupied me for months. I spent special attention choosing the rosebushes that line my stairs. The one that is on the landing was the hardest. It took me forever to find it, but when I finally did, it was chosen for not only the color of the flowers, but the smell of the roses. (Yep, I can get obsessed that way.) As I walk down those stairs everyday, before my first cup of coffee, I stop and smell the roses and I smile. It is a simple act, but it connects me. It grounds me in a fundamental way.

The best smelling roses ever.



The other roses along the stairwell.

How Safe is Your Home Birth?

Last night I read my friend Jessica's post on a home birth turned tragedy, and immediately replied that I'd weigh in on it today.    The tragedy, the death of a baby born in an unassisted, unmonitored home birth.  So, here I am.

As a neonatologist, my profession, my passion is taking care of critically ill babies, most of whom would not survive without medical assistance.  I live in the world of the <1% of births that go really wrong. Approximately 10% of babies require some assistance at birth, included in that number is the ever increasing percentage of preterm births. And yet still many argue that we are "medicalizing" a process that is natural and  has occurred without medical assistance for thousands of years.  True, but for those same thousands of years there was generally a midwife or some trained person who assisted the the delivery.  Further, for those same thousands of years childbirth was the number one cause of death for women and babies.  Like I said, I live in the world of 1%.  I have seen crazy things.  There is one case that is burned into my mind of a home birth where the mom refused to listen to the midwife and her husband and go to the hospital when things started to go wrong.  After the woman passed out, the midwife drove her to the hospital, the baby was delivered, saved, but left neurologically devastated because of waiting too long.  A few hours earlier, they might have had a healthy baby.  The list is long and bad things happen even under the best of care, but wouldn't you want a chance to intervene if things start to go wrong, a chance for the baby and the mom.

 Reading the article about this woman in Australia it is clear that her labor was not going as planned, that she had to have an emergency c-section for her first child makes it even less safe for her to be completely unmonitored and unassisted. That she labored for 5 days, something no physician or midwife would allow, especially with the risk of uterine rupture after a prior c-section.  That the baby is dead is a tragedy.  Could medical intervention definitely have changed the outcome, no.  However, it would have given this baby a chance.  

Just like riding a bike

I'm one week into having committed to this triathalon thing and the training has begun.  As I said before, I'm confident I can handle the swim.  The run will be rough because it is last, and 4 miles is pretty much the longest I've run.  So I definitely have to work up my running tolerance...  However, I haven't been on a bike in years.

So, phase 1 of triathalon training is to get comfortable riding a rode bike.  A friend from work lent me a Bianchi rode bike.  I had to get new pedals for it last weekend because I'm not quite ready to have my shoes clipped into the bike pedals.  Maybe that will come.  Then I had to start riding the bike.  People always use the phrase "just like riding  a bike" to describe something that should be rote muscle memory.  Something you haven't done in years, but that comes back to you immediately when you try again.  I am here to tell you IT ISN'T QUITE THAT EASY.  It is going to take some work for me to get really comfortable on this bike.  So, that is phase 1 of triathalon training.  Oh yeah, and to continue to build up my cardio toleranace.  On that note off to the gym I go. 

Are Hospitals promoting Health?

I put this post up on facebook from work the other night when I discovered that the food that I had brought to be my evening snack was bad.  It was simple-  "I'm in trouble, I'm at work, I'm hungry and my hummus is bad.  What will I eat?".  This was after spending 2 hours at the gym earlier in the day which always leaves me somewhat hyperphagic and after recommitting to my healthy eating habits.  So, there I sat HUNGRY with just plain celery to eat.   As I munched away on my celery I pondered my possibilities to get something solid to eat and got some hilarious comments from my friends.  The sad reality is that at 8 pmon a weeknight while stuck in the hospital, my options are limited. There is a  McDonalds in the hospital open 24 hours, but I won't eat there. The cafeteria has almost nothing by processed overly salted food I wont' eat and if it were a weekend it wouldn't even be open at all.  I found an old banana in my desk drawer and some trail mix.  

So there you have it my options were McDonalds v. processed cafeteria food v. old food leftovers in my desk drawer.  Fortunately, the food in my drawer wasn't bad so I ate that. However, it really is a sad commentary that at an institution that is supposed to be promoting health there is nothing healthy to eat.  In an era when childhood obesity is an evergrowing problem, The only place to buy food from at on certain hours and on the weekends at a large freestanding Childrens Hospital is McDonalds.  Is the hospital really promoting health?  And it is not unique to this hospital. I have worked at several children's hospitals in the country and most of them have a McDonalds because of the link to Ronald McDonald houses, and most of them primarily serve unhealthy, fried food in the cafeteria.  As leaders in pediatric healthcare shouldn't we be promoting healthy lifestyles? I don't get it.  As I lay in my bed hungry that night this thought plagued me.  

Tonight when I came to work I packed plenty of healthy food and made sure it was all still good.