Doctor Heal Thyself

A few months ago, I saw a young woman in my office complaining of knee pain. She had just started running and after several 30-45 min straight runs developed anterior knee pain. Even before I examined her knee I knew she had developed patellofemoral pain syndrome (PFPS).

She had been a competitive swimmer in high school and hadn’t done any running before this. She just decided one day she was going to start running. I admired her.

Her knee examine was pretty straight forward. I was able to elicit pain along the inferomedial aspect of her patella; she had a very minor joint effusion, but otherwise the rest of her exam was normal.

I spent the rest of the visit counseling her on what PFPS is and how it happens. I spoke about imbalance in the muscles around the knee and showed her specific quadriceps strengthening exercises. I suggested she take a regular dose of an anti-inflammatory medication for at least a week if she was in pain. I advised her to get a proper gait assessment done for her running shoes and told her she had to stop running for a few weeks at minimum. She obviously didn’t like that last part but I reassured her that she would get back to her running if she listened to her body and took the proper steps to heal and strengthen her legs, particularly the quadricep muscles.

She returned to see me about six weeks later for a different reason. I asked how the running was going. She told me she took my advice and her knee feels great.

Remember that saying, “doctors make the worst patients”? It really is true. Ten days ago, at the first sign of knee pain, though I did “rest” I didn’t take any medication and I didn’t do the exercises. Granted I was on vacation with my family so having any time to myself to exercise was difficult. There were a few mornings I found myself alone on the deck so I did squats and yoga but it clearly wasn’t enough.

But, since the run two days ago, I have been faithfully doing my quad strengthening reps and taking acetaminophen for the pain. Normally I would be taking Ibuprofen but it’s been upsetting my stomach of late. I’d forgotten what a good painkiller acetaminophen can be; there have been moments when I think I could run again, my knee feels almost back to normal.  Gone is that annoying ache I experienced walking down the stairs! But I know that is the Acetaminophen working.  Not to worry, I told myself no running for another week, at minimum.

These particular quad sets, I find, are very helpful, but there are many more that are equally important.  Not only should I be strengthening the quadricep muscles, I also need to remember that the gluteus muscles and the hamstrings are key to a healthy knee as well.  I found this PDF to be particularly helpful. And just to prove that I am practising what I preach this time, here is a short video of me doing a quad set.  (And yes, that’s Katy Perry in the background and at the very end, my son demanding attention.)

 

 

A Week Was Not Enough.

I forget how fast 7 days can go by. We are back from our week at a cottage rental. The kids had a fantastic time and though the weather could have been a bit better, we all got to enjoy the lake and I even got a tan!

The kids were up at the crack of dawn and were ready to go. Thank goodness this cottage has a phenomenal basement full of toys. It certainly kept the older kids occupied for an hour or two while husband and I struggled to get another hour of sleep. The baby was so incredibly easy. The fresh air made for great naps and he loved crawling in the grass and exploring the ground.

I was hoping that the week off with no running would help with my knee. Sadly, it hasn’t done much. I may not have been running but I certainly was walking up and down stairs a lot and up and down a slopey hill to get to the lake. “Rest” just wasn’t in the cards for me.

A few hours after we got back to the city I suited up for a run to test the knee and quickly realized that I’d made a mistake. I struggled through 3km.

So, having gone from this:

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And too much of this:

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I am now sitting with an ice pack on my knee and swallowing my pride. I guess my body wasn’t as ready as I thought it was for 10km.

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Looks like I’ll be seeing the physiotherapist this week.

Woe is the Knee.

My knee is buggered. I’m pretty sure I have a case of patellofemoral pain syndrome. Jesus. I sound like a broken record.

I felt great after my 10km achievement last week. I didn’t run for 4 days. Earlier this week, on my day off, husband and I took all the kids to an amusement park and we all had the best time. It was a long day of walking and ended near dusk with me having to carry my 35 lb 3-year-old who was exhausted. The next day my legs felt tired, heck my entire body was tired, but I ran home from the office anyway. That was 5.75km and shortly after the 2.5km mark I realized just how tired I was and had to shorten my run:walk intervals to make it home. I felt blah about that run so last night I decided to go out again. I could feel a nagging ache in my right knee from the get go but I pushed on. Did 4 km and changed things up a bit. Firstly, I turned off the coaching feature and ran with no music. Secondly, I ran the first kilometer steady, the second kilometer intervals, the third kilometer steady run again and finished the 4 km with an interval.

I woke up this morning with a throbbing knee that got really mad at me when I walked down the stairs. Pain in the front of my knee right under the knee cap. It aches when I sit with the knee bent at 90 degrees (the theater sign).

We leave for our annual summer cottage getaway this weekend. I was planning on getting a few runs in. Clearly that is not going to happen. I must rest the knee and strengthen my quads and glutes.

In the meantime, there is always wine.

wine

 

Juggling.

 

 

 

how-to-juggleIt’s been a week.

I’m covering for both of my colleagues this week. We have a locum physician covering their practices as they are off for the summer, but she is off as well, on a much deserved holiday. So it’s been a bit crazy.

It’s not so much the patient flow – I can handle a fully booked day with a few add-ons; it’s the lab results and the follow-up required.  Doing my own labs and clearing the decks for the day is sometimes hard enough but doing it for two other practices? That’s another story.

It’s 5pm and I just finished seeing all the patients. I start reviewing one colleagues’ lab results. Oh look. A 50-year-old woman whose platelet count is 23,000!  (Normal range is 145,000 – 400,000). She is a new patient to my colleague and so I have to spend 20 minutes reviewing her old records, only to find that yes, her platelet counts have been low in the past but apparently the previous doctor never bothered to investigate it.  It’s now 5:20pm.  I call the patient and start asking her a bunch of questions – yes, she’s been bruising a lot for no reason (and she’s complained about this to the previous physician for the past few years!!!), yes she is tired all the time, yes she is having bleeding from her gums.  Oy.  She likely has ITP.  I got her an appointment with the hematologist for next week.

Then there was the patient with a CK level of 10,000.  CK is creatine kinase; it’s an enzyme that breaks down skeletal muscle.  I didn’t know the patient, so I had to review the chart.  She’d been complaining of vague abdominal pain and muscle aches for a while now.  All manner of testing (abdominal ultrasounds, CT scans, etc) failed to reveal any pathology. She’s not on any prescribed medications (that would be easy, right?). And of course,  there wasn’t a baseline CK to compare, so now I’m supposed to figure out why she’s breaking down muscle.   Or is she?  After a phone call with the patient, I find out  she’s taking a protein whey supplement as she trains for a 20 km obstacle course run.  Hmmm … I’m not so worried anymore – the elevation in CK is likely a byproduct of the protein supplement, so I told her to stop it and recheck the levels in a few weeks.  Crisis averted! But the entire exercise took 15 minutes out of my day that I never got back.

While reviewing another colleague’s lab results, I see a very low white cell count from the end of June ordered by another physician and our office was copied on the result.  The WBC (white blood cell count) was 1.6 (normal range —  4 – 11 x 10 **9).  The differential shows a very low neutrophil count (these are the white blood cells that fit bacterial infection).  I reviewed the patient’s chart – he’s not on any medications, has no history of malignancy – so I cannot for the life of me figure out why he’s neutropenic.  Of course I have to call him now.  Has he had unexplained fevers?  Who ordered the blood test and has he been informed of the result?  The answers to both those questions was no.   Great.

And then there’s the lovely 60-ish-year-old lady who comes in for her annual check up.  Her gynecologist does her Pap tests and orders her mammograms (she had breast cancer 10 years ago).  I have repeatedly told her I am happy to do her Pap tests and order her mammograms, but she likes the gynecologist and wants to continue to see him.  Fine. Great. No problem.  So at her check up, as I’m checking her blood pressure in her left arm, I noticed a rather large bulge coming from the side of her neck.  I don’t even remember what her blood pressure was, I’m sure it was normal, but mine certainly wasn’t.  I assess the area and it’s a large mass arising from the left side of her neck. It seemed too low for a lymph node but also felt like it was in the supraclavicular fossa.   FML.

 

 

 

 

 

 

Back in medical school, I was taught that if one felt a lymph node or a mass in the supraclavicular region, it was cancer until proven otherwise.

The fact that my patient didn’t even know there was a growth there is concerning.  A painless mass that goes unnoticed (or is ignored) is concerning.  The fact that she’s already had a history of breast cancer is concerning.  The ultrasound report confirming the mass and suggesting a CT or MRI is concerning.

Could this week get any worse?

Why, yes, it can. It is kind of ridiculous that I could sit here and write about another four or five lab results.   But you know what?  I just can’t talk about it anymore. This week needs to be over.  I need to stop saying yes.  I have to learn to say no.  I can’t be the one to cover for both of my colleagues at the same time anymore.  Something is going to get missed and I don’t want it to be on my watch.  One doctor covering almost 3000 patients is insanity. Yet, I agreed to this knowing full well I’d likely feel this way. What is wrong with me???  And why is this July the worst July on record for patients?  The summer used to be dead slow.  WTF is going on??!

Rant over.

 

 

So Close, I Can Taste It!

So, I’ve written before on my goal of running 10 km.  Remember, this isn’t straight out running, rather, I run intervals.  Last winter when I started running straight, I did too much too soon and got those nasty posterior shin splints.  So, I took it down a (huge) notch and am running 4:1 these days.  For the past month I’ve been running 3 times a week on average and increasing my distance by 500 m every 10 days or so.

This week I ran on Monday (4.77 km) and Wednesday (6 km).  Last night (Friday), I set out for 4-5 km primarily because I felt like I would do my next “long” run sometime this weekend.  Lately, I’ve been finding the first 2-3 km really tough – like I have to stop after 1.5 km to stretch out my legs.  It’s been like this for the past month and I’m still not quite sure why.  My legs feel tight, the anterior shins start burning; but after those first few kilometers, it’s as if the legs finally loosen up.  (Maybe I am destined to run longer distances??)  In any event, last night, I almost felt like quitting around2 km but then I got on the local trail near my house.  The ground was softer than the asphalt and my legs finally felt happy.  As I approached 3.5 km I realized that if I turned back for home I would have a 7 km run under my belt.  Suddenly, my thoughts drifted to 8 … then 8.5 km.  Could I do it?  The weather was perfect, the trail was pretty quiet. I decided to go for it.  On one of the 1 minute walk breaks, I texted husband that I was going longer and was about half-way.  I didn’t want to worry him.  He was prepping our steak salad dinner and putting the older kids to bed.  He had plans to go out to a club but I didn’t think he was leaving until later …

So, on I went.  I ran to the end of the trail before it splits under a major highway.  I made a U-turn and headed back, with the sun behind me.  I ate a few bugs along the way (ewww… gross!!!) and took a few snapshots of my view.  At one point, I saw a kitten on the trail, her owner just ahead of her.  I’ve never seen anyone “walking” their kitten and thought it was pretty hilarious. Never mind that I absolutely adore kittens. Of course, I had to stop to grab a photo but the little thing was not interested in posing, so the shots are blurry (and there’s some weird filter on them too, I think one of my kids was messing with my phone!).

Seeing the kitten gave me a spurt of energy that lasted a few minutes (ha ha!) but I really needed it.  By this point I was about 6 km in and was starting to feel tired.  Thankfully the scenery was beautiful.

 

 

By the time I hit the 1 hour mark, I got a text from the husband.

testApparently, he was supposed to leave at 8:30pm and he was waiting on me to get the steaks on the BBQ.

Oops.

I didn’t care though. I was on such a high at that point because I looked at my phone and saw this:

9km

YES!!!!

Of course, husband’s comment … “Why didn’t you just go the extra kilometer and do the 10?”

Ha!  Indeed.  Why didn’t I?

Because I thought my legs were gonna fall off.

I cannot explain how stoked I was when I got home.  I’m sure the marathoners out there know.  For me, 10 km is like a marathon.

It won’t be long now.

The Inspiring Blogger Award.

 

The wonderful ladies at Hot Heels, Cool Kicks & a Scalpel honored me with the Inspiring Blogger Award.  Thank you!

When I started this blog, it was meant as a way to chronicle my journey from maternity leave back to the workforce, but somewhere along the way it evolved into a diary of being a mother to three wonderful children, a doctor to many, a wife to one and a runner.  It has been cathartic in many ways and to think that I am helping to inspire other young physician mothers is something I never expected.  So, I thank you.

Now, here are the rules:

  1. Thank and link to the amazing person(s) who nominated you.
  2. List the rules and display the award.
  3. Share seven facts about yourself.
  4. Nominate 15 other amazing blogs and comment on their posts to let them know they have been nominated.
  5. Proudly display the award logo on your blog and follow the blogger who nominated you.

Seven facts about Dr. Mom:

  • I have a tattoo; it’s a small green alien
  • My favorite television series of all-time is The X-Files
  • I’ve wanted to be a doctor since I was 13 years old
  • I have an old-lady hobby… I cross stitch.
  • I went to an all-girls high school, let’s just leave it at that.
  • I am not a girly girl at all; I’ll take wearing jeans and a t-shirt over heels and a skirt any day, much to the chagrin of my husband
  • I have a hard time saying “No” to people.

Now, I’m supposed to direct you to 15 other bloggers whom I enjoy reading and find their stories inspiring and thought-provoking,  though I can only come up with 13 (*ducking*).  I don’t know if they’ve been nominated (I’m too busy to find out), so here goes:

http://halftherun.blogspot.ca/

http://crankygiraffe.wordpress.com

Behind the White Coat

Runner Under Pressure

Surgery At Tiffany’s

A Game of Diapers

Anna in Med School

Violent Metaphors

Doctors’ Bag

At least we made it this far…

The Poxes Blog

The Blog Runner

Generally Medicine