The Agony of Accomplishment

I hurt today.

I knew it would hurt to get out of bed the moment I stretched out my legs.

My left knee at the fibula where the IT band inserts.

Both calf muscles and the Achilles’ tendons.

The right lateral thigh along the entire length of the IT band.

My deep, deep core muscles.

They were all mad at me for what I put them through yesterday.

IMG_6355

After a self-imposed rest of 3 days due to inclement weather and a broken furnace, I set out for a long run. I’ve been increasing my distance by 1 km every 2 weeks, so this week had me facing 13 km. With all the snow that fell I knew that only the major streets’ sidewalks would be clear enough to run on so I headed out and ran to the office. I tried to take it easy as this was supposed to be a LSD but after each kilometer clicked by it became clear that I was running at my 5km pace. (I can hardly believe I can even say that!). I reached the office and kept going for another 1.5 km. By the time I had to turn back I was getting pretty tired. I briefly considered hopping on transit but remembered I didn’t bring my wallet or any loose change. I allowed myself a few extra 100 meter walk breaks and thank goodness for traffic lights. I was able to catch my breath and stretch out the legs.

I made it home and felt like collapsing. My legs were jello and I was dripping in sweat. I drank a lot of water and made a cheese omelet even before I got all my gear off. I was starving. I stretched afterwards but obviously not enough considering how my legs felt this morning. A few hours later the dreaded migraine came on with a vengeance; a sign that I will need a water belt and gels for my next long run. I think I am going to wait another week before increasing my distance again. My legs definitely need a break. For the next few weeks I will stick to 5-10 km and work on getting my 5 km pace even faster.

Oh and just for fun here’s a shot of me as I ran by a storefront window. I’m pretty sure this was around 9 km. I’m surprised I’m not completely hunched forward!

IMG_6360

Oblivion.

What’s worse than one kid being sick?
How about three? Each one on the tail of the previous. Just as the eldest turns a corner towards the healthy side of the force, her baby brother spikes a fever and her other brother’s cough takes a turn towards the dark side.

FML.

I am curled up in bed waiting for the 1/2 tab of Gravol I just took to kick in. I am beyond exhausted and still feeling the remnants from last nights’ gingerbread festivities (hence the Gravol).

If I prayed to God I would wish for an uninterrupted nights’ blissful sleepy oblivion. That’s not too much to ask for, is it?

F is for Cancer…. as in .. FUUUUUK, it’s cancer.

I saw my colleague’s patient the other day as I was covering her practice for a few days. It’s haunted me ever since. She was diagnosed with a bladder infection last week and I got the culture report back just before the weekend. I had to change her antibiotics. I spoke to the patient on the phone and told her if she still wasn’t better after the weekend to come to see me.

Well she did. While the bladder symptoms appeared to be improving she also mentioned how light-headed and dizzy she was and “oh yeah, by the way, I’ve lost about 10 lbs in the past month.”

Fuck.

I looked through her chart at her recent blood tests. Hemoglobin was normal but compared to 2 years ago, there’s been a 20+ point drop.

Fuuck.

Upon further review of her chart, I noted a family history of colon cancer in her mother and stomach cancer in her father. Both deceased.

Fuuuck.

Oh and she repeatedly refused to be screened with colonoscopy or fecal occult blood testing.

Fu—-

You get the drift.

She’s got cancer and it could have been caught early with a simple screening test.

Recovery.

Last week, I ran 5 days out of 7.

You can probably guess that my knee has been feeling a lot better.  Except for the little “click” I keep hearing on the opposite knee every time I walk down stairs. But it doesn’t hurt, so I’m going to ignore it. In fact I think it might be gone today.

Now that I have run my goal of 10 km (okay, so only once, but still, I did it!), I feel like I need to set another goal.  While I fully intend on running that 10 km again, I want to improve my endurance.  Before all the injuries set in, I was running 5 km at a steady pace, with no walking.  I know that running:walking is a common practice for even the long distance runners, but there is still a small part of me that thinks that if I call myself a runner, I should be able to run a distance, you know?  Must be that type-A personality coming through.

Last week, I drove to the waterfront and had a fabulous run on the boardwalk.  I don’t know if it was the scenery that helped, but I found some energy the last kilometer and had my fastest kilometer in quite some time!  I was so excited.  I even had my first negative split!

neg split

So, the last couple of runs, I have changed things up a bit (yet again!).  I ran the first kilometer straight, it was about 7.5 minutes. Then I walked for a minute.  Then I ran the next kilometer straight, then walked for a minute.  Repeat x 4 km.  I have no idea if this is even a thing, but there you have it. After two runs like that, my legs were feeling the strain.

Being the good girl that I am, I took the last 2 days off. My legs needed it. I was really tempted to run last night, but I didn’t.  Partly because I was so damn tired, but mostly because I was too busy eating these little guys.

cookies

So, of course after eating far too many of these cookies, I really felt like I needed a run, but instead I sat my butt down on the couch and cross stitched for the rest of the evening. I had every intention of waking up this morning and going for a run. I don’t work on Mondays and thought it would be good to get the run out of the way and before it got too hot.  Yeah, well, it didn’t happen.

I blame the cookies.

Swamped.

For the first time in the almost-10 years that I’ve been a family doctor, do I actually feel like I’m a family doctor.

I’m busy!  I am pretty much fully booked every day that I am here and often don’t leave the office until at least an hour after I finish seeing patients.  I’ve been back to work for two months and initially the busyness was expected, and I thought things would have settled down by now. But no, it hasn’t.

Don’t get me wrong, I’d rather be busy when I’m at work then sitting around twiddling my thumbs with unbooked appointments. I’m glad that I am available for my patients. I’m glad they don’t have to go to a walk-in clinic.  Sure, a few will go regardless if I’m available or not, after all, I can’t accommodate everyone’s schedule, but when it’s a steady stream of patients all day with no break, it gets pretty exhausting.

Gone are the days, I fear, where I could see my last patient and be out the door a little after 5pm. Now I have to finish charting my notes, call those two patients, do that referral and finish that insurance report.

When did I grow up to be the typical busy family doctor? It seems to have happened overnight.

I used to pride myself on running an efficient day and not being late. But then fifteen minutes behind turned into twenty, and now sometimes thirty-five to forty minutes. Thankfully it’s not often because those days when I run late stress the hell out of me. I don’t want to keep people waiting, I know they have places to be and busy lives and lord knows I don’t want to be getting home well after 6pm every night – that’s when my kids go to bed! I want to tuck them in and tell them a story. I feel guilty when I’m late because that means husband has more to do and doesn’t get a break. Thankfully he totally understands and knows it comes with the job but still, if our roles were reversed I could see it getting to me.

My practice is growing, patients are getting older, and life just happens. I can’t control the mother of two small children who comes to see me at 4:45pm and then takes a half hour to explain how she found out her husband is cheating on her and feels like her life is falling apart. How am I supposed to tell her that her time is up at 5pm? I can’t, obviously. These situations don’t happen often but they always seem to happen on the days when I am already running behind. It’s like the universe knows or something.

More importantly, illness happens. On any given day there is no way to predict what will walk through my door. The majority of the time family medicine is pretty run of the mill and preventative care. But when illness happens it throws a wrench in my day.  Sometimes I feel like I’m drowning in a sea of paperwork and lab results; in insurance and medico-legal reports. Some days I wonder what was put in the local water supply because all the “crazies” show up on the same day.

But most days, I love being here and seeing my patients and even though I’m tired and hungry and may not want to listen to someone else complain about their life, I really couldn’t imagine doing anything else.

Happy News Bear.

Sometimes being a family doctor is amazing. It is a great privilege to care for an individual or an entire family. One of the best parts of my job is delivering good news.

The other day a young woman came to my office. I hadn’t seen her in quite some time. A lot had changed in her life. She’s gotten married last year,l and they bought a house. She is a busy woman, working long hours which was one of the reasons she has come to see me.

She was tired. More tired than she had ever been before. We talked for a bit, then I asked her a few questions. Some of my followers who are physicians will likely already guess the diagnosis.

My first question was about her period. I asked her when her last menstrual cycle was. Her face went blank.

“Um … I … maybe … oh, geez, I have no idea.”

“Have you been using contraception?” I ask.

“Not really, no.”

“Well, let’s do a pregnancy test. And while you are in the bathroom, think back and see if you can remember when that last period was.” Is she a few weeks pregnant, or a few months?!

Upon her return from the bathroom, she reports that she thinks her last period was in February.  (As an aside, how did three months go by and she didn’t notice she wasn’t getting her monthly cycle??!).

Of course, her pregnancy test was positive.

I suspected she was probably close to 11 to 12 weeks pregnant.  She is a fairly thin woman and upon further questioning, she admitted noticing that her clothes were fitting a bit tighter.  Uh huh.  I had her lie down on my exam room table and took out the doppler.  It took a few minutes, but there it was.  The sound of very fast hoofs.  A gentle gallop, about double the patient’s heart beat.  The distinct sound of a new life growing.

“Do you hear that?”  I asked her.

Her face told me she did.  Tears welled up in her eyes.  “Is that… is that a baby?”

“It is indeed,” I said.  “If I had to guess, I’d say you were about 3 months pregnant, and probably due around the end of November, maybe early December.”

“Wow.”

She left my office stunned, but happy.  Suddenly it all made sense to her, why she was so tired, why she was gaining weight.

It never ceases to amaze me how some patients can get so wrapped up in their lives that they miss something so obvious when it comes to their health.  In this instance it was good news.  The best news, really.

On this Mother’s Day, I am reminded how lucky I am to love my job.

Back In The Game

My regular readers will have noticed by now that the look of The Urban Dr. Mom has changed.  I hope, for the better.  I felt a change was needed. I wanted to brighten up the look of my blog.  I hope you all enjoy it.

Well, as of about 20 minutes ago, I survived my first week back to work.

Yay!

I’m relieved to have it over and done with.  My favorite part of being back is knowing how much I was missed.  Ha!  Seriously though, I love showing off pictures of my brood and catching up on the lives of my patients.

I won’t lie, I’ve been pretty tired.  Thankfully the baby is giving us a solid 7-8 hours of sleep after midnight, so that has been super helpful.

I also managed to run home from the office the other night.  I think I am over the hump of my injuries (more on that in another post), and I can’t tell you how amazing that feels.  To run for almost 5km and not have any significant pain?!  O-M-G! Talk about a little slice of heaven!

Here’s the proof!

map

Time to go home and have a nap. (Ha!!  I wish!)

Back On Duty.

Final weekend of maternity leave.

Last night I had a lovely dinner meeting with the doctor who’s been taking care of my patients.  We had a “handover” of sorts.

Handover – A handover is the transfer of responsibility and accountability for some or all aspects of care for a patient or group of patients, on a temporary or permanent basis. It entails appropriately transferring information to help deliver safe care. (CMPA)

I had been keeping up-to-date on a few patients since I was off, but not many.  Our three-hour meeting was informative and extremely useful.  This physician has done an excellent job and a quick peek at some of her clinical notes on the EMR confirmed it. I am officially back on duty as of, well, now.

I have to admit, I feel a little apprehensive.  I am used to this feeling – I’ve had it every single time I returned to work after an extended leave like this.  Am I going to remember how to write a clinical note?  Will I remember how to take an appropriate, concise but detailed history?  Thankfully in the past, after the first few hours back, it generally feels like I never left.  I certainly hope this is the case next week.

Another variable thrown into the mix is my 6 month old son. When I returned to work after the previous two maternity leaves, the kids had been sleeping through the night for at least a month.  (How did I get so lucky?  Third time’s the charm, right?  Right?!) Sadly, no.  He’s not quite sleeping through the night yet.  He still wakes at least once, usually between 11pm – 2 am.  Husband has been wonderful and doing these feeds more often, but I still wake up.  I am still tired during the day.  I worry how I’m going to function now that I have to actually use my brain again.

Despite the fatigue and the apprehension, I am ready to get back to my work.

I love my job.

I love medicine.

My Chunky Monkey.

My 6 month old just got his vaccine yesterday. He weighed in at a whopping 18 lbs 6.5 oz.   Two months ago he was just under 14 lbs.  Talk about weight gain!!

Ah, the marvels of formula.

Pediatrician noted the huge jump in weight and asked what changed.  I explained the transition to formula and then the next question was about his sleep. He has been still consistently getting up around 2-3am and then again at 5-6am.  This is after going to sleep around 6pm, sleeping for 5-6 hours, then waking for a feed before husband and I turn in for the night.  He is also now consistently taking solids (mainly just a mixed cereal now).  She suggested that the 2-3am wake up probably isn’t related to hunger and we should try to let him cry it out.  Alternatively, we could try the dream feed.

I’d heard about this dream feed from a friend of mine several years ago, but never needed it for the first two kids.  Both had started sleeping through the night well before I returned to work (the first at 4 months of age, the second at 5 months of age).  With less than two weeks to go, I really need this little man to start sleeping longer.

So, last night, I woke him up at 10:30pm and he drank 4-5 oz of formula.  He fell back asleep pretty quickly after that, (and so did I), and didn’t wake again until 5am.

WIN!!!!

Fingers crossed this keeps up for the next 13 sleeps.