Why is November such a hard month? Daylight savings should have made my mood better, but coming home now with it being darker and darker I'm finding it difficult to get my shit together. I've been managing to follow my turboing and biking regime to try and stay sane, but I just can't find the motivation to read and learn. The journals and piling up and I feel like I'm getting dumber. I'd better snap out of this soon because I need to start studying for the CCFP. Guidelines Guidelines Guidelines!

In Flanders fields the poppies blow
Between the crosses, row on row,
That mark our place; and in the sky
The larks, still bravely singing, fly
Scarce heard amid the guns below.

We are the Dead. Short days ago
We lived, felt dawn, saw sunset glow,
Loved and were loved, and now we lie,
In Flanders fields.

Take up our quarrel with the foe:
To you from failing hands we throw
The torch; be yours to hold it high.
If ye break faith with us who die
We shall not sleep, though poppies grow
In Flanders fields.

let's all insult family doctors

I'm working with a specialist right now who is VERY good at what he does, but constantly insults family doctors. Most of his stories revolve around how a family doctor sent him a ridiculous consult or screwed up or gave the wrong med or was manning the ER when someone died. Does he not realize that I'm a family medicine resident? Or does he not care? Or does he not see how insulting his stories are.

I had a very nice day with my Mom today. Is it the sign of a youngest child that I still go home to hang out with my parents when my husband is away?

Today I had a non-alcoholic beer. I think this is a sign of progress in my recovery from the LMCC-II. Now I have until December 16th to try and forget about it before results come out.

That was the worst exam I've ever done. Seriously. There are 2 stations I absolutely bombed.

I'm SO OVER EXAMS. Damn you LMCC II.

When I see children dying and I read about children dying and the PAIN that their parents go through, I can't help but ask - how can people do it? Is it insanity that people want to bring a life into this world when there's a chance that life will be cut too short and cause them immeasurable pain? Or is it the promise that most people make it to adulthood alive that drives the need to reproduce? Or the opportunity to bring a new and wondrous life into the world?

I struggle with the fact that right now I have no desire to have a baby. I'm too worried. I am content to bring them into the world and hand them off to those more prepared.

And then she was 29.

Kitty

So,
Kitty is still alive but now unable to walk, use the litter box without help, or manipulate his position very well. He often looks like me in an undergrad lecture, nodding off to sleep with his head on his chest only to jerk awake realizing that he can't sleep and hold his head up at the same time. The prednisone is at least increasing his appetite, although he's just skin and bones. Poor thing's owners can't get home soon enough - they'll need to put him down soon and I just can't bring myself to do it without them seeing him. Friday seems like such a long time away.

What kind of karma do I have? I am cat sitting one of my attending's cats while he is on vacation for 3 weeks and 1 week in one of the cats contracts a deadly neurological disease... I guess I should have helped that old lady across the street last week.

When I said I had an interest in palliative care, this isn't what I had in mind.

R3

I'm struggling with whether to pursue R3 training in obstetrics and women's health. On one hand, it would be great to match to a program in the same city where Ben is living/working so we could be together and I could get to know the city/hospitals etc. On the other hand, I could probably just go get a job there post-graduation. My hesitancy with the "just get a job" route is that I don't feel prepared - but does anyone? I still have >6 months of residency left and I don't feel prepared to even make the decision but applications are due Oct 15 so I'd better get my ass in gear if I want to apply. Plus, applying would mean revealing to my program director and colleagues that I'm not planning on staying in the city I'm training in (which I would love to do if Ben could only get a job) - which will make a lot of people unhappy. But seriously, Ben and I cannot live apart for any longer!

To dance or not to dance? I am going away for 2 months during this year's dance season and I think I'll have to pay for those classes whether I take them or not. Is it worth the money for the months I can take class to just suck up the 60 bucks, or should I not start off the season at all since I'll miss a significant portion? What to do!

In other news, I came second in my weekly mountain bike series!! I had so much fun and met so many awesome people. I'm totally motivated to do it again next year along with my goal of doing a solo 8-hour race and maybe a 24 hour race. I need something to motivate me to keep up the winter training!

The contrast between my studying and my urgent care clinic tonight is very obvious. The text talks about all these classic clusters of symptoms. My patients come in with weird shit that I have no idea what it is. It's unfortunate that studying doesn't teach clinical judgment.

LMCC Study day 2

lipid guideline
diabetes guideline
reading about januvia and Victoza
ovarian cancer
asthma guidelines (to be continued)

LMCC II study day 1

A study of randomness:
1) cardiovascular events TOP guideline
2) Cognitive impairment TOPS guideline
3) Urinary tract infection in nursing homes TOPS guideline
4) progesterone for luteal phase support - Cochrane review + other resources
5) Gout
6) Polycythemia vera
7) Canadian guidelines on Sexually Transmitted Infections (to be continued tomorrow)

I should really start doing something systematic, but these were clinical questions from my day/past week I needed to look up anyway. The Alberta TOP guidelines are really useful! They can be found at: http://www.topalbertadoctors.org/informed_practice/about_informed_practice.html

It never ends to amaze me how much people appreciate a simple gesture like a phone call from their GP when something tragic happens in their life. I have had two pregnant patients who got devastating news within the last month - each took it differently, each was heartbroken in their own way. All I could offer was words and a shoulder to cry on - it was almost as if they had expected less.

random crying

I missed my exit on the highway today because I started crying because there were bagpipes on the radio and they reminded me of my wedding day. I'm not sure how I feel about that.

The joys of trying things you're not good at

I never participated in a lot of sports in high school. I was a figure skater and a bit of a dancer, but never found the pleasure from competition and sport that some of my peers did. I think it was because I just wasn't very good at it. I was really good at school and got a lot of pleasure from reaping the rewards of being smart and it motivated me to try harder - which I can thank for getting into med school and getting my commonwealth scholarship to do my Master's degree. In sports I was so behind everyone else I felt like there wasn't a small gap to close that I could strive for, I felt like I needed binoculars to see the rest of the field.

Fast forward to now. I have started doing some mountain bike races and I still need binoculars to see the rest of the field most of the time, but you know, it has started to feel good just to get out there and participate. I know that sound corny, but participation and trying something new and exhilarating has become more important than proving I'm the best or not trying because I can't be the best. I'm married to the man of my dreams, I have the job of my dreams (or I'm on my way anyway) and this added new challenge seems more like the icing on the cake than something I need to hang my self-esteem on. It feels pretty good to have fun just going out and trying, no matter the consequences.

It's nice to be a PGY-2 going back and doing things you've already done for a second time - makes you feel like you actually know something about something! Sometimes. Other times it's extremely challenging because you are viewed by most attendings to be able to do everything yourself and asking PGY-1 type questions is frowned upon. Freedom always comes with a price!

I had my first palliative patient this week who actually expired during the consultation. While I was trying to clean his face with warm towels so the stains of death didn't disturb his family, I noticed that I no longer have overwhelming feelings of sadness when people die. I'm not sure that's a good thing. This month on palliative I have yet to cry and considering I treated someone the other day who's younger than I am and who is dying of metastatic cancer - I'm starting to wonder what's wrong with me. Is my skin growing in too thick after many years of being tender-hearted? Has my disillusionment with residency extended to not emotionally engaging with my patients? Or is it a compensation for one of my colleagues that cries over every patient. Who knows.

Back to OB next! I've delivered 2 of my own babies so far and have another due this week so I'm pretty stoked!

Dear Squirrel

Dear Squirrel,
I know you have baby/adolescent squirrels that are running around with you chucking chestnuts out of the tree on me, my car, my path, but WHY DID YOU HAVE TO EAT MY PEA PLANTS??? That's where I draw the line!!!!!

I hate when a delivery goes well, but not perfect, and I come home and obsess about it. Is this going to be the story of my career?

whole wheat kraft dinner sucks.

So, my current rotation is total balls! Not because the actual rotation is bad, but because the scheduling is a nightmare. I took 2 weeks of vacation during this 6 week rotation (which we are entitled to) and that caused a scheduling problem that was sorted out... or so I thought. Over 4 weeks I need to do 9 shifts and I show up for my shift tonight and find out the person who was supposed to teach me traded the shift to a person who doesn't teach. So, I had the ward clerk bring up the schedule for the week and not only was this shift traded but 2 other shifts have been traded... which leaves me 3 shifts short for the rotation... out of 9. Two thirds of my shifts are gone. I'm not sure what I'm going to do.

Does anyone know any physicians who were trained in Canada or the US and moved to the UK recently to practice?

I know it's a silly thing to say, but I'm nervous about my holiday. Husband and I are going to Italy and we're landing in Rome and driving 6 hours south to see/stay with my father in law and his partner. I've been getting maps and directions and phrase books and trying to figure out where we're going and how best to do it. It doesn't help that the directions I got from my father in law say that he lives on an "unknown road" and the last few directions on the google map have no street names. I know that people went on vacation and made it without GPS units and fancy gadgets for decades and I'm sure it will all be fine, but I'm a worry wart and this apprehension is make me hard to live with. I think my husband wants to kill me.

First year almost over

So, first year of residency is almost over. Someone the other day asked me what I was going to do in July... he thought I was done my two years already. That made me wonder - what am I going to do next July? Things are up in the air with the husband's job and whether he will be able to move to the town where I'm doing my residency. Right now we live about 1.5 hours apart and only see each other on weekends. It's a good thing, because my one bedroom apartment is waaay too small for both of us. We are constantly tripping over each other on weekends and now that we have 5 bikes between us, storage is becoming increasingly difficult. So, if he's making the move here, I think I'll have to make the move into a bigger place... I think a 2 bedroom is ideal for us. A bedroom and a bike room! We also still need to be on a ground floor because taking the bikes up and down stairs is very inconvenient!

Anyway, I know that I want to do OB as a part of my family practice and I know that I want to be in an office with a more experienced doc or a group of more experienced docs to bounce things off of. I have lots of patients in my resident practice who will want to follow me and some I would rather didn't!

I signed up for the LMCCII the other day - SO EXPENSIVE. I never knew it would cost me 1850 dollars. Good thing I got in on time because the late fees are ridiculous as well. If anyone has any tips - I have no idea what to expect.

I'm on holiday. I hate holiday when there's no actual holiday. I'm at home. With a cold.

I was planning on training a lot this week. This cold is really slowing me down. I tried to compete in a race this weekend and had to pull out because I felt like ass. This racing thing isn't going as planned right now. I'm hoping to see some improvement over the next couple of weeks after this pesky cold is gone. It's funny - it feels like everyone else is getting faster and I'm getting slower. How frustrating!

I'd better start reading my big stack of journals so I feel productive. And stop eating chips. Yikes.

What a shit ride!

It was raining, I had the wrong tires on and it was muddy muddy muddy. I slip slided my way around 3 laps of misery. I HATE biking in the rain. I HATE biking in the mud. I HATE when my husband tells me how I should enjoy my back wheel skidding out because it's FUN and why else would I mountain bike. I was just looking for some G-D Sympathy! OK?!?!

And they're back

The palpitations are back. I think it's a mixture of stress, exercising and caffeine consumption. I'm going to go tea free for a while. I always know this is related to stress because not only do I get PVCs but I also get horrible GERD at the same time, making me think I'm having chest pains. The summer ramp up in my training schedule probably doesn't help.

I had an awesome mountain bike ride yesterday with a bunch of guys and girls from our club. The rain fell but we weren't deterred... well, atleast the 5 of us that kept going weren't deterred. We did about 25 km of mountain biking in 2 and 1/2 hours with lots of stops to keep the group together. All in all I think my skills are improving with only one fall on a slippery wooden bridge. I did that Wednesday night race series ride last week and will be heading out there again this week and I'm stoked! There are only 4 of us in the sport women cat but there's one girl who does the o-cup cross country series as well so I think she's really going to motivate me to be more competitive.

And she died...

My first family practice patient to die passed away yesterday. She has been in palliative care for quite some time and I really met her at the end of her life. I wish I could have cured her. I wish I could have made dying even easier, I wish I could have predicted the day she would die so her family could have had more peace. I wish I had the perfect words to say to the husband she leaves behind.

New Things

I'm debating going to a weekly race series in town here. I would be going alone because husband isn't here during the week and I basically wouldn't know anybody. But, it would be an opportunity to meet people and mountain bike during the week instead of only rode riding. Bad news - I wouldn't get any more work done than I am now (um.. zero).

The first race is tomorrow. What to do!?!

ENT

I'm starting ENT on Thursday. Something I admit I know very little about. Anyone got a good ENT resource for primary care?

Ocup 1

The bike computer is found! It was in a box of granola bars we'd taken to the last race. Hoorah!


This weekend was the first o-cup race in Mansfield Ontario. It also marked my first sport category mountain bike race, which would have been much better if a girl hadn't fallen on me right at the start causing me a penalty of about 30 seconds to a minute as she couldn't get up. Anyway, I did ok (6 of 9) for my first one and learned some valuable lessons - I should eat before I start. I should try to drink something at some point on the course (point to be determined for next race). I should hold back a little on the first lap for the second. I should shoot the guy who adjusted my gears after replacing my drive train last week because I dropped my chain several times.

In other news, I spent a lot of the weekend worrying about a patient of mine who has just gone into hospital. She had bad back pain and he has cancer and then later she started having abdo pain and throwing up and I convinced her to go to the ER. When she came to our office with back pain I checked her for compression fractures and there were none and his symptoms seemed mechanical, but our usual pain meds weren't helping. I was lying in bed last night thinking, maybe she has kidney stones. I hope they do a CT on her. I'm not sure why I didn't think stones in the first place - I can't remember the exact character of the pain off the top of my head but she had been seen by two of my colleagues the week earlier and diagnosed with mechanical back pain and the pain started around the time that she was doing some heavy lifting to take care of a sick child. I wonder about diagnosis momentum. This is one of the biggest errors I've noticed in my practice so far. I need to go back to first principles when someone comes to me and they're not getting better. A valuable lesson.

I spent the weekend feeling so good and now I feel so bad. The husband is away in Mexico on a work thing and he's going to be there all week. No phone calls because of the expense and his work won't cover it. Just emails. No snuggles. I miss him.

I lost my bike computer and it sucks. I got all ready to go out on a bike ride today and then couldn't find it and realized how messy our house is. I'm not sure I could find anything in here. So... took off the bike clothes and started cleaning. Still haven't found the computer.

I really need some vacation. I feel really burned out. I have a week off in May and then 2 weeks in June. I'm ready for them now.

Medstudentitis Triumphs over Paris to Ancaster knocking 1 hour and 30 minutes off her time from last year!

big day

Big day tomorrow. Big race - Paris to Ancaster. I did it last year and suffered really badly. This year I'm gonna kick it's ass.

Yesterday I attended a memorial service for everyone who has died in our palliative care and cancer care units over the past year.

One of the staff physicians gave a speech and talked about how patients ask her how she goes to work every day and deals with death and dying over and over. She said something that resonates greatly with me - the greatest burden we carry is yesterday. Very apt for a time in my life when I have many regrets on a daily basis and fears about performing badly and disappointing my patients.

We all carry a bit of the sorrows of the past with us and the memorial service is an opportunity for us also to cleanse our souls clean and move on. It reminds us that people's lives go on after their loved one dies and they leave our doors and ours will too.

One missed diagnosis and BAM, one of my good friends and colleagues is partially blind in one eye.

4 weeks of intermittent one sided headaches that aren't relieved by the usual migraine medication. History of cluster headaches but never with this odd "Vaseline vision" in one eye.

Saw them in the cafeteria - mid fixed and dilated pupil. Took them to emerg to be seen. Expedited their entry but couldn't stay with them because I had clinic. Found out later they'd discharged with meds and a diagnosis of cluster headache.

The doc didn't look at the eye - dismissed it.

2 days later a 6 am. phonecall - "I think I've got acute angle closure glaucoma" - a sleepy drive to emerg. Thank god for a smart medical professional self-diagnosing on google.

We are all relieved when we miss and it makes no difference - but how do we deal with the one we missed that resulted in a bad outcome? I am as guilty as they are - I saw the pupil in the cafeteria and I tested the reactivity and misdiagnosed it myself - all those ophtho lectures in med school didn't sink in. I will never miss a case of this. I will never miss a case of the thing I missed a month ago - but what about all those other things I've never seen?

I'm struggling with the responsibility that comes with my profession.

Today was a horrible day. I made a mistake. I made a big mistake. The mistake was caught right before it was too late. I apologized and they accepted. I still feel like crap.

Easter is a dangerous time. I can fit a lot of mini eggs in my mouth at once.

I was angry because I got my schedule for June (emerg) and I had been scheduled for several shifts during my vacation... which was booked several months ago. Along with the schedule came a note asking if I could change my vacation to suit the emerg department. The Husband and I have spent quite a bit of money on plane tickets, rental car, bike boxes, etc. for this trip and some of those things are non-refundable. The good thing is that my program director is supporting me in still taking the portion of my planned vacation that I'm spending away (I took 2 weeks but I'm only away for a week of it). The bad thing is that without the emerg shifts during that week, I might not have enough shifts to complete my rotation. Fortunately, my program director is going to help me navigate this tricky situation.

So, more to come on this at a later date.

I shouldn't blog when I'm angry
I shouldn't blog when I'm angry
I shouldn't blog when I'm angry

back outside

Ah... this "false spring" that we're having is amazing! 2 days in a row of outdoor riding and saying a (if only temporary) goodbye to the rollers and staring at the wall. I even bumped up my average a little from yesterday to today. Plus! I found a type of bike food that I like!

I tried the cliff shot blocks and hated them (too salty and they hurt my teeth and they were too big for my mouth) and then I hit the holy grail - Gu Chomps! Cranberry apple flavour - very good. I'm still holding out to try the jelly belly sport beans (they were out when I went and bought my variety of things to try) and Luna chews. I'm definitely not into the gels and tablets. yucky texture.

I'm on ortho/rheumatology now and I really have very little to say about it. It's fine but I'm not sure I"ll miss it when I'm done. The people are super nice so that's a bonus.

YAY!!! CANADA BEATS THE USA!!!!

Figure skating controversy

Watching Elvis Stojko today on TV makes me laugh. If he was competing in today's system he would have never won because he can only jump and can't skate in between. He doesn't understand that pushing the envelope can include more difficult footwork and spins and doing your jumps in the second half because it's mentally more tiring and you risk falling on non-jump elements. One jump doesn't make a sport. It's just like any other sport - a perfect 960 can beat a scrappy 1140 that loses you all your speed.

Overall Plushenko's jumps weren't great, he wasn't in a good position in the air, his toes basically came through his skates to save a few. He stood around and posed on the ice in the last minute of the program and didn't do any jumps at the end of the program. His choreography sucked and he hardly moved on the ice at all during his footwork. The quad alone doesn't win the olympics.

There are some things you just can't look up. There are some scenarios that just aren't in "up to date" or your pediatrics textbook.

I had a friend call me today about a case and she was afraid to talk to the consultant in the hospital because they are slightly disgruntled that we are taking care of our own newborns. Hmmm... what to do? Especially if our direct family practice supervisor is away for the day. Conflict doesn't bode well for patient care.

I have olympic fever. Or, more accurately, olympic tears, joy and bliss. I have already cried on the highway, honked my horn like a maniac on the highway and stayed up WAAAAY too late watching olympics on tv.

My childhood friend Mercedes is competing in half-pipe today and I have my fingers crossed 10 or 12 times. GO CANADA!!!

Fix

Will someone please let me know if they fix google reader so you can read password protected sites?

phew

One of the physios at the arthritis program today me yesterday that it took her two years to really be confident about her examination and findings. Good thing because I am not confident in my joint count AT ALL at this stage. Oh well. The rheumatologist will check all my findings but I just find this skill elusive.

Today I have to go sit in a lecture theater and hear all about practice management. Good thing I'm already sleepy. Should be easy to snooze through it.

The battle to keep motivated

Sometimes keeping motivated is a real battle. I can just sit here and be fine with the dishes piling up and the laundry not being done and not reading journals or reading around my cases. Sometimes that feels just fine - until I wake up in a mess with no clean clothes and no dishes. Or even worse, my husband comes to visit on the weekend and feels like he's been made to be my maid and clean up after me and we argue. I need to get back on the wagon. I need to train more. I need to pull my socks up and get out of this hole.

It's funny that when you've bottled up or pushed down a lot of emotions they come out in weird and wonderful ways. For me I think all of the emotions of palliative care hit me yesterday while driving to work and hearing that Andy Barrie is stepping down from his broadcasting booth on CBC. As most listeners know, Andy has parkinsons disease and is finding the early mornings harder and harder on his day to day living. My brother hates Andy Barrie (mostly because he has a long standing habit of throat clearing even from his pre-parkinsons days) but I love him. I find him funny and relaxed and pretty amazing to keep working at 5 a.m. despite his disease. Cheers to you Andy Barrie.

I forgot how good Guns n' Roses are... damn. Best 12 bucks I ever spent on itunes.

This week is my last week in palliative care. My only home palliative care patient sadly went to hospice today and has taken a real turn for the worse. Hopefully she'll still be there when I visit the residential hospice on Thursday. I'm not sure that I'm ever going to be a "palliative care physician" but I certainly learned more about looking after my own patients in the community until end of life.

Next up is MSK - a mixture of fracture clinic, hand clinic, arthritis program, rheumatology and OR time in ortho. I'm not really looking forward to 2 months of that! Here's wishing I didn't just request all my remaining vacation in June!

I can't say it with strong enough words to convey how I feel - I am surprised, outraged and very saddened by the news that the little medic has been diagnosed with testicular cancer. What a bomb dropped into the middle of his and Miss Bliss's lives. He is getting married shortly after I have, he started his first job at a similar time. I feel like we're in the same stage of life and yet he is facing this gigantic beast. I am so thankful for my health.

paged when not on call

Getting paged when you're not on call sucks. It makes you worry about your patients when you aren't supposed to be the one managing them and it makes you conflicted about whether to manage the problem or not because you're already on the phone. Especially when it's your patient and the on-call doctor doesn't really know them.

So... I dealt with the problem and then shut off my pager. Lesson learned, shut off the pager when you leave work!

I'm not sure how people do this palliative care thing all day every day. I can't give any more of myself or there will be nothing left. I haven't cried yet. I think it's coming.

Happy New Year

Happy New Year

This year has been a pretty big one for me - graduation, starting residency, marriage, a new city and a new hospital. Let's hope 2010 is as fruitful!

sisters in cycling

My town isn't exactly big on women's cycling. Or any sort of winter cycling training. So, I ride my rollers daily in isolation. If I'm lucky, Ben and I train together in the kitchen but he has this crazy endurance-aimed training schedule that involves not being able to do any intervals or talk or do anything fun, so basically we do our own workouts and stare at each other while watching old videos of the tour.

Today I was thinking - wouldn't it be great if a group of like-minded female cyclists could get together over the internet and train together. I envision 4 or 5 female cyclists getting together once every 2 weeks or so and each taking turns instructing a spinning class. I see it being over a skype-type video conference utility where the "instructor" is seen by everyone and what the instructor sees switches between the different people on-line or is a split screen so they can see everyone else at once.

Anyway, this is a pipe dream, but I think it would be good for any of those of us who are lonesome training alone.

How come vacation always sounds so great until you're sitting alone in your living room watching toddlers in tiaras trying to resist eating all the chocolate in the fridge? Good thing I'm going to the movies with a friend to eat nibs while sitting on my ass later this afternoon :)

I'd better turbo tonight or I'm going to turn into a giant lump of chocolate. I'm looking forward to going to the cottage on Thursday and cross country skiing like mad! I wish I had my skis here because we just got fresh snow today. Unfortunately, the thermometer also dropped to -12 last night.. ouch. Ben bought new cross country skis the other day and I'm looking forward to spending some time finally being faster than him for once! I'm sure that will only lastfor a week because Ben never does something without getting really hardcore into being the best at it! Soon he'll be looking at biking as training for cross country skiing not the other way around. Plus, it's a sport that involves tights/spandex/red clothes so it'll be a hit with him.

Now that I'm married, I get really excited about other people's weddings. My friend wrote me a 2-line email asking for a little advice about planning his up coming wedding - whether to do it in Toronto or London (England) where his fiance is from and whether location has any bearing on citizenship application approval. I wrote him back a 4 paragraph message. Why? Because I secretly want to be a wedding planner. I keep asking Ben if he wants to have another wedding just for fun but he has declined. What a party pooper! So, I have to be contented with helping others.

Merry Christmas Everyone!

And to all a good night.

Gearing up for working xmas eve in the cath lab. I worked Monday in my clinic, Tuesday cardiology clinic and then OB on-call, Wednesday post-call and now cath lab. Cath lab doesn't really excite me. Let's hope I get to go home early.

Bike shorts review #1

So, I bought some shorts yesterday because they were cheap and seemed to have a relatively good chamois, and had a nice fit. They were the MEC Rapide cycling short . I'm sure there are fancier shorts out there, but I have to say, after 50 minutes on the rollers, they really stood up to the first test. I haven't washed them yet so can't say how they will fare, but my crotch was suffering a lot less yesterday compared to riding with my old shorts. The only down side is that they are a bit "squeeky" - the fabric kind of rubs against the saddle making vibrations. I'm sure I'll get used to it.

I have a pair of Pearl Izumi Sugar women's shorts and I have to say that they are just too short. They end mid-thigh and bunch up into the crotch while riding so I end up with excess fabric rubbing in my inner thigh. I'm pretty sure they're made for people without inner thigh fat. They do make a selection of longer shorts and I should have gone for one of those.

I'm really tempted to buy a pair of women's bibs. Mostly because of jersey ride-up leading to back exposure while mtbing. Jersey ride-up never bothers me on the road but I think I just move around a lot more on the mountain bike and end up with my jersey around my nipples. Maybe I should just start wearing 1 piece suits!

In other news, I did some standing up on the turbo yesterday and then managed to fall backwards off the rollers because instead of the normal side to side motion you try to stay in the middle of the rollers stationary but some of the momentum gets turned into this forward and back bumping against the front roller and then if you get enough momentum up you fly off the back of the rollers. Oops. The lino in our kitchen now has some of the rubber from the tire on it.

Have I mentioned that I really dislike cardiology? I worked with a really nice guy this afternoon, but the medicine just lacked interest for me. It all seems like a bit of mumbo-jumbo - the up-sloping ST segment means something in one patient but not in another. The q-wave is significant here but not there. Disregard this lead from the ECG - it's meaningless. Bah!

Courtesy of M and 2S, what all female cyclists need to know:
http://www.bmj.com/cgi/content/full/325/7356/138

Ok... so my rollers experience has indicated one thing to me: I need new shorts. Badly. As I don't have the skills to stand up on the rollers yet, my crotch gets REALLY numb. So, cyclists, what brand are your favorite shorts? Keeping in mind that I cannot afford Assos :)

First time on rollers - note the improper "shorts" i.e. my lululemons rolled up over the knee because I couldn't wait to jump on them when I got in the door!

I have now graduated to riding in front of the TV, but still in a doorway.

And... Our christmas tree!

Tap dancing is hard! But, I'm going back next week because it was fun. Everyone else in the class is a teacher and over 40... except me. But, that's ok, they're fun and very friendly and inviting. Now I'm debating whether to ride the rollers before going to bed.

Being a resident is all about trying to wrack your brain for that thing you learned about that disease in medical school and trying to pinpoint the right parts and ask the right questions before leaving and taking a quick peak at "up to date" before reviewing with your consultant/senior. It's all about taking 1 tidbit you remembered and trying to spin it into "knowledge". Then getting put on the spot when your attending asks you questions about all the other parts of that disease/medication/treatment that you forget. Then going home and trying to remember what you didn't know to read about it. Although, after getting through my clinic and paperwork today I got home at 8 and had to eat dinner and am now to fried to learn anything. So I drink a beer and watch a 1/2 hour of tv and go to bed. Isn't life grand?

I'm trying to start a beginner tap dancing class tomorrow. Problem is, I was supposed to go get some tap shoes after work today and ended up leaving after all stores were closed. Hopefully it'll happen tomorrow before the class.

Rollers

So,
I bought rollers today. Rollers with a front fork stand for those lazy days! The best of both worlds between a trainer and rollers. I actually wasn't too bad my first time, it just takes a lot of concentration. I didn't fall off once and I was pretty stoked about that. Ben tried to steal them from me for a while, but I beat him with a rubber chicken and he backed off :)

Tomorrow is a BIG OB day. Lots of preggos, lots of 3rd trimester management. Wish me luck!

Oh, and we put up our Christmas tree today! It's really pretty but I'm SO paranoid it's going to fall over when I'm at work and I"m going to come home to a giant mess!

Another day, another weekend trying to make up for non-weekday riding. It's freezing outside (literally) so I'm riding the trainer while Ben is insane and goes outside. Let's see if I can make it through the whole hour and a half without losing my mind. It's funny how much different the stimulation and torture factors are on the road vs. inside. I have to remind myself not to look at the clock... it just makes things worse!

For everyone who was wondering, these are rollers:



this is a turbo trainer:

The beginning of winter was not a good time for me to start internal medicine. It's my sleepy time, my low mood time, and my most frustrated time of the year. To be frank, adding something depressing to my low mood isn't all that helpful. Coupled with the fact that I start palliative care next after Christmas, doesn't seem very helpful.

In other news, I'm trying to figure out a new exercise regime as the weather becomes more hazardous for cycling outside. The question is: trainer or rollers? Riding Ben's trainer is ok. But, he thinks rollers will help my pedaling technique more. However, I think there's an element of Ben wanting access to rollers in that equation. I am afraid that I'm going to fall off rollers, although tapered rollers are easier to manage. Any advice anyone? I'm looking at you Dr. K.

In other news, I went for a cheer-up visit to the craft store today to buy a wreath for my door - I bought a nice real pine wreath with some berries and pinecones in it and a fancy hanger that goes over the top of the door. I'm really excited to buy our Christmas tree in 2 weeks time (Ben won't let me get it before them because it will die too early).

I love this... I LOVE THIS bracelet.

Do you ever discharge a patient only to lie awake at night and wonder if you could have done better for them in terms of follow-up? I didn't sleep until 1 am last night because I was fretting over a discharge I did yesterday. Now, today, I'm going to fix it because I can't have another sleepless night (I'm too tired already).

Yesterday was a long day and an exhausting day. Went in early to round on my internal patients before family medicine day. Worked until 8:30 in the evening. Came home and crashed. Starting over again today. I have a patient who's going down hill and nobody can figure out why. Her husband is very angry and yells at me over the phone or in person. All I can tell him is that I'm doing the best that I can.

Last night I made the YUMMIEST dinner ever. Amy's Nawlins shrimp (really Webbers cookbook, but Amy made them for me first and I love them), arugula/toasted pumpkin seed/chevre salad and rice. Yum! Ben laughed at me because I was enjoying it so much - but hey, I like food!

what happened to you thatmirrorbelongstofrank?? I just went to see if you've written anything new and it looks like you've gone private? How do I request and invite?

Oh my god, M and 2S hit it right on the head - so many COPD exacerbations and swine flus my first day (Tuesday). We were there from 7 am to 7 pm to get through all the consults in the ER. One very sad case, which lead to a woman with an exacerbation of COPD/heart failure being tubed in the ICU. We started the DNR conversation, but she wasn't ready and now she's vented and I'm not sure anyone will every know her wishes. Hopefully she talked them over with her husband.

In addition, one of our employees of the hospital has been admitted to ICU with swine flu. We're all a little freaked.

I start internal medicine today for two months. I am dreading it. I feel this is really my downfall because I'm not a detail-oriented differential diagnosis junky and that's what internal really is. I feel ill-prepared and nervous and I'm not looking forward to two months of this sinking feeling when the alarm goes off in the morning. And, this rotation starts at 7 am, which when I was in med school was the norm, but here in the community is on the early side since everything else starts at 9. This is going to be a shock for my body-clock!

I think the winter blues are coming upon me. The dark dark evenings and lack of time to do outdoor exercise during the week is sinking in again. Bah humbug.

Got the shot... my arm is killing me! But... no swine flu for me! Hopefully I won't be infected in the next 2 weeks while I"m waiting for it to take effect. Wouldn't that be a crapper!

I went to get my H1N1 shot today and much to my surprise, the clinic had closed its doors to new people at 5 o'clock due to being at capacity. Damn. I'm gonna have to find someone to give me the shot at work or something.

h1n1 myths

Some valuable resources for dispelling h1n1 myths:
http://aap.org/advocacy/releases/swineflu.htm

the webcasts of Dr. Bernstein from Dartmouth are very good:
http://www.aap.org/audio/cisp/bernstein2.mp3

rumors about guillain barre and the vaccine are rampant. This Vancouver Sun article tackles that question head on:
http://www.vancouversun.com/health/Separating+myth+from+fact+debate+about+vaccine/2149677/story.html

a quote from the novartis prescribing highlights:
"The 1976 swine influenza vaccine was associated with an increased frequency of Guillain-Barré syndrome (GBS). Evidence for a causal relation of GBS with subsequent vaccines prepared from other influenza viruses is unclear. If influenza vaccine does pose a risk, it is probably slightly more than 1 additional case/1 million persons vaccinated."

Some people when reading product monographs don't really understand what they're looking at. Listed in the monograph, especially in the CPS, there are study results showing every possible side effect that was seen in vaccine trials, often there are tables showing the number of people in the control group vs. vaccine group who had a certain effect. These effects aren't always statistically significant and often the incidence of the effect is higher in the non-vaccine or non-treatment group. These adverse events often happen in such small numbers in the studies that there isn't enough power to establish a cause and effect relationship. I.e. if there were fewer pulmonary embolisms in the group taking the vaccine that doesn't mean that the vaccine protects you against having a PE.

In addition, every medication has risks associated with it and we have to critically think about the level of risk. If there is a 1 in 100 000 risk of having a certain complication, but in our group the risk of dying from the disease is 1 in 30 000 (not actual statistics from any known disease or treatment) - we have to decide whether we accept the 1 in 100 000 risk in exchange for protection against the 1 in 30 000 risk.

awake

Last night I was awake from 1:45 am until 4 am with no hope of getting back to sleep. Why? Who knows. What did I do with these wee hours? read my book and cursed the fact that I'd be struggling today. And, boy did I struggle. I could hardly keep my yawns in and my head in the game. I slacked. I almost fell asleep in heme rounds and the only thing that kept me awake was free candy.

Please if there is a god, let me sleep well tonight.

Tis the season of darkness when I have to get up in the morning. I'm finding it a hard adjustment. I keep convincing myself I can get up later and later because I still feel so tired. This is just about the time of year I wish again that I had a sunrise alarm clock to turn on a light for me!

I'm slowly getting my exercise mojo back. I bought a new bike this weekend and that definitely helps. 2 x 1 hour rides after work so far this week and I'm hoping to do at least 4 during the week and a longer ride on the weekend. Unfortunately, it might rain tomorrow and I'm not sure about my bravery going out on my new oh so skinny tires in the rain.

I bought a Devinci Silverstone SL4 - I will put up a picture when blogger lets me. It's awesome, but has pointed out to me how out of shape I am!

Ben finally killed the fly.. Hallelujah!

Not much is happening around here, so that's why the posts are scant. I'm behind on writing wedding thank-you cards (about 1/2 way through) and even more behind on studying and those kinds of things, but keeping my head above water in the day-to-day. It's funny though, all of Ben and my friends seem way busier than we are. We try to make plans with people and without making them 4 weeks in advance, nobody is available. Is it that we just don't have very many friends? Probably.

Ben applied for a mortgage today.. and then called me afterward to tell me about it. Somehow I think that's a bit backward ?

There is a fly in my apartment that has been alive for 2 months and mocks me with his alive-ness. I cannot kill him no matter how many times I bludgeon him with a tea towel - not that a tea towel can really bludgeon all that hard.

Today is the first time in a long time that I'm dreading going to work tomorrow. Actually, I am really dreading Wednesday when our university "big brother" comes out to oversee our clinic day. It's a funny thing to be scrutinized and feel that if you let yourself down, you might just let your whole program down.

So far peds has been busy. and independent. and busy. A different kind of busy from obs - more scut on peds and more trying to figure out what the heck I'm supposed to be doing at each moment. I have found a good mentor though and have been following his patients. It makes it harder here because different people cover their own patients instead of the on-call doc. I haven't had much exposure to high-risk deliveries or NICU yet but hopefully I'll get called for something one of these days. I'd like to use my NRP before I lose it.

In other news, my birthday is tomorrow. I got up this morning and someone asked me the date and I realized I had no clue - and had forgotten my birthday was the next day. What am I doing for my birthday? Not much. It's thanksgiving so we're all going to the cottage. I don't feel very birthday-y this year. Maybe it's because I'm tired, maybe it's PMS, who knows.

Back to reality

Well, I've been back since Monday but there's still a big pile of papers on my desk and the apartment's a mess. Ben's coming back from work tonight so I need to clean up and make a nice dinner. Put my wedding dress in the washing machine the other day and it survived and is now going into storage until I have a bad day and need to pop it on. The tiara is probably enough for most disasters.

I was voted chief resident today by my peers - there was another guy who wanted it and so he's vice-chief. Since we're a new program this year, I'm not sure quite what it's going to mean to be chief but so far it's a bit like being a therapist :)

Ben and I doing the Gay Gordons in Scotland

The Scottish bride and groom
running after some guests who drove the wrong way!

I'm not sure who was talking, but they must have been saying something good!

There's no backing up in a wedding dress... you've just got to run around in a circle.

I am getting married. Today. How weird is that?

I am getting married in 2 days and I"m exhausted. Sleeping in tomorrow here I come.

so... the jeweler f-ed up my ring. ugh.

I am getting married in 11 days. I'm surprisingly calm... not quite a basketcase yet. I think that's because I'm at work. This weekend I felt a bit baskety. I've done most things. Still need to print out the place cards and mount them and make the seating chart and card box. Need to buy a guestbook. Need to figure out a way to convince my hairdresser I dont' need THAT much volume on the top. I have my last dress fitting tomorrow and then she's going to steam it and I'm going to pick it up (when I'm going to pick it up is a mystery to me...)

I'm hoping our rings are ready soon...
Even when there's not much to do there's still stuff to be done!