Back of the Medic

Elbow Update: I am hardware free!

2010-02-05T18:25:00.000-08:00

I went to a massage appointment today, mostly to get the crud out of my muscles. I picked up a bug recently, and was left pretty sore everywhere by it. But I had the CMT work on my left arm as well (not around the elbow, but all the muscles around it), and my shoulder. By the time she was done, I had more comfortable movement in my arm in a long time.

So, I fired off an email to my orthopedist, letting him know that I had really good range-of-motion, and that the massage really opened it up. I also asked if I could start going without the brace, as I didn't think it was making much of a difference right now. About 30 minutes later... I got his blessing to remove it.

Yep! I am hardware-free! While I have it if needed, I am working slowly to get my arm back to its norm, and hope to never wear it again. I still need to wait on major strength work until I get cleared on the 11th, but this is a significant step forward for me. My mobility is really good. With increased range-of-motion, I started feeding myself with my left arm again this week (Thankfully! Try using chopsticks with your non-dominant hand!), which has improved my muscle tone a bit, and my arm is no longer shaky when I hold something.The back of my arm is still tight near the elbow, but I suspect that will improve as well. Muscle-mass... um, yeah... there isn't any right now. Once given permission, I will be doing some serious strength training again, to get that back. My poor right arm has been a victim of overuse syndrome, so I am sure that will improve as well.

Marching onward! I will be back on my bike soon! And working more hands-on in EMS again. :-)

Back in School

2010-02-03T21:16:00.000-08:00

On January 25, 2010, I became a student again.

No, I didn't quit my day job; I am still working for the State of CA. What I did do was to sign up for two classes at a local community college this semester. The first is Introduction to Investigations. I have had an interest in criminalistics and forensics since before "CSI: Crime Scene Investigation" debuted on television. After all, I am a microbiologist by training. I've been thinking about incorporating criminal investigation into my CV, so I figured this was as good a time as any.

The second is one that is the real love... it is a pre-paramedic class. Basically, this class gives students a "leg up" with paramedic training, something that I am absolutely going to get. The program is totally different than when I got my EMT-II back in the early 1980's... I am effectively starting over. We didn't have 12-lead EKG. We didn't have the autonomy that paramedics now have. We didn't have most of the drugs that are now in the arsenal (And some of the ones we used are no longer there, or are not frontline meds.). We weren't allowed some of the advanced airway techniques that are now in use. Yes, we did endotracheal intubation, and we had esophageal airways (Those were actually in the EMT-I scope of practice at the time).

Twice now, the part-time program I wanted to take was canceled. One way or another, this WILL happen. I will find a program. Somewhere.

2010-01-29T17:53:00.000-08:00

I don't normally share other blog's posts here, but this one deserves a special place:

http://6yearmed.blogspot.com/2009/05/quiet-place.html

She gets it. She REALLY gets it.

An MRI... and good news

2010-01-26T16:05:00.000-08:00

Last Friday, I contacted my orthopedist, because I was concerned about some things with my elbow. These were:

Could not bend my elbow more than 90 degrees without pain (I have been doing exercises per my orthopedist for mobility, not strength). I wasn't sure if the pain was due to the tendon tear, or due to it needing to be stretched.
An odd "ache" that had started, with no known reason
No major improvement since I saw him on January 11th.

During my last visit, he offered the opportunity to MRI my elbow if I had increased pain, or no major improvement within a few weeks. So, after sending my email to him on Friday morning, I was surprised to get a phone call from him in the afternoon.He decided it was a good time to get that MRI done. He sent off the request, and gave me the number to call to followup ASAP. So, after getting off the phone with him, I did just that. I left a message for the MRI scheduler, figuring I'd hear something in a week. I did mention in the message that my doc had just put the request in for an ASAP MRI.

Surprise! I got a call 20 minutes later. And an even bigger surprise... an appointment at 5:30pm that night. I took it.

I showed up, and was taken to the MRI trailer. I've had 3 other MRI's, so this one wasn't a concern. Some people have real issues with the noise and the claustrophobic feeling the tube can cause. I've actually found the sound almost soothing. I know... I'm wierd. You can't have magnetic metal at all in the MRI tube. I removed my glasses, elbow brace, put my keys and ID on the counter next to my brace and glasses. Hearing protection was given to me, and I was placed in a modified "Superman" pose, prone (on my stomach), with my left arm straight out past my head, my arm locked into a tube with wedges placed inside (stuffing material) for the machine to do its magic on and scan my arm. My head was cocked to the right a bit, with my right arm bent and under my head. I had a pillow also. The scan was expected to take 30-40 minutes.

Initially, it wasn't a problem. About 20 minutes in, my deltoid and biceps muscles (shoulder and upper arm) began to cramp and spasm. I tried to not move, and succeeded for a while, but after 10 minutes, the pain from the spasms was too great, and I couldn't help it. MRI's are very sensitive to movement. So the last 2 scans didn't come out. They needed to be repeated. I mentioned to the tech what was going on, and I had two choices... hold still no matter what, or come back another day after taking a prescribed muscle relaxer. I thought about it for a minute, and decided to just get through it. I did a little repositioning of my head, and rubbed the muscles for a second, then tucked my head down and went somewhere else for the next 10 minutes. Where did I go? I went to the beach; walking on the wet sand at the water's edge in Huntington Beach in my mind. Great trick I learned years ago when dealing with pain. Doesn't always work, but most of the time. But the pain was mounting...

I was just about to say I couldn't do it any longer, when the tech announced he was done, and he got the last two scans. Whew! He pulled me out of the tube, and initially I couldn't make my left arm work. It was like a limp noodle. Started wriggling my fingers, then wrist, and finally could get my shoulder to cooperate enough that I sat up. It still didn't want to move much. And a good part of my shoulder had actually gone numb. Got my brace back on after a few minutes, and then was escorted back into the medical center, where I then left to go home.

I sat in my car for several minutes before leaving. My shoulder was twitching and cramping constantly. It plain HURT. But, the scan was done, and I hoped it would tell what the orthopedist and I wanted to know: How bad was the carnage in my elbow?

When I got home, I emailed my orthopedist to let him know the scan was done. He emailed back to me that he would check on it first thing Monday morning. I took some pain meds and went to bed.

Sure enough, on Monday, I got an email from him around 8:40am.The MRI confirmed the fracture in the bone spur, and I have a helluva contusion (bad bruise) on the triceps tendon, BUT THERE IS NOT A TENDON TEAR! WOO HOO! YEE HAW!!! We emailed back and forth a bit, with him warning me to "behave myself" (in other words, don't be working EMS directly - still supervisory only). Of course! I want this to heal NOW.

So, I can deal with a fracture. Bones heal eventually (usually). This is a bone spur, so it might not behave. If it doesn't there are options. So, I am still allowed out of the brace for minor range-of-motion exercises, and to shower. That's it. No lifting, tugging, or pulling on the arm (Not that I have anyway... I've been good.). My next appointment is on 2/11/10. Here's hoping it is healed by then.

An exercise in patience, as healing continues

2010-01-18T19:53:00.000-08:00

Just a quick update.

I am continuing to do what my orthopedist has told me to do, including brief forays out of the brace while at home to reduce stiffness. Mild movement only. But I am able to get my arm to bend to 90 degrees now without pain. Anything further, and it hurts. I have to remind myself that it was just 3 weeks ago that I got hurt, and that I really need to be patient with my healing. 3 weeks to go...

Disasters and Individual Readiness

2010-01-15T17:14:00.000-08:00

January happens to be one of the "on-call" months for my DMAT. About a week before each on-call month, I go through my 72 hour pack and my main gear bag, making sure that anything I "borrowed" from it was put back in, any foods that need to be replaced are, and that everything is in good shape. I potentially have to live out of my 72 hour bag. It has food, my medical gear, first aid kit, change of clothes, stuff to keep me busy, some survival gear, etc. And my gear bag is replacement clothing, sleeping bag, sleeping pad, pillow, spare bag (Things expand while on deployment! I swear!), MREs, and more.

I had begun this process, then got hurt. On December 31, I called my unit commander to advise him I would not be deployable for 6 weeks. I think that hurt worse than the injury. I joined DMAT to provide medical care during disasters. I made the decision to join the team right after 9/11 (I had heard about them during my EMT recert class), and I've been with them ever since. I've deployed since in 2004, and 2008, with wildland fire medical and CalMAT thrown in in-between. Even when the orthopedist told me the news, I had not immediately thought it would take me out of deployment availabiltiy, but that realization hit a few moments later.

This week, as hopefully all of you are aware, a 7.0 earthquake hit in Haiti, a few miles from Port-Au-Prince. Casualty estimates are 50,000 to possibly 500,000. That's just the dead. Injured? Try 4 or 5 times that. Illness, infection, rescue/recovery/rebuilding injuries will increase that. And the hospitals and clinics are destroyed. This is a first for DMATs. We have historically worked US missions, although some teams have gone to US territories, such as Guam, and American Samoa. Teams landed in Port-Au-Prince today, along with DMORT (Disaster Mortuary Response Team), IMSuRT (International Medical Surgical Response Team), and more. My team is on standby, although not first out the door for this mission. The medical response for this mission will be prolonged. The magnitude of this disaster is almost surreal. 3 million people are homeless. Malaria, Dengue, HIV/AIDS, Hepatitis B, and TB are endemic in Haiti.

I was asked last night "how broken I was", by one of my teammates. A few want me to deploy with the team, but I can't. Part of my readiness is assessing my capability. I am an EMT. Yes, I am also the Electronic Medical Record expert on the team, but I am first and foremost an EMT. I can't do that work right now. And I need to let my elbow heal, so that I can continue to be a responder, for the team, for my company, and for my employer. This is my livelihood at stake right now. Back in July, I had to make the same decision when I had my knee worked on. Each of us has a responsibility to ensure that we are capable of performing our work. And to assess ourselves and determine that we are not putting our team or partners at risk due to illness or injury. I don't want to do something that will make my arm worse, and potentially send me to the O.R., when I can potentially avoid it by allowing my arm to heal. And I don't want to risk the safety of my team.

Besides, there will always be more deployments. And I suspect multiple deployments to Haiti.

Elbow update

2010-01-11T16:51:00.000-08:00

I went back in this afternoon for another round of x-rays, and time to chat with the orthopedist. Although he requested an "in-splint" x-ray, the brace covered the area to be seen, so I needed to remove it for a good shot.

This is a print of the x-ray (I need to remember to bring my camera with me next time), cropped:

The text was added by me. You can see where the bone spur I have tore away from the bone (That was the initial injury on 12/28/09). Additionally, if you look at that bone spur, you can see a break in it. That was what happened 24 hours after the initial injury at the gym, when I slung my backpack on my back. Worse injury, in other words. This shot was actually taken on 12/31/09.

So, today's film shows that the bone spur hasn't moved. Which means it is still a partial tear only, and should heal on its own. But, with my propensity to shred things really well, cautious optimism is the term of the day. No surgery now, thankfully! Hopefully never. When the doc checked it out, and had me pull up with my forearm against his hand with my arm bent at about 90 degrees, it still hurt like hell. Extension is good, though, which bodes well also that it isn't torn horribly.

At this point, I am still to keep it in the brace, but I can remove it for very passive exercises when I am at home (and still for showering, thankfully). Otherwise, it stays braced. Even while sleeping. No lifting with my left arm at all. This will continue for another 5 weeks. Any increase in pain, "pop", or no improvement over the next few weeks will send me to have an MRI. But not for now. And yes, I am still banned off my bike.

Thank you to everyone for all your well wishes while I deal with this injury. Your thoughts and prayers are very appreciated.

Las Vegas Trip

2010-01-11T13:38:00.000-08:00

Last Wednesday, I took off for Las Vegas, to attend the 2010 Consumer Electronics Show. Aside from the show, my family lives there, so it affords me the opportunity to visit them as well, which I always love. The drive out there was actually quite nice. I didn't see the sun until I got onto highway 58 and up the hill a bit. As many in California know, in winter, northern and central CA are either fogged in, or it is rainy. Once up the hill, the sun was out and the temperature jumped from 44 to 60 degrees. It was comfortable.

I got there in about 10 hours, taking a few breaks along the way to rest my arm a bit. I was pretty sore when I got to the RV that I stay in. Typically, I bring the SUV for around town transportation, and my father brings his RV for the show. This year, he also brought his own truck. His RV is really comfortable. I happened to arrive near sunset, and fired off a few shots:

The show itself was fun. I wasn't very impressed my first day there, but Friday and Saturday, I got to play with a lot of cool stuff. And Thursday night, I attended a fun party, that also had a lot of great stuff to see. Some of this years swag was fun, but less companies were offering it. I didn't win anything (that I know of at this point), but I still entered the freebie contests as I found them. I reviewed a few items for publication, and will be doing more soon, including some headphones that are semi-custom in fit. And inexpensive!

Thursday night, I happened to witness a medical issue that occurred in a casino. I watched it from start to finish, since they had EMTs there. I was walking by as the casino EMTs arrived. It was interesting to watch how they handled a patient having a stroke while playing blackjack. They provided excellent care for the patient, who was tranferred over to Clark County fire paramedics, and transported to a local hospital for further treatment.

Friday after the show, I needed to rest. I did gamble a little (Hey, I have to pay my Vegas visitor's fee, right?), but got some dinner and went back to the RV. My arm was pretty sore after being down by my side most of Thursday and Friday, and being protective of it, so people didn't smack into it (The show floor was VERY busy). Some booths are extremely popular, and resemble mosh pits for the freebies given out.

Saturday evening, I got to spend time with my family, enjoying a really good dinner that was cooked by my sister-in-law, Paula (I want that recipe for the rice!). It didn't last nearly long enough, and soon I had to head back to the RV to get some sleep before leaving the next morning.

Yesterday's trip went quickly. I basically drove straight through, stopping only to get food and for some "brief relief". Took today off, just to kick back, but also because I have a doctor's appointment this afternoon to get more x-rays on my elbow, and chat with the orthopedist to make sure that my injury is stable and doesn't need surgery. I will let everyone know later today...

Working EMS as a supervisor

2010-01-02T12:50:00.000-08:00

While I am a supervisor as one of the owners of a BLS provider, I am usually a "hands on" supervisor. I am not the type to stand back and not have direct patient contact. Unfortunately, with my triceps tendon injury, and my arm in the brace at a 45 degree angle, there isn't a lot I can do, EMS-wise, except to supervise. So, I've decided to turn lemons into lemonade, and hone my supervisory skills during this time.

While I did assess one patient who has diabetes with a minor hypoglycemia issue, he self-treated while we watched him. But if he had gone to the ground, I knew I would not have been able to drop him in a controlled manner, to avoid injuring him and myself. Thankfully, the two EMTs I was supervising were right there as well and would have been in a capacity to care for this patient. After that, I stepped back and let them handle all the patient care for the duration of the shift. I need to really work on being only a supervisor for the next several weeks. And keep my hands in my pockets. :-)

On the injury front, the brace has done wonders to stop the spasms in my triceps muscle. I do have a fair amount of upper arm soreness, but I think that is due to sleeping positions and from holding my arm in a protective posture (which I am correcting and learning to relax while walking and sitting). And the soreness is in the biceps muscle, which is uninjured. The brace slips a little, so I need to re-adjust it occasionally, but it is infinitely more comfortable than a cast. The pain is down to a level that I hardly notice it any longer. Except when I bonked it a bit last night. I am going back to the gym today, but to work on my cycle time (stationary bike only - I am absolutely not allowed on my MTB), and work on lower body and core strengthening.

My 2010 Resolutions

2010-01-01T07:12:00.000-08:00

Now that we are officially in 2010, I thought I'd publicize my resolutions. None of these are out of reach, but these will take me effort, which they should do:

1. To continue my weight loss journey, losing at least 20 pounds this year.
2. To pass my pre-paramedic class with an A.
3. To find, enroll, and begin a paramedic program
4. To exercise at least 30 minutes daily for 3-5 times a week.

What did I do? - Part deux

2009-12-31T11:25:00.000-08:00

Well, I got in to see my orthopedist this morning. I am actually grateful that he was able to squeeze me in before his office hours started. Grateful, but not happy.

We chatted about what happened on Monday and Tuesday, and I explained how Tuesday, I almost hit the ground due to the pain, the lack of sleep since then, and the continuing pain and muscle spasms. He then checked out my arm, and yep, the point tenderness was right at the back of my elbow, just above the "funny bone" area. Medically, it is the olecranon process, which is a part of the ulna, one of the two bones in the lower arm, and one of three bones that make up the elbow (The others are the radius and the humerus). He thought it was a real good idea to get some films of my elbow, so off I went to the x-ray room in orthopedics.

When I came back to the room, the medical assistant put the images (I love digital x-rays!) up on the computer monitor for the doctor. While I waited a couple of minutes for him to come back, I took a look. Uh oh was right... I avulsed a section of the bone away (tore the bone) from the olecranon process. I have had a bone spur there for some time, courtesy my years of bowling (which I stopped doing 5 years ago). It is actally the bone spur that has both broken, and pulled away. What this means is the triceps tendon that attaches to the bone there is essentially partially torn.

The doctor and I discussed all of this. He made the comment, "Now, this is why we get x-rays." He wanted to cast me immediately. We chatted, and instead of a traditional fiberglass cast, I have a Bledsoe Telescoping Elbow Brace, which works as a post-op brace, but is also used as a cast replacement. THANKFULLY! I hate casts with a passion. For many reasons. One of which is I get a serious skin breakdown issue when I am casted. He told me if it was anyone else, he wouldn't even allow the Bledsoe, but he trusts me to do what he tells me, which was nice to hear.

My new hardware

So, I am in this for at least 6 weeks. I have to go back in 10 days for another x-ray, to verify that the bone has not shifted. If it has, I will need surgery to repair this. That's a big deal, because it means removing the bone spur, which means detaching the tendon and then re-attaching it once the spur is removed. It means a minimum 4 month recovery. Naturally, I am hoping this remains stable, heals well, and keeps me out of the O.R. I am going to be a damn good patient, just like I was with my knee, and do everything he tells me.

This means no EMS work, no working out the arm (obviously), and NO MOUNTAIN BIKING DAMMIT! I had my first race EVER that I was going to compete in coming up on February 7th. Pre-race is on January 24th. I am NOT happy right now.

Uh oh... what did I do now?

2009-12-30T08:08:00.000-08:00

I've gone back to the gym lately, more as a result of the weather not being very conducive to riding my bike lately. But I realized I was also losing muscle mass since my knee surgery in July. I just haven't needed to really USE my muscles much. The last time I really had to lift a patient was back in October. So, I needed to get back into a good muscle building regime, along with some good cardio.

I like mixed cardio/weights in a workout, not isolating to one or the other, when I am in the gym. Part of this is to break up the monotony, but I think (for me) that I get more out of my workouts when I do this. I'm not a body builder, nor am I a long distance runner. I am simply someone trying to lose weight, to build some muscle, and generally feel and look better. That said, sometimes I do just use the bike, or the elliptical, but I never just do weights.

Two days ago, I was at the gym, and had moved from the elliptical to a 30 minute weight session. Worked on the legs, and the back, and went to work on the biceps, triceps, and lats. I have a 3-way method on the lat pull-down machine for this. Standard lat pull down behind the neck, forward, and then I work the triceps using the same machine, but with my hands close to the center of the bar, elbows close to the body, and just bring the bar down so my arms are at a 90 degree angle, then up again, not moving the upper arms from my body (so the triceps are forced to work). No problem, right?

Set the machine for 40 pounds. First two exercises went off without a hitch. Then I moved to the triceps. First 4 felt good, then something went "pop!" in my elbow, and I felt a tearing sensation. I stopped right then. Checked out my arm, and moved it. Moved ok. No real pain. Dropped the weight to 30 pounds. 3 pull downs later, the pain returned. OK. I stopped the exercise altogether. This was going to be the end of my workout time anyway, so I went home, and iced my elbow.

Yesterday, I woke up, and my elbow felt ok. Pushing down hurt a bit, but not bad. I went to work, and finished out my day without a problem. Not that a keyboard really works out your arms a lot, mind you. Got home, and was pulling my backpack out of the back seat like a normally do, and went to sling it over my left shoulder, when WHAM! Sudden, searing pain in my elbow! 10 times worse that at the gym. I think they could hear me yell a few streets away from my apartment complex. I know one of my roommates did. Damn that hurt!

I closed up my car, and went immediately into my apartment, grabbed the ice pack in my freezer (A zip-loc bag full of peas - works great), and iced my elbow. This time, the pain didn't subside. And my elbow was feeling hot. Crap! After 45 minutes of icing it, I had some improvement, and could move it a bit without pain, but putting pressure, even typing, hurt. I spent most of last night before bed icing it off and on, fired off a message to one of my docs, letting him know what happened, and went to bed.

I didn't sleep much last night. Positions that didn't allow my muscles to completely rest were uncomfortable (read: painful). I am still waiting for an answer from my doc. I hope he is in this week. If not, I may have to call in and get an urgent care appointment. I don't know if I just tore some old scar tissue in my elbow (from years of bowling), if this is a new injury, or a combination of the two. I can move my elbow this morning, but it still feels warm, and pushing down on things hurts (I can type again with my left hand, as long as I rest my arm while doing it.). I've also started back on some non-steroidal meds (started those last night), hoping the combination of NSAIDs and icing will calm this down. Based on the improvement since yesterday, I am hopeful that I didn't tear anything major, but since I am dealing with ligaments and tendons that don't heal normally, I do have to be careful. EMS-wise, I am not working until Saturday, and if I had to work, I could right now. Might not be the happiest EMT around, but my arm does work.

In the meantime, I am going to work more on strength in other parts of my body, riding, and other cardio. I do have MTB season starting soon, and I plan on participating this year.

Merry Christmas!

2009-12-25T08:00:00.000-08:00

Just a brief message to all my readers, wishing you a Merry Christmas. I hope you are spending it with family and/or friends today. If you are working today, may your shift be busy enough to go quickly, and no majors.

New look...

2009-12-14T15:09:00.001-08:00

If you've taken notice that the site is no longer dark blue, that is intentional. I decided a change was in order, in preparation for my changing the site in a larger way. I won't tell you everything, but there will be some enhanced functionality added here soon, including links to some of my other sites.

Stay tuned, and please put up with the web "dust" for a little while... :-)

December update

2009-12-12T19:06:00.000-08:00

Not much to report lately. I've been working my "day-job", still dealing with the governor taking almost 15% of my salary under the guise of "furlough". Yeah... what its done is to cause me and 200,000 other State of CA employees major problems financially. We don't have the money, so we don't spend it. Less spending is less sales tax money for the state... see where this is going? And he calls it a "haircut"... I call it something else. Oh well, the courts will sort it out... eventually.

Still working EMS (always!), both at events with my own company, and also for the Sacramento Rivercats. Yeah, I know it isn't baseball season. Corporate events... fantasy baseball, meetings, etc. I was supposed to go out of town tomorrow, but that event was canceled due to inclement weather. In the world of mountain bike racing, that is a rare event. Its a little wierd being on a first-name basis with some of my patients, but I treat many of them over and over... kind of a "frequent flyer" system that many working on an ambulance see. One thing I do like is the follow-up I do tend to get. My patients come back and let me know how they are doing, or they email me with updates (Facebook also!). Its nice, actually. Most people working a rig just deliver their patients, never learning about how they did.

Oh... we got snow this week! I know, those of you in areas that get snow frequently are thinking... wow... not. Well, its a rare event here. Monday morning, about 2:00am, it started snowing here in the Sacramento Valley. Most areas got a dusting. We got about 1 to 1-1/2 inches. Didn't stick long, though. The last time it snowed this much was in 2002. Mike had never seen snow falling, so at 2:00am, he was out playing in it like a little kid. I wish I could have seen that, but there are pictures to memorialize it! Here is a picture of the ambulance with snow on it. Temps have been REALLY LOW for this area most of the week. Finally, the temps have come up a bit, but only due to storms that are bringing rain, and the occasional lightning strike. I wish it would snow again. Two pictures I took:

Altamont Pass

The Fremont/Milpitas foothills

What I saw on my laptop Sunday evening... 100% chance of snow in my area.

I'm not going to be traveling anywhere for Christmas. Finances are just too tight. So, I am working on decorating my apartment a bit. Found most of my decorations. Can't seem to find the ornaments for my tree, though... They have to be somewhere... I thought they were in my green and red box, but alas... I am going to be working on Christmas cards tomorrow. So, Mike, Mary, and I will spend Christmas and Hanukkah here (Mary is Jewish, and I am learning about Hanukkah from her, and she is learning my traditions, including the lighting of the Advent candles, and the prayers I make when I light them).

I do hope that the holidays bring great things to all of you. May the Lord bless all of us this coming year, as many are still working on getting back on their feet with the economic issues still facing a lot of us. If any of you are traveling in my neck of the woods, please feel free to let me know! I'd love to have you over!

Family Time

2009-11-28T07:32:00.000-08:00

Last Sunday, I received a phone call from my mom. She was asking me what my plans were for the Thanksgiving holiday. I told her that I had none, and I was just going to stay home and relax. "Aren't David or Diana (my adult children) coming?", she asked. Nope. It was just me and my roommates, one of whom had to work on Thanksgiving. Last year, I made dinner and delivered it to Mike and his co-worker. Figured I'd do the same this year.

"We're having a get-together here in Las Vegas. Why don't you come out?", was her response to me. I would if I had the money, I told her. With the governor's "haircut" taking 15% of my salary, there was no way I could afford it. We talked for a few minutes, and she let me know she was going to "work on it". Hmmm...

A little while later, I got a call from my brother John. They wanted to know what days I could travel. I could leave Tuesday evening, but I needed to be back for Sunday, since I worked EMS that day in Salinas. The next thing I knew, they were purchasing a roundtrip ticket for me to Las Vegas.

Tuesday night, I flew to Las Vegas. I met up with my brother Josh at the airport, and then John, one of my other brothers, picked us up and took us to the house. Since then, I've enjoyed just relaxing and spending time with my family. I finally got to meet my nephew Ian, who is 9 months old. I've seen pictures and videos of him, but this was our first F2F meeting. Even his daddy, my brother Josh, hasn't seen him in person since September, when he was stationed in Reno for military reclassification training. He has to go back to Reno tomorrow. Josh and Ian got to know each other again. I spent time with my brother Danny, his wife Jaclyn, and their kids, Trent, and Kaylen (my niece that I haven't seen since she was 6 months old. She's 2 years old now). Time flies!

My family has some older cats, Bear (AKA "Gut boy"), Rissa, Misty, and Peanut. Bear is the patriarch at 18 years old. The old man is still a friendly bugger, and basically lived on my bed the entire time. I guess if I was over 100 years old, I'd probably hang around my warm bed, too! Rissa is a tiny thing, but friendly. She's up there in age also, and I think she might have congestive heart failure, but it doesn't seem to bug her too much. She's my brother John's baby. He and Rissa have been best friends for a long time. Misty is extremely shy, and wouldn't stick around me for more than 30 seconds before bolting and going under the beds and hiding. Then there is Peanut. That cat is friggin' nuts! She attacks at the slightest provocation, and I have the marks to prove it. If schizophrenia exists for cats, she has it. I still managed to pet her once in a while, but that cat needs medication. Seriously, there is something REALLY wrong with that cat. Ironically, this morning, she was friendly as hell. Probably her way of telling me to get lost.

We even did a bit of Black Friday purchasing, starting with the sales at Nellis AFB at the BX. Why Nellis decided that morning was a great time to do a 100% ID check, I will never know, but we had to get visitor passes for myself and Josh's girlfriend. I decided not to be a smartass and show my federal ID. Figured it was easier with my state driver's license. And it was. We then got some items for Christmas, and I perused the bugout bags. Later, we went back, since Josh needed to get measured for and order a new class A uniform. I did get the bugout bag I was looking for (A smaller version of my bigger bag.), some 550 cord, and some other items I needed for DMAT. In between, we went to Walmart (after the bulk of the crazy crowd had left) and picked up some items.

We kicked back last night, watching the movie "Taken". I recommend it, by the way, but not with little ones in the room. Ian crawled around the entire time. He is so full of energy! Later, I packed...

Now it is Saturday, and I am sitting at Las Vegas International waiting for my flight back to Sacramento. I'm missing my family already... I told my mom that she needs to come visit me next.

At What Point?

2009-11-17T08:52:00.000-08:00

Note: A few things have been changed in this post, so the person I am referring to cannot be identified. But I wanted to share this with all of you. Chances are, you know someone like this.

A few nights ago, I was on the phone with a friend of mine for over 2 hours. This wasn't a bullshit session. She woke me up at 11:30 in the evening with a phone call, sobbing uncontrollably. She has had bipolar disorder since she was 15, and I could tell within a few minutes that she was clearly off her medications. This isn't the first time she's done this. We've been friends a long time. But this is a lifetime illness, and at age 43, she knows better. It wasn't a matter of affording the meds, although in the past, this had been an issue for her. She makes good money (a lot more than I do), has insurance that pays for her medications, and for her medical appointments that she needs to maintain her bipolar disorder (BPD).

We talked, and she unloaded on me. She was in the middle of a divorce (her 3rd marriage). This time, he was seeking alimony, custody of their 14 year-old daughter, and essentially most of the life she has made for herself. This is hard for most people to handle, but when you have a serious mental illness, it can be absolutely devastating. She had called and hung up on three other people before talking to me. I can't say I didn't see this coming. Some of her recent emails to me seemed, well... negative.

I've mentioned her before in some previous posts, because I have talked with her and even traveled to meet her when she was clearly suicidal. That time, I helped her to check in for what started as a 72-hour stay at a hospital, but which became nearly two weeks long. Each time, she stopped taking her medications. When she is on her meds, you can't tell her from anyone in the crowd. Those meds keep her brain chemistry in check. But, they have side effects that eventually cause her to stop taking them. That's when the problems start. She had been off her meds this time for 3 weeks. Last time, it was just over 2 weeks when she reached me. One time, it was over 4 months, and she was almost to the point of living on the streets. Each time, reality hits eventually, and she comes back. Her employer has always looked the other way, knowing that this occurs with her. She is an incredibly talented software engineer. With her BPD, the timing isn't predictable. Some people with BPD have a predictable cycle. Not her. It can be 3 times in a year, or nothing for 2 years.

Something about the way she was talking told me she had already decided to get help and get back on track again. But I wasn't sure if she had started. Mentioning meds is something approached at the right point, not right away. But, as an EMT, it is part of my thinking, and eventually I asked her if she had restarted her meds. Not yet, but she had gone and gotten them refilled again earlier that day. OK. That's good. She has them. What were her plans at this point? First, she knew she had to get back on her meds to be able to handle any legal actions, especially custodial proceedings. But the depression she was in was keeping her from opening those bottles and taking those pills. Or it could push her over the edge and make her take more than she should. A lot more. Its happened before. Which is why we talked and talked and talked. Letting her dump on me gives her an outlet that I always hope will allow her to see some things clearly and essentially go back and do what she knows she needs to do.

Its hard dealing with someone in the cycles of BPD. Even harder over and over again. But she's my friend. She's been through tough times, and she has an ability to rebound that is just unreal.

By the time our call was ending, she was less upset, but I could tell the brain demons were still working on her.

... She called me yesterday when I was driving home, and let me know she was ok, which was good to hear, and she had started back on the road to her recovery. She restarted her medication regimen, contacted her doc, and had an emergency plan in case she relapsed in this acute period for her. She hasn't spoken with her soon-to-be ex-husband yet, but was hoping to in the next week or so. She didn't do anything on Sunday except stare at pictures most of the day. Pictures of family, of friends, and of parts of her life she clearly wants back, but can't have. Her daughter is staying with her father, who moved out before I was called. I think she understands that she more than likely won't get sole custody of her daughter. We may meet up later this week or early next week, as she is thinking about a little travel while she gets back on track. Can't say its the smartest move for her, but if it works...

I am sharing this story to you, because when I was done talking with her, I realized the drain it had on me that night. I'm not giving up on a friendship, nor do I feel I have to maintain this friendship to keep her going (I'm not that unrealistic). But it made me think about all those people, including her husband, who have reached the end of their rope... at what point do they stop and say, "I can't deal with this any longer"? I'm not at that point, and I don't think I ever will be with her, but it did make me think. When I was dealing with my husband's illness, I have to admit, I felt that way sometimes. When would the rope break? It never did for me, the stresses of dealing with his medical conditions did add up, and took a heavy toll on me (some of which I still deal with to this day)... But it did come very close to breaking. I did almost walk away back in 2002. In my case, I had the realization, through my religious beliefs, that God never gives me more than I can handle. And that includes friends calling me at 11:30 at night needing someone to talk to.

Commitment

2009-11-10T13:07:00.000-08:00

I've made a commitment to a few things...

1. To continue losing weight via exercise (mountain biking primarily, but also at the gym), and food control. BTW, I am now down 45 pounds from my all-time high weight of 280. By the first race, I want to be a lot closer to 200 than I am now (235). Hopefully less than 200.
2. To actually COMPETE in 3 mountain bike races this spring. This should keep me on track with #1.
3. To make damn sure my asthma stays under control as much as possible, so I can get #1 and #2 accomplished.
4. To get my living room and my laundry under control tonight and tomorrow. Its driving me nuts.
5. To get my paramedic back.

So, there. I've put it out for the world to see. I plan on posting regular updates on #1-3, including that lovely weight tracker up at the top of this page.

Now, for those of you asking, "Why in the WORLD do you want to race in mountain bike races? After all, you treat these guys and gals all the time. You KNOW they get hurt." True... but I trail ride already. And its fun. Its a little different when you compete. I can be a very competitive person, and having a goal of racing (i.e. finishing) is a good goal to start with. These are simple races. I am not going down a 2000' foot decent or anything here, folk. This is decent singletrack located near my home, and I am familiar with it. Both from a perspective of riding it, and from getting people out of there. I came back to trail riding partly to understand a little more of the injuries I was seeing at the races, but being out there... well, I got bit by the bug again. And since my knee surgery, I've made a decision that I WANT TO DO THIS. Yeah, I might get hurt. I've slid out just riding the trail before. But hey, I know my EMS company will be out there providing EMS at the events... I know I'll be in good hands if I do get hurt. They are "the best"!

On the last commitment, I've decided to take the pre-paramedic class at Sierra College this winter/spring. I've already registered, and am waiting to schedule the class. Its the first step for me. I've been away so long, I need to start over. This is my chance. Then, I am HOPING that the fall part-time paramedic program will be up again at ARC. If not, I will find another program. I'd do it full-time if I could find someone to support me for the year it will take... any takers?

Athletes and medical conditions

2009-10-29T11:39:00.000-07:00

Anyone who has a significant medical condition will tell you a story or two of how they (or someone they know/knew) had an issue with their condition, and couldn't relate that to the EMS/Fire/Police/First Responder that came to their aid. In some cases, the results have been tragic.

Someone at some point created necklaces and bracelets with basic identifying information; "Penicillin Allergy", "Diabetic", "Heart Problems", etc. are all available to purchase at most local drugstores in the U.S. But it was and is for the most common health issues, and not for unusual health problems.

Then in 1956, the MedicAlert Foundation formed, and eventually had custom bracelets available.You could put basic information on it (think up to 30-40 characters total), and there was an 800 number that hospitals and other medical professionals could call to get more information. And it was a great idea. I got one for my daughter when she was an infant, as she had apnea (she would stop breathing), and other medical issues. Hers was the necklace, and we pinned it to her with a diaper pin. I also had one for years, until it came off one day out in the middle of nowhere.

As beautiful and functional as some of their products are, most of their items are, for lack of better words, bulky. And loose. Both the original bracelets/necklaces, and the MedicAlert versions are great for providing some basic information to those rendering emergency medical assistance. I look for them on my patients. And, as I stated, they come off rather easily. It was time for improvement...

Along comes ROAD ID Inc. They came up with a few designs, and began marketing them to the athletic community. These are designed to go on and stay on during exercise; something that caught my eye.Runners, bikers, and others have become their customer base. And they recently sponsored a large bike event, Levi Leipheimer's Granfondo, which I was proud to work as an EMT.

Yesterday, I received a Tweet (a message via Twitter, for those that don't know) telling me that for the next 36 hours, if I ordered a ROAD ID, 100% of the sales go to the Levi Leipheimer's Granfondo charities. I've been thinking about it, since I happen to have a severe bee sting allergy, and don't currently wear a medical bracelet (Bad EMT! I know better.), I'm playing Russian Roulette out there, working event medicine. And a bracelet designed to stay on is just what I need. Yeah, I have an Epi-Pen in my pocket, but I crashed fast the last time I was stung. And I almost lost my life.

So, I decided to order one for myself. This is what it will look like when it arrives:

So, they are taking orders through midnight tonight for the fundraiser. If you want one, go to: http://www.roadid.com/Levi/LeviCharity.aspx. Use promo code: PCLEVI if it doesn't fill it in automatically for you. You can still order one after tonight, it just won't go to this worthwhile cause.

My MedicAlert bracelet is somewhere up in the hills of Toro Park in Salinas. If anyone finds it, let me know...

Toddlers and Surgery (or... Adventures with my grandson's eye surgery)

2009-10-19T16:47:00.000-07:00

Today was another pediatric learning day for me. My 3-1/2 year old grandson had strabissmus eye correction surgery. We prepared him as best we could ahead of time, including allowing any and all questions. I was surprised at the caliber of his questions:

Are they taking my eyes out?
Will I see?
Will they cut my eye with a knife?
Will it hurt?
Will you be with me?

We very honestly answered each question as they came. For a 3 year old, these are pretty intense questions. I learned a long time ago to be honest to children, especially when it involved medical procedures. We showed him some simple pictures of an eye, and explained it. I also introduced him to a pediatric BP cuff and my pulse oximeter ahead of time.

When we got to the hospital (Primary Children's Hospital, in Salt Lake City), we found a very child-friendly facility. There were toys immediately available to the children as they arrive in the Outpatient Surgery area. And it was decorated in a way that was immediately welcoming to children and parents. Jonny immediately began playing. My daughter checked Jonny in, and was given a pager similar to the kind you get at a restaurant when waiting for a table. When it went off, she registered him, and then returned to the waiting area. A few minutes later, they were ready for Jonny to go to the pre-op area.

Jonny was assigned a room for pre-op vitals. Because he was familiar with having his BP and pulse ox checked, he had no issues with it at all. The nurse was pleasantly surprised. Some children have real issues with this. We got Jonny changed into his hospital pajamas, and we were escorted a few minutes later to the pre-op waiting room. There were several children waiting for surgery, all in pajamas. Some clung to their parents, but most were playing with the abundance of toys in the room. There was a nurse there that had tympanic thermometers (non-functional, but real), BP cuffs (functional), BVM masks, some of the odorant that the children could choose for their masks in the O.R., dolls to draw on and keep, and even small I.V. saline bags the children could all touch. Jonny chose to play with the BP cuff and tympanic thermometer. He decided *I* needed to have my vitals checked also, driving the tympanic thermometer to my brainstem, and putting the BP cuff on my wrist (it was a pediatric cuff), and pumping it up. He was remarkably calm. When the surgeon came out, Jonny knew him already, and was comfortable with him.

The anesthesiologist came out and spoke with Diana and myself, and then with Jonny. He got down on Jonny's level to talk to all of us. He explained how they would take all of us down the hall to the surgery area, then Jonny and us would have our hugs and kisses, and then he would take Jonny to the O.R. Diana told the anesthesiologist to use watermelon scent for Jonny. Jonny got a little clingy when we got up, and asked me to carry him, which of course I did. We gave Jonny hugs and kisses at the O.R. doors, and then the anesthesiologist took Jonny's hand, and he and Jonny went into the O.R. Jonny showed no fear at all as he walked in. The confidence and experience the anesthesiologist had with children was apparent with Jonny.

Roughly 45 minutes later, the surgeon came out and let us know that surgery had gone very well. He let us know that Jonny did not have the congenital abnormalities that my husband had (THANK GOD!), and that this was a good repair of Jonny's eyes. This surgery has an 85% success rate.

About 20 minutes later, Diana was escorted to post-op, and approximately 45 minutes later, I was. Jonny was still pretty groggy from anesthesia and more than a few doses of morphine for post-op pain. He couldn't tolerate light, so a wet washcloth was placed over his eyes while he recovered from anesthesia. Once he knew I was there, he started asking questions. And I answered them honestly. As I said, I learned a long time ago to NEVER LIE TO A CHILD ABOUT MEDICAL PROCEDURES.

Soon enough, it was time for us to leave. Jonny slept most of the trip home, which was delayed by a trip to a pharmacy for some narcotic pain reliever for Jonny. He had also been prescribed eye drops (antibiotic and steroid combination), which were given to us at the hospital. Jonny, once he woke up, was pretty much himself again. He even told us his eyes didn't hurt.

His first dose of eye drops was a reminder to me of how fear drives us. Jonny either remembered the first dose of drops in his eyes at the hospital (in the O.R.), or was just plain afraid of anything in or near his eyes. Diana and I had to physically restrain him to put the drops in. He complained that it hurt (which I do not doubt for a second). We got him a wet washcloth and laid it on his eyes, and gave him a dose of the Lortab elixir (mixed in Hershey's chocolate syrup to hide the bitterness). Soon enough, he was ok.

The second dose was even more difficult. But we got through it. Third dose also. Then yesterday I tried a new tactic. I explained to him that sometimes we have to take medicine we don't like, but that it was very important, and this medicine would help keep his eyes from getting sick, and would make his eyes feel even better in time. I told him we needed to put drops in once in a while. I even showed him the prescribing information (Yes, I know he can't read it), and explained that all the kids who had eye surgery had to take them. He told me he didn't want them until later and ran to his room and shut the door. Since he didn't need them for another hour, this was not a problem.

About 40 minutes later, he emerged and let me know he was ready for his drops. And I got a washcloth for him ahead of time. I put the drops in, and he let me know they didn't hurt! I praised him for being a big boy and for not getting upset. And reinforced it multiple times. I also told him he needed to tell his mommy he did the drops. He was so proud to tell her. And we now don't have a problem giving him the eye drops. They do hurt first thing in the morning (not sure why), but are easier with each dose during the day.

And so, it has been reinforced with me that honesty and reasoning work with a 3 year old. Both for the surgery, and for dealing with medications postoperatively. I was honest, his mom was honest, and the hospital staff was honest. Good take home message for all of us. Be honest with your patients, especially the pediatric patients. Lying to them only makes them mistrust you, or other healthcare providers.

The Storm

2009-10-13T22:13:00.000-07:00

Today, California got hit by a rare October storm. This storm had a lot of energy from a super typhoon that hit Japan last week, and it dumped a lot of rain today on our state. As many of you know, I live in the Sacramento region, in Northern CA. We got nailed. Trees down, wires down, trees catching fire due to the wires and transformers, traffic accidents, including a spinout that I witnessed at 6:30 this morning near my apartment complex. The power went out at my apartment for a few minutes. It was down a lot longer at my work; over 2 hours. But power is back on, and seems to be staying on.

Tomorrow, I am traveling to Salt Lake City to see my daughter and grandson. Little Jonny is having surgery on Friday to correct the problems with his eyes. We've been trying to make this happen for almost 2 years now. FINALLY! Everytime someone mentions the surgery, he tells them he wants me there. Well, he will have his wish. I think my being there will help Diana, as she is really getting nervous about her little man having to endure surgery on his eyes. I don't blame her.

I mention the trip in this posting, because I may be traveling right through the storm that just pounded us here in Sacramento. I am hoping most of it is long gone by the time I start out tomorrow.

Wow... its October!

2009-10-05T09:00:00.000-07:00

I've been running around like crazy lately. So much, that October 1rst hit, and I didn't realize it. It finally really hit me Sunday night (Yeah, the 4th) that, wow, this is October already. Just over a week ago, temps were over 100. Now, they are barely in the 70's. Of course, they will go up a bit, but fall is here. I had to grab a jacket this morning for the first time since April.

My knee is doing well. So well, in fact, that I did bike EMS up and down a trail in Santa Rosa on Saturday during Levi Leipheimer's Granfondo. Figure I did about 20 miles. Half on gravel, half on asphalt. I was the last one out on the course, EMS-wise, including the local ambulance companies who had bugged out long before we did.

Jonny will be having surgery to correct his eyes at the end of next week, and I am going out to Salt Lake City for it. Still working out the logistics, but I should leave on the 14th.

Finally! Back on the bike!

2009-09-28T17:57:00.000-07:00

Its been since July 19. That was the last day I rode my bike, until today. July 21rst marked the day I had surgery to repair the damage I caused when I fell on May 5th. Until I woke up from the anesthetic, I was working off the idea that I would take about 3-4 weeks off my bike. It was the next day that I realized the surgery was much more involved than I (and even the surgeon) thought it would be. Rehab started two days after surgery, when I began to do quad sets and isometrics.

Reality still didn't really hit until I had to have the surgical drain placed. That was 2.5 weeks after the surgery. Then the infection that set my recovery back a few steps. And finally getting the drain removed. Once the drain came out, it was finally safe to get to the gym and ride the recumbent stationary bike. Then the upright. And I've been walking. And walking... and finally a little jogging (very little). But my knee felt good. A little tight, but that's going to be the case for a while.

Today, I got on my bike and actually RODE some of the rolling hills around Antelope. And my knee didn't hurt!

It was only 5 miles.

But I did it.

Tomorrow will be the ride from my home to light rail. And back later in the day. :-)

Kids as Patients

2009-09-08T08:33:00.000-07:00

When I work events that are youth oriented, such as soccer, football, and even triathlons, I always strive to remind myself that kids are not "small adults". Many people in EMS treat kids as if they were, which is not good for a variety of reasons, including:

Their physiology is not the same as adults
Their understanding of what is happening to them is not on the same level as an adult
They sometimes display differing symptoms than adults for the same problem

I was never reminded more of this than on Sunday, when I treated a young man with a very probable ankle fracture. This kid was trying to act as an adult, but clearly was very scared, and in a lot of pain. His ankle was swollen, even though this injury happened mere minutes before. His pain was in a specific location above his ankle along the bone called the fibula (Technically, it isn't a broken ankle at that location), and bruising was starting right at the point of impact. When I asked the him to show me where it hurt before I touched his ankle, he drew a very defined line across the bone.

I explained to him that splinting him was going to hurt, but then it would get better. Its never easy to tell a child you are going to hurt them for them to feel better. So I set to the task at hand. I gently removing his shoe, as he was complaining of some tingling in his toes. Turns out, his shoe was causing the tingling, which went away as soon as the shoe came off. Then I splinted his very painful ankle, with his father assisting as an extra pair of hands and talking his son through this procedure. Once the splint was on, you could see the relief in this youngster's face. Was it really relief from the pain? Or relief that the splinting was completed? I think it was a combination of the two. He was still in pain, but not as much as before I splinted him.

The adults around us kept trying to offer the child support, but making statements that clearly went above him. He had a puzzled look on his face when one of the coaches told him, "Now that its splinted, we can get you back out there playing.". The child didn't see that this was humor. To him, what his coach said was serious. He looked at me, and I told him it was a joke. Then he smiled a bit.

I offered ambulance transport, primarily for pain control, but the father decided to take his son to the emergency room himself. So, I helped get this young man over to their vehicle, using the motorized cart I had. I gave the father instructions on how to get to a nearby emergency room. And then they were gone.

Infection Control and an update on Jackson-Pratt

2009-08-31T18:53:00.000-07:00

The antibiotic I am on is really making a big difference. Its knocking out the infection really well. My knee hasn't felt this good in a while. Mobility is much better, pain is down to almost nothng, swelling down, and redness is gone. My surgeon made an interesting comment when he was checking it last Friday, "Hey, its starting to look like a knee again!" I've been 100% on the antibiotic. Even have an alarm that wakes me up at midnight to take it. Haven't missed a dose yet.

Last Friday, 5 days after I visited the E.R., my surgeon and I sat down to make a decision about the drain. It was at a point where we needed to decide if the drain was causing the fluid to continue, or if the drain needed to stay in longer because my knee needed more time to heal. But since it was already the cause of the infection, it would probably mean I would either be on antibiotics until it came out, or I would end up sick again.

So, the drain was removed. The surgeon started putting together everything he needed to pull the drain as well as to cover the hole left over and provide good compression. While he was doing that, I asked him if I could get a release to work EMS again. He asked me, "Will you be careful?", with a tone that was a little comical, but that implied he was serious and not joking. "Yes, I will be.", was my response. And I meant it. I don't want to go through this again, not that my work in EMS did this to me.

Remember how I mentioned the joy of it going in? Taking it out was without anesthetic. Not that I think the anesthetic would have worked, since infected tissue doesn't anesthetize very well. He takes a 4x4 and places it on my knee right where the drain came out of my skin. I mentioned to him that I accidently tugged on the drain line the day before, which gave me a taste of what this was going to feel like... ugh. But, I wanted it out like no tomorrow.

"Are you ready?", he asked. "As ready as I'll ever be..." Only took a minute, but yeah... it hurt. Sometimes they do, sometimes they don't when they are removed. Since it was infected already, the tissue was pretty tender. Yeah, I watched the whole thing. I also got to take a good look at the drain (the portion that stayed under the skin for over 2 weeks). It didn't have holes. It had rails, made of a flexible plastic, along the sides. The suction pulls the fluid into the rails, and it comes out the tubing. Really interesting, actually.

So, I ended up with a bulk dressing again. Lots of 4x4s over the hole left where the drain came out, and a bulky pad over that, wrapped up with a gauze wrap and and ace wrap over that. In this case, the "bulk" of the dressing is to provide pressure on my knee to discourage fluid from accumulating again. I took the rest of the day off of doing anything, and went home to be kind to my knee. With the drain out, the pain level dropped instantly. Still tender, but not painful except a few twinges once in a while. I did fax my work release over (Yes, he gave it to me) to the Rivercats, so I could work there again. I've really missed it a lot.

On the EMS front, Saturday, I worked a triathlon, then went to a football game and worked there. Saturday night, I worked a shift for another EMT at the ballpark. Sunday, I worked another triathlon. It was really hot both days. Yeah, I jumped in with both feet. But it felt really good to be hands-on with patients again, and I needed to get tired again doing some good physical work. My sleep hasn't been very good lately, due to the pain from the surgery, the drain, the infection, and more. I slept really well the last two nights. I know mentally I've missed the work. I didn't realize that I physically did as well.