Sunday, October 31, 2010
When I went camping last weekend, I had to pull out some way to (reliably) cook food! Fire is an option, but we were getting in late, wouldn't have time to collect much kindling, and I didn't want to be hungry.  So out came the camping/backpacking stove!

When I get a new piece of gear, I like to make it generally useful for many purposes, rather than having lots of different things that serve one purpose. So when I bought this stove, I wanted one that I could use car camping, but also one that I could take backpacking without having to lug something huge around. I got this at a local outdoors store (Great Outdoor Provisions), and asked the sales kid a barrage of questions about the stoves they had before settling on one I thought would serve the purpose. I wanted something lightweight, compact, versatile, relatively inexpensive but high quality, and durable. After looking at a number of stoves and fuel sources, I went with the Primus Express Stove with Piezo Ignition (ie, no matches needed).
There are a number of great things about this stove.  First, it's lightweight and compact.  It screws directly onto a fuel canister (see picture) and the three support arms collapse towards each other to make it flat and able to fit in a small nylon carrying bag.  The piezoelectric ignition does something involving crystal lattice, matrix something, and engineering I don't get to make a nice little ignition spark with the push of a button.  It works perfectly every time.  It's generally stable, although I haven't used it on very uneven ground or in high winds.  And it boiled water very quickly, in just a couple minutes.  Although that might be helped some by this:
The little ripply things on the bottom supposedly make it heat up faster.  I have no proof that it actually works, but it seemed to heat faster than I expected, it wasn't really more expensive than any other pot, the size was right, AND it came with the pot holder.  I was sold.  And it worked.  I got the 1.7L version, which was plenty of space for a meal for 2... probably would be fine to feed 4 people.  And it matches the stove, and the fuel.  And we all know how much I love matching

Overall, it needs a few more test runs in harsher conditions before I can make my final declaration, but so far, so good!  Works as well as any camping stove I've ever used, is self contained, and is easy to pack!  I can fit the stove, the pot holder, and a couple packets of food all inside the pot.  Now that's efficiency.

Happy cooking (on the trail, of course),

Friday, October 29, 2010
Yesterday, I spent a lot of time thinking about hands.  Mostly because I spent a lot of time looking at hands.  Not how you and I normally look at hands though.  I was looking at a hand with no skin... the naked, impersonal, functional, stripped, insides of a man's hands.  It was strange.  And made me think.

I'll give you a little background.  Remember that big burn I talked about in my last post?  The one we spend 8 hours operating on on Monday?  Well, we took him back to the OR for another 8 hours yesterday, to finish excising (removing) his burns to start the healing process.  Like any other damaged, dead, or dying organ, the damaged skin has to be removed or it will continue to wreak havoc on the body and make him very sick.  So, we worked on removing the burns from his chest and arms while the plastic surgeons removed the burns from his hands. 

I spent a good amount of time holding his hand to lift his arm off the table so we could get to all the parts we needed to.  And it was strange.  You can tell a lot about a person from their hands;  how hard they work, if they smoke, if they nervously bite their nails, if they use lotion, if they have had a lot of sun exposure.  But when you take all the skin off, you can't tell any of that.  A hand with no skin is depersonalized.  But you can see what a hand can do, how it works, where the muscles and tendons and veins go. 

Before surgery, his hands were still and leathery, immobile.  Once the skin was removed, they were pliable and mobile, like normal hands.  You could imagine them doing things again, feeding himself, scratching an itch, holding someones hand.  And while they were depersonalized, there were no judgements or stigmas attached.  Just a hand, a person's hand, who was injured, whose life is totally different than it was a week ago, who needs our help to live.  There's no difference between a perfectly manicured hand that spent it's life playing the piano, and the dirty hand of a homeless man, when there is no skin left. 

By the end of surgery, his hands, and every other part of his body where we'd removed skin, were covered with a synthetic dermis that will hopefully allow for him to heal, and eventually we will graft new skin onto them.  And then they will be hands with scars, suture lines, and skin.  Right now, they are just hands, stripped down, exposed, and waiting to be turned into something new. 
Wednesday, October 27, 2010
In burn surgery, it is important to hydrate.  With something other than coffee.  While not ALL burn surgeries take place in sweltering operating rooms, some do.  Especially for patients with big burns, regulating their body temperature is near impossible (no skin = no barrier to heat escaping...).  So since they can't keep the heat in, we have to make the room their body temperature... or warmer.  Usually warmer.

I mentioned that last week, we got a big burn patient.  He's a gentleman who caught his shirt on fire while welding, and has full thickness burns to basically everything except his face from the waste up.  On Monday, we did the first of two surgeries to remove all the burn eschar (all the dead burned tissue).  Tomorrow, we will do the second half.  Because of the extent of his burns, he definitely falls into the category of poor body temperature regulators.  So, when we went to the OR with him Monday, the room was HOT.

And by hot, I mean they have to super-heat the room (above what the normal heat system can do), tape the doors shut so that no one opens them and lets the heat out, and bring in a fridge with water for us (breaking all OR no eating/drinking rules), because passing out in the OR is not cool.  When I asked, somewhere in the middle of the 8 hour surgery, what the room temp was, I believe we were in the 102-104 degree range. 

At some point, everyone took a break (as it should be!).  When I took my break, I went to change scrubs because mine were SOAKED, and before I even left the locker room I changed again because they were already sweaty again!  Maybe it'll be the latest in fad diets... I swear I lost like 13 lbs during that case!

We have another case just like it tomorrow morning...  so tonight I am drinking lots of water :) 

Maybe we'll be able to hang out in the less than 100 degree range tomorrow....
Sunday, October 24, 2010
Have you ever had water fresh out of a mountain spring?  Not out of a bottle that says, "bottled from fresh spring water, with minerals added for taste".  That doesn't count.  I'm talking, water comes from middle of mountain, out a rock, and into you belly.  Okay, so in this case, there was also a bit of man made piping involved.  I'm not sure why the pipe was put in.  But, still, straight from the mountain.  See!  It was possibly the most delicious water I've ever had...  Bottle that, Aquafina.  Yours doesn't compare.  But, lets rewind to the beginning of the weekend.

It started WAY to early Saturday morning (6:30... blech!) when I headed out for a 7K race in Huntersville, NC (about 1:15 hr drive), which was sponsored by the burn unit.  I stopped by Starbucks and grabbed some oatmeal and a small coffee for pre-race breakfast.  I would have eaten at home, but I woke up too late!  I didn't get much sleep at the end of this week because we got a new big burn patient whose been pretty sick, and I'm getting sick myself and not sleeping well.  So, I ate on the way down, and got there with plenty of time to register, pick up my race packet and timing chip, and warm up a bit.  It was CHILLY!  The course was through a business park, and was hilly but not too bad!  I wasn't setting any expectations for time  because I have only been able to run for a couple weeks since my surgery, and am definitely not in any shape to be setting land speed records!  I was hoping to pace less that 9:00 minute miles.  I ended up finishing in 35:09, which is an 8:05 mile pace.  I was very happy with that!  I ALSO won $20 in gift cards to Omega Sports in the door prize raffle!!! 

After the race, I headed to the last men's rugby game of the year.  They got beat up by South Carolina, but held their own better than I would have guessed based on South Carolina's size!  And most importantly, no one got seriously hurt (not much for us to do, but it's better that way...)

After the game, I ran home to pack, then Betsy and I headed out towards Boone to camp/hike for the rest of the weekend.  We got to our campsite at the base of Grandfather Mountain at about 6:30, set up camp, made dinner (keep an eye out for the Gear Review post about the stove we used to cook it!), read for a while, and went to bed early!  This morning, we made oatmeal and coffee for breakfast before packing up camp and heading out to find a trail to hike.  We weren't sure where we were going to go, but we knew we wanted to find good fall color, and we wanted a somewhat long hike.  We've been meaning to go to Grandfather Mountain, but to drive to the top and hike those trails you have to pay!  I think hiking should be free.  Rumor on the street was, there are trails that start off other roads that you can use to hike up to the summits, and not have to pay.  We drove around for a few minutes, and stumbled onto the Profile View trail!  The friendly neighborhood park ranger told us that it was 3.1 miles to the top, and we could do more from there as we wanted.  We ended up hiking to two peaks (Calloway Peak and McRae Peak), which ended up being a total of 9.2 miles of pretty strenuous hiking.  But it was a PERFECT day, the views were beautiful, and it was all in all a pretty spectacular day.  I also learned that you can camp along the trail and am plotting a backpacking trip return....  Here are a few of the pictures from today, to review the fun!

This is our tent-home. 

Our fire... that didn't last long :(

B-E-A-utiful view of the fall color!

Me, sitting on the edge of a cliff.

View of the Blue Ridge Parkway from Grandfather Mountain.

Well, hey there trees.

Now, I'm off to bed.  It's going to be a BUSY week, so I need to at least not start behind the sleep 8-ball!


Thursday, October 21, 2010
Last summer, I was getting ready for a trip to the US/Mexico border that would involve "camping" like living arrangements, and I realized that I basically had NOTHING of my own at my apartment that resembled camping equipment.  I'd always had access to stuff at home, but most of it didn't make it south with me.  So I set out to collect the things I would need for the trip (a tent, a sleeping bag, other odds and ends), and realized that I needed some light.  A head lamp to be precise.  I have a few flashlights, but when I'm camping I always prefer a head lamp because it's hands free! 

When I worked at Eastern Mountain Sports through high school and college, I would demo the head lamps for people interested in buying one.  We'd check out the brightness, different settings, comfort, weight, etc, etc, etc.   The things I was looking for in my new headlamp were comfort, brightness but multiple settings(didn't want to go blind just reading a book in my tent...), light weight, single head strap (vs one around and one over the top), and easy battery replacement. 

One of my favorites when I worked at EMS, and the one I decided to get this time around, was the Tikka Plus.  It's a 4 bulb LED headlamp with an adjustable angle to you can point it towards the ground and not have to look down to light up the path in front of you.  It's got three brightness settings and one flashing setting (in case you get lost in the woods or stuck on the side of a cliff, and need to attract the attention of a rescue helicopter...).  And unlike when it first came out (while I was still working at EMS), it not comes in MANY color options!  This is the one I got...

It worked great in the middle of the Arizona desert!  The low setting was enough light to read with, but not blinding.  The high setting was plenty to light up the path in the middle of the night, but I didn't feel like I was walking around with a headlight on my face.  If you WANT something that lights up the whole world, I would recommend something a little heavier (like something in the Petzl Myo line).  But this works great for around the campsite, on a trail sort of lighting!

Seriously, if you've never had a headlamp and always fumbled with a flashlight, invest!  You'll love it.  I promise.

Adventure on,
Fact: There was always 409 under the kitchen sink (or above the washer) at home growing up.
Fact:  I rarely used it, and only when forced.
Fact:   The bottle was much more boring than the 409 bottles now....

(PS, I'm having serious picture flipping problems.  Just tilt your head.)

If the bottle had had red swirlies back in the day, maybe I would have used it! 

Maybe I should explain to you why I am so excited about a cleaning product.  The other night, I made chili with some ground venison my grandpa sent me home with from Michigan!  It was DELICIOUS!  But that's beside the point... the point is that I started to get a migraine in the middle of the cooking process (it was just sitting there, bubbling).  And so when it was done I scooped some up, but was having the normal crazy vision loss issues I get with migraines, and had NO interest in trying to clean anything up.  So I put the ladle and a spoon on the counter, and went to bed (at 6:45).  The next morning, when I woke up, there was lots of dried chili all over the counter.  Uh-oh.  And THEN, I pulled out the 409 (in the cool bottle), which I got because my mom was in town and appalled (rightfully so!) that I didn't have any.  And I sprayed it on the dried up chili (and the rest of my kitchen surfaces), came back 5 minutes later, and PRESTO!, clean counters.  That smelled good.  It was like magic.

And I LOVE clean counters.  It makes me want to cook. 

Cleaning makes me happy.  Sad to say.  But it's true.  I like cleaning. 

And I like 409 to do it.  In the fancy, shiny, red swirly bottle.

Mom, you'll be so proud! 

Tuesday, October 19, 2010
The coffee shop in the hospital gets pastries fresh every morning from a local bakery.  One day, I discovered the cheddar basil scone.  I never knew that you could make a savory scone, but ohhhhh can you.  It was potentially a defining moment in my life.  Since then, I've wanted to recreate them (or try to) at home.  But it's taken me a long time to get all the ingredients in my apartment at the same time!  I went out and bought cream and then basil, but then realized I didn't have any eggs, then I bought eggs, but used too many, then I bought MORE eggs, but my basil was bad, but luckily my little basil plant I bought with Sarah had grown into a big basil plant, and had MORE then enough to offer for this recipe... then I didn't have time.  Until today.

Today, I made basil cheddar scones.  Lots of them.

I started my collecting the ingredients, just to make sure I had everything...

This is the basil from my plant.  HUGE leaves!  Now maybe the rest of the plant will get some sunlight!

Hey... I used whole wheat flour... that makes them healthy, right???

Until I added this.  I misread the recipe and really needed 1 1/2 C butter, not 1/2C.  No more butter = other solid fat.  Enter, Crisco!!

First, mix the dry ingredients (flour, salt, baking powder).

Then cut in the butter... I forgot to take a picture of that!  Then, add cream and eggs.

Chop up the basil (finely).

Add the basil and cheese, mix all ingredients together.

I skipped LOTS of steps here (because my hands were covered with dough).  Kneed the dough, spread out, and cut into wedges!

Then, brush the scones with cream (or egg, I saw recipes with both!).  I was pumped to use my new silicon brush!!!

Then, bake.

Side note, this is the leftover crumbs from my home made granola bars... I have yet to master the "forming bars that stay together" part of this recipe, but have DEFINITELY mastered the delicious part.

Rather than just eating 4 scones for dinner, I opted to throw together a chef salad with lettuce tomato, cucumber, green pepper, cheese, and turkey.  Yummmmm.

Here's the actual recipe (with some suggestions)

Cheddar Basil Scones
4C Flour (I used whole wheat, but recommend regular old white... really, lets not pretend that these are something they're not...)
1t salt
2T baking powder
1 1/2 C butter (I used 1/2 C butter, 1C Crisco, but I recommend all butter... Crisco is not quite firm enough)
1C heavy cream
4 large eggs
1C cheddar cheese (I used a bit more)
1/2C basil, finely chopped (I used a bit more of this also...)

1.  Mix first three ingredients.
2.  Cut in butter until a fine crumble.
3.  Add eggs and cream, stir until just combined.
4.  Add cheese and basil, stir until combined.
5.  Place the dough on a floured surface and knead for one minute.
6.  Divide into two balls of dough.
7.  Flatten each ball into a circle, about 1/4 inch thick.  Cut each into 8 wedges.
8.  Brush top with extra egg or cream.
9.  Bake at 400 degrees for 20-25 minutes.
10.  Eat and be happy.


Is it bad that the interview trail is already making me tired, and I'm only in the scheduling phase? 

Since traveling always excites me, I'm sure that once I start actually GOING places, I'll be having a grand old time.  But right now I'm just trying to get them all scheduled in the time that I have off, without scheduling too many during rotations. 

So far, I have 9 interviews out of 10 applications, although the last one I'm waiting for is potentially the MOST important!  I'm not very patient. 

I'm also trying to figure out what to do with Wyatt.  He hates being alone... because he's a people cat.  So I don't want to leave him alone for too long!  Ahh logistics, I used to be so good at you. 

First interview is November 12th (as of right now)!  I'll have to practice my suit wearing and question answering/asking.

Who wants to guess where I'll be this time next year???

Not me.

Sunday, October 17, 2010
It's not as far away as Japan, the center of the Earth, or Jupiter.  But I don't have any best friends who decided to spend a year on Jupiter, so it doesn't really matter how far away it is!  I do, however, have a friend who decided to live in London for a year, and I barely got to see her!  But now, she's home.  For good.  And this weekend, she came to visit.

So, we had to make up for LOTS of lost time.  We started with an ice cream cake.

You can't read the writing, but it says, "We're Awesome".  Trust me.  I don't know why people always insist that you get something written on a cake!  But they always seem to, so this is now our default.  It started with this cake, from a cruise we took a couple years ago.

And I believe two cakes make a tradition... so now we've gotta do it.  Rough life.

So, after our ice cream cake eating, we made plans for the weekend... more than we had time for :( 

I introduced Courtney to the wonderful world of bike racing (ie, our Cyclocross race!), but only after introducing her to the wonderful world of warm Krispy Kremes.  She said the donuts were fabulous and the cyclists were all crazy.  I agreed.  We sat in waiting to save lives.  Luckily none needed it. 

Then, we made lunch.  It was healthy, to prove we can balance out the cake and donuts.
Roasted veggies a la farmers market.  Yum.  Then we headed to Lexington to spend the evening with some friends, and came home and went to bed early like a couple old people.  We're okay with that.

This morning we did what all the cool kids do at 9AM on a Sunday morning.  We watched Meet the Press, drank coffee, and carved pumpkins.  We checked them out in the bathroom with the lights out to see if they looked good.

They turned out pretty awesome.  Between the two of us, we have about 15 years of higher education... but if that doesn't pan out, we are planning to fall back on a career in pumpkin carving.

After pumpkins (and pumpkin seed toasting/roasting), we headed out for more friend visiting, and some errands/walking.  It was a BEAUTIFUL day and I live far to close to the places we needed to go to not walk.  So we did.  It was perfection.  Then we came home and made dinner. 

Venison tenderloin w/ red potatoes in my brand spankin' new Le Creuset pot.  It was a perfect way to break it in!  Dinner turned out delicious (the pic above is clearly BEFORE cooking, FYI).  We also polished off a bottle of wine we opened Friday with our cake. 

Then, we lit our pumpkins because it was dark outside, and sat looking at them proudly.  Until the candles burned out.  Aren't they festive?

Now, I'm alone again because Courtney had to go home :(  At least I still have the "We're Awesome" cake.

Ahhh, good times. 

She's not allowed to go back to London.  Unless I go too. 
With fall a'commin (I know I've been talking about fall for, like, a month, but these 80 degree days keep popping up and resetting my clock...), I was in need of some new outdoorsy pants with a touch of insulation.  I have a great pair of Patagonia lightweight pants that work well for the summer, and for fall hiking, but when I'm going to be doing some camping/sitting around in the fall, lightweight just doesn't cut it!  I found these Nike ACG (All Conditions Gear, Nike's outdoor line) pants at Dick's Sporting Goods while shoe shopping with my dad, and used some of his hard earned reward points (thanks, dad!) to get a few bucks off and bring them into a medical student budget. 

What I was looking for was something comfortable, warm, and durable that fit well, seemed well made, was easy to move in (read: jump over rocks/run from grizzly bears/climb mountains and cliffs).  I got them in khaki because I have shirts in all sorts of bright random colors, and I definitely didn't want the pants to limit which awesome shirt I could wear!

They were tested the other weekend for the first time when Chris and I rode the VA Creeper Trail, and then went hiking in some cloudy/sleety conditions.  I'm pleased to say they performed quite well.  They survived the cold temps of  evening (sitting by the campfire... err, stove), they sleet of hiking, and the vicious pony attacks. 

See how stretchy they are?  My only complaint is that they were a bit long and soaked up the rain water about halfway up my calf.  Although (as you can see from the picture), I was wearing my Keen sandals, which don't have a whole lot of elevation.  So with regular hiking shoes, they may be alright.

I liked them enough to go buy another pair (in charcoal).

I'm holing to test that pair next weekend... perhaps at a waterfall from my yet to be used book of waterfalls in NC?  Perhaps...

Adventure on,
New season = New layout!  Let me know what you think!

I've been negligent in my updating this past week... Here's a brief review of what's gone on.

Relay for life meeting
Flag football semifinals (don't worry, we won)
Two days of surgery
A few new burn trauma patients
A BasketBall Gala
A giant migraine
A few good runs
Some cyclocross racing
Courtney Harvey
Dinner theater
Olive garden

I'll post a real update soon, with a new gear post AND a recipe for the amazing pumpkin seeds that we are currently roasting (I think worcestershire sauce and butter make the best oven smell...)

Tuesday, October 12, 2010
Okay, so today was really day 2 in the burn unit, but I was tired yesterday, and fell asleep before I had time to post.  But day 1 was certainly more post-worthy that day 2... so we're just going to pretend.

I chose to do a rotation in the burn unit this year, because I did a rotation last year during surgery, and really loved it.  I chose to do one last year because I thought I was going to hate it.  Burns are one of those things that I was always afraid of, that seemed kind of mysterious, and seemed almost "beyond medicine", beyond help.  But during my month last year, I came to enjoy the surgeries, the medicine of taking care of burn patients, and the progress you can make with a burn patient, albeit slow, that gives them back a normal life. 

So yesterday, I headed up to the BICU (burn ICU) at the time I was told to be there, ready to jump right back in where I'd left off almost a year ago.  I was met with a situation I hadn't experienced last year.  Not only was I alone on the unit (there was a 3rd year med student, but neither the PA's nor physicians had arrived yet, but we had a patient who had come in overnight that they needed some direction on.  Normally this wouldn't be a problem, except this was a situation that I could do NOTHING about.

Overnight (around midnight), a patient came in after being pulled from a mobile home fire in which his home was burned to the ground, and he was pulled out by fire fighters after being found right inside the front door.  He made it from the ED up to the burn unit, but he had a "nonsurvivable injury".  Over 93% of his body had full thickness (3rd degree) burns.  He required a surgical airway in the field to ventilate him, his face was completely burned, part of his feet had been burned off.  The only part of his skin that remained intact was a portion of one arm and flank.  There is a score that we calculate that determines, based on age and percent burn, what the likelihood of death is in a burn patient.  His score was 149%, meaning there is a 149% chance of him dying from these injuries.  Given modern burn care, we actually can save people up to 120%.  But he was well beyond even that.  He we kept alive with comfort care while they tried to locate family, but after hours and hours of trying, we were not able to contact them.  Eventually, it was decided that it was inhumane to continue to keep him alive, and support was withdrawn.  He passed away less than an hour later. 

It's something to see, a person with injuries like that who is still alive.  The truth is, he would have lived a bit longer if we'd continued care.  But he was in excruciating pain.  And the body simply can not heal such huge wounds.  Infection, organ failure, fluid loss, huge metabolic needs; any number of things would have eventually taken his life. 

When I was in the BICU last year, we didn't have a major burn come in during the whole month (meaning >60%).  I hope we don't have another one for the rest of the month.  Today, we saw many more manageable cases.  People with smaller burns that we can treat, heal, and give back normal lives.  It's extremely satisfying to take a patient that, without care would most certainly die, and take them to the point that the only way to tell they were burned is to see the scars. 

I'm sure there will be many more stories over the next month, hopefully of success.

In the mean time, I'll leave you with some lessons learned on burns.  Please, heed this advice.  It's based on 2nd hand experience.

Don't, ever ever ever, smoke while wearing oxygen.
Don't burn the fringe off cut off jeans... while they are still on your legs.

Stay safe!
Saturday, October 9, 2010
I have quite a busy day planned!  It started with a trip to Lowe's, and the farmers market, and now I'm getting ready to go to a rugby game, then heading out for a run, then going to the football game (or maybe dinner with a friend... not sure yet!)!  And it's a BEAUTIFUL (although a bit warm) fall day!

So, after going to Lowe's, I decided I needed to stock up on produce for the week.  I love going to the farmers market because there are lots of interesting people, I can get basically anything I want or need, it's all local, fresh produce, and it's cheap!  Today there was a crafts festival also, and the place was crammed!  I don't think I've ever seen it so busy.  But it was definitely to my advantage, as there were all sorts of new stands I hadn't seen before (breads, cupcakes, goat cheese, chicken, tree nuts).  I'm going to try to make it a weekly outing, at least until winter :)

Today, I got squash, zucchini, three sweet potatoes, red potatoes, a couple bunches of broccoli, a dozen eggs, a loaf of fresh bread, and a huge apple muffin for under $20! 

And then, I came home and proceeded to promptly drop my brand new light bulb from Lowe's onto the floor, where it shattered into 4500 pieces.  Whoops. 

And THEN, I made a delicious egg sandwich with my fresh loaf of bread, farm fresh eggs, and a slice of cheese I already had in my fridge.  And it was delicious. 
Thursday, October 7, 2010
As people who race bicycles go, I am NOT the most coordinated of the lot.  You'll never see me cross a finish line with both hands in the air, my left had rarely leaves the handlebars, and while I can ride around all day with my right hand in the air, if I hit a bump, it'd better be ready to save the day from a wobble and crash.

Taking all of this into account, I have had one (maybe two...) not so awesome experiences with refueling during rides.  These include chugging down a big glob of undissolved electrolyte "beverage", and disasterously finmbing a stramberry Gu, resulting in strawberry Gu all over my hands, shifters, cables, stem, and tire, which, PS, is not easy to get off.  Gross.  So, with these various catastrophes NOT making my rides more enjoyable, I went on a quest for something that would provide adequate fuel, taste good, and not make a mess if fumbled.  Enter: electrolyte "gels".  There are many many brands, and I tried lots of them.  Two of my favorites, in texture, flavor, effectiveness, and ease of eating/access are Gu Chomps and CarbBOOM energy chews.  I've had more experience with the CarbBOOM chews, so I thought I'd throw them up in the Gear section, and give them the props they deserve.
They come in citrus and wild berry, and I'm definitely a bigger fan of the citrus.  I think it's a bit more refreshing, especially when I'm hot and thirsty.  So what I like about these chews:  the flavor is excellent, the package is easy to open, the proportion seems excellent, they don't melt/stick together if they get warm, each piece is small enough that you don't feel like it's a whole mouthful.  The one con is that they are incredibly sticky, so it's pretty hard to "chew" them.  It is, however, easy to get them stuck on your teeth and suck on them until they dissolve, which, for me, works wonderfully. 

I will say that sometimes, I need faster fuel (ie: rapidly impending bonk), and gels are definitely better in those situations (and I do use them, they just sometimes make me gag a bit...).  But, for general timely refueling during long rides, these CarbBOOM chews hit the spot. 

What is your refueling item of choice? 

Avoid the bonk,
I'm coming to the end of my orthopedics (foot/ankle/trauma) rotation.  In the past 4 (almost) weeks, many people have asked or assumed that I'm going into orthopedics.  Some are surprised, some not so surprised, when I tell them I'm actually going into Family Medicine and want to do Sports Medicine.

For those of you who have not known me since I was a youngin' (or, in high school I guess), orthopedic surgery was kind of the plan since I decided I wanted to go into medicine.  That was also the plan as I started medical school.  I was never really interested in the spine/joint replacement side of orthopedics, but really liked musculoskeletal medicine, trauma, and sports medicine.  I think a lot of it comes from orthopedics being very mechanical, and very logical.  But as I went through the first two years, and into third year when we started doing rotations, I realized that I also really liked patient continuity (not that that really surprised me), taking care of everyday problems, and getting to know patients and being able to at least address all of their problems and concerns.  I also discovered the world of primary care sports medicine.

Prior to coming to medical school, I thought the only way you got to take care of athletes was to be an orthopedic surgeon.  I'd never though about all the other stuff that athletes need that doesn't fall into the realm of things that orthopedists take care of.  But as I rotated through family medicine, got to know some of our primary care sports medicine docs, and spent time doing event coverage with them, I realized that I was incredibly comfortable and happy in that setting.  It gave me all the musculoskeletal medicine I liked, the acute sports injuries, but also the ability to take care of concussions, heat illness, normal illness in an athlete, nutrition, conditioning, and also leaves the flexibility to take care of normal family medicine patients.

Now, don't get me wrong, I still definitely enjoy the actual surgery part of orthopedic surgery.  And on some level I know I will miss not being able to take care of patients from injury through complete recovery (if their injuries require surgery).  I also think that I would probably be a pretty good surgeon.  But I've figured out over the last couple years of trying to make this "career" decision, that no matter what I choose to do, I will have to give up something I know I would enjoy doing.  But, unfortunately, I can't do EVERYTHING.  Fact.  Sad, but true.  So the question became, what will I miss less?  Will I miss surgery less, or will I miss family medicine/patient continuity less.  And I decided that I would rather give up the surgery than give up the ability to continue to take care of every day medical problems. 

I don't want to be the doctor on the sidelines who gets called to the stands for a spectator whose passed out or had a seizure, or is having a heart attack, and have no idea what to do.  It's important to me to have the skills to take care of people, not just injuries.  I know that if I did orthopedic surgery, I would miss being able to take care of everything else, being able to be the one person who takes care of a whole patient.  I know that as a sports medicine doctor, I want to be able to take care of athletes of all ages and abilities, through many injuries and illnesses, and during different times in their life.  And I'm confident that this is the decision that is right for me. 

Sometimes, I get twinges of sadness that I won't be in the OR once I finish my training...

And then I spend a day in clinic, an evening on the sidelines, and I get over it.
Monday, October 4, 2010
This weekend, I put my new CamelBak M.U.L.E to work.  I also just spent about 27 minutes googling "M.U.L.E" because I figured it had to stand for SOMETHING (seeing as there are periods after each letter...), but I came up with nothing.  Disappointing. 

But that was really the only disappointing thing about this pack.  I've used it once before, but not for any long trip, so this was it's first true test, and it passed with flying colors.  When I bought it, I was looking for a day pack with a couple specific features.  I wanted it to have a hydration bladder, a low profile, enough storage for all the small stuff I take for a full day hike, and some external straps for stuff that wouldnt' fit inside (like a jacket).  I also wanted something that looked nifty.  Hey, if I'm gonna spend the money, I at least want a cool color!  After much hunting (like, a year or so), I finally broke down and went with the CamelBak MULE, which has a 100oz hydration bladder (with easy fill opening, antimicrobial tubing, and a lifetime warranty!), and 600 cubic inches of storage space.  It's perfection in a hydration day pack. 

Test numero uno of the weekend was the 50 mile bike ride down the VA Creeper trail and back.  It needed to hold: water, a couple Gu's and clif bars, a map, my camera, my phone, my sunglasses, my bike headlight.  It also needed to not flop around while going through bumpy stretches, needed to not make my shoulders hurt, and needed to be cool enough that my back didn't get sweaty.  Success on all fronts.  Because it wasn't hot outside, I didn't fill the bladder completely, but even if I had, it's equipped with a hook to hang the bladder from so it doesn't slough to the bottom of the pack, and keeps the weight distributed evenly.  I stuck my phone and camera in the iPod pocket at the top, which has a water resistant zipper seal.  I put everything else in the lower organization pocket, which kept it where it was supposed to be.  All in all, it was a success.  Comfortable, cool, organized.  I took the waist belt off (easily unclips), and just used the sternum strap which was comfortable and kept it in place plenty well.  Here you can see the pack in action... as a platform for my camera.  It didn't do that job so well.  But I bet it would do an excellent job of holding a Gorillapod.  This one even matches. 

On Sunday, I used it for a hike and had equally awesome success.  I jumped around a lot more (ran down a mountain for a bit), and it didn't shift or bounce like some packs I've had.  It held everything I needed, and could have easily accommodated my jacket in the compression straps had it not dropped to 45 degrees and started sleeting!  Here you can see the pack really in action.  It must have some scent barrier protection, because it was the only thing the ponies didn't try to chew on.  It also made me relatively visible in the dense fog. 

So, there you have it.  My CamelBak M.U.L.E is a win.  Now if I could only figure out what M.U.L.E. stands for!!!  Any suggestions?

Soon to come in the gear review department: Nike ACG pants, Petzl headlamp, CarbBOOM energy gels, and Columbia softshell jacket (a couple of which are in the picture above!).  Stay tuned!

Adventure on,
Apparently, in the world of trauma orthopedics, it was a slow weekend.  Which, for me, means that we finished both our cases by 9:30, I got coffee with my attending, and have time to write a blog post I have been avoiding for a long time.  So, here it comes!  We are about to delve into the world of chronic pain...

Chronic pain, and the narcotic use and abuse that comes along with it, is one of the most difficult things to manage in medicine (according to me).  Patients with chronic pain don't fit into one box, although I think a lot of times we try to put them all into the same one.  These patients are as varied as patients without chronic pain in all of the things that we tend to label patients for: noncompliance, motivation, obesity, comorbidities, disability, job status, tobacco and alcohol use.  When someone comes in complaining of chronic pain who works a white color job, has never smoked, exercises regularly, has followed all the recommendations doctors have given them, and has never lost a prescription for vicodin, we tend to trust them.  When someone comes in complaining of chronic pain who is on disability for back pain, smokes a pack and a half a day, eats cheeseburgers, and calls in the middle of every month for a refill of oxycodone, we tend not to trust them.  Right or wrong, good or bad, that's how it tends to be.

Taking care of a patient with chronic pain means you are trying to accomplish a number of things in an undoubtedly frustrated person.  You're trying to treat their pain, prevent addiction to narcotic medications, give them as much of a functional lift as possible, treat their other medical problems, set out clear expectations and boundaries, and identify treatable sources of pain (ie treatable by means other than pain meds). 

The problem with treating pain is that there is no way to monitor how well the treatment is working, or how much pain a person is "really" in.  The end goal, one would hope, would be to control pain enough that a person could function normally, without being too zonked by pain meds, and without being in too much pain to do the things they need to.  This is a difficult balance that is dictated by the amount of pain, a person's pain tollerance, their motivation to do normal function, the kinds of pain medications they are on, their dependance to the medication, and any secondary gain that is always a concern with narcotic medications.

As I see it, these are the major complicating issues in pain treatment:

People have different pain tollerances.
People have different motivations.
Some pain medications are controlled.
We can't measure effectiveness by anything other than patient report.

These are the questions I ask myself when considering treating someone with chronic pain:

Who am I to judge how much pain they are in?
What kind of meds are they on, and what have they tried?
What is the source of their pain?
Is what we're doing helping?
Is there an end in sight?

And these are the tough questions that make me think I will be very conservative with pain medicine when I actually can prescribe it.

If narcotics aren't working, why keep prescribing more?
Is it my responsibility to refill their meds if they keep "losing" them?
If their functional status doesn't change with pain control, what's the point (ie why are they on disability)??

I realize that some of this makes me sound jaded, or mean, or whatever.  That's part of learning the balance, I think.  Patients have real pain, and need real treatment.  But it's important to give them realistic expectations of how much you can help them.  For the most part, patients with chronic pain will never be pain free.  There are lots of people in the world who live in pain every day and live normal, productive lives.  I think that is my major hang up with the whole pain thing.  If you're going to be in pain doing stuff, or not doing stuff, why can't you do stuff?

That's what it boils down to for me.  But that is coming from a person who likes to do stuff.

So, will I treat chronic pain, prescribe narcotics to patients when I'm actually a doctor?  Sure.  But I imagine I will lean on the more conservative side than some people.  This very well may change as my time in medicine moves on.  But I think setting boundaries and sticking to them from the start is important for both the physician and the patient.  That way, if/when a situation progresses to the point that the physician is concerned that there may be dependance, abuse, ineffectiveness, or secondary gain, there are established rules to fall back on. 

How do the medical and the non-medical people of the world feel about this issue?  Should doctors give pain medications freely without question to patients who request them, or should they be restricted?

Weigh in!
Sunday, October 3, 2010
... Sort of.

So this was the general plan for the weekend:  Wake up Saturday, drive to Whitetop, VA with my cycling friend, Chris, and his wife Erin.  Set up camp, unpack, then drive to the start of the VA Creeper trail.  Ride.  Ride some more.  Maybe stop for lunch.  Finish riding.  Go back to camp, eat some tasty dinner, shower, do camping-like stuff.  Wake up Sunday, eat breakfast, pack up camp, do a little hiking, drive home.  And that's pretty much how it went... except I spent a LOT of time distracted, and not taking pictures.  Sorry.  Here are the ones I did take!

Chris, status-post somersault over handle bars.  He successfully tried to be friendly and greet a couple on the trail, looked up, hit a rock, and gave the poor woman a heart attack by flipping over his bike and slamming into the ground.  But he's okay!  This is our halfway/turn around point, 25 miles into the ride.

This is a cool hotdog stand we found on the side of the road.  I think it was out of business... they left everything inside though!  It was very strange...  But made for a good picture.  Those are our bikes, PS.   This was about 10 miles from home... ish.  I should have downed a Gu at this point... but I didn't.  And I paid dearly for like 45 minutes.  The last 10 miles were painful.  And uphill.  But I survived.

This is the attempted setup so we could set the timer and get a picture of both of us... it failed.  But we gave it the good ole' college try.

Post-ride, I found this flower stuck in my spokes.  I thought it was cute.

Start of our hike.  Chris, Erin, and Cash's head.

Chris was repacking his bag.  Apparently somersaulting onto the bladder of his hydration pack caused a little leaking... Being soaking wet on a 45 degree hike is not cool.

This is for you, Dan.  We did a little Appalachian Trail hiking!  No views... except for of clouds.  But it was still fun!

Pony gate, and clouds.  It's so the ponies don't escape through the gate, but people do. 

Here is a white caterpillar. 

Cash frolicking on some rocks.  He had a good time running around crazy.

A man and his dog.  On a rock.  In a cloud.

Cash, and his new best friend Bubba.  They looked alike. 

Hey, look!  A Pony!  Wanna be my friend?

Hi pony!  Lets be friends.  You look nice.

There's nothing in there!  The other one wants to be friends too...

Just call me The Pony Whisperer....

Give me back my pants!  I started calling that pony Goat.

Why's the pony so nice to Chris?!?!

Cash did not like the ponies.  Apparently he used to play with them, and then he got kicked in the head.  At least he learned!
So, there's my weekend!  50 miles on a cyclocross bike (pretty epic), 8ish miles hiking, delish camp food, quality time with friends and mountains, leaves changing colors, fall weather, and Aunt Bea's for lunch on the way home!  Oh, and a farmers market.  Which is always a good addition to a weekend. 

Look for a gear post soon... I got to try out some new stuff this weekend!  And it was all successful.  Phew.

Adios for now!

About Me

I am a Family Medicine intern at a community hospital in Indiana, navigating the new world of being a physician. I am privileged to work in a field I love, where every day is a new and unpredictable challenge.
I am not only a doctor, but also a cyclist, runner, DIYer in the making, lover of the outdoors, traveler, and human.
Human, MD is a glimpse into the world of a young doctor who is just trying to stay true to herself through the grueling whirlwind of residency.


Visitor Count