Tubed the Goose

Today I had airway in the OR...I missed an intubation for the first time. But I don't really consider it a bad thing. I had to miss sometime, and this patient was very difficult. I tried a different laryngoscope blade, because I've used the same one for my first 5 intubations and I wanted to try the other one. This patient had an excellent airway exam but once he was induced he turned out to have a very poor (Grade III) view, in other words, no cords to be seen anywhere. I tried anyway, tried to direct the tube where the trachea should be, but "tubed the goose" instead (intubated his esophagus, or 'goose'). The CRNA I was with tubed the goose after me, and the MDA ended up having difficulty too and used an Eschman stylet to intubate the patient. So I didn't feel bad for not getting this tube, AND I got to see what a Grade III view looks like, for the first time. The Dr. got on my case for trying a new blade so early, but we've been encouraged to try both blades the whole time by John, our airway instructor, and the CRNA also said I did fine and there's no problem trying a new blade, especially on someone who had a good airway exam preop. So I really felt okay about the whole thing. The patient was easy to ventilate between intubation attempts, so there shouldn't have been any pressure, and I really wanted to try again with the Mac blade, but the doc was feeling the pressure of the room, which was a case done by a surgeon who has a history of anger management problems, so the whole room is always tense for his cases. So she just intubated the patient, and that was that. Still, a good learning experience, and I got my first "miss" out of the way so I don't have to worry about that coming. I think when I do IVs on Tuesday I might stay for an airway when I'm done...we'll see.

Just got back from a swim a few hours ago. I got in 40 laps in 30 minutes. It was very tiring. But I felt pretty good. I kind of felt like running instead, actually, but I wanted to stick to my plan of running every other day. Twice a week weights...I'll do them once this weekend.

We got a long weekend, early! We're supposed to have class tomorrow, but one thing happened and then another, and all our classes ended up being cancelled. So I'm taking the train to Portland tonight, yay! It will be nice to be out of Spokane for a few days. I have major studying to do for our A&P exam on Monday, but otherwise I'm in good shape I think.

Milestones

Well, I had a lovely couple of days' visit with hubby. We visited the Buddhist temple on Sunday, and were able to spend quite a bit of time together for a few days. Yesterday we went down to the Rocket Bakery (a Spokane favorite) and had lunch together, and then I was able to study for a few hours while he worked. It was really nice. He headed back early this morning, and I'm hoping to be able to come out to Portland this weekend. I have an exam on Monday morning, but if I'm able to get my cards made early and get organized so I can study effectively in Portland, I might be able to do it. I'd like to hang out in Portland for a little bit, and go to the Portland Running Co. to get new shoes, and go to Saburos. We'll see how studying this week goes.

I had the big airway exam today. It's sort of a milestone in the program; you have to pass it with 90% or better, and it's long. John gives us 4 hours to take it, although I finished in 2. I always finish exams quickly, usually first. It's not intentional, I just don't write as much as others, and I think quickly. I don't get the best grades in class, but they are high enough to keep me strong in the program, and I don't really see any reason to change what I'm doing, so I don't. Anyway, the exam wasn't terribly hard if you studied, which I did. He told us what would be on the exam, in general terms, and it's all stuff we have to know, period. It was fair, but long, because it's mostly short essay answers. It's nice to have it behind us. I'm reasonably certain I got better than 90%, but of course you never know until you get the exam back. I had enough time left over to go home for lunch, and relax for a couple of hours before pharm at 3. Our class only lasted about an hour, and then I went to the gym.

After the rather poor last run with the shin splints, I decided to take a couple of days off from the gym altogether, so I didn't go Sunday or Monday. I looked on the Couch to 5K schedule and figured out about where I've been training at, and decided to follow it from that point on. I decided I was at about week 6 out of 9, so I did the first week 6 run today, and it went great. No shin splints, yay! It was a total of 21 minutes, broken into 5-8-5-3 minute chunks. I felt good and was able to hit a good stride (a slow one, mind you) and felt good during it. I did my full set of weights, and got done around 6. It was very chaotic in the locker room, so I came home to shower. The morning clouds have finally given way to a lovely sunny evening, so I'm going to throw some laundry in and go enjoy the day a little before the sun goes down.

The weight I gained back is VERY slowly coming back off, so I guess the plateau isn't officially over. I must need a fill. I have been letting more (sugary) snacks sneak back into my diet than usual, too. I'm shaking things up with my exercise, doing some cross training and such, and I have a fill scheduled on Thursday, so hopefully I can get things back on track here. The no-coffee thing is going okay. I have had an occasional cup when I can't stay awake in 3 or 4 hour lectures, but otherwise I've abstained. Even if the coffee itself doesn't affect the weight loss, certainly the sweetened creamer I use can't be good for it, and I like a bit more than I should really use. So it can only be a good thing to cut out the coffee. Thanks for the tip, Lori.

Wow: A fantastic resource

Anyone who is a newbie runner like me will appreciate this great resource, from the old Cool Running message board (it's been changed and apparently it's not as great anymore). This is packed full of valuable info for those who are totally new at this, like me, and maybe for some who have been running a while but don't know all the vocabulary or details. It's the Cool Running Newbie Wiki:

http://coolrunningnewbie.pbwiki.com/

Awesome info there. Enjoy.

Hmmm...maybe not

I tried the 2 minutes run/1 minute walk method endorsed by Jeff Galloway tonight. I ended up feeling sluggish, never getting a good cadence, and developing what seems to be anterior shin splints. I thought I had been doing pretty well in avoiding the beginner overuse injuries, but guess not. It could be something else, of course. I don't think it's a stress fracture, because there isn't a particular spot that really hurts, which is usually the case, according to my reading. My left is worse than my right, and it throbs, an hour after my run ended. I need to ice, and take some ibuprofen. And I need to hold off on running for a couple of days, which won't be a problem. I was planning to swim tomorrow anyway. I might not, and take tomorrow off and swim on Monday instead. We'll see how it feels.

What do I think happened? For one, the short bursts of running (shorter than I'm used to by now) meant I never got into a groove, and I could feel my toes hitting the surface sooner than usual. I think my calves didn't get warmed up adequately, which may or may not have anything to do with the Galloway training method. (Which I might be doing wrong, anyway; I ordered his book and will check it out before I blame his method.) I also think it's time for new shoes, which I was planning to get fitted for next weekend in Portland. Looking at my feet, my arches seem a little flatter than they used to a few years ago, now that I look at them. I was told I had high arches several years ago, but they don't look so high now. I have no idea what kind of motion my foot makes when I run--supinate? pronate? Who knows? I can't really watch my feet when I run. So the gait eval and fitting will be a good thing.

My plan, then, is to take a couple of days off from running and make sure that the pain goes away. Mayo Clinic recommends a number of things, including adding toe lifts and lower body weights, which I have been doing since January, so I'm not concerned about that. I'm already planning on more cross training, so that's good. I'm backing off a little on the distance. I'm getting properly fitted for running shoes. And tonight, ice and advil. Not that they hurt badly, they really just ache. But I want it to get better.

I didn't get to that yoga class...but I did make a cute bag for my yoga mat, so that counts for something. The scale inexplicably jumped a couple of pounds today--I don't freak out about a sudden jump that doesn't make logical sense, I just try to adjust my eating and watch over the next few days to see if it gets back to where it was. So I'm eating a bit less, trying to be a bit careful (although I had a cookie and some dark chocolate today...so maybe not THAT careful, hehe) and see if tomorrow is closer to what the past 5 days or so have been.

Now I go resume making A&P my beyatch.

Something new...makes me shiver with antici.....pation!

I hit the 0900 yoga class this morning. It was interesting. Even though I have done yoga before (ashtanga, vinyasa, "gentle") I've never done Iyengar, which is what Harmony Yoga does. This was also a new place for me, of course. On my way to the studio I thought about how many times I've been in the position of being new and awkward at something since mid-January of this year, when my new career as a grad student started. You'd think I'd be used to it by now. At least I am getting used to telling myself that the anticipation is worse than the actual experience and everything will be fine. So, I went. The teacher, Brit, a lady in her late 40s or early 50s, I'd guess, was fantastic--involved in everybody's practice, made sure she was checking in with those of us who were new to her class, and demonstrated every sequence before coaching us through it. Iyengar yoga is known for its extensive use of props--all the blocks, belts, bolsters and blankets that you may have seen in yoga studios but never or rarely used, they use them all. Prepping for class was sort of a mystery to me. In addition to 2 or 3 folded blankets, 2 blocks, a belt, and for some a bolster pillow, most people had a folding chair next to their mats at the beginning of class, which totally puzzled me. I grabbed all the other things, but not the chair. Just when I was trying to figure out if it was "optional" or "mandatory" for this class, someone came over and brought me a chair. Guess it's not optional. I've never really used props in a yoga class before--sort of the ego thing, "I don't need those things" kind of attitude I suppose. This yoga doesn't go for that kind of ego thing. Props are used to get the ideal alignment, and I went with it, and although it was perhaps a little more rigid than I've experienced with ashtanga style yoga before, I liked it. The one thing I missed was inverted poses, but this was a Level 1 class I attended. Tomorrow is an open house at the studio, and there's a late morning Level 1-2 class that I'd like to try out.

The rest of the day, I didn't accomplish quite as much as I had planned. I went to a coffee shop and studied for a little while. Then I went to a local fabric shop to get fabric for a new bag for my yoga mat. I actually saw the wife of one of the junior students there--it took us a while to realize where we "knew" each other from, but we figured it out. Then I went out to a movie (Forgetting Sarah Marshall, cute) and dinner with my girls from school. Tomorrow, I make A&P my bitch, as my classmate Connie would say. Sunday is more studying for the big airway exam on Tuesday.

I did check out some of Jeff Galloway's tips for beginner runners on Runner's World and on his website. Lots of great info for the newbie runner on there! I think I will buy his book (Galloway's Book on Running, I think, considered the "runner's bible") and check out his methods. In brief, he is a big fan of frequent walk breaks during a run, and insists that even top marathoners can train on 3 runs a week, including 1 long weekly run. His method would have me walking MUCH more than I am currently. I thought I was going easy, but his method would have me backing off a lot. He says his method prevents overuse injuries, and he's been running for 50 years now, including being an Olympic runner. He says he hasn't had an overuse injury in almost 30 years. So, based on all the reviews of his books and all the blogs that point his way, I'll give his method a try. Meanwhile, this gets me back to 3 days a week of running. What to do on the other days? Is swimming okay? Yoga certainly should be. 2 days a week of weights and running, 1 additional running day, 1 yoga day and a day of swimming? That would be 5 days. That sounds more balanced than what I've been doing, and hopefully would prevent me overtraining. Training for what? I don't know yet. Perhaps nothing, but perhaps...?

False Start

I got up at 0445 this morning to start IVs in SAU (surgical admit unit) which we students have been doing about every 2 weeks...got to the hospital, changed into scrubs, in the SAU by 0545, only to find that the surgery schedule is very light today and as a result, there were no IVs for us to start. All the SAU nurses were standing around looking for something to do--they are usually very busy early in the morning, getting ready for the first cases of the day, of which there are usually lots. So Cari and I stayed until about 0605 and then were dismissed. No IVs today. I'm glad I didn't put in my contacts this morning; I might take a nap.

Or I might go to a 0900 yoga class. I'm not sure yet. Yoga would be a good workout for today, after a day of swim and a day of running and weights. I'm trying to take it a bit easier on myself. Today I lost another pound, putting me at 176 for the first time since--hmm, I don't even know. At this point, every pound I lose puts me in uncharted territory. The last time I was in this neighborhood was somewhere between 18 and 19, when I was trying to ignore my weight because it was starting to get out of control. These days I realize that my skeleton carries a significant portion of my weight, and 176 on me looks more like 156 would on most. I'm lucky this way, I know. This is my reason for not shooting for a BMI of less than 25--I can't lose weight in my bones, so why make my lean body mass pay for it? Just seems logical to me.

This weekend is another long study weekend. I don't know yet if hubby will be coming back to Spokane this weekend. I'd like to think yes. But see we shall, hmmm? (doing my best Yoda impersonation)

Zoomin'!

Tonight I changed my workout a bit, and decided to swim instead of run. I've always enjoyed swimming, and technically I've always been a strong swimmer, but for most of my adult life I haven't been cardiovascularly fit enough to swim for long enough to call it a workout. So I started looking into swim fins. I always thought that swimming with fins would make me a wuss. But it turns out that the shorter, firmer fins they sell for lap swimming are designed to improve your workout and train for sprinting (among other things). So I got some Zoomers Z2 fins.

According to the literature that comes with the fins, these things were designed to load more of the workout onto the legs--when swimming, the arms are the most efficient source of propulsion but have only a small percentage of the body's muscle mass, while the legs are about 60% of the body's muscle mass but contribute very little to propulsion. The solution (according to the developer) is the short, firm swim fin: they improve the efficiency of the leg kick but because they are short, they do not overload the leg muscles. This should allow for use of a higher percentage of body mass in the workout, a higher level of intensity, and a longer workout. Working the legs a little more and the arms a little less allows the swimmer to be more deliberate about upper body form, have more time to breathe and get enough oxygen to sustain the exertion, and decrease shoulder strain (due to swimming in a higher position in the water, because of the additional propulsion)

My first run with the Z2 fins seemed to support these claims. I was able to swim 30 laps in 30 minutes, including all the pauses I had to take to catch my breath and let my heart rate recover. (Those are 25 yard laps, so I swam 750 yards; not bad for the first time swimming in about 6 months.) My legs are going to be SORE, I can already tell. Getting more propulsion and moving more efficiently through the water makes the workout more enjoyable, and I was definitely working out in the Zone--in fact I had to swim slower to keep my heart rate low enough to sustain it. I think these are a good investment for anyone who has similar problems that I had with swimming--simply unable to sustain a long enough workout, and feeling sluggish and slow in the water. My legs definitely did more of the work--I usually feel like I am sort of dragging my lower body along the pool, despite putting a lot of concentration and effort into my kick.

My weight loss plateau ended; I lost 2 lbs after the 12 days of no change. 3 changes were made just prior to the end of the plateau:

1. My husband came to Spokane, after about 2 weeks apart.
2. I stopped drinking coffee
3. I stopped working out.

I have no way of knowing if any or all, or none, of these things were related to ending the plateau. But I suppose all of them probably had something to do with it. I definitely was happier, more relaxed and less stressed with hubby here. The coffee thing, I still can't really find any actual literature addressing coffee and weight loss (caffeine has an appetite suppresant effect, but I don't know why coffee could make one retain or gain weight, although I could make some guesses, including the sustained high blood sugar finding.) Working out? I had been working out 5-6 days a week for a long time. Over the last 2 months, that has included increasing amounts of running. So perhaps I have been overtraining? It's been suggested to me before, but I've never seen it reflected in a plateau. (Let me say for the record that I know 12 days isn't really much of a plateau. But that was 12 days of the exact same weight, down to the 0.1 lb. The plateau lasted much longer than that, a bit over a month of being the same weight or higher, up and down in a 3 lb range.) With this in mind, I plan on (A) varying my workout more, and (B) reducing the frequency a bit. 2 days a week of weights, and 3-4 days a week of cardio. At least one of those days has to be something other than running on the treadmill. I also need to start bike commuting, but that means I have to get access to the bike lockup at the hospital, and so far I haven't been able to do that. Anyway, we'll see how this all goes.

Today we had an airway day in the OR. I was in ECT (electroconvulsive therapy) today. Yes, it is still done today. No, it is not barbaric. For one thing, the patients are anesthetized for the electrical impulse and subsequent seizure that is induced. That's why I was there, to learn how to do this, and manage the patients' airways while they were being treated. The patients do not feel the treatment, and have no memory of it. For another thing, it is very helpful for people who either can't tolerate antidepressant drugs or for whom they don't work. It's also voluntary; patients are only mandated to get ECT in extremely rare situations, when the patient is so debilitated that their life is in danger and they cannot consent to it themselves. They have patients who have been coming for years to get periodic ECT treatment, and they have gone from being institutionalized and completely debilitated by their depression to being productive, even happy members of society. It's unclear how the seizures help treat depression, but it has been known to work for a long time, and for some people it's the only thing that works. Google electroconvulsive therapy, you'll find some interesting information out there. There's a lot of misinformation that was spread by popular culture, particularly by the movie One Flew Over the Cuckoo's Nest.

So, anyway, the ECTs we did today were voluntary, of course, and it was quite interesting and not barbaric at all. We anesthetize the patients and then bag-mask ventilate them for the entire treatment (i.e. no breathing tube is inserted) which is about 10 minutes of masking, including the 1 minute for the actual treatment. It's not easy on the hands, but it's great experience for new people like me. When we were done, I still had a bit of time, so I was given a case to intubate (a gallbladder removal, or lap chole) and intubated my 5th patient. This one wasn't as easy or clear as most of them have been, but luckily I was able to get it without too much trouble. It was a long day--in the OR from 0630 to 1100, then in class until 1630. Then I went to study for a few hours, then home for a little bit, off to the gym, and now here I am blogging. All in a day's work.

All streaks must come to an end

The streak is over. I dropped 1.2 lbs, finally. Maybe it was the coffee? Going without it this weekend wasn't bad. I'm on my way to a 4 hour A&P lecture, so I might break down and get some during a break. But so far I'm doing okay.

Not much to add this morning. We tried to go to the Buddhist temple yesterday morning and check out their service, but it was the day of their semi-annual Food Bazaar, so we bought some treats instead, and went to the Perry Street Cafe for breakfast, which was underwhelming. Hopefully we'll both be here next weekend to attend the service.

Eat like a 3 year old

Day 11, same weight. Wonder how long this can go? Even 0.1 lb change--EITHER DIRECTION!--would be reassuring. But, I will roll with it.

Today's rule is: Eat like a 3 year old. Hungry? Eat. Get full? Stop. Not hungry, food's there? Push it away.

Also, I'm going to cut out coffee this weekend. Some bariatric docs swear that you have to stop drinking coffee to lose weight. Elsewhere I've heard that the caffeine is an appetite suppressant, as long as you don't load up your coffee with too many calories. But I'm on a plateau, and I have to change something. On Monday I suspect I won't be able to get through 4 hours of A&P lecture without some coffee, but this weekend I can do it.

I didn't get to yoga this morning--it was 2am by the time I got to sleep, and my 8am alarm was NOT happening. Turned that bad boy off and slept until 10. I love having no classes on Fridays. I know this will end soon, and I am enjoying it for now. Today I have a lot of studying to do, of course (don't I always?) so I am getting to it shortly. That Friday 9am yoga class probably will never happen--who am I kidding?--I sleep in on Fridays. I'll have to find another one. Yes, the life of a childless anesthesia student. It does have its perks. I know most of my classmates, who have children, got up early today and are already studying, rather than enjoying a slow wakeup with breakfast and the Interwebz.

More later, I think.

Sushi and books...

My weight has been exactly the same for 10 days now, down to the 0.1 lb. WTF? No change at all. Actually I didn't even weigh yesterday. I knew it would be the same. But I weighed all other 9 mornings, same time, same Bat channel. Today I didn't work out because I did yesterday, it kicked my ass, and the day before I ended the evening with a round of about 10-12 Sun Salutations at home. I haven't done any yoga for about 3 months, and all those Plank poses killed my arms. Clearly I need to do more of those. I plan on taking my first Iyengar class tomorrow morning at Harmony Yoga, at 0900, if I get to bed soon enough. That will have to be pretty soon....

I have a long weekend of studying ahead of me. We are on the autonomic nervous system in Pharm, and I don't get it...and it's a BIG important part of anesthesia, actually it's about 90% of what we do when you come down to it, so I need to really understand this stuff. I don't think it's going to be impossible if I just hunker down and pick it apart until I really understand it. Physio, we are doing a bunch of stuff that I need to understand better. I have a big 4 hour airway exam coming in less than 2 weeks. Today we asked the juniors about it, and they said to start studying now. So there's that. And my final project for Adult Ed, which is not anesthesia related and is kind of fun, but will need some attention nonetheless. We are supposed to do some in-depth learning on a subject that we don't know much about (and isn't anesthesia related) so I am studying sushi. Although I love to eat sushi, I didn't know much about it. So there is a lot to do for my power point, and my paper, both of which are due on Tuesday morning.

I did get my pharm exam back that I took on Monday. I was nervous because I left the test feeling really great about it, and the rest of the class thought they bombed it, which totally made me second-guess my instincts about it. I had no idea if I was on target with my personal assessment and really wanted to know. Well, I ROCKED the exam, got 52 out of 50-- I missed 2, but got 4 extra credit points, and I think I got the best grade in my class. :) So that was very exciting and uplifting! Especially since I did most of my studying on Saturday and just decided not to go over it anymore on Sunday, because I felt like I knew it. And I did. I'm very happy about that.

Today I bought some things for my sushi presentation: some nori, some sushi rice, pickled ginger, etc. And then it occured to me that I ought to try making some sushi, since I'm buying all this stuff anyway and I'm supposed to be learning about sushi. So I did...I prepared the rice, I got some sushi grade tuna at the market, and followed the steps and made a maki tuna (maguro, I guess) roll. Let me tell you, I already had a lot of respect for the itamae (sushi chef) but I have much more now. I made an extremely simple roll and it was not pretty when it was done. It tasted pretty good--I would be disappointed if I bought it at a sushi bar (by flavor alone, even if it looked pretty--it just wasn't that interesting) but it was definitely edible. The tuna was tasty (I don't know if I'll trust Spokane again as a source for sushi grade fish, but this experience will let me know) and my sushi rice wasn't bad. I should have taken pictures. Maybe tomorrow...I have quite a bit left.

Back to studying...but first, I am very excited that my hubby is coming to Spokane tomorrow night! Multiple issues have prevented him from making the trip over the last 2 weeks, and it's been very hard for both of us, but I'm thrilled that he will be here very soon. I can't wait. Hurry hurry! :)
p.s. Snow predicted tomorrow. Was 65 degrees today. WTF?