One step forward, two steps back

There has been an interesting turn in events over the past week, that once again, has encouraged me to evaluate purpose and lifestyle.  After returning to work, over a month ago now, I’ve been able to gradually increase my hours and appreciate the return to a normal schedule.  Time spent collaborating with patients, colleagues and coworkers has ignited a fire inside and is keeping me warm and inspired.  Although I still feel frustration when the computer randomly knocks me out of our EMR (electronic medical records) or the mice inside the computer appear to be churning molasses, I am still invigorated by the love surrounding me in friends, family and patients.  

Unfortunately, life isn’t just sunshine and rainbows.  With a massive fire displacing our administration and business office personnel, we’ve had to accommodate and be flexible with adding more people to the office and changing workflows.  And yet, positivity has remained elevated. People have been accommodating and in some ways, we’ve pulled closer together as an organization, getting to know each other better.  Like the phoenix, we will fly out of the ashes, more united and beautiful than ever.

The downtown Bothell fire - July 22, 2016

Concurrently, I’ve been attending physical therapy to restore strength and decrease the aching pain that lingers in my right arm and shoulder.  While I’ve been working hard for the past month, doing my home exercises, regaining more range of motion, the pain has worsened.  At my last evaluation (before obtaining insurance approval for more therapy), the therapist noticed my scapula winging (displaced in comparison to the other shoulder), something I couldn’t see because it’s behind me.  After further assessment, the therapist suspects a long thoracic nerve injury.  While daunting, this diagnosis fits the symptoms, the mechanism of injury (surgery and port placement) and reasoning behind my increased pain and yet persistent weakness.  Unfortunately, the prognosis is a 1-3 year recovery (if at all).  In the interim, my surrounding shoulder muscles must learn to stabilize the joint, which keeps gliding in and out, creating the muscle spasms that deter me from sleeping.  When the pain intensifies, I must use my left arm to glide my right arm into position, so I can raise a stethoscope or reach overhead.  While attempting to bowl with the kids, a week ago, I lifted my 14 pound bowling ball, temporarily forgetting about my weakness, and as soon as I lowered my arm, the ball went flying onto the floor.  Of course, it led to a few chuckles, but magnified the realization that there are activities that I just can’t perform at this time.  It was a daunting reminder to appreciate the small things in life.  The ability to lift a mug or walk a mile are daily activities that we often take for granted.  And yet, for many, these feats are major hurdles.  And so, I’m channeling my inner left-handedness (which Chris is enjoying) and count my blessings for the great many things that I can accomplish.  

If that setback wasn’t enough, I learned on Friday, that I have joined the ranks of many octogenarians with the diagnosis of osteoporosis.  If that comes as a shock to you, you can only imagine how shocking this was for me.  While I knew that chemotherapy and its induction of menopause would worsen my bone density, I generally prided myself in the fact that I’ve been a good milk drinker, eat healthy, perform a great deal of weight-bearing exercise and have excellent genetics that these strengths would protect me from this formidable diagnosis.  In fact, I scoffed at the idea of even performing a dexa (bone-density) scan when my oncologist suggested it, as certainly the pounding of greater than 10 years of running 40-50 miles per week would leave me with bones of steel.  With the encouragement of my wise primary care provider (always listen to your family physician), I reluctantly agreed to evaluate my bone density.  And now, unfortunately, we need to determine how to treat it.  

While I don’t plan to jump out any airplanes, I worry about downhill skiing or other physical activities I enjoy.   Since the majority of my bone thinning is in the spine, my biggest threat will be a compression fracture.  I’ve seen the pain from compression fractures, the height loss and how modifying life can become after a fracture and I want nothing to do with that.  I’m too young to restrict the activities I enjoy.  So, I will take hormones, bone building medications, calcium/vitamin D and whatever it takes to strengthen those bones once again.

My other major challenge has been the pitting edema (swelling) in my legs (see picture).

Fingerprints in my leg show the degree of swelling

 While this is more of a nuisance than a limitation, the heat has not been helpful.  After standing or sitting all day at work, my feet become so puffy and painful that I look forward to taking off my shoes and sitting in trendelenburg on the recliner (elevating my feet).  It would be nice if I could just poke my feet, like a balloon, to let all the fluid release, but unfortunately, that would just leave me looking like a fat pin cushion.  Wearing compression socks and hose is helpful, but can be a struggle to don on and off and they aren’t exactly fashionable or comfortable in the hot weather either.  I’m sure I’ll do better with the compression attire in the winter and fall months.  

Although grappling with my physical challenges and limitations has been frustrating, as it’s such a deviation from a year ago, each day, I remind myself how lucky I am to live, laugh and run.  As a physician, I know that I can’t “fix” every problem and sometimes my role is solely to help people understand what is going on in their body and learn how to most comfortably live with the maladies that we cannot mend.  As aggravating as cancer and chemotherapy can be, I am thankful that I survived it and I’m thankful that I’m able to return to a profession that provides me with so much joy, challenges my brain and produces rewarding relationships that generate so much empathy, love and support.  In posting a happy birthday wish for my niece, I perused through my pictures trying to find the perfect one(s) for her.  The sheer number of joyous pictures and memories that I’ve accumulated over the years, with so many different people, reminds me of all the blessings that God has given me.  My challenges are just a drop in the bucket of a life filled with so many great people, adventurous journeys, beautiful surroundings and so many positives that I refuse to be distracted by the bumps along the way.  My greatest strength will arise from my ability to overcome my weaknesses.

The greater the obstacle, the more glory in overcoming it. ~ Moliere

Challenges are what make life interesting and overcoming them is what makes life meaningful. ~ Joshua J. Marine

Getting in the Groove

It’s been 2 weeks since I returned to the workforce and 3 weeks since my port was removed.  While life is taking on a more rapid pace again, I’m trying to slow the pace and stay on course with balancing my physical, emotional and spiritual well being.  Allocation of time and priorities have changed, leading to less time on social media, blogging and reading.  Coffee consumption has increased, along with my blood pressure (at least there are good medications to control this).  Yet, I find my career more fulfilling and rewarding as ever.  Perspective has improved, making the “little things” less stressful while maintaining focused on the present and the gifts, rewards and beauty surrounding us in nature, the people we encounter, and the challenges that we accept and fulfill.

Unemployed people returning to the workforce likely recognize the value of routine better than anyone.  As I find myself arising at 6 am and attempting my previous routine of running before work (which has only happened a few times), I notice that my muscles are stiffer when I awaken, my goopy eyes take longer to focus and in general, I am more sluggish.  Once I get outside, I’m sure the neighbors assume the zombie invasion has started, as I take those first few stiff steps as my muscles are still tight, sore and fatigued.  Along the course, I hope to gain some flexibility and lose some of my rigidity, and if that occurs, I will stretch my run into a 5 mile jaunt, and if it doesn’t, I stick with a 2 or 3 mile run/walk.  Either way, it’s rejuvenating to be outside, especially if it’s sunny.  I enjoy every breath of fresh air travelling through my lungs, the wild rabbits scurrying to hide, the birds chirping as if calling to their lover and the friendly smiles of neighbors passing by.  When you live in the present, instead of always looking at the future, everything seems more alive, enriching and fulfilling.  

Starting with a new, young, but experienced, medical assistant (MA), I try to arrive in the office 30 minutes before the first patient arrives, which means 8:30 am.  I admit, “I try!”  More often than not, it is 8:45-8:50, but so far, I have always arrived before my first patient.  My first 6 days of work, I saw patients for 4 hours/day.  Shockingly (to me, at least), by 2 p.m., I found myself exhausted and nodding off while eating lunch.   I’d struggle to complete the days’ charts, correspondence and paperwork before heading home, but usually found myself leaving for a nap and attempting to finish my work in the evening instead.  As my schedule started filling up, I found myself yearning to see more of my clients as I noticed them popping up on other provider’s schedules.  So, I added another hour to my afternoon schedule and extended to about four in the afternoon.  The first couple of days of this, I struggled, as my sleep pattern (or lack thereof), at night, was still terrible.  With multiple awakenings and the persistent joint achiness, I found my energy level still low.  Yet, adding the hours, didn’t seem to make it worse.  In fact, I think the elimination of the afternoon nap has actually improved my energy level in the long run.

As I am re-learning the EMR and developing operational efficiencies with my new MA, my end of day workload is gradually diminishing.  Not only does it take time to establish a fluent workflow, but developing a team strategy evolves methodically, as you learn each other’s strengths and weaknesses.  One of mine, of course, is the desire to catch up on the lives of all my patients!  

If you had asked me a week ago, “how’s it going?”  I might have responded, “a little slower than I expected.”  However, I’m finally noticing many of my residual chemotherapy symptoms, starting to fade.  Two weeks ago, I felt like my body was perpetually battling the flu with constant hot flashes, sweats, achiness and a generally ill feeling.  I tried multiple medications to help diminish these symptoms and generate restful sleep.  None of these “remedies” quite helped as much as the passage of time, which is why I suspect they were persistent manifestations of chemotherapy. The nerve pain, shooting down my arm, resolved within days of removing my port.  However, the recovery of my strength, range of motion and pain from disuse, will take time, with the help of home exercises and physical therapy.  Once again, requiring my most elusive trait, patience.  

Although I could write more about how elated I am to return to my vocation, I will leave you with these words from Maya Angelou:  “Success is liking yourself, liking what you do, and liking how you do it.”  While I’ve got 1 and 2 down pat, #3 is a work in progress.  I’ve had 6 months to evaluate the way I do things and I suspect I will continue learning this for the remainder of my life.  Yet, in returning to work, I’ve learned that in order to “like the way I do things”, I must: (1) avoid staying up late and losing sleep, (2) balance my family life better (drawing boundaries and remaining in the present, rather than always thinking of my “to do” list), (3) maintain perspective (seeing the good, even in bad situations or frustrations) and (4) spend time reflecting on what’s working and what’s not and eliminate the aspects of my life that are not adding value or interfere with my accomplishment of 1, 2 and 3.  Life is too short to let frustration, anger or discontent run me down further.  I choose to live with a heart full of beauty, love and happiness and it starts with me and my perspective.  

What lies before us and what lies behind us are small matters, compared to what lies within us. ~ Henry David Thoreau

Perspective is everything. Looking at a field of dandelions, you can either see a hundred weeds or a thousand wishes. One small positive thought in the morning, can change your whole day.