Friday, March 30, 2007

Medical March

The past two weeks have been another interesting. It all began on March 20. I went to my primary doctor for my fall in January. After a brief discussion and a few pushups and neck bends, I was declared in good health with ths suggestion of resuming normal activities. That even meant the end of physical therapy; I will be glad to have the time back in my schedule. The preceding weekend I'd done a few long walks in the mountains with my dog, Maggie,covering the terrain of the bike crash in January. She enjoyed eating the fresh long grass, and I proved to myself that I was back and going again. I even did a 9 mile flat bike ride. That weekend, and especially the twelve hours after my appointment with Kahan were peak times. Little did I know that a new trough in the cycle of life was headed my way.

Tuesday evening had me out for dinner (Indian food) with a number of compatriots from work. In the middle of dinner, my shoulders started getting sore, which I thought was strange, but I chalked it up to sitting still for too long. The fun began when I returned home. My stomach (left side of body, mostly) began to spasm. I threw up numerous times. I had cold sweats like a fever, and could not find a comfortable position to sleep or sit. In fact, every sore muscle and joint in my body, and there are many of these, lit up like a five alarm fire. The pain was like a purging fire; I am much less sore after this than before. Except for those times I was kneeling before the porcelain throne, I stood up until 5:30AM. I was still in questionable shape for conference calls that started at 7 AM, but I made it through the day. My major outing was a trip to the drugstore for anti-nausea medicine, Ginger Ale, Seven-up and crackers. I ended the day feeling somewhat better. I did make an appointment with my doctor for Thursday.

Thursday was a somewhat normal day. I had energy again. I did visit the doctor, and we concluded that I had a quick bout of food poisoning. I had a somewhat exciting dinner (microwaved chicken breast and rice). Friday was also ok, although I had a bit less energy. I also noted that my abdomen was a bit sore, but I chalked that up to starting to use my muscles again.

Ann was off with her sister and a conference for her new business for the week, and was returning Saturday. I had little energy Saturday, and my abdomen was starting to hurt more. I still couldn't figure out if the pain was on the left or the right, so I constrained myself to a diet of Ginger Ale and Saltines. When the evening came, I suggested that I was not in shape to pick her up at the airport, but that she should take a cab home instead; this is a sign of me not being at all well. She walked into the house, looked at me, said "you don't look right," felt my forehead, and a thermometer was in my mouth in two minutes. The answer came back slightly over 100. She also said that my color was grey (never the best of skin tones). I then went to sleep within a half hour, and had a fitful sleep. When I awakened at 6 AM, I decided that my abdomen hurt more (it hurt when I inhaled deeply), and that the pain was definitely on the right side.

I awakened early Sunday morning, and the pain in my abdomen was more intense. It was definitely on the right side. There was pain if I took a deep breath. I went to the medical books, and read the various fault trees. It came down to appendicitis, diverticular infection, or gall bladder issues. I had learned that I had gallstones from a CAT scan in January, so that seemed a possibility, but I couldn't decide which it was. One thing was clear however: none of these were issues where you hang around the house and see what develops. I awakened Ann at 7 AM (having made some coffee first) and suggested that this would be a good time for a hospital visit. 7:45 brought us to Good Samaritan Hospital's door (a very good time for an emergency room visit). I explained all this to the doctor, who ordered a CAT scan. Within a few hours, he came back and said "it's not diverticulitis, and it's not your appendix, which leaves only one thing left... you have a gallstone lodging in your common duct, and bile has backed up into your liver. You're jaundiced (I had yellow rings around my eyes by that point). So, a few surgeons will come in, but we'll remove the stone today by ERCP (see below) and remove the gall bladder soon."

To make a long story short, they did the ERCP and removed the stone. I began to feel much better. I was admitted to the hospital for Sunday evening, but had a relatively healthy stay (as opposed to my crunched face in January). The Laparscopic removal of the gall bladder took place around 9 PM on Tuesday evening, and I was released on Wednesday afternoon. The incisions hurt for a day or two, but I'm approaching normal like again.

If you'd like to know more about the surgical procedures, check out some of the links below.
Information on Laparoscopic gall bladder removal (it contains a 54 page presentation on the surgery and the glall bladder in general, which is quite complete... I suggest you load the PDF version)
ERCP - Removal of Gallstone blocking bile duct.
A site on Laparoscopy that includes a video.

Monday, March 05, 2007

Myers back on the bicycle

I've talked about getting back on the bike for about two weeks. The key impetus was my sports medicine doctor saying "you're doing ok... it's time to get back on the bike and conquer your fear." I wouldn't say that I had a fear of riding, although I do have a more profound respect for that one downhill corner on Kennedy/Priest Rock Trail. But I will leave that challenge for the future.

What I do have is an extreme respect for all of the minor muscles in the body. When you do weights, you concentrate on the big guns (delts, traps, quads, biceps, triceps) and lump all the small muscles into "stability muscles." I found a Gray's Anatomy online, so there is a picture and some text. When the muscles been shut down for a month, they let you know of their existence when they start up again. This is especially true for small muscles along the spine connecting the vertebra and small muscles that stabilize the shoulder blade. I avoided biking until I'd gone through most of the reactivation pain.

My first bike ride since January 16 was on a beautiful sunny Los Gatos day. The temperature was almost 70F. I put sunblock (spf45) on my entire face to minimize scar damage. I inflated my tires again (they'd lost 40 pounds... a sign of how long it had been) and then went out on my road bike. I will not be on a mountain bike for a few months; this is from three issues: (1) having shoulder strength, (2) making sure that my broken cheekbone (zygoma) is fully set, and (3) having the physical stamina to do crazy climbs. You can read more about the zygoma (I broke it at all four of the junctions) in Gray's Anatomy.

I made it about 2 flat miles away from home before my awakened muscles told me of their presence. I felt pain across the lower back and sides near the bottom of the rib cage (the serratus muscle). You don't even pay attention to these guys until they speak to you.

I traveled 4.6 miles in just over 20 minutes. The warmth of the sun felt great. The wind in my face was invigorating; it was a wonderful feeling to deeply inhale fresh air again. I was in terrible shape, with an unjustified racing pulse rate and muscle pain. But I had a smile from ear to ear as I entered the house.

A number of relatives have suggested that I go safe and do a stationary bike indoors. This short bike ride convinced me to the contrary. I can't wait until I'm back doing 50-60 mile rides again. And it'll be a bit longer before I go for a mountain bike ride.