Running

Doing Nothing and Nothing Doing

Posted on by writenp

Even when I am not “working” as an NP, friends and family still solicit my advice. That’s no problem. I can’t stop thinking like a nurse practitioner, keeping up with new advances in health care or wanting to help people negotiate our health care system, which is broken, in so many ways.

What advice do I give? Sometimes it’s a matter of using the right lingo, even some key words, emphasizing one symptom, and being persistent. It also helps to put yourself in the shoes of your health care provider. NPs, MDs, PAs, we all want to solve your problem. We love a mystery, and most of us really care about making you feel better. So if you finally get an appointment and describe your problem — back pain, say — the assumption is that you want it to stop, at all costs.  But is that really the case?

Maybe you can put up with the pain. It’s not that bad really and gets better as the day goes on. But you want to make sure the pain is not caused by anything serious, and rightly so. A malignancy is always in the back of one’s mind, as well as that of your provider. Or maybe it’s something that, if not treated, is sure to get much worse. You don’t want that either. Providers get 15 minutes a visit, if they are lucky, and they have a lot of mandatory charting to do on the computer. You have to distill your symptoms and your concerns and communicate them succinctly. That is just the way it is these days.

Perhaps the next step is some kind of imaging, an ultrasound, Xray or MRI. The radiologist who reads the image is likely overworked and usually errs on the side of caution. So further imaging might be suggested to rule out “something bad.” MRIs and ultrasounds are fairly benign in that they don’t expose you to radiation. CT scans do and the exposure is cumulative over a lifetime. What you decide to do is dictated at times by the level of uncertainly you are willing to live with.

Sadly, this can be a slippery slope. You then see an orthopedist who tells you your pain is caused by a benign cyst pressing against a nerve on your spinal cord. You could get it removed or injected with a steroid, which might alleviate pain or cause it to “pop.” The orthopedist gives you these options because you consulted her about your pain so obviously you want her to make it go away. Now you are on to invasive procedures and invasive procedures, every one, has the potential of making things much much worse.

Always ask what happens if you do nothing. Might it get better on its own? Might it just stay the same? Consider if you can live with this new normal. And of course, there is always a second opinion.

Case in point: I am a runner and developed arthritis in one foot that caused significant pain after, but not during, a run. I consulted an orthopedist who was touted as being a runner who specialized in foot problems to see if there was any recourse. Orthotics, joint replacement, I was open to hearing about options. I was concerned it would get worse and prevent me from running. First red flag was when he was surprised at how far I ran – 6-8 miles.  He was a runner, after all, that distance should not have surprised him. Then he suggested a little surgery to “clean the area up.” There is not such thing as “a little surgery,” but I had already written him off by then. I sought out another orthopedist specializing in feet, who looked at the Xray, did a quick exam and said he would never operate on me because, although only a surgical fusion would relieve the pain, I would no longer be able to run afterwards. He suggested a steel orthotic available on Amazon. Six years later, I am still using it and still running.  

Asking the Nurse Next Door: What I Tell Family and Friends about Staying Safe During the Pandemic

Posted on by writenp

I never learned to intubate, only suctioned a dummy, and can’t start an IV. Procedures are not my strong suit. The skills I pride myself on — diagnostics, well visits and health screenings,  follow-up of chronic health conditions, and communication, aren’t particularly useful in the thick of the pandemic. I’m sure they will be again, but for now, I try to use my training to make sense of the science and to advise friends and family when they ask. Or in the case, of my children, even when they don’t.

Before I go on, a caveat: this information should not take the place of consulting with your health care provider. Especially if you are vulnerable due to a compromised immune system, age or other health conditions, you should follow expert advice to the letter and err on the side of caution. The CDC and local department of health websites are excellent sources for timely information about best practices for protecting your health in this changing situation. Think of this as my attempt to share, in layman’s terms, what I believe, and what I am doing currently for my own well-being.  

In terms of the science, there is so much unknown. When I first started hearing about the virus’s infectiousness, I questioned whether it was spread solely via droplets as was being reported.  The way the virus has spread appears more like a hybrid of droplet and airborne contagion. Both tuberculosis and chicken pox spread through the air, which explains why they are so very contagious. We’ve also learned that duration of exposure and dose of virus particles are key to whether you are going to get infected, and perhaps how ill you will become. Of course, age and other health conditions also play a role. But we have seen young, healthy people get very sick and even die, while some nonagenarians survive. And then there are questions about genetic immunity, whether it’s blood type or some other genetic determinant that makes the lungs more susceptible to the havoc Covid !9 can wreak. We will understand so much more of this in time, but for now here’s what I do, and suggest others do to be safe without going crazy.

When you leave your home: Always have a mask that covers your nose and mouth ready, in case you cannot maintain a distance of at least six feet. I am a runner and hate running with a mask on – it makes me gag. But I have one around my neck before I venture out for a run and if there’s a chance I will come closer than 6 feet to someone, I put it on. Always wear a mask when entering an enclosed space. Avoid touching your eyes, nose and mouth. And wash your hands for 20 seconds as soon as you enter your home.

Grocery shopping. From what we think we understand at this point, the risk of contracting the virus is inversely proportional to the amount of time exposed and the dose of the virus – ie, whether you are exposed to copious secretions of an ill person up close. So masked, socially-distanced-grocery shopping is not as risky as we once thought it was, as long as you take precautions. Have a list and be efficient so you can limit your time. Sanitize your cart. Use hand sanitizer once you are back in the car, or when your leave the store, if you are walking.

Taking in mail and packages. While the virus has been said to exist on surfaces up to 72 hours in ideal conditions, keep in mind that conditions outside the lab are not ideal and viruses are notoriously fragile. At the onset of the pandemic, I used to leave the mail and packages on a table for 48 hours. Now I am not as worried so I am just careful to thoroughly wash my hands after handing deliveries.

So far these are all caveats, and isn’t it tiring to always hear what not to do?

Here are activities and routines that help me feel better during this stressful and uncertain time: Maintaining a healthy diet with lots of fruits and vegetables and drinking plenty of water. Sticking to a regular sleep schedule. Not overdoing it with the alcohol. Exercising vigorously 3-5 days a week and getting outside every day.  Plus limiting the times I check news and social media during the day.

These are the health-related items I tell my friends and family to have on hand: A thermometer, acetaminophen, and a pulse oximeter to measure your oxygen level if you get sick. This last item will help your health care provider determine how your lungs are functioning and whether you might need to go to the hospital for breathing assistance. A spirometer is also a good thing to have to exercise your lungs if you are sick. You likely used one if you’ve ever had surgery. All of these items are available on-line and some at drugstores.

Okay, what else? I for one have been trying to live more in the moment, not a natural thing for me. Setting some time aside to meditate, or just breathe slowly and let your mind wander. Just a few minutes will help and is worth it no matter how busy your lock-down life is with work, childcare, school. Plan things for which you can look forward with happy anticipation. A walk in the park, a game or book. And yes, this is the time to binge watch for entertainment. Definitely schedule virtual meetups with friends and relatives even if they feel artificial at first.

Looking ahead. Yes, things are loosening up, for sure. The other day we had our first social event in real life since the lockdown. We sat on our next door neighbors’ open deck at our own table at least 6 feet away from theirs and we brought our own libations. But no masks since we were outdoors. It felt incredibly liberating. We will plan similar gatherings, but at this point, always outside and socially distanced. We might consider sharing food in certain situations but will be especially assiduous about hand disinfecting and not touching ones face. That’s it for now. Stay well.

All rights reserved. © 2020 by Eileen Healy Carlsen

Hobbled: Running, Plantar Fasciitis and My Mom

Posted on by writenp

One of my earliest memories is of my mother instructing me how to propel myself on a swing to soar above the then cement-covered playgrounds of New York City. “Stick your legs out and pump!” she coached three-year-old me. I didn’t know what “pump” meant and she had no understanding of aerodynamics. It didn’t go well.

Like many runners, I did not grow up athletic. In fact, I come from a family of remarkably uncoordinated couch potatoes, particularly on my mother’s side. This did nothing to stop my mother from attempting to teach me physical skills she herself did not possess, such as the afore-mentioned swinging.

One concussion and many skinned knees later, I accepted my lack of athletic prowess. After all, I was in good company. Hardly anyone in my family knew how to swim, let alone skate, ski, or play tennis. You’d think it had to do with lack of money but my father, the lone exception, grew up poorer than anyone, yet knew how to swim and skate. He learned to swim by being thrown by his buddies into New York City’s East River. I know. Amazing he was able to procreate after swimming in that toxic soup.

According to family legend, my mother sank like a stone when thrown into a local pool as a teenager and had to be pulled out ignominiously by the seat of her raggedy bathing suit. I have to assume being thrown into a body of water was a rite of passage back then. Lacking my father’s innate abilities, my mother was unfazed, and determined that I learn how to swim.

When teaching me by the side of the local pool didn’t pan out — “Kick your legs, and alternately stroke with your arms, taking a breath every other stroke!”– my mother scrimped to send me to a day camp specifically to learn to swim. I contracted a bad case of swimmer’s ear on day one and had to sit out pool time for the remaining two weeks.

Cutting her losses, my mother set her sights next on bike riding. Quickly she realized this kind of tutelage required a degree of coordination and strength far beyond her own. This was especially true when the child in question had no sense of balance. Someone was bound to get hurt.

My father finally managed to teach me how to ride without training wheels when I was eight, a feat akin to teaching Koko the gorilla American Sign Language. Soon after, I got bumped by a car when I attempted to cross the street between two parked cars. (Hey that’s how we rolled in the Bronx.) Lacking the self-preserving reflexes possessed by most humans, I failed to put my arms out to break my fall. For weeks I sported a grotesquely fat lip and lost the tooth I hit 10 years later.

Catholic school did not help me improve my athletic skills. The backs of my legs always sported welts from misadventures in jumping rope. Jumping-in eluded me and forget about Double Dutch. The dreaded dodge ball in gym was a little bit “Lord of the Flies” in terms of lax supervision and Piggy, I mean I, knowing neither how to throw nor to dodge, was often the worse for wear.

I found my people when I left the nuns and went to a “special” public high school with a concentration in science. You had to take a test to get in and it had nothing to do with physical fitness. Our most popular team was math team. My dodge ball days were over.

In college, there were two major obstacles for the non-athletic — the dreaded swim test and a gym requirement. The swim test, though well intentioned, was a source of severe anxiety to certain demographics. Namely, the poor, the foreign and the phobic. We had not learned to swim as children and could not believe we had to do so now.

There was no choice but to take the introductory swim class. Yes, it was a bit like that rite of passage my parents endured. But at least it counted toward the mandatory gym credits. I found it was a major advantage not to be phobic and to have English as a first language. I actually learned to swim the required three strokes as well as tread water after jumping off the deep end, a feat never to be repeated.

I’m drawing a blank on how I managed the remaining college gym requirements This might have something to do with repeated head trauma sustained during introductory volleyball — I couldn’t help closing my eyes when the ball was in flight.

I know I tried to be more active during those four years. Inspired by a boyfriend at the time, I even attempted “jogging” for the first time. I barely got to half a mile before I had to sit down on the curb, out of breath and half suspecting I might be having a heart attack.

Fast forward 25 years or so. My daughter joins the cross country team her first year of high school. Inspired by a not well-received wish to show solidarity, I start to run. And I like it. I took it slow and was gratified to find that my prior life of sloth left me pristine knees and hips compared to experienced runners.

I started doing some races. Controverting popular running wisdom, I began with a very hilly 10 K and finished (that alone was my goal) in a little over an hour. The vomiting at mile 3 was just an added bonus. Running became my way to relieve stress, to think, and to keep middle age weight gain under control while still eating (and drinking) what I wanted. This past summer, I toyed with the idea of a half-marathon and upped my distances, getting to 12 miles.

I felt strong and fit. Clearly I was overconfident. Ran perhaps more than I should have one weekend with friends who were marathoners. Or maybe it was the neon Easter-egg colored minimalist shoes that didn’t give enough support but were so cute. The next time I ran, I felt this searing pain in my heel about 2 miles in that would not permit me to continue my run. I hobbled home.

Plantar fasciitis (PF). Once thought to be an inflammatory condition, currently the etiology was being debated. There was no consensus on best treatments. It depended somewhat on whether you consulted a podiatrist or sports medicine orthopedist, how far you were willing to go (injections of platelet rich plasma, anyone?), and how much you were willing to pay.

As a health care provider, I tried what the literature suggested and what I in turn had suggested to my patients. Non-steroidal anti-inflammatories and prednisone, an oral steroid, didn’t help, which gave credence to the latest thinking that PF might not be an inflammatory response to injury. I did all the proscribed stretching exercises daily. I took up yoga again. (Downward dog is the perfect stretch for plantar fasciitis.) Decided to eschew steroid injections based on my research and orthotics based on prior bad experience.

I believed the cause in my case was a sprained ankle about six weeks prior that I ran on too soon. The ankle was weak and threw off my gait. So I started cross training at the gym to build up strength. Faithfully stretched, used a foam roller and massaged my foot with a frozen rubber ball daily. Wore the snazzy Strasburg sock at night (https://www.amazon.com/strassburg-sock).  Got fitted for more supportive (albeit slightly less cute) shoes at a running store.

Almost six months later, it is definitely getting better. Some days I have no pain at all. I can run four miles outdoors, five on the treadmill with minimal discomfort. I’m back, baby.

I often wonder what my mother would have made of this newfound running obsession and my recent struggles. She wouldn’t have understood it but she would have put her two cents in. “Propel yourself forward while swinging your arms,” she might have called out, undeterred as always by her lack of personal experience. “Shorten your stride and increase your cadence. And don’t forget to stretch.”

Thanks, Mom. I think I got this.

#plantarfasciitis #RunningInjuries, #unathletic, #HobbledNoMore #RockingThatStrassburg Sock