Wednesday, 29 October 2014

Keep (the USB cables) safe... Wear Protection.

I go through a lot of USB cables (particularly Apple USB cables, that are so flimsy and fragile), that some of them, when they break, are too expensive to replace sometimes that I resort to cheap knock offs that just doesn't charge as well as the original.

In order to combat that, I longed for cord protectors.

Thankfully, a good friend of mine, Ma'am Pam, one of my favorite nurses in the ER, ordered these for me.

Now, travelling, or having duties at the hospital, not aware at times how I store my cables won't destroy them...

So, let your cords wear protection... use cord protectors...

Tuesday, 28 October 2014

Shaving "Cut" Short

Now, I was just shaving, and having been growing my own mustache and goatee since the age of 12, I know a thing or two when it comes to shaving.

I rarely get cuts, and when I do it's small and caused by a cheap-o razor that I had to buy on a whim to shave either in school or at work for a surprise special occasion.

This time around, I got cut with a trusty Gillette razor; the brand I've been using for years... Not sure if I was not at the right state of mind or something, but I got cut good, that I had to use ice and lots of compression to ease the bleeding... took me 10 minutes. Wow my clotting time sucks.

Anyways, here's to another night of something strange happening... lol

"Cut" Short

The Road to Recovery: Rehab Session 4

Had another session done and dusted and me and my PT were glad enough to see that the swelling on my right knee has decreased; I can now flex my knee unsassisted for around 30 degrees, and able to flex nearly 80 degrees assisted.

I will be having another one this Friday, as well as, have a follow up check up with Dr. So, my rehab physician, to see if we can start doing weight bearing exercises.

Again, as hasty as I am, I was reminded to stay cool. Don't rush the recovery...

Little by little, I am starting to accept this long, long, road to recovery...

Monday, 27 October 2014

Such is Life...

Just when I got my groove back and started studying, I lost momentum and the urge to read when one of my reviewers was missing some pages... ugh...

I know it's just 4 pages on the 1st chapter and I can always read an ebook or something for the first chapter, but I don't know, something like this puts me off reading, at least tonight only...

And I was on such a roll, finishing 3 other books prior to this in less than 3 weeks... was hoping to finished this before the end of the month... ah well.



Some time in the middle of the morning I woke up, and started to have this headache, and based on my experiences, I know, by the time I really get out of bed later in the morning, this headache would turn into a full blown migraine. 

Knowing this, however, I still didn't take my medications to prevent my migraine from occurring, because come on, it was 3 in the morning, I just stood up, figuratively speaking since I am still a limping bastard that recently had his knee surgery, just to take a leak in the bathroom, and I had no intention, with my half asleep demeanor, to find a couple of medications that point.

So upon waking up later that morning, my fears came true that my migraine was so bad, that I started to have an attitude and was feeling nauseated by the pain that I ended up retching the entire morning and eventually vomiting once.

Unfortunately, this inhibited me from going to my 4th session of rehab for my knee, yet fortunate enough to be rescheduled tomorrow afternoon so as to not waste any time.

Well, my migraine has long since disappeared thanks to my go to medication when this get a little too rough.

This way I can study and possibly game later on...

That's all... lol


Saturday, 25 October 2014

The Frustrations of a Crippled Senior Medical Intern Continues...

Not really sure what is really bothering me and as to why I am in such a rut today. Just today in particular, but then again, I can't speak of tomorrow, I might, hopefully not, be much in a rut like I am today.

It could be because I miss some one, I don't know... Could it be because I wish I could go out and see the world without the constraints of having a wheelchair, crutches, or a cane, I don't know... Could it be because I miss working in the hospital, maybe...

It might really be the workaholic in me that years to return to the hospital and work (without pay), interact with patients and my mentors, and learn. I miss those hectic schedules where having to stop and take your breath can mean the differences between the life and death of another person (and subsequently yours by your bosses that will claim negligence).

I guess I just miss being a doctor... though I may not have a license yet, but I'm ever closer to get my license, had it not been this injury. Sans the license, being in the hospital, seeing patients as a doctor, a medical senior intern, and not merely a medical student, giving your diagnoses and management to your resident boss and have it right, and then earn praise, is the best feeling for a young doctor. I miss impressing... I miss overdoing things... I miss being toxic.

A little, huge, setback was this injury, I might be delayed (no I am not pregnant! lol) for the medical licensure exams next August, and forced to take the following exam on the immediate February after, broke my heart, but seeing as everything happens for a reason, I look at the bright and say hey, at least I get more time to prepare and target a great score in the exams... Better late than never anyways.

Hope my feeling of depression and frustration will end soon...

The Road to Recovery: The Rehab Sessions 1-3

I am a bit late in posting some of my progress post surgery in terms of rehabilitation sessions.

So this post, though short, will be covering my first 3 sessions of rehab. So here goes!

October 17, 2014 marks my first session of rehab post surgery. That is to say, that I had 1 session prior to my surgery so I kinda had an idea of what will happen and was actually quite excited, because it felt great doing those exercises. have ultrasound on my thigh (not the ultrasound you'd use for imaging of course), TENS, etc... IT was literally therapeutic for both my recuperating muscles of my right knee, and whole leg in general, as well as my soul. It was great!

So I was excited to have my rehab session.

Rehab Sessions
First Day! Take a look at my smoothe shaved right leg...
Rehab Sessions
Session Two! The upper photo is when they were applying TENS or Transcutaneous Electrical Nerver Stimulation and wrapped my knee with a hot towel; Lower photo is FUP or Faradism Under Pressure; I'll discuss both later in the post.
Rehab Sessions
Session Three! More or less the same routine... But I got some visitors!
On the last photo, I mentioned that I had visitors... Well, I always had visitors in ALL those three sessions. Ranging from my resident bosses, consultant bosses, co-interns, clerks, nursing staff, etc... I was humbled. To see how many of my colleagues and friends really cared. That's another reason why I enjoy these sessions... there is always a visitor!

And the plus factor, is my physical therapists there are all my friends since I was there during my medical clerkship last year. And my personal PT is my great buddy, JD. So it is never a dull moment.

Now what is TENS?

It is one of the more commonly used forms of neuroanalgesia, hence is used for pain management. How it does this is sending electrical stimulation to the nerves of the affected area where it can cause presynaptic inhibition in the dorsal horn of the spinal cord, release endogenous pain control like endorphin, causes a direct inhibition of an abnormally excited nerve, or restore an afferent input. All of which for pain control. Though I won't go into detail as to how they lower down the pain.

So what about FUP?

Well simply put, it is an electrical stimulation, much like TENS, but causes muscle contractions. Muscle contraction of the lower extremities is one of several mechanisms that can counteract venous pooling of the blood (other mechanisms include the baroreceptors in the carotid body that will sense the decrease in arterial pressure, due to the pooling, stimulating higher centers such as the autonomic nervous system to aid in venous return); venous pooling, if not mediated by our body's compensatory mechanisms or by contractions, such as the case of a post surgery patient with limited motion on affected area, will cause edema or swelling.

Since FUP causes contractions, it will aid in the recession or reabsorption of the excess fluid by venous pooling.

Those were a mouthful...

So my next session is this Monday, October 27, 2014, and I am looking forward to it!

Til next time!


Wednesday, 22 October 2014

The Frustrations of a Crippled Senior Medical Intern

September 5, 2014, the day that will be remembered in infamy for me. That was the faithful day that I had a relapse of my lingering right knee injury that I have sustained way back in my high school days in part due to an event in the department I was currently rotating at that time, Department of Ob-Gyne, and had to dance for the event; sadly, as simple as those dance moves were, my knee thought otherwise, and left me a partial laughing stock of the entire department, no, the entire hospital.

Well, maybe I am not a laughing stock, but I very well should be because of my utter weakness. To have those simple dance moves break my knee all over again, in front of my co-interns, my clerks, and my bosses. Jeez, I know I am not physically strong, and everyone does too, but this was pushing it too far.

After said activity, I was taken to the ER, no sooner than me attending to a meeting being the president of the hospital's senior interns for 2014-2015, had an X-ray done, and sent home with pain medications and advised for follow up to my orthopedic surgeon for further evaluation.

This is my X-Ray for my right knee, lateral view; note the patella is higher than it should be
Upon returning to work the following day, I braved the hospital with a cane, and severe pain, along with a knee immobilizer, knowing that I am in fact 24 hours duty that day, but not wanting to miss a day at Ob-Gyne, or any rotation for that matter, I still went through it.

Sadly, there were still some scattered laughter from my peers and whatnot, this was just reciprocated with the most faux smile I have ever given in my entire life, but dear lord, did I just want to sermon them about laughing at someone who is injured, it is identical to kicking someone in the groin when they are already down.

As the morning continued, it was becoming more apparent that I am having difficulty with the pain and the overall inability to walk. Asked permission to meet my orthopedic surgeon who had clinic that morning in the hospital, and was subsequently sent home and was given a week's off.

At first I was glad to have that off, because of the pain I am going through, but later on, I yearned to go back to work, so after said week's off, I returned, without a follow up to my orthopedic surgeon for clearance, and was greeted with warm hellos, welcome backs, and occasional, "OH! Why are you back!?". The latter came to haunt me later that day.

As the day was about to end, my knee, gave up once again. Warranting me to be admitted. I cried. Yes, that showed how much of a weakling and a cry baby I can be, but I cried because of the things happening to me. I could see my dreams of finishing my internship and taking the board exams next August slipping away; I cried because, damn it, why am I so weak that I had to have weak knees; I cried, because I felt people were looking down on me; and I cried, because so much pain, both on my knee, and to my very own feelings.

I didn't want it anymore. I really wanted things to just stop. I wanted everything to just start over. But I had to go through with it.

Upon Admission

The above photo, my groupmates, also in the white coat, heard of my knee giving YET again, went down the ER to see how I am doing. And my co-intern, Doc Mike Paroli, the one not wearing a white coat that day, was actually with me when it gave way again, and I am thankful that it was my best friend that was there to help me up again.

I didn't do anything in that room upon admission but cry cause of the things that are happening, and thus, the things that are not happening cause of it. I hated everything, but masked it with a mask of smiles and laughter.

My orthopedic surgeon then visited me the next day during his rounds, and gave me the news that surgery is needed. My world fell apart, and I am sure my mother's world fell apart too. We share a lot of the same traits, my mother and me, and yes I am a mama's boy. Hearing that I needed surgery, she knows that I wanted to go through life without surgeries, or go through life with such hardships that would follow from such injuries and surgeries.

After giving me the news of surgery, Dr. Dychioco, who happens to be my professor in Surgery class back in medical school not too long ago, was explaining the procedure and such, but my mind was fixated by the fear of the surgery. So I didn't understand anything he told me. It was typical I guess, I was blanking out in fear.

I was sent home later that day and prepare for my surgery.

And I had nearly a month to prepare because Dr. Dychioco's partner in this particular surgery was out of the country; Dr. Valenzuela specializes in arthroscopic procedures, and mine was arthroscopy with ligament repair for recurrent patellar tendon dislocation of the right knee. He would be back by first week of October and my operation was scheduled on October 7, 2014.

Tried going back to work while I wait, but the pain, the inability to stand for long periods or walk long distances hindered me to return to work, and was advised against it anyway.

And so the long wait began. The long wait where I felt stupid, unproductive, and useless. I hated it. I wanted to be useful, but seeing that I can't walk anyway, what more can I be but that?

Thankfully, I finally started to collect games in my Steam Library to help me out; I've had a 5 year old account with not that much games... in fact, most were free to play... Plus I forgot my username, password and email for that account. This led me to create a new account 2 years ago when a mod of sorts for the Source SDK 2007 toolkit named Black Mesa, essentially a Half Life 1 remake on the source engine (not to be confused with Half Life Source). I started adding games to that 2 year old account and to this writing, gathered 45 games in less than 2 months. Thank you Steam sales.

I will not buy digital copies of all my favorite games; the ones that I still physically own the discs, I'll pass on Steam.

My Humble Steam Library, 2 years old, but only started purchasing games less than 2 months ago. Waiting on Winter Sale...

To help go through this phase of initial depression, I say initial and you'll find out why later on... Me and my best friend, Brian, each got a copy of Borderlands 2 and started playing co-op online together. He is my best friend who moved back to the states, and boy, was it hard to go through these hardships without your best friend to annoy you and overall pick on you, and inevitably put a smile on your face.
Her we are at Pandora

Another method of keeping my sanity in this hardship was, texting, PM'ing, and Skyping with my favorite girl in the world. She is lives like 2 hours away from me, so visiting eachother, especially with a bad leg, her job, and all, isn't really ideal. Anyways, hearing her voice, seeing her sometimes pixelated face (thank you internet), and hearing my phone notify me of a text message and it's from her, makes me happy and forget about my problems.

Just because she makes me happy

The last "feel-good" pill that I took in order to make this phase of my life any easier is that I fell in love with a smartphone. The very first smartphone I really ever wanted. The ASUS ZenFone 5 in white. I never bought my own phone; my past phones were either gifts or hand me downs by my older sister. I am more into DSLR, guitars, and computer gear, than I am ever interested with phones. But being a computer geek, always dreamt of a good Android phone. And the ASUS ZenFone 5's price is right up my alley. Sure it doesn't have all the features you'd expect with something more expensive, but the features, and the lack thereof, is enough for me and my daily needs. And Android, being as open source as it can ever be, I am enjoying tweaking it to get the very best performance for my needs.

Then the inevitable... October 6, the day before my operation, and it happens to be my dad's birthday too so we didn't really celebrate his birthday. I was scared of everything at this point.

Count down to surgery

Obviously I couldn't sleep the night before, then only sleeping by 4 am knowing that my operation is on 9am. Having being woken up by 8:30am to be tranferred in the OR but was slightly delayed that gave me time to cool down and as everything was escalating too quickly for me. Got my sister, Dr. Debbie Udarbe, to scrub in and keep me company the whole time. And she wasn't shy taking pictures...

My classmates and co-interns wishing me well before I go under the lights

My groupmate and my buddy when it comes to wreaking havoc, Dr. Richard Lao, escaped from his duty to wish me well...

Pretty much all nurses in the hospital are my friends, but only a few are my close buddies that I can really pick on and be picked on. Sir Marbie is one of them. Blessed to have him as my circulating nurse at that time.

Finally, the procedure started. The best part was when I thought Dr. Enriquez, the anesthesiologist was giving me diphenhydramine to feel more relaxed due to its sedative nature before giving me my spinal anesthesia, I was wondering why I was feeling the effects really fast, and it was as if I was on my favorite pain reliever, demerol. it was only when I got home, that I found out that I was indeed right, It was demerol. It was funny, because after that injection, everything was an absolute blur... woke up in the recovery room after the procedure and was greeted by my sister, and my pseudo sister, Dr. Rayzen Canono.

The first they told me was "they shaved you". I was still under the effects of spinal anesthesia so I can't feel or move anything below the level of T10 (umbilicus). So I didn't know if they meant they shaved my private area, thus leading me to think they place an indwelling foley catheter, but having reached down there, I was relieved that it was my right leg that they shaved. Another funny moment.

And so it goes

My professor in medschool and my anesthesiologist, Dra. Enriqeuz

On the right, with glasses, is also my professor back in medschool and my main orthopedic surgeon, Dr. Dychioco

On the left, is Dr. Valenzuela, specializes in arthoscopic procedures.

Finally, being allowed to return to my room after spending at least 4 hours in the recovery room, I was greeted along the way by my fellow interns, the nurses, my resident bosses, and my consultant bosses... it felt great knowing people were worried about your procedure and they are as happy as you are that it went well.
And I was greeted by this on my wall!

What a surprise!!

Notes by my best friends, my favorite resident bosses, my ER nurse staff (who are my closest friends in the hospital), my favorite interns that taught me a lot when I was a clerk, etc. I was happy. And like what all the nurses said, the doctors said, and all my friends said when they visit me and see this on the wall "This will really help you get well soon". And it did.

And finally... after a couple more days being confined at the hospital for observation and pain management... I was sent home.

Time to go home...

Upon arriving at home, seeing what my family has done to the house to make it easier for me to walk around with crutches and whatnot, means a lot to me, in fact, all this that I had to go through, they had to go through to... my family, friends and relatives, that each helped out in one and another, having to deal with my short temper due to the pain, having to put up with my mood swings because I feel so useless and helpless with what happened to me... everything. I appreciated it all.

Having sat down in my computer chair, of course, sitting in a new way because I can't flex my right knee just yet, but having to be in a familiar environment, where my PC, guitar, and DSLR are, helped me with this phase of recovery.

I turned heavily to gaming, self studying, and of course PRAYERS, when I got back home. I have always turned to prayers in time of need. And in time of thanks. But it was more apparent now how I used prayers to help me go through this, to help me accept what happened, and to make me accept that maybe I can't take the physician licensure exam August next year yet...

All in all, I miss going on hospital duties... I miss wearing my white coat. I miss seeing patients and be puzzled as what have befallen them in health, and feeling the jubilation of getting the diagnoses right and the euphoria of getting them better with the right management. I miss being a doctor. I hate being the patient.

But as everyone reassures me time and again, maybe God had better plans for me, and this is why this happened. Maybe, just maybe, I am not meant to take the boards next year just yet... Maybe I need a couple more months to study harder for the exams. There will always be something better... I just have to keep my faith up.

As of this writing, I have had 2 rehab sessions already done and dusted and will continue to do so until I can walk without crutches and revert back to my cane and eventually to walking all by myself again. Here's hoping I can recover faster.

I guess why I am writing this is just to chronicle what happened, and to let out some emotion of this phase of my life. The dependence on others frustrates me the most, because I have always tried to be independent, that's what separates me and my sisters; the pain, that then triggers my chronic migraine; the slow recovery; unable to finish internship on time; and the mere fact that I feel like a total weakling is the worst of it all.

I just thank my family, especially my mother who had it just as rough as I did; my relatives, my friends... for without them, I'd be spiraling more and more into depression, frustration, and everything else.

I also thank God, for watching me all throughout this phase of my life. He was there before, and sure He will always be there well after my recovery.

This is one my longer blog posts, unstructured, but full of emotions...

With that... I end it here.

'Til next time!

Friday, 3 October 2014

Blog on th Go: Visiting my Sis in the Clinic

So today is the first day my sister has her own clinic sched at the hospital... though it is not her clinic per se; it is not under her name, but finishing her 3 year residency training in the department of internal medicine last July 2014, she was given the privilege to start seeing her own patients in the clinic. She is afterall a consultant now.

It was nice seeing her in action, and a senior medical intern, she is still my inspiration in becoming a good doctor myself in my own right.

I still have ways to go; board exams, 3 years of internal medicine training, diplomate exam, cardiology fellowship training... and it goes on.

But, seeing her the way she is now, I want to be like that myself... So I must do everything I can to get it.

Posted via Blogaway on ASUS Zenfone 5

Blog on the Go: Gamer Problems...

Gamer problems...

Non-stop Steam sales of great games! I though these sales would be for awful games but come on,  titles like Borderlands, Crysis, Torchlight, even Dragon Age Origins (I already have the physical discs, so I need not buy the digital copy), so how do you expect me to not buy these!?

I was saving up for Steam winter sale, by adding funds to my Steam Wallet every 2 weeks to a month, but darn! I think I spent 70 dollars in 2 weeks on great deals!

So my latest purchases are Borderlands 2, Torchlight, and Torchlight 2. For a total of 10 bucks... great deal!

I swear, those are going to be my last purchases for now. I will save ny funds for Winter Sale.

Thank you Steam!

Posted via Blogaway on ASUS Zenfone 5

Thursday, 2 October 2014

Blog on the Go: Studying... or trying.

Since I am still on leave due to my injury and my upcoming operation for my right knee on October 7, 2014, I have nothing better to do than to study. Or at least try to study.

Well, I could play some games, but I just bought Borderlands 2 that was on sale in Steam and still waiting for it to finish downloading. And the internet speed by local ISPs here in the Philippines is slow at best. Ah well.

Time to hit the E-Books!!


Posted via Blogaway on ASUS Zenfone 5