Will post soon

Hey everyone, I'm sorry I haven't had a chance to post - we had a fun day yesterday in Beijing! But, I didn't get a chance to post all our stories and pictures, so I will tonight...about 12 hours from now. Look out for it then!

=) alan

local celebrity

Yes, Nicole is a local celebrity. We are staying in a town called Yanjiao City, just east of Beijing, a residential place where you don't see the international tourists attending the Olympics. So apparently its quite a hoot for the locals to see a whitey like Nicole! She gets double and triple takes, stares and whispers all the time! But thats okay, she waves back when she sees them looking.

The opening ceremony was last night, and was pretty spectacular! I'm sure many of you have seen pictures or highlights. We weren't able to get into the Olympic Green (the park on the olympic grounds) cuz they required tickets to get in. Some people watched the fireworks from the city. We decided to come back home and watch it on tv. It had much of the fanfare that New Year's Eve had.

We spent yesterday wandering the city a little, getting to know the buses and subways. It sure is confusing when you can't understand the language! The city seems less crowded than I would have anticipated. It is a city of 10 million people, but spread out over a large area, so its not like New York City. There is a pretty extensive subway and bus system, which always seem busy. We haven't yet seen all the famous sites yet - that will be coming up the next few days.

along a main road...

some cool buildings...

We had to wait to cross a bridge over this street; I think it was being blocked for some VIP like president Bush to drive through...

Shoe heaven for Nicole....

Jenny and Amy arrive to Beijing this afternoon! And our first events are tomorrow morning - women's gymnastics. We'll be sure to take plenty of pictures of the Olympics then.

Some other funny things - when its hot, the guys around here walk around with their shirts pulled up. Babies around here don't wear diapers - or for that matter, they don't wear any bottoms!

Maybe I'll work here in the future....

In the lobby of a 5 star hotel....

These little guys just hang out on the sidewalks of our condo.

- Alan and Nicole

arrived in Beijing!

Hey everyone!

Well Nicole and I arrived in Beijing, safe and sound. Here we are in the main terminal of the Beijing airport. It was pretty crowded and all decked out for the Olympics!

I was star-struck on the flight over here from Shanghai! There were a number of Olympic athletes on our flight, sitting right amongst us! From what we could tell, there was the Swiss olympic team, which included track and field and BMX competitors, flying with us. There were also some athletes from Liberia, though I think they were all students in American colleges, and they seemed like track stars as well.

What really made my day was that a Swiss olympic female pole vaulter sat right next to us on our flight! I was starry eyed - and Nicole totally saw I was star struck. Her name was also Nicole (but short for something more Swiss), and she was a very down to earth girl, still a college student, but was the top Swiss pole vaulter in the country! She was telling us how the Swiss and Norwegian olympic teams were staying in a house together while they train, 2 hours outside of Beijing, and then would return to stay in the Olympic village with the rest of the athletes. All of the athletes get to go to the opening ceremony - I was so jealous. I told Nicole, "I wish I were an Olympic athlete." Here is a picture of Nicole, the Swiss polevaulter, and Alan....

My parents picked us up at the airport, along with their "chauffer" - their hired taxi driver whom they got to know. We had about half-hour drive to the Eastern part of Beijing city limits, to a town called Fucheng, and thats were my parents' condo is. It less than 6 months old. The way construction happens, is that you pay for the "shell" of the condo - the bare concrete walls and floors, and thats it. And then you have to hire someone yourself and choose all the amenities - from the walls, to floors, to toilets, to appliances, to curtains, to lights...everything. Apparently some people have just enough money to buy the shell, and then try to make ends meet and slowly build up their home, so some homes are pretty simple.

Here we are on the sidewalk/entrance road throughout the complex where my parent's condo is...
This is the main entrance, we are in building #12, one of the newer ones.

We are pretty jet lagged, as we took 4 flights to get here, so we did some grocery shopping, will go out to dinner, and will probably head to bed early. Tomorrow is the opening ceremony, so we hope to be down at the Olympic village to watch all the fireworks!

Talk to you later,

Alan and Nicole

In the land of the rising sun

Hey everyone,

Well its been about 16 hours into our trip, and we are in Tokyo waiting for our next flight. It's already been an interesting trip!

First, we originally had a 9:40am flight out of Raleigh to Chicago, then connect to Tokyo, then to Shanghai. However, this morning around 6:30am an American Airlines representative called and said that flight was cancelled, and that they only had an 8:55 flight from Raleigh to JFK, and then from there to Tokyo, and that it would be coach rather than first class. So we had to rush and scramble to get to the airport to catch that flight, or else we wouldn't make it to Tokyo. Everything went alright - we ended up with a flight actually from Dallas to Tokyo.

The flight from Dallas to Tokyo was 12 1/2 hours, but we were in business class so it was sweeet! Except the part where the dreaded announcement occurs, "if there is a doctor on board, please come to the middle of the cabin." So hesitantly, I step up, but also a female doctor (cardiologist) also steps up, and I follow her to the patient, who is allergic to shellfish but accidentally ate some clams, and was having tingling of her face and voice changes and wondered if there was an Epi pen on board. We give her benadryl and prednisone from the cardiologist's stash (she has kids with asthma), and the patient does great. Whew!

Finally, our poor dog Sofie has had diarrhea the past 3 days, and even had an accident at home before we left - which is very unlike her. Our dear friend Stephanie is staying at our house and watching her, and we check our e-mail when we arrive to Tokyo - and Sofie has crapped in our house 3 times. =(::::: I hope she's ok....she's eating and playing, so it sounds like a simple case of the shits.

We'll upload some pictures of the luxurious 'first class lounges' and of the Japan airport soon....thats all we have so far...

Will keep you posted!

Alan and Nicole

About to board...

We r about the board our flight to china...let the games begin :)
Sent from my Verizon Wireless BlackBerry

Facebook

Well I have officially joined facebook, and I'm addicted.

You can check it out at www.facebook.com

Just got back to Durham, from a very awesome vacation. Had a guy's weekend with Andy and Aarish in DC!

Then, Nicole and I and Sofie took a week-long vacation, stopping through Savannah, and staying with Jason and Amy Rice in Jacksonville, then seeing Amy (my sister's) apartment at UF, before finally arriving home in Tampa to see the family. Spent the weekend playing Rockband with Jenny and Jeff, and hanging out with their ever-so-cute kids Tyler and Kaelyn, had dinner with Danielle and Mike and Kristen and Colin. Then, Nicole flew back, and Sofie and I drove back north, and stopped over in Atlanta where I got to hang with Ben Yin, and stayed with Amy and Nate, and then it was back up to Durham! I just started back at work, although in a nice cush rotation where I do exercise treadmill tests for the old folks for cardiac rehab.

Will write more soon!

Old habits die hard

Well, again I knew it would be hard to keep up with the blog...its been since November. And then I start my vacation, and realize I need to get a lot better at this.

My first post in 2008. And with the old wishful thinking, I'm hoping to keep up with this again. I'll try my best. There's alot thats happened since my last post, too much to tell all at one time. So I won't try to do it all now...I'll be writing a series of posts to get you up to speed.

Here's a summary, and I'm sure I forget a lot too...

- Our whole family, including Nicole and I, are goint to the Beijing 2008 Olympics!
- I've been offered the position of Chief Resident for 2010-2011
- My family came to stay with me for Thanksgiving (while I was on crutches)
- We spent a weekend at Barkwell's, a dog friendly resort in Asheville, NC with Amy and Nate
- Spent Christmas in Dallas, with Nicole's family
- Just finished two challenging months on Cardiology and Oncology
- Was in Washington DC last weekend hanging with Aarish and Andy
- Dave and Karen, our friends from residency, are pregnant
- Visited Amy in Gainesville and saw her dingy apartment!
- Have recovered from surgery pretty well, now jogging again and playing basketball
- Will see Kristen and Colin, and Danielle and Mike during this vacation
- Little Tyler is getting so big - now in preschool, and does soccer practice!
- Little Kaelyn is now able to stand!
- Amy and Nate, and Phil and Zenia are engaged and getting married this summer
- Aarish now purchases technology for the government
- Andy now works on offshore wind power policy
- Jason and Amy are pregnant, and Jason is about to become an orthodontist
- Alex and Sarah just bought a house in Tallahassee, and Alex is about to finish his ER residency

So much to talk about, I'll start on that soon. In the meantime, here are some pictures from Washington DC.

There's McDreamy and McSteamy...

Many of you have probably seen Grey's Anatomy, where there are two attractive surgeons nicknamed McDreamy and McSteamy.

Well, Bryan has given me my own Gray's Anatomy name...McSquinty! Not quite what I was hoping for, but I think it will stick.

- McSquinty

Bum foot

So I spent halloween morning on the operating room table, having a walnut-sized cyst removed from my right ankle. I had whats called 'tarsal tunnel syndrome'; its like carpal tunnel syndrome, where your median nerve is compressed causing pain and numbness in your hand. Instead, my posterior tibial nerve was compressed from this cyst, and I had these symptoms in my foot. So for the first time in my adult life, I became the patient and underwent the series of clinic visits and tests that we often send patients to.

First, I visited UNC's orthopedics clinic, which wasn't bad at all. Got x-rays, then was seen by a resident then the attending surgeon. Told me I had tarsal tunnel syndrome, and suggested an MRI and an EMG-NCS (electromyography and nerve conduction study).

So I did the MRI - which is sitting in pretty dark and narrow tube, with lots of loud machinery sounds, for about 40 minutes, just to scan my ankle. I received gadolinium, which is contrast, and couldn't help but wonder about the 1:10,000 odds of an anaphylactic reaction or possible kidney toxicity. But I managed just fine.

Then I got the EMG-NCS. The nerve conduction part is easy. They place stimulators on your ankle to stimulate your nerve, and then place sensors around the other parts of your nerve, and see if the nerve can transmit the signals. Because my posterior nerve was compressed, it was not conducting any sensation at all.

The EMG portion is horrible. They stick a not-so-small needle in your muscle that they want to test, then they say "flex that muscle" even with a needle sticking in it, and it can read both the level of nerve and muscle activation. So there was a damn needle going in sideways into the arch of my foot, and they're telling me to move my foot around and spread my toes. Painful as hell!

So of course, the MRI revealed the walnut-sized ganglion cyst. Interestingly, they're also called "bible cysts" and most commonly show up around the wrist area. People use to put a bible on the cyst, and then slam the bible hard to pop the cyst! Wasn't an option in my case - it would just make my nerve impingement worse. And the NCS showed abnormal nerve conduction. The EMG showed that I wasn't able to activate the muscle. And I was scheduled for surgery.

Now I haven't undergone surgery since I was 6, when I was bit by a black lab on my face and had to get plastic surgery. All I remember then was that my jaw hurt and it was hard to eat the frosted flakes after surgery. But as an adult and a doctor, I was kinda fascinated by what I was about to go through.

Here are some observations:

- Wearing a hospital gown really does render you very vulnurable. I had the good fortune, however, of being given one-size-fits-all boxers so my bare ass wasn't hanging out.
- Versed (a benzodiazepine, like valium) is a sedating medication that's like IV alcohol. Instantly, I felt drunk, drowsy, and uninhibited. What a weird feeling.
- Apparently, I was belligerent when I was awakened after the procedure. According to Nicole, I was blabbering very loud, saying things like "I didn't get a Foley....that's awesome"; "You ligated my nerve?!"; "What was my drip rate for the propofol?".
- Percocet, a common narcotic prescribed for pain, makes me feel dizzy, out of balance, and nauseous. I don't know how people are hooked to it.
- You get many separate bills. For the MRI only, I got charged for the MRI itself, then the use of "hospital facilities", then a bill for the radiologist to read it. Its about a $2000 test!
- IF YOU HAVE A WEAK STOMACH DONT LOOK AT THE PICTURE BELOW.

I TOLD YOU!!

And now I have a large splint wrapped with foam and an ACE wrap on my leg, and I'm not allowed to walk for 4 weeks. All in all, the process has gone pretty well, and I'm lucky to have Nicole and my mom taking care of me. But it does suck to be a patient.

Saving a life

In medicine, I think its less common that we are honestly "saving lives". More commonly, we are treating flare-ups of common conditions, such as congestive heart failure exacerbations or COPD (ie chronic obstructive pulmonary disease, aka emphysema or bronchitis) exacerbations. However, there is a case that I treated recently, in which we saved a 21 year old's life.

I just finished the ICU (intensive care unit), a grueling and challenging month where you are treating the sickest of the sick. One of UNC's functions is as a "tertiary referral center", a place where other hospitals send their patients if they need more advanced care. This also applies to ICU patients. If other hospitals receive ICU patients who are too sick...they come to UNC, and we take care of them.

I had a 21 year old patient, who I'll call John Doe, referred to me from an outside hospital. He was found outside unconscious, and an ambulance was called. When he reached the outside hospital, he body temp was 88'F, and his toxicology screen showed opiates, benzodiazepines (like valium), and cocaine. He wasn't breathing well, so he was intubated and attached to a ventilator. Then, he was sent to us.

When he arrived, he was still cold, but in a matter of hours he began to have fevers, and he became exceedingly difficult to ventilate and keep his oxygen levels up. His lungs began to show a dense pneumonia (lung infection), and also began to show signs of diffuse injury, something we call ARDS (acute respiratory distress syndrome). ARDS can occur when there is any sort of severe insult to the body. He was at the tenuous balance, where we needed to give him as much ventilator support as we could, but not give him too much support which would injure his fragile lungs further. His kidneys had been injured. We placed invasive lines in many parts of his body - there was a tube in his lungs to help him breath, a tube in his stomach to feed him; a large central venous line in his neck to give him fluids and antibiotics; an arterial line in his wrist to closely monitor his blood pressure and take samples of arterial blood to make sure he had enough oxygen; a tube in his bladder to drain his urine; a tube in his rectum to drain his feces. We didn't know what kind of damage to his body the hypothermia caused - we hoped he didn't suffer any brain damage, or that the cold temperatures didn't hurt his organs. And just as dangerous, rewarming him can also cause "rewarming syndrome" which could hurt his organs.

And in addition, no one knew who this person was. We had no name, no ID, no family. He was found by strangers and an ambulance was called, and then was transferred to us.

I was his primary doctor. But we had an ICU team. Other residents and interns took care of him when I wasn't there. The ICU fellows and attendings provided guidance. The nurses carried out the orders, and looked after him very closely.

And then his family showed up, and we found out about this person's life. Had much of an antisocial life, misbehavior, frequently caught up in drugs, stole from his family. All too sad in a 21 year old kid, that he has been slowly ruining his life and killing himself, and now he's here attached to tubes in our ICU.

But he started turning around. Slowly made improvement. We were slowly able to wean the ventilator settings, and his ARDS and pneumonia were beginning to improve. He exhibited signs of drug and alcohol withdrawal, and required high doses of sedatives, but we began scaling back. And after 8 days, we were able to extubate (remove him from the ventilator) him, and he was breathing on his own. He was able to talk to us, and could move all his limbs. He was still intermittently delirious, but had survived the most horrible part of his illness, when he was in total respiratory failure. Now that he did not require a ventilator, and his vital signs remained stable, and no longer in withdrawal, we released him from the ICU to be taken care of by a floor team. I imagined he would be in the hospital another week, recovering and regaining strength and hopefully normal function. We consulted our psychiatry service, to address his underlying drug habits and probable mental illness, hoping they could share some insight with him.

2 days later, I got a phone call from one of my fellow residents. He told me that Mr. Doe was about to be discharged home, and that he would like to come up to the ICU to thank us. To walk to the ICU! And he did. This 21 year old guy walked up to us, and said "Thank you for saving my life." Gave me a handshake, then a hug. He wanted to see the room where he spent the past 8 days near the brink of death. He wanted to know how sick he was. And then he told us that he was going to change his ways. No more drugs, and turning his life around. Hugged me again, and then walked out of the ICU, and later that day walked out of the hospital and, hopefully, to a new life.

That was one of the best moments of my life as a doctor.