my favorite

It's my favorite organ. I know that sounds silly.
Or weird.
But it is true. I love my heart.

This isn't some shallow decision, to love my heart above the rest.
I know more about each organ than most people.

I know about my brain. About the beta-amyloid and neurofibrillary tangles that may already be accumulating, even if I won't know it for a few more decades.
And the circle of Willis. And the courses of the cranial nerves. Even how to test them.

I know about my lungs. The little nodule that scares the doctors every time they get an x-ray. Sitting there, looking suspicious, but unchanged all these years later. And about pleural transudates and exudates. And neuroendocrine tumors. And my theoretical marfanoid predisposition to apical pneumothoraces.

I know about the gastrointestinal tract. From the complex neurological mechanisms that make swallowing possible (truly a miracle in my book), to the terminal ileum and its lymphoid follicles. Even the colon. And the fact that Westerners seem to get colonic diverticuli in the descending colon, while Asian's often get them on the ascending side.

I know about the kidneys. Both of them. Their blood supply. The glomerular basement membrane, podocyte foot processes, electrostatic charges - all these crazy things that really mean that my kidneys filter my blood hundreds and hundreds of times per day and only allow the loss of a select filtrate balance of chemicals and fluids. And I know about those sly adrenals perched atop each renal miracle.

And the endocrine system. It's complicated. I'll tell you that. But I can map and explain the hypothalamus, the pituitary, the thyroid, the adrenals, the gonads, the pancreas, and so much more. How they flip the switch to the on position. How they flip it back off. Even what happens when they get outta wack.

The reproductive system. I know about that, too. Follicles and fallopian tubes, vas deferens and seminal vesicles. And when the two systems work together, I know about the embryology - that crazy biological origami, folding and turning the cells as they differentiate and form a human. And the missteps along the way the lead to a cleft pallate, or spina bifida.

I can tell you about the skin. Oh, it does so much more than you think. I simply can't even begin to explain it here.

Or the nervous system. Nodes of ranvier, supratentorial lesions, venous sinus abnormalities, and the electrical system that makes everything else work together. Can you believe those nerves can actually tell the difference between hot, cold, pressure, vibration, and pain? God is a Master Electrician, among other masteries.

But the heart. It is truly my favorite. No other system can do its job without the heart. No other system works in quite the tireless, faithful way the heart does. Dutifully. Quietly. So central and important that death is designated by its state. If it is pumping, you are not dead. Not completely anyway.

It has an electrical system built-in, keeping it beating. If one shorts out, another takes over. If that one goes, another backup is already ready. And so-on, down the line, striving to stay alive even under the worst circumstances.

When I sit quietly, I can feel each heart beat. Every one. I can tell you my rate just by paying attention.

Laying in bed at night, I can feel each part of the process: the slamming closed of the mitral and tricuspid valves, the shifting of the heart as it squeezes the blood to the organs, the quick and solid closure of the aortic and pulmonic valves - sometimes together, sometimes slightly split. It just depends on where you are in your respiratory cycle, you know.

Unlike my other organs, that silently do their work, my heart quietly but firmly reminds me that it is there. This isn't true of many people. Maybe not even of most people. But it is of me.

My heart is why I love. That wild and beautiful girl of my dreams, by my side in bed every night. Those three little weeds and their bursting laughter, creativity, and passion for smiling.

My heart is why I run. Oh I love to run. Getting into my own head. Dumping out the waste and frustration and confusion. Running to exaustion. 4 miles or 41, my heart simply meets the demand.

When the endocarditis hit, I could hardly believe it. Had my heart betrayed me? Or had I betrayed it, allowing those gram positive cocci to find a home? But it was treatable. Truly recoverable. I thank the heavens for ultrasound technology. That tiny aucustic camera, snaked down my throat, gave a perfect view. Intact. Undamaged. Still ticking. Fully recovered after a month of antibiotics.

Then this week. New pains. New sounds. A fluttering rub I'd never felt before. Of all the injuries or illnesses, nothing consumes my mind with worry and frustration and even anger like my heart. The thought that it could be malfunctioning. Or damaged. Or sick.

The thought that it might be the rate limiting factor in this life-long chemistry experiment.
The thought that it might cut short my time to love.
The thought that it, the greatest supporter of my running, might force retirement.

Those hours in the ER were frustrating. I had already spent a sleepless night taking care of a children's hospital full of sick and dying children. Now I sat waiting. A private ER room. Those magic words got me in fast. "Chest pain." "Cardiac history."

I know how to play the game. Not that it matters. It was all true.

Blood tests. No enzyme elevations.
EKG. Normal sinus bradycardia. No ST elevations. No prolongations.
Cardiac monitoring. Alarming simply because I'm healthy.
Another echocardiogram.
A useless 500mL bag of 0.9% saline open wide. It only made me need to pee.

10 hours of waiting.

Drowsy
eyes closing
cardiac alarm sounding
waking me back up

You see, when most adult's hearts go below 60 beats per minute, there is a good chance there is a problem.

Sitting and conversing, mine hovers at 50. Sometimes 44.

And then I get drowsy.
I start to fall asleep.
And that dutiful heart, made efficient by countless miles pounding the pavement, it gets to relax a little, too.
44 beats per minutes
42
40
38
even down to 36.

Beautiful. Emotionally magical. That is my heart! So strong. So powerful. So efficient. Only needing 38 beats per minute. One every couple of seconds. Having trained and improved itself under my constant demands. Having created its own efficiency.

It has mastered itself.
Oh if only I could do the same.

The echo result was fine. But not perfect. Few people have a perfect echo.
But mine?
How could it not be perfect?

In reality, I'm just getting to know it better. Getting to know things that surely have been there all along. And coming to grips with the reality of life. Things get old. Things get rusty. Things wear out.

In the mean time, I have a life to live.

And I love it. I love life. And I love my heart.

______________________________________________

My scourge

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Me, sleepless

My wife took this photo of me while traveling across the midwest last week for med school graduation.  The watch tells the time and date.  I had already skipped a full night's sleep to drive.  And that night I was facing another near allnighter to make it to the next destination.  

Little did I know that Kirksville, where I was heading for graduation, would be struck by a tornado that very night.  

Jake

He slept well during the night drives!

Jake

Apparently he loves the pole.

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Breakfast

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My PICC

It bled a little yesterday for some reason.

PICC

Up to my room where I stand of chance of enough solitude to get the job done.

Clear the laundry off the battered cedar chest.  Roll out two paper towels in its place.

Wash hands.  Sanitize hands.  Pay close attention not to touch anything but the task in front of me.

Lay out the supplies.  

The first syringe has only saline - salt water.  White cap.

The second is bigger.  And colder.  Fresh from the fridge.  A red cap.  This is the one that'll keep me alive.

Number three is just like the first. 

Number 4 is smaller.  Yellow cap.  It'll keep the tubes from clogging between doses.

I peel the white cotton fishnet sleeve off my upper arm revealing  Tegaderm, like a 4x4 inch plastic window.  It keeps the site clean and, with luck, infection free.  I can peer right through it.  My pale white skin.   A thin purple tube, like a spaghetti noodle, traverses the window and disappears into my skin.  

Beyond that I can't see.  But I saw the last fluoroscope image when the physician was finished.  From the vein in my arm it goes across my chest.  It ends where every vein eventually leads.  The right side of the heart.    

You get perfect delivery that way.  From syringe to heart.  

Pulling off the sleeve the extension unwinds.  From the entrance in my upper, inner arm, the terminal end falls into my palm.  

No needles.  Don't need them with this tube in place.

Unclamp the line.

Clean #1.  Clean the tip of the terminal.  Kiss the end of each together.  Twist.  "IV push."  The salt water goes in, only takes  a few seconds.  A part of my mind sighs in relief.  The tube is still patent.  Didn't clot off.  

Number 2 doesn't need cleaned.  It was filled under sterile conditions by a pharmacist.  Or maybe a tech.  20cc.  Ceftriaxone.  Pale golden yellow.  Cold.  Clean the end of my extension.  Kiss.  Twist.  Push this one more slowly.  It'll take 10 or 15 minutes.  Fewer side effects that way.

As it crawls up the tube under the Tegaderm I feel the cold against my skin.  I feel the cold as it penetrates my skin.  After that, I feel nothing.  How warm is it by the time it drips out of the tip of the catheter and into my heart?

Clean #3.  Push as quickly as I like.  But I don't like any part of this.

Clean #4.  Push.  Just enough in the syringe to fill the line.  I pray it'll do its job.  Keep the line from clotting off until tomorrow.

Four empty syringes.  A couple dozen drying alcohol pads.  Throw it all away.  

Wind up the extension.  Tuck it into the mesh sleeve as I pull it back on.   

Its Spring.  But I'll be wearing long sleeves until this is over.  Nobody wants to see this.  

Only 22 days to go.

Fastnacht Day

 

Fastnachts.... you see that puddle between the donuts?  That's lard.  Liquified. Having seeped out of the donut itself.  

Imagine the Dunkin' Donuts guy.  He's sitting around saying, "Hey, I got these people addicted to coffee.  How can I get a few more bucks out of them?  Oh!  I know!  I'll deep fry balls of sugary dough, then coat them in icing and sprinkles.  Maybe even powdered sugar.  Perfect!"

Now imagine a Pennsylvania Dutch guy taking those donuts and soaking them in lard.

That's a fastnacht.  Happy Fat Tuesday.  

Playing with the kids

A little warm weather, an hour at the park with the kids. Those short people mean everything to me.

Acupuncture

During a demonstration at a medical lecture at the hospital today I volunteered for acupuncture. My chi is flowing now.

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The Map

on the wall..

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A run to the mall.

Finally, nice weather was predicted so I went for a run to the mall - York to Lancaster.  20 miler, nice easy pace.  Burned 2,800 calories and I'm starved.  This is mortgage guru Andy who came with me....doing business on the run.  Gotta love Blackberry.

DC Temple

Took a trip to the temple to clear my mind. Always worth it.

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Don't touch Jacob it's hot

16-month-old boys are more adventurous and curious than the ol' Spanish Explorers. Here's Jake a few hours after grabbing a hot iron.

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PHUNT Marathon

More details to follow...

50k...T minus 48 hours

I have just over 48 hours before the PHUNT 50k trail run.  It's an ideal run.  Not that 31 miles in a predicted 39 degree day is "ideal" per se.  (Fun thought, for sure).  The ideal part is the cost.  Free-ninety-free.  Zip. Nada. Cero.  No timing chips. No finishers medals. No crowds.  Only a loosely organized group of 200 people running in the middle of winter.

My buddy Andy is coming, too.  We'll help keep each other motivated and un-lost.  I've run this distance once before, but not on trails.  

Only 3 aid stations on the entire course.  And those will be stocked with whatever the other runners bring and donate.  Gotta make a run to the store so I can pack some water and food for what I'm sure will take at least 6 hours to run.  

Hopefully I can send some photos from my phone.

Northern Centrail Rail Trail Marathon

November 29, 2008  (a little over a month ago...)

Marathon #4 for me.  

TIME:     4 hrs 14 min something seconds

Ran a marathon on the rail trail in northern Maryland.  Essentially a very flat marathon along a comfortable trail that used to host a rail line.  Further north, near my house in Pennsylvania, the rail is still intact and the trail runs along side it.  Down in Maryland, at least where this marathon was run, the rail was gone.

I ran in trail shoes that I've used before on my technical trails.  This marathon was so flat I really should have stuck with my regular road shoes.  By mile 5 I had hot spots on my toes and by 7 I had stopped and taped the outside edges of both small toes. Unfortunately the tape then rubbed against the 4th toe on the right foot and I had to baby a very deep, painful blister over the next week.  That was the first marathon that really gave me blister trouble.  

The hardest part of the marathon was the last 1- 1 1/2 miles.  We exited the rail trail and headed up paved, steeeeeep roads back to the sch

ool where we started.  It was a mean trick to play - 25 comfortable miles then steep uphills.  But I survived and even stopped to kiss my wife a few hundred feet from the finish.