avascular necrosis

28 Jul

2011 was not my year, and it started with breaking my shoulder.  Happily, the surgery was a success, I healed quickly, and enjoyed full use of my shoulder until last summer.

I started noticing some discomfort in my right shoulder joint while I was doing kettlebell clean and jerks (sub-par description: snap the kettlebell up to the front rack position with one arm, then quickly press it overhead with the same arm).  I took it easy and backed off, things seemed to improve, but the discomfort would always come back…kind of had an eery quality about it, if that makes sense.  It just felt like something was wrong.  I stopped doing any movement that caused pain, including any weightlifting overhead.

About a month later, I got pregnant.  I knew that no surgeon would touch me in my status, so I used the pregnancy as a practice in patience (if it wasn’t that already), I listened to my body and tried not to be overly frustrated.

The last two months have been the worst for my shoulder, as it’s a pretty much constant annoyance.  I can’t hang from a pull-up bar without feeling pain; I can no longer sleep on my right side.  Carrying two children at once has likely been an exacerbation.

John made the good point that, since we had met our deductible this year with Evie’s birth, I should try to figure out the problem sooner rather than later.  If it was just a question of a screw being out of place, going in for surgery before the new year would be financially beneficial, not to mention easier on my daily comfort.

I was, frankly, shocked  by what the x-ray of my shoulder revealed: “There is extensive subchondral lucency and patchy sclerosis involving the humeral head suggesting avascular necrosis.”  Layman’s terms: my bone is dying due to interruption of blood supply, a rare complication from the kind of bone break I had.

Tomorrow I go in for an MRI to determine how quickly the necrosis is evolving, if I’m in danger of bone collapse, or if it is relatively stable.  Bottom line is that I will need a joint replacement, but the question is when.

Although this news isn’t terrific, I’m encouraged by the options available to me and my surgeon’s optimism–his goal for me is full use of the joint.  First screws, now a brand new joint!  I’m becoming more and more bionic with every procedure!  At the end of whatever road we go down–pain management, watchful waiting, surgery, recovery and rehab–I’ll be very happy when I’m able to carry my daughters on my shoulders again.  It’s the best (“dah baest!” as Ari declares).

This weekend I dragged a febrile 21-month-old, her sister, and friends to the zoo (“ztou!”) in the 94-degree heat.  I liked the giraffes.  Ari preferred the cold ice cream.  (I’ve noticed that on weekends in which John works, I don’t shower.)

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don’t get sick on a plane

25 Jul

We learned from firsthand experience that there isn’t much on a flight that will help save your life from a medical standpoint: a small automatic defibrillator, like 500mL of normal saline, an injection of epinephrine, a couple bandaids.  Here’s another reason you should try to avoid cardiac arrest on a flight that I’m on: as of 10:30 this morning, according to the American Health Association, I am a qualified Advanced Cardiovascular Life Support (ACLS) provider, and therefore deemed fit to come to your rescue.  While I feel comfortable cycling through the algorithm (shock, two minutes of CPR, 1mg epi, etc.), I would rather not be the one calling the shocks on your poor fibrillating ventricles.

So maybe I should just not get on an airplane without John.  He will always be seven years ahead in medical training and is, as an ER doc, uniquely qualified for this sort of thing.  He can be the rescuer and I’ll stay with the kids.  How bad could the latter be?

Happy Friday!

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weekend in charlottesville/celebrating the marriage of a mentor

24 Jul

Could I have picked a longer post title?

Last weekend (like, 14 days ago now) we went to Charlottesville for wedding of one of my mentors, the conductor of the University Singers, a professor, a composer and author, a student (we took a course on Joyce’s Ulysses together), and a dear friend of mine.  It was fantastic.  We went to celebrate the marriage of friends.  In Charlottesville, our happy place (apparently for good reason) and the home of other super close friends (including one who is was just three weeks old at the time!).  With daughters (!!) in tow.  AND there was singing.

Truth be told, the first 48 hours were a little rocky, since I took the trip solo with the girls (I had to be in Charlottesville sooner since I was singing in the choir) and John met me in Charlottesville after finishing up a string of shifts.  Lesson learned: never take a road trip during regular toddler waking hours–oh the bitter, blurry tears of an exhausted mini-monster (whom I love dearly even during her convulsive rages).  I called in a lot of favors, including having my overly-tired and generally confused children babysat by two professional oboists while I went to rehearse with the choir.

Too much good stuff to enumerate in a post, but one of the highlights was the wedding ceremony itself.  Seems obvious, but in this case the ceremony was described by many as two concerts with a wedding intermission.  There were some old favorites like “Set Me As a Seal” and “I Was Glad,” and then there were also original compositions by family and friends, one written specifically for the occasion.  The chorus was made up of all former U-Singers and it was a rare privilege to have the opportunity to create such a pure and easy blend with listeners–I loved every moment.  The kids made it to the wedding for a few moments before John found that keeping two children quite so long was an impossibility, but apparently Ari welcomed the music with as much enthusiasm as I witnessed during this performance.

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For the reception, we left Ari with a good friend (who also happens to be a pediatrician!–could we be more spoiled?) but took Evie, since she doesn’t really have a bedtime yet and we’re taking full advantage of the “potted plant” infant stage.  I get a little sad separating them for things like this, but it gives Ari a little extra individual attention while keeping her somewhat rested, and allows us to not always be distracted by a 100 mph toddler.

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The eldest was rewarded the following day with a sweethaus date with her favorite Charlottesvillians:

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and then this happened…

16 Jul

We had a tremendous weekend, about which I’ve been looking forward to writing.  It involved travel, music, a wedding, family, friends, lots of little people, and a little booze.  But my two girls are asleep, one perhaps a more deeply due to two-month shots–proud to say that, unlike last time, I did not burst into tears when Evie’s face crumbled in pain.  So I’m about to turn in, but quickly, because this is just too ridiculously obnoxious…

On the drive to the pediatrician’s, I was thinking that, despite making the mistake of getting on the scale last week, I’ve been good about psyching myself into feeling comfortable in my own postpartum skin.  Woot!

So comfortable was I that I didn’t self-consciously suck in my tummy as I walked around a local coffee shop, bouncing my friend’s infant in my arms, ooo-ing and ahh-ing at all his distinct, adorable idiosyncrasies.  An older woman approached me, “And when is your baby due?”

Straight-forwardly, and without animosity, I said the only thing that came to mind, “I’m not pregnant.”

“Uh.  Oh, I see.  Um, that was rude of me.”

I smiled at her, as if in agreement, and walked away.  John later asked if I told her I was two months postpartum.  No, better just let the woman feel uncomfortable, I thought.  Can’t say my self-confidence didn’t take a stumble.  Whatever.

A few snapshots of the Oppenheimer women from the weekend:

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56(+) days!

15 Jul

56 days evie

This little nugget turned 56 days old last Wednesday.  For those of you in pediatrics or emergency medicine in the Philadelphia area, you know that is a BIG milestone.  (Going back to this post, I realize that I included the wrong age, citing 60 days instead of 56.)  Now if Evie were to develop a fever (with a toddler older sister in daycare who loves to kiss her little sister, that is entirely possible), the doctors caring for her would at least take pause before initiating a full sepsis work-up.

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I have been relishing the snuggles a little more so than I had with Ari…maybe because I am acutely aware that they will not last, but I think more so because I’m not so horribly sleep deprived and, frankly, not as much a victim of baby blues or depression as I was with Ari.  The weather, the fact that Evie sleeps rather than goes ballistic in the car, the 3- to 4-hour chunk of sleep I’ve come to rely on in the middle of the night, all makes for a happier, calmer mama.  Oh, and we’ve officially started hiring a few hours of babysitting a week so I can complete my application for residency!  For the women who get good writing done during infant naps, I am in awe.

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blueberries

7 Jul

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One of my three favorite foods (a superfood!) and the semblance of this sweet one’s eyes.  Love. love. love.

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Off subject and truncated: In the last week I’ve found that, at least for me at this time, it’s acceptable to ask for help before I’m running purely on survival mode; it’s okay to say “yes” to generous offers purely because they make life more enjoyable.  John’s been working the evening shifts recently.  On Tuesday last week, he got home at 1am to an explosion of legos, books, and caked applesauce, with me and Evie passed out on the couch downstairs.  Yes, I could put both girls to bed by myself.  But the following night (and the next night and the next night), a friend came over to hold Evie while I put Ari to bed–heaven!  Those five minutes by myself with her were crucial, to both of us.  Breastfeeding alone necessitates that I get a lot of one-on-one time with Evie; but I also need my time with her brave older sister.

Cuteness: Ari has been insisting of going to bed with 2-4 books in her crib.  Sometimes she flips through one after I put her to bed, before she falls asleep.  Sometimes she stacks them in a corner, then gingerly places her lovey on top and snuggles in.  Twice now, a book has fallen out of the crib and Ari has responded with blood curdling screams.  When I arrived, she was standing up, fat tears on cheeks, howling.  I retrieved the book and handed it to her, crying instantly stopped, and she dove back into her pile of books and stuffed animals and went to sleep.

 

parallel play

3 Jul

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It feels like a very long time ago that I would purposefully plan nothing over a weekend so I could sleep in, vegetate, and recharge.  I’m sure most parents know (and probably most non-parents who are even a little less oblivious than I) that, with toddlers (especially the toddler + small infant combination), life is so so much better if there’s a game plan.  Otherwise we end up with me breast-feeding Evie crouched in a mountain of legos and board books while Ari pulls my index finger and the hem of my skirt toward the door…that’s the tear-free rendition.

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Luckily, this toddler requirement forces me to be social, get out of the house, and proactively seek out my friends.  I’m happier for it, especially in the early infant days when, for me at least, it’s so easy to just not leave the house.  And fun is easily satisfied with a friend who will still want to engage in parallel play even after getting bitten (can we guess whose kid is the biter?), a sprinkler, mud, a perching rock, and two pups.  I’m expecting my girls will be not so easily satisfied in the coming years, but I’m hoping that mud continues to be an impetus for fun.

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(Can we get caption suggestions for the picture above?)

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