Thursday, July 19, 2018

Tandigm Health Scholar

"What year are you?" I was asked last night as I was checking in for a scholars recognition dinner. I stared back in confusion for a few seconds. What year am I? Are they referring to residency year '07... med school year '04.... college '97... ?? I haven't been asked what year am I in a long time! Oh!  They are actually referring to the fact that I'm a new 2018 Tandigm Scholar. I have a year associated with myself again!

So what is a Tandigm Scholar? My boss had been encouraging me to apply for this since he found out about it. "Do you still have medical school debt?" he asked me. Do I ever! I'm on a 30 year repayment program... even if I do get this scholarship, it will only make a dent.

As they put it on their website, Tandigm Health aspires to "enhance primary care physicians to provide the finest possible care to patients". Physician led and clinically focused, their mission is to create a new paradigm of healthcare quality and value for patients. As part of this endeavor, they created a Tandigm Scholars Program to offer financial assistance for primary care physicians with significant educational debt. According to projection reports, our country is facing a serious shortfall of primary care physicians. Tandigm Scholars Program intends to encourage medical students to enter this high demand field and help them succeed by easing the burden of school loans. It also provides tools and data for primary care doctors to better serve their patients and to recruit and retain top-tier physicians. The aim is to bring primary care back to the center of healthcare delivery.

I tell my Penn medical students all the time how our field is in dire need of quality, passionate, and competent new doctors. So few graduating medical students are choosing primary care. I think back to my fourth year in medical school when I voiced my desire to enter primary care and was actually discouraged to do so. Why? I love what I do and would not change my decision if I had to do it all over again. What other field provides such breadth of experience and yet personal and deep interactions. Constantly being challenged and stimulated, my mind revels in the problem solving aspect of the job. At the same time, my heart basks in the rewarding relationships built over time, the meaningful connections. From advising new mothers on nursing their newborns to providing palliative care to grandparents, I am stretched. From cutting out moles, freezing off warts, suturing up cuts, or injecting joints, there is never a dull moment. I truly enjoy my work.

Now the program allows the scholars to work with mentoring physicians to perform a project aiming to research an area in healthcare where improvements made could increase efficiency and boost quality care to patients. Last night, we listened to the previous year's recipients explain their findings. It was both intriguing and inspiring. I had a hard time falling asleep because of all the ideas and thoughts swirling in my head. To be honest, up to this point I was starting to feel bogged down by logistics and demands... just the day to day paperwork... ins and outs.. dots and checks... But this program is forcing me to step out of my zone and examine everything in new light. I have renewed motivation to ponder... to ask questions... to seek answers.

When I was applying, my husband asked if I really wanted to add more to my plate that already seems so full. Yes.. my plate is full. It is filled with wiping spilled milk, resolving disputes, kissing scraped knees, hugging little bodies... driving to piano lessons, driving to sport games... answering questions, answering phone calls... scheduling... planning... being a wife, being a mom, being a daughter, a sister, a friend, a doctor... It is full. I cannot deny it. And yet... my personality is such that it thrives on full.

I've been telling folks that I feel like I'm coming out of a mom cloud. My body stretched in pregnancy and then tied to nursing every 3 hours for years and years is finally free to be just mine again. My mind affected by countless nights of interrupted sleep resulting in fragmented thoughts is finally able to string together coherent ideas. So being a Tandigm Scholar is exciting to me. Not only do I see it's value and potential to help my personal patients in my clinic but also in the greater scheme of healthcare.

I don't know... maybe I do tend to take on much and underestimate the time and energy things require. However, I am a big picture person. That is why I have four kids... because although it's a little crazy now, down the road I see the fun, the blessing, the joys. So although it may be adding to my plate, I am honored to be a Tandigm Scholar and thankful for the renewed passion it is giving me. I'm reminded of why I chose to become a doctor in the first place. My desire to help, to transform, to make a difference is reawakened. So here we go!

Thursday, July 12, 2018

101 on Calf Strains

So I've been thinking about writing this post for some time now but I finally am throwing it together.

In May, my husband and I took a trip to the Dominican Republic for some rest and relaxation away from our four kids. We were celebrating our 16 years of marriage. 

Well, you know you are getting old when you pull a calf muscle on the last day of the trip requiring wheelchair service at the airport! It was not only the severity of the injury that threw me into disbelief but how I acquired the injury. I wish I could say that I was climbing to the peak of some mountain or playing an extreme water sport... but no... I merely jumped a wave at the beach and landed wrong.

Now, I've pulled muscles before. It would hurt and I might have to limp and put less pressure on the affected limb. However, this injury caused such sharp, unrelenting and debilitating pain that froze me on the spot. It took a whole lot of effort to maintain balance and not topple over from all the crashing waves indifferent to my mishap. I could barely move without excruciating pain and yet I needed to make my way back to our umbrella and lounge chair so I could nurse my wound.

There really was no one near me in the water, but a whole bunch of folks laying out on the beach. It must have been high tide or something because the waves were massive. Pride and embarassment prevented me from calling out right away to my husband. I really did not want to draw attention to myself.  Who pulls a muscle on a beach while jumping waves? I peered at his figure in the distance... watching him get his lounge chair ready for a nap. I was sending telepathic messages to his brain... "Come on... look over here... I need you to come over! Don't make me call out!" So now... aren't couples supposed to be so connected that they can communicate without actual words? Well, not in our case. After staring and willing him to come over for what seems like an eternity... and even frantically waving my hands like a mad person... I gave up. I had no choice. I would be stuck out there forever if I didn't call out. Sigh. So I did... reluctantly... but even after he finally looked my way, it took another eternity for him to figure out that I needed him to come out where I was... in the middle of all the waves. Well, I wasn't going to yell out across the sand for all to hear that I was stuck and couldn't move and needed help to get back to our chair. Oh I'm mortified just recalling how ridiculous that whole scene must have looked!

Finally, back in our chair... I then had to doctor myself. Flagged one of the attendants to bring me ice, found pillows for leg elevation, then sent husband to buy an ace bandage for compression and ibuprofen for pain. It was so not fun being the patient and so inconvenient to not be able to bear weight on that leg. We found a random bamboo stick for me to use as a crutch and I had to hobble to dinner and hobble back. It was even difficult to pack that night because shooting pain would freeze me every time I flexed my foot. Even now I have a hard time believing how seriously I injured my leg.
So there are basically 3 grades to a muscle strain:

Grade 1
  • torn muscle affects only a few of the muscle fibers, maybe 10%
  • mild pain and can also get a cramp
  • symptoms last few days to few weeks

Grade 2
  • more fibers are damaged but muscle is intact
  • moderate sharp pain at time of injury
  • may have resultant swelling and bruising
  • will limp due to pain and weakness
  • symptoms lasts 4-6 weeks
Grade 3
  • complete rupture of the muscle
  • pain severe and immediate
  • unable to walk on affected leg
  • considerable bruising and swelling
  • may have bulge in the calf above ruptured muscle
Treatments include...
  1. Rest
  2. Ice
  3. Compression
  4. Elevation
  5. Medication (like ibuprofen/advil/motrin)
  6. Crutches
  7. Heal Pad
  8. Exercises
  9. Sports Massage (by trained professional stretching and preventing scar tissue
  10. Ultrasound (usually by physical therapist to help blood flow)
I was not sure if I had sustained a Grade 2 or Grade 3 strain at the time. Now that I've fully recovered, I believe it was only a Grade 2. But really... I still can't get over that it was merely from jumping a wave!

So I've instructed many patients before about this but I suppose I need to listen to my own advice... the older one gets the more time one needs to warm up and stretch. For sports, yes... but to go to the beach?? See-rious-ly... it is no fun getting old...
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