Super storm Sandy

Storm of the year ...

Started off labeled as hurricane which of course forecast to hit on Sunday 10/28 when I was flying back from London to Cleveland.  I was one of the lucky flights that left on time and was not delayed.  Got to JFK airport plenty early and heard all the reports of the 3 NYC airports going to close sometime between 7pm and 9pm and bus lines and subway also close sometime late that night.  Thankfully my Cleveland connection was scheduled @ 4pm but we still sat on the tarmac waiting for 2 hours for the take-off.  I think by the time we took off, there were over 40 planes lining up on the tarmac.  I didn't get into Cleveland until 8:30pm which was 2hrs later than originally but nonetheless made it.

The hurricane was then re-labeled as superstorm and didn't hit Cleveland until Monday afternoon.  Lots and lots of rain and wind.  It wasn't super cold but expected for the time of year.  Power was out in a lot of places and quite a few street lights and homes did not get power back for 2-3days.  This was probably the worse I have seen personally in all the places I have lived in.

The news about NYC after was definitely devastating as my friend living in the Bronx was said "NYC was destroyed" the day after the storm hit. Definitely sad to hear that boardwalk in Atlantic City was destroyed too.  It was one of the iconic Northeast thing and the re-build is going to be different and who knows how long before everything will be back to normal.

Scotland and England

My trip of the year ... Scotland and England

The trip started with arrive in London and I was able to spend a couple of hours wandering around in London before meeting up with rest of the group. Then next day, bright and early, started the tour going north into the real England as our tour guide say.  It was really different than the London city itself.  These towns were more the English towns that were described in novels, quaint, friendly and has lots of character.  London itself was more of metropolis, high fashion and finance dominated.

We went all the way north to the Highlands.  The mountains scenery is very different from the Western states.  They definitely got the rolling hills with small towns, random ruins, small bridges interspersed.  You can feel the history with the scenes.  It was absolutely amazing.

Of course, can't miss Liverpool with the Beatles, Edinburgh with the castle and palace, Bath with Roman bath house and Jane Austen and York with the Shambles and haunted ghosts.

It was an amazing trip.  There were definitely places that I want to go back.  London (of course), Edinburgh and Liverpool.  I can dream on right?!

Photos

Month 3

Today I had my 3 month post op check.  So far, just experiencing dry eyes after sleeping.  Even with the refresh and lubrifresh pm.  I would wake up in the morning feeling like goop over my eyelashes and still needed at least 2-3 drops per eye to get the day started.  Of course, my left still not crystal clear like my right and still experiencing starburst at night but it usually goes away if my eyes are not dry.

Per my check up, my right eye is 20/15 and left is 20/20 with slight astigmatism.  I was told that usually there's another burst of healing between 3-6 month.  I was given a trial of Genteal gel for severe dry eye to try.  Will see how well it goes.  So far, loving this, no more glasses, no more headaches from glasses.

Next check in 6 months.

NYC ... again

For this weekend in NYC, it was a chill relaxing one.  Had no real plans and kind of just playing by ear.  Originally it was more of a girls weekend but 2 of the girls backed out, so it ended up being me and Kirstin.  It seems like every time we plan for something for NYC, it ends up falling through whether it's with other residents from her hospital or other stuff.  Oh well.  It ended well though.

We had our lobster dinner with champagne.  It was a full lobster from head to toe and we totally destroyed it and have pictures to prove it.

Then we went to Cirque de Soli Zarkana.  It was an awesome show.  There are things that they do that seem nearly impossible. Standing on the pole probably 2 times the height of the girl and the pole on top of the guy. Simply amazing with what they can do to their bodies.

College Roommate Wedding ... LA

What a weekend. Flew to LA for my college roommate, Sarah's wedding.  It's been 6 years since the last time I saw anyone in LA.  I stayed with Florence for the weekend and had a good catch up with her.  It was weird seeing her as a teacher.  She always seems to be free spirited type, not the traditional teacher type.  But I could tell that she enjoys it and her students seem to as well.  It's so weird seeing college roommates/friends to be grown up and working real jobs.  I guess I'm still in the student mentality, sort of as residency is a job but still learning.

Anyways, the wedding was beautiful, on the smaller side but very much Sarah's taste.  I got to catch up with my old small groups and with few other GOCers. It was nice.  It was what I expected with it being at Grace Church, doesn't run too late, no dance floor and nothing too crazy.  But it was done to the true expectations of wedding vows as it should be between bride and grooms and God with friends and family as witness, not some huge celebration or reason for big parties.

Photos

Crazy next 6 weeks

This is the start of my crazy 6 weeks where I'll be either out of town or on call for weekends.  We'll see how much havoc it will wreck.  The first 2 weekends will be weekend calls, hopefully they won't be too bad.  After that, I'm going back to LA for the first in 6 years for one of my college roommate's wedding.  I have already missed 2 of their weddings. Then I'll be flying home then flying back for the next 2 weekends.  Finally, going to NYC to see Kirstin before I get a breather.

Whew! I can only imagine how my life during the week will be crazy.  But can't wait.

Freaky Friday the 13th

This was my first weird day during residency so far. It was like everything gone wrong with every on of my cases.  The first was supposedly simply J tube for feeding but the patient first had a doomsday feeling and then went into PEA arrest where heart stopped beating but still sending electrical activity. This happened when we busy starting IVs and intubating.  We almost didn't believed it happening but we reacted quickly. Of course, case was cancelled.

Then we got another add on, which was a disaster as the surgeons didn't know exactly what they are going to do until they open him.  Of course, we have to prepared for the worse. Since we were somewhat ready, it wasn't as bad as expected. Just busy throughout the entire time to make sure he was very stable.

Whew! what a day. busy, long, tired, so happy when I got relieved to go home.  My feet hurt and I just wanted to sleep.

Month 1

Wow! It's been a month since the surgery.  It's been going great. My vision is clear pretty much all the time with occasional bouts of haziness that clears up with blinking and eye drops.  Today at the check up my vision was 20/15 right eye and 20/20 left eye.  Got a cornea mapping done and had prescription checked, had a little of astigmatism on the left, which I was told that it should get better as time goes on.  Otherwise, I use now about 3-4 vials of eye drops unless I have a really bad day, not common.

Night vision is also slowly getting better. Still got the starbursts but completely clears up when I blinked. I have been able to read the normal computer print about size 11. I have also resume my attempts in working out when I could and officially got the go ahead to get into pool and hot tub. Yeah! I ran out of my steroid eye drops by the end of 3rd week and I call my doc and was told that it's fine to just stop.  Hopefully there's no repercussion from stopping the drops early.  I can't wait to have my dry eyes go away completely.  I asked how long and was told about 6 months to 1 year with PRK closer to 6 month spectrum and LASIK closer to 1 year spectrum.  Hopefully by Thanksgiving, my dry eyes will be thing of the past.

The only funny thing is that in the morning and after shower, I was in the habit of looking for my glasses since I was 6. So now all of the sudden that I don't need them, it felt like I'm missing something at times.  The feeling is getting better and I sure don't miss wearing glasses and getting headaches from them. Now just waiting got 3 month check up!

Week 1

Today I have my 1 week post op check and get to have the contacts bandages out. Yippee!!!

So before removal, I had the eye chart exam. I was able to see without the pinholes and read about 20/30 right eye and 20/25 left eye with little bit of blurriness.  Then the contacts came out, it feels like it was a layer being peeled.  When doc looked at the corneas, I was told I had some dry spots and keep using the artificial tears (refresh plus) as needed and often.  Now I'm down to just using the steroid drops, on tapering dose.  Guess I'll have to up my usage, I have been using about 5 vials a day, I'll just increase it to 6 a day.  Still using the refresh pm at night and need a vial of artificial tears in the morning when I first open my eyes.

Also, it's my birthday!! I had to work late so I just bought myself birthday dinner and dessert.  I got dumpling noodle soup and jade tofu with fish fillet from Wonton Gourmet, and cassata and tiramisu cake from Presti Bakery. I went to my go to Chinese restaurant here in Cleveland and a yummy Italian bakery in Little Italy.  Overall, a quiet birthday, my typical since I've been living by myself and not being able to go home for it.

Day 5/6

Day 5 was better, light sensitivity was not as bad, definitely improving.  Words on monitor are getting clearer and vision in general is getting pretty clear.  Still using the drops as scheduled and as needed.  The contacts bandages were now really irritating, keep wanting to pull them out myself.  Can't wait for the 1 week post op to get those out.

Day 6 was my first day back to work.  My day starts early and I still drive in the dark in AM so lights were definitely starbursts so I keep my focus away from oncoming traffic.  But otherwise, working wasn't too bad.  Used the drops as needed and scheduled, computer screen was turned down dimmer and I had to squint a little to read the words since they were not enlarged due to computers being shared in the hospital. Sunglasses were definitely my best friend during the day time. c(:

Day 4

Work up in the morning needing about a full vial of refresh to open my eyes without feeling dry and grainy.  Then I had an appointment midday and a baby shower in the afternoon.  This was my chance to see if I'm able to drive and be able to work on Monday.  I can definitely drive, but needed to squint with my darkest sunglasses due to the midday sun.  So I ended up getting a ride from a friend for the baby shower.  Coming home at night, definitely see starbursts with the light a little worse than with my contacts but it gets a little better with lots of blinking.  Didn't feel like I needed a lot of the refresh drops, but I keep reminding myself to use them every hour or so. By now, I just feel like the contacts bandage needed to come out, it was beginning to irritate me.  I'm the type of person who hates wearing contacts to sleep, only occasional naps.  Again slept with my ipod.

Day 3

Today was slightly better, still slightly light sensitive and wearing my sunglass, but no pain. Thank goodness I'm one of those that had no pain.  Lots of refresh drops with scheduled ones.  Able to start read off my laptop with larger font.  On my Mac, it's about 2 swipes to enlarge the font. But not able to stare at the screen too long.  Overall, it feels like it's getting better, vision is clear but definitely ghosting and blurry.

Day 2

Today I woke up with the worst feeling for light sensitivity, but no pain.  I could barely keep my eyes open with my blinds closed and curtains drawn.  I even ended up wearing sunglasses indoor and minimal lights on at night.  Even the TV glare was too much for my eyes.  So I pretty much just keep my close as long as I could, nap if I could.  But every time I wake up from nap, my eyes were super dry and ended up using 1/2 vial of refresh plus.  Continued the scheduled eye drops with refresh plus.  Since I napped too much during the day, I just didn't feel sleepy at night, so I thought percocet would help. Bad idea, it actually kept me up. I did end up start using refresh PM for night time, so I had to keep my eyes closed and just listened to my ipod.  Thank god for ipod. :)

Day 1

No pain, but feels a little like something is under the contacts, especially the right eye.  The drops helped with the sensation.  Wow, I can see, don't have to squint like crazy to just see something right in front of me.  It's great that I can see across the room. 

First follow up appointment today.  Vision check was 20/70 right eye, 20/60 left eye but with pin holes 20/40 right eye and 20/30 left eye. So all in all, not bad.  Doc approved, no problem.

After, had lunch and ice cream with a friend and wandered around for a bit in the mall.  Feel a little light sensitive, otherwise no problem.  Had to keep reminding myself to put refresh eye drops in my eyes hourly so not to dry up. I wasn't sleepy at bedtime but could sleep, probably not deeply so I ended up taking tylenol pm to get me to sleep and not wake up in the middle of the night.

PRK Surgery

Today is the surgery.  And I'm post call, thankfully I was able to get some sleep throughout the night at the hospital so I was not completely exhausted, bleary eyed.

I took 1 valium as I arrived to the office then checked in and paid.  Then I was taken into their suite and was given a baggie of eye drops, lovely plastic sunglasses and sleep goggles and instructions. Lovely hairnet like cap placed and laid down on the surgical chair.  Numbing eye drops to each eye.  Right eye first, so a soft patch to left eye, then tape to protect the eyelashes and the eye lid spread to keep eye open to right.  The first I noticed was light sensitivity with the bright lights around the red/green laser area. Unfortunately, those bright lights are needed for the beginning during the cornea epithelium scraping. More drops are placed, some sharp looking thing picking and scarping, water to wash off, more scraping with a magnified glass and more water to wash off.  This part took at least 5 min and the laser itself was about a min. Then more water wash off, cleaning and finally the last set of eye drops and the contact bandage before patch goes on.  Then it's a repeat process for the left eye.  The whole process took about 30 min. After all was done, I could see but hazy/cloudy.  Sunglasses on once I left the suite.

For the rest of the day, pretty much slept on and off and continuous use of the eyedrops.  I didn't feel the pain that others have described. Everything is hazy and blurry and I had all my blinds pulled and kept my apartment fairly dark.  I put my audiobooks on my ipod to good use for the day.

The drops given:
Pink top: Prednisolone 1% - every hour for the first day, then 4x/day for 1 week, 3x/day for 2nd week, 2x/day for 3rd week, 1x/day for 4th week then stop
Beig top: Ciprofloxacin - 4x/day for 7days and done
Grey top: Diclofenac - 4 more times then stop
Refresh Plus: use as needed

Personal stock up and research additions:
Refresh Plus - stocked up from Costco, $19 for 100 vials, cheaper than Walgreen/CVS
Refresh PM - for night time to prevent dry eyes or stuck eyelids in the AM.
Humidifier - don't have one, so large bowl of water to allow for evaporation
Vit C/ Omega 3 - started about 2 weeks prior

Pre-Surgery Visit

I actually had the free consult at Cleveland Clinic about a year ago, April 2011, when I thought I should at least find out whether I'm a candidate for Lasik.  In my mind, I was only thinking about Lasik and didn't really think about other options.  The visit and exam were pretty thorough, took about 2 hours.  They checked my prescriptions and checked my cornea thickness with some form of mapping.  The results were that my left cornea was just under the limit for lasik and was about 10 microns too thin for it. My right cornea was ok.  Dr Kruger, my ophthalmologist, recommended PRK especially with my prescriptions and that in the long run, it might even be better.  I don't know much about PRK but understood from the appointment that it's longer process (takes at least 3 months to heal completely and up to 1 yr), may be more painful, scraping of cornea epithlieum instead of flap, but still done with customized wavefront laser and still will have dry eyes.  The total cost would be $3200 with the employee discount and I could use flex spending for it.

I did my own research on and off since.  In the beginning, I was kind of freaked out by other people's personal accounts on the internet.  There were lots of bad experiences especially people who had theirs done early 2000s.  They really put me off for for couple of months then researched again and found that it was not as scary.  So I finally decided that I'm going to do it and the question becomes when would be a good time with my residency rotation. I found a couple more recent personal accounts that were more helpful, in particular post op care. Through all the readings, I understand that my vision will not be absolutely perfect but I know that I can't wear glasses because it gives me headache from my nose up.  Contact lens were fine and I see starburst at night with them anyway since I don't have the astigmatism in them, so I'm used to the starburst look.  The only thing about contacts were that when I'm on call, I can't wear them and I have to look all over the place for my glasses if I get called when I'm napping.  I really just want to not wear glasses anymore.

Blog #1

Blog #2

I asked around as well, a couple people in my program has gotten PRK and their experiences were pretty similar to what I've read, a little painful, long time to clear vision and took up to a week off for recovery.  So I took 3 weekdays + weekend off before going back to work and just pray for the best that I will be able to function normal by day 6.

Surgery set for 3/6 and today was my official pre-op visit to finalize my cornea mapping and prescriptions.   It was more the similar exam as last year my prescriptions did not changed and had my eyes dilated for the laser wavefront mapping.  Got the scripts for valium and percocet and instructions.  I'm all set for surgery.

PRK Experience

I finally got my butt in gear and not be freaked out by the process (especially after scouring the internet for personal accounts) to have PRK done and get rid of my glasses.  I have decided to blog about my experience which I'm sure that it would be different from others as well.  So please take the post/ experience with a grain of salt.  No 2 people have the same experience.

A little background, I have been wearing glasses since I was 5yrs old and contact lens since 12yrs old.  I have worn RGP and then switched to soft, but I never liked the idea of wearing contacts overnight.  So by the time I was in college, my prescriptions were -7.5 right eye and -6.5 left with about +1 -1.5 astigmatism.  My prescriptions would vary about 0.25-0.5 every year but really about the same for good 10 yrs.  I have always said that I will have my eyes corrected after all my schooling were done; therefore not while in college or in med school.  Now I'm in my second year of residency and my hospital give a decent discount for it and the only issue is just making sure that the service I'm scheduled for won't be something that strain my eyes for the first month out. I've scheduled the surgery for 3/6 which is the last week of my general anesthesia service and then I'll start back up on PACU (recovery room) service, which uses less eye strain.

Pre-surgery consult
Surgery
Day 1
Day 2
Day 3
Day 4
Day 5/6
Week 1 (Day 7)
Month 1
Month 3
Month 6

Hospitalist ... Again

This month totally reminds me why I chose anesthesia again.  It was definitely a torture for me with chronic patients with never ending problems that don't get better.  Also non compliant patients and patients that couldn't find answers to their problems and expected Cleveland Clinic to wave its magic wand.  Patient load ranges from 12-14 daily with multiple discharges on most days.  It's never ending busy work and totally an intern rotation.  Literally for me I was counting down the days from the first day I started, with working 6 days a week.  So not like the first time around.  Oh, well.

Fun Weekend

This was a great weekend, the last one right before my hospitalist month torture to start.  It's going to be my last month of floor medicine and it's not the same as last year in terms that I'm the only resident with 10-15 patients and working 6 days/week.

Kirstin came for the weekend and it was great to see her, it's been 3 months since our Caribbean trip.  It's going to be a low key weekend, just relaxing and hanging out.

Went to Westside Market on Saturday. It was fun, having our lunch there, wandering around looking at the stalls.  Found the homemade pierogies, we each bought 3 kinds, can't wait to eat them.  They've got interesting flavors and sound very good.  For dinner, it's Indian, originally planned for Saffron Patch but they've got a wedding party going, so we went to Indian Flame, so yummy.  Of course, it's a snowy evening, but we went to Velvet Tango Room anyways to have our after dinner drinks.  They specialize in handcrafted cocktails, everything is freshly made, not instant stuff.  I've got the apricot sour and boy was it yummy.  The ambience is fun too, Jazz group playing and we just catched up and had a good night.

For Sunday, we went to Velocity Church.  It's a young church but somewhat charismatic as well but not as much as what Kirstin is used to.  People are nice but I just don't feel like it's somewhere I could grow.  It just doesn't feel as Bible based as I'm used to. After church, I introduced Kirstin to Vietnamnese food. We went to Superior Pho, I had the vermicelli and had her ordered the sweet and sour fish (also one of my favorite).  It wasn't the best I had but I still like the places in Cali.  Can't wait to go home to have good Vietnamnese food.

For the rest of the day, we just chill, caught up on our gossip and tried to hang out as much cuz who knew when's the next time.  My plan to is to got to NYC in April and June.  We shall see.

ENT Rotation

Today is the last day of ENT rotation, one of the intern rotation.  The rotation is not bad, it's split with airway clinic and inpatient consults.

The 2 weeks in clinic is busy in the sense that it's a long day.  Starts around 6:15a for morning rounds then clinic usually from 8a-4p then evening rounds after the ENT residents are done with their ORs. Days end sometime between 6-7p.  We don't do anything for rounds, just stand there and sometimes help with sutures removal or copy previous notes.  As for clinic, we do nasal fiberoptic scope for the larynx, so very similar to our fiberoptic intubation.  It was a good practice for our nasal fiberoptic intubation.

Then the next 2 weeks were on consult which we would just hang around from 7a-5p to help out with consults.  Most days we would get abou 2-3 consults and someday we were ignored cuz the resident in charge did want to give us any.  It was good time to get reading done.  I think I've gotten about 2/3 of Morgan & Mikhail done, but the question is more of how much will I retain for the ITE coming up.

New Year 2012

This year I decided to do something different.  I'm setting goals this year as a trial to see if it really help me to organize my life.  This is not to say that my life is a mess but I'm just trying to see if setting goals can become part of my life.

Goals:
1. spend some quiet time daily with the Lord
2. pick a church and go on average twice a month
3. lose 30lbs by end of year
4. spend more reading time for residency
5. call home more often

Let the New Year of 2012 begin!!