When Paul and I travel, our dogs stay at Mile High Mutts, a fabulous doggie day care and boarding facility in Denver. They don't miss us one bit!
Yesterday, they sent me this picture of Mae, so happy with a Kong:
As I write this, Mae is just outside... but I miss her!
Last week, I had a great four days of snowboarding in Beaver Creek, then one final day of skiing. Much to my delight, the third day offered six inches of glorious powder -- and that much powder transforms snowboarding from "yay fun!" to "OMG OMG OMG THIS IS THE BEST THING EVER!"
My snowboarding skills are definitely improving with every day on the slopes. (These were days five through eight on a snowboard.) My turns are much better: I can do pretty flat s-curves down the milder slopes, and I can do turns on steeper slopes now too. I'm able to get off the lifts reliably, thank goodness. I'm only falling on occasion now too.
Interestingly, I'm pretty much ambidextrous on the snowboard. I'm goofy-footed, mostly because the inflamed nerve (morton's neuroma) in the ball of my right foot is happier when strapped in full-time. However, I'm happy to go down the slope with left or right foot forward, and my turns are equally good (or bad) on either side. That flexibility is good: I can face whichever way makes the most sense given the terrain, not based on my own body's preferences.
I snowboarded or skied for four to five hours every day. I was tired by that, but not wildly exhausted. (The only exception was the first day, but that involved waking up early and driving three hours to Beaver Creek, then snowboarding.) Also, I was sore after the first day or two in my quads, but that faded. That tells me that my 20 minute SuperSlow workouts once per week are keeping me in as good shape as CrossFit did.
By the time we went home, the only thing that hurt was the backs of my knees. I couldn't figure out why... until I realized that the problem was likely my construction-style knee pads, because the main strap wrapped around the backs of my knees. I've ordered knew knee pads, so hopefully those will work without causing strain.
Finally, due to my still-super-strict elimination diet, I cooked all of our meals in the kitchen of the condo. We usually had bacon and grapefruit for breakfast. (Hence, the caption on on the picture!) Paul had coffee, and I had my cinnamon hot cocoa. I packed some meat (ham or leftovers), plus sweet potato for lunch. Then we had yummy dinners: slow-cooked pork ribs, roast chicken, pork roast, and so on. That worked really well: I kept strictly to my diet, and I enjoyed what we ate. Also, we probably saved a few hundred dollars, since eating out anywhere neat Beaver Creek is ridiculously expensive.
Overall, I'm really happy that I took up snowboarding this season. I'm enjoying the challenge of learning a new snow sport, particularly that difficult process of forcing myself by sheer will to overcome my fears. (I hope to write more about that later.) Mostly...
YAY FUN!
We got a foot of snow yesterday... and the doggies had extra extra extra fun wrestling in the snow.
Last Sunday afternoon, Paul and I headed out to Breckenridge for a few days of much-needed vacation. I decided to try to learn to snowboard on this trip. (I'm a pretty good skier, but I've not yet skied this season.) I wanted the challenge of learning a new sport, and snowboarding seemed like a good fit for me. Plus, I suspect that snowboarding might be easier on my increasingly painful Morton's neuroma. (That's an inflamed nerve in the ball of my right foot, acquired by wearing bicycle clip shoes.) So with three full days to play in the snow, I decided to take the plunge into snowboarding!
The first two days were pretty darn miserable. I'm not exaggerating. On the first day, I took a full-day lesson to learn the basics, and that was essential. (We had one instructor, plus an instructor-in-training, for four people. That was awesome.) The class worked on the bunny hill of Peak 9 for most of the day, but our final run was on a green slope. While I improved over the course of the day, I struggled to learn how to shift my weight properly in order to steer. Still, the green run was good... including the bit of real hill toward the bottom.
The second day -- my 37th birthday -- was the worst. I still struggled to steer, even just on my heel edge, and often I was sucked into the edges of the run by seemingly insignificant fall lines. Also, I had serious troubles "skating," i.e. moving with one foot detached. That's tricky to learn, and because I switched from regular-footed to goofy-footed after the first day, I had to relearn it. (I'm pretty sure that I could go either way in my stance, but my bad foot is always strapped in with a goofy stance, and that puts far less stress on my neuroma. So goofy I am!) Alas, I had lots of skating to do on this day because I was stupid enough to return to Peak 9, with its long stretch of flat with that strong fall line to the right. (I'd never even notice that skiing!) That was a mistake. However, the absolute worst was the platter-pull lift on the bunny slope: it was not merely ridiculously difficult to skate on a snowboard while being dragged uphill, but also extremely tiring. I was always more winded at the top of the slope than I was at the bottom. After switching to the green run later in the day, I got better at controlling my direction and speed, but I'd not even been able to think about turns yet.
On the third day, I dreaded returning to the slopes. Every muscle in my body ached, and after my first two days, I didn't see much hope for fun. However, I was determined not to permit all of my pain of the first two days go to waste by my giving up, so off to the slopes I went.
Happily, I had a blast! I went to Peak 8, and I stuck with an easy green run and an easy two-person lift. (I could only stay for three hours.) That was perfect. The hill posed enough of a challenge that I never got bored. I worked on my heed-side traversing, then my toe-side traversing, then my j-turns, then c-turns, then s-turns. If I tried to turn on a steeper portion of the hill, I'd crash in a most spectacular way, but I was able to do the turns pretty well on the flatter sections. Control over my speed and direction began to come naturally to me, meaning that I didn't have to think through every body motion. Also, I was able to practice my skating to get on and off the lift. I even managed to skate off the lift perfectly a few times. (Really, that was a feat!) Oh, and it was awesome to have an inch of powder on the slopes that day too!
I'm now eager to return to the slopes to continue learning the basic skills of snowboarding. Obviously, I have much to learn yet, but I think I've gotten over the painfully frustrating portion of the learning curve.
I've never fallen much in skiing, even while learning. I fell over and over again in my three days of snowboarding, often suddenly and hard. However, I didn't suffer any other aches or pains or bruises from that, apart from muscle soreness. (The only exception is a dark circular bruise, two inches wide, on the side of my thigh. I have no idea how I got that!) I stayed out of trouble because I wore a slew of protective equipment, including:
We've had a lot lot lot of snow and cold over the past few days here, and snow is always a great opportunity for pictures and video of my wild and crazy doggies. First, the pictures:
Last week on Modern Paleo's new PaleoCooks list, I asked, "What did you make for Thanksgiving that you particularly enjoyed?" Here's my answer:
We did a pot luck with friends who mostly eat paleo. I made the sweet potatoes and an appetizer.
The sweet potatoes were just roasted in their skins, then skinned and mashed with a fork -- one batch with butter and salt, and the other batch with coconut oil and the zest and juice from one orange. They were super-easy and got rave reviews!
For an appetizer, I made olive tampenade, loosely following this recipe. I used 3 cans of black olives (drained and rinsed), about a half a head of garlic (which was too much, but still yummy), about 1/3 cup of sun dried tomatoes, about 2 tbsp olive oil, and the juice from one lemon. (I didn't have anchovies on hand... or rather, I forgot to check.) Everything got processed in the food processor. (I did the garlic first, because I wanted to make sure that it was chopped fine.) I served it with sliced red, yellow, and orange peppers as delivery devices. It was very much enjoyed, and not too heavy. Plus, it only took about 15 minutes to assemble and make... and leftover olive tampenade is great to add to sautéed vegetables or fried eggs!
Oh, and I also made brussels sprouts cooked on the stovetop in a cup of cream. (That's not for those who don't do dairy, obviously!) They only take about 15 minutes to cook, and you want to reduce the cream so that it's actually just gooey (not liquid) and a bit brown. Add some nutmeg, and you're all good!
The whole dinner was excellent, I was particularly glad to be able to take a much-needed post-dinner nap:
Here's the whole crew, before dinner:
As you know, my ancient horse Tara died on the Tuesday before Thanksgiving. Lila seemed to adjust to being alone well enough, but horses never like to live alone. So I wanted to find a companion for her sooner rather than later. 
Happily, I was able to do just that in just a few days, on Saturday. One of my neighbors told me that another neighbor was looking to find a home for an extra horse. Our neighborhood has a stupid three-horse limit, and this horse put her owner one over the limit. So she had to find this horse a new home.
This horse, originally named Espy but now renamed Elsie, is a 14.2 hand mare and 22 years old. (Like dogs, smaller horses live longer than older horses.) She's friendly and quiet, although with a touch of that bitchy mare-ish streak. (Lila doesn't have that, but Tara did.) She's healthy, sound, and even rideable, so she'll likely make herself useful in more ways than just as a companion for Lila.
Like Lila, Elsie is an easy keeper, needing just hay, and she's very food-oriented. That's highly useful, because I don't need to separate them for feeding. I had to do that with Tara since getting Lila last year, and that required four to six trips down to the barn every day. And she and Lila seem to like each other well enough.
So... welcome to the family, Elsie!
Happy Thanksgiving!
This year, I'm grateful that...
I had to put down my elderly horse Tara today, very unexpectedly.
She was fine last night when I fed her. This morning, I found her lying down in the pasture, unwilling to get up. I called the vet immediately, and he arrived within an hour or two. She had colic -- not an impaction but a twisted gut. Nothing could be done for her, other than to end her suffering. She died quickly and quietly.
Tara was about 28, and that's very, very old for a horse her size. Colic is often the way that such horses die, even if they've never had any history thereof.
I'm very sad that she's gone. I knew that her death was coming, but I just didn't know that it would be today. So I'm in a bit of shock.
I'm so grateful that she gave me so many good years as a horse to ride and then as a companion to Lila. In return, she was well-cared for until the very end.
I recently had my 10-week postoperative check for my left hip fracture. As you can see from the image below, the fracture shows considerable healing and improvement from the earlier 6-week image (click on image to see full size):
The image on the left is the most recent 10-week image; the image on the right is the earlier 6-week image. The arrows point to the fracture line.
For reference, here is the matching CT scan of the hip just prior to surgery (click on image to see full size):
In particular, the fracture shows good bony union on the 10-week image. There is no breakdown of the fracture repair site, and no bending or deformity of the three titanium screws which would indicate abnormal stress at the repair site.
Nor is there any sign of the complication known as "avascular necrosis" or AVN, which is when the bone of the femoral head starts to die off due to inadequate blood supply (a known risk from certain types of hip fractures). If I had developed AVN, then this would have meant that the attempted repair failed and I'd likely need a second surgery for artificial hip replacement.
My orthopedic surgeon (Dr. Steve Morgan) has now given me the green light to get rid of the crutches and start walking with cane. I'm continuing my physical therapy and am now much more mobile. He'll continue to monitor my progress over the next few months, but for now everything is looking good.
Diana deserves tremendous credit for putting up with my relative immobility these past 10 weeks, including doing all the unpleasant household chores that I used to do (like cleaning up the kitty litter).
And we'd like to extend our thanks to all our friends who have offered their support and encouragement during this challenging time!
Earlier posts on this topic:
"My Hip Injury", August 31, 2011Read more...
"Hip Injury Aftermath", September 6, 2011
"Open Letter to Apple: My iPad and My Hip Fracture", September 7, 2011
I have so many things that I want to blog, but I've been short on time lately. For now, I just can't resist posting these pictures of our ever-so-cute beasts in today's snowstorm... including a video of Snow Doggie Wrestlemania!
This Oatmeal comic segment -- part of the brilliant "if my brain was an imaginary friend" strip -- perfectly captures how my brain works. (Click here or on the image to view it.)
I have the same problem with all particulars, such as dates and places. When taking notes on a history lecture by Eric Daniels, I've had to replay what he said in my head, to get down the notes properly. I can hear it perfectly word-for-word -- almost. Inevitably, it sound something like, "The soldiers were despondent after General BUUZZZZZ moved his troops to BUUZZZZZ in the year BUUZZZZZ."
Apparently, after seven years of graduate school in philosophy, my brain decided that particulars were unimportant. Or maybe the causation runs in the other direction. Either way: DOH!
Yesterday, Paul had his six-week check-up with his orthopedist. The good news is that nothing has gone wrong so far -- although he's not out of the woods yet. Unfortunately, the femoral head fracture is still plainly evident in the x-ray, and the doctor wants him to stay off that leg for another four weeks. Basically, as with the last six weeks, he can only put a wee bit of weight on that leg for balance.
That came as a major disappointment to us, as we'd hoped and expected that he'd be able to switch to a cane and start bearing some weight. However, we were surely just expecting too much. So we're bummed... but we'll manage.
The good news is that the doctor has lifted Paul's restrictions on his range of motion with that leg. So that will make some daily tasks easier, including showering, getting in and out of the car, and even putting on his own left sock. Overall, Paul is much better able to drive himself to and from work than before, so that's good.
I'll be so freaking happy when Paul is back to his old self. It's been a hard slog for both of us.
Dear Apple:
I've been a happy iPad2 owner since March 2011, but I never fully appreciated its value until I recently broke my hip in a bad fall and required subsequent hospitalization.
I am a physician, so I had already been using my iPad for my work, reading PDFs of medical articles, communicating with my colleagues via e-mail, etc. But when I broke my hip in an accident a few days ago, the iPad became my lifeline to the outside world:
Because I had my iPad with me at the time of the accident, I was able to immediately notify my friends and family of what had happened once I arrived in the ER.
In the ER, the iPad also helped keep my spirits up as I checked e-mail, followed my friends on Twitter and Facebook, and followed the regular world news. When my orthopedic surgeon presented my treatment options to me, he also e-mailed me some relevant medical literature in the form of PDF files which I could digest at my own pace on the iPad. And of course, I was also able to perform Google searches on my various surgery options, the complication rates, postoperative care requirements, etc.
Because of the specific nature of my fracture, I had to choose between two treatment options, each with its own pros and cons. I found it enormously helpful to be able to gather the relevant medical information literally "at my fingertips". Because of the iPad, I was able to more quickly make an informed treatment decision that I was comfortable with.
I did briefly leave my iPad with my wife during the surgery itself, but she gave it back to me immediately after the surgery. Other than that, it did not leave my side while in the hospital.
While in the hospital after my surgery, I used the iPad to read eBooks, check my e-mail, surf the internet, and keep up my regular blogging. It was a real morale booster to be able to continue as much of my regular online routine as possible, despite my impaired physical condition.
My wife also had her own iPad with her while I was hospitalized, which allowed her to update our friends and family in real time on my condition, as well as keep her occupied while I was asleep or in surgery.
And now that I'm at home recovering, my iPad is still at my side!
For someone such as myself with limited physical mobility, the iPad2 with its light weight and long battery life was perfect. A laptop computer simply would not have worked while in the hospital. The iPad was literally an emotional, medical, and physical lifeline for me during a difficult time in my life.
I know Apple has been in the news lately because of Steve Jobs' decision to step down as CEO. I just wanted to take this opportunity to publicly thank Mr. Jobs and Apple for creating such a wonderful, life-enhancing product.
In your advertisements, Apple has touted the iPad as "magical" and "revolutionary". To that, I would add the term "life-saver".
-- Paul Hsieh, MD
[Crossposted from GeekPress.]
After my earlier left hip fracture, I underwent successful surgery to repair the broken femur head. The surgeon was able to get a good repair, and here's a post-op image:
For comparison, here's a matching pre-operative CT image:
For the record, those were definitely the three most expensive titanium screws I have ever purchased! But of course, I wasn't just paying for the screws but for the highly customized, personalized, urgent delivery method as well.
I'm now home for a few days of Medical Leave before I return to work. Fortunately, I should still be able function pretty well at my job at a computer work-station, although I won't be able to perform invasive procedures (or anything that involves prolonged standing) for a little while.
I do have a few observations in this immediate post-operative period:
1) American medical care is really really good. My care at all steps from the ambulance to the ER to the pre-op to surgery to the surgical aftercare was superb. Again, I want to give my kudos to the Level 1 Trauma Center where I was treated.Finally, Diana has been a tremendous help during this challenge. She's been unfailingly cheerful despite now having to do twice as much work around the house as before. Certainly, if you value her work on NoodleFood or the Rationally Selfish webcasts, please feel free to be extra-generous with the tip jars! Read more...
2) It's very easy to think that this superb medical care "just happens" and grows magically on trees. But knowing how bad care can be in other countries with socialized medical systems, I appreciate the current semi-free American system even more than ever. And I want to continue to fight to keep it as free as possible.
3) Some of the various personnel at the hospital knew I was a physician on staff there, but many did not. For those who didn't, I deliberately didn't mention the fact that I was a doctor just to see how they treated a "regular" patient. They were consistently competent, courteous, and professional -- and that makes me feel much prouder about where I work.
4) It's amazing how much one's life changes when one has restricted mobility on a single hip. Even simple ADLs (activities of daily living) such as sitting in chair, taking a shower, going to the bathroom, etc., become much more challenging. Fortunately, part of my patient education included some extremely helpful training sessions with the Physical Therapy and Occupational Therapy teams to prepare me for functioning at home.
5) The first shower at home after surgery feels really, really nice!
6) Some of the postop physical therapy exercises are a real b*tch!
7) Having an iPad was a huge boon throughout the entire process, staring in the ER, then at home prior to surgery, then in the hospital immediately postop, and now at home. Being able to reply to e-mails, keep up on the news, interact with friends via Twitter/Facebook, look up medical literature, read my Kindle books, etc., was an enormous morale boost. A laptop would not have been as convenient or portable for someone like me with limited physical mobility.
As many of you know, I sustained a fluke hip fracture yesterday. Basically, I was crossing the street to my office when I tripped on something in the intersection. I'm not sure if it was a rock or a crack in the asphalt or what. I landed hard on my left hip and had a classic, "I've fallen and can't get up". My left hip was twisted in an unnatural position and I couldn't put any weight on my left leg.
To get out of the road, I had to crawl out of the intersection to the traffic island. A passer-by alerted 911, and the paramedics took me to Swedish Medical Center, which is top-tier level 1 trauma hospital that my radiology practice helps staff.
The emergency team there was superb, including all the docs, nurses, EKG techs, radiology techs, etc.
My initial x-ray showed a dislocated left hip:
The "ball" of the femur is out of place, no longer sitting within the "cup" or acetabulum socket.
Here I am looking at my x-ray on the ER physician's laptop:
The ER team then arranged for a "closed reduction" (relocation) of the hip. For this, they had to heavily but briefly sedate me, both so I wouldn't experience the pain and to help relax my muscle spasm. I don't remember much of this portion, but I do recall the IV sedation was very rapid acting. Then a lot of blurriness, then a resumption to groggy-consicousness with the ER doc telling me the hip was now back in place.
So that first step was went okay!
(Note from Diana: I was in the room for the reduction, and it wasn't easy! Paul required three doses of the sedative to keep him under. His ER doc wasn't able to do the reduction himself, despite a valiant effort, so he called another very muscular ER doc who was able to do it in short order. The whole procedure was a bit hard to watch, but I was glad to be there.)
The next step was a CT scan to see how much damage there was to the ball and/or socket. Unfortunately, I do have fractures of both portions, as you can see below:
Presumably, the force of the dislocation also caused the fractures.
Yesterday evening, while still in the hospital, the orthopedic surgeon reviewed the images, discussed various options, and recommended surgery. He decided that I was sufficiently stable to be able to go home on crutches, and surgery is planned for tomorrow.
One of my partner radiologists -- who is also an orthopedic trauma radiologist like myself -- has already filed my images in his list of "interested cases". Basically, you never want to be someone else's "interesting case"!
17 years ago today, Paul and I met for the first time in St. Louis. Holy cow, that's forever ago!
Here's a picture that I took of Paul this spring that I rather like. Honestly, he doesn't look much different than he did those 17 years ago, except that he's about 30 pounds lighter (and hence, handsomer).
In another 17 years, he'll probably look pretty much the same... and people will be wondering how I managed to snare myself such a young man.
I'm going to be off camping with my parents for the next few days. They're RV'ing around the interior west, and having tons of fun, as you can see from this fabulous picture.
I'll be back online on Friday. Until then, please don't e-mail me if you can help it.
However... I'm going to try my very best to empty my inbox before I leave. If so, that will be the first time I've been "inbox zero" in months.
P.S. I have some blog posts scheduled for while I'm gone, mostly related to the Rationally Selfish Webcast. Don't let that fool you! I'm not here!
Last weekend, I shot this video of our wild and crazy doggies wrestling outside. Conrad is the black-and-tan German Shepherd, and Mae is the smaller black dog. The barking dog is Red Dog, who we were watching for Kelly and Santiago Valenzuela of Mother of Exiles last week.
Conrad and Mae wrestle exactly like in this video a few times per day. Although it looks completely wild and crazy, they've never injured themselves.... and they love it!
Mae is definitely the instigator, and Conrad often gets very frustrated by his inability to control her. (Hence, his growling and occasional barking.) Mae is just a hair slower than Conrad, but she's also far more clever about using obstacles to slow him down. She does seem to love to be caught and rolled over -- to the point that she rolls herself over twice in this video to try to get Conrad to come after her.
So, now you know that when I say, "my wild and crazy doggies," I'm not exaggerating!
I'm Diana Hsieh, a philosopher specializing in practical ethics. I received my Ph.D in philosophy from the University of Colorado at Boulder in 2009.
Paul Hsieh is a physician specializing in orthopedic and emergency radiology. He blogs about science, technology, and random humorous items at GeekPress. He's a co-founder of Freedom and Individual Rights in Medicine (FIRM) and regularly writes for its blog, We Stand FIRM. He has published a slew of op-eds and essays on health care policy. You can e-mail Paul at paul@paulhsieh.com, and follow him on Twitter @PaulHsieh.
Greg Perkins is a software architect working in the R&D labs at Hewlett-Packard, Boise. His degree is in mathematics and computer science. Greg hosts The Objectivism Seminar. Aside from work and philosophy, he plays jazz saxophone professionally with groups such as The Sidemen and Onomatopoeia. You can e-mail Greg at greg@eCosmos.com, and follow him on Twitter @gregperk.
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