ACL Chronicles

Currently Listening: Landslide (in the style of the Dixie Chicks)
Currently Reading: TF&S; Mindfulness in Plain English

Going to do a little something different for this Wednesday post: ACL Chronicles will be updated as the days go by, keeping track of the details of my rehab journey. In classic "Flowers for Algernon" style.

[12.17.2014]

First, the surgery day!

Before my knee becomes
a cantaloupe :[

6:45AM Check-in: Straightforward. I have the medications and the medical history forms pre-filled out. The only medical thing I need to mention, really, is my 2006 knee surgery and the relevant titanium screws. The receptionist asked if I was Filipino and later asked if I knew Tagalog. my response: I am your typical Fil-Am and I am sure you know what that means. to which she fervently nods and says 'yup. I don't know Tagalog either.' I really need to immerse myself in Tagalog somehow.

7:30AM Pre-op: I talk to the nurse, who gets a urine sample from me, and asks me to wear a standard hospital robe with just my underwear on. The nurses all say I look like a young little thing... (but I'm 24!) I put my belongings in a bag and keep my phone on me until the last possible minute. She asks me my name, DOB, and the operation I'm going to have: "left knee arthroscopy with possible (read: probable) ACL reconstruction and meniscal repair". I talk to the anesthesiologist who recommends a "femoral block" which will be a local anesthesia injected into my femoral nerve. It is strong and lasts for up to 24 hours after the surgery. It will help manage pain. I don't remember having that before but he recommends it. And since insurance no longer covers "cold therapy systems" (see Donjoy IceMan Cold Therapy System) for knee surgery patients (I have one from my last surgery but we've lost the AC adapter), I decide to accept his recommendation. I am wary of anesthetics but I don't think there are any other options to help me avoid excruciating pain. He gives me a dose of valium to relax me and tells me it'll feel like two shots of tequila. Eh. Didn't really feel like that as far as I remember. But perhaps I was more friendly? The doctor meets with me to mark me knee. The PA meets with me to tell me what kind of graft I am going to get, the bone screw, and the company that distributes these materials:

Arthrex BioComposite Interference Screw (10 x 28 mm) made of 30% biphasic calcium phosphate and 70% PLDLA, intended to be bioabsorbed into the bone.

Arthrex ACL Tightrope (Tibialis Tendon Posterior Frozen from the Achilles of a donor)

Later, I ask for my medical records and a copy of the serial numbers of these implants. 

I'm slightly amused by the fact that I have part of someone's Achilles heel in my knee.

8:30AM OR: I am wheeled to the OR, half an hour later than scheduled. They sprawl out my arms to make me more comfortable and the anesthesiologist (Dr. Ho) talks me through what he is doing: 'I'm going to inject you with the anesthesia now. It's going to be really strong. Strong enough to put you out in about 5 seconds.' He distracts me with various questions as I tell him that the injection kind of hurts. 'Are your parents from the Philippines? Think about going there.' is the last thing I remember. I remember seeing the time before then: 8:42AM.

10:15AM Post-Op:At around 10:15, I awaken to my dad beside me and the nurse unstrapping me from something. She says 'Welcome to the land of the living. Your surgery went really well.' I ask the nurse a few questions as the brief me on the discharge instructions. She asks if I want something for pain and I say I don't need it because it's a narcotic. They say the center will call me to check up the next day. My dad and I spend about half an hour making small talk until I decide it's time to go. Sandra and a nice nurse named Sonny helps me onto a wheelchair while my dad gets the car. We leave by 11 something AM. I am recommended to not bear any weight on my knee because of the meniscectomy and the biocomposite bone screw. Too much too fast can cause failure of the bone screw to reabsorb, I'm told. The meniscal damage was worse on the medial side (a buckethandle tear) with some damage laterally.

Homeward Bound:

Throughout the day, I feel pretty good about my knee. There is very minimal pain (1/2 out of 10) because of the femoral block. But I am very numb where the femoral region is as well as throughout the leg all the way to the medial side of my ankle. It is a strange feeling and I wonder what kind of pain I'd be in if I hadn't taken the block. I take care of a few work-related things, read, and put ice on top of the ace wrap and bandages (I can't feel anything though...).

My mom finds our old Donjoy Iceman but we are missing the AC adapter and I contemplate ordering a replacement so I can have it around when I go back up north.

Thursday will be the moment of truth...

"Lo que no fue en tu año"

Ahora Escuchando: Thinking Out Loud (Ed Sheeran), Seaside (The Kooks - Boehm Remix)
Ahora Leyendo: Thinking, Fast and Slow; The Isaac Newton School of Driving; Mindfulness in Plain English

"Lo que no fue en tu año, no es tu daño" (tambien: no te hace daño)

Sofía me enseñó esta frase cuando expresé que tengo miedo al amor. Ella dice lo pasado, pasado. Y es verdad. Pero, como que expresé en mi carta anterior, el miedo es un rival muy fuerte.

El miedo es un rival muy fuerte.

He amado y perdido en el pasado. Tambien, he amado sin una razón lógica .

Tal vez yo estaba cegada.
Tal vez yo no puedo recordar con claridad.
Tal vez yo quería que el concepto de amor más que el intercambio de amor.

Diferenciar entre amor, capricho y deseo no es una cosa fácil.

Todos tenemos unos pasados.
Todos tenemos bagajes emocionales.
Pero, todos estamos tratando de vivir la vida.
Y todos estamos tratando de encontrar algo real.

Pues, no debemos ser demasiado desconfiando o miedo.
Tener estas cosas es más probable que resulte en fracaso.

Por otra parte, la autenticidad y el valor son maravilloso y sanador.
Sólo podemos ser valiente.
Y, tal vez, es vale la pena el riesgo.

Headlock

Currently Listening: Let Go (Frou Frou)
[Still] Reading: Thinking, Fast and Slow; The Isaac Newton School of Driving
Recommended Reading: Mindfulness in Plain English (Bhante Gunaratana, 1992), The Machine Stops (E.M. Forster, 1909 short story)

“You gain strength, courage and confidence by every experience in which you really stop to look fear in the face. You must do the thing you think you cannot do.” – Eleanor Roosevelt

The most annoyingly epic 38-point #Scrabble play. #ZEN

Human relationships are a wonderful way of pushing your own boundaries and learning about yourself. In my most recent lesson, I realized that not only do I spend a a LOT of time thinking about random things, I have also locked myself in my head. My mind is a safe zone. I protect myself from losing the illusion of control I get from remaining in my head and outside of the sensational world. I am self-conscious. Not really about how I look, no. But about the physical manifestations of my soul... (does that sound weird or make any sense at all?)

In moderation, self-consciousness and deliberation are excellent constructs. They are tools for personal growth and development. Without self-awareness, I would not have this blog. Without deliberation, I would not be focused enough to work towards the person I'd like to become.

I can avoid an overall stasis and yet I cannot avoid paralysis in situations where it is essential to be in the moment. You see, I have this idea in my head that when I finally find the ability to "let go" and lose my inhibitions, I'll be able to dance and sing and feel things around me--truly live in the moment. I can't remember a time I ever felt truly lost "in the music" or "the rhythm" or even in nature. For example, I went to Rave of Thrones, my first [semi]rave, this week in SF and while I enjoyed myself, I recall myself caged in thoughts of what other people thought of me, my appearance, my inexperience... all because it was new to me and outside of my comfort zone. Why can't I just step out of my shell and embrace the vulnerability?

Everyone struggles with this. This entire "Life Cartogprahy" blog basically documents my efforts to deconstruct and restructure my world, find balance, and live life with conviction and managed inhibition.

Yes, I've been cultivating confidence all this time but the epiphany here is the existence of this headlock. Understanding my mental framework is the first step. Andrea "Unlocked" will take time; baby steps, baby steps.

Someone recommended mindful meditation as a way of processing my existing states. I prefer therapeutic jogs, but after knee surgery, I might need to turn to meditation to stay sane.

Mmmm... let's get it on, 2015.

Musings on Science and Psychology

[Belated Post]



Disclaimer: I am not a physicist and I apologize for skimming over the scientific concepts presented in this post! The ideas presented here might be used to generate interesting conversations about science and philosophy but the ideas are by no means comprehensive. I don't have time to go too deep into the details!

While I concede I had a fascinating romp through the history of atomic physics and psychology, I don't recommend reading Deciphering the Cosmic Number for leisure.... It was a chore reading through the heavy physics of the book. I probably would have enjoyed it a lot more if I was concurrently studying (quantum) mechanics since it goes through Wolfgang Pauli's scientific life in depth - but for me, this book took a lot of brainpower and focus to read. The most enjoyable moments for me were when I read about the science from a historical context. We take for granted how much we know now about atomic physics and don't realize how much there is still yet to know.

Overall, this book is a synthetic piece on the lives of Wolfgang Pauli (physicist) and Carl Jung (psycho-analyst), who are in their time premiere experts of their respective fields. They come together and, essentially, muse on the mysteries of the universe. Many of these musings were represented through geometric figures, archaic symbols, and numerology. A large portion of the book focused on dream interpretation and imagery and, by extension, the mystique of consciousness and life. Interesting stuff.

You can read an excellent review about the the book and its writing style here.

What exactly is the cosmic number according to Jung and Pauli? There was a very long debate in the book between the number 3 and the number 4. Both of which represents different types of spiritual completeness.

Number 3: Represented by the Holy Trinity in Christianity and appears multiple times in biblical stories. The triangle is a representation of strength and stability and Pythagorean properties are unique in geometry. In popular culture, three is often considered an important iterative number (e.g. "third time's the charm" and the Wiccan rule of three). Our physical world is known as three dimensional.

Number 4: Pauli believed strongly that the number four was the 'next level' three. While there did exist the Holy Trinity, the addition of a fourth (probably the human spirit or some other representation) made wholeness and completion. Jung believed that there are four major archetypes within the human psyche. In Pauli's field of work, atomic physics, the fourth quantum number was necessary in understanding electrons and quantum mechanics. Originally, the theory encompassed three but was not unified before the introduction of the fourth quantum number (electron spin, ms). Our world's fourth dimension, time, is quintessential in our understanding of the perceived universe.

Reasonably, these numbers would have special meaning from a mystical perspective.

But in the end, according to Pauli, what was the real cosmic number?

The fine structure constant. Or, to remember it better, the square inverse of 137.03597.

The fine structure constant is a dimensionless quantity derived from many fundamental physical constants such as elementary charge, speed of light, and the Planck constant. It is also known as the "coupling constant" or alpha, and is used to explain the mysterious electromagnetic force that governs interaction between electrons and photons (elementary particles and light). The constant was determined while the Bohr model was the cornerstone of atomic physics in 1916. At this time, everyone knew that Bohr's model could not explain the splitting of spectral lines in H2 molecules. Thus, the introduction of this number was pivotal.

From a numerological perspective, the number is very mysterious. It finds itself related to the golden ratio and is theorized to be the value for stable matter, and thus the number that makes "life" possible.

I presume that physicists and psychologists seeking to reconcile science and consciousness would be fascinated with the idea of a constant that describes life on a fundamental level. An extension of this is the possibility of objective beauty and unity in life that springs out of the chaos and increasing entropy of the universe. (am I getting too poetic here?)

Pauli's famous quote is this: 'When I die, the first thing I shall consider asking the devil is -- What is the meaning of the fine structure constant?'

Perhaps the meaning of the fine structure constant was the answer to Asimov's The Last Question: 'Can entropy be reversed?'

Antiquated Anecdotes

Currently Reading: Thinking, Fast and Slow (Daniel Khaneman, 2011), The Isaac Newton School of Driving: Physics and Your Car (Barry Parker, 2003)
Finished Reading: The Communist Manifesto (Karl Marx, Freidrich Engels, 1848, audiobook/paperback), The Last Question (Isaac Asimov, 1956, short story), Divergent (Veronica Roth, 2011)
Currently Listening: Dancin' in the Moonlight (King Harvest), Beautiful People (Sam Ock)

Blurbs from the past two weeks.:

1. I have decided to change my weekly blog post day from Monday to Wednesday. Monday was very difficult for me to keep apace with!
    
2. I will be getting knee surgery (ACL Reconstruction) for Christmas. I got my knee imaged by MRI and saw an orthopedist. I need the surgery, though. Apparently there was no ACL to be found (PCL intact; ACL was completely torn...) and there was significant meniscus damage. Totally knew this would be the case, though. I have been struggling with my left knee for quite some time. I will need all of the moral support I can get from my friends and family. It didn't scare me at first but now I'm rather nervous about it, especially when I consider if I should get an allograft vs an autograft. My approach to knee surgery now is a lot different than my reaction to surgery in high school. Now, it's more like "Challenge accepted."
     
3. Spent Thanksgiving with the family. We had Thanksgiving lunch together and saw Big Hero 6. BH6 was a very memorable and funny movie. (Ba da da da da. I cannot deactive until you say you are satisfied with your care.) I also spent a few hours (distributed over 3 days) working on my first art project in years, thanks to the mentorship of my youngest sister (a high school senior). She has been applying to colleges and art school.
    
4. The art project was a gift for a very special guy. ;) I sometimes like to think we are the bananagrams dream team.
    
5. Been busy reading. I downloaded the audiobook for The Communist Manifesto so I could listen to it on my way back up to Northern California. The word "antiquate" and its variations were oft used. I like that word. Also, the manifesto is quite intense but a worthwhile political read. I was never really into politics but I realize now that the backbone of politics is philosophy. And philosophy is interesting. (Thanks, Tiffany, for lending me the paperback copy.)
    
6. Got in touch with old friends during my the Thanksgiving break! (Albert, Jimmy, Ann, Tiffany, Jayce, etc.) Most notably, an old high school flame. It was nice reconnecting; we have done so sporadically over the years.
    
7. Went to a murder mystery birthday party! (Ann!) 'Twas awesome. She did a terrific job organizing the party and getting people to go with the role play, involving steampunk wardrobe and time travel.
    
8. Went indoor rock climbing for the first time with Marvs and my upper body is INCREDIBLY SORE. But the sense of accomplishment you get from it is so much fun! It is such a functional/useful workout. I had so much fun that I purchased a Groupon for lessons/day passes at Bridges Rock Gym in El Cerrito and will go with Eric this Saturday! I might continue pursuing this hobby after knee surgery. (After the hip hop dance classes? haha... too many things I want to do in life...)
    
9. Notes to Self: Scrabble, Hiking, Just Dance, CAH charades
    
10. I have shifted very far from my happy baseline. I am more than happy these days... I have "so much zest" and I am inspired. This shift probably has very much to do with blurb #5. Somehow this person makes me simultaneously confident and vulnerable; strong and weak; hopeful and anxious.... Some kind of madness, I tell you! Madness!

That's it for now!

Libros Antes del Fin de Año

Ahora Escuchando: Madness (Muse), Explorers (Muse)
Ahora Leyendo: Divergent (Veronica Roth, 2011)

1. Divergent (Veronica Roth, 2011)
2. Cat's Cradle (Kurt Vonnegut, 1963)
3. Thinking, Fast and Slow (Daniel Kahneman, 2011)
4. Snow Crash (Neal Stephenson, 1992) or Babel-17 (Samuel R. Delaney, 1996)
5. Insurgent (Veronica Roth, 2012)
6. Allegiant (Veronica Roth, 2012)

Aquí está una lista de libros para que yo no me olvido. Es muy larga ahora. ¡Necesito leer mas! Mi objectivo es leer estos antes del año 2015. Muy ambiciosa... Casi un libro por semana.

Espero tener tiempo porque tengo muchas cosas nuevas que estudiar para el trabajo. Pero, me siento como que puedo completar.

Me siento como que puedo hacer cualquier cosa - que todo es posible. Me siento de esta manera muchas más, por alguna  razón indescriptible, cuando estoy con un cierto hombre que me gusta mucho. Soy tan feliz... casi demasiado feliz. Tengo miedo de ser demasiada emocionada. Pero, esta vez siento que ser valiente es vale la pena.

Que cómico. Por alguna razón, estoy más dispuesta a escribir sobre mi vida amorosa en español...

Digital Health Commons

Are larger health institutions and hospitals capable of supporting a digital health commons?

Last Thursday, I attended a Stanford Medicine X meetup with Teresa "On Peer-to-Peer Healthcare and Human Centered Design." The speaker, Sean Ahrens, a down-to-earth guy that spoke to the audience on a beanbag chair, beer in hand, spoke on how public good can be created with the advent of an online community that allows truly shared health data (a digital health commons).

Sean talked about his website, Crohnology, which serves patients diagnosed with Crohn's disease, a chronic condition with no cure. Inflammation can occur anywhere within the digestive system, taking a huge toll on a patient's quality of life. Sean developed a website in many ways reminiscent of sites like Livestrong and Weight Watchers because it builds a community where people can talk about their health progress, share information, and motivate each other. However, the site also serves a broader public good: it accumulates health data that contributes to research for, at the very least, quality of life management. If you want to think with a little more grandeur, it may one day help researchers find a cure for Crohn's. I was most impressed with the intuitiveness of patient journals - they report on how they are feeling in their journal on a scale of 0 to 100. This perceived health would then be charted against the diet, medications, supplements, and lifestyle changes they report to manage their disease. Patients can look at their own data over time and see how that compares with other people who have Crohn's.

Ultimately, the goal is to build a "Patient-Powered Research Network." Sean shared his struggles with creating Crohnology - he journeyed from trying to make a business out of his patient-powered research network to realizing that monetizing the site didn't align with his personal values. But if there is no return on investment, funding and support for the site is extremely difficult to find. Currently, Crohnology is kept alive with the help of the Patient-Centered Outcomes Research Institute (PCORI).

Key issues for this type of platform include:
1. Funding: How do you keep true to your philanthropic goals without selling yourself out? The website needs to be supported monetarily.
2. Open Access: How do you maintain open access and protect privacy?
3. Integration: Can data be shared between other information sources? For example, health data from Fitbit?

I thought that the challenges presented here were particularly interesting because the idea of "patient powered" research seems erroneous. Scientists would be skeptical in the validity of this research because of the sheer amount of subjectivity and myriad confounding variables (McKenna 2011). However, more and more, patient-reported outcomes (PROs) are becoming a valid research model - because a patient's happiness, outlook, and support group correlates with survival (Kyte 2013). I would argue that the more data they can obtain over a specific population, the more we could try to deduce and intrepret. Traditionally, we look at PROs with questionnaires that calculate an outcome measure on a scale or a score so it is less subjective and mores scientific. 

The key to creating a digital health commons, however, is giving patients the tools and the guidelines for them to look at their health objectively. In Crohnology's case, the system--a perceived health rating scale alongside other tools for recording objective data and the potential to add in data from other sources like wearable devices--is simple enough for patients to understand and comprehensive enough for self-awareness development.

In thinking about some of the problems Sean was dealing with, I thought about the potential of the VisionTree platform my team is working on implementing with Dr. Damato and Dr. Dunn. The cloud-based platform stores clinical information from existing EHR and creates a portal for patients to log in and answer questionnaires--thus creating a central space for data analytics to take place between PROs and clinical outcomes. Our main goal, ergo, is to enable research in PROs, based on validated psychometric and psychosocial measures. But a platform for patients to simply log in and fill in questionnaires seems too limited in scope.

What if we built in a forum or an analogous health data commons within VisionTree? UCSF patients could have a single portal where they learn about their disease and look at their medical records and images, fill in questionnaires for the hospital's own research, and provide a personal account of their own outcomes, thoughts, and feelings. Provided a patient was willing to volunteer their anonymous personal data via informed consent, they could freely participate in the data commons and learn about how other anonymous patients are dealing with their issues. Patients could then build a community within VisionTree that doctors could also see - enabling unprecedented feedback and understanding of their patients.

However, I foresee plenty of things wrong with this idea.

1. Institutional protection of data and lack of open access to other people outside of the community may conflict with the values of a truly "shared" community. This could create an "Uber" of the health industry.
2. Privacy concerns are always present. Although a patient signs informed consent, it does not mean they will always know how to manage their anonymity on the internet. This is an inherent "internet of things" problem.
3. A radically different relationship between doctors and patients could develop as patients will naturally discuss their misgivings about the care they receive from the healthcare institutions. This could have a negative impact on the economic incentive of the institution enabling a Data Commons within the platform. Antagonism may be inherent in this kind of community. On the other hand, this would encourage hospitals and providers to become more patient-centric.
4. A lot of developer work and maintenance is required. A large commission would be needed to develop a platform and maintain it. As mentioned, funding is very difficult to obtain because, in general, the return on investment for obtaining patient-reported outcomes data is uncertain. The trade-off, of course, is the sheer amount of subjective data we could obtain in conjunction with the objective data collected in the clinics, including medical images, tumor sizes, genetic factors, visual acuity, etc. But thinking of the kinds of questions we could answer from a research funding standpoint is a whole new ballpark.

So is this a feasible idea? Is it better to leave digital health commons to more separate entities, subject to altruistic funding? Or would institutions be willing to take on the potential challenges associated with hosting a platform?

I don't really know much about the landscape from a clinical or logistics standpoint - I am mostly, out of curiosity, laying out my thoughts and wanted to bounce it off of someone.

References:
1. Stanford Medicine X <https://medicinex.stanford.edu>
2. Crohnology <https://crohnology.com/>
3. Patient-Centered Outcomes Research Institute <http://www.pcori.org/about-us>
4. Measuring patient-reported outcomes: moving beyond misplaced common sense to hard science. Opinion. McKenna, Stephen. doi:10.1186/1741-7015-9-86 <http://www.biomedcentral.com/1741-7015/9/86>
5. Patient-reported outcomes helped predict survival in multiple myeloma using partial least squares analysis. Kyte, Derek. doi:10.0001/jama.2013.277222 <http://jama.jamanetwork.com/article.aspx?articleid=1741830>
6. VisionTree Software, Inc. <http://www.visiontree.com/>