San Juan 70.3 Race "Sherpa" Report

While I like to think of myself as spontaneous, I am also a HUGE planner. When we did personality testing at work, my strongest trait is "Structure". I LIKE IT! I have pre-typed packing lists in my computer (hey-whatever works when you are packing for three people). There is one for trips to Florida to see the "Greats", one for the annual trip to Nags Head, one for my annual nursing conference....you get the picture. So after a rough few (six) months, one of my awesome Trakkers Teammates invited me to join her in San Juan for her 70.3 race. It went something like this:

Andree: You should join me in San Juan, no pressure though

Me: My passport is expired

A: Puerto Rico is a US territory, I don't think you need a passport

Me: Oh, good point [Checking my work schedule, weighing the pros and cons]

Three days, twenty-seven checks of airtran flights later, one conversation with my EXTREMELY supportive husband, and an early birthday present from my grandparents later, I was IN! My kids were awesome- they helped with the dogs and drew awesome pictures for me to take on my trip.

A note to readers- while Andree and I email often, we have never actually met in person. This might be sketchy if we weren't Trakkers teammates and didn't know lots of people in common. Of course I showed my husband several pictures (since Andree is pronounced the same as Andre- didn't want him to think I was pulling a fast one).

I arrived in San Juan on Thursday at 10pm. I was a little nervous about catching a taxi that late, but my friend Hector (from Mid Maryland Tri Club) assured me that I would be fine. I felt even better when I had a female taxi driver. I arrived after 11pm. There was a key for me at the desk. Andree was sound asleep (as she should be), so I crawl into bed. We both woke up around midnight, and chatted for a while. Again....we still hadn't officially met.

Friday: Andree and I finally met on Friday morning. Our room had a view of the water and the sun was shining (meanwhile 30 degreees at home). While Andree did her pre-race routine, I checked out the resort. It was BEAUTIFUL, and in an ideal location for the race. Pools, swim-up bar, ocean, gorgeous views, and walking distance to swim start and transition. They had several restaurants in the hotel, and the pool bar was the site where the Pina Colada was invented. Yum! The hotel gym was really nice, with a view of the water, so we got in a great workout.

We checked out the expo, and hung out with Doug from Recovery Pump. It was fun to chat with him about the medical science behind the recovery pump. We also got to hang for a bit with Trakkers Pro Amanda Lovato. For lunch? Mahi mahi tacos (and a mojito) for me. Yum. Andree had some mechanical issues with her bike after her flight (thank you, TSA). To ensure her gearing was ok, she took a spin in the hallway (I ran interference).

For pre-race dinner we ended up going to the Italian restaurant in the hotel (I told Andree it was her race and her choice...I can do some sympathy carb-loading anywhere). I might have exaggerated slightly when I told my husband "It was the worst service EVER." The Puerto Rican people were so welcoming, and so kind, but there was definitely an island attitude toward service. One great thing about Puerto Rico- an island feel but cell phone service at no extra cost. It was great to stay in contact with my family while having a great trip.

Saturday: This was the first time EVER I have attended a triathlon I am not racing and not volunteering. It was also my first "Ironman" event. I love Rev3 events, so I already know that if my body ever lets me complete a 140.6 race it will be at Cedar Point. That being said, I was looking forward to seeing what the hype is about. I got up with Andree, and hung out people-watching at transition. I was so excited to see Hector (my tri club friend from Maryland and a native of Puerto Rico). Transition was in an old sports stadium. It added to the race-day atmosphere. Walking into transition, you had to walk the gauntlet of body markers. I have never seen so many body markers...all smiling at 5:30am.

The walk to the swim start was a hike from transition (the run from the swim finish to transition was quite a HIKE). I met up with Andree, who was not feeling well. (You can read her race report here). She said she would do the swim and see how she felt. I got to know her husband at this point, texting him. He told me she would finish if she started (a girl after my own heart). We saw Hector before the swim start, and he looked totally hyped.

As soon as the pro gun went off, I race-walked the mile+ from the swim start to transition. Whew! This sherpa stuff isn't easy. It was fun to cheer for Trakkers pros Amanda Lovato, Richie Cunningham, and Chris McDonald (I got a few crazy looks when screaming "Go Big Sexy!"). When Andree and Hector came through transition, I yelled like crazy!

T1: T1 for me meant breakfast (breakfast #2 since the Starbucks was open at 4:30 am- awesome!). The breakfast buffet was outstanding, and the service impeccable. They even had fried cheese (I steered clear of that one, though). I finished breakfast and made it back in plenty of time for T2. I didn't know the area well enough to be out on the course, so I figured transitions and the finish would be good.

T2: I never realized how hard it is to keep track of the athletes when spectating. I was trying to tweet about the pro race, and sometimes you can't see the race number, or it has rubbed off their arm. New respect for the people who do this on a regular basis. The fans were great..especially when there were Puerto Rican athletes going by...they cheered like crazy. My favorite volunteer? A twenty- or thirty-something woman who had her T shirt tied in a knot and low-slung pants. Shakira's "Hips Don't Lie" came on, and I swear this woman could give Shakira a run for her money. She was cheering and dancing like nobody's business. She embodied the spirit of the volunteers there. I was surprised by how quiet the crowd was at times, though.

Once again, I cheered on the pros and then Andree and Hector. Watching the pro finish was really cool. I'm usually hours from finishing when they cross the line. Important spectator scoop for this race- there is a local bar just feet from the finish. When the clock struck noon, I purchased two bottles of water and (very large) pina colada. (All for $9). Definitely a nice spectator perk. I can be a bit chatty (you think?), so I met several people, including a man who went to high school with my Mom (small world!). The biggest bummer to me about the finish was that people kept getting sternly reminded that they would be DQ'd if they finished with their children. Finishing with my daughter was my favorite moment at Rev3 Cedar Point.

Hector finished waving the Puerto Rican flag, with a huge smile on his face. It was really a neat moment. His father, who had never seen him race, was there. The whole family had "Team Garcia" shirts.

Andree came to the finish looking tired but determined. I cheered like crazy, then ran to the "catch" area of the finish. When she came through the crowd, she was being supported by two volunteers and saying she needed to go to medical. (Keep in mind that feeling like crud she finished in the time it would normally take me to finish...she is one tough cookie). The benefit of bringing a (bossy) nurse practitioner with you to your race is that she will recount your medical history in the medical tent. I was texting Andree's husband, getting Hector his stuff, and crossing my fingers that IV fluids would work. After just a little fluid, she looked like a different person.

For the rally of the century, Andree hung at the pool bar with me later that afternoon. We caught up with Kelly Williamson (pro triathlete, winner of Rev3 Costa Rica and San Juan 70.3, and Recovery Pump athlete) and Recovery Pump Doug. Kelly is very cool (and a crazy fast runner). I'm always amazed by how down-to-earth most pro triathletes are. We might have (allegedly) sampled the mango mojitos (or was it classic mojitos??). The post-race party that night was probably the biggest disappointment of the evening. The ticket cost must have gone toward the entertainment, as it was a cash bar and no food. The bar inside was actually much more entertaining (there we met up with Doug, Team Trakkers pro Amanda Lovato, and some other age groupers).

Sunday: Recovery day. Lots of time by the pool. It was overcast, but relaxing. We ran through Old San Juan (beautiful, and lots of restaurant choices to explore next time) in the morning, and saw a rainbow over the old fort. If my body cooperates, I would definitely race this myself (and make it a diving trip for my husband). I am very thankful to Andree for letting me tag along!

Perspective

So this evening, while I am folding laundry, our daughter asks us "What is the difference between half full and half empty?" My answer? "Perspective". Then Tommy and I had to explain perspective to her.

I haven't blogged in over 3 weeks. This is a triathlon blog, and I have awesome sponsors and incredible pro and age group teammates, and I'm not sure if I can be a triathlete this year. I have put off racing until August (but will be there to cheer my teammates on at Rev3 Knoxville). My knee started hurting suddenly on a run two weeks ago. It feels exactly the same as my torn meniscus did. I saw the ortho, who suggested the symptoms don't sound like a torn meniscus. Since they are exactly what I had before, I'm not so sure. I rested the past couple of weeks, and did a lot of strengthening, and it still hurts like crazy if I do the wrong thing. Even swimming and deep water running hurt it. So I will get an MRI this week and try to figure it out.

This brings me back to my daughter's question. I seem to be a magnet for non-life threatening medical issues this year. I am frustrated as all of my tri friends and teammates blog about their training and the start of race season, but at the same time there is a feeling of acceptance. I fully realize that I have SO MUCH to be thankful for, and I am. So while I am putting it out there right now, I know whining gets old.

I was laughing to myself the other day as I told a friend about reading other blogs where friends/teammates/fellow bloggers post their training numbers (swim/bike/run distances logged). My training is virtually nonexistent (though thanks to teammate Andree I am ready to begin my pro career as race sherpa).

Here are my 2010/2011 numbers so far:

- MRIs - 2 (soon to be three)

- CT scan-1

- Ultrasound-1

- Blood draws- 7

- Hearing tests-3

- Little round scars after attempted ablation- 3

- Little round scars on left knee- 3

- Courses of oral steroids- 3

- Courses of antibiotics- 2

- 2x normal (size my foot was after swelling up in reaction to a foot spray)

- Expletives uttered after recent knee injury (too many to count)

- Reasons to suck it up and get over it- countless

Maya Angelou said it well.

"If you don't like something, change it. If you can't change it, change your attitude. Don't complain."

How Does a Professional Athlete Get a Pulmonary Embolism???

Upon hearing that Serena Williams got a Deep Vein Thrombosis(DVT), it was easy for me to call on my medical knowledge and understand how this happened. I teach a lecture on DVT and Pulmonary Embolism (PE- a blood clot in the lung) for nurses new to critical care. This is my thing. Though I work in cardiology, I take often take care of patients with PE. When the lungs are impacted by a large blood clot, the heart is under stress. This can cause symptoms similar to a heart attack. So I figured I would write a blog on the topic since what is obvious to me might not be to those in other lines of work.

Disclaimer- I am a Nurse Practitioner, and work in cardiology, but the purpose of this blog is not to provide diagnosis. I am happy to provide references for any of the information provided. If you have any of the symptoms listed, please contact your medical provider or go to your local Emergency Department if they are severe.

Understanding the terminology:
DVT (Deep Vein Thrombosis)- a blood clot in a deep vein, usually in the leg or arm, which obstructs blood flow. This eventually causes impaired circulation and swelling.
PE (Pulmonary Embolism)- a DVT that dislodges and moves to the lung. This often causes difficulty breathing, and in instances of massive PE can cause cardiac arrest.
VTE (Venous Thromboembolism)- the "catch phrase" for DVT and PE

Some alarming statistics:
- 900,000 people in the US have an initial or recurrent DVT or PE each year
- An estimated 200,000-300,000 people die each year from PE
- 25% of PEs present as sudden cardiac death
- PE has a "Golden Hour". In 2/3 of fatal PE cases, cardiac arrest will occur in the first 1-2 hours
- PE causes more deaths each year than AIDS, breast cancer, and motor vehicle collisions combined

How does someone develop a PE?
Three major risk factors (Virchows Triad) predispose people to DVT and PE:

1. Venous Stasis (aka poor blood flow)- anyone who has surgery, illness, is on bedrest, is hospitalized has venous stasis. Even prolonged periods of inactivity can lead to venous stasis. It isn't just long plane flights, but also long car rides, and periods of immobility at your desk or on your couch.

2. Hypercoaguability- I always think about this as "sludgy blood". Things that dehydrate you make your blood thick, as well as some other factors. Dehydration, oral contraceptives (ever wonder why they tell you not to take birth control bills and smoke? Huge increase in DVT risk), pregnancy, tumors/cancer, blood clotting disorders are among the causes of hypercoaguability.

3. Vascular Damage- Surgery, trauma, burns. Anything that damages the blood vessel walls increases the risk of clots.

What are the symptoms of DVT/PE?
Symptoms of DVT include:
- Pain/discomfort in one or both of the legs (or arm)
- Swelling/Redness/warmth in one or both of the legs (or arm)
- Reduced ability to tolerate walking/exercise

Symptoms of a PE are often difficult to diagnose. When the PE is small in a healthy person, the symptoms are vague. When severe, the symptoms can mimic a heart attack.
- Sudden onset of shortness of breath, pain associated with breathing fatigue, decreased tolerance for activity, cough (sometimes coughing up pink foam).
- Massive PE may lead to low blood pressure, abnormal heart rhythms, and
- Again, the presentation can be vague. It is often the patient history that provides a hint to the diagnosis.

How are DVT/PE diagnosed?
Ultrasound of the affected limb is used to diagnose DVT.
CT Scan of the lung is used to diagnose DVT/PE. A different scan called a "V/Q Scan" can be used to diagnose PE in patients who have contraindication to CT Scan.


How are DVT/PE treated?
Patients are given blood thinners. These prevent further clot formation and allow the body's natural clot-busting system to do its job and break up the clot. This does not happen quickly. The body may take several weeks to dissolve a clot. In some instances of massive PE, patients may be given a clot-busting drug (similar to those given for strokes and heart attacks).
There are also surgical procedures for patients who cannot receive blood thinners or clot busters. A filter can also be placed to "catch" the clot before it gets to the lung in some patients.

How can you prevent DVT/PE?
- PE is the leading cause of preventable death in hospitalized patients. If you are hospitalized, ensure you are ambulating regularly, or ask what you are being given for DVT prophylaxis. You may receive shots in the abdomen, or "leg squeezers" (pumps that mimic the circulation changes with walking) to prevent DVT.
- If you are going on a long trip, hydrate, get up and walk around at least every two hours. Remember that this includes car trips. You can also use compression socks, and pump your legs if you aren't able to get up and walk around.

So how does a "healthy person have a DVT"?
I am not privy to Serena Williams' medical records, but from listening to interviews it is easy to figure out.
1. She gets a cut on her foot. Vessel Damage
2. She travels a lot. She is also at an age where she might possibly be on oral contraceptives. Venous Stasis

Listening to her interview on the Today Show, she thought she was just out of shape. Her symptoms were vague.

Visit msnbc.com for breaking news, world news, and news about the economy

She was eventually taken to the Emergency Room and diagnosed with PE. To treat this, she was placed on a blood thinner (shots in the belly). As a result of the blood thinner, she developed a hematoma (collection of blood) in her abdomen. Who would have thought????

David Bloom, the NBC reporter, died of a PE after ignoring the symptoms of DVT. He was embedded with troops in Iraq, spending lots of time immobile in a tank. He described symptoms of a DVT to physicians, who urged him to get treatment. He was driven to continue with his work, and suffered a fatal PE.

Whew- a long post! So what is the point? While hospitalized patients are at higher risk, healthy people who suffer injury (or even just travel a lot)are at risk, too. So if you took a minute (or ten) to read this, perhaps it will come in handy if you or someone you know have these symptoms.
Thanks for reading.

No Answers...Time to Move Forward

So I write this post knowing that in comparison to what is going on in Japan, my health issues are completely manageable. Completely. I'm glad it is me and not a member of my family, and so far nothing is life-threatening. That being said, I haven't blogged in several weeks. There have been a couple of (very random) things going on for me.

Hearing Loss
I woke up three weeks ago with sudden hearing loss in my left ear. It feels like I am hearing under water. There is no infection/fluid/pressure in the ear. The hearing test two weeks ago showed that I lost hearing at the highest pitch in my left ear. They aren't sure what is causing it. The leading diagnosis is a viral infection of the nerve in my ear. I saw a Neurologist who is also an Ear/Nose/Throat specialist. No answers there- just orders for an MRI, a CT scan, and two more hearing tests.

As treatment for a potential nerve infection, they put me on steroids. It took about four days, and then I made the Energizer Bunny look lethargic. I was downright manic for two days. Both my sister and my partner at work wanted me to stay on the steroids (Mere so I can help her paint her walls, and Patricia because I was a data-collecting fool at work). Tommy was probably ready for them to stop! (I talk a lot to begin with...me on steroids annoyed even me!). Unfortunately, the steroids didn't fix the hearing loss. I continue to feel like I have water in my ear, challenges with hearing in noisy places, and intermittent ringing in that ear. In the grand scheme, I will deal with it, but definitely frustrating.



SVT (Supraventricular Tachycardia)
Since the hearing issue is out of my control, Today was my EP (Electrophysiology) Study. In preparation (as only a nurse would do), I painted my toenails (who wants skanky toenails when you are in a hospital gown?!). You can read more about the procedure here (if you are really that interested). The bottom line is, they put three catheters in the vein in my leg (ok-groin) and tried to induce the abnormal heart rhythm. My bartender (aka anesthesiologist) was incredible. He had me asleep before they even stuck my leg with a needle. Of course they had to wake me up during the procedure because they were having trouble inducing the rhythm.

When I run hard, my heart rate (normal rhythm) is in the 190s. With Isuprel (a medication) and a pacemaker, they were only able to get it up to the 170s-180s, and they couldn't cause the abnormal rhythm. I coughed, which was the only thing I could do. If only they had let me run on the treadmill or bend over and stand up...hard to do with huge catheters in the groin. They know I have two pathways for electricity, but couldn't burn on of them without inducing the rhythm (if they got the normal one, I would end up with a pacemaker). So from here I think it is just watch and wait. See if and when it happens again (frustrating because it isn't predictable), and consider a different medication. The first medication I was on (a beta blocker) really made me fatigued and down...I could not tolerate it for more than a week. (Of course I was on this the week before the steroids, so I went from loooow to hyper).

So no answers on the ear or the heart. I am a planner...I have pre-printed packing lists, and calendars, and like to PLAN. Apparently someone is teaching me a lesson. I'm going with the flow. I don't know if my hearing will come back, and I don't know if I will end up on another medicine for my heart rate. Again, in the grand scheme these are not insurmountable. They are just annoyances, and beyond anything I need to keep perspective. I said I would have my pity party today and then suck it up and move on.

I am so thankful for my husband, for never complaining about my issues and picking up my slack. He truly is my best friend. I'm also thankful for my wonderful family, friends, and teammates, who give me a boost when I need it (and sometimes a kick in the pants!). I got a nice email from my teammate Ryan today. His business motto is always at the bottom of his emails, and today it definitely resonated. "Don't look back....forward motion is everything." Time to move forward.

Monday Rundown Part 2: Be Still My Beating Heart

Ok, so I don't want my heart to be still, but it could slow the heck down. I have a naturally fast heart rate. My "resting" heart rate when awake is in the 70s. Most athletes run in the 40s-50s. When I did my VO2 max testing, we found that I don't get anaerobic when running until a heart rate of 192. My target heart rate during a race is in the mid-190s. Bottom line, my heart is fast.

Several years ago, I was seen for palpitations. I wore a monitor, and was found to have periodic early heart beats called PVCs (Premature Ventricular Contractions). They are not dangerous, but can be annoying. Each beat after one of these abnormal beats tends to be more forceful, and in people who are symptomatic there is the sensation of your breath being taken away.

Once every six months or so, starting in 2005, I would have a brief episode of SVT (Supraventricular Tachycardia). This is a heart rhythm that is more annoying for me than dangerous, but becomes an issue if it impacts your lifestyle. Once every six months isn't really an issue. Mine was always happening during or after exercise, and always when I bore down or had a "vasovagal" (i.e. bending over to untie my shoes or to stretch). The second I stood up, I went into a rapid heart rhythm.


Working with cardiologists, I have the benefit of running things by a doc. I had decided that it wasn't worth medication or intervention yet. Things went downhill a bit in the past 6 months. It started with IronGirl in August. While treading water waiting for the swim start, I emptied my bladder. (This sounds gross to non-triathletes, but to the rest of us is totally natural). Just the act of bearing down a bit while exerting myself (basically it splits a heartbeat into two heartbeats) caused me to go into SVT. My heart rate went from 120 to the 190s. I had to decide then and there whether to race or not. I decided to try, taking it easy on the swim. Eventually the rhythm "breaks", going back to a normal rhythm. It broke midway through the swim and I was able to keep going.

I had several more episodes this fall and winter....
- Once while doing planks at the gym after a workout. I stood up and there I went. I feel fine in the 190s when it is a normal rhythm, but absolutely crummy when it is abnormal.
- On the treadmill in the gym at work (I was a dummy on this one, because I didn't get an ECG while it was happening even though I was in the hospital. It would have helped me identify the rhythm).
- Christmas Eve while sitting at dinner (after some wine). This is the only time it has happened when not exercising, and took longer to break than usual.
- Once while walking briskly from my car back to my office

This past Wednesday, I went running with my marathon buddy Katy. It was going to be an easy 3.4 mile run outside (it was a beautiful day). We got to the halfway point, 1.7 mi away from work. I had a cramp in my toe, so I put my foot up on a post to stretch. When I put it back down and took a few steps running, my heart was off to the races. Again, I was in the 180s while running and felt like I was pushing it but felt fine. Suddenly I was 208 and felt awful. I tried to jog and hope it would break, but then my arms got heavy and I felt like I could pass out. We walked for a few minutes, then I tried again. I tried to bear down and break the rhythm, but I couldn't. Eventually I decided that I would rather stay in the rhythm and actually get an ECG. We walked/jogged back to work, and I went straight to the ER. I told the ER doc (a friend of mine) that I needed an ECG right away, and then she could register me. I wouldn't sit down until they were ready for the ECG- I actually walked in place to keep it going. (This sounds crazy perhaps, but I hit the point where I needed an answer). So we got the ECG. My heart rate had slowed down to 147, but it was still an abnormal rhythm. We had an answer, and the cardiologists I work with thought they would need to give me medication to convert the rhythm. Thankfully the rhythm broke (which I knew it would). Of course the ER staff was awesome to me, which makes all the difference in the world. Have I mentioned that I love the people I work with? (Thank you Emily, Angela, UJ, Paula, and of course Darcie!)

So I've hit the point where I have to do something. While this isn't life-threatening it is impacting my quality of life. The choices are medical therapy or ablation. I meet with an electrophysiologist (cardiology version of an electrician) who I know and like on Thursday. He is moderate in terms of aggressiveness, which I appreciate. This will be a big decision to make.

Medication: (Beta Blocker)
Pros: Non-invasive, relatively inexpensive each month, relatively effective, may help with my migraines though did not work when I had them as a child
Cons: Cost over time, Being on a cardiac medication indefinitely, lowers the heart rate and the ability of the heart to respond to exercise- this means my heart rate zones may change and it may affect my endurance (other side effects include fatigue, decreased libido, etc....as if being a Mom and working full time doesn't already cause these).

Intervention: (Ablation)
Pros: 95% effective at getting rid of the arrhythmia, No medications needed, curative rather than treatment
Cons: Invasive procedure (a catheter is placed into the femoral vein and fed up to the heart, the irritable tissue is ablated), 1% or so risk of needing a pacemaker (lower risk in people under age 45). I don't know yet what the recovery time is for the procedure, and what it would mean for racing.

So I have a lot to think about. I'm composing my questions for Thursday, and I may give the meds a month before I make any decisions (I started the Beta Blocker last week). Since this isn't life-threatening, just bothersome, I have time to make a decision. Trying to stay upbeat (no pun intended) about this one. I am so thankful for Tommy being supportive through all this, and for Katy who I know was mortified I might drop during our run on Wednesday but didn't get freaked out. Of course I'm doing a crummy job in terms of my "Healthy in 2011" goal, but what can you do?

Monday Rundown: Things That Go Fast

This week's rundown is inspired by some new finds, and the past week's events. On Wednesday I ended up in the ER for my rapid heart rate (6 times in 6 months). I'm doing a whole separate post on this so that I can share some fun stuff. Things that go fast.....

The Athletes at Rev3 Costa Rica:

I can't wait to hear more about this weekend's races in Costa Rica. I have been living vicariously all weekend through the Rev3 live coverage. It sounds like it was a hot weekend, but a great race. Congrats to all the finishers! Trakkers Teammate Andree won her age group in the Sprint, and I am waiting to hear about her Half Iron race today. Trakkers/Rev3 pro Courtenay Brown won the Sprint race overall, and Brian Fleischman and Richie Cunningham has 3rd and 4th place finishes in the Olympic race.

My New Blender:

Inspired by my teammates, I got a blender so I could start making smoothies. My favorite smoothie includes frozen bananas, chocolate protein powder, peanut butter, skim milk, and a cup of spinach. My husband and kids are completely grossed out by the last ingredient, but you honestly can't taste it. I just need to figure out something to eat about two hours later because I am always hungry again.

My New Avia Bolt IIs:

I can't wait to try these out. They came last week on the day I ended up in the hospital, so I didn't have a chance to test them out. I am hoping for a good run this week. They are really lightweight, with a high back to allow you to get them on easily in transition. They are also an awesome red color.

My son's cars on his new carpet:

Many thanks to my dear friend Kathi for "repurposing" some of her sons old toys. My son is loving driving them around...especially because there is a police station, firehouse, and hospital.

How fast I put on my new Recovery Pump when I get home from work:

The Recovery Pump is an awesome compression system which promotes venous blood flow during recovery. It helps with the removal of metabolic waste and lactic acid after exercise. They have been particularly awesome this week after some very long days at work. (This picture was taken during the first use, before they were inflated).

"What Would You Do?"

There is a show on ABC that uses a hidden camera to asses what people would do in an ethically challenging situation. (These include witnessing bullying, having underage kids ask you to buy them alcohol, etc.). I don't generally watch the show, but I feel like our week has been one long "What would you do?". Work was crazy all week- the full moon and lots of sick people led to ridiculous numbers of patients. Some of them were interesting cases, so that made it stimulating.

I blogged last week about our experience coming home from a birthday party and coming up on an accident. We stopped and helped with a little girl who had a bad laceration on her face until EMS and Fire arrived.

Later in the week, Tommy had an experience where he went to pick the kids up from school and saw another father banging on a car window. Tommy went to help. The two of them could not wake up the man in the car (doors were locked). Tommy was ready to break into the car (which was running) to get the man out, when he woke up. When he rolled down the window, it was apparent he was under the influence. He was checked out by EMS to ensure that there wasn't an underlying medical condition (some things like Diabetes can mimic a drunken state), and the police were called. The school administrator was asking Tommy's opinion on what to do. Should they call the mother to get the child. He let them know that under no circumstances should she go with her father. The police dealt with the situation (who knows how many times this might have happened before?!), but I told Tommy how thankful I am to be married to someone who acts rather than walking by. Talking to my good friend (also a Mom at the school), we discussed the fact that we are usually so distracted (thinking about what to make for dinner, getting laundry done, work stuff, etc)that we might not have noticed anything out of the ordinary. I would like to hope I would have seen the guy sleeping in his car, but I don't know. I'm glad someone did, and that hopefully he gets the help he needs.

Then yesterday, we witnessed a road rage incident that could have gone really badly. I was (allegedly) sleeping while we drove home from the playground and lunch. I woke up when Tommy made some comment about someone driving erratically (he said the Mustang ahead of us had passed him "like I was standing still"). Then the guy cut across three lanes to the left turn lane. He was at a red light, and the guy he cut off pulled behind him and threw open his door. The Mustang driver saw in his rear view and jumped out of his car. They were in each other's faces yelling, but jumped back in their cars when the light changed. Thankfully there was no physical violence. Meanwhile, I had my phone out ready to call 9-1-1. Tommy joked that I was ready to tape the fight for Youtube. I can't say I would have jumped in to break up the fight, but at least reported it to the police and let them deal with it.

The full moon has definitely led to some crazy happenings. Last week I mentioned a book that I really enjoyed reading called "The Unthinkable: Who Survives When Disaster Strikes and Why". The main premise of this book is that in a crisis, 10% of people do the right thing, 10% of people do the wrong thing, and 80% freeze. If your brain has never encountered the situation or a similar one before, it doesn't know how to react, and gets stuck cycling through your memories to figure out what to do. It is why people stayed in their staterooms on the Titanic...they didn't know what to do so they froze, why Capt. Sully was able to land his plane so amazingly on the Hudson...because he had practiced what to do. I can't say that I would react in every situation, but I think that Tommy's job as a firefighter and mine as an NP lend themselves to us being more likely to respond. We are used to crisis mode. (Or perhaps it is your personality that causes you to get into a job like that). Regardless, I would like to think we did the right thing when needed this week, and I hope we aren't tested anymore in the coming week. I met a new friend (over a beer with the girls on Friday) who is a teacher. I was decompressing about the week and she said that she would be more than happy to jump in if someone needed an "Emergency Tutor", but aside from that she didn't have much to offer. Sometimes just getting the right help there is the best thing someone can do.

So next time you witness a situation that doesn't seem right....do you respond or do you walk away?