Je vacille, un pied dans ma tombe

Tu t’en vas rejoindre une colombe

Qui te rend fou et fait tomber ton armure.

Cette attente vaine, assagie par une violence

D’une force inouïe qui brûle mes restes

En suspens, j’erre comme une ombre

Et me perds dans un gouffre immense.

Ton sourire, ou serait-ce ta peau, ton odeur,

Méchant, agressif et fuyant,

Je me fais oublier de ta colère,

Annonciatrice de tant de peine.

C’est un pays qui s’éloigne,

Une âme qui s’envole,

Qui avait dit qu’aimer la fougue est illusoire ?

Le vent t’emporte plus au nord,

Doux rêveur, ta vie prend désormais sens

Auprès d’une belle dont tu t’es épris,

Tu revis enfin, sans aucune douleur.

Nos errements nous ont désunis ;

Tu naviguais naguère au gré du vent,

Toujours relié à mon ancre,

Mais tu as pris peur, as lâché les amarres

Et aujourd’hui redécouvre le monde.

@Magda

The steam broke through Third Avenue near 86th Street just after 1 p.m. Tuesday. No one was injured or evacuated.

As the steam poured from underground, traffic was rerouted.

Con Ed was able to close the valve around 30 minutes after the leak was reported.

The utility said a main ruptured, causing the steam to discharge.

Please leave your comments below…

Officer Marc McWilliams with the California Highway Patrol said a tractor struck a gas main Friday morning, creating a small explosion and a fire.

The highway is shut down at Avenue 9 northbound and at Avenue 12 southbound. Rail traffic also has been halted in the area.

PG&E spokeswoman Brittany Chord said there are no injuries, but crews are on the scene to shut off the gas that’s blowing off the ruptured pipe.

The CHP said the highway will probably be closed for at least an hour, until the gas can be shut off.

(Copyright 2012 by CBS San Francisco. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.)

I got the idea to write about Achilles Tendon Rupture because of a football player I have a crush on, so I hope he and everybody else can find something beneficial from this article. What is the Achilles Tendon? The Achilles Tendon is the strongest and thickest tendon in your whole body that connects the gastrocnemius and soleus to the calcaneus. It begins near the middle of the calf. This tendon, along with the contraction of the gastrosoleus plantar, makes it possible to walk, jump, and run and is the most commonly injured tendon in the body. An Achilles Tendon Rupture can occur with sudden explosive acceleration such as pushing off fast or jumping. The Achilles can also be torn with direct trauma to the tendon.

Recovery and Exercises For Achilles Tendon Ruptures

Recovery time for an “Achilles Tendon Rupture” can be anywhere from 6 to 12 weeks, but that’s not including rehabilitation if surgery was involved. This could last for a year or more depending on the person.

Someone who has injured their Achilles Tendon should be sure that when they are strengthening their Achilles Tendon that they are also stretching it out to keep from causing further injury. This can be done with a resistance band. Another exercise to strengthen their Achilles Tendon is to sit in a chair and rise up on the toes putting a small amount of weight on their feet.

Athletes Should Use Kyani For Achilles Tendon Ruptures and Performance

The Kyäni Health Triangle unites complete nutrition and Nobel Prize science to provide all-natural power for athletes.

Benefits include increased stamina, endurance, and strength, faster recovery time, and resistance to injury.

Kyäni Nitro FX™ and Kyäni Nitro Xtreme™

Kyäni Nitro FX™ and Kyäni Nitro Xtreme™, made from the noni plant, trigger the body’s ability to generate increased levels of Nitric Oxide. The discovery of Nitric Oxide’s function in the body is one of the major discoveries of the modern era. This molecule is one of the most important signaling molecules in the body. It affects a wide range of physiological functions including circulation, inflammation, injury recovery, and glucose utilization for endurance. Nitric Oxide also positively affects the oxygen released from red blood cells to tissues to increase stamina and energy.

Athletic benefits of Kyäni Nitro FX™ and Kyäni Nitro Xtreme™:

• Dilate blood vessels to deliver more nutrients to the muscles resulting in more stamina and endurance.
• Convert existing satellite cells (found on fast-twitch muscle fibers) into new fast twitch fibers aiding in recovery after muscle injury and increasing endurance.
• Immense increase in the uptake of glucose into the muscle cell, replenishing vital glucose to the muscle’s glycogen stores essential for recovery and endurance.
• Build muscle strength; a clinical trial showed that athletes with more Nitric Oxide in their systems were able to bench press 34.7% more weight than the placebo group.
• Stimulate the production and size of new mitochondrial cells. The mitochondrial cell is the powerhouse of the body producing nearly all the energy needed to perform any physical activity. Higher numbers of large mitochondrial cells will increase an athlete’s energy and stamina and result in faster recovery time. This is a critical element for athletes with demanding schedules.

But Kyäni Nitro FX™ and Kyäni Nitro Xtreme’s™ production of Nitric Oxide is only as good as the nutrition of the athlete.
The rest of the Kyäni Health Triangle is vital to athletes, ensuring that required nutrients are present to meet cell needs.

Kyäni Sunrise™

Kyäni Sunrise™, a natural blend of Wild Alaska Blueberries and other Super Foods, is an unmatched source of essential nutrition. Kyäni Sunrise™ neutralizes free radical damage in the body to increase strength and reduce recovery time. It’s anti-inflammatory properties assist in recovery and reduction in the severity of athletic related injuries. Kyäni Sunrise also helps promote a healthy vasodilator system to improve blood flow for optimal performance. This nutraceutical also protects the nervous system helping athletes make faster decisions for quick response.

Kyäni Sunset™

Kyäni Sunset™ features Omega-3s from Wild Alaska Sockeye Salmon and other wild fish as well as Tocotrienols. Kyäni Sunset helps maintain the proper function of the 75 trillion cells that make up the human body. Tocotrienols are all natural and the most potent and absorbable form of vitamin E. Tocotrienols preserve the important donut shape of red blood cells to maintain efficient oxygen-carbon dioxide exchange. They also support proper nutrient delivery and waste disposal in the body. Furthermore, Tocotrienols are an excellent anti-inflammatory that assist in recovery and reduction of athletic injuries.

The ingredients in the Kyäni Health Triangle help athletes naturally achieve maximum performance by increasing strength, endurance, stamina, and reducing recovery times. The combined benefits of the Kyäni Health Triangle will ensure every athlete is at peak performance!

To learn more about Kyani please visit  http://teeyakemp.kyani.net/

Source: http://www.kyani.net

Parenthèse : j’ai beau être extraverti, quand vient le temps d’approcher une fille, je gèle. Alors l’épicerie, l’autobus et le reste, c’est un peu difficile pour moi. Et les amies de mes ami-e-s sont casées ou dans la case amies, alors… fin de la parenthèse.

Voici l’histoire de ma toute première rencontre.

Des messages à profusion

Même si la gêne – ou le manque de confiance en moi, c’est selon – m’empêche d’agir lorsque je croise une femme à mon goût dans un lieu public, la réalité est toute autre sur les sites de rencontre : j’ai le verbe facile!

J’ai donc pris l’initiative d’écrire à Monroe. On s’échange quelques courriels et paf, comme ça, elle m’invite à souper. J’étais déjà occupé et I don’t do dinners pour la première rencontre. Choix personnel, mais le souper au resto n’offre AUCUNE porte de sortie pour les protagonistes.

Nous convenons donc d’aller prendre un verre sur une terrasse.

Le détecteur à flags fonctionne encore           

Après l’invitation hâtive à souper et les courriels que j’ai reçus suivant celle-ci (« j’ai dit quelque chose de pas correct?! » , « est-ce que c’est trop vite pour toi? ») mon détecteur à flags s’est réveillé.

C’est que je n’ai pas envie de retomber dans des vieux patterns qui, je sais pertinemment, mèneront à une rupture. Je vous en dirai un peu plus là-dessus cette semaine…

En me rendant au rendez-vous, mon téléphone n’arrêtait pas de vibrer : “t’es proche? Moi j’arrive bientôt, je suis stationnée je t’attends, écris-moi quand t’arrives…”

I-n-t-e-n-s-e. Trop pour moi en tout cas.

On se salue de loin, partie de la date que je déteste. Est-ce que je reste planté où je suis? Est-ce que je vais rejoindre ma date? Je fais signe de la main? Je souris comme un imbécile?!

Elle est cute : chubby (me like chubby!), beau sourire, camisole, jupe en jeans…On s’assoit dehors, on jase un peu en attendant que la serveuse vienne nous voir. Elle n’a pas soupé, alors elle commande une salade tandis que je prends une bière.

Toute la job

Je remarque très rapidement que Monroe n’est pas la fille la plus jasante en ville. À mes questions, elle n’offre que des réponses monosyllabiques. Lorsqu’elle m’avoue être un peu gênée, je me rends compte que moi, je ne le suis pas du tout, ce qui est inhabituel.
Deux constats s’imposent

1. Je suis capable de ne pas être timide avec une fille que je rencontre à peine
2. C’est dull pour la personne en face quand quelqu’un est timide lors d’une première rencontre.

J’ai beau poser des questions, creuser, la conversation stagne autour de sujets sans grande substance. Et ça m’emmerde. J’ai le goût de partir. Mais Monroe mange encore sa salade.

Et je sais que je dérange Monroe : je parle trop, je ris trop, je suis trop.

Mais bon, ça, c’est pas mon problème.

J’ai le temps de m’enfiler une deuxième bière – pas de trop – pendant qu’elle termine sa salade.

Résumons Monroe : jolie, passionnée par sa job (au moins) mais inactive le reste du temps, ce qui ne fonctionne pas vraiment avec moi.

Épilogue

Nous nous sommes embrassés sur les joues en nous séparant. J’ai dit « on se redonne des nouvelles pour une autre sortie ! » et elle a acquiescé. Deux jours plus tard, je lui ai envoyé un texto pour lui expliquer que ça ne fonctionnerait pas, parce que nous n’avons pas la même énergie.

1. Qu’est-ce que vous dites à la fin d’une date lorsque vous savez qu’il n’y en aura pas de deuxième?
2. C’est acceptable de flusher quelqu’un qu’on a vu une seule fois par texto?

I am still performing the various drills prescribed and have also added a proprioception exercise using a tennis ball under my foot whilst sitting at my desk. This has helped build co-ordination as well as washing out stiffness and “bubbling” under the arch. There has been considerable improvement over two weeks so that has been successful.

My tendon is still enlarged – up to 3 times thicker than the right leg. It does reduce to around 2 times thicker after massage so my girlfriend has been treating me every night. The pain when I exercise tends to be focussed at the sides of the back of the foot. The physio suspects it is the protective sheath around the bottom of the tendon which is inflamed and being difficult. The good news is that the tendon itself is not causing pain.

I have progressed to riding my bike on the road and have been out twice: a little 45 minute ride and a longer 90 minute ride. My ankle was eye wateringly painful after 60 minutes and I had to ease off the pedalling on my left leg to reduce the pain. Hopefully when I go out again next time it will take a little longer for the pain to kick in.

As well as adding plyometric drills to my exercise plan, the physio allowed me to start running this weekend so I tried a 5Km run on Saturday. He explained that I should start running with a run walk strategy: 200metres running followed by a walk rest. I did think he was being a little cautious but it turns out he was right. I couldn’t run for more than a few hundred metres without needing a break. All in all it was my slowest 5km run for a very long time and my legs were quite stiff afterwards. As was my ankle which was sore for two days so maybe I over did it a little

Looking forward to longer runs and rides over the next month. Hopefully by the end of December I will be running 10Km again easily and running at full pace. This will tell me how hard I can go when skiing in January.

We all know those high pressure air pumps that can be found at gas stations or in factories, but have you ever wondered what it would be like to stick that hose in your rear and let her rip?

Me neither.

Nevertheless, for those with a morbid curiosity, a factory worker in China was cleaning his pants with an industrial strength air pump when a slip of the wrist sent highly pressurized air rushing up his rump.  Amazingly, the 26 year-old survived to give a detailed account of his ordeal.

We’ll go with the unnamed worker’s story of “accidentally” inserting the air into his butt while cleaning his pants. After all, using these devices to clean is not uncommon – nor recommended as we will see.

The man afterwards said that when the hose came in contact with his buttocks he didn’t “feel anything special”, but afterwards began to experience an intense pain in his abdomen.  It would seem that the air had shot into his colon, bursting it and causing his entire abdominal cavity to swell and put pressure on his remaining organs.

Coworkers at the unnamed but reportedly major company transported the man to Sun Yat-sen University Sixth Hospital where he received a CT scan. The scan revealed that a massive amount of air was inside him and his condition was deemed “urgent.”

He was immediately sent into the operating theatre at midnight.  When the doctor made the first incision a pop was heard (this is not a joke) as the air rushed out.  After that, it was a matter of cleaning out the bile that entered his body from his burst colon and posed risk of serious infection.

When he was all cleaned up the surgeons stitched his colon back together and called it a day – six hours later.  The man spent four days in ICU and, though he can now eat and drink again, he currently remains in hospital under observation.

When interviewed, the doctors said that the man was extremely lucky. Even the slightest bit more air entering his anus would have damaged his diaphragm and other organs, putting his life in further jeopardy.

More surprisingly, this is not the first such case the hospital had dealt with before. A mechanic once had air injected up his backside from a tire pump while he was… testing the pump… yeah… that’s it…

Source: NicoNico News (Japanese)
Image: Peter Southwood Wikipedia

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**Left**

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I rapidly progressed to a 90:10 weight-bearing ratio on my calf raises but getting over the last 10% has taken much longer. I can sense each day that it becomes easier to walk and have even hurried or “dashed” to catch a train without feeling any strain. Seeing the progress each day is motivating and I am bracing myself for the time when progress appears to slow as I get closer to full recovery.

I have been cycling in London each day as part of my commute and it is great to get off the tube and back out onto the road despite only being allowed to cycle very gently. Having injured myself in August and not cycled in London since, I was shocked at the massive increase in cycle commuters over 10 weeks – I sense up to a three-fold increase in numbers. I attribute it to the “Tour de France and Olympic Effect” where Brits did pretty well in the cycling events in the Olympic and Paralympic games. I am secretly hoping the newbies are all fair weather cyclists and I can reclaim the streets once the rain and cold set in for a couple of months:-)

I have added a second set of exercise drills to my calf raises. Butt work! I have noticed that I have lost strength in my left glute so added the following drills:

 Hip Hike, Single leg Deadlift and the Three Way Leg Raise. I can feel the positive work they are doing as my butt is tired from the workload. I found the exercises at Runners World here.

My limp is less pronounced now and almost imperceptible once warmed up but comes back when the leg tires. One curious new feature I have is a cracking or popping ankle joint. My damaged ankle now cracks when I walk around and put weight on it. I assume this is due to the recent lack of movement and will recede after a while but we shall see.

I had my 3^rd Physio appointment to check progress and prescribe more exercises. Progress is good and I am now building up towards jogging at the end of November. I am now adding sideways stress to the ankle and plyometric work in preparation for the jogging. The exercises I was given were: sidesteps, sidesteps crossing over the legs and lunges. I can also start doing some power walking.

I had a consultation with the orthopaedic surgeon and was filed officially as “fixed”. He doesn’t need to see me again and approved my ski holiday in January! I am not sure if the physio agrees with him but I prefer the consultant’s answer so went ahead and confirmed my trip One of the concerns I had when agreeing to conservative treatment for the Achilles tendon rupture was the “re-rupture rate” which is apparently higher following the non-surgical approach. During this meeting, my consultant said that in 3 months time my chance of rupturing the tendon will be the same for my good and bad legs, thus the same as it has always been.

So far I am quite impressed with the NHS. My treatment has cost me nothing and I have been able to call the physiotherapist or consultant whenever I have had a concern. I have never felt rushed in consultations and the wait times at the clinics have been short.  What is more impressive for a free service is that the medical staff have all taken into account my active lifestyle and desire to return to sport when assessing me and prescribing a treatment. I had assumed that I would be “fixed” to a point where I could have a slothful like existence ahead of me but they are all keen to see me get active again without pain or muscle imbalances. Let’s hope my body doesn’t let them down.

The physio had warned that I might need to learn how to walk again properly and he may use the assistance of parallel bars for support whist I took my first steps. The reality is that once the boot was removed I walked, or rather shuffled okay. Not great but I didn’t need to use the parallel bars. The physio explained that my steps are short on my left leg due to poor flexibility and strength. This is indeed the case hence the feeling of shuffling. But walking it is, without crutches and without the Vacoped so it can certainly be called progress.

The focus is now almost wholly on rebuilding strength and flexibility to enable the ankle and calf to get back to normal. The physio prescribed calf raises to be done 4 times a day. Initially 90% of the body weight would need to be on the good leg with a gradual switch to 90% of the weight on the recovering leg. It is amazing how little time it takes for the muscles to atrophy: I have lost 2cm size around my left calf compared to my right calf and it is impossible to do a single leg calf raise.

After a few days walking was much easier as the flexibility in the ankle and foot improved, although there is still a pronounced limp.  The ankle does swell up considerably during the day and I find myself needing to RICE the leg for half an hour each night. I have been getting the leg massaged each night as well and the ankle returns back to normal quite quickly.

The calf strengthened rapidly and after a week the weight balance during calf raises was already at 50:50 and two weeks later it was up to around 80:20 favouring the weak leg.

The other exercise I was given was a calf stretch which to be honest I have been scared out of doing. According to the Physio, it is common to see the Achilles tendon stretched too much at this stage of recovery and I know of a girl who now requires further surgery to correct that same problem. So for that reason I haven’t done any calf stretches and have relied on normal use and movement for the tendon to stretch naturally. So far, so good.

Let me start out by saying that I am absolutely all for breast implants. I still put a lot of them in and they’re great. They are. Most of the time. When everything’s good, they usually look better than real breasts of comparable size, because they give you that upper breast fullness that we start losing in our mid-twenties. You can get them done in a way that nobody will know, or in a way that everyone will know and show them off. You can go without wearing a bra. Men like them (see previous post, Do Men Like Breast Implants?) And they don’t sag like natural breast tissue does.  Women who come to see me for breast reductions can never understand why anyone would want to make their breasts bigger. It’s simple–DD breast implants defy gravity much better than real DD breasts that hang and pull, causing back and neck pain and bra-strap grooving and rashes.

But, as many of you out there know–and you’re probably the only ones still reading this blog–with breast implants, you’re never out of the woods. They move, they ripple, they (RARELY) rupture (rupture rate of the new Sientra implants recently reported at less than two percent, so that’s good.) They can be great for five years and then, for no reason you develop a capsular contracture (rates reported at anywhere from eight to thirteen percent for all gel implants). Or even worse, you could be one of the unlucky ones who gets a contracture from the beginning, and winds up getting one side removed and replaced three times in less than two years. Dr. Roger Khouri, one of the “fathers” of fat grafting to the breast calls those patients “Implant Cripples.” Sounds harsh, but he makes a point. For some women, they just never work.

So far, my patients and I have been extremely happy with the results with this procedure–removing breast implants from someone who’s “done” with them and re-augmenting with their own fat.

My goal with this particular blog is to help those of you who are genuinely investigating this procedure to understand how it’s being done. When patients ask me about it, they seem to have an image of me just taking out the implants and putting a big glob of fat in the space that’s left behind.

That’s not how it works.

I think that as surgeons, we make the mistake of assuming that our patients have a clear mental picture  of the anatomy of their surgery without explaining it to them, and then we’re confused when they don’t understand the limitations and mechanics of a certain procedure.

Just warning you, this is about to get somewhat dry and technical, but is extremely useful information for those of you who really need to know:

Whenever I am discussing a breast procedure with a new patient, I usually draw pictures like the ones below, which are diagrams of where  “under the muscle” (left)  and “over the muscle” (right) breast implants sit.

The white line around the implant is the “capsule.” This is your own normal scar tissue that has formed around the implant. If this scar tissue becomes thick, it squeezes on the implant, making it feel hard, and that’s a capsular contracture. 

When I am switching someone’s implants out for their own fat, after the lipo, I remove the implant through an inframammary (in the crease under your breast) incision. The fat is then placed not in the space where the implant was, but in tiny micro-tunnels in the layers of tissue between the capsule and the skin. This is one of the cases where we say that the “capsule is your friend” because it is keeping the fat from getting into the space where the implant used to be. And it’s okay to leave the capsule there. If we’re not putting a new implant in, and there’s not ruptured silicone all over the place, it doesn’t have to come out. It’s your own tissue and it will eventually reabsorb. A drain is placed in that space (those of you who’ve had multiple breast aug revisions are probably familiar with those) and the space closes down on its own.

How much fat can you get in there?

Depends on how much you have, and how thick the layer of tissue is that I’m putting it in. As you can imagine, it’s better for everyone if your implants are sub-muscular, because then there’s the added layer of muscle to put the fat into. Most of the time I can get enough fat in so that when I’m done, the breasts look almost as big as they did with the implants. In fact, most of my patients who have undergone this procedure laugh about how their friends say, “Are you sure she took them out?” (Obviously they haven’t explained the lipo part of it. )

But won’t my breasts be saggy afterward?

They might. And you may elect to do a mastopexy (lift.) I personally prefer to wait to do the lift as a second surgery because the breasts get swollen when the fat is placed, and you can get a better lift if you wait till the swelling goes down.

So, for those of you who are considering this procedure, I hope that this blog helped you understand exactly what it’s all about.

Before I leave you–here’s an update on the “Paris Girl” that everyone always asks me about, two years out from her fat transfer to the breast, still wearing a C cup.

She has no scars, and her breasts look and feel so natural in fact, that when she had a little tryst with a member of a royal family over there in Europe…well, I guess you could call it, “The Prince and the Pea.”

XO

LQ

Sometimes you have to learn things the hard way. I do, at least. I have ruptured a muscle in my left thigh. No more running in two-three weeks. I will basically be back where I started.

And then again, not quite. I have learned an important lesson, well, two actually: When experienced runners constantly preach an increase in training volume of maximum 10% per week, I have to take it seriously. In just three weeks, I went from 25k per week to 50k. Bad choice.

Also, I need to start training my core again, and this time I will include a special program with a simple exercise, which, according to a new Danish study mentioned in Danish daily Politiken (sorry, article only available in Danish), reduces the risk of ruptures in the thigh significantly. Soccer players who had a rupture the year before and started performing this exercise, reduced the risk of a new injury by a factor 7.

I got my injury in the very beginning of a otherwise wonderful 14,5k run on Friday from Dyrehaven in Klampenborg to Copenhagen. It so happened, I caught a glimpse of one of the best marathon runners in Denmark, winner of Copenhagen Marathon 2012, Martin Parkhøi. I suppose he was running to his home after work. He sure did look determined.

His incredible story is a true inspiration to many Danish runners, me included. I will share his story in my next posting.

1:00 am
As contractions got longer and closer together, I realized there was something I could do about the pain and told the nurse I was ready for an epidural.

Me: I would like an epidural, please.
Nurse: Ok.
Me: How long will it take to kick in?
Nurse: It takes about 5 minutes to place, and 15 minutes for pain relief to start. Our anesthesiologists are really good, we just have to make sure there’s one around. And actually the one on duty now is next door at the moment.
Me: Yessssss. Bring it. Pump me up.
Anesthesiologist: Hello. Ready for an epidural?
Me: Hello. And oh yes.
Anesthesiologist: Ok, swing your feet over the side of the bed, sit up, lean forward, tuck your head down, and curl your back like a cat.
Me: Ok. Now this “curl like a cat” business…I’m only so foldable at the moment.
Anesthesiologist: You’re doing great.
The husband: Are you ok, baby?
Me: Mmmfnethkyu.
The husband: Good.
Anesthesiologist: Epidural placed, 1:18 am. Nurse, please record the time.

The husband helped me curl forward while the nurse held my head down and still and the anesthesiologist placed the epidural. It was news to me until a few days before that an epidural stays put during delivery. What I thought was a shot is actually a tiny little pliable needle that stays in your back and can have extra numbing power added to it as necessary, which would turn out to be absolutely crucial for me in the coming hours.

With the epidural placed and kicking in, I could no longer feel the contractions but could tell I was having one when I was suddenly short of breath. It was an interesting sensation and the husband and I watched the contractions register on the monitor when we weren’t sleeping through them. Shifting around in my bed became increasingly difficult as my entire lower body lost feeling and being checked by a nurse or ob to see how labor was progressing was quite the production. For me, that is.

Me: I’m like a mermaid on land! Heehee! Look, my legs are like a tail and I can’t move them!
The husband: Zzzzzzzzz. Zzzzzzz.

2:30 am
With the epidural working, I was able to sleep pretty steadily.

Me: Hey, wake up.
The husband: Are you ok?!
Me: I think my water broke. Or I’m peeing the bed. Either way, I can’t move to find out.
The husband: I’ll call the nurse. <pages nurse desk>
Nurse: Hello?
Me: Hi. I think my water broke.
Nurse: Ok, I’ll send your nurse in.
Me: Ok, I’ll be here.
The husband: Are you in pain?
Me: No. It…tickles. It seriously feels like I’m piddling. How come I can feel this but can’t feel my legs enough to move them?
The husband: Good question.
Me: I’m glad they didn’t have to break my water. At least one thing is happening on its own with this labor!

Sure enough, my water had broken. On-duty ob 2 came to check me, a nurse came to change my piddle pad (little known fact: while piddle pads are typically used for house-breaking small dogs, these are also used under the business ends of in-labor women…although they’re probably officially not the same product, the result is the same), and the husband got me some more ice nuggets.

The Pitocin, which was by now cranked up to 18 because not much had happened in the seven hours of inducement, dripped along. The nurse placed a catheter and soon I was resting again.

7:00 am
Before she left, on-duty ob 2 checked me one more time and announced that I was at 8 centimeters and could probably begin pushing in about two hours. A baby by lunchtime, I thought! So I went back to sleep. The husband and his slippers did, too.

9:00 am
On-duty ob 3, a jovial middle-aged man who told me it was my lucky day because I was going to have a baby and his lucky day because he was going to get to deliver her, came to check me. I was still 8 centimeters dilated, but the little oyster was now at 0 station. A little more progress.

On-duty ob 3: Your baby is taking her time. If you start pushing now, you push for many hours. We have you labor down. I come back soon.
Me: Sounds good, thank you.
Nurse: Labor down means we’re going to wait for the baby to move further down the birth canal before we have you push. Otherwise, like he said, you’ll be pushing for hours. We’ll let gravity help. Let’s sit you up straighter.

10:30 am
Me: Excuse me, but I can feel the contractions again. Is my epidural wearing off?
Nurse: Possibly. How much pain are you in, 1-10?
Me: 8. And I don’t feel good.
Nurse: I’ll call the anesthesiologist.

During my entire stay, my temperature and blood pressure, along with the oyster’s heart rate, were monitored constantly.

The anesthesiologist added power to the epidural and the nurse took my temp again. Oddly, it was up. Also oddly, I started shaking uncontrollably. The effectiveness of the epidural came and went, depending on how I was angled. Sitting up straighter to help me labor down seemed to dilute the pain-killing effects so that was a double-edged sword.

Nurse: You’re running a temperature.
Me: Oh. I don’t feel good.
Nurse: I’ll be right back. <returns with another nurse>
Nurse 2: How are you doing?
Me: My body hurts and I can’t stop shaking.
Nurse 2: When did your water break?
Me: 2:30 this morning.
Nurse: The doctor is having her labor down. The anesthesiologist just upped the epidural.
Me: I don’t feel good.
Nurse 2: Are you going to throw up?
Me: No. I ache all over and I’m having really bad heartburn.
Nurse: I’ll get you some Pepcid.

11:00 am
The Pepcid didn’t help, my fever was climbing, the pain was getting worse, I couldn’t stop shaking, and I was still pregnant.

Me: I can feel the contractions again.
Nurse 2: <pages anesthesiologist> How much pain are you in?
Me: 9. And the heartburn is really bad!
Nurse: I think she needs to start pushing.
Nurse 2: On-duty ob 3 is delivering next door. We need to call his back up.
Me: I can’t breathe. I feel like she’s trying to come out of my chest.
Nurse: Her fever is still up. She needs to push.
Anesthesiologist: Hi. The fever is burning off the epidural, that’s why it’s not lasting. I’m going to increase it again.
Nurse 2: I’m going to hold this leg and your husband is going to hold your other leg. When I say push, I’m going to start counting to 10 and you’re going to push as hard as you can until I get to 10.
Me: Ok.
Anesthesiologist: Why is she shaking?
Nurse: Her water broke at 2:30 this morning, we think there’s a small infection.
Me: I’m infected?
Nurse: It can happen if your water breaks and you go a few hours before pushing.
Anesthesiologist: The pain in her ribs is strange. I don’t think it’s heartburn. Are you sure there’s no rupture?
Nurse 2: Very unlikely.
Anesthesiologist: She shouldn’t be shaking like that. You should check for a rupture.

11:30 am
On-duty ob 4, backup for 3, arrived. She was no-nonsense and I was told to keep pushing, keep pushing, deep breath, keep pushing, push again. I pushed and I pushed and I breathed and I breathed and the “heartburn” got worse and spread to my lower left abdomen. I pushed for an hour. No progress.

Me: If I push again, I’m going to throw up.
On-duty ob 4: We’ll change your position but you have to keep pushing.
Me: I can’t. I can’t! She’s never coming out.
Nurse: Her fever is still up and the baby’s heart rate is increasing.
Me: I really can’t push. I can’t. I just can’t.
Nurse: I think she’s rupturing.
Me: <starts crying>
The husband: Hey baby, you’ll be ok. They’re taking good care of you. I’m right here.
Me: <still crying>
On-duty ob 4: How long has she been complaining of the pain and fever?
Nurse: About two hours. She’s had three rounds with the epidural but the crying is new.
On-duty ob 4: No option then. <to me> You need to have a c-section. This baby needs to come out now.
Me: <bawling>
The husband: I’m right here with you, they’re going to bring our baby out! You’re going to be great!
Me: <still bawling> But I don’t want one!
The husband: Are you scared?
Me: <still bawling> Yes!
The husband: You’re so brave. We need to do what’s best for you and for our little girl. They’re going to take such good care of you and I’ll stay with you. <hugs my head>
Me: <bawling harder> Nothing is going right!

1:00 pm
Moving from my rolling hospital bed to the operating table was very hard, physically, since I was weak, numb, tired and no longer feeling like a mermaid. On to the table I went, up went the blue sheet to shield me and the husband from the operation, out went my arms crucifixion-style on side tables, and in came the husband, dressed in what the nurses called a bunny suit–white scrubs and a hat.

I remember the anesthesiologist tinkering with the epidural some more. Nurses wetting cotton balls and running them up my sides and belly, telling me to say when I could feel the cold; when I was sufficiently numb, they applied some disinfectant. The ob asking why they chose the disinfectant that takes three minutes to dry because “we need to get moving on this.” Lots of pressure on my belly. The husband sat by my head. I think he held my hand. The nurse at my head leaning over my face and telling me she had a c-section on this same table 11 months earlier and I’d be fine. She had brown eyes.

1:24 pm
The husband: She’s here! Our daughter is here! She’s out, baby!
Me: Why isn’t she crying? Why isn’t she crying? Why isn’t she crying?
<oyster lets out a wail>
The husband: from from me to the warming table, back to me> She’s beautiful! She’s here! Our daughter is here!

Then I passed out. Later in the evening I saw the pictures a nurse and the husband had taken of the little oyster getting all cleaned up and wiped down. She looked so big! At 8 lbs. 12 oz. and 21 3/4 inches long, she was pretty big for a newborn. Her hair was curly (I was so excited she had some!) and she did not look pleased to be out.

Later in the evening the husband also told me that the nurse handed him the baby as soon as all her initial testing was done and they ushered my family out of the operating room. As they left, someone came in to get the anesthesiologist who told that person that they’d have to find someone else, he had a patient hemorrhaging on the table.

The husband said it was one of the scariest hours of his life, alone in the recovery room with his brand new baby, waiting for his wife who, last he heard, was bleeding out on an operating table. A year after a brain surgery that went 100% according to plan, we were having baby with absolutely nothing going right.

It turned out the anesthesiologist was correct a few hours earlier. I had a placental abruption, a complication that, ironically, considering Martha, affects about 1% of pregnancies. I lost 1200 ccs (40 oz.) of blood during delivery and woke up in recovery to a nurse telling me to breathe and breathe again. I just wanted to sleep. When she left, the husband had to stand next to me and remind me to breathe. Our new baby girl was snuggled into his chest, asleep like I wanted to be.

The day before his visit, Bruno had gone out in the leash free park playing and romping with some of his best buddies. His owner had been chatting with another dog owner, while Bruno was off with his friends. He was unaware that anything had happened, but when Bruno came back he was holding up his left rear leg and would only walk on his three other limbs. There really had been no change since it happened. He had eaten his meals, gone out for bathroom duties, just about everything as usual, except he did everything on three legs. He was a bit reluctant to let his owner examine the leg but did not appear to be terribly painful with it and his owner could find no cause for the problem.

On the other hand, Julie’s problem had been more gradual in onset. Her owner thought it had been probably been about 2 weeks ago that she had noticed Julie favoring the leg. Also, although not using the leg normally, she was not holding it up like Bruno. Rather, she just would not fully bear weight on it, causing her to hobble along as she walked. Just like Bruno, Julie seemed otherwise normal in body functions and behaviour. She also showed no pain or discomfort when her owner felt up and down the leg.

Although each case had quite a different presentation, when they received an examination by their veterinarian, the same problem was suspected for each patient. There were some other tests planned to confirm the diagnosis but the tentative diagnosis in each patient was a torn or ruptured anterior (or cranial) cruciate ligament.

A dog’s cranial cruciate ligament, just like our own, is found in the knee joint. It stabilizes this joint by limiting internal rotation and preventing the tibia ( the bone running from ankle to knee) from moving too much forward relative to the femur ( the bone between the knee and hip). It prevents hyper- or over extension of the knee joint. It can be injured acutely as a result of trauma or chronically as a result of more gradual degeneration of the strength of the ligament. Problems can develop as a result of either complete or partial rupture of the ligament. It is one of the most common causes of hindlimb lameness in dogs. Injury to the ligament is a major cause of degenerative joint disease (arthritis) in dogs. Cruciate disease is quite uncommon in cats.

It occurs most commonly in dogs older than 5 years of age, although in large breeds it often occurs between 1 and 2 years of age. It can affect any breed of dog but Rottweilers and Labrador Retrievers have increased incidence of cruciate rupture when they are less than 4 years of age. Female dogs may have slightly more risk to have the problem.

Diagnosis of ligament rupture is made when cranial drawer motion can be demonstrated in the knee joint. This abnormal motion or movement between the bones that meet at the knee joint will only occur when the ligament has been torn or ruptured. Sometimes a veterinarian is able to detect this during the routine physical examination of an animal. It may be necessary to sedate or anesthetize a patient in order for them to be relaxed enough to make the diagnosis.

Surgery is the treatment of choice for dogs who sustain this injury. It returns stability to the joint most quickly, speeding recovery from the injury. It prevents further degenerative changes in the joint and therefore reduces arthritic development in the knee. There are several different surgical techniques used for the repair. No one method seems superior to the others. Some methods make use of implants to replace the torn ligament; others transplant or reposition other body tissues located near the knee to accomplish the same effect.

After surgery, good nursing care and physiotherapy will help the patient’s recovery. Some exercise restriction is necessary while healing occurs. Non-steroidal anti-inflammatory drugs and analgesics may be used to control post-operative discomfort and arthritis. Alternative drugs like glucosamine and chondroitin sulfate may help limit cartilage damage and degeneration. Most patients require 2-4 months to fully rehabilitate. Unfortunately, 20%-40% of dogs who develop this problem in one knee will experience the same problem in the other knee within 17 months.

After recovery, Bruno was probably out bragging to his buddies that he had suffered the same knee problem that had afflicted hockey players, Grant Fuhr and Pavel Bure and he would be back just like they were. Practical Julie, on the other hand, embarked on a weight management program to lessen future complications from her knee injury.

Abstract

This article discusses conversion to Protestantism in the Zapotec communities of the State of Oaxaca in Southern Mexico. Conversion to Protestantism in these predominantly Catholic villages has a rupture effect on converts’ relationships with their families as well as the Catholic majority. This transformation can be interpreted as a ‘social cost’, which influences religious choices made by individuals and the sustainability of their new religious affiliations. The cost is generally higher for native villagers than for migrants to the communities. Focusing on the adverse effects of conversion and scrutinising the choices of individuals who do not convert or who return to their previous faith contributes to a more nuanced understanding of religious change. The process is often far more complex and multi-directional at the local level than macro-level trends of rapid Protestant growth suggest.

By the weekend I dialled in complete ROM (from 0-30 degrees) and changed the sole on the boot to a flat sole. This was quite uncomfortable to start with and frustrating with it. But little by little it is easy to get used to. The flat sole really makes you feel very mobile and the boot almost feels like it is there for protection rather than anything corrective.

I was also given the go ahead to get on the gym bike or turbo trainer which is great news. But I have to ensure the heel of my foot is directly over the pedal and that there is no stress on the foot forcing the foot upwards. The first turbo session was difficult and I only lasted ten minutes, the effort of keeping the foot flat was the main challenge and I subsequently resorted to wearing the boot, which was more comfortable and felt more secure. I had to change pedals on the left side to provide a wide stable platform for the boot. I managed several 30 minutes easy rides on the bike and felt so much better for it. The ankle felt good and it feels like the extra blood flow has helped eased some of the stiffness.

Generally this week I can feel real progress!

Next week I get to remove the boot completely!

09/04/2010

I spent some time this weekend looking for 1vs1 fights, usually trying to sneak into less populated realms in Black Rise.  I managed to get into two fights with my Incursus, which at the time was an armor plated set up.  My first 1vs1 was against a Dramiel in the Riahbaka system.  Normally I wouldn’t have tried as the Dramiel is just so vastly superior.. but he had aggroed the local NPCs on the Plex and I was still feeling a bit cheeky, so I decided to try it.  We raced toward each other and we snagged each other at close range.  What he wasn’t expecting was my Tracking Disruptor.  We traded blows for a minute or so, his drones and autocannons pecking away at my 200mm plate, while my Neutrons and the NPCs pecked back.  His ship though, wasn’t as heavily shield tanked, and once I broke through, he started losing armor quick.  However, I hadn’t dealt with his drones either and they were making nice holes in my armor.  It was clear that in this situation, we were well-matched.. and he thought it a good idea to kick his AB on and bug out.. which was good for me because I wasn’t going to last much longer anyways.

The second fight was in the Caldari system of Kinakka.  I drove off an Incursus who was running a plex.  Since it was a home system, I chose to push the plex back toward Caldari.. that’s when the same pilot came back for another go.  This time, he opted to fight.  We traded blows at short range for a bit, my armor slowly being taken off, while he managed to mitigate the damage from both myself and some NPCs that were way far away.  Pretty soon it become apparent that I wasn’t going to win.. but he had overheated his AB and ran out of cap, so he wasn’t holding me down.  His drone I had dispatched already, but my ship was barely holding together, so I warped out, gave a “GF” in local.

So, ziltch on the kills, but no losses either.  Not great.

In Other News – Cruisers and Missiles and Bounties, oh MY!

Ah, first we saw the “Disruption” Cruisers get updated, then the Tech 1 Mining cruisers get changed into full blown support Logis, then we got to see the faster Attack Cruisers on display.. and now, now its finally time to see the Combat Cruisers and what they look like.  I can fly all of these, but I have usually flown the Rupture, so it will be interesting to see how these ships will do in the new combat environment.  Probably the biggest distinction is the fact that most of these ships actually LOST a high slot, with the Moa being the only one with high-slots left untouched (probably to make up for its looks).

Maller:
Cruiser skill bonuses:
5% bonus to Medium Energy Turret damage
5% bonus to all Armor Resistances
Slot layout: 5 H (-1), 3 M, 6 L, 5 turrets
Fittings: 1000 PWG (+100), 280 CPU
Defense (shields / armor / hull) : 1200(-168) / 2100(+225) / 1700(-19)
Capacitor (amount / recharge rate / average cap per second): 1550(+50) / 515s(-22.5s) / 3 (+0.2)
Mobility (max velocity / agility / mass / align time): 205(+41) / 0.56(-0.045) / 11550000 / 6.1s (-0.4)
Drones (bandwidth / bay): 0 / 0
Targeting (max targeting range / Scan Resolution / Max Locked targets): 47.5km / 280(+10) / 6
Sensor strength: 16 Radar (+2)
Signature radius: 130
Cargo capacity: 480 (+200)

The first on the list is the Maller, which finally gets a decent direct damage bonus.  While it does lose a high slot, it gain a nice amount of powergrid and armor.  The capacitor, speed, and agility were all massively upgraded too.  We will definately see more of these on the field now.

Moa:
Cruiser skill bonuses:
5% bonus to Medium Hybrid Turret damage
5% bonus to shield resistances
Slot layout: 6 H, 4 M, 4 L, 5 turrets, 2 launchers
Fittings: 800 PWG (+20), 375 CPU (+15)
Defense (shields / armor / hull) : 2100(+225) / 1200(-129) / 1500(-24)
Capacitor (amount / recharge rate / average cap per second): 1425(+50) / 475s(-16.25s) / 3 (+0.2)
Mobility (max velocity / agility / mass / align time): 195(+31) / 0.54 / 11720000 / 5.9s
Drones (bandwidth / bay): 15 / 15
Targeting (max targeting range / Scan Resolution / Max Locked targets): 55km / 260(+7) / 7
Sensor strength: 17 Gravimetric (+1)
Signature radius: 135
Cargo capacity: 450 (+200)

The second (perhaps even first) ugliest ship in the game, the Moa loses its range bonus and becomes the shield version of the new Maller.  Increases across the board from shield HP to fitting attributes, to capacitor charge and speed, while maintain its slot layout.  You’ll see a lot of this ship too, and I think Kirth Kodachi will probably feel vindicated in that this ship will likely replace the Rupture as the new top end Cruiser.

Vexor:
Cruiser skill bonuses:
5% bonus to Medium Hybrid Turret damage
10% bonus to drone hitpoints, damage and mining yield
Slot layout: 4 H (-1), 4 M (+1), 5 L (+1), 4 turrets
Fittings: 800 PWG (+125), 300 CPU (+30)
Defense (shields / armor / hull) : 1100(-73) / 2000(+515) / 2000(+515)
Capacitor (amount / recharge rate / average cap per second): 1450(+200) / 482.5s(+36.25s) / 3 (+0.2)
Mobility (max velocity / agility / mass / align time): 215(+46) / 0.6(+0.03) / 10310000 / 5.8s (+0.3)
Drones (bandwidth / bay): 75 / 100
Targeting (max targeting range / Scan Resolution / Max Locked targets): 52.5km / 280(+4) / 6(+1)
Sensor strength: 16 Magnetometric (+2)
Signature radius: 145 (-5)
Cargo capacity: 480

The Vexor retains its combat bonuses, while getting upgrades everywhere else.  The only cost to this is the loss of one high slot.  For that loss, it gets two additional slots, one midslot and one low slot.  The Vexor gets upgrades in every feature, with a 30% increase in armor and hull, increased in Powergrid and CPU, a larger and faster charging capacitor, a 30% increase in speed, a 20% increase in agility and even a smaller sig radius.

Rupture:
Cruiser skill bonuses:
5% bonus to Medium Projectile Turret firing speed
5% bonus to Medium Projectile Turret damage
Slot layout: 5 H (-1), 4 M (+1), 5 L, 4 turrets, 2 launchers
Fittings: 860 PWG, 350 CPU (+25)
Defense (shields / armor / hull) : 1500(-63) / 1800(+159) / 1600(+37)
Capacitor (amount / recharge rate / average cap per second): 1275(+25) / 425s(-21.25s) / 3(+0.2)
Mobility (max velocity / agility / mass / align time): 240(+48) / 0.54 / 11650000 / 5.9s
Drones (bandwidth / bay): 30 / 30
Targeting (max targeting range / Scan Resolution / Max Locked targets): 50km(+5) / 290(+8) / 6(+1)
Sensor strength: 15 Ladar (+3)
Signature radius: 125 (-5)
Cargo capacity: 450 (+150)

Ah, the ship that is close to my heart, the Rupture.  Looking over these changes, the Rupture really didn’t get that much of a makeover.  It lost some DPS with the highslot being dropped and it gained a midslot, but I am not so sure how effective that will be.  Certainly one configuration that will shine more will be the 1600mm plate version.  The additional armor and cpu will be helpful, and in that configuration you go from having the holy Trinity (MWD, Web, Point), to a whole host of configurations, including better ASB and passive tanks to better E-War offense like Target Painters or Tracking Disruptors.  Or Dual Webs.  Or Dual Prop… hmmm..

But combat cruisers weren’t the only thing CCP is rolling out, the next big thing hits the Caldari pretty squarely, and some of the Minmatar and Amarr as well.  Yes, I am talking about the missile update, shown here:

FIX ALL THE MISSILES
Increase missile acceleration so that real range is much closer to the client assumed range of flighttime*speed against a stationary target. This means a slight range buff for all missiles, and missiles will act in a way that is more intuitive to newer players.

Short Range Missiles
Change the Guided Missile Precision skill, as well as all associated implants and rigs to affect all subcap missiles
Reduce HAM launcher PG requirements by 10%

Light Missiles
-Decrease all Light Missile Launcher fitting requirements by 2pg and 4cpu
-Explosion radius reduced from 50 to 40
-Damage increased by 10% (rounded to closest digit)
-Affects all variant light missiles, including FOF.

Heavy Missiles
-Base flight time reduced by 35%
-Base velocity increased by 14.66%
-In total, base range reduced by ~25%
-Damage decreased by 10% (rounded to closest digit)
-Explosion radius increased by 12%
-Affects all variant Heavy missiles, including FOF.

Tech Two Missiles
-Remove ship penalties from tech two missiles (ship velocity and signature radius)
-Precision: Increase bonuses to explosion velocity to +20%, increase damage to match T1 missiles
-Fury: Increase damage bonus to +35%, reduce flight time to 50% of T1, unify penalties to explosion radius (+72%) and velocity (-16%) across the sizes
-Javelin: Just remove ship penalties
-Rage: Increase damage bonus to +35%, Unify flight time to match T1, unify velocity penalty (-16.7%), unify penalty to explosion velocity (-14%), increase penalty to explosion radius (+72%)

Tracking/Range Mods and Ewar
Tracking mod and disruptor changes moved out of this release until the first set of changes settles a bit

Overall, this is a good, good change and in all honestly, it has been a long time coming.  The penalties on the Tech 2 missiles made them too task specific.. as in, if situation developed where “x”, “y”, and “z” happened at the same time, then those missiles would be useful.  Outside of that, you were simply better off to go with faction missiles.  Now, they  have a use.  Heavy missiles, the staple of most Caldari pilots, have gotten an interesting, albeit probably not a solution I would agree to.  Their range and their damage has been decreased, though not nearly as much as they were initially. 

The problem I have  isn’t so much the reduction in damage, it really the reduction in range that is the issue.  Because really, Heavy Missiles should be the Caldari’s long range weapon, as compared to HAMs.  My thoughts would be to have a minimum timer where the missile does less damage until the timer hits zero.  Maybe it should be one or one and a half seconds before it gets to full damage.  “Time to arm” they could call it. 

The major downer to me is that they are delaying the Tracking mod change.  I was hoping to see it released soon.

Oooo.. how many Boba Fetts in Eve are there?

So, turn on the lights.  Play some romantic music.  And listen to the sounds of a half a million Excel spreadsheet supernerds (yes, that includes those that use Google docs) cheer in their native tongue in celebration that WE MIGHT NOW BE BOUNTY HUNTERS!! (I’m pretty sure though, after seeing fanfest pictures.. that the sound would be more like a warble).

There isn’t much detail yet, except to say that the bounty system appears to allow you to place bounties on ships in general and they can be placed again alliance, corporations, as well as individuals.  In addtion, you can now sell or rent your killrights.  As it stands now, it looks very likely the the formerly defunct “bounty hunter” career of Eve Online might actually come true..

Discussion Areas:

• For Bounty Hunter Wannabes, press one.
• To get your freak on with the new combat cruisers, press two.
• To ALL THE MISSILES!!, please press three.