RussH

Send Message

Block

Add Friend

Austere environments and WLS

 

I recently came home from an extremely austere environment, Haiti. I went to Haiti as part of the New Mexico Disaster Medical Team; I was told that this deployment would be the most austere environment that the team has ever been deployed on. Guidelines were strict as team health was a concern for this deployment; hypertension, heat issues, and BMI’s greater than 35 were among the disqualifications for deployment.  Four days after the quake we had our quarterly training where our team commander dropped the bomb shell on us saying that we had a 75% chance of deploying to Haiti prior to our official on-call month and a 15% chance of going to the Olympics. He laid out the criteria for the Haiti deployment and asked that if we had questions to please hold until after the briefing and any medical concerns to bring them to our medical director. He also said that we should start hydrating now for waiting until the team is in theatre to starting hydrating would place the person behind the eight ball. 

 

I was only over by 2 points on my BMI and so I spoke to our medical director.  His first question was; “How do I feel?” I responded by saying that I have never felt better and I wasn’t lying. He knew that I had undergone weight-loss surgery and I answered the questions that he asked well as I could.  I went on to tell him that if chosen to go, I would be bringing food that I knew would be safe for me to eat as he was concerned for my well-being.  I was 266 pounds and so looking forward to going, I packed my bags with enough clothing/gear to last the entire deployment and enough food also but remain under the 45lb weight limit imposed by the team.  Some how I managed to pack all of my gear, clothing, and food; 2 cans of Monster Milk, Sesame crackers, high protein granola, etc. and still manage to come in 12lbs under the limit.  We get to Atlanta and it’s snowing, the weather seemed to follow the team from Albuquerque, we wondered if it would follow us to Haiti. We joined up with a 20 member surgical augmentation team with members from Oregon, Ohio, Massachusetts, Illinois, Arizona, Alabama, Texas and Alaska.

 

Before leaving the hotel, I filled my hydration kits as we were told that we would be heading directly to the site once we hit the Port-au-Prince.  Its 3pm and like 90º+F, we board these tour style buses that look to have been armor plated.  We start out to the field hospital that would be our home for the next two weeks, we found out why our vehicle was fortified. The streets of Port-au-Prince were rough; the belief that the bigger vehicle had the right of way was quite evident. This made the worst traffic in the U.S. seem like a nice stroll in the park, there were functioning traffic signals but they were rarely obeyed.  We get to the site and it looks like a war zone and in the back of my mind I was thinking oh my god what have I gotten myself into?  Everything was surrounded by razor wire and a detachment of the Army 82^nd Airborne, I felt safe.  We settled in and began the transition process as we were taking over from another team and had to hit the ground running. The first few days were a bit rough; I found out that I am allergic to DEET. So not only did I have to acclimate to the environment, I also had to deal with the allergic reaction,  mosquitoes and the chemoprophylaxis medications that we started prior to deploying for malaria.  

 

While everyone consumed M.R.E.s (meals ready to eat/meals reluctant to exit) for the first few days and then started to complain about the constipation that ensued, I merely continued my high protein regiment and had normal movements.  I didn’t account for the heat, I knew it would be hot but I didn’t expect that it would be that hot; heat indexes were generally over 105ºF.   So I started consuming more water than I would have normally, easily double the amount and I added electrolytes so I wouldn’t get sick.  I decided to throw in an occasional M.R.E. to my meal rotation so to keep things fresh.

Meal choices weren’t the best, meatloaf (w/ anchovies), jambalaya, chicken and dumplins, chili, and several other horrible meals. Now each kit contained a full meal; drink pack, main course, a bread type product, desert and condiments for an average meal of about 4000 calories, 300grams of carbohydrates, and about 125grams of proteins.  That’s enough to kill in my opinion.  I pretty much stuck with the jambalaya and a cheese omelet MREs, I didn’t eat the sides just the main course and over a couple of hours.  I began to see the issues that the others were commenting about, but having the Duodenal Switch I didn’t seem to have them as bad as the others.  I figured that I would eat my food and augment with the MRE as necessary to maintain the food supply. We were able to get showers at our site so that was a big thing and I was able to get some of my clothing washed. It was nice to be able to have clean clothing and body.  

 

We were a 24/7 field hospital and so that ment that we had teams up and working in the middle to the night. A couple of nights we had late night arrival of patients, many pregnancies and multiple casualty accidents. One night we had two women present at our gates at what appeared to be full term without pre-natal care, they both delivered healthy kids. The next night, 30 minutes after shift change we heard a commotion on the 82nds radio, it turned out that it was an accident down the street and was a pick-up truck/bus called a TAP-TAP vs a dump truck, you can guess who won. Ten patients, 3 surgeries and probably 5 hours later we only kept 2 of the ten overnight.  Life was never dull at the Gheskio field hospital be it; rain that made the hospital area a lake, gun shots, the ever looming smells of burning petro-chemical products (tires, plastics, Styrofoam) as many of the Haitians used them as a source of heat in the evening hours.  

 

Going to Haiti has really put my life in perspective on things that I took for granted; getting short for things that I didn’t get right away, patience, and many other things/luxuries that we Americans take granted. If I had not had the surgery, I do not have a doubt in my mind that I would have been disqualified to go. I made some great new friends; those in Haiti, people from other teams, and strengthened the friendships of those on my team. It has almost been one year since surgery and in that time I have lost 171 pounds, and I am only 11 pounds from the goal weight my surgeon, Dr. Crookes set for me and only 69 from my own goal weight.  The heat was intense, mosquitoes were a nightmare, the living conditions were rough, and the earthquakes were crazy but my DS and I made it through the two week deployment and if given the chance I would still be there to help make a difference, to work with our translators; Estime and Jerry and hang out with some of America’s finest men, the Army 82^nd Airborne.

 

In the end we were forced to shut down at night and stay at the embassy as the structures we worked in and around were again damaged from the quakes. The hospital was transitioned to a clinic and we worked with a Non-Gov’t Org to assume care of the citizens of Port-au-Prince. We left Haiti and returned to Atlanta, where the team celebrated a successful and injury free mission by enjoying a REAL meal. I had a 6oz filet steak and a lobster tail… it was to much to eat but it looked awesome.  Now I am home with my better half and settling back into a routine. As of this morning, Sunday, March 07, 2010 we have just finished being on ALERT for deployment to Chile, we were on ALERT for potential deployment if the Secretary of State deemed that disaster medical teams were necessary to go. 

I miss my friends in Haiti and I pray that they are safe.

Its been a while since I have blogged on here. A lot has gone on since my last post, Thanksgiving, Christmas and new Years to be exact amongst other things. I was even supposed to go see Dr. Crookes in November for my 6 month check up, but that didn't happen as my boss inhibited time off longer than 16hrs(2days). Oh well.

I broke my tooth back on June 1st when I went to see Dr. Crookes, I called my dentist and he said that there wasn't anything that could be done until I got home.  Peter told me that I was doing awesome in the roughly 2months since surgery. Anyhow my dentist looked at my tooth in November as he couldn't do anything until then. He saw the break and was wanting to send me to a specialist, I told him that I would have preferred if he did it.  

Thanksgiving was the first major food holiday since my surgery and I was concerned about eating. I am still learning what I can eat and what I can't and there are some items that just made me so GI unhappy. I made it through Thanksgiving without much issue, so I was quite happy. I took Alex on our first long trip together, we traveled almost 300miles south to Las Cruces to watch the Trans-Siberian Orchestra. It was awesome and even though we were in the nose bleed section, I wouldn't have changed it for the world. I loved it and it as her first time seeing TSO, just watching her experience the show was worth it.  I saw my dentist again because of a couple of small dental issues that he wanted resolve, I asked him about the broken tooth and he still wanted to send me to a specialist to extract it. Then the hospitals' Christmas party came...oh wait it was called a holiday celebration. I am sorry, it is a friggen Roman Catholic hospital and yet they choose to take out the most important holiday of the Roman Catholic church from their celebration. Anyhow, Christmas came and went as did New Years.

The new year was suppose to be a new beginning and something wonderful, but that was not the case. Only days after the start, I got into an argument with a pharmacist because he was violating hospital policy and a directive from the head of the pharmacy. The next two days, I was scheduled off for an extraction of the broken tooth...which was successful. I was on the second day of leave, still in pain and drugged up mind you when my boss called me and said I was on administrative paid leave until further notice.

Monday came around and was called into HR where the director just said your fired. He sided with the pharmacist over his compliance person/pharmacy technician. The tech is far more easily replaced than a pharmacist. So with only 8 days left before my 5 year anniversary with the hospital they decided that I my services were no longer needed.

That same day a massive earthquake ravaged the tiny country of Haiti. That day I realized that this separation could have been a very good thing, as the DMAT team could be deployed to that area. On the 16th we had the first team training of the new year where our commander informed us that we are most likely going to be deployed earlier than our on-call time of February. I did my first team briefing where I informed the team of our current communication capabilities and the necessary information on how to use the radios, satcom units and other toys in the logistic section. We are preparing to deploy into one of the most austere areas that our team has ever deployed into. January 25th came and went and we didnt deploy so the team expected to deploy on the first.

January 30th at 0800hrs EST, our commander received an alert from our command center in DC informing him that our team has been put on ALERT for a deployment on the first. The email informed the deployment team that we should have our bags packed and ready to go at a moments notice and that we would have a mission by noon that day. Well it didnt happen, the commander emailed us again and said that we were still on ALERT. We are 5 days into our on-call month and we have yet to deploy to Haiti. We also have a small possiblity of deploying the extreme northern edge of Washington state and into Canada for the Olympics. So I am down to 266lbs from 432lbs and I am 66lbs from my initial final goal and only 74lbs from my revised goal of 192lbs. I am feeling great other than not having a job, I have applied for unemployment and I have applied for about 20 different jobs plus putting my resume up on USAJOBS and Monster.com. My stalker aka Alex has been a constant source of reassurance and support, not to mention stick by me during my weightloss. She really does care about me, maybe even love me, hell she has stuck with me for nearly 5 months. Her family loves me.

More to come later, gotta jam over to REI for more supplies for potential deployment.

So on Halloween I went down to see Melly, Guy and Wendy in Albuquerque. We met at Guy and Wendy's restaurant (btw, KICK ASS BBQ) and we visited for a while. Much of the conversations seem to drift to  toward the subject of Mike's trajic passing and Elena's subsequent hospitalization. It has been a sad time on the OH SBA board and on Facebook with the loss of Mike (Skulldoctor). We sat on Saturday remembering our encounters with Mike and the in-person teddy bear he was, Melly spoke of the first time she met him and how the place wouldnt allow trucks to park.

I can honestly say I miss Mike, he made me laugh, smack hand against my forehead thinking oy vey, and feel appreciated. I know he has found peace and is no longer hurting. He has left many with fond memories of meetings, words of advice (as Unidos spoke about) and some in total bewilderment of his personality.

Elena, Stephanie and Tammie have experienced a great deal over the last week or so. I heard that Elena was having difficulties and that she was seeking help for them and this made me happy. The strength of these three women is unmistakeable and my hat is off to them. The pain of this event will slow subside over time but it will never truly go away. It is like loosing a parent/sibling/child the pain is unbarable and never goes away.  Grief councilors are wonderful and they help more than many know or care to acknowledge. Even just talking to others is a way of dealing with the loss. Not getting help will just prolong the pain and suffering.  It has been six years since the loss of my brother and it feels as though it was just yesterday that it happened.

Anyhow, I had a ball hanging out with Guy, Wendy and Miss. Melly and I cant wait to do it again.

This past weekend on Saterday I was officially inducted into the New Mexico team for the U.S. Department of Health & Human Services' Disaster Medical Assistance Team. They issed the ID Badges, uniforms and administered vaccinations to those who haven't had them. I walked into the uniform room to find the Longisitics Chief and his female assistant issuing the BDU's, I was asked what size I wore and I answered around a size 46-48 in pant, 2XL in shirt and a 2-3XL in jacket. I was handed a small pile of gear and then asked for the changing room, they chuckled and said right here. I looked down at the olive drab gear tags and figured they pulled a joke on me as everything they handed me was smaller than what I told them.

I shed my black ems BDUs to squeeze into the 36"-43" XL-Reg pants they handed me. I was dumb founded to see that they slid on, they were a lil snug but the fit. I tried on the belt that looked totally to short and the jacket, they fit also, I was like holy shit I down that much well no wonder my jeans dont fit anymore?  I was down right flabergasted.

The day began to come to an end....a day of learning about the: H1N1, seasonal flu,  quarantine, skills assessment (ems, rns, and MDs), embarassing comments and shocking announcements. I drove back up to Santa Fe and Alexandra, I stopped at her place where we sat and spoke about the day's events and activities. She told me that she wanted to see me all dressed up in my uniform and swooned when I put it on. She said it accentuated all of the right parts and left nothing to the imagination. sighs.

Well today is my six month surgiversary and I would have to say I feel wonderful. A lot has transpired in the last 30 days that has been for the better. Much of that can be read in my previous blogging, "Bumps in the Road of Happiness." I hit a mini-goal and that was to be below 300lbs by the time I was 6 months out, I actually wanted to be at GOAL by today but I began to realize that close to 250lbs in 6 months was not healthy by any means even for me. I am a shadow of my former self, I have more energy, stamina, self esteem and I am not as depressed. The only problem that I see is the hanging skin and the hormone dumps that are trapped in my fat deposits, but on the flip side my health according to my labs I am like perfect.

So as many of you know, I have been seeing my stalker...Alexandra. Things have been going great, we have met each other's parents and seem to get along amicably. Heck, we even discussing Thanksgiving arrangements, you know whos house we go to my parent  or hers.

So here is the thing she is renting a room from her mom and step-father as she is trying to save up for her own place and a car. Well her mom told her that she didnt mind if I stayed over for the night, so I stayed over a night while her mom was out of town at a conference in Boston. Her step-dad through a fit, saying I was violating their trust and stuff.  Alexandra was annoyed to say the least, she was called by her mom and asked about the situation. Ann told her that there was not an issue and that it would be delt with when she got back into town. Needless to say, the turmoil and drama has been quite huge. I told Alexandra that for the time being that I should not stay over again until there is a resolution to the drama and we both agreed that would be best. That does not mean she can't come stay with me at the firehouse anytime she wants....and she is talking about a lot of stalker-napping in the future.

I applied for a job with the State of New Mexico's Department of Homeland Security and Emergency Management, knowing full well that I didnt have a chance in getting it since I didnt have the necessary education for the job. On, September 28th, I received a phone call from the person who posted the position on the state website asking if I could come in for an interview on the 30th. Needless to say I was shocked, ecstatic, and a few other choice adjectives. I went and was confident, honest and straight forward in my answering of the questions presented. Although, I was cought a bit off guard when the Deputy Security of the department was one of the interviewers. Jacque said that she would like to have the position chosen by October 2nd, but she said that I would hear something possibly by October 7th.

October was the start of my next semester in school. I am taking:
Chemistry of Explosives
Chemistry of Hazardous Materials
Meteorology 1/Lab
Electricity, Electronics and Explosives

I taking these as part of my core requirements for my degree in Emergency and Disaster Management. I received an email from my school and then one from the book store saying that half of my text books were on backorder and classes have already begun. I quickly emailed the instructors and asked for direction on how I should proceed. They said to do the online reading, proceed to do the diagrams and write the short paper. So all is not lost.

I am wearing a 2XL scrub top very comfortably, I even can fit into a XL, but I am seeing alot of hanging skin. I need to see if my exercise routine can rid me of that.

Well I had my first follow-up with my PCP since Dec of last year, yeah I know such a bad bad patient. I figured that I am in a hospital setting why should I go and see my pcp? So I went and had the surgery then came back and since I was feeling great I decided I shouldnt bother going and having more people telling me that I am doing well and that to keep up the good work.

Well I got to be 5 months out and I starting thinking about what my peers were saying about getting my lab values checked and the status of my pulmonary embolism. I went in and my nurse and pcp were utterly shocked with my progress...130lbs in less than 6months. I told her about my mood swings and other gastric issues and she put me on Cymbalta and Welchol. OMG, I cant stand the Cymbalta, I am having the tremors and lethorgy, it is kind of difficult to function when you are fighting to stay awake.

I asked my pcp to order the labs that Dr. Crookes requested on my initial visit and everything but a couple of items were within normal limits.

Total Cholesterol: 93      Way below normal but VERY good
Glucose: 101   because I had a sip of gatorade with my morning meds   (64-99mg/dl)
Hemoglobin: 14.4    (14.5-17.7g/dl)

So now comes the CT Scan...I was really concerned that the embolisms would be still active and I would have to continue my Coumadin. I got into the hospital today, logged into the radiology computer system and accessed my report. I opened the file and read the first couple of lines:

Findings:
Heart size is normal. There is no evidence of pulmonary embolism or thoracic aortic dissection.

So everything else is good. I am on cloud nine, I have a wonderful cuddle buddy my health is getting to be awesome and I have a great support group in you all.

Yesterday my mother called me to inform me of her intentions on putting down her dog of 16yrs, Chicharron. Chic was a miniture poodle who was a gift to my mom from my step-father, Tony on their 4th wedding anniversary. She was truly a momma's dog and was by her side at all times, was never bad and always brought a smile to mom's face. Mom was under the impression that Chic was more of a human than dog and saw her as a daugther. When I came to visit, she was always happy to see me, jumping up in the chair, laying down and putting her head on my lap. She was a great friend.

About 4yrs ago, mom got another poodle, a little black female that mom named after her aunt Katie Bee. Katie and Chic went everywhere together and mom figured that it would be good for Chic as she aged to have someone to attempt to keep her active. Then 2yrs ago, mom was given an apple head tan/white chihuahua which she named after her other aunt, Maxine. All three of them just terrorized each other. It was great.

Over the last couple of years Chic had beginning to have various health issues associated with her age. She was about 90% deaf and blind in both eyes, she started having other health related issues that was affecting her way of life. So mom with a heavy heart informed me that she was going to put her down and 45min later Chic was gone.

On the way home I called mom to check on her and she was depressed as she had just finished burying her. Chic went everywhere with mom and Tony, she would never be in a cage when in the car. She would just hop in and lay down on her blanket and would be on her marry way to where ever the destination. She was truly an awesome best friend.














Goodbye Chic.

In 129 days since my surgery I have lost  113 pounds of ugly weight. I havent been this light since the first Iraq conflict in the early 90s.

I am thankful of you all, especially Barbara, both Mike N. & P., Dawn and several others. Oh and I cant forget my angel, Ocean and jr. angels: Leslie and Sandy.

Well 2 weeks ago tomorrow my grandmother passed away and on Monday of last week my boss told me that he would enter bereavement leave for me on my time sheet. Over a week goes by and he emails me again and questioned my relationship with the deceased.  I replied with the following, for the past 20+ years, she’s been my step-grandmother and had treated me as she did all grandchildren, with love. The fact that 20+ of my 32 years, she has been my grandmother.

He replied with this:
A step-grandmother does not meet the definition of "Immediate Family" according to HR Policy 3.03.  The policy does not address the quality of the relationship, only the relationship.  Nothing prevents you from using SCL to cover the time you missed from work.  I've taken action to cancel the Bereavement Leave that I previously authorized on this.  You were not clear with me as to you're relationship with this person.


My question is  when does a step-grandparent goes from being step to just being a grandparent?  I am going to fight it, I am looking into getting the wording changed on the policy as I feel that this is bullsh!t.  Because of this I lost 3 days of pay...and now I am short of funds.