Sunday, January 31, 2016

Big Red Ball, or Not Counting

I hate to count. A big part of physical therapy is counting how many times you do something, like lift your leg. I find this depressing and demoralizing.  I am fine with the first few, but by time I get to 27, I am ready to kill myself. It have to have this super force of will to complete 28, 29 and 30.  My leg throbs, my hip hurts and I think I never want to raise my leg ever again.

Also, I lose count. When I am on the ground doing my exercises, my family and dog think this is free time.  They see me as a captive audience, unaware and unconcerned that my main goal is to count how many times I do something. 

I don't mind the distraction of my daughter telling me about her day. She only talks to me when she thinks I am not paying attention. This is the best way to get my teenager to talk about her life: pretend I'm not listening. Sometimes, it is hard to pay attention when I am on my third round of thirty leg lifts, but then I am done and she keeps talking. My son spent ten minutes yesterday discussing what his user name should be on a STEAM website. He wanted something clever and witty and not tacky.  I suggested "Dr. Whom" but it was already taken. He settled on Sriracha Rocket. Could I have had great conversations if I had been counting? No.

Fox is my other exercise companion, but he tries to distract me.  Here he is trying to prevent me from unrolling my yoga mat. Sometimes he is nice and will sit by my head. Other times, he will sit directly under the leg I am trying to lift. I don't see the point in that, but he is a dog, so there probably isn't a point.

I use a yoga mat because my floor is covered in dog hair and whatnot.
Instead of counting, I turn on music and time my workouts based on the length of the songs. This solves both the boredom of counting and being distracted my kids and dog. I figure if I do one leg lift in three seconds, then I can do ten in thirty seconds, or thirty in ninety seconds which is about half of a song. Instead of wanting to die by leg lift 28, I am happily jamming to "Put a Ring on It" and don't even notice I've been lifting my leg for three minutes.

Here is my new big, red ball. My son is 12 and my daughter is 15. The way they act around the ball, you would think they grew up in some barren, desolate, war torn place and have never seen a ball before. As soon as I bring it out, they think it is time to play. They throw it, jump on it, and bounce it around as if this was the first ball they have ever seen. We have a small house, so I am not so cool with this ball taking up a lot of space. The occupies more space when it is moving. I am glad my kids are kids, but I am also annoyed that they are having so much fun as a result of my injury. 

The Big Red Ball

Friday, January 29, 2016

Life in the Slow Lane

Today I was at the YMCA on the stationary bike.  Three weeks into my physical therapy routine, I have figured out to look at the exercise class schedule to determine the best time to find parking at the Y. On Tuesday through Thursday mornings, there is an AOA class--Active Older Adults, which means I won't get the disabled parking spot unless I get there before the class starts. The geriatric crowd is very nice, and often ask about my knee.

"Skiing," one seventy year old-ish man said to me as he looked at my crutch and brace. It wasn't a question ("Skiing?"). He stated it as a fact, as if he were Sherlock Holmes who deduced by my age and clothing that I was an affluent middle age woman, and the best way for affluent middle age women to get injured is by skiing. He then told me how physical therapy helped arthritis in his shoulder.

Today, there was only one early class, All Level Cycling, which I am assuming is a spinning class where the goal is to spin as fast as you can with minimum resistance and lots of momentum. My guess is they get up to 120 rotations per minute.  My target is rpm is 80.  Eighty isn't that slow--according to the bike computer, that is about 12 miles per hour.

When I am at the YMCA, I often see people on the stationary cycles on what Jack would call a "bike walk." This is when you cycle fast enough to move around, but slow enough to comment on the landscaping of various houses you are passing as you bike. There are people at the Y who are reading very thick and heavy books going about 20 rpm, barely moving their legs. I am guessing these folks aren't disabled, but rather are engrossed in their books and forgetting they are supposed to be exercising. As Pope Francis says, "Who am I to judge?"

Today was a different story.  I was pedaling along when a group of eight women my age or younger all wearing black tank tops with bright colored bra straps peaking out come into the cardio room where I am doing my physical therapy. No problem, until I figure out these woman all likely came from the spinning class and are now doing their post-work out run on the treadmills.  Some women are mildly jogging, but some are pounding it.

After three weeks of being surrounded by the book reading and geriatric crowd, I realized I am in the slow lane. Not only am I not in the spinning class, I am not doing a second round of exercise. Back in the day, I would go to the crazy hard core aerobics class at the YMCA in St. Louis after a morning bike ride. The gym was huge and almost a hundred women were in the class. This aerobics instructor has a cult following: this guy will make you skinny and you will have fun in the process. I lost 20 pounds after Clare Adele was born through this class. It was a miracle.

Now I feel like I am being left behind, even though I am making progress compared to where I was a month ago.  While it stings, I can handle getting left behind at the YMCA. What is really hard is getting left behind by my family.  They are going skiing this weekend, and I will be home alone. It isn't just the skiing, it is the adrenaline junkie husband of mine who keeps our vacations packed with white water rafting, zip lining, mountain biking or crazy hikes, like the Grouse Grind or Mt. Eleanor. How will I fit in? Will they adjust, or will I get left behind? Adrenaline junkies need their junk. I am afraid it will be me being left behind, and they go on grand adventures. It is not that they are willfully mean or cruel. I was part of the duo that raised my kids to like being outside and active. Now, it is like the old Sesame Street song, "One of these things is not like the others. One of these things just doesn't belong."

My previously flaccid thighs are firming up, though they are not as firm as they would have been if I had been skiing, walking the dog every day, going to yoga, biking on a moving bike, etc. It is nice to see them returning, albeit slowly, to their former shape and glory, even though they have a ways to go.

What I am doing in the meantime between straight leg raises, being hooked to a TENS machine and stretching? The opposite of adrenaline junkie stuff: reading, quilting and writing.





Thursday, January 28, 2016

"Not Meeting Goals," or Milestone Based Progress

I was down in the physical therapy torture chamber again today, buried in the basement of one of the largest structures in Seattle.  They have to hide it away where there aren't any windows or sunshine for some I-don't know-why reason. Maybe they don't want people to see the torture--I mean healing-- that is going on here.

Today, I was explaining to my daughter a painful technique they used to stretch my legs. "He had me sit on the table with my butt on the edge and then grabbed my right leg in one arm, and pushed down on my left leg with his leg."

My fifteen year old "Cosmo" reading daughter raised her eyebrows at me.  It sounded like I was describing some bizarre (or maybe not so bizarre) sex position.  I didn't realize it might have looked or sounded like that until I described it. At the time, any amorous feelings were a million miles away as I was focused on the pain I was experiencing. This was about as sexy as being in labor. Jason's wife is studying to be a mid-wife. Perhaps she should have been helping me out.

Jack told me that some of these physical therapies have milestone based progress. Instead of doing the same exercises for three weeks, they closely monitor my progress and adjust from there. While I am making progress, I am not anywhere near meeting my goals yet. Here is a table from today's summary.



Short term Goals
Number of weeks
Goal Met
1
Full AROM of knee
3
no
2
Able to perform 30 SLR w/ out quad lag
3
no
3
Pt to be independent in HEP with 100% accuracy when demonstrated
4 weeks
no

Long term Goals

Goal Met
1
Able to double leg squat 10 times
6
no
2
Able to walk unlimited distances w/ out increased symptoms
8
no
3
Pt to be independent in HEP with 100% accuracy when demonstrated and able to progress as symptoms allow - 8 weeks
8 weeks
no

My PT team sends me an update after my sessions, which is very nice, except I can't understand much of it as it is written in technical terms. I don't mind technical terms.* I am glad my PT team knows more about PT than me. I can, however, understand what "Goal Met" means at the top of a chart and what "no" means beneath it.

On the other hand, I am glad that I can at least walk without a brace and/or crutches at times.  I am glad I can bear weight on my leg, which I couldn't do before. Here are a few milestones I have made recently:
  • Went to Trader Joe's and carried three bags of groceries up our 22 steps in two trips. This includes one bag that contained a five pound bag of clementines.
  • Went to QFC and carried one bag up the stairs, including a very heavy pineapple.
  • Cleaned part of the deck in the back to remove thin layer of organic growth (i.e., slime) due to extremely wet Pacific Northwest Climate and lack of sunshine on the north side of house. Needed to clean so I don't trip and fall when walking down steps. 
  • Went to Pacific Northwest Ballet studio rehearsal for Romeo and Juliette (the best ballet ever) and left crutch in the coat room. I did not want to bring bad juju into the practice room with my crutch. I also walked in such a manner that belied the fact I was wearing a monster brace. Turns out I was not the only one using an assistive walking device, but I was the youngest one using one by thirty or forty years.
  • I went to Queen Mary to buy tea even though I had to walk half a block as that was the closest I could park. In my pre-injury life, I would walk the half mile to Queen Mary from my house. Oh well.
Goals I would like to meet
  • Squatting is actually a useful thing to do. I had a hard time digging into the bottom cabinets the other day and I had to perform some unique gymnastics to get out my tea tins for my newly purchased tea.
  • Taking a shower.  I have been taking baths since the injury as I have been afraid to stand in the shower for that long without the brace.
  • Walking the dog. I miss walking Fox.
  • I was listening to "Time Warp" today while doing my home exercises. Some day I want to jump to the left, then step to the right, put my hands on my hips and knees in tight.
  • I want to take a Barre class.  Just finished reading Raising the Barre by Lauren Kessler about her dancing in the Nutcracker in middle age. Great read, btw.
  • Step on a chair to reach things in high places.
  • Sit on my left foot. When sitting on the couch or at my desk, I like to sit on my left foot. Why? I don't know.  It usually makes my foot sore after awhile, but it is my favorite position. I can't even bend my leg that much. I can't even pretend to get my leg that high.  This is some bizarrely comforting habit I have. When I can't do it, I feel like a toddler who can't suck his thumb. I get a little antsy and things aren't quite right.
  • I would like to walk gracefully, without a limp. I came close to that the other night at my son's soccer party when The Boy's coach said to me, "Oh you are the one with the injury!" after I grabbed my crutch.
Celebration
  • I might have a big dance party when this whole shebang is over. Disco ball, the whole nine yards, perhaps while wearing my favorite shoes.
I am so tempted to wear these into a physical therapy appointment before the surgery and see what my team says. Will they notice? Freak out? Or, will I fall, trip over myself, and need surgery on my other knee?
* I am going to ask someone on my team next week to give me a quick briefing on the acronyms.

Wednesday, January 27, 2016

Breathing

As you may know, my number one life goal right now is to get my left leg straight. Yesterday I had physical therapy, and Jason was trying to help me achieve this goal. Part of physical therapy is massaging and pushing the muscles around to get them to loosen up and move as they should.

Sometimes this is not pleasant.

As Jason was pushing down on my hamstring to loosen my quad and increase my extension, I was wincing.

"Does this hurt, or do you not trust me?" he asked. His question was sincere. He was worried that I thought he was going to hurt me. PT are a little bit like dentists in this regard: they know at times they are causing their patients discomfort. Jason seems to not like this part of the job. When I mentioned that my friend's mom said patients should dislike their PTs, he seemed not to like that idea, either.

"I don't think I am like that," he said, slightly worried that I might perceive him that way, which I don't. Before working in a sports medicine clinic, he used to work with children. I can see him not wanting to cause children pain. Children, however, are for more resilient and flexible than many adults. Plus, you can plug kids into a video game while they are getting worked on, and they will feel no pain.

Seriously. Some medical center has done a study that show that video games have the same effect on kids as narcotics. This could be good if a child is coming out of surgery: video games are far less impactful on a child's health than narcotics. The downside is kids can't play video games while they sleep. The other thing to consider is if kids need an equivalent to a narcotic after school on a Wednesday when they haven't had surgery.

I digress.  While I am likely not a candidate for a video game playing jag during physical therapy, I did think about the breathing techniques I used in my childbirth classes. (Maybe women in labor nowadays play Mario Cart or Grand Theft Auto.)  I never thought I'd have to use that breathing/relaxation method again, but here I was breathing deeply and trying to let go of my muscle so it would relax.


Tuesday, January 26, 2016

Straight Leg

I met with the orthopedic surgeon last week about my knee.  Let's call him "Tex." In order for me to get surgery to fix my ACL, I need to get my leg straight. He estimated that it would take three to four weeks to get it straight, and if it wasn't straight, he would postpone my surgery. In order for me to get my leg straight, I have to keep up with my physical therapy.

"How long will I have to wear a brace or use crutches after surgery?" I asked.

"You have to earn your way off the brace," he said. "You need to show that you are doing the work so you can walk." Earn your way off the brace? I was just asking for a ballpark estimate, but something got crossed in our communication. This whole thing is new to me. I am not hiring him for his bedside manner. I am hiring him so he will fix my leg and I can walk, ski, play tennis and dance again like a normal person. Jack reminds me Tex is a surgeon. His job is to poke around inside my knee and fix it, not to reassure me.

Nevertheless, I cried when I got home. I was hoping the surgeon would have said, "I have an opening on Tuesday, if that works for you..." I've heard it takes six to nine months to fully recover from ACL surgery, and I want that clock to start as soon as possible. Waiting another month just might kill me. The other surgeon in the practice has the same opinion about the straight leg. They believe in "pre-hab," getting all of your muscles working before the surgery to improve the outcome. Tex wants to operate on a straight leg, not one that is bent.

I've been straightening and flexing my leg when I was younger for ballet, tap, jazz, aerobics and drill team for years.
  • High kicks: straight legs, both the standing leg and the kicking leg. 
  • Splits: straight legs. 
  • Yoga: Warrior 1, 2 and 3, tree pose, etc -- all have a straight leg in there someplace
Now something that was so simple is now my greatest challenge. My number one goal is to have a straight left leg when it is relaxed, not just after a half an hour of stretching. Today, I went into my physical therapy (PT) appointment at 8:00 and my leg measured zero for extension! I was thrilled, until I looked at my right leg, which has a natural extension of -10. My left leg might be straight, but it doesn't match my right one.

I talked to Jason, my PT Assistant, about this.  "Shouldn't my left leg match my right one in the way to bends?" I asked. "It might look stupid if my legs don't match."

He agreed. "Our goal is to get you to -8 on the left before the surgery." Straight means not just straight, but almost equal to my right leg. I am sure my surgeon Tex would still fix it with 0 extension, but word on the street is listen to your PT.

Last night, my son had a soccer party. When I am at social events, everyone wants to talk about my leg. Not that my leg is the most engaging topic on the planet (sorry, gentle readers), but they are curious and empathetic, and ask questions ("What happened? Does it hurt?" etc.) I usually find out lots of good information. My friend Kathy's mom is a physical therapist.

"A good physical therapist is mean," she said. "You should hate them. If they are any good, they will work you harder than you want to work. And do what they tell you to do. You will get better." I was kind of hoping my PT would be more like my hairdresser--a cheerleader/therapist/friend whose job it is to make me look good. I am learning PT is not like going to a trainer.  I went to a trainer after Claire Adele was born. The trainer didn't try to get my non-functioning, flaccid quadricep to try to move. I went to the trainer able-bodied but flabby. My PT team's job is to get my leg to do things it doesn't want to do or stopped doing after the accident.

"Follow every word your physical therapist says," said Will's dad. "I had work done and I did everything they said and I am fine. They people who don't get better go to physical therapy once and then they can't figure out why they can't lift their arm above their shoulder."

"I skipped out on my physical therapy and now I limp," said Mark's dad.  I was getting the picture: Physical therapists are gods. Follow them. A friend of mine who is a doctor said the same thing: do what they say.

This put me into an interesting position. My surgeon said to not wear the brace and use crutches. My PT team said to wear the brace and lose the crutches.  Who should I listen to? Based on the general wisdom of the room, the PT trumps the surgeon in this case. Both my surgeon and the PT team want my leg straight, ASAP. Yet, my PT team understands that I have twenty-two steps up to my house and I need to make breakfast and dinner for my family. My surgeon does not, but in fairness that is not his job.

After I have been working my butt off biking and doing 270 leg lifts* a day while slowly limping around my house, good news came from an unexpected place. Our family carpools to soccer with another family.  The boy, Asher, said to me at the party, "Lauren you are looking great! You are walking so much better than the last time I saw you. You don't have crutches anymore." He was truly sincere in his gushing, and I drank it up. Asher sprained his ankle in the fall, and was on crutches briefly. He knew the drill of recovery. "Before you couldn't walk at all before and now look at you!" What an adorable kid! It was nice to know my progress is visible to the human eye, not just measured by the PT's rulers.

* Maybe closer to 180.

Monday, January 25, 2016

Bullshit

I got back last Tuesday from Ohio where I visited my dad and my mom.  I now list them separately, in a sad way. My dad and I visited my mom in her new home in the Memory Care Unit, which is a nursing home for people with dementia. The staff there are very nice, and seem genuinely concerned about taking care of these people who are struggling. They are also trained to support people with dementia.

I last saw my mom a year and a half ago. At our first visit this time, her verbal exchanges were limited to
  • 25% introductory clauses (e.g., "You know what I think...")
  • 25% Blah Blah Blah.  Literally.  "You know what I think, blah blah blah." There is a little singsongy cadence to this.
  • 25% Raspberry noises.  I am assuming this means she is lost or doesn't know what to say.
  • 25% Singing the Mexican Hat Dance. I am assuming this means she is happy.  My dad asked if I could teach her another tune.
My mother seemed to be in a reasonably good mood on the first visit--not so much on the second and third. Belligerent is the best word I can describe use to describe her mood on the second and third days. She wasn't belligerent the whole time, but enough that I was walking on eggshells, worried that I would set her off. On the first visit, my dad brought a photo album with my kids.  She enjoyed looking at that, and would carry the book around. When I picked it up to return it to her room, she stared at me and said, "That's my book," as if I were taking it away from her.

The next day, my dad brought a photo album I had assembled for her years ago of Michael's and my childhood birthday parties. I showed her pictures of my brother and I as babies, along with many of our relatives when they were young.  She started to cry, so I turned the page.  She continued to cry, so I put the book aside. The television was on in the background. A commercial for the ASPCA came on with the most forlorn looking animals ever assembled, all of them in wire cages. This did not help her crying. This commercial was followed by a commercial for St. Jude's Children's Hospital.  Even with her memory loss, my mother understood that children without hair have cancer. She was now in a mode of unstoppable sadness.

I decided to see if I could further distract her. My father bought a coloring book of Christmas drawings, and I brought it along. I got out the colored pencils she had bought a few months ago, and started to draw. I asked her if she wanted to draw, too, and this filled her with anger.

"What are we doing here? What are we doing?" I put the coloring book away, and went and sat beside her.

"This is bullshit. This is bullshit," she said, her belligerence building. "What are we doing? Why am I here? Bullshit."

"Laurie thought you might want to color," my dad said.

"Bullshit," she said, glaring at me.

"She loves you," he said.

"Bullshit," she said. I had no idea what to do. I was afraid to say anything for fear for further making her angry. At the same time, it is really hard to love someone when they are screaming "Bullshit" in your face.

I like to swear, but I avoid swearing at people. My son likes to swear, and we've had conversations about the appropriate audiences for swearing. Having my mother swear at me was highly unsettling, and there was little we could do to reason with her. Ester on the other side of the room looked over to me and made a patting motion with her hand. I reached out and patted my mom on the arm.  Ester nodded.

"Give her a kiss," Ester said looking at my father. My dad leaned over and kissed my mom.  The swearing stopped. Ester seemed to know how to cope with my mother better than my father and I.

The next day was rough, too.  My father and I walked in and the group was in the middle of an activity. It was the Martine Luther King, Jr. Day of Service, and five college were students hanging out with the group. We apparently interrupted my mother, because before we even made it down the hall she started yelling at my father and I.  She interrupted the circle with numerous "Bullshits."

The students kept the residents busy, so I didn't get a chance to talk to my mom.  When it was time for lunch, I walked her down the hall, holding her and singing the Mexican Hat Dance. I was wearing my leg brace and left my crutches in the closet outside of the Memory Care Unit.  I was leaving at noon to join my friend Beth from high school for lunch.  I figured if I walked off with my crutches, she would see I was leaving and that would upset her.  The staff says a stealthy departure is best, because the person with dementia will forget three minutes later that you were even there.

As we got in the dining area, my mother stumbled. I realized that me and my weak leg were not the best person to support her as she ambled down the hall. I feared I would have dropped her and landed on the floor myself. I was lucky my brace held both of us up.

I left Columbus on Tuesday.  I said goodbye to my dad at the baggage check-in. I remembered my carpenter Carl said he had his best airport experience when he was in a leg brace and in a wheelchair. I would say that was true for my time at Seatac. I got a wheelchair and the Delta guide wheeled me to security. I told the TSA staff I was wearing a leg brace. I forgot to tell the TSA folks in Seattle, and they were surprised when I set off the metal detector.  The woman in Seattle was kind when she saw I was wearing a leg brace.  I went through the body scanner and had a pat down.

"Can you take the brace off?" asked one of the TSA guys in the Port Columbus Airport.

"I can, but it takes ten minutes to readjust," I said.

"Okay, we'll send you through the body scanner and then you'll get a pat down," he said.

"That's fine with me," I said, trying to be agreeable. I went through the body scanner and they did a pat down. The woman who did the pat down wanted to look at my brace. Fine again. I complied.

"I need someone to scan this brace," she said.  In the meantime, another woman starts yelling at me about sending my laptop through without putting it in a separate box.

"Is this your laptop? You are supposed to pull it out..." she said. I know, I thought. I am in a wheelchair, and my helper put my bag through security. I didn't have to do this is Seattle.

The woman with the metal detector wand scanned my leg while the laptop lady continued to yell at me. The metal detector lady said, "You need to take the brace off."

What? I thought, This is absurd. I didn't argue. I took off the brace. I know the job of TSA is to make sure we are safe, but what about showing kindness to the people they are supposed to protect? Like an obedient child doing something against their own will, I hiked my yoga pant leg cuff up to my thigh, and removed the brace. I asked my helper for my crutches. I was so frustrated. In Seattle, I had worn corduroy pants and the only way to take off the brace would have been to pull my pants down.  What I had just had surgery and couldn't take my brace off for six weeks but needed to travel? Seriously. What if I were permanently disabled, and not temporarily? How are we supposed to manage? Have these people ever spent time on crutches or in a wheelchair? Is there empathy training for these folks?

By time I got my brace back on and wheeled to the gate, I was in tears. I wanted to scream "This is bullshit!" I wanted to be like my mother and not have a filter and express whatever emotion came to the surface. Logic, patience and rationality be damned!

The women at the gate were lovely and nice, but empathy after the fact doesn't negate an awful experience. One of the women had a knee replacement, and was regularly harassed by TSA, even though she has a card from her doctor. Not everyone travels for happy reasons, either. Not everyone is going to Disneyland. Some of us are traveling not because we want to, but because we have to visit our ill or dying or dead relatives.

When I got home, I told my daughter I wished she were there to videotape this event with her phone and we could post it online. She smiled with glee at the thought of her video going viral of me being abused by TSA agents. I was right there with her, even if it meant me standing in the middle of airport security in my underpants.

Like my mother who would rather have her memory back, who would rather be busy and be able to participate in regular life, I'd rather not be in this spot, needing extra support. But here we both are, needing help because of loss of independence.

Wednesday, January 13, 2016

Parking

I have a temporary disabled parking permit. As soon as she heard about my injury, my friend Jen recommended I get one. One of her son's broke his leg, and the parking permit was a godsend.

I have mixed feelings about using the permit.  At the YMCA the other day, there were regular spots open next to the disabled parking spot, so I used those.  I didn't want to take a spot from an octogenarian in a wheelchair. Yesterday, I skipped the disabled spot and found another spot. The downside was there was about ten inches between my car and the one my my left, making it hard to get out, especially while hauling a backpack and crutches.  As I left, a woman waited while I go back in my car.

"Are you leaving?" she asked.

"Yes," I said.  She wanted my parking spot. Here I was hogging a regular spot when I could have used the disabled one.

I told Evan my physical therapist about my parking permit and the moral questions it posed for me.

"Use the spots," he said. "You deserve it."

The expert spoke, and I will obey.  Even though the whole clinic is driving me to work hard, they are cutting me some slack when is comes to getting a good parking space.  He even encouraged me to use the wheelchair services at the airport.

Carl and Knees

Carl the Carpenter came over today to look at our front porch to add a handrail.  A few years ago, he hurt his knee and had surgery and six months of recovery.  He recommended I get the surgery, and then follow my physical therapy routine afterwards.

"I spent six months focused on physical therapy. Some people go back to their desk jobs and don't do any of their exercises. They don't get their knees back like they should," he said.

"I like the physical therapy, and I wish I would have started it sooner," I said. "I am jealous of pro-athletes and professional dancers who get someone looking at their injury every thirty seconds after it happens. I had to wait three weeks before I could get in to see someone."

"Billionaires have invested millions of dollars into those people. They are going to be taken care of," Carl replied.

"True, but Laura Tisserand is a ballerina," I said. "Her pictures are all over the UW sport medicine place. She probably got into therapy right away, and no one invested in her, although she does make her livelihood through dance." I am jealous for the immediate attention she probably got.  Her left thigh, while significantly less flabby than mine to start, probably didn't atrophy for three weeks before she got it moving again.

Carl nodded.

"I am sure glad I don't live in the Middle Ages," I said.

"I thought the same thing when I was recovering," he said. "If I lived in the Dark Ages, my leg would have been cut off at the knee or I would have half go my leg just dangling there."

I laughed. "Your wife would have sent you out in the woods to hunt for bear and then you'd never come back.  In the Middle Ages, I probably would not have been skiing, so I might not have been injured."

"You probably would have already been dead anyway.  Life expectancy was thirty," he said.

"I probably would have died in childbirth," I said. Gallows humor can be helpful when looking at an injury. We laughed at our good fortune to have been born in the era of modern medicine. Even a few years can make a difference. I learned today from my physical therapist that Dr. Roger Larson, who just retired from UW, brought arthroscopic knee surgery to the US from Japan.  This technique improves outcomes and recovery times.

My Left Quad

I was at the physical therapist this week, which in some ways is nice and others a fresh slice of hell.  First, the hell part. Monday, I met with the PT tech. Before I even got to the bench, she was commenting on how I was walking as we were walking past a mirrored wall.

"Stop.  Your gait is wrong," Jane said.

What? My gait is wrong?

"You are walking on your toes.  You need to put your heel down first." My gait looked something like C3PO's, except with worse posture and a bent leg.

Hmmm.  I felt like a toddler, needing to relearn how to walk.  This sucks. I practiced walking. After a million years of ballet and jazz dance lessons, my parents would be proud.  I should have brought my tap shoes: Heel, toe. Heel, toe. Heel, toe.  It sounds like a combination. Shuffle, ball change.

I thought physical therapy would be like going to a trainer where I'd have a guided workout. No. Here I am measured and massaged and pushed.

"Let's go ride the bike," she said.  My brace was off, so I grabbed my crutches.

"No, you can walk over there," she said.

This was my worst nightmare--I feared they would make me walk unaided.  "Heel, toe, heel, toe, heel, toe.  Lift your knees. Keep your feet close together." Somehow, I managed to talk the 20 feet to the stationary bike.  "Let's walk some more." Oy, but I did it. As I got on the bike, she commented "Don't wiggle. Your core and hips are weak."  This woman made Miss Lenore, my childhood ballet teacher, sound like a cupcake. Point your toes, lift your chin, shoulders back. Smile! will forever been etched in my brain.

Before I got on the bike, she measured my extension and flexion.  When I got off the bike, she measured my extension and flexion.

My flexion is good, but my extension needs work.  Right now, I am walking with a bent leg, not a straight leg.  My biggest problem is that my quadriceps muscles aren't firing or sparking.  Jane massaged (read: kneaded) tendons around my knee. I did more leg lifts and got zapped by the Tens machine.  They put pads on my tight and send a mild electrical current through my leg to my thigh to flex. Lots of fun. (Not.) Now I feel like one of those guys who needs viagra or cialis--I have a part of my body that just doesn't work, no matter how hard I try to get it to move.

The funny thing is that in all of my life, many parts of my body have been flabby (arms, belly, butt), but not my thighs.  When I was a kid, I'd ride my bike almost every day. In my twenties, I rode centuries where I covered one hundred miles or more in a day. I went mountain biking with my friend Helen once on Angel Island. I could bike up hills where other people had to walk. At the end of ski season, my thighs are like rocks. Now, my left quadracep is useless. The goal is to get it back into shape, even if it means zapping it.

Today, I was talking to my physical therapist, Evan. I joked that it took two seconds to crash and now months and hours of work to recover.

"It's a great business model," he said. I stared at him blankly. He was right but...

"It's physical therapist humor," he said.

Aside from my inert left quad, PT isn't all bad. I am supposed to ride an exercise bike every day for 30 to 45 minutes to get my leg moving and to move the fluid out of the joint. Since I don't have an exercise bike at home, I head out the YMCA.  Gary my optomotrist said he doesn't like to ride stationary bikes. He thinks it is boring, and I agree. Given the choice between exercising inside or outside, I'll pick biking on the Burke Gilman Trail rather than have the very limited view of the houses across the street from the Y.  (Nothing against the Y -- it is great when it rainy and cold, and I love their yoga classes.)  Now, I don't mind the stationary bike so much as it is the most cardio work I can do.  Plus when I am on the stationary bike, I get to catch up on the latest celebrity news and fashion and dating tips!

Intellectual junk food reading while on the stationary bike.

Shit

Last week, my dad checked my mom into a Memory Care Unit for her Alzheimer's disease.  He has been attending Alzheimer support groups for a few years, and they told him "You'll know when it is time to put your loved one in a home. You will know."

I had a hard time swallowing this advice. While I agree that different people have different thresholds, people need some guidelines to consider. Maybe for some people it is when their loved one doesn't sleep through the night, or they sleep all day. Maybe it is when they leave the house and wander off every time their caregiver takes a shower or goes to the bathroom. For my dad, the final point was when my mom lost control of her bowels. This is not intended to humiliate my mom, but rather to show how this disease demeans and dehumanizes those afflicted, and how difficult it is for the caregivers. We are not talking about a bed bound person who can use a bedpan. We are talking about someone who has become functionally a toddler.

At this point, my dad determined the level of care she need was beyond his ability to provide.  Not that he wouldn't have cared for her, but he couldn't maintain proper level of cleanliness or hygiene for her to be healthy.  She wouldn't shower or brush her teeth. Her mouth started to stink, so he gave her some mouthwash, which she then drank. She had gotten a urinary tract infection, which was probably hard to him to figure out she had in the first place, so it probably was worse than the typical UTI all women get once in a while. She wouldn't eat what he prepared for her. When they'd go to restaurants, she'd forget what she ordered and want something different when the food arrived.

"I was happy to take care of her," my dad said, "but she wouldn't let me. And I didn't know how."

My dad hired a woman to come in a few times a week to help her bathe.  My mom was agreeable with the home healthcare worker and would take a bath. This woman would bring tacos for my mom, and my mom would eat them.  All of this was good, but the bowels did my father in. The healthcare worker wasn't there 24/7. My mom wouldn't let my dad help her, and she needed help.

"It was for own good," he said with remorse, relief, guilt, and optimism. "She is happier now." And clean. And busy and social.  The place she is staying has activities like baking cookies three times a day. The food is good and she is eating. She is now getting a level of service and attention that he was previously unable to provide because, ironically, he was too busy taking care of her.

My dad said my mother had also been depressed. I talked to him during the Winter Break before he put her in a home. When I asked how it was going, he said "Fair to poor."  My father is an eternal optimist.  "Fair to poor" means the seventh circle of hell for a normal person. It wasn't until after my dad put her in a home that he told me she lost control of her bowels.  No wonder she was depressed. I'd be depressed, too.

The hard part about Alzheimer's is the middle, the slow and tedious transition between the beginning and the end.  In the beginning, the person is just forgetful, but is still themselves.  In the end, they don't recognize anyone and need total care. Getting between the beginning and the end must have been torture for my dad. And he tried.

My dad is getting his life back.  He is finding dozens of things that had been neglected, like the furnace, one of his cars, and his teeth, among other things. He feels relieved and he misses her.  While things are finding a little bit of equilibrium, the fact my parents have to go through this at all is horrible, an exercise in suffering for all parties.

Sunday, January 10, 2016

My Right Leg

My poor right leg.  It has been carrying the load these past three weeks.  I feel like need to do something nice for it, like get it a bow or something.  My right leg might get pissed off if I were to give it a floral tattoo or something festive.

"This is how you repay me for doing all of the work? By sticking needles in me? No thanks."

Part of my physical therapy involved riding a stationary bike to get my knee and left leg moving without bearing weight or needing to balance.  I started yesterday, and the first cycles were slow and awful. I can barely get through fifteen seconds, I thought. How can I do the minimum five minutes, let alone the thirty minutes they want me to work up to?

My right leg came to the rescue. She got the power and momentum up on the bike, and the left leg went along for the ride. I was able to ride for 30 minutes, no problem.  Again today, I rode for thirty minutes and it was the same.  The first few pushes were hard, but once we were spinning, it was fine.

Stairs are another place where my right leg has been carrying the load.  I had to google how to climb stairs with crutches on the internet.  "Up with the good, down with the bad." My right leg has been schlepping my entire body weight up and down stairs for three weeks. For the first week and a half when I couldn't bear weight, I had to hoist myself upstairs on my butt, using my right leg to push up and ease me down.

Dear right leg, how can I repay you? I know you know that it is in both of our best interest for my left leg to recover as soon as possible. I've taken you to massage.  I've tried to stretch you out, but I know that is hard given my left leg can't yet bear the entire weight of my body. I take warm baths, not just for the sake of my left leg, but for your sake, too.  You need rest just as much.  I bought some body butter today at Trader Joe's. While I can't do much else, I can take care of your skin.

In the meantime, bear with me. I'll try to be gentle to you as the left mends. I am working as hard as I can to get my left leg back as an equal partner.

Saturday, January 9, 2016

Physical Therapy

I am on Day 21 of my skiing injury and I started physical therapy (PT) yesterday. I was really excited to start, and I was proud of the progress I thought I was making, just on my own. My sports medicine  doctor told me to do lots of range of motion exercises, so I did.  I flexed my leg up and down, several times a day, every day.  I was able to place more weight on my leg, and walk using the brace and no crutches. Likewise, I was also walking more comfortably without the brace and crutches.  I have mastered climbing stairs.  Yay!

I went to physical therapy and my flexion (the amount I can bend my knee so my foot can touch my butt) was at 120. This is a major milestone in one sense, but I have a way to go as my right leg can bend 150 and my foot can touch my bottom.

The one thing I can't do--and who knew this was a big deal?--is stretch my leg out straight.  My extension is less than it should be, by a lot.  No one told me I needed to work on getting my leg straight, or that it was a major deal in being able to walk.

Now my quadricep won't "fire" as my physical therapist said yesterday. I can't flex it at all. I don't even know how to flex it.  I tried, and my physical therapist said, "That's your butt muscle." I never once thought about intentionally flexing that muscle, and now I can't.

Since the injury, my quadricep has shut down, not wanting to work.  My therapist said my knee shut down to protect my knee from further injury.  Who knew?

Lottery

The Powerball is up to $800 million, maybe even more.  I normally don't buy lottery tickets, but I decided to buy a few when I read an article in the newspaper about the giant jackpot.  Jack and Pedro went out and bought tickets last night after dinner.  The odds of winning are 292.2 million to one.  We bought several numbers, decreasing our odds to fifty million to one.

As anyone who buy buys a lottery ticket, I am imagining what I will do with the money. I will make sure my father has enough money to support my mother as she continues her decline with Alzheimer's. I'll make sure Jack's parents are secure in their retirement, and I'll pay for the kids to go to college.

"Thanks, Mom," Pedro said at dinner last night when I listed sending him and his sister to college as my third priority.  He might have been waiting to see when his name would come up.

While it would be nice to have enough money to never have to worry again (not that I am worried now), money doesn't give someone purpose. Money could be fine, but we all still need to find something meaningful to do with our lives.

That being said, I am considering buying lottery tickets more often, but for a different purpose. I read in the Seattle Times that the State of Washington is using sales of lottery tickets to expand funding for education, among other things. Here the state is using the lottery as a revenue source, and I don't contribute. Lottery tickets is a tax on low income people, people who worry about money and spend a little bit as a wager on the chance that they might not have to worry again.  Is it fair in a state that has a regressive tax system that they should carry this burden? Perhaps I should participate and contribute some funds.

Just a thought.

All of this talk about the lottery reminds of when I was at my grandparents' home when I was in elementary school and the lottery selection came on.  The little numbered ping-pong type balls were bouncing around a clear container.  The woman opened a little door, and some of the balls floated into the tube.  Those numbers were the winners. My grandfather and I joked that we were going to rig the system by putting fishing weights inside all of the balls except the ones we picked, so our numbers would float to the top and we would win. It was our grand plan.

Thursday, January 7, 2016

Not Sharing

I had an MRI earlier this week (which is kind of trippy, if you ask me. Lots of noise rhythmic noise in a quiet clean space is kind of weird.)  I told the tech at the end of the MRI I was hoping for just a sprain and he said, "Yeah..." in the tone of "Good luck with that. Enjoy that little fantasy until the radiologist reads the images and sends you a report because your knee is really f---ed up."

I have a torn ACL, a mildly torn MCL and a possibly torn meniscus.  Jack asked if I was hit by a linebacker instead of crashing on my skis. I talked to the sports medicine doc, and he said it was up to me if I wanted surgery or not.  He recommended starting physical therapy, seeing how it goes, and then deciding.  Some people are fine without an ACL -- others have their knee slip so often that it isn't functional.  While I am happy to start therapy, I am leaning towards the surgery.  It was nice to have an opinion that I could live without it.

Here is my dilemma -- I don't want to share this in Facebook and I don't know why.  Maybe because FB is always so filled with happy crap or politics (at least with my "friends") that I don't know where this fits. Maybe I don't want to be a downer.  I've written three posts, and then deleted them all. I don't know why I am so reluctant to share this.  Maybe this injury is too complicated for me to spell out in just a few sentences.  That I am doing reasonably fine, but I hate my stairs and I have a love hate relationship with my brace. That I find it strange that I have no pain, but when I walk without crutches, I get really tired. That I am feeling old but lucky enough that I have had an accident and not something internally or fatally wrong with me, like cancer or ulcerative colitis.

But I want to share. I want people to know. I want to talk about it. Maybe it is because FB has become so impersonal.  Some people might say it always has been, or that it is not.  When I first joined, I had a few friends who would post stuff about their personal lives, thoughts and observations.  Now, most of my friends just repost articles, share pictures of their vacations or tell major life changes, like they got a new job, all of which is fine. But where does something in the middle fall? The personal challenges and struggles which aren't all good or all bad?

Tuesday, January 5, 2016

Regression

"A coward dies a thousand times before his death, but the valiant taste of death but once." 
                       -- Shakespeare

I would hardly call my mom a coward, but watching someone with Alzheimer's is like watching them die a thousand times. Alzheimer's is death by a thousand cuts, dying a little bit each day, slowly, slowly, slowly. The mind and then the body falling into decline.

My dad had to put my mom in a Memory Care Unit yesterday. It must have been one of the most difficult days of his life. She couldn't take care of herself because of her Alzheimer's, and it got to the point where he could no longer take care of her. She can't remember how to walk sometimes, can't bathe herself, or brush her teeth. My dad couldn't keep up with maintaining her basic hygiene. It was almost like inadvertent neglect, which was by no means his fault for not keeping up.

I have a friend whose son is profoundly disabled with autism. She said that for families with disabled children, every milestone their child doesn't reach is a loss, and grief ensues. When other kids are mastering counting or the alphabet, some of these children lag behind. They might not ride a bike, or learn to drive, go to prom. They might not leave for college or work or marriage. For the parents who see the missed milestones, they grieve. So it is with losing a parent to Alzheimer's. Instead of just having a funeral and dying straight up, each step is an erosion and loss, with the knowledge that things won't move forward.

In many ways, my mother has regressed to being a toddler. Unlike toddlers, my mother won't improve. Unless a miracle cure is invented in the next few weeks, her path is towards decline. The Memory Care Unit sounds almost like preschool. There are three activities a day. Today, they baked cookies. My friend Eleanor, who is 94, said she has been to nursing homes where they teach those with dementia letters and how to read. There are even places called "Adult Day Care" where people can send their ailing loved ones during the day to be cared for so the other adults can go to work, grocery shop, or care for children. My dad is fortunate he can pay for this service, buy what about those who can't? What becomes of them and their families? Or, perhaps my dad isn't so lucky. Jack spoke with a friend whose father spent $1.2 million on his wife's institutionalization for his wife with Alzheimer's.

My friend Eleanor said "We are living too long nowadays." This is true for some but not all people. She is of very sound mind and has a healthy body whereas my mother is outliving her life. I wonder is Shakespeare had ever heard of Alzheimer's disease, or if such levels of dementia existed during his time. What did they do? Did those people die because they wandered off in the woods and were eaten by a bear? Who took care of them in a world of subsistence living? Even today, wandering off and getting lost is one of the major causes of death for people with dementia. They might fall into a creek, or get hypothermia in the winter. Again, my mother is fortunate that my father can take care of her, if not by himself, but that he has found a safe place for her to stay.