The long ascent ahead

In the last several weeks at physical therapy I have moved from basic skills (walking, balance, stairs) to kinetic strength building (more sets and more reps), finally getting my heart pumping again with perspiration streaming down my face.  I can transition back and forth from standing upright to lying on the floor, so have increased the range of exercises I can accomplish.  Feels good! 

And not a moment too soon, . . . I've regained all the weight I'd lost during the first several weeks of surgery & convalescence, and there's no way that it is all muscle (although hardware remaining inside definitely contributes) so it must be chub and that just won't do.  No more desserts for Bill.

Doctors & PT folks encourage me to walk to tolerance, so I leave the power wheelchair at work and walk as much as possible while away from work.  The power chair allows me to keep my feet elevated for the majority of the day while at my desk, and I use it when traversing further distances around The Mountaineers Program Center.  My feet and ankles swell after PT and extended walking episodes so I've taken to icing them afterward, and because feeling is still limited throughout the damaged areas the cold doesn't really distract me.

That lack of feeling in my left ankle / foot is the biggest distraction at this point.  It feels very similar to the pins & needles sensations you get when a joint has gone to sleep after being restricted for too long and when you begin to move it again.  Rather than lasting a minute or so this feeling has been with me over these last several months and will be with me for many months more while nerves slowly mend (one millimeter per day or an inch per month).

Pain remains a minor distraction.  Feet & ankles are "tender" when walking, but in no way eye-watering. The back has never been anything other than stiff and maybe just a little sore.   Hands/wrists/forearms respond typically to PT range extension exercises (ouch) but during day-to-day activities they report just an occasional dull ache.  The doctors assure me that arthritis will be a constant friend going forward and the ache is likely a precursor.

Good news!  I've been able to remove tight compression socks by myself and with the help of a "sock donning device" I'm now able to put them on by myself as well (just five months after the accident).  Had worried that insufficient flexibility would forever limit my ability to dress myself!  This minor victory is especially satisfying, as it is the last vestige of being unable to fend for myself and it allows me to shower at my whim rather than scheduling assistance to remove and replace socks before and after showering.  (Thanks Marijane!!!)

Yesterday morning I dropped off all the other convalescence aids (slide boards, etc.) at Anderson House (the skilled nursing center I stayed at after departing Harborview) to assist others on their way to recovery.  Still holding onto a couple of walkers and a portable wheelchair just in case, but those will eventually find a new home as well.

From here on it's just a matter of remaining resolved to push hard and keep going, walking further and faster, increasing strength building reps, . . . typical Mountaineering stuff and Ashby protocol. 

Onward.

Pictures worth a thousand words

Pictures are worth a thousand words . . . but not for the faint of heart.

In service of this being a cautionary tale, I offer the before & after film of the injuries I sustained as a result of taking a 40 ft fall from a climbing gym wall.  All of this is the result of literally two seconds of distraction as I began climbing my last route of the day using auto-belays where I failed to use my standard safety protocol of double checking that I had clipped into the auto-belay, and as a result I climbed the route unprotected. 

I fell at a 45 degree angle back first, so my feet hit first, then butt, then hands, and finally face (must have been looking over my shoulder on the way down, . . . I have this fleeting memory of checking to make certain I wasn't about to land on somebody by mistake!) 

As it was the last thing that hit, there was nothing broken on my face/skull, . . . just a concussion, black & blue bruising all over, and a bloody nose.  I exploded one vertebra (which was replaced as can be seen in the film below ) and had four others fused to my hip bone (titanium train tracks running down my back).  Lots of snap, crackle pop in both hands, wrists, forearms, feet, heels, ankles, and shins. 

The pictures below are a representative set from the many hundreds taken over the last several months.  I've definitely received more than the usual dose of x-rays!

Hand repairs viewed from top down

Hand repairs viewed from side on

Back repair viewed from front & side (the block is the replaced vertebra)

Shins before repair - left & right

Left shin before repair

Left shin after repair

Right ankle/heel before repair

Right ankle/heel after repair

The Harborview trauma teams definitely know their stuff!  What great fortune to be put back together by folks who have done it thousands of times!

I climbed stairs, . . . and drove

Now, when walking at PT I carry trekking poles only as insurance, dragging them along behind me around the PT room.  Also my PT person encouraged me to arrive early and put in time on their peddling machine, so I'm building on balance and a little cardio capability

Between PT sessions I have been walking on my own around the office at The Mountaineers or up & down Ballard Landmark hallways.  Last weekend I overdid it by walking two full circuits around the ground floor of the Ballard Landmark, which resulted in a swollen left ankle, so I reigned it in this week to get the swelling down in time for a first attempt at stairs this morning.  Henceforth I'll use ice on the left foot/ankle after PT sessions or walking on my own until it begins to behave as well as the right foot/ankle.

This morning, after warming up on the peddle machine and demonstrating satisfactory pace and balance walking around the room for a couple laps, we headed outside to a half flight of stairs near the PT entryway and I began to make my way carefully up and down.  "Bad foot first on the way down, and good foot first on they way up," is the rule.  All went well with my PT person close at hand and ready to catch me if I got wobbly.  No sweat!  Afterward, we agreed that we should work on this several more times before she'll give me the green light to try this on my own out in the world.

Earlier this week she had given me permission to try driving, so this afternoon I met the AAA person at our house to jumpstart my car, and once it had warmed up thoroughly I drove around quiet Ballard streets to reintroduce basic driving skills, and then I drove along Ballard arterials and beyond through the nearby neighborhoods.  After an hour of anti-climatic tooling around I returned home, nonplused that getting to drive after five months of convalescence wasn't more euphoric.  It was like nothing had happened between now and the end of June.  I suppose that's a good thing?  

The good news is that with an ability to navigate stairs and operate an automobile, I am very much closer to heading back home, very likely before year end. 

This morning I asked my PT person what it would take use a bicycle and after a pause she suggested I work on balance and endurance by increasing the speed and distance I can walk before trying a bicycle.  OK, so those are my next goals, . . . speed & distance while walking and then commuting to work via bicycle, both awesome ways to build up conditioning and muscle mass.

Oh, . . . first I'll need to figure out a way to put socks on by myself!  Thus far I haven't regained enough flexibility to reach down with both hands to the tips of my toes to pull on socks.  I'll figure out something though! 

Steppin' it up

So that first walking experience wasn't a fluke, and there were no after-shocks or repercussions as far as pain or soreness afterward.  Since then I have returned to PT several times and have walked further & "faster" each time.

On my next visit I made a circuit around the PT room with a walker, leading with one foot and stepping up to, but not ahead of, the lead-off foot with the following foot.  The visit after that I made it three times around the PT room with the walker, still stepping "up to but not through." 

This morning---after totally dominating standing up out of the wheelchair, . . . why was that so challenging last week (?!)---I began taking honest to goodness full-on steps with the trailing foot moving ahead of the planted lead-off foot.  Did that several times with the walker and then graduated to two trekking poles for several laps and finished with a couple more laps using a single trekking pole, . . . which was kind of frightening with my balance still not where it needs to be.  Was glad to have my PT's hand on a gate belt strapped around my torso just in case I started to topple.  At the end of the session I was sweating and my legs were quaking from the effort.

In my minds eye, I see myself climbing the big glaciated mountains & volcanoes of the Pacific Northwest, . . . Rainier, Baker, Adams, Hood, Olympus, Glacier, Shuksan, Little T, etc, . . . and so there's an interesting little disconnect between that mental image and being tuckered after several very slow laps around a PT room carrying zero weight on my back and with no elevation gain and wearing comfy slippers rather than heavy mountaineering boots!  None-the-less, I savor every incremental improvement and revel in every new "personal best."  This is getting fun!

And it is so easy to celebrate as there is a Mighty O donut shop just across the street from my PT place, so I stop off there and pick up a dozen for the crew at The Mountaineers before catching a Metro bus to work.  Yah, . . . it's all for them, . . . what an altruist! 

I walked

Yesterday at physical therapy I stood up out of my wheelchair for the first time since the accident. I stretched my hands high above my head, looked up at the ceiling and gave a bellow of joy. It felt so good to be standing straight up, arching my back and flexing all my muscles.

Next I began gently swaying back and forth weighting each foot,  and then I began to shuffle gently and carefully sideways keeping balance with my hands on the edge of a table. After one circuit of sideways shuffling I turned and began walking straightforward with one hand for balance.  No pain. Okay well maybe just a little.

When I arrived at physical therapy yesterday morning I didn't really know what to expect. I had received a prescription from the foot surgeons to begin load bearing and it said something about load-bearing "to tolerance" and I wasn't exactly sure what that meant.  I thought maybe we would just apply gentle pressure initially while remaining seated in the wheelchair. Turns out "to tolerance" means "go for it!"

Achieving this milestone was totally unanticipated, as I wasn't expecting to start load bearing for another two months and I figured that I wouldn't be standing for another two months after that.  I'm completely off the map as far as where I'm going and what's next---which is not a bad thing and I'm not complaining---but I am just a little discombobulated is all in a very good sort of way.

Somebody pinch me!

It's amazing how quickly the days are passing, but this most recent Thursday marked another six weeks since the last visit with the Orthopedic Trauma teams who worked on my feet. Anticipating this visit I've been cautious and careful about transfers to and from the wheelchair--- trying especially hard not to load bear on my feet and cause swelling--- and I've taken extra precautions while under way in the wheelchair to ensure I don't run into things--- my feet always protruding in front as tender, ineffectual, and unintending battering rams!

I go to these appointments with a certain amount of trepidation, not knowing whether I've unintentionally done something to my feet, hands or back that has compromised progress or even permanently limited the potential for full recovery.  Have I been using them too much while bending, twisting, and lifting in all the little ways you really can't avoid when making your way in the world in a powered wheelchair? It's a compromise after all between forgoing daily explorations in the world to ensure the maximum potential for recovery and throwing caution to the wind while just getting on with life.  Hopefully the path I've chosen is well-balanced between mindfulness not to push the boundaries too far while getting out there and contributing.

So with fingers and toes crossed for good luck I made my way once again to Harborview in the unusually wet and blustery Seattle fall weather---lifting my feet high while fording street-side rain gutters, the wheels of my chair making wakes as they rolled through the puddles standing in the sidewalk dips & valleys, the poncho that covers me and most of the chair drenched and dripping whenever I come in from the elements.

The doctors wanted an extensive set of films, so the x-ray techs had me transfer from the chair to the exam table and we went through the motions of me striking multiple poses with both feet.  Pleased with their results they sent me away to an exam room to await the doctors' verdict on the healing process and next steps.  Once the doctors arrived we started slow, looking through the prior series of films and then looking at those taken just now, pointing out where various bone shards ended up after the fall, where they were resettled after surgery, and the extent to which they had regrown.  (As an aside, it amazes me that bones actually know which way to grow and they don't just end up growing in a puddle down there.)

The doctors recited what they had told me after the surgeries and upon each of the prior visits: this was the most trauma they had attempted to repair for over a decade (and these are trauma center docs!), the uncertainty of the outcome, the likelihood of early-onset arthritis, the necessity to be extremely careful as convalescence progressed, the possibility of additional surgeries. . . Yada yada yada.  Then they started talking about needing to wear the removable protective boots---that have been a constant part of my life since removing the casts a month after surgery--- only when I practice load bearing on my feet.  What?!  Huh?!! No more boots? Load bearing??

They described how I should begin limited load bearing by transferring to a non-powered wheelchair at work so that I can push myself around the office with my feet. They wrote prescriptions for the new wheelchair and a walker and for the physical therapists to begin working with me on a program of gradually increasing load bearing over the course of the next six to eight weeks with the intent of achieving 100% lead bearing within that time frame. Was I dreaming? Somebody pinch me!

I asked them to repeat themselves. It was like I was in an alternate reality. I wasn't expecting to be able to begin load bearing for another two months and now they were telling me that I could get going anytime.  I wanted to get out of there as soon as I could before they changed their minds or discovered that they had made a mistake. Everyone was smiling, the doctors, the nurses, Marijane and me. It was apparent the hospital staff were proud of what they had achieved and it felt a little like some sort of graduation ceremony.  Pretty heady stuff. I was going to walk again and two months sooner than I thought.

It occurred to me to ask why they hadn't given an inkling of this possibility at our last visit but then it became clear that there's really no saying what would (and will) happen from visit to visit and they didn't want to raise any false expectations along the way.  With all this very excellent news the doctors did also manage to slip in the possibility that at some point they might (probably would) need to go in and remove one of the large threaded screws (especially after it shears from repeated cross-load pressure with each step) and/or add another plate to stabilize (fuse) my left ankle.  Details, details, . . . In a matter of several  short weeks I am going to be a walking man!

Outside the hospital, under the cover of a large glass awning, Marijane and I hugged for a long time and we thanked each other for having worked so hard to get to this point.  She waited with me at the bus stop, we waved farewell multiple times as the bus pulled away, and I thanked my lucky stars (and all eminences of good will) for our love & friendship, for this life, and for this day.  Once at Magnuson Park I blew through the leaves billowing from the trees and raced them scutting along the ground as I wheeled my way back to work at the Mountaineers, . . . .

Tools of the trade

Some of you are probably curious how I get certain things accomplished, so I thought it would be helpful to share certain tools of the trade and the skills you acquire when you're living in a wheelchair.

First of all there's the wheelchair itself. Mine is a Permobile M300 and it is quite a thing to behold (a cobalt blue body with black trim).  Important features include the high-tech seat with dozens of separate but interconnected pressurized air cells that gradually shift air back and forth as you lean this way and that, which makes for incredibly comfortable seating (of critical importance when you're in the chair 16 hours per day).  Three electric motors control the chair's angle of repose, and you can adjust the leg support and the back rest from a sitting position to nearly horizontal; haven't done it yet but it would be easy to take a nap in this thing. A separate motor drives the wheels, and the battery holds enough juice for up to 10 miles.  You can adjust the sensitivity of the joystick direction & speed controller to move with more dexterity in tight quarters and otherwise to power up when you're out on the street.

Eventually you've got to get out of the chair---like when its bed time---and how does that work? Well there's this thing called a transition board.  You tuck one end underneath you and you set the other end on the thing you want to transition to,  and then you do this miraculous skootching motion, where you defy gravity for a fraction of a second while you slide/hop your butt along the board without placing any weight on your feet or hands.  Takes practice to keep both ends of the board in place and to keep your balance on the way.

So you've transitioned into bed and drifted off to sleep, but eventually you're awakened with the need for a bathroom break.  Are you going to set up a transition and roll to the bathroom? No way!  Enter the portable urinal, an oblong plastic bottle with a wide mouth and a handle for easy manipulation. I don't know how this works for women but for men it's a fairly straightforward deal; just position the urinal and take care of business.  Of course it's very important to have a secure place to set the urinal after use and you never want to fall asleep without first moving the urinal back to its secure position. Messes ensue otherwise (or so I'm told)!  This portable urinal trick works throughout the day to avoid having to transition to a toilet.

Eventually though you'll need to transition to a toilet which isn't a big deal as long as you have another transition board ready at hand. One thing to consider though is the amount of time it takes to set up and execute a transition so you've got to be extremely aware of your body's internal time clock and anticipate the need because you really can't afford to be 20 seconds late.  Everyone has their own means of getting things moving but I have found a couple cups of coffee and a couple of prunes first thing in the morning insure that I've taken care of business before it's time to leave for work, which is actually kind of critical for me because I commute via Metro bus for over an hour and I would be totally SOL if urgency struck while commuting.

Rolling the tape back several weeks---right after the surgeries---while still bed ridden and with arm casts up to your shoulders, your only strategy is to endear yourself to the assistants who bring the bedpans and clean you up afterwards.  But once the casts are off and you or able to transition to a toilet all by yourself you are not necessarily completely in the clear. If your wrists are still fixed in place with plates & rods for example, then there are certain places that you just can't reach unaided.  Enter the bathroom buddy device. This little guy is worth its weight in gold!  It is a curved plastic handle with a paper grabber on one end and it totally solves the inflexible wrist problem.  Just don't drop it while in use, as it's not so easy to retrieve and kind of messy even in the best case.

No doubt you're going to unintentionally drop things (hopefully not in a toilet) so you need a means of retrieving them. The Grabber is a two foot long hollow aluminum pole with a handle and trigger on one end and a little grabbing device on the other end. You will get really good at using the grabber (just don't drop it)!

 Hmmm, so what other tools are there? I use a 20 liter summit pack (Zero Point by Montbell) to carry odds and ends while motoring around in the wheelchair.  Inside the pack resides a waterproof poncho and a puffy jacket with enough room remaining to carry food for the day.  I use Seattle Metro to get just about everywhere beyond a five minute roll; if I lived in a town without public transit mobility would become expensive very quickly.  Oh, . . . and I use voice recognition on a tablet or phone to create blog posts like this or any other longish email, text, or other virtual message.  Typing? Not.