It's been a year (tomorrow)!

A close friend emailed me early this week wondering whether the anniversary date is getting close and I realized that yes, it is either June 30^th (this coming Saturday) or tomorrow (the last Thursday in June), . . . right around the corner in either case. 

Thursday morning feels like the more appropriate marker as it aligns with last year’s weekly routine, so I’ll drop by Vertical World tomorrow first thing for a moment of silent reflection and thanks giving.  If you haven't yet, you should visit Vertical World's website sometime to get a sense of their amazing climbing walls.

I have experienced further improvement in walking gate smoothness and speed in the last week or so after starting a very modest course of aspirin in the AM and PM.  I happened to be reading something that indicated aspirin is excellent for reducing inflammation and joint pain, and after restarting with it (and bumping up dosage slightly to AM &PM) I noticed immediate improvement.  My left ankle hasn’t looked this svelte in months, and I can step right through the ankle bend with nary a twinge.  Pretty cool.

Last week I had the last visit with the spine surgery team (one year hence), and they were all "your healed, get out of here!" They still warn that because fewer vertebra are carrying the bending/twisting load there's a likelihood that they will need to fuse the next one down in 10 years or so.  I asked, and they indicated that strong core muscles will slow the degradation, . . . 10-minute abs here I come!

Pain, drugs, and backing off the meds at Anderson House

Before Harbor View could discharge me to a skilled nursing center and free up a bed in their trauma center, I had to be off of intravenous pain meds and stable on oral meds.  This all seemed to be happening pretty quickly and it gave me concern as pain meds were definitely still required to maintain an even strain, but in the last couple days at Harborview I gained confidence meds could be administered effectively orally and leaving Harborview wouldn't result in a major set back.

Looking back on the transition from Harbor View to Anderson House, I can understand how cautious I felt about "change for the worse," but there's no question that Anderson House was a much better place to begin convalescence.  Harbor View is a place to get put back together, . . . not a place to mend over a longer period of time, . . . It's hectic, fast paced and staff are stressed, . . . it's like a war-time mash unit!  Regardless, I still ended up wanting to hang onto "the devil I knew" versus being cast off into the unknown.

In a much earlier post I indicated what a good living environment Anderson House provided for early convalescence.  Peace & quiet, helpful & friendly staff, a large private room, good food, encouraging & resourceful physical & occupational therapists, access to an shaded outdoor patio, . . . overall Anderson House put together an excellent program.  No skilled nursing center can fully meet expectations every minute of every day, but Anderson House came pretty close.

Naturally, there were times (usually around the meal hours) when assistant staff were heavily engaged getting people up and out of bed for meals, and so I needed to adjust expectations to account for these busy times.  On rare occasions, my needs would become unforeseen & urgent (think, I need a bed pan!) and there just wasn't anyone immediately available.  Oh well, . . . suppose there are worse things than dealing with these relatively minor consequences / inconveniences.

Anderson House nurse staff were almost always timely with meds and were uniformly friendly, helpful, compassionate, and looking out for my best interests.  Right off the bat it was apparent they were not as maniacal as Harbor View staff about reducing med levels, as they were not under the gun to discharge folks and free up beds.  We still did the "what's your level of pain" dance, but they were much easier to work with in making adjustments.  They instilled confidence that if we tried reducing meds and it wasn't working we could always readjust.  I was anxious to demonstrate zero dependence on pain meds and so we established plans to reduce first one prescription, then the next, and then the next.  Then we worked through each plan and celebrated being weaned off of each med. 

In retrospect, there were several comical / farcical episodes associated with coming off various drugs (Oxycontin, Dilaudid, and Gabapentin).  I weened from Dilaudid first and without memorable complication.  Although Oxycontin is a great pain med, it can be addictive and it definitely causes constipation.  So on the one hand, I had a choice of maintaining Oxy dosage at the risk of becoming dependent but also at the cost of frequent suppositories, and on the other hand, I could work down the Oxy and transition from suppositories to prunes.  Seems like a no brainer right?!  Yah, but you gotta' be careful about backing off of Oxy or you'll find yourself in a very uncomfortable state.  Looking back, it's comical to reflect on the fact that I initially leaned in favor of continuing suppositories!   There were definitely celebrations by all involved when I zeroed out the Oxy and was able to keep things moving with prunes and coffee!

The last med I was on was Gabapentin, and when I talked to the doctor about it she indicated it "just soothed nerve endings."  So later that day in a moment of hubris, I told the nurse to go ahead and zero out the dosage rather than go through a more gradual reduction regime.  Mistake!  Around bed-time it became apparent what Gabby was doing for me, . . . and what it felt like to go without. Going cold turkey off of Gabby resulted in turning up the thermostat in every square inch of skin to top-bench sauna temps. 

Holy fish cakes & mother of pearl, what an uncomfortable night!  Not "pain" per se, but incredible debilitating/maddening discomfort.  The next morning I had a "conversation" with nurses & doctors about the benefits of more gradually backing off of Gabby, and I didn't take the last pill of it until several weeks later, well after I was discharged from Anderson House and living at The Ballard Landmark assisted living center, the retirement home that housed me while I was still non-weight bearing and refined to either bed-rest or a wheel chair 24/7.

Since leaving the pain meds behind I have been on a daily regime of one aspirin, four Tums, and a drop of vitamin B, . . . the aspirin to keep blood a little thinner than usual to reduce the negligible odds of a blood clot breaking off of ongoing internal repair work going on in my shins/ankles/feet, Tums for calcium bone-building material, and vitamin B as a catalyst to absorb the calcium. 

Seems to be working, . . . the last time I visited the foot orthopedic team they were impressed with the amount of bone generation that has occurred since surgery.  They said I can do just about anything I want other than play basketball and sky dive!

Better living through orthotics

Can't believe I had been trying to walk distance without orthotics!  Wish I had looked into them much sooner; and it just shows what a stubborn cuss I can be.  Walking with and without them is a night and day difference, and at this point I wouldn't imagine going anywhere without them.  Miraculously, they totally smooth my walking gate, and it feels fantastic to be able to walk smoothly versus hitching along. 

The orthotics team made several sets for me, and I keep one set in shoes I leave at work (to save weight and volume in my backpack when biking/commuting) and another set remains at home.  It is easy to swap them in and out of whatever foot gear I am going with.  The orthotics aren't necessary or helpful while biking, and that's the only time I go without them.  The contrast between clumsily walking in non-adjusted bike shoes to & from the bike, compared with gracefully gliding along once on the bike, is poignant.

The jury is still out on the clam-shell brace.  It feels constricting, and it gets warm and, well clammy, inside, and that is something I'll just have to get used to.  Also, where my foot exits the brace there is an unavoidable lip / transition from the brace to my shoe that crosses the bottom section of my foot that is still recovering nerve sensation, and it is causing annoying discomfort after just a little bit of use.  Maybe I can lessen the sensation by adding a cushioning extension / transition.  In any case, I don't think it's going to do the job in it's current configuration.

Finally, the brace works fine when walking on mostly flat terrain or when stepping up onto things like curbs, benches, rocks, stairs, etc., but because the brace restricts so much ankle motion, it is difficult to walk up simple, smooth, inclined grades, and the steeper the grade the more awkward it becomes.  It'd be no problem climbing a boulder field, or kicking steps up a snow slope, but walking up a steep trail may be a bit difficult.  Hmmm.  I'll do more testing.

Fine tuning.

All this biking, physical therapy stretching, calisthenics, stair climbing, and swimming has done wonders for my overall strength.  Still, my walking gate is far from smooth, and as I am learning through visits with the surgeons and orthotics' specialists, this has far more to do with bone & joint mechanics than muscle strength or even range of motion.

Based upon the physical clues mentioned in previous posts, it is clear that my right leg is shorter than my left leg, and my left foot is no longer flat but leans outward.  These two physical-structural-mechanical imbalances have caused a significant hitch in my stride.  It's as though I am walking along a railroad track, stepping up with my left foot on a rail that slants outward, and then stepping back down with my right to the bed of the track.  After observing my walk at a recent visit, the orthopedic surgeons gave me a referral to an orthotics' specialist who I visited last week.

We talked through the physical symptoms, they watched me walk, and they concluded a lift for my right foot and a wedge for outer portion of my left foot should help straighten things out.   Also, we talked about the ankle pain that has limited my walks to no more than six miles and/or two hours.  They suggested creating a custom-built clam-shell fiberglass ankle brace to hold my left ankle mostly motionless while walking, which would mimic fusing the ankle.  The braces straps will hold it firmly to my calf, so it will also transfer some of the impact load of walking from the heel/ankle to the upper calf.  This type of brace will fit inside a mountaineering boot, and fingers crossed, it will allow me to go further & longer.

At the follow-up appointment to create the caste for the brace and take accurate measurements for the lifts, the orthotics team determined my right foot needs a 5/8” heel lift and my left foot needs a 3/8” wedge on the outside edge to level it.  On a whim we measured the length of my feet, and it turns out my left foot has lost one-and-a-half shoe sizes!  Both feet used to be size 11.  Now my right foot is still an 11, but my left foot is a size 9.5. Crrrraaazzzy!! 

This will definitely improve my bragging rights when "comparing scars" with friends.

Gotta' love a bicycle, . . . and swimming pool!

These days I am biking to work just about every day (with a few exceptions) and I am loving it!  My body mechanics // chemistry thrive on cardio workouts, and I am so relieved to have found a ready source of physiological exercise that doesn’t cause debilitating pain in my ankles.  Gliding fast through beautiful outdoor scenery---akin to flying---is an added bonus.

It is interesting how quickly my psychology has shifted from finding rationales for driving to finding rationales for biking.  The same little voice inside that pushes me to achieve the summit of a climbing objective or accomplish one more lap during a workout now coaxes me to jump on the bike rather than strap on a car. 

When I first started biking, if the weather forecast indicated steady rain (with more than a ½ inch accumulation) then I may have reconsidered.  If I needed to stay especially late at The Mountaineers, I may have been tempted to drive instead.  If I needed to go somewhere after work, then shouldn’t I use a car?  Nope; all these impediments to biking are easily overcome.  Rain beads and slips off appropriate clothing.  It is easy to load a bike on the front of a Seattle Metro bus and commute home rather than riding in pitch black along the Burke Gilman Trail.  And usually there’s a decent bike route to any intermediate destination between The Mountaineers and home.

For example, last Friday afternoon after work I planned on commuting to REI in downtown Seattle to attend a conservation presentation about protecting The Methow River Headwaters region from a natural resource extraction project (a large open-pit copper mine).  Bad idea.  Anyway, in thinking through commute logistics, my first inclination was to drive to work, so that I could drive to REI, and afterward drive home to Ballard. 

Then the little voice began nagging, so I checked out Seattle Metro routes and determined I could bike to work, and then take Metro to REI and then home after the presentation.  The little voice continued to nag, so I checked out the bike route and distance between The Mountaineers and REI, and decided to bike the second leg as well, and then I could use Metro to get home.  But then after the presentation was over, there was still plenty of light, and the bike route and distance from REI to home was less than from The Mountaineers to REI, . . . so the little voice kicked in yet again, . . . and I biked home.  Yep, I am a glutton for cardio punishment!

So every weekday I bike to work which is a little more than twenty miles round trip.  Then, each morning, I spend twenty minutes on ankle range-of-motion physical therapy.  I stand next to a wall and lean forward as far as I can with legs straight and feet flat on the floor for 100 seconds, then I lean backward as far as I can for 100 seconds, and I do three reps of these stretches.  Then I do full rotations of my legs & upper body, circling through 360 degrees of ankle extension while keeping my feet flat on the floor.  Then I do knee bends, keeping my heels on the floor and lowering down as far as I can (last week I did full squats for the first time!).  I finish up with 40 toe raises, and finally I stay up on tip toes for 40 more seconds.  Ouch! 

That leaves Saturday & Sunday for my prior exercise routines.  On Saturdays I  do the full calisthenics workout (squats with heavy pack, pushups, and various other arm, core and leg exercises).  If the weather is nice I’ll bike to Golden Gardens beach and use a park picnic table as a workout platform (with an exercise mat for a little cushion comfort).  Working out with views Puget Sound, sunshine & blue skies, and budding spring cherry tree branches above is fantastic! 

On Sunday I do an hour of Golden Gardens Park stair climbing with heavy pack, and then afterward I go for a swim at the Ballard Community pool.  I try to get to the pool early enough to spend time in the hot tub with bubble jets playing on my back (aaahhh!) and my left ankle up and out of the hot water.  At this point I’m not really swimming, but doing what looks much more like an old-guy side-stroke or breast stroke, mostly because I don’t feel ready for full-out swimming just yet.  I do however, keep from touching the side or bottom of the pool for the hour that I swim, and that’s not too bad!

Near misses past & present

Just wanted to share a quick “random” story related to a fantastic scramble of North Twin Sister last April before the fall. 

I had near miss on this trip.  We brought bicycles for the approach up and back down a long forest road.  My front brakes had become inoperable during our drive to the trailhead when they got hung up with another bike on the rack, so I was coming down the forest road with just my back brakes.  They got hot and eventually stopped working (!!) on a long, straight, narrow, steep down-grade.  I was unable to stop or slow down and could not help but accelerate down the road.  I was totally freaking out and thought I was about to be dead (or at least severely injured). 

Literally the only thing that saved me was that at the end of this long straight away was a wider than usual turn with fresh gravel spread liberally across the road. I was going fast at that point, but somehow as a last ditch last chance, I side-slipped and lay the bike down, and came down hard and fast on my leg, hip, fore-arm, elbow, shoulder and head (the bike helmet saved me as well).  I got up cautiously testing for breaks, but found only significant road rash on all parts (and miraculously the bike was on one piece as well)!  The bike was inoperable so I walked it the rest of the way, and thankfully I was close to the trailhead at that point so it didn’t take too long.  I was bleeding in a bunch of places, so when I got back to the cars I put on a coat and bandana so it wasn’t obvious (I was embarrassed about the accident --- and I was OK --- so I chose not worry everybody, . . . it had been such a cool trip and I didn't want to be a downer).      

The week after I got back to Seattle I fixed the front brakes and replaced both sets of brake pads, then did a quick test ride to make sure all systems were “go” before parking the bike in the garage.  It hadn’t been used again until this last weekend, when I rode it from Ballard to The Mountaineers Program Center and back.  I’ve been wanting to expand my workout routine, but needed to prove to myself that I could complete the round trip.  The weekend test ride was successful, so this morning I commuted to the Mountaineers for real and afterward brought the bike into the office (common staff-member practice) for the day.

This afternoon after returning from a meeting, people sitting close to my desk said they were surprised when my bike’s back tire exploded!  While replacing the innertube, I inspected the tire and discovered the tire-wall was worn thin and had finally given way in one place.  “Odd,” thought I, while adding just enough air pressure to ride on the tire from The Mountaineers to Recycled Cycles in Fremont.  I arrived at 6:58pm (they closed at 7pm), bought a new tire & innertube and had them install both on the rear rim.  While the technician was doing the work, we got to talking about how a tire might randomly explode like that, and he said I probably “hit something” or maybe "my back brakes may have been mis-aligned and were rubbing on the tire.” 

Hmmmm, . . . thinking back to when I last used the bike, it finally became obvious what happened.  Can you believe the tire held out for three trips between Ballard and The Mountaineers and finally gave out while sitting motionless by my desk?!  Had it blown this morning while riding at speed, I’d probably be back at Harborview right now!  Turns out that bike back tire saved me twice.

I am so lucky!

Pain, drugs, halucinations, and other facts of life at Harborview's trauma center

I am not an addictive personality, . . . haven't gone through periods of being obsessed by certain foods, music, or people.  From my teenage years through college, I drank socially, occasionally to excess, but never got hooked.  I smoked socially as well when out with friends, and never got hooked.  Thankfully, I hadn't been exposed to lots of heavy-duty medicines throughout my life.  Pretty much just over-the-counter pain meds (Tylenol, Ibuprofen, Asperin) for head-aches and muscle& joint pain.

Then this accident happened.  While at Harborview intensive care and going through numorous surgeries I was medicated intravenously with several strong & potentially addictive pain meds.  Finding the correct dosage seemed to be mostly trial and error.  The nurses and doctors would frequently ask "what is your pain level right now 1 to 10?"  and very soon it became apparent that my pain-level rating was different than most, in that most everyone else reported higher levels than me. 

I had to explain to the nurses & doctors that a “10” for me was so severe that I would use a weapon to end it.  A “9” was excruciating pain with uncontrollable writhing and being strongly tempted to use a weapon.   An “8” was extremely uncomfortable but with an ability to control physical movement, but likely with groaning/grunting/whining.  A “7” was very uncomfortable with control of both physical movement and utterances.  A “6” was uncomfortable and still very much needing pain management.  A “5” was uncomfortable with a preference for using some pain management.  A “4” was annoying and distracting but able to manage without pain management.  A “3” was distracting but manageable without pain management.  A “2” was noticeable.  And a “1” was virtually no pain.

Bottom line is that most people’s “8” is my “5” and so the nurses and doctors tended to under-prescribe pain meds for me.  The good news is I can count on one hand the number of times I was at an “8” (extremely uncomfortable but able to prevent writhing, but with groaning), but the bad news was I found myself in the “6” to “7” range too often.  There were only a couple of instances where I was over dosed on pain meds and had wild dreams and hallucinations.

Getting the right level of meds was often challenging.  Quickly you understand the hourly cycle time for each pain medication and you ensure the nurses are timely in providing the meds.  Most of the time the nurses arrived timely, but because Harborview is a trauma center and my bed was in the burn section there were times when the nurses were busy with more important/urgent activities, and hitting the nurse call button didn’t always result in a visit.  More frustrating was when the call button would slide to a position that I couldn’t reach (recall I was in restricting casts up to my shoulders and was instructed not to attempt to roll or twist to prevent back damage), and I had to wait for someone to walk by the room or drop in to check up on me.  Calling out for help into the void seemed so pathetic!

Also, when the prescription wasn’t working, going through the routine of explaining my pain levels took time, and the nurse would then need to convey the information to the doctors so they could adjust the prescription, and sometimes the doctors would need to come and talk with me in person, going through the same routine as with the nurses before they would change the prescription.

Probably the most frustrating medication problem while at Harborview was when I was prescribed a self-administered pain medication that would be effective for a couple of hours.  Great you say, self-administration means no pain, right?  Yes, that’s true, . . . until bed time and then you get to choose between sleep and staying awake to press the button, because if you don’t hit the button on time then you wake up extremely uncomfortable. 

Gaining an audience with the right set of doctors and convincing them that I wasn’t exaggerating my pain in order to feed a nascent drug habit took a great deal of constant hounding of the nurses to ensure the doctors would show up, and then a high degree of persistence in stating my case.  Even then the doctors were extremely reluctant to adjust dosages, and as a result, while at Harborview I never slept through the night, choosing to stay awake to ensure the proper doses of pain meds occurred on time.

What does one do to stay awake in a trauma center hospital bed in the middle of the night?  My sister gifted me a small portable Sony MP3 player, but because of the state of my hands it was too small to hold and the buttons were too small to manipulate, and I couldn’t reach my ears to press in the ear buds in any case.  She also purchased a Samsung tablet for me but I couldn’t keep it balanced at the right angle to see the screen and the on-screen buttons were too difficult to manipulate.  Another sister gifted me an Amazon Echo device“Alexa,” but it was such a new concept and I didn’t have the emotional/psychological resolve to have someone open the box and help me figure out how to set it up and use it.  Finally, there was no way I could use a notebook PC keyboard because my arms were fixed in place with casts.  All that left me was TV late night movies, . . . really bad TV late night movies, . . . and for that to work I had to have the TV remote taped to one hand so that I could reach it and adjust the channel and volume with the other.  Miserable!

About the only thing that allowed me to remain reasonably lucid while at Harborview was taking naps during the day while Marijane & Marie visited (they could rouse me just long enough to hit the pain med button), and when nothing else was going on like the never-ending series of x-rays, doctor & nurse visits, and other interactions with hospital staff.

I'll share one "G" rated (and yet bazaar) hallucination.  Coming out of a particularly deep anesthetization after yet another surgery, I was unable to rouse myself more than being aware of a completely blank white state/place.  Nothing. Zip.  Eventually I found I could barely move within the space, and so I very gradually crawled along until I arrived at a corner/edge where boundaries converged.  Sigh.  Can't go forward, . . . don't want to go back, . . . so I tried harder to discern anything other than blank white.  Looking very carefully, I noticed a slight variance in the blank white space closest to where the boundaries converged.  Looking closer still, I discerned small movements.  At this microscopic level I saw incredibly tiny "things" manipulating space/time to create something other than blank white.  I sat their transfixed as these things very gradually created just the tiniest beginnings of a reality.  It became apparent that these tiny things manipulated space/time in order to create entire realities that we experience.  I realized that scads of these tiny things do nothing other than constantly adjust space/time to seamlessy "stream" our reality.  As I continued to watch and comprehend, I learned that these things "specialized" in their space/time manipulations, . . . a gazillion of them combining their efforts to create the reality of one of the door knobs where you live, . . . and only that.  It goes on, but you get the picture.

More on de-escalating pain meds and consequences there of another time.