A little farther & a little faster

During the first week of January I visited the side-opening doctors so they could evaluate that pesky bulge on the side of my abdomen.  Great news!  They are reasonably certain that it’s not a hernia but rather a flap of muscle that came loose from sutures somewhere along the way and is now bunched up and useless.  Turns out that muscle tissue is difficult to sew back together and hold fast, and now that this bit has separated there’s not much sense in going back in and sewing it back together again.  Instead overtime the non-functioning flap will atrophy and resolve itself, and underlying smooth muscle bands will bulk up and take on the job.  In the meantime, I’ve replaced casual slacks with Under-Armor work-out pants and their elastic waist bands nicely resolve the buttoning issue.  Now I can wear something other than rugby shirts (that are OK left untucked)!

I’ve held true to the three-day exercise routine for these last two weeks and have progress to show for it.  On the walk day, my new personal best is two miles in 65 minutes, and on the calisthenics day I’m doing 16 flights of steps up from eight.  My ankles/feet are still plenty tender afterward, but I’m sensing they are recovering faster.  Torso, butt, and leg muscles are always stiff and sore as they are under constant pressure to rebuild; they feel as they would after a typical weekend climb/scramble in the alpine but without the payoff of sublime views.   But you know, if I can walk two miles, then I should be able to walk four, and then eight, . . . we’ll see about that.

Rather than walking around the block at home, now I am walking at The Mountaineers, either at lunch-time (so I can ice for the rest of the afternoon while at my desk) or after work while the commute grinds along throughout Seattle (and then I’ll either stay late & ice while keeping up with work stuff or I’ll head home and ice while catching up on personal email / tasks).  The Mountaineers Program Center is situated on a Naval Air Station (now known as Magnuson Park) on the western shore of Lake Washington, and so there are great expanses of ideal, quiet park setting, sports fields, play grounds, etc., with paved or graveled flat trails to walk through. 

Tomorrow’s another walk day and this time I’ll use the Backcountry Navigator App on my phone to record a track and get a better fix on distance.   Those sports fields are tempting though as they present a perfect surface to safely build up speed, and now I’m thinking how wonderful it would (will?) be to sprint, kind of like the first time I stood up from the wheel chair.  

My pace is becoming somewhat less stilted and erratic although it remains no thing of beauty.  Because my left foot / ankle is still mostly asleep and less limber than my right side my reptile brain automatically wants to favor it (without nerves providing feedback, autonomous protective systems can’t confirm I’m not causing damage) and it takes focus to over-ride auto-pilot and force a smoother step.   It sure will be nice when (if) that left foot / ankle regains more sensory perception; all-in-all the left foot / ankle has me worried, as I just don’t know if it will be able to make the full recovery.  It won’t be for lack of effort.

Now that I’m walking distance it is making less and less sense to haul a portable collapsible wheel chair around in the back of my car (soon it will be time to pass this barely used convalescence aid on to goodwill) and the trekking poles have long since been stowed in the garage.  However, I remain thankful for the handicap placard displayed on my dashboard that allows for prime parking spots.

The power chair remains at my desk so that I can elevate my feet / ankles, but it moves less and less as the days progress.  Goodness, how indispensable it was in enabling Metro bus commutes from The Ballard Landmark to The Mountaineers, which remarkably ended just three weeks ago!

Thanking all my lucky stars, . . . 

I walked a mile!

Yesterday, it took about 40 minutes to complete two laps around our neighborhood block, so what I was doing looked far more like an old guy shuffle than a walk, but completing a full mile all in one go by the end of the year was a small goal I'd set for myself, so I just kept going and going and going.

Pretty sore this morning, so I went for a standard two-hour workout (hair of the dog so to speak) consisting of high-stepping back and forth across the exercise room multiple times, ascending flights of steps, completing a series of leg, arm, and torso calisthenics, and then stretching to increase range of motion in these thick and stiff ankles.

This afternoon I've had feet/ankles elevated and iced for a couple of hours to reduce pain and limit swelling.  I'll take the day off tomorrow to let things settle before going through the same drill again, and again, and again, . . .  walk one day, work-out the next day, recover the following day, . . . a little further, a little faster, more reps, etc.  At some point I'll add elevation and pack weight, but first I just need to develop a better/faster walking gate.

Huzzah!

I'm home! With a small complication . . .

Last Saturday, twenty-four weeks since the fall, I moved back home from The Ballard Landmark Assisted Living Facility.  This was my first time back home, . . . it's been a while! 

Because our home has steps leading up from the sidewalk to the front yard and more steps to the front door (with similar obstacles approaching the back door) there was no way to make it wheel chair assessable and so returning home was dependent on safely traversing steps & stairs.  I am now doing this (carefully) in spades.  When I get up from my desk and head to the break room for coffee I tack on a couple laps up & down the indoor flight of steps to The Mountaineers top-floor meeting room.

Marijane moved my clothes and the other stuff that fit in boxes, and Dolly.com moved the bed, night stands, table, and chairs.  Thanks again Marijane!!  Dolly.com deserves a shout out as well.  If you haven't used them yet, it is like Uber for folks who own a truck and for folks who need a truck.  It was incredibly easy (and cost effective) to schedule a micro move, and the two helpers who did the "heavy lifting" were timely, friendly, and professional.  Couldn't ask for better.  If you need a truck and folks to move stuff for you, Dolly.com is a great way to go.

The complication has to do with one of the things I talked with the back doctors about at my six month visit last week.  Everything with the back is fine (and they were pleased with the most recent set of x-rays), but there is a lump/bulge on the side of my abdomen close to the 6" incision which allowed access to the blown out vertebra (so they could pull out the shards, and replace it with a titanium cage).  The bulge doesn't hurt at all, but it has altered the shape of my torso enough so that pant waists no longer fit. 

It could be that the nerves in the vicinity disturbed by the surgery aren't yet firing and so muscle tone isn't consistent across my abdomen, but more likely it is the result of me doing too much in-bed leg-lift physical therapy with leg casts which caused a hernia.  Yikes!  The back doctors gave me a referral to the side-opening doctors (interesting note, . . . as it turns out a different set of doctors actually opened me up and moved all the internals out of the way so the back doctors could do the vertebra replacement work) who are also familiar with hernia repair and I'll visit with them next week.  Once again under the knife!

It ain't over 'til its over . . .

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!