A Better Reason

The rest of October flew by with me biking to work every day, staying until late and biking home in the dark. 

The Burke Gilman Trail after 10pm is an interesting place.  First of all, in many places the trail is far enough from the road that there is practically zero ambient light, so you bike by the moon & stars and hope for the best.  Second, the trail gets a little wild after dark so there is noticable scurrying in the brush on either side and I imagine the reflection of little critter eyes in the glare of bike head lights flashing by.  Third, oncoming bikes with super-bright lights---intended to “see” rather than “be seen”---are blinding and I whisper casual oaths under my breath as they approach.  A few considerate riders shield their high-beam lights, but most don't bother and I do my best to guess where I am in relation to the side of the path. . . . can’t see a blessed thing.

Then also, people occasionally leave the ubiquitous green and yellow bikes-for-rent sprawled near the path making for difficult-to-perceive and unexpected near-miss obstacles.  Speaking of the ubiquitous green and yellow bikes-for-rent, . . . by day, folks peddle these bikes slow and steady, and us bike commuters can make our way around them all right.  After 10pm however, a few of these bike renters are as well lit as the bikes themselves!  Having emerged from the local pub and unsafe to drive a car these riders feel steady enough to rent a bike.  But I digress.

I have implied the cause of not pushing hard on convalescence has everything to do with being super busy at work, but that is not fully accurate.  Truth is other distractions have arisen on the home front.  This is tuff to talk about.  It is not like falling off a climbing gym wall which is easy to overcome by comparison.  This hurts in a different way.  So very, very sad.

Procrastination

Well, the bright work project certainly was a distraction and it proved how adept I am at procrastination!  By end of August I had layed on seven coats of varnish and decided to call it good enough for this season.  Seven coats will keep the teak protected and so the bright work project is in a safe temporary holding pattern.  Next spring I’ll add an additional four coats and call it good. 

In September and the first two weeks of October---without the excuse of needing to drive so that I could get to the boat after work fresh enough and with enough time to make progress---I have returned to biking to work, and I am really feeling improvement.  I am able ride faster for longer, and I feel less muscle ache during the ride and afterward.  Also, I have discovered several short-cuts from the standard Burke Gilman Bike Trail route that shortens overall distance and eliminates several busy intersections, so there are only one or two spots where I might have to stop.

Also, I have continued working on left ankle range of motion, and it is frustrating how little progress I am making there.  Although I am able to bend it a considerable amount by leaning against a wall (first facing in and leaning far forward and then facing out and leaning far back), without the added pressure the ankle is still very stiff and doesn’t yet bend back and forth of it’s own accord.  

Thankfully, I am sensing gradual improvement in feeling in my left foot.  In addition to pins & needles I am now also feeling internal stinging & itching (which I suppose is a good thing), and now I am able to feel whether the foot has successfully slipped into a slipper when getting up out of bed at night with the light still off, which is more than I could do several months ago. 

The doctors indicated there’s typically a two-year window for repairing nerves and recovering feeling after an injury, so I still have eight more months of potential progress.  It is really important to have good sensation in your feet for technical rock climbing, because you have to be able to feel how well your foot is attached to the a particular placement on the rock (or climbing wall), so I have continued to hold off on climbing until I have better sensations my left foot.

No more procrastinating, . . . time to get back to hiking and the thrice weekly workout routine!

Distractions are OK, as long as they are kinetic.

So, . . . in addition to climbing and getting out into the Alpine, I love getting out on the water, and have owned a wonderful sailing craft for years.  Care & feeding of "Rhythm" is a labor of love, and requires countless hours of just "messing around on a boat." I will be testing my full-body convalescence with a big summer-time boat project requiring bending, stooping, kneeling, and crawling around all while applying significant "elbow grease."

Several weekends ago, with a sharp scraper and heat gun, I began peeling off Rhythm’s exterior varnish.  The ship’s log indicates it has been 10 years since last she was back to bare teak, so this is several years overdue.  Typically, the base varnish coat begins detaching from the wood substrate after seven or eight years depending on climate.  Teak is an oil-saturated wood which, on the one hand, protects it from deterioration due to the elements, but on the other hand, destines brightwork to a decade life-span at best.  It makes sense to “scratch & patch” the first tell-tale failure points, although the repaired areas are lighter in color than the rest.  Eventually after many patch jobs the brightwork looks mottled, and with new areas delaminating in increasing size & frequency, the daunting task of scraping off all the old, sanding to clear wood, and then building up a new varnish system, becomes unavoidable.

Getting to the point where I was ready to apply fresh varnish took over 100 hours of heavy duty sanding, working first with an orbital sander, then a hand block, then free-hand, and finally using small “invented” tools to work in tight corners.  What you see prior to laying on the first coat of varnish is what you’ll live with for the next 10 years, so the prep-work needs to be thorough.  Similar to varnishing, sanding requires multiple passes, first with 80 grit sandpaper (to clear the remaining old varnish and “shape” the wood), then 150 grit (to smooth the 80 grit surface and reveal the wood grain), and finally 220 grit (to increase resolution and beauty of the wood grain leaving a silky smooth surface).  Thinking through the routine now, there are eight unique passes over the wood before it’s ready for the varnish primer coat.

After sanding and detailing, you need to tape off the surrounding surfaces in preparation for applying the varnish primer coat; only professionals lay on varnish without masking tape that catches errant brush strokes, drips, etc.  It will take the rest of the summer to build up enough varnish coats to call it brightwork, . . . at least 220 hours to complete 12 coats @ 7 hrs to varnish and 9 hrs to sand after each new coat, plus un-taping and re-taping after every 3rd or 4th coat. 

Thankfully thus far no setbacks or accidents other than small burns from the heat gun and sanding off my finger prints.  I have had to change the security feature on my mobile phone that reads my fingerprint until they grow back.  Sometime, I’ll tell you about the time (10 years ago) when I picked up the heat gun by the wrong end, . . . now that caused some damage!

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.