Sunday, April 14, 2013

Excuse Me as I Quote Kobe Bryant

Last Friday LA Laker Kobe Bryant stepped wrong on the basketball court and ruptured his achilles. Twenty-four hours later he was in surgery, but not before a 3:30 am Facebook post.
This is such BS! All the training and sacrifice just flew out the window with one step that I've done millions of times! The frustration is unbearable. The anger is rage. Why the hell did this happen?!? Makes no damn sense. Now I'm supposed to come back from this and be the same player Or better at 35?!? How in the world am I supposed to do that??

I have NO CLUE. Do I have the consistent will to overcome this thing? Maybe I should break out the rocking chair and reminisce on the career that was. Maybe this is how my book ends. Maybe Father Time has defeated me...Then again maybe not! It's 3:30am, my foot feels like dead weight, my head is spinning from the pain meds and I'm wide awake. Forgive my Venting but what's the purpose of social media if I won't bring it to you Real No Image?? Feels good to vent, let it out. To feel as if THIS is the WORST thing EVER! Because After ALL the venting, a real perspective sets in. There are far greater issues/challenges in the world then a torn achilles. Stop feeling sorry for yourself, find the silver lining and get to work with the same belief, same drive and same conviction as ever.

One day, the beginning of a new career journey will commence. Today is NOT that day.

"If you see me in a fight with a bear, prey for the bear". Ive always loved that quote. Thats "mamba mentality" we don't quit, we don't cower, we don't run. We endure and conquer.

I know it's a long post but I'm Facebook Venting LOL. Maybe now I can actually get some sleep and be excited for surgery tomorrow. First step of a new challenge.
As a professional athlete Bryant reached this "what now" moment a bit faster then I did. I believed Dr. Hubbard, my first surgeon, when he said I would be back to normal in 6 months. I went into that first surgery grateful that, after almost a year, the pain would stop. Excited that I would be back to normal, able to get back to travelling and taking longer assignments without having to work through pain and ice and elevate every night and pray I could walk the next morning.

Fifteen months and a second surgery later and I'm having to relearn how to walk properly and wondering if the neuropathy is permanent. Not to mention that even if I can finally walk normally without pain, my career is basically non-existent and I am back to starting from the beginning, or having to move in a new direction. Unfortunately, unlike Bryant, I don't have years of 8-figure salaries behind me. At this point I'm just hoping my insurance will agree with my physical therapist on how many more sessions I need.

As a friend pointed out, after two years and two surgeries, I could practically write a book on the subject. Here are a few of my top tips for Bryant and others:

1. Make sure you have a good rapport with your surgeon. You are trusting them with your life and future. If something does go wrong, like you can't feel your toes, you want a surgeon that takes your concerns seriously and is more concerned with responding to your needs then making a magazines top doctors list. A sense of humor and self awareness are also important - I will never again trust another surgeon who can't laugh at himself, or gets paranoid when I mention I have a surgery blog.

2. Know your body and fight when something doesn't feel right. If number 1 is covered you shouldn't have to fight. Within four days of my first surgery I questioned why I wasn't feeling my toes. My doctor kept putting off my concerns until I told him I was going to see a neurologist, at which point he tried to steer me to his choice. The anesthesiologist later said he should have been notified by the surgeon the first time I made the complaint.

3. Find a really good physical therapist with a sense of humor. All therapists are not made equal and the number of years experience does not mean they are right for you. I had originally chosen a larger PT practice in a neighborhood hospital believing that it would be better equipped and have excellent staff, then I had the opportunity to work with a private practice therapist in a one-on-one setting, now I am back to a larger group setting, but linked to a specialized hospital. At the first center I had to push to see one therapist consistently - they were happy scheduling me with whoever was available. This was both a help and a hindrance - a new therapist didn't know my progress level, but might have a new exercise that I found helpful. Having Christine be solely focused on me for an hour was great, both for pushing me and ensuring I was doing the exercises correctly. Also helped that she specialized in feet. So, by the time the second surgery arrived I knew to ask for recommendations beyond the list the hospital provides. I'm even getting used to the hour-plus commute each way to see Bob twice a week, and I have begun to train yet another set of Starbucks baristas on how to make my chai.

As for a sense of humor, if they are doing their job you are going to find yourself wanting to kick your therapist - the movement of my right foot has become a very good indicator of how much pain my left is in. They need to know how to keep you motivated and engaged.

4. You are going to feel stupid and frustrated. Warn your family and friends. Things that were easy last week may not be easy again for awhile. After my first surgery I found myself afraid of my shower - one leg, water and rubber-tipped crutches, not a great combination. Simple household chores become herculean tasks on crutches or knee walker. And later you will get frustrated that physical therapy is not progressing as quickly as you want. (Don't actually kick your physical therapist.) Some of that frustration can and will spill over into your personal relationships. You don't mean it to, and you feel bad when it does, but your life has taken a sudden turn you did not expect and it's not just 3 am when those scared thoughts creep into your brain.

5. Keep perspective. Whether you are a pro-athlete, photographer or work in an office you are going to spend a lot of time focused on you, your foot and getting better. For those of us who can't work while we recover it becomes easier to isolate and fixate on yourself and your recovery. Think about doing some volunteer work, I met some amazing veterans overcoming huge challenges who reminded me in the grand scheme of things my achilles is nothing. Have you ever wanted to try painting or writing? You have a chunk of time between weaning yourself off the pain meds and the splint being removed. Later, even with daily PT, there is going to be some time to fill. The perfect time to try a new hobby. Have you ever thought about playing the bassoon?

6. Be willing to ask for help. That is still the hardest one for me. I have always been stubbornly independent. Even asking a neighbor to take my recycling to the basement, or get my mail is hard. So, while I say understand that things are suddenly difficult and it is okay to accept the help being offered by friends and family, I know that gracefully giving in to the need for those offers of assistance is not easy. Also understand for some, those offers are their way of saying they care about you.

7. Know this too shall pass. Yes, I have been dealing with this for two years, but my challenges have been different over those years. And as I have dealt with each issue I have learned something new. There may be life-long repercussions from the tear, and for me from the neuropathy. But right now, I'm in a better place then I was a year ago. Who knows where I will be a year from now. I will not be the same person who was looking through her lens instead of her feet that I was two years ago, but in some ways I'm not sure that's a bad thing. To quote Emerson "Life is a journey, not a destination."

   

Thursday, April 4, 2013

24 Degrees

Did my first exercise on a Power Plate vibrating platform. Not a fan! Had to keep my chin rolled down to my chest or the vibrations were overwhelming to my head. But after doing three sets of thirty second stretches on it, Bob was able to measure my dorsiflexion (how far I can bend my ankle towards my toes) at 24 degrees. Since before my surgery I couldn't get my ankle to neutral (zero degrees) this is a great improvement. Now if I can get my walking gait better.

Still having pain through the inside of my ankle and Bob found a muscle knot in my calf today that almost got him kicked when he tried to massage it. Still not good at standing on my toes, but found going up on my toes on the leg press noticeably easier today.

After PT it was off, through the building maze, to see Dr. Ellis. He seemed very pleased with my progress and thought I would be a new person by the time I see him again in six weeks. He said Dr. Shetty had called to talk to him about my neuropathy and I told him about my EMG later this month. He gave me a new PT prescription and I gave him triple chocolate, double toffee cookies - seemed like a fair trade.

Tuesday, April 2, 2013

Touch Your Toes

It has been just over four weeks since my surgery. It feels like longer! At least I am in matching sneakers, not something I had attained a month after my first surgery.

Because of my schedule I am having PT every third day for two weeks - Tuesday and Friday last week, Monday and Thursday this. Probably a good thing. Still having a struggle on the leg press and Bob added new stretches yesterday that had my right calf protesting. He also has me working on my hip strength as he noticed I'm doing a bit of a swivel when I try to climb stairs foot over foot. I swear by the time I finish one round of home exercises it's time to start the next. On my own I have added practicing stairs on the three steps between the elevator and my apartment.

On a happier note the swelling in my left foot has gone down enough that I could wear my red polka-dot Keds this weekend. They add a bit of whimsy and garnered a few compliments.

Still battling the disassociation with my foot, though since starting with Bob I have some signs that I might be regaining some feeling in my big toe. Instead of just looking at it, Bob has recommended touching it. He said sensory input from fingers may help my brain. So when I put on the Topricin, I also feel my foot, explore my toes and heel. So far I've learned I need to get a pumice stone and work on removing some dead skin.

I have to say that getting up has become significantly easier. Before this surgery I would lie in bed and worry about how long it was going to take for me to feel secure walking. I would stand up and windmill my arms as I tried to get my left foot to flex enough to allow me to stand. Now I can just get up without having to over think it - my only worry that my slippers will slide on the wood floor before I have full weight on them.

I feel like if I could just get my talus (ankle bone) to pop back into proper alignment every thing else would be fixed. I have to assume Bob agrees, or he just like pulling on my foot.

Basically, I went to Dr. Hubbard to fix one problem and he left me with a myriad of others. Because of the neuropathy and the achilles tightening I rolled my foot out to the side which tightened the tendon on the inside of my ankle and partially tore the peroneus brevis tendon on the outside of my ankle, and allowed my talus to shift locking my ankle. All of which Bob, Dr. Ellis, Dr. Shetty and I now have to fix.

Remind me again why hitting people with my cane is bad?!

Tuesday, March 26, 2013

Grunting Through the Easy Stuff

Stand on your toes. Go ahead, I'll wait. You can even hold on to the couch or wall. Should be fairly easy.

Not for me.

Had physical therapy today. I learned that Bob has very strong hands as he gripped my ankle and worked on manipulating my bones. Then he had me roll my foot, like I would when taking a step. Ouch. But nothing compared to what came a bit later.

Then it was time for standing on my toes. I found myself throwing almost all my weight to the right foot. Bob decided that wasn't hard enough, so he asked me to only use my left foot. That did not work, so we moved to the leg press and tried it there.

Using both feet, with my right doing most of the work, I could press 50 pounds up on my toes and then  let my heel flex beyond the bottom of the foot brace. He had to remove all the weight before I could use just my left foot, and then I felt like I was pressing 500 pounds just to get my foot to move less than an inch. I found myself wanting to grunt like Maria Sharapova during a Grand Slam tournament. I also felt a bit pathetic, that something that should be so simple as standing on your toes is absolutely beyond me at the moment.

By the time I got home after 2 subways, 2 buses and a combined 11 blocks of walking (that was just after I left HSS), all I wanted was to put my feet up for a bit. When I got back up a but later my ankle was so stiff it hurt to flex to neutral. And I am expected to abuse myself with these and 10 other exercises five times a day!

I just keep repeating the mantra that this will be worth all the pain!

Dr. Shetty, my neurologist, called yesterday and agrees with Bob that I may have had the lack of feeling in my heel before this surgery, but because I was not walking properly I did not notice. No suggestions on how to handle the disassociation I am still having with my foot. She did order another EMG - now scheduled for late April, just shy of a year after the first one.

Someone asked me today what to do if the feeling never comes back. I don't know. I'm trying not to think like that. Hoping a positive outlook will produce a positive result. Originally everyone - Dr. Hubbard, Dr. Tsai, Dr. Shetty - kept telling me the feeling should come back in a year. It's now been 14 months and Dr. Shetty (the only one of the doctors I am still in contact with) says it could be 18 months. I couldn't find any information on the Neuropathy Association website. Seems they tend to focus on illness related neuropathy.

I have to push it back or the fear of never being able to walk normally again will overwhelm me. Bad enough that Bob has ordered me to keep the cane until my gait is a bit better - especially when my cops keep telling me I will be arrested if I start hitting people with it.

Right now it's time to do more stretches!

Friday, March 22, 2013

PT Drama and New Shoes

Today was my first appointment with my new Physical Therapist. Bob was recommended by both Dr. Ellis and Mark (my pre-surgical PT). He has over 20 years experience with a focus on feet and seems to also have experience with nerve issues.

Had a minor bit of drama at the beginning of my appointment when the therapist I had seen on my last two sessions wanted to know why I wasn't seeing him and implied that since he had done my initial evaluation I was supposed to be his patient. How does one nicely say that he was a place-holder until Bob returned from vacation and had he been the therapist I was assigned to, I'm not sure we would have been a good fit?

Nothing against the first PT, I am sure he is very competent, but he had me doing a few minor exercises like rolling my ankle, pointing and flexing my foot, and using a dog leash to pull my foot and stretch my calf - all without weight bearing. They are all good basic exercises, but he also talked about taking it slow and not doing anything more strenuous then the bicycle until the swelling in my ankle had dissipated. In contrast, Bob jumped in with two new floor stretches as well as two new bed stretches specifically designed to remind my nerves they go all the way down to my foot. He's pushing me to run through the routine at least 5 times a day.

Bob is doing what I really wanted and needed, which is treating me like one of their athlete patients. Though it was a bit disheartening to hear him say it could still be months before I would be discharged from PT. After two years, two surgeries and too many physical therapists to name, I am getting tired of the whole process!

The only complaint I have is the same one I had with Carlos, but hadn't realized until I saw Christine. Because it is a large facility the therapists see more than one patient at a time - though this seems to be two at a time as opposed to Carlos' schedule of four. But it still means the PT is jumping between patients, meaning both that my appointment doesn't begin on time (Bob didn't come get me from the waiting room until 15 minutes after my scheduled start) and that I am left alone to run through a set of exercises and then twiddle my thumbs until the therapist returns.

On the plus side, Bob could push my foot past neutral today. In fact, when Bob pushed, my left foot flexed further then my right could on it's own. He also said my heel pain, recurrent blister and calf cramps are from my foot having spent so long in the equine position - and that the pain is likely to get worse as I begin wearing sneakers full time this weekend. I am now trying coconut water to help with the cramps.

After PT I did something I haven't done in a very long time - I went shoe shopping! Admittedly it was for sneakers, but beggars and all that. Earlier this week it occurred to me that all my sneakers (by all I mean my two, possibly three, pairs) are designed for walking or cross-training, and as such they have built-in heel lifts. So today I spoke to Steve, Dr. Ellis' PA, and confirmed I needed flat sneakers - Bob actually recommended earth shoes, but not until I'm a bit further along. So I went to DSW and picked up a pair of red polka-dot Keds and gray Roxy Castaway high tops.

The negative of moving from air-cast boot to sneaker is that my walking speed - already fairly slow - will, for  awhile, become sloth-like. Always something to look forward to!

Sunday, March 17, 2013

CRAMPS

Around 3:00 am I began to wake up and started to turn over when I was brought wide awake by a giant cramp in my left calf. I could not seem to move my foot in any way to lessen the pain. Finally it began to pass and I started to straiten my leg, which started everything up again. It took about 5 minutes for the cramps to finally subside. I kept my knee bent at an odd angle and finally fell asleep.

Then this morning, as I straitened my leg to prepare to get up, the cramps returned. This time, just relaxing after the first cramp caused a second. Later, trying to do my morning stretching exercises caused another round of cramps - needless to say, I did nit finish them.

Even just sitting here, I feel twinges as if my calf muscles are just waiting for an excuse.


Friday, March 15, 2013

The Psychology of Neuropathy

When the nurse removed the splint yesterday I remember looking at my foot and thinking it looked wrong. I knew it was my foot and yet felt disconnected to it. Then as I mentioned, when I felt my ankle and discovered the lack of nerve response I wanted to cry.

The disconnect continued when I removed the boot to go to bed last night. I again stared at my foot and even took cell phone photo of it.


But I felt like I had no connection to it. Later in bed, I tried to position my foot in neutral. When I looked down I could see the angle of my foot, but when I closed my eyes I couldn't have said where on the bed my foot was and if pushed would have said my toes were down almost in a ballet en pointe position. 

While the pain was less this morning, the psychological component was still there as was the lack of sensation, leading to a very nervous shower. I felt safer in the air-cast boot, as I knew my foot was tightly encased. 

With this worry in mind I played phone tag with my neurologist this morning while having my physical therapy evaluation. I also did some internet research when I got home, but could not find any articles or abstracts dealing with psychological disconnect and neuropathy. But it feels like it should be related, especially as my sciatic axonal neuropathy presents with hyposthesia (loss / lack of sensation). I will try to talk to Dr. Shetty when she gets back from her conference, especially if this emotional component continues. Just what I need, new and strange foot issues!

On the positive side, I was able to get around in the boot with just my cane while outside and no support in my apartment. I even took a bus and subway home from PT (the return of my sociology study of who offers me a seat on mass transit); stopped at Target to pick up a few items; and was able to walk the six blocks home - albeit slowly. 

The physical therapist sent me home with simple stretch exercises, though he seemed loath to start pushing me to stretch while standing until next week. Did tell me to bring a left sneaker to my next appointment. 

Relatively quiet weekend ahead as I try to balance my need to stretch and move with not over exerting myself and doing more harm than good.