Responses to "Return to Work"

I think it is important that I share the two comments below that I received by email this past week from two loved and trusted people in my life. They are spot on and fill in thoughts and feelings where I may have trailed off (in my mind). I really appreciate the support and love that surrounds me while I walk along this bumpy path. These people (amongst others) really do complete me as a person. Thank you for telling me to chill out sometimes and for bringing things into perspective!

Comment #1
"With regards to your people at work I'd say: focus on YOU!  As you know, people respond in a variety of ways to challenging situations (i.e. fear, over-care-taking, awkwardness, pity, trying to cover their own asses in terms of liability yada, yada...).  You never know exactly why it is that people say what they do, how they do, when they do.

Just be clear about what your intentions are for next week, do your best, listen to your body and take breaks/"call it a day" when you need to. If you feel good and have energy, then keep on truckin' - to hell what everybody else thinks!! Let others' comments, tone of voice, facial expressions, body language etc. go by the way side for now.  If there are repeating patterns that come up again and again with the same person over the coming weeks, then I'd day sure, go ahead and bring it up/address it. Otherwise, my council is to forget about this level of analysis for now and focus on what your goals are, how you know you are feeling/doing and what you know you want/need to do. Make all this clear to others and let them deal with their own doubts/fears/issues..." C.F.

Comment #2

"You got it girl, always good to hear from you. Good job!  Have a great time back at work, that schedule sounds good :) I think getting your mind off yourself and back onto your job is gonna be great. You will love the new energy and business I bet, and you will sleep good at night!

Have fun and good luck, my sisterly advice is try not to confuse peoples concern, compassion, or wanting to help with pity or fear, ok? There is definitely a big difference... Remember over the years how compassionate you have been to others, even to people you never met before! You would have never wanted them confusing your compassion for anything else right? So give them a chance, let them care for you, it's ok, You would do the same for a coworker if it was reversed.

So be patient with people and just keep your heart open, soak it in, you will do great!! I'm not sure what happened there, or what conversations you have had with coworkers recently, I wasn't there, but to me it doesn't seem like the type of work place or community that would hinder your progress or productivity, so try not to worry to much, ok pal. Just reeeelax." B.B.

Retuning to Work

The short of it is I am starting back part-time at my work, Boulder County AIDS Project, on Monday November 7th. My goal is a twenty hour work week, 4 hours per day. Then building up to 2 full days and 3 part time days. Then 3 full days and two vacation days the week of Thanksgiving. And then, the last week of November, be back to 40 hours per week. This is a plan that my doctor and I talked over and agreed upon... work feels slightly differently, that I should do 3 part time days to start and "talk it over" and see how I feel. Kind of like the under-promise / over-deliver philosophy. I think, from their perspective, they are also being thoughtful, careful, and protective.

On Monday, November 7th it will be 10 weeks and 2 days post-injury/post-op. I feel ready and excited to return to my previous routine. Well, within reason - who wishes they didn't have to work or cook and had people waiting on them hand and foot? Seriously though, this transition is good and I am ready for it! I am also working with a bit of nervous energy. I believe it is mostly to do with dealing with people who have not seen my progression all along and who might be scared or nervous that I will "reinjure" myself at work. 

I am so freaking careful and body-mind aware at this point that I do not expect to be derailed in this transition. Of course, there will be moments and I will just keep a keen awareness of myself and what's going on for me. I have goals and a sense of something to prove TO MYSELF, but not so much to others yet inevitably and naturally that will occur. Regarding some recent conversation with my employer, in some ways I feel very supported and there is a strong degree of excitement and confidence with my return. And yet there is also, from different people, what I interpret as doubt and a lack of trust that I am able to accurately assess and assert my needs and set appropriate, safe boundaries. I do not need others to do that for me, especially my employer (which is sort of what it is feeling like, but I must not ruminate on this...). Maybe we will butt heads, maybe it will be a more relaxed "coming together" of sorts. I hope for the latter.

Certain people at my work habitually operate from a fear-based perspective and that will not help my recovery process. I believe that is what is evoking my response of distrust. It also evokes a response of feeling powerless and incapable. This is NOT how I am going to spend my energy or any portion of my recovery process at work! I am just venting it here. I say this with the most kindness and compassion I can muster: some coworkers are in for a realization because I am not going to put up with people looking at me and treating me through a lens of their own fear and discomfort. I will let them know it's direct impact on me, like how I do my job and progress in my recovery.

Boy, does this bring up personal stuff or what?! I am now "on the other side of the fence" where some people see me as compromised, challenged, etc. and their fear is a bigger barrier than anything else to my progress in the world.

In the last two months I have learned a great deal about when and how to push myself, how to interpret my body-mind experience, what to anticipate, how to articulate my concerns/frustrations/advances, and when to back off and relax and be patient with myself. I sense now I am going to be pushed in a new way (like with the care providers and doctors) about how to be patient with others, let them express themselves, and also how to be direct and nip things in the bud so shit does not get out of hand! Actually, I have a feeling I am not going to be all that patient. Patience in this context will not actually serve me or others. What a realization for me! It will behoove me and others to be upfront and straight forward and not hold back what I am feeling and thinking at work, about work, and about my healing and recovery - who or what may or may not be helping or hindering my progress and productivity.

Everyone I have talked to lately agrees that we are all impressed with my progress! This comes from a variety of perspectives including my surgeon (Dr. Fulkerson), physical therapist (April Smith), parents, friends, Alon, and my massage therapist, Bree, and just today - my Shiatsu healer, Dale (who last saw me at week two). And of course, me! 

I continue to work hard every day to get my physical stamina and mental acuity back to where it was (or better). And I think it shows. Getting to the gym yesterday and doing my PT routine and biking made me feel great and tired, but not like I had to go home and sleep kind of tired. Alon and I actually went out and had a nice lunch afterward. The stamina dip is expected and normal. I've realized there are times to work through that and it makes me feel stronger and more present. Then there are times to just close my eyes and let my body and mind recover. I am better able to tell now more than ever before in life, what I need and when as far as personal needs go.

That is my rant for today. Thanks for virtually checking in! :-)

Play Therapy at the Park! (pictures)

Yesterday, Alon and I and our friend Kat went to North Boulder Park. While Alon and Kat walked her dog, I played on the swings and started making up my own exercises. It was freeing, uplifting, empowering, and fun! Before hand, I honestly just wanted to go home and fall asleep, but deep down I wanted to test my endurance and push myself. I had already pushed myself that day (socializing, eating out, crutching around plus a lack of sleep)... but I am so glad I pushed a little more and discovered these moments of joy in the fresh, crisp Boulder air at the base of the Foothills.

Here I am (click on photos to enlarge):

Extension on the way up...

Flexion on the way back...

Runner's lunge, Position 1: Flexion. The majority of my weight is supported by the swing's saddle, my back (right) leg, and hands. Just a light toe touch on my left leg (permitted by doc).

Runner's lunge, Position 2: Extension. Just trying to straighten that left leg and feel a good stretch!

Look at me, I can fly! :-)

Physical Therapy Breakthough!

Pain is okay today. Still took an oxy and rubbed pain reliever cream (like icy hot) on my knee today because I could feel some sharp pain seeping in. But as I type I am sitting without a brace with both legs dangling over the edge of the couch. Right ankle crossed over left, applying slight pressure to push my left leg back. Knee feels tight, but tolerable.

Kind of made a break through in PT Tuesday! I was laying face up on the exam table (per usual - sometimes we do face down, and that is no fun). Face cloth in mouth to bite down on and muffle my screams. I know, kind of a pathetic sight. Squeezing the bajesus out of the stress ball in my right hand. Right foot pushing down furiously into the table top. Glutes flexed... talking myself into relaxation. April by my left side ready to get me bending. I had come into the appointment, smiling and laughing, the usual Erin. Then, Jekyll meets Hyde.

That said - On Tuesday October 25th during out patient PT with our beloved April Smith, it was easier to get to 98 degrees than ever before (still painful). Maybe it was all that talking to my knee in the wee hours of the morning. At 108 degrees of flexion my hip actually relaxed with less effort each time. We did this repeatedly with the same success about 3 times. We held it at 108 degrees for about a minute each time. It still hurt, but I could mentally and physically feel a shift. It made me (all three of us) so happy. We all realized this change was happening. All the while, Alon hovered over me holding me down and pushing my shoulders down into the table so I wouldn't skootch back. It actually worked as awful as it sounds. And I loved having Alon there, with his good energy and intentions and strength supporting my progress. 

April noticed that the muscles in my leg were contracting less (or something like that). She said we have worked through most of the muscular pain. The muscular contractions and pain were previously stopping us from progressing (she could feel it as could I). She said she felt like I have started to move into an actual physical stop, the scar tissue. This is good. This is okay. She says it should be easier and less painful to work through the scar tissue. Should I believe her? I do.

I can really see and feel progress, like my left leg hangs more easily around 90 degrees and I can push just a hair beyond that without so much pain as before.

YAY! Love to you all!

Dear Left Knee, that's right I'm talking to YOU.

It was 3 o'clock in the morning on Tuesday October 25th when I woke up with stabbing pain through the sides of my knee and deep soreness, which had continued over the last 24 hours or so. It kept me up for about 3 hours. About one hour into it I decided to take 7.5mg of oxycodone, even though I had taken one plus 5mg of valium about 6 hours prior. I haven't had to take this much heavy pain medication back to back to help me sleep for about 2 weeks.

I decided to have a little heart to heart with my left leg and left knee. It went something like this:

Dear Left Knee,

I want you to know that I hear you, I feel you, and I love you. I know you are hurting and tired. The rest of your body is here to offer love and support. We will be patient while you recuperate and regain your strength. Please try to be patient too and just rest. You worked harder than usual this weekend and last night. I know you're trying to be more social, mobile and active, and we realize it takes its toll on you. We commend you for your bravery and attempts at finding joy and normalcy in your day to day life. It suits you. Keep trying and keep taking it one day at a time.

Tonight you're feeling a bit hopeless and frustrated, tired and obviously in pain. Like someone is stabbing a knife through one side of your knee and out the other, while your quad and hip are in spasm. We feel it too. Your body is here to support you. You're not alone. In fact, your feelings are universal.

We hope you can find some peace in knowing that we (your body and mind) and many other humans and living beings in this world may experience something similar to what you're going through or see someone they love struggling and fighting like you are. We hope you can find that restful place inside you. Know that it's okay to let go of the pain. That others share in your pain.

Rest and peace are everywhere in every thing. You can tap into within you and all around you. Let the pain and discomfort and emotions you feel sink into the earth or float up into the stars. The universe can take whatever it is you can't or don't want to handle right now. You are not a coward for doing this. You are human. You should not feel the need to do it all and keep it all together all of the time. There are billions of people and other sentient beings that are sending you love and light right now. Right now. Receive that love and light and let it fill you up. See your pain and struggle for what it is. Let it go as much as you can. Let in the abundance of life and healing power of peace and compassion and gratitude.

With ever lasting love,

Erin

Update: Week 8 - Accomplishments

Hi!

Here's a run down of some recent accomplishments in my recovery period. I haven't been so quick to update my blog lately, so this is about a two week summary:

10/8/11 - 6 week follow up with Dr. Fulkerson, my orthopedic surgeon, who says I might be able to start weigh bearing at 10 weeks and to keep my brace unlocked, encouraging as much bending and movement in my knee as possible. Push for 90 degrees ROM in the CPM (working on it!).

10/14/11 - First out-patient physical therapy appointment at Boulder Orthopedic Physical Therapy with April Smith (and Megan, assistant) - they are GREAT. I completed 6 minutes of half rotations (think back-forth not all the way around) on a stationary recumbent bike. This bestowed much confidence in me hence the follow couple days of advancements...

10/14/11 - Showering on my own, no brace or trash bagged leg. Showering every morning now which feels so great and no more sponge baths for my left leg.

10/14/11 - No bucket in the shower to prop my straight leg up on; instead using the removable plastic toilet seat to rest my foot on.

10/15/11 - Sleeping without the brace on; laying on my right side with a pillow between by knees and ankles or laying flat on my back with a pillow under my knees.

10/15/11 - No more raised toilet seat & no more bucket! We ditched the raised toilet seat which was helpful because, well, it just was. And since I can bend my leg comfortably to at least 60 degrees, there is no need to prop my straight leg up on a upside down bucket on the bathroom floor.

10/16/11 - Warming up my leg in morning using the CPM which we left on the couch for the first night in almost two month. This meant no loud, bulky CPM or ice machine in bed!

10/16 & 23/11 - Helped prepare breakfast and dinner. Put a chair in the kitchen and sat and chopped fruits and veggies, stirred the pot, and occasionally stood with crutches or hobbled around to get one thing at a time... a little scary because I had to be careful not to slip.

10/18/11 - Unassisted bathing; getting in and out of the bath tub on my own (still sitting down in the tub and using the transfer bench).

10/18/11 - No more toilet seat in the bath tub - sounds funny, but true! When I was able to shower without the brace, we ditched the upside down bucket in the tub and used the 8 inch removable plastic toilet seat thingy so that I could rest my foot on something and my leg wouldn't just hang like dead weight and strain my knee. Well now my knee is more flexible. It hangs, I bend it, and try to get some extra motion in the knee while I warm up the muscles with hot water.

10/19/11 - Completed my forth out-patient PT session and did 6 minutes of full rotations on the stationary recumbent bike. Struggling to keep my hip down (raising the hip was a learned compensation to provide more leverage to bend my knee - not helpful!) and PUSH THROUGH a full rotation. April Smith (my fabulous physical therapist) had me concentrate on engaging the quad and glute of my RIGHT LEG and pushing hard with the right foot, forgetting the left leg and just letting it follow the motion determined by my right leg. All while taking my right hand and pushing down hard on my left hip to keep it from popping up off the seat. My low back and hip muscles would tense up, and this is something I'm working on changing. By the end of six minutes I had about 5 really smooth, fluid rotations. THAT felt amazing.

10/20/11 - Went shopping... like a normal person... I fulfilled needs without over doing it. I bought a new fleece-lined hoodie sweat shirt for the cold weather approaching and some new yoga pants (since that is all I pretty much wear these days). These are some things I needed but in no way felt "up to doing" in the days and weeks prior. Simple, but good progress.

10/21/11 - Disability Claim - Began a dialog with my surgeon to submit paperwork for an extension of short term disability to long term disability coverage, as a safety net. WE HOPE I can start back to work sometime around November 21st. My short term disability claim expires Nov 19th. It takes about one month to process a long term disability claim. I may go back to work by November 19th, but it may only be part time for a little while. The disability insurance company's rule is that an individual can continue to receive disability benefits, with doctor's notes, as long as the individual is working less than 80% of their regular hours.  In my case that would be 32 hours or less per 40 hour work week. Doctor's notes, recommendations, specific instructions like "part time" or "light duty" or changes to the work place are required by the insurance company. I think it makes sense to get the ball rolling on the long term disability coverage as a SAFETY NET, with the goal of being back to work at 100% as close to that 12 week mark (Nov 19) as possible.

10/22/11 - Pampering and self-care! Got my hair cut today. Simple as that. Made me feel really good. Also went out to brunch and sat with both legs bent under the table (yay! normal!) instead of one propped up or sticking out straight. Opened several of my own doors (to public bathroom, etc.), crutched along the Boulder Creek and sat on a bench with Alon by the creek, enjoying the autumn day. I also crutched about 5 blocks along the Pearl Street mall to check out BCAP's Souper Bowlder display at the Boulder Arts & Crafts shop. Later that afternoon I took a nap for nearly 3 hours - I was absolutely wasted when I got home at about 3pm. Alon had to wake me up at 6:30pm!

10/22/11 - Guided visualization used instead of pain meds to fall asleep. Alon took me on a verbal and visual journey through the stars and deep into the earth to help easy my pain and relax. He was great! It was a new approach brought on by the fact that I was just sick and tired of taking oxy or valium to fall asleep. So Alon's technique really helped and I think has a lot of promise if we take the time to keep practicing it. Alon actually fell asleep about 15 minutes before I did in this initial trial which was pretty funny, but all good!

10/23/11 - Washed a few dishes (about 10 minutes worth of standing and "doing"). Did a load of laundry by myself - I might think twice about telling Alon about this :-) I basically dragged a bag of dirty clothes while crutching from bedroom to laundry room (about 15 feet apart), separated items, and started her up.

10/23/11 - Skyped with family showing them how I can bend my left knee and lift my leg up and down. They were very excited so that was cool.

10/23/11 - Range of motion - "Gravitational Flexion" progresses at home. I sit on the kitchen table with both legs dangling off. I bend as far as I can go. Then Alon takes one hand and places it on the top of my ankle, where leg meet foot. I push into his hand as hard as I can, then relax, then he pushes my leg back. I keep my seat, pushing my left hip down and massaging my leg in different spots. We repeat this 2 or 3 times and hold each one for a few minutes until I can't bend any further. It HURTS! Duh. Then we release my leg altogether. I bring my leg up to straight, trying desperately to kick Alon's hand that is suspended high in the air. I more like just barely tap his hand. I repeat this part a few times till the motion is relatively fluid and smooth and then return to the bending exercise.

10/24/11 - Made tea for myself and Alon and put a few dishes away this morning! After that 15 minutes of doing stuff I was tired (mostly in my arms and right leg). The blood also rushes down into my left leg/foot and my left hip is holding so much of the weight that it also starts to feel the strain. So I hustled to sit down and stuck my leg in the CPM (up to 80 degrees in CPM this morning!).

Range of motion (ROM) - At the beginning of each physical therapy appointment April and I take about 30 minutes of loosening and bending and straightening my left knee and leg. It SUCKS, but it is worth every second of torture so I can make a full recovery. Here's a recap of how I'm doing at the start of 30 minutes (when I arrive) to the end of the 30 minutes. April assures that I am doing well and making progress, despite measurements that vary and show decreases:

Degrees of ROM:

10/12/11: 67.5 to 90 (took 500mg Tylenol)

10/14/11 65 to 90 (took 7.5 mg Oxycodone and 325mg Tylenol;

10/19/11 85 to 110 (took about 10mg Oxycodone and 650 mg Tylenol);

10/21/11 70 to 90 (just barely - I was very tight and soar from PT two days prior and did not take any oxycodone before this appointment)

I think next time I am going to try 5mg Oxycodone, 325mg Tylenol, and 5mg Valium. My low back and hip muscles were going into spasm on 10/21 so I think the Valium would help with that. Also, I get pretty worked up emotionally, so the Valium might take the edge off a bit. I also think the Oxy/Tylenol helps me get through the first painful 10 degrees (somewhere between 90 and 100 degrees) and then I just deal with it. This pain and emotional management thing is an ongoing learning process!

By the way... my quad, glutes, adductor and abductor muscles are getting visibly stronger now from two weeks of PT and daily home exercise routine. I just need to make sure I keep up on my shoulder and back exercises at home (using a T-band) because I've been slacking off there with all the focus on ROM lately, and my shoulders are starting to hurt a bit (from crutches/walker and previous shoulder injuries). ALSO, my left foot is getting better but still soar/swollen (tendonitis) and not back to 100% of its range of motion yet. When I stretch the foot it almost feels like I have shin splints. Eight weeks later, the left foot and knee are still a bit swollen. Most of my bruising is gone - just one little one left on the lateral calf that we are rubbing out daily.

A bit of reflection...

I've realized a lot recently about taking things granted - my life, my body, my friends and loved ones, help and kindness from others, the way I spend my day (thinking, eating, laughing, stressing out, doing, not doing), my sanity, and my "good" moments. I have a renewed appreciation for all of these things every day.

 Me at Boulder Creek this weekend.

Week 7: Bullet points from my first week of out-patient PT

Take the pain meds about 1 hour BEFORE your PT appointment. If you have a good physical therapist, which you MUST, she/he knows what they are doing and you're not going to re-injure yourself. I am pushing through the pain and difficulty of scar tissue, swelling, and stiffness accompanied by muscular atrophy.

Arrive 10 minutes early to get some heat on this part of your body about to be worked on. This gets blood flow to the area and loosens up muscle (what's left), soft tissue, and tendons.

Bring a stick, leather swatch, or as I did, a face cloth to bite down on as you cry and scream at the top of your lungs including many expletives within ear shot of the rest of the physical therapy office.

Make your appointments at least 2 weeks out at a time, and get the days and times you want.

Bring a friend (if you're the type who wants people around during trying times) - someone with a strong stomach who can take seeing you in pain and working hard without offering pity or condolences.

I was at 67.5 degrees at the beginning of my appointment and the physical therapist got me to 90 degrees with a half hour of aggressive assisted flexion. It sucked, but anything is possible!

Massage the area of the injury and the scar as often as possible; break down scar tissue and restore sensation. Make friends with your body; with the painful parts, the numb parts, the skin that feels spongy and weird. If you don't want to massage it, have a trusted friend or massage therapist do it.

Keep pushing yourself at home with all PT exercises, including the range of motion, at least two times per day, as prescribed. Take the pain meds, suck it up, and make progress!

The Constant Passive Movement machine is still in active use. My goal is to increase by 5 degrees every day or so - or at least continue to make steady progress. Sometimes I have hit plateaus, like at 40 degrees and 60, I was there for a few days and that's that. But today (Sunday) I'm at 75 degrees. And by Wednesday, by God, I really hope to be at 90 - feeling the pain but able to keep my left hip down and body relaxed with as little wincing as possible. I've decided to try to do the CPM for a half hour per day at max range of motion a few times per day and then lay off it while I sleep.

Unlock the brace. Let your leg swing, dangle, and move as much as possible.

Trust your physical therapist. Your mind and body might say "Stop! It hurts!". Your PT will say otherwise. Listen to him/her. You want to walk again and do athletic type activities again, right? 

DO THE WORK. DON'T SLACK. ASK FOR HELP TO MEET YOUR GOALS.

TREAT YOURSELF RIGHT. LOVE YOURSELF. REWARD YOURSELF. YOU'RE NOT A BABY OR A WIMP. 

(All of the info above and through out this blog is my experience and interpretation of instructions from my doctors and physical therapists regarding my injuries. Consult your own medical care providers regarding your own specific care and injuries.)