No News is Good News

... so here's the news:

Last Saturday I learned about two of my temporary limitations. Jumping and fast lateral movement.

In my new favorite group exercise class, Butts and Guts!, we had a kick ass 25 minute routine last Saturday. Part of this routine included jumping up in the air and bending down to squat and touch the floor. About 24 times. I remember doing these in basketball practice in high school. My first thought when I did this Saturday turned out to the be right one. You shouldn't be jumping. Nothing happened immediately. I modified to smaller, less frequent jumps. Still... bad idea as it turns out.

Another part of the class routine included a Bosu ball workout. I've grown to love and admire the Bosu for it's ability to provide continuous challenges and rewards. Staring at it like it knows it just made my life harder for the better. Smirking at it as I contemplate the positioning, balance, and agility I need to master it.

Saturday in "Butts & Guts!" we were literally leaping like ballerinas laterally over the Bosu to land one leg on the soft inflated part and one leg on the floor, and sitting back into a squat. BAD IDEA. What fun it seemed like at first... and then, that little voice. Side to side leaps over a half ball followed by one legged squats? Probably not there yet. Slow down, girl.

Well, yes, I continued... modified and slow, but still pushing the limits... wondering what my body will say to me later.

Here it is Thursday... six days later... and this week has been somewhat hellish for the ole left leg. I've had to scale back my workouts and walk a bit gimpy. Sharp pains through the inside of my knee. Soarness and stiffness from hip to toes. Rubbing the massive knot in my upper calf (probably from landing on my toes continuously instead of flat footed) and standing up to stretch during meetings more often. I've taken a few thousand milligrams of Tylenol and ibuprofen over the course of the week and today, reported all this to my physical therapist.

She told me exactly what I had learned, "You're just not there yet, but you will be!". We practiced some "jumping" and "running" simulation exercises using about 60-70% of my body weight. That was encouraging. We used the Total Gym for the running and a 2 inch high box platform for the jumping. This all felt pretty fine which was good. Although walking is not so easy tonight. I feel like I just don't want to move my leg at all, or else, pain. Fortunately, this is not the kind of pain that wakes me up at night. 

For all intents and purposes, I am doing great! The last two weeks or so I have observed marked (albeit small) increases in mobility, flexibility, feeling "light" and relaxed muscles. I'm walking A LOT and I'm much better at stairs (no awkward thumping). I also had my first REAL bike ride out on the open road yesterday! I rented a chill little step through cruiser-type bike by GIANT from Full Cycle and peddled my way to the gym. I even rode through the corner where I was in my accident. It was at least 70 degrees and sunny and that's all I really cared about. I was in complete bliss... peddling... warm... and free. I want to do this all day, every day. The weather has been so perfect for it. Another temporary physical limitation observed on the bike ride: standing and peddling... um, not so much. Hence, the term "cruiser". I am excited to continue to watch my progress, find balance in my every day experiences, and focus on more good times ahead.

My body is my temple

Quite a few people have asked me lately, "has this injury been a spiritual experience for you?" It's a really difficult question to answer. I think I can see where people are coming from though: has my experience affected me in some profound way? What is meant by "spirituality" anyways? I think it has changed almost constantly throughout my lifetime. In a good way. In a way that allows me to learn something new, see things in a new way, and not get stuck in a specific dogma that excludes all others. 

While blogging, I've shared with you the glimpses and glimmers of spirituality as it is often woven throughout my experience (and all of ours, if that's how we chose to see the world).

Today, while silently thinking about people's inquiry around spirituality and developing my own... I thought, "what is my spirituality to me right now?" At times I have been more focused on the intellectualizing of spirituality and religion, more devoted to my meditation practice, and more open and aware of the spiritual teachings of others. 

For the past 6 months I have been so enveloped by my recovery, physical training, emotional well-being, and relationships with my loved ones that my focus on spirituality has in a sense become less, I thought. When in fact I don't think it's become less. I think it has shifted even more from an external experience to an internal one. 

During this time I have never been so dedicated to my self. At the same time, my gratitude has never felt more abundant. I have never had to open myself up so much to receiving help and love from others. I have never been faced so directly with the challenge of self-acceptance and harnessing will power to overcome great personal adversity.

So anyways, as I sat kind of glazed over on a stationary bike at the gym staring out into a bright, sunshiney day I asked myself about spirituality - have I drifted away from it? What has changed for me? What is my spirituality now? 

An answer billowed inside of me:

"My body is my temple." 

Yes! This made perfect sense to me! To me, it meant that all the while this divine presence, the spiritual teachings I sought or thought that I might be missing were always within me and within my own experience as a physical being of this earth. This is great, I thought! Keep going! Ride this wave.

I didn't just hear the words my body is a temple or hear someone nearby say it (cuz lets face it, it's not the most original phrase, especially here in the yogi capital of the world: Boulder). I really felt my body as a sacred temple - as a place to experience my "awakening" of sorts. This body of mine is a place to cherish, to nourish, to take care of, to believe in, to accept, to love, to protect, to give of freely, and to be amazed by! 

Deep in my bones and in my muscles with each revolution on the bicycle the words echoed in my mind and resounded in my heart. It was reaffirming to know and deeply feel that my dedication to myself is not fleeting and it is so important. This is a forever commitment to myself. Who knew I would be woken up in this way by this injury and recovery process? 

This body of mine, this thing so easily taken for granted, so under appreciated at times, so neglected in the past... is not only what takes me on my spiritual path but it IS my path toward awakening, toward understanding, toward gratitude, and toward cultivating more love and acceptance of myself and in turn, of others.

The Darker Side of Me

Self-pity

Rehab is lonely

Being injured, different, damaged is lonely

My body doesn't work right

My body doesn't trust itself

My ankle is so swollen I can't see the bony parts

My knee looks deformed where the bone was crushed and reconstructed

I can't explain what this feels like, nobody knows it but me

I can't bend my leg into the "butterfly" stretch

I can't straighten my leg completely

It takes a really long time just to gain a few millimeters of extension when stretching

My foot is pronating in a new, weird way

I don't want to take another step

I have so much to do and I have to pace myself, I can't do it all right now

I'm done for today

I get to start again tomorrow, I'll be stronger then

What should I do for self care?
Refresh

Update: Week 11 - Mind Over Matter

Mind over matter:

In no other instance was this truer than a shared experience today during my first half hour of physical therapy with April and Alon.

I was bending at 116 degrees. We'd done it three, maybe four times. We'd been going for about 15 minutes or so, of bending and extending (straightening). Sharp pains increasing like daggers stabbing through the side of my knee. The knee began to tighten. Mentally I started to feel weak and tired. (I was actually tired going in - I think the oxycodone I took an hour before hand was making me feel fatigued. I may skip it next time, since the only time I seem to take them is right before PT). My hip was lifting off the table. Then I could only get to 110 degrees or so. Frustration and weakness set in. The tears began to fall. My breathing got short. April reminded me to stay calm and try not to get anxious or down on myself. Alon demonstrated deep inhales and exhales. I mimicked them.

"Don't let it get to you!" I thought to myself, then said it out loud. 

"Acknowledge the pain and fear and frustration, briefly. Then, tell yourself to RELAX."

"JUST RELAX." I repeated over and over out loud.

"It's okay. Calm down. Relax into the pain. You're okay. Nothing bad is going to happen."

Then, we got to 116. 118. 120!

I actually felt relaxed. My body was laying in a somewhat peaceful state. My mind was somewhat peaceful as well. The discomfort and tightness in my knee and quad was there, but it was not unbearable. I was talking. Taking long slow inhales and exhales. LAUGHING EVEN. We were making jokes of some kind. I think I said, "Let's do it for all the American Soldiers!" (Being that it was Veteran's Day.) I was half-joking (at least Alon & April laughed) but also trying to find any inspiration or distraction I could to KEEP GOING and OVERCOME.

Bent at 120 degrees we held this for about a minute. I relaxed and straightened the leg (always painful after bending like this). Then back to 120, not two, not three, but FOUR TIMES. I was absolutely amazed. My mind and heart and soul had overcome the mental and physical barriers of pain, fear, weakness, and frustration yet again. Right then in a matter of moments.

It was some kind of bliss seeping through a sieve of pain and frustration from sheer will and determination. I felt liberated.

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

6 Week Update: Medical, Emotional, Mental, & Physical

MEDICAL UPDATE:

Here are the bullet items from my appointment with my surgeon, Dr. Fulkerson, yesterday (Thursday 10/6/11):

• I experienced a BI-LATERAL tibial plateau fracture (TPF). This was new to me. I thought only the lateral side was crushed but the medial side had a huge fracture down the entire length, splitting it off into a triangular piece. I became fully aware of this on Thursday when Dr. Fulkerson, Alon and I looked at the pre-op x-rays together. This is the first time I had seen the pre-op x-rays - they were troubling and interesting to say the least.
• Medial: closer to the body's midline. Lateral: closer to the left (in my case) or right side of the body.
• There is a Roman Numeral scaling system for TPFs that goes from I-VI (least severe to most severe). When you have a bi-lateral TPF both sides of the plateau are fractured and you are in the range of IV to VI, based on my internet research and chatting with my doc. I was likely a V. Had both plateaus (instead of just the one) been crushed or broken off completely I would have been a VI and likely a candidate for a full knee replacement! Holy crap, right? Imagine if I came out of the operating room with a scar from mid thigh to mid shin and a truly bionic knee, not just a plate and a 6 screws? This new news, increasing the realization of the devastation of my injury and need for a major comeback scared me immensely and totally overwhelmed me. As I write this (one day later), I still feel scared and overwhelmed.
• My injury: The medial side of the tibial plateau was severely fractured (like the picture of the left knee in the link above) while the lateral side was severely crushed (just small pieces of bone fragment and chunks of cartilage flaking off - patches of cartilage gone for good) - the latter was the primary concern during surgery.
• Lateral TPF: This is the side that was crushed, bone graphed and plated. The top contour, from front to back, of the lateral side of the tibial plateau was congruous (smooth) which is great, yet still lower than the lateral side which is, well, not so great but not surprising. The surface formation was also good. Dr. Fulkerson's goal was to raise that crushed side up as much as possible to its original state using the bone graph and plates. She did her best, and a great job at that. It is what is now and she is satisfied with the outcome. My call to action now is to strengthen the crap out of my left leg so I'm not weak in that area and have less of a "knock-knee" (that she predicts).
• Medial TPF: This is the side that had the jagged break that created a triangle piece of broken bone. Looks like it's healing ok. No surface damage or crushed bone here like the other side. Still SHOCKED that this side was busted too... oh well!
• Other fractures: There were two fractures along the shaft of the tibia that were clean breaks and are healing if not healed by now. The fracture at the top of the fibula that connects to the lateral plateau: same. 
• Weight-bearing: The non-weight bearing issue is basically related to the crushed plateau and how quickly that heals. It is possibly that I might be weight-bearing at ten weeks instead of twelve. Exciting! We'll see at my next follow up appointment in four weeks (Nov. 7th), which will be the ten week mark.
• Ligaments: The meniscus tear was in the back on the medial side. Dr. Fulkerson said she had to cut some of it in order to do the repair. She said there was an avulsion of the meniscus. The ACL, as I mentioned before, was not visibly torn, but instead tore off with a piece of bone attached to it. She gently, accurately placed the puzzle back together and is hoping for a complete recovery. She said it is possible that there were micro tears in the ACL, but of course impossible for her to tell since she is an awesome orthopedic surgeon but does not have microscopic vision. At this point, there is no way of knowing how either ligament is healing. We'll know more as I go through the physical therapy, etc.
• Physical therapy: I received a prescription from Dr. Fulkerson to start out patient physical therapy next week (exciting and scary!), one to two times a week until they can progress me to more visits per week. Part of me is thinking "Well, it's about a 3 mile walk to PT. I wonder when I can do that?" Then, a friend or loved one gives me this stare down like "You're crazy. Give it time." And I am reminded to "be in the moment!".
• Prognosis: Overall, Dr. Fulkerson is "reasonably optimistic" that I will make a "near full recovery". So that's about the best news you can get from the mouth of a reasonably cautious, very talented doctor.
• There is no additional surgery needed at this time. My assumption is, sometimes there could be additional surgery at this time if someone is healing properly. I have been encouraged to bend my knee as much as possible to avoid having surgery to "scope out scar tissue". Yuck. I am currently bending at about 85 degrees, but could go to 90 with an extra dose of courage (much needed at this point!). My goal is to advance my range of motion (ROM) by about 5 degrees every day. We have a new technique for this (see "gravitational flexion" below).

PHYSICAL/MENTAL/EMOTIONAL UPDATE:

So speaking of bending my knee. I am feeling very disconnected from this part of my body right now. I have been feeling this way for the last few days. Disconnected from my left leg in general. For six weeks I have been lifting my leg with both hands in and out of the brace or on and off the CPM when necessary or up onto a bucket to rest when I go pee, as if I was a paraplegic. This is incredibly frightening. The entire experience.

Yesterday, with Dr. Fulkerson we tested my range of motion in this way, Gravitational Flexion: sit up on the examination table, scoot to the end so that the knee is past the edge of the table. Brace removed, Dr. Fulkerson rests the heel of my left foot in one of her hands with her other hand supporting near the top of my calf. My leg is now out in the open air, supported solely by this woman, who I thought I felt trust and respect for. However, I was scared. My reaction to this test: I start to cry, shake, hyperventilate, tell to her stop, ask her what she is going to do next. NOTHING BUT FEAR. So much fear came over me: it felt like someone was pushing me out of an airplane with no parachute. 

Dr. Fulkerson immediately identified with what I was feeling. Told me it was understandable and reasonable, that she would probably react the same way AND that FEAR was going to be my biggest obstacle right now and then I HAD to get through it/over it. It was an earful - but she was right! Yes, I need to listen to my body (and I do) but the mind is a powerful thing that has the ability to convince of something that is not true or prevent me from progress, in this case. We talked about how my leg would not snap off and break in half, that the plateau fractures would not get re-injured in this way, and that I was okay and I was going to get through this.

We graduated to a bent leg of 75 degrees, off the edge of the table, allowing gravity to do it's work. It was actually easy in a sense. There was NO PAIN, only fear. 

The mental trip was this: I was dangling my limbs off the edge of Half Dome (a 2000 foot flat faced rock at Yosemite National Park - a favorite spot for experienced rock climbers - otherwise a place to embrace one's fear of heights reconciled by natural beauty). Dr. Fulkerson said I could likely bend to 90 degrees right then but she thought she had traumatized me enough. We both laughed! I said, "We could try 90," with like ZERO conviction. She said NO and slowly raised me back up to 180 degrees. Where I kind of shuffled to get back into my security blanket, the leg brace.

So I think I have some stuff to work with!

Alon had his hand on my back the whole time I was with Dr. Fulkerson. I could feel his gentleness and strength right there coming through his hand. It reminded me of a Hakomi (type of psychotherapy practice) workshop exercise I had done with a partner, where the precise placement of a gentle hand on someone's back can fulfill a need and provide the exact comfort one desires. Alon somehow knew exactly where and how to place his hand. I imagine the experience might have practically brought him to tears watching me, but he seemed okay. Alon shared later that I made a huge step toward normalcy today and that I was very strong overcoming more fear and uncertainty and re-discovering ability! Yay! for positive reinforcement!

I do have some leg muscles left; coupled with desire and will power. I am able to do leg lifts and slides much more easily than before and so I have been trying to shift my behavior from this assisted lifting with my hands to mindful, coordinated action of: engage the core, tighten the glutes, tighten the quad, flex the toes, lift the leg. Go. Annnnd REST. There is no question that this process is tiring, frustrating, strengthening, and courageous. Whether I'm doing some sort of necessary bodily function or activity (like walking or bathing) or doing PT or modified yoga poses, THIS extreme attentiveness is what it looks and feels like. Eventually, it will all become second nature again and I can bend my leg more and do things with but for now I have to be completely present with whatever action I need my left leg to do or it won't happen or I risk hurting myself. 

Despite all this, despite my modified yoga poses in the sunshine in the backyard which give me a few moments of bliss and accelerated heart rate... I still feel very disconnected from my leg, from my body. It sucks. It's depressing. It's scary. It makes me angry. It makes me sad. I feel lost and overwhelmed right now. I balled my eyes out this morning, soaking the shoulder of Alon's t-shirt with my tears. Alon and my care provider, Pauline, agreed after that moment that I've been so strong and positive up to this point, it's okay to be in this space, in fact, it is NORMAL in my situation to be exactly where I am right now, emotionally. Not the normal I want but the normal I've got! So, okay... I'll just keep putting one foot in front of the other, take one day or moment at a time, and breath in all the loving support that my friends, family, co-workers, care providers, strangers, and neighbors have to offer.

Alon, my love and support and sanity and saving grace through all of this assures me that I just need to keep doing what I'm doing and that I'm healing great, even the doctor said so! 

The other night when I was going to bed all could think about was the bi-lateral fracture. So I needed a way to get out of the negative thoughts and into the positive. I asked Alon to give me something else to think about and he said, "Think about your muscles and how strong they are going to be." He's also said that I can probably put a 70 pound pack on and go back packing in the back country again someday. That these activities are not off limits. And I soon drifted off to sleep, thinking of my soon to be Wonder Woman figure :-)

There will be days when I'm climbing up hill both ways in a blizzard and then there will be days when the wind is at my back. Nevermind DAYS. Try MOMENTS. Moments in my day when the "wind is at my back"... these are the things I need to try harder to keep track of and relish in, and to talk about and think about. Like all the positive aspects of physical therapy and being around all these people who love and support me (and Alon).

Each of us experience our share of suffering, loss, challenge and chaos. What about the moments when we truly feel supported, at ease, progressing, and happy? Whether those feelings come from within or surround me in my immediate environment, this is a difficult time in my life where it is imperative to deeply acknowledge those good feelings which can put that wind back in my sail propelling me through the rougher patches of open water.

Thanks everyone for taking this journey with me on my blog; and I hope some one else with injuries or challenges like mine find my sharing of my experience helpful in some way. I know I have gotten a lot out of the stories you all have shared with me recently in relationship to past injuries and recoveries you've made. Our bodies and minds are amazing! Love to you all!