Getting unstuck

I've been doing Pilates at home on my (friend's) mini reformer, the AeroPilates, for about three months now. I've increased from once a week to three days a week, now to about every other day and sometimes more often than that. I've also been getting incredible "rolfing" or deep tissue massage which couples the physical massage experience with a much deeper stored memory (usually trauma), emotional, and spiritual release. The massage was every other week for about two months, then every three weeks, now every four to six. Every other week (on average) I attend a "restorative yoga" class which I nickname as "assisted naps". It's the slowest, most gentle, effective "yoga" one can imagine. I took this class the day after one of my massages last week, and for only the second time in a year was able to fully go into Child's Pose without much effort or strain. I quietly celebrated with a little wiggle of excitement as everyone else in the room dozed off momentarily. All of these acts of self-care have been incredibly transformational, moving, and encouraging. I've found the groove that has taken my body to the next level of healing and strength. 

At work, I've transformed my office to include a stand-up computer workstation. This allows me to get up and down a lot more frequently and even stand for extended periods of time. For a girl who battles the concept and physical reality of sitting at a desk all day, this sitting-standing combo has brought much relief and spring in my step you might say. I get up from sitting and can walk with ease, no stiffness when walking at all (usually having only sat for a few minutes, not a half hour or more).

The combination of Pilates, deep intentional massage, restorative yoga, and the stand up work station have dramatically improved the stiffness in and around my left knee. At times the massage has worked "miracles" in my opinion. I come out of a ninety minute session moving and feeling as light as a feather. My mood dramatically improves as well. The massage has truly facilitated incredible breakthroughs. The yoga instills relief and a sense of deep inner peace and trust and truth seeking. I wake up in the morning and it takes only a couple steps to shake the kinks out and walk normally to the bathroom. I end my day easily traversing the steps to my bedroom. I bike everyday, sometimes standing up on the pedals to power up a hill. All this without a hitch.

The thing that still bugs me is the soft tissue pain, mostly behind my knee, when I try to do a full extension. This is something my massage therapist and Pilates instructor/physical therapist and yoga teacher continue to monitor and reassure me that it just needs some good stretching. Regardless, it's frustrating. All the stretching and massage help certainly but only temporarily for this tiny little bit of stiffness felt upon full extension of my left leg. Last night I had this sudden insight. My subconscious lit up and said loudly, "Go get acupuncture." Then I thought, is it acupuncture or some other energy work - like reflexology or reiki - that I need? 

There's always something we can do to move through stagnation, even the tiniest effort or awareness can cause a dramatic shift. I've heard the calling to do something different about this bit of stiffness behind my knee, which has been plaguing me since my first "quad set" with the home physical therapist last year. I'm excited about this new awareness and invitation to bring in more alternative healing modalities. There's really no telling where it will lead in both my physical body and my day to day life. It's time to get unstuck, one level deeper.

I will never again take for granted the ability to walk!

It has been exactly 99 DAYS since my bike accident and surgery. In just the past couple of days I have been able to go without any walking assistance (no crutches) about 50% of the time, still wearing my brace. What a great break through!

At physical therapy today I showed April how I could walk down the hall, in my shuffle sort of way. She took the crutch away from me and said... "Get going! Last room on the right." So just a few hours ago there I was walking, no crutches and without my brace for the very first time. I actually felt really strong without the brace. It was liberating. I don't feel this way in the morning - and sometimes during the middle of the day, I feel so weak and tired and painful that I can hardly bear another step. But tonight I did a little dance (like waving my arms in the air) for April as I strutted down the hall to the examination room. After our bending session (where I went to 122 degrees), I raced April to the bike to start my work out. I flew through my PT routine in about 1 hour (versus the regular 2), iced up, and went and met friends for drinks!

Last weekend I watched people walk across the crosswalk at a nearby intersection while Alon and I sat outside Atlas cafe drinking tea. It brought tears to my eyes as I thought most of them take walking for granted. I was sad and mad and jealous. I'm never again going to take walking for granted. I swear it. I'll remember this experience and all these emotions for the rest of my life. Walking carefree and being "able-bodied" is such a gift.

All week my coworkers have watched me go up and down the couple of stairs to the back entrance of our building. Cautiously move around the building with more ease. Go a few more feet every day with one crutch, then no crutches. Venture up a flight of stairs to the second floor for the first time in several months. Walk from my office to the front lobby without any assistance. Every moment I walked another step on my own, I really relished in the moment. Every time I took a step was a diligent, tireless, purposeful effort of reminding myself to engage my leg muscles, flex my quad, straighten my back, engage my core, touch my heel to the ground, straighten the knee, push off the toe, bend the knee, plant the heel again. Tighten the muscles. STEP. Repeat. My walking has turned into a mindfulness practice, and it's been truly amazing.

Last night I coordinated with Alon to make us some smoothies for dinner. My coworker Jenny would drive me home from work at 5:30. Alon and I would scurry off to the gym for one hour, then we'd make it - albeit 40 minutes late - to the BCAP Annual World AIDS Day Concert at First United Methodist Church. The coordinated effort was critical and we pulled it off! As we slowwwly walked across the icy parking lot to the church at 7:35. That was an awesome effort!

The last couple of days have been particularly sketchy as we have had very cold temperatures, snow, and most walkways and roads hardened with slick ice last night and this morning. Everyone who saw me out and about said with a loving, cautious tone, "PLEASE be careful." And I was. I walked out of my house this morning to start the car as Alon was finishing up something inside. We were about to head out together. As I stood on the curb getting ready to step down into the street this morning and start the car, the reflection of glaring ice stopped me. I felt doubt, discouragement, and then, most of all rationality. This experience has made the most obvious EVEN clearer. I poked the ice on the road a couple times with my crutches and decided that I couldn't take the step knowing I would be safe. It would be pushing the limits. I was reluctant, yet I stood there with my head down, just staring, wondering if I could do it, HOW I could do it. I decided I couldn't do it without help. Mind and body fought for a while, but my body knew more than my mind. My ego reared it's head and then was cast aside. I still stood there, contemplating, staring at the ground - wishing for an alternate reality yet knowing the truth - until I was ready to turn around to go back inside and wait for Alon.

Just then Jenny drove by. Sweet little southern gal. What timing. She always drives by my house on her way to work in the morning, but I'd never actually seen her unless she was stopping to pick me up. Well, by golly, there she was! She put on the brakes just a bit past me and pulled over, rolled down her window, and yelled, "Hey Erin, do you need help?!" To which I replied, "Yes, I'm going back inside to get Alon!" "Ok. See you at the office!" Jenny yelled back. "Sounds good, thanks!" I said.

It's really hard to ask for help but if you listen REALLY carefully you know WHEN... and listen even more carefully and you know HOW and WHO to go to. It's amazing to me the friends, family, coworkers, and complete strangers who have come together for me lately to be my support team when I need it. To say to myself, "I can do a lot of things, but I CAN'T do this on my own" without feeling some sense of defeated self-worth is really difficult to come to terms with. But when I'm surrounded by people who just want to see me succeed and be happy, everything seems okay again. My decision by the curb this morning felt rational, solid, and self-assured. I knew I didn't want to get hurt or take a risk that could ultimately result in injury or set back. The love and support of those around me and those whom I hold in my heart help empower me to make the right decision. I acknowledged that I needed help, I sat with it - literally, as I stood there holding my crutches and stared at the ground without moving. Jenny reminded me that it's okay to ask for help. And I knew I could always count on Alon's patience, kindness, help, and loving understanding - even for the simplest of things. Even when he doesn't realize how awesome and helpful he is, he's that much more amazing to me.

This last week in particular there have been several times when I have felt strong and weak, tired yet determined all at the same time. When someone asks me if I have pain, I've learned to craft my answers in such a way that allows my body and mind a chance to respond genuinely and for "both" to be acknowledged. For instance, "Yes, I feel pain in my foot like I'm walking on a sprained ankle but the more I walk on it, the more blood flow it gets and the quicker it will heal. My quad feels weak and my knee is swollen and stiff, so I can't take a long normal stride but I CAN walk a little bit. See?" I'm where I'm supposed to be. I just need to keep working out and trying to walk and tell myself to walk even when I don't want to anymore. 

Life is really that simple: ONE STEP AT A TIME - while every step seems simple it is a challenge (to some degree) and requires the utmost dedication or else it simply will not happen.

The Down-Swing to the Up-Swing

That sadness and fear and weakness that I pushed back during physical therapy on Friday seemed to resurface Saturday evening. What a surprise. 

The sharp, frequent, stabbing pains through the medial side of my knee were really getting to me. They've been happening with more frequency the last couple of days. I am certain it is from increased, constant weight bearing at PT from Friday. 

I had a somewhat "full" day Saturday with out over doing it, I thought. Started the day with a lovely Skype session with my brother Mike and his girlfriend, Alicia, in New York. Got a quick and tasty breakfast burrito at Illegal Pete's with Alon. Viewed an apartment (with a billion stairs and down branches everywhere). Scooted around Whole Foods with Alon (me: in a power scooter that could literally turn on dime, a 1000 times better than the Target version). And in the afternoon, I finally sat for about two hours while I got my hair colored. I decided to take the day off from the gym/PT. I was feeling fatigued since I woke up but decided to continue activity at a relatively slow pace, checking in with myself (did I want to go home and sleep or go grocery shopping with Alon? for instance). By late afternoon and night time, I was completely beat, a bit cranky, and the pain had not subsided at all despite 1000mg of Tylenol since morning. Alon and I cooked dinner and watched two movies. I iced my knee a bit, later on putting heat on the medial part of the knee. I was trying everything.

Did I mention Boulder was experiencing 60+ mph gusts yesterday? Today it's not so bad, less wind up, but still up there at probably 30-40 mph. Anyways, that kind of wind always makes me feel unsettled, even on a good day. And surely challenges my stability (physically and mentally) while on crutches.

As I write this and reflect more on my day yesterday, I realize, "Shit. I did not actually take it very easy." Well, I tried. I did go slowly, if that counts. The conversation I had with myself yesterday was "If I went home I would be letting the fatigue win and probably feel sad or something." 

I was starting to have regrets later in the day that I didn't go to the gym, since I was feeling so crappy. Alon reassured that I was fine and it was probably an okay thing to do (and it was).

The balance I was trying to achieve was activity without increasing my pain while not giving in to fatigue. That's hard!

By night fall, as I tried to stretch and massage my left leg in bed, I wept. Whether it was pain, fatigue, or frustration that set it off. There I was, crying yet again. Oh well. It was, again, cathartic. I remember yelling (in a nice way!) to Alon in the other room, asking if he could please put away the left overs from dinner. He was like, "Sure." Here's the straw the broke the camel's back last night: the fact that I couldn't do it; I couldn't muster up the strength to crutch to my wheel chair in the other room, put down the crutches, wheel into the kitchen, put everything away in Tupperware, clean up, and put stuff in the fridge. It was just too much. There's got to be a word for angry-self-pity-weakness-discouraged. That is what it felt like.

Anyways, that was my moment last night. The down swing to the up swing.

I woke up with a headache this morning. Scarfed down a bowl of gluten-free granola and drove to the gym, where I proceeded to do rehab work out. I felt good about getting there and that is was the right thing for my body and mind. I was still very stiff and sore when I work up. The work out did help with that. The interesting part again was the first few minutes on the bike. I just cried. Discretely trying to wipe the tears from my cheeks. I focused my pain, tiredness, weakness, and frustration into the healing process and strength of my leg. I listened to some good music in my headphones and 15 minutes went by on the bike. I continued with the rest of my work out and headed home about an hour and a half later. Slightly less tired, slightly less pain.

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.

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.)

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!

A picture of my anger

I think it was Wednesday last week... two weeks ago now. I've been sitting on this update for a while; not wanting to return to it or even re-read it for typos and what not. Anger is a tough one to write about because it require reflection and it just kind of sends me spinning in a way. 

The day was coming to an end. I was somewhere between restless and getting ready for bed. Alon was preparing "cold therapy machine" for the evening ( Breg Polar Care 300: http://www.breg.com/cold-therapy/polar-care-300.html ). I may have started a little PT or just started the routine of changing into my pj's. A sharp jab of pain through my left shoulder ignited. The waves of emotion and pain can come on so suddenly and so intensely. As I mentioned in a prior post, at least 1-2 times per day, I get teary.

This time was different. Pain preceded anger. I was feeling straight up ANGER, with notes sadness, coursing through me like boiling hot water. The anger was thick with pain. Mentally, I felt as if I was suddenly walking along a delicate precipice where I could plummet from hopeful to hopelessness in the blink of an eye.

I cried so hard and so loud I could barely breathe or recognize anything familiar. In the moment, the feeling reminded me of how hard I have cried when someone I loved has died. It was this incredible experience of anger, hatred, and the loss of control in my life. I could barely catch my breath. Sometimes the tears wouldn't even come; it was so cathartic.

I pounded this poor, defenseless feather pillow on my bed with a gentle fist. Truly gentle. I had this other image of digging through sand on a beach and just flinging the sand high into the air.

Alon walks in, continuing to set up the ice machine. I know he is not ignoring me; I know he is just letting me express my anger and sadness - uninterrupted and unhindered. He finally walks over to me and sits on the bed, looks me in the eyes, his big beautiful brown eyes, and says simply, "It will all be okay. You're doing great." Then he said something funny that made me laugh.

Friday was another one of those days last week... a learning experience between me, my doctor, my doctor's assistant and Alon. Boiled down to advocating for oneself and seeing my Alon step up and advocate for me. He is such a rock. I don't want to get into the details now, but thought I should post this since I've been sitting on it for over a week now. There was a lot of anger, rage in this little episode as well.

And then most recently, this past Thursday... a complete release (trauma response?) during a massage from my friend Bree. Everything was going great. Bree is a wonderful new-ish friend. We were in a good space; chatting; breathing; relaxing; finding those sweet spots that needed attention in my body. She is able to help me work through some fears and insecurities about my body as I know it and more specifically, to the injury as it heals and we explore "the hurt area" more. Then a little massage in a gentle circular motion with her thumbs around my left knee cap. And I just started to shake, cry, and nearly hyperventilate. I was so glad to be in her loving, caring, comforting, capable hands a presence. It was kind of wild. I got so cold so fast and my body remembered more about that day, August 26th at about 3:30pm, than my mind could comprehend. More to talk about and think about later I suppose...