July 13, 2006
Doing the bowel program actually turns out to be quite simple. Maybe this means I’m weird (but you already know that ;-)), but I found it rather interesting to experience the mechanics of it, to feel the bowel muscles squeeze my finger in peristalsis, the BCR reflex provoked by the rotation of my finger.
However, I don’t find it interesting enough to be leaping at the chance to take over this duty on a permanent basis ;-) He needs to develop his endurance and shoulder flexibility quick!
After I’d finished with that (earning a “pass” from the nurse) and helped Gary with a bed bath and getting dress, we did a transfer to his chair and took off for the gym for a session with the tech (it just occurred to me there are two kinds of techs and I may have confused you – there is the therapy tech, with whom he does PT stuff, and then there is the nursing tech, who aids the nurse). The tech started him off on the Uppertone machine, on which he did side raises and rows (he joked that he needed less than no weight when he does raises with his left arm, as I had to even remove the pin on the machine for him to be able to lift the lever arm). After the side raises, he asked me to make up some of his protein drink, and he joked to the tech between the sets of the rows that he needed to drink some of this “muscle juice” to refuel him for the next set.
She next got him on the hand cycle, and when he started in with a little huffing and puffing, she told him he could breaks. He said he wanted to avoid doing so, because while there were lots of things he was strong enough to do now, he poops out and therefore needs to build his endurance.
Next came his stretching routine. Gary and I finished it up on our own because we ran out of time with the tech. While we were doing that, Gary’s PT walked by, and I reminded her she was going to show Gary another hamstring stretch, one that he can do on his own rather than depend on me to lift his leg up straight while he is lying in bed (though after he gets more flexible and stronger, he should be able to do that one himself). This new stretch consisted of him having his legs out straight in front of him and sitting as upright as he can while keeping his knees straight (as opposed to his knees popping up). A more flexible person might even be able to lean forward and keep his knees straight, but Gary had to stay in a backward lean.
After the stretching, he lay back down and prepared to roll to his side so he could get closer to the edge of the mat, in preparation to sit up and get his legs over the edge so he could transfer to his chair. As he took a few preliminary swings with his arms, he commented his shoulders were stiff and sore. He stuck out his lower lip. “They’re hurting me,” he pretended to pout. We laughed, and I offered to help him stretch his shoulders. We did that for a few minutes, and then he rolled, sat up, and we did his transfer into the chair.
We had a half hour break, and then it was time for his session with the OT. Gary thought she was planning to do another community IC with him, and he was right. I wasn’t sure I was invited, but I acted like I was and wasn’t told otherwise. So there we were, three of us – two females and a male in a wheelchair – all in one of the stalls in the public men’s room on the third floor of Shepherd (fortunately the stall was a large one). As Gary set out his equipment on the transfer board he’d set across the toilet and went through the steps of the IC, the OT kept up a running conversation – asking Gary if he would talk to another patient who was about to have flap surgery and was worried about it (yes, this guy too had gotten a bedsore while at another hospital), asking us about the van class we’d attended, and so forth. At one point I laughed, saying it seemed odd to be carrying on this conversation as we all waited around for Gary to finish with the job at hand. The OT said she’d thought it better to talk than to stand around in awkward silence during what is usually a private moment. I told her Gary had told the nurses, kiddingly, that he was going to have to watch it when he went home, so used was he now to so many people seeing him unclothed. He didn’t think it would go over very well if he announced, “Sorry, class, it’s time for my IC” and then proceeded to do it right then and there.
We all got very quiet as a man entered the restroom and went into the other stall. The OT and I held back snickers as, for some reason, the guy kept heaving sighs. The man gave no indication that he noticed all the feet in the next stall. After he left, I commented to the others how we’d all fallen silent, saying I had done that because I hadn’t wanted to freak the other guy out, and they
agreed with that motivation.
Gary passed this test successfully this time (asking the OT, “So, does this mean we don’t need to spend any more time in the bathroom together?”), and as we were getting ready to leave the john, the OT commented that she wanted Gary to work on his method of propulsion in his wheelchair. After you push your wheels, you are supposed to drop your hands down and bring them toward the rear of the wheels, so they kind of describe a circle. Gary has the tendency to bring his hands straight back, which means he only gets them to the top of the wheel, and which, according to the therapists, is harder on the shoulders. The OT seemed ready to end the session, but I innocently ;-) said, “Is that all for today?” (Hey, there were another ten minutes to go – I want Gary to get his money’s worth whether or not he likes it ;-)) She looked at her watch and decided she could set up a little obstacle course of chairs for Gary to weave in and out of and practice the proper push. So he did that, but I know it didn’t break his habit: I pointed out shortly after his session, as we went back to his room, that he had already fallen into his old pattern. He isn’t quite convinced that he needs to break that habit, I know. I found a rehab article on the 'net comparing the different techniques and saying that the method the therapists here recommended was the better one to prevent shoulder problems, so I will have to show that to him. Maybe he’ll do some web research on it on his own.
By the way, speaking of bathrooms, Michel Smith emailed us that he is discussing with the university’s ADA officer about refurbishing the men’s room on the third floor of the math dept. building so it will be accessible to Gary, rather than him having to use the one on the second floor! Michel also wanted the measurements of Gary’s chair in order to make sure Gary would have a desk that would be a comfortable working surface :-)
A little non sequitur note (you remember those, don’t you?): Gary no longer is restricted in how long he can sit in his chair, as of today! (Though a nurse confided to me that the patients were usually back in bed by 6pm anyway – they’re still healing, after all, and there’s all this therapy tiring them out.)
During a break after lunch, Gary found the other person who was going to have flap surgery and talked with him awhile about it. I wasn’t there but Gary said he spoke about how good the doctor is, that his own flap is healing slowly but surely, that the three weeks in bed afterwards wasn’t all that bad – therapy is still done at bedside and your bed is rolled to classes so you can attend them.
In the afternoon, Gary had a wheelchair maintenance class. Between some combination of hearing the information again and not having the information rushed through, I didn’t find it as confusing as it had been when I’d heard it during the family training class.
Next we went to “group chair class,” whose stated purpose was to strengthen you for using your chair. I wasn’t quite sure what that meant, but it turned out to be a group weight training session. Gary thought I’d be bored during it, but I wanted to at least see what they’d do, and it turned out to be a good thing I stayed. First they started with arm stretches, and Gary had problems with that for two reasons. First was his lack of shoulder flexibility, so to get anything out of the exercises he really needed someone to provide a little support and a little extra stretch. Secondly, they did the stretches while sitting up in their chairs, and as the exercises required both hands being used at the same time, Gary didn’t have the balance to do them without me holding onto him at the shoulders so he wouldn’t fall over. Same thing with the weight exercises. He can barely hold both hands up in front of him in “chipmunk” position, for example, without tending to fall forward in his chair, so holding weights in his hand while in a similar position just aggravated that propensity, and moving the weights forward or out caused him to topple. Even in doing the various exercises with just one arm at a time and trying to use the other to help provide support, with the weight in his hand he couldn’t keep his balance on his own. So I held him by his shoulders the whole time as he did biceps curls, triceps extensions, rotations, side raises, punches, etc. I guess the other people in the group either had more abdominal control or their chairs gave them better support, as they didn’t have this problem with their balance.
I did not like how the exercises were led. The therapist counted off the repetitions at a rapid rate, so the only way the exercisers could keep up was by slinging their dumbbells around, using momentum rather than muscle, not getting the full effect of the exercise. I muttered something to that effect to Gary, and when there was a break between sets I whispered in his ear, “Think I should tell her she needs to slow things down?” To my surprise, since I hadn’t really been serious and he is usually the “don’t make waves” type (or at least, that is my impression of him), he said, “Why don’t you?” So I “asked” her if it wouldn’t be better if they did the exercises at a slower rate, so that muscle rather than momentum would be used. She claimed they couldn’t use momentum in the positions they were in, which made no sense to me, but I didn’t push it. But when she started another set and it looked to me like Gary was feeling pressed to keep up the pace with the others, I burst out, loud enough for her to hear, “Slow down. You’re going to hurt your shoulders.” Since we had already told her he couldn’t do the stretches like she wanted him to on account of his shoulders, I figured she would accept this as a reason for him not try to keep up with the others – and besides, it was true, he was more likely to hurt his shoulders if he didn’t keep the weight under control, not to mention that the exercise would be more effective if done under control. I wasn’t sure he’d listen to me, but he did, and it then became kind of funny in a tenderhearted way (at least to me): she wanted them all to participate in counting out the repetitions, so he would call out the same number as the rest of them, just to be part of the group, even though he was doing the exercises at about half their speed and therefore was way behind them on what repetition he actually was on. She did comment to him that his form was good and she liked how he went for quality, but why she didn’t encourage that in the others, I don’t know.
After that session was over, I told him anytime he wanted to work on balance exercises with me, to let me know. We are going to try to remember to ask his PT what would be good ones for the two of us to do – I don’t want to do any where there is any danger of him falling forward off the exercise mat, for example. We are also going to ask if his chair needs any adjustment so that it is not so difficult for him to keep his balance when his hands are raised in front of him.
We talked to my brother Joe a few times throughout the afternoon. The main thing going on at the house right at the time was that the floors were being leveled in preparation for the wood floors being laid tomorrow. The pictures we’ve seen of the house look fantastic – I can hardly recognize the place. Joe is such a perfectionist in his work. I guess that shouldn’t surprise me – we are related, after all ;-).
I went off to the chiropractor again so he could try to bend me back into my proper shape – I feel like I need to see him about every four hours. In the evening when I came back to Gary’s, the man was fast asleep, so I worked on the blog awhile. After he woke, I got him some ice cream, then we went through the stretching routine. When we did his shoulders, he looked down at his forearm as I held it. “Wow, they really are bigger, aren’t they?” he commented. I told him they were about twice as big as they had been when he’d first come here, that I could have practically wrapped my hand around them twice at that time (exaggerating a little ;-)) but that now I needed two hands to get around them; I said that when he’d first arrived, even the tops of his arms had looked like sticks. He then said that the Birmingham PTs and OTs certainly could have done better by him – he’d seen them maybe twice the entire time, they’d given him an exercise band to pull on, which he couldn’t use because of it pulling on his IV needle, and that was it. I said it sure made a difference, coming to a place like Shepherd with such expertise. Then I added with a wink, “Of course, now I tell them how to do their jobs.” He told me I’d make a good boss (no, I wouldn’t – my employees would hate my perfectionism), that now I knew their jobs better than they did. “Or at least I think I do,” I said in self-mockery. “I think you do too,” Gary said.
I then did his wound care, and after that I gave him a little massage. He had complained after waking up from his evening nap that for the last two nights there has been a spot on the back of his shoulder that is bothering him, like a nerve is being pinched. It only bothers him when he lays in certain positions too long. I hope this resolves quickly, as he sure doesn’t need this kind of problem along with everything else. I massaged him a bit on the tender part and reminded him that he could have the chiropractor come here, or a massage therapist, to see if they could help with the problem. Then we got him positioned on his side, and I climbed in for a little hoodle. Shortly thereafter, I gave him a kiss goodnight, and told him I loved him very much. “I know that,” he said, “based on what you did for me this morning.”
I laughed.
Doing the bowel program actually turns out to be quite simple. Maybe this means I’m weird (but you already know that ;-)), but I found it rather interesting to experience the mechanics of it, to feel the bowel muscles squeeze my finger in peristalsis, the BCR reflex provoked by the rotation of my finger.
However, I don’t find it interesting enough to be leaping at the chance to take over this duty on a permanent basis ;-) He needs to develop his endurance and shoulder flexibility quick!
After I’d finished with that (earning a “pass” from the nurse) and helped Gary with a bed bath and getting dress, we did a transfer to his chair and took off for the gym for a session with the tech (it just occurred to me there are two kinds of techs and I may have confused you – there is the therapy tech, with whom he does PT stuff, and then there is the nursing tech, who aids the nurse). The tech started him off on the Uppertone machine, on which he did side raises and rows (he joked that he needed less than no weight when he does raises with his left arm, as I had to even remove the pin on the machine for him to be able to lift the lever arm). After the side raises, he asked me to make up some of his protein drink, and he joked to the tech between the sets of the rows that he needed to drink some of this “muscle juice” to refuel him for the next set.
She next got him on the hand cycle, and when he started in with a little huffing and puffing, she told him he could breaks. He said he wanted to avoid doing so, because while there were lots of things he was strong enough to do now, he poops out and therefore needs to build his endurance.
Next came his stretching routine. Gary and I finished it up on our own because we ran out of time with the tech. While we were doing that, Gary’s PT walked by, and I reminded her she was going to show Gary another hamstring stretch, one that he can do on his own rather than depend on me to lift his leg up straight while he is lying in bed (though after he gets more flexible and stronger, he should be able to do that one himself). This new stretch consisted of him having his legs out straight in front of him and sitting as upright as he can while keeping his knees straight (as opposed to his knees popping up). A more flexible person might even be able to lean forward and keep his knees straight, but Gary had to stay in a backward lean.
After the stretching, he lay back down and prepared to roll to his side so he could get closer to the edge of the mat, in preparation to sit up and get his legs over the edge so he could transfer to his chair. As he took a few preliminary swings with his arms, he commented his shoulders were stiff and sore. He stuck out his lower lip. “They’re hurting me,” he pretended to pout. We laughed, and I offered to help him stretch his shoulders. We did that for a few minutes, and then he rolled, sat up, and we did his transfer into the chair.
We had a half hour break, and then it was time for his session with the OT. Gary thought she was planning to do another community IC with him, and he was right. I wasn’t sure I was invited, but I acted like I was and wasn’t told otherwise. So there we were, three of us – two females and a male in a wheelchair – all in one of the stalls in the public men’s room on the third floor of Shepherd (fortunately the stall was a large one). As Gary set out his equipment on the transfer board he’d set across the toilet and went through the steps of the IC, the OT kept up a running conversation – asking Gary if he would talk to another patient who was about to have flap surgery and was worried about it (yes, this guy too had gotten a bedsore while at another hospital), asking us about the van class we’d attended, and so forth. At one point I laughed, saying it seemed odd to be carrying on this conversation as we all waited around for Gary to finish with the job at hand. The OT said she’d thought it better to talk than to stand around in awkward silence during what is usually a private moment. I told her Gary had told the nurses, kiddingly, that he was going to have to watch it when he went home, so used was he now to so many people seeing him unclothed. He didn’t think it would go over very well if he announced, “Sorry, class, it’s time for my IC” and then proceeded to do it right then and there.
We all got very quiet as a man entered the restroom and went into the other stall. The OT and I held back snickers as, for some reason, the guy kept heaving sighs. The man gave no indication that he noticed all the feet in the next stall. After he left, I commented to the others how we’d all fallen silent, saying I had done that because I hadn’t wanted to freak the other guy out, and they
agreed with that motivation.
Gary passed this test successfully this time (asking the OT, “So, does this mean we don’t need to spend any more time in the bathroom together?”), and as we were getting ready to leave the john, the OT commented that she wanted Gary to work on his method of propulsion in his wheelchair. After you push your wheels, you are supposed to drop your hands down and bring them toward the rear of the wheels, so they kind of describe a circle. Gary has the tendency to bring his hands straight back, which means he only gets them to the top of the wheel, and which, according to the therapists, is harder on the shoulders. The OT seemed ready to end the session, but I innocently ;-) said, “Is that all for today?” (Hey, there were another ten minutes to go – I want Gary to get his money’s worth whether or not he likes it ;-)) She looked at her watch and decided she could set up a little obstacle course of chairs for Gary to weave in and out of and practice the proper push. So he did that, but I know it didn’t break his habit: I pointed out shortly after his session, as we went back to his room, that he had already fallen into his old pattern. He isn’t quite convinced that he needs to break that habit, I know. I found a rehab article on the 'net comparing the different techniques and saying that the method the therapists here recommended was the better one to prevent shoulder problems, so I will have to show that to him. Maybe he’ll do some web research on it on his own.
By the way, speaking of bathrooms, Michel Smith emailed us that he is discussing with the university’s ADA officer about refurbishing the men’s room on the third floor of the math dept. building so it will be accessible to Gary, rather than him having to use the one on the second floor! Michel also wanted the measurements of Gary’s chair in order to make sure Gary would have a desk that would be a comfortable working surface :-)
A little non sequitur note (you remember those, don’t you?): Gary no longer is restricted in how long he can sit in his chair, as of today! (Though a nurse confided to me that the patients were usually back in bed by 6pm anyway – they’re still healing, after all, and there’s all this therapy tiring them out.)
During a break after lunch, Gary found the other person who was going to have flap surgery and talked with him awhile about it. I wasn’t there but Gary said he spoke about how good the doctor is, that his own flap is healing slowly but surely, that the three weeks in bed afterwards wasn’t all that bad – therapy is still done at bedside and your bed is rolled to classes so you can attend them.
In the afternoon, Gary had a wheelchair maintenance class. Between some combination of hearing the information again and not having the information rushed through, I didn’t find it as confusing as it had been when I’d heard it during the family training class.
Next we went to “group chair class,” whose stated purpose was to strengthen you for using your chair. I wasn’t quite sure what that meant, but it turned out to be a group weight training session. Gary thought I’d be bored during it, but I wanted to at least see what they’d do, and it turned out to be a good thing I stayed. First they started with arm stretches, and Gary had problems with that for two reasons. First was his lack of shoulder flexibility, so to get anything out of the exercises he really needed someone to provide a little support and a little extra stretch. Secondly, they did the stretches while sitting up in their chairs, and as the exercises required both hands being used at the same time, Gary didn’t have the balance to do them without me holding onto him at the shoulders so he wouldn’t fall over. Same thing with the weight exercises. He can barely hold both hands up in front of him in “chipmunk” position, for example, without tending to fall forward in his chair, so holding weights in his hand while in a similar position just aggravated that propensity, and moving the weights forward or out caused him to topple. Even in doing the various exercises with just one arm at a time and trying to use the other to help provide support, with the weight in his hand he couldn’t keep his balance on his own. So I held him by his shoulders the whole time as he did biceps curls, triceps extensions, rotations, side raises, punches, etc. I guess the other people in the group either had more abdominal control or their chairs gave them better support, as they didn’t have this problem with their balance.
I did not like how the exercises were led. The therapist counted off the repetitions at a rapid rate, so the only way the exercisers could keep up was by slinging their dumbbells around, using momentum rather than muscle, not getting the full effect of the exercise. I muttered something to that effect to Gary, and when there was a break between sets I whispered in his ear, “Think I should tell her she needs to slow things down?” To my surprise, since I hadn’t really been serious and he is usually the “don’t make waves” type (or at least, that is my impression of him), he said, “Why don’t you?” So I “asked” her if it wouldn’t be better if they did the exercises at a slower rate, so that muscle rather than momentum would be used. She claimed they couldn’t use momentum in the positions they were in, which made no sense to me, but I didn’t push it. But when she started another set and it looked to me like Gary was feeling pressed to keep up the pace with the others, I burst out, loud enough for her to hear, “Slow down. You’re going to hurt your shoulders.” Since we had already told her he couldn’t do the stretches like she wanted him to on account of his shoulders, I figured she would accept this as a reason for him not try to keep up with the others – and besides, it was true, he was more likely to hurt his shoulders if he didn’t keep the weight under control, not to mention that the exercise would be more effective if done under control. I wasn’t sure he’d listen to me, but he did, and it then became kind of funny in a tenderhearted way (at least to me): she wanted them all to participate in counting out the repetitions, so he would call out the same number as the rest of them, just to be part of the group, even though he was doing the exercises at about half their speed and therefore was way behind them on what repetition he actually was on. She did comment to him that his form was good and she liked how he went for quality, but why she didn’t encourage that in the others, I don’t know.
After that session was over, I told him anytime he wanted to work on balance exercises with me, to let me know. We are going to try to remember to ask his PT what would be good ones for the two of us to do – I don’t want to do any where there is any danger of him falling forward off the exercise mat, for example. We are also going to ask if his chair needs any adjustment so that it is not so difficult for him to keep his balance when his hands are raised in front of him.
We talked to my brother Joe a few times throughout the afternoon. The main thing going on at the house right at the time was that the floors were being leveled in preparation for the wood floors being laid tomorrow. The pictures we’ve seen of the house look fantastic – I can hardly recognize the place. Joe is such a perfectionist in his work. I guess that shouldn’t surprise me – we are related, after all ;-).
I went off to the chiropractor again so he could try to bend me back into my proper shape – I feel like I need to see him about every four hours. In the evening when I came back to Gary’s, the man was fast asleep, so I worked on the blog awhile. After he woke, I got him some ice cream, then we went through the stretching routine. When we did his shoulders, he looked down at his forearm as I held it. “Wow, they really are bigger, aren’t they?” he commented. I told him they were about twice as big as they had been when he’d first come here, that I could have practically wrapped my hand around them twice at that time (exaggerating a little ;-)) but that now I needed two hands to get around them; I said that when he’d first arrived, even the tops of his arms had looked like sticks. He then said that the Birmingham PTs and OTs certainly could have done better by him – he’d seen them maybe twice the entire time, they’d given him an exercise band to pull on, which he couldn’t use because of it pulling on his IV needle, and that was it. I said it sure made a difference, coming to a place like Shepherd with such expertise. Then I added with a wink, “Of course, now I tell them how to do their jobs.” He told me I’d make a good boss (no, I wouldn’t – my employees would hate my perfectionism), that now I knew their jobs better than they did. “Or at least I think I do,” I said in self-mockery. “I think you do too,” Gary said.
I then did his wound care, and after that I gave him a little massage. He had complained after waking up from his evening nap that for the last two nights there has been a spot on the back of his shoulder that is bothering him, like a nerve is being pinched. It only bothers him when he lays in certain positions too long. I hope this resolves quickly, as he sure doesn’t need this kind of problem along with everything else. I massaged him a bit on the tender part and reminded him that he could have the chiropractor come here, or a massage therapist, to see if they could help with the problem. Then we got him positioned on his side, and I climbed in for a little hoodle. Shortly thereafter, I gave him a kiss goodnight, and told him I loved him very much. “I know that,” he said, “based on what you did for me this morning.”
I laughed.
posted by Peg Daniels at 7:41 AM
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