July 14, 2006

This morning while Gary and I were waiting for the tech, we stretched Gary’s shoulders, did his transfer, and then he did a little balance exercising – sitting on the edge of the mat raising his hands and trying to stay upright. The tech soon joined us, bringing along pushup blocks. Gary’s first task: forty depression lifts using the blocks (turning the lifts into dips). He told me to kneel right behind him to make sure he didn’t fall backwards. (While he has gotten much better at “saving himself” by throwing his hands behind him when he falls backwards, this really isn’t possible to do when he has pushed himself up on the blocks and then falls backwards – no time to release the blocks and then get his hands behind him). He did the forty lifts in four sets of ten. Next, the tech wanted him to do forty more, this time with his legs up on the mat, straight out in front of him, instead of them dangling over the edge of the mat. This turned the lifts into a much harder exercise. In fact, getting into the proper position was an exercise in itself, as he had to do depression lifts to hop backwards on the mat while the tech held his legs to give him a little help. Once he was in the proper position (and after taking a little rest break from getting into it), he tried this new exercise. No way could he do it unaided – he couldn’t push up on the blocks without falling backwards (his already iffy balance made even worse by his inflexible hamstrings). So I held him upright by holding my hands against his shoulder blades while he did the lifts. With a little moaning and groaning in exertion, he got through those too.

The tech giggled as she read to herself the sheet of paper the PT had given her listing what was to come next, and we had a sense of foreboding. “Seventy-five pushups,” she informed Gary. “Seventy-five pushups!” he exclaimed in disbelief. “This is a fifty-nine year old body!” She told him he’d do it easy, to take a little rest from his lifts before starting. He rolled onto his stomach and collapsed face-down onto the exercise mat. “Seventy-five pushups,” he informed the mat in a “she’s out of her mind” tone of voice. But he did them, five sets of fifteen, beet red at the end of each set. I told him I bet if someone had told him a year ago he could do seventy-five pushups, he wouldn’t have believed he could. “You got that right,” he informed me. For the rest of the day, whenever anyone asked how his day had gone, he told them in mock indignance how his therapists had made him start if off with eighty depression lifts followed by seventy-five pushups. But I suspect he is proud of his accomplishment.

He was grateful that the final task on the tech’s list was his stretching routine. We went a little over time again, and ended up with a half hour break before his next session instead of an hour. I asked him if he wanted to practice anything else before the next session, but he wanted to rest, as next up was an hour in the gym with the exercise rec therapist, and he feared the torture she planned to inflict on him. So we did a transfer back into this chair, intending to return to his room for a short while. After the transfer, he asked if I’d given him much help. I said I’d helped a little, both because it hadn’t felt like he was getting a major leap and because I thought he might be a little tired out from all the lifts and pushups. I admitted that when the therapists weren’t around I probably tended to help him with the transfers more than I had to, that I couldn’t stop myself from doing that – I didn’t want him to get hurt so I wanted to make damn sure he landed square in the chair. He said he understood, that “better safe than sorry.”

On our way to the exercise rec therapist, Gary again said he was worried about the session, that he was still feeling the effect of those lifts and pushups. I told him that those exercises worked his triceps and chest muscles, and if he told her what he’d done, she would probably work his back. He started off the session by making sure the therapist knew about all the lifts and pushups. She thanked him for informing her and told him that they would therefore work his back muscles :-)

She started him off on the NuStep machine (see http://www.nustep.com/ for a picture), which is the machine the “been there done that” guy had advocated, and Gary really liked it. He transferred onto the seat of the machine, then the therapist strapped his feet onto the pedals and put another strap around his thighs so his legs wouldn’t splay out. He exercised on it for ten minutes, pulling on the hand levers, which caused his legs and feet to move as well. As the website mentioned above states, “NuStep® Recumbent Cross Trainer's unique design lets you move arms and legs in a fluid motion that simulates walking with the added benefits of resistance training.” The therapist told him that among other benefits, it was a really good way to get the circulation going in his legs. I opined that one of those benefits would be that it would help disperse the fluid accumulation Gary has in his feet (which is a common problem for those with SCIs, due to sitting in the wheelchair all day without the use of the legs), and she agreed.

One thing that she noted during the session was that Gary now has one shoulder hiked up way higher than the other, something we never noticed before the accident (and in fact didn’t notice until he’d gotten to the point where he could sit in the wheelchair and do rehab). She told him to consciously try to keep his shoulder down so the muscle wouldn’t stay in a contracted state, and also to stretch his neck muscles. A little later, when the OT was working with Gary on his balance, she too commented on his uneven shoulders, and, lifting the back of his shirt and feeling his ribs, she noted that he had one of the ribs really sticking out (she had us feel it too). She thought maybe this was a result of how his broken ribs had healed after the accident. She wondered if he should get lateral supports on the back of his wheelchair to keep him more even in the chair and in that way help with his balance. I don’t think Gary wants that though – that would mean he’d have to have a solid back on his chair, and he likes the canvas one better as it gives him more mobility.

Back to the gym. The rec therapist showed him the cable tower and had him do rows and internal and external rotations on it. She told him he could do all the exercises on it that she’d shown him last time on the Bowflex. She also pointed out the exercise tubes (“stretch cords,” we used to call them in my swimming days; see, for example, http://www.exercisetubes.com/), telling him that using them was a nice portable way to do a lot of these exercises.

She finished by showing him the “Easystand machine.” (See http://www.easystand.com/products/6000.html ) He isn’t ready for this machine yet, but when he is, the first step is to get him standing upright in it, as in the bottom picture on that website. She warned him that many paraplegics got lightheaded, could even faint, when first brought upright, on account of the blood rushing down into their legs. So, it is a gradual process. Once he can stand upright in it (for half an hour, I believe she said), he can try to pull on the upper levers, which will move his legs in a cross-country type of motion. But even the standing would be good weight-bearing exercise for his leg bones, she said.

So, it turned out he hadn’t had to fear that exercise session – the therapist did a lot of talking and he did hardly any work. I notice he didn’t complain about that ;-)

Next came the lunchtime routine. Brad Bailey, one of Gary’s grad students, called during that time and informed Gary that he had cleaned out Gary’s office (for some reason Hercules’s task of cleaning out the Aegean stables came to my mind – not that I should talk ;-)). Gary was very grateful – as I said ealier, if you’ve ever seen Gary’s office, you would know that with his papers piled everywhere, it was not wheelchair accessible (nor habitable by many humans ;-) – again, I should talk). Gary couldn’t stay on the phone long, as it was time for the OT, so we toodled off to that session. The OT wasn’t in sight when we arrived, so I asked Gary if he wanted to do one of the stretching exercises she recommended – crossing one leg over the other – or to just wait for her. I then asked him, “Why are you smiling like that?” He said, “Because I feel like there is a right answer and a wrong answer to your question.” He is lucky I didn’t smack him ;-). He escaped that because he then gave the right answer.

When the OT came and found him with his legs crossed, she said that this would be the perfect opportunity for him to work on getting his one foot up so its ankle is crossed over the other knee, working toward the goal of being to be able to get his own shoes on and off. So he attempted to get his foot up, using chain loops to help haul his foot up his leg, but he needed lots of help from the OT. Once they’d gotten his ankle up, the OT stretched his leg in that position, trying to get knee level with his ankle instead of pointing upward as it was. She couldn’t help laughing, saying she knew we’d been stretching him in that position, but that there hadn’t been a tremendous improvement. I pointed out to Gary how much of a stretch the OT was applying to his leg, telling him to note that I hadn’t been doing that any more than that. “Yeah, but she’s the expert,” he said. The OT said that I was getting to be an expert just from being there; then she said, “Don’t look too good, Peg. We’ll lose our jobs” (then she added, “Just kidding”).

Ah, another ego boost – good for keeping my enthusiasm up.

They then worked on Gary’s balance, Gary having mentioned to the OT how he hadn’t been able to do any of those weight exercises yesterday in group without me holding onto his shoulders. She named some exercises he could do while sitting in his chair or in his bed to help develop his sense of balance – such things as dressing; any activity involving two hands, like drinking from a cup; a weight exercise where he lies on his side and moves a light dumbbell in front of him and around to the back. Then she gave him a walking stick to hold and had him try various things with it: hold it by both hands out in front of him, touch the tips to one side or the other (trying to shift his head and therefore his weight to the opposite side), lift the cane straight up with both hands, bring it straight out (putting his head back to counterbalance), bring it in (bringing his head forward as well – all such moves to keep the center of gravity at “the balance point”). Then she gave him a large beach ball and had him try to roll it from side to side or touch it gently from side to side. All of this was clearly exhausting, his face carrying an intense look of concentration as he wobbled around like a bowl full of jelly. He was definitely ready for a break after that, and fortunately we had one before seeing the PT.

During that break, Gary and I ran through his stretching routine (first transferring him back into his bed). We wanted to do it then, because there was another scheduled outing in the evening, from 6 to 9 – a dinner outing – and I didn’t want to have to do the stretching after that. I noticed that after getting him into bed, he was having some muscle spasms in his legs and abdomen. He said he was having more spasms lately, and wondered if that was good or bad. I told him something that had been said in one of my classes: it could be either – good, in that the muscles were getting some activity, bad, if the spasms got to the point where they were causing pain or interfering with daily activity. I hope his don’t get “bad.”

The PT started out with “fun” activities, also with the goal of working on Gary’s balance. First she and Gary played something with “Koosh ball” raquets, though they didn’t have an official koosh ball. I don’t think any of us really knew what that game entailed, but she and Gary batted the ball back and forth in a manner similar to table tennis (and sometimes it got accidently swatted to me, and I became an involuntary participant). Next she had him practice quick turns in his chair – he was to face sideways, then do a quick turn at her command and hit the beach ball back to her that she’d toss him. She left us in order to help an OT for a while with something, so she had me be the one to toss the ball to him while he made these quick turns. Then he and I were supposed to play catch, me tossing it not just straight to him but to one side or the other. (I later regretted these activities – the jerky motions and running after the ball caused me to pull some things in my shoulder, back, and leg, not noticeable at the time, but definitely noticeable later). He finished up with the “fun stuff” by dribbling the ball to one side of the chair or the other. I thought he was pretty good at this.

We then went out to the parking garage, and she and he practiced car transfers. He only experienced one head clunking, and his last transfer was a really good one – he was pleased about it for the rest of the day. The PT thought the way she’d aided him during the last transfer he did would probably be the way I should help him – one arm under his arm and across his chest for balance, the other under his butt, mostly for guidance, not lift – she said she’d helped him about 20% on the way out of the car, but only guided him on the way in. I would have to be his eyes as well, to tell him where butt was in relation to the car seat so he didn’t end up on some of the hard rims of the door frame.

After he’d made his last transfer out of the car, the PT noted that this time he’d managed to keep his shoes on (for some reason, they kept coming off during many of his previous car transfers). Gary noted that not only had his shoes stayed on, he’d managed to land so that one of his feet had ended up on the footplate of the wheelchair. “Just the way I planned it,” he joked. He told the PT that he felt really good about this session, that he could almost do this “for real.” He brought that up several times the rest of the day, and I would add to that his lift and pushup accomplishments, so I think he felt really pleased with the progress he’s making.

On the way back into the building, at the PT’s direction, Gary “took the curb” instead of going up the curb cut. He approached the curb at speed and did one of his wheelies, the PT right behind him to make sure his wheelchair didn’t tip over. I asked her whether when we went home and Gary had to go up a curb (assuming he ever does), if I’d be doing that kind of thing with Gary, or if I’d be doing the other way, which is harder on me, the way where I put my hip against the chair and push. Of course the way that is easier on me carries a greater danger of Gary tipping backwards, so we wouldn’t want that! The PT said we would practice that after Gary got more proficient at doing those with her. Gary said the first few times he practiced it with me, he would wear a helmet. Good idea!

After that session, I took off for my hotel to cook up some rice and zukes to take on our outing, then rushed back to Shepherd and waited for Gary at the bus. The patients’ chairs were strapped down in the bus, and then we took off. It was a short journey – the Bear Rock Café was only about six lights away, in the same shopping center as the Publix I sometimes go to.

Gary was first off the bus (because he was last on, and therefore strapped down in the rear), and the rec therapist told him his task was to open the door to the café while the others were getting off the bus. It was a heavy door, and it took him several tries. A man and a woman seated outside looked on in puzzlement, no doubt wondering why I was making this poor man struggle with the door, so I made sure I said to Gary in a voice that would carry to them, “Good job,” when he finally got through the door – thus assuaging any of my own guilt ;-).

The café was similar to a Paneera’s – soups and sandwiches, in this café the bread all organic. Gary ordered a root beer, a cup of paella soup, and what I think was called a beef dip sandwich – beef and gorgonzola cheese and peppers, etc. We wandered into the seating area and for some reason took an inordinate amount in choosing a table. The couple who had been outside had come in, and they offered to move for us so we could have their table. I’m not sure why they did that – maybe to have the opportunity to ask what was going on, because when we declined their offer, the man said that he could tell by the door incident we were on some kind of training run, so we explained a little.

Right after we’d chosen our table and I’d set my food carrier down, Gary’s order was called, so he went over to pick it up. I trailed behind him. The patients were supposed to try to be as independent as possible, only calling on the aid of their helpers as a last resort. The pickup counter was extremely high. Gary asked me if his bowl of soup had a lid on it, as he couldn’t see into the basket the food was served in, and I said “no.” It took him a couple calls of “excuse me” to get the attention of a worker in order to get the lid. I almost grabbed the basket as he lifted it down to his lap but refrained – however, had the basket been any heavier I fear its contents would have been dumped out.

After setting his food down at the table, it was time for a drink ;-). The drink dispenser was set up in a corner, making it hard to maneuver a wheelchair near it, and the handles for dispensing the drinks were too high for easy access – Gary couldn’t see how much drink was in his cup without tilting his cup – which of course he couldn’t do while dispensing the drink, as that would have been a two-handed activity (as his Saturday PT said, he may never be able to do such two-handed activities, on account on not having the balance due to the height of his injury). He filled the cup about half way. He then placed the cup on the counter next to the drink dispenser and reached into a compartment to get a lid for the drink. Again, the compartment was too high for him, and he ended up just grabbing at it and snaring a couple of lids instead of trying to carefully get out just one. Getting a spoon for his soup presented a similar problem.

Back at the table, he realized he’d forgotten napkins, so he wheeled back to the same area for some. When he returned to the table, he told me that the woman in the wheelchair now at the drink dispenser must have had even more problems than him, because as he’d wheeled away, she’d said, “Oh, shit. Somebody help me,” and the rec therapist had come to her aid.

We sat at a table by ourselves, and while eating Gary decided to put his long-sleeved shirt on – he’d made sure to bring it, having learned his lesson on the Dick’s outing ;-). I spaced out for a while, concentrating on my food. When I looked up, it seemed like quite some time had gone by and Gary only had his shirt on over his head. I looked at him. He looked at me. We both started laughing. He finally got the shirt down around his torso, me giving it only the final touches, both of us still laughing. “I don’t know why it amuses me how long it takes me to get a shirt on,” he said. “Better than ‘frustrates you,’” I pointed out. “That’s true,” he agreed.

After finishing his meal, he went to the dessert counter – tonight was “free dessert” night (or maybe they just did this for our group, I don’t know). Gary picked out a cake called “Chocolate Thunder,” which he said was very rich. He had only a couple bites. Unfortunately, since the accident, his body strongly reacts to the diuretic effects of caffeine, and he therefore can’t have much of it because he needs to keep his ICs under 500ml. So, he hasn’t been having any coffee (a true sacrifice, for him), or caffeinated tea (a couple trials where he took a few sips indicated he needed to give that up), and he hasn’t made much of a dent in all the chocolate sent to him.

After finishing the meal, Gary decided he wanted to get a paper, so he told the rec therapist he was going out to find one. Boy, was it muggy outside, like a sauna – particularly noticeable after the refrigerated air of the restaurant (why, in the South, do they keep the airconditioning on so cold??? I don’t recall the buildings in the North being kept at such frigid temperatures when it was hot outside). We didn’t find an outside paper box, but the drugstore in the shopping center carried papers. The employee behind the counter rushed over to open the door on our way out, but Gary told her he was practicing his wheelchair skills and not to help. On our way back to the restaurant, a woman at an outside table at another eatery said, “Looks like you’re on an outing.” It turned out that she was on the junior committee at Shepherd, a fund-raising and support group. We chatted awhile, Gary telling her to keep up the good work, that Shepherd was a great place. Then we returned to the café. It was time to go, and he and I waited outside while the others were loaded into the bus. He commented that he seemed to do more than the others on the outings – he was the only one to buy anything at Dick’s, and here, he’d gone out to get a paper. I told him he was going to be more prepared for the “outside world” when he left Shepherd. In fact, his PT had said something similar today, that we were already more prepared than most people when they left Shepherd. I would hate to be in their shoes then – I don’t feel ready to go.

We got back in his room about eight. We’d already done his stretching, and the nurse had changed his dressing in the morning, so we had all this “free time” we were no longer used to having. “What do you want to do?” Gary asked. “Get into bed and have a long hoodle,” I replied. “Sounds good,” he said. It took about a half hour to get him transferred into the bed, undressed, and positioned. Then I crawled in with him and we dozed together for about a half hour before I left for the night.

Mail call: Thanks to Todd Eisworth. I hope he doesn’t mind my sharing this, but in his letter, he said, among other things, that he had been thinking about Gary, was wondering about how he was doing, wasn’t sure how to find out, and that a Google search led him to my blog! Incredible. This reminded me that Jo Heath had told me in an email (and I hope that she doesn’t mind if I share this as well) that when she and Bob were at the conference in Greece, a number of East European and African mathematicians mentioned that they read the journal (blog). Truly amazing. (I laughed when she said that when they asked her how Gary was doing, she couldn’t tell them anything more about Gary’s recovery than they already knew from reading the blog.)

Todd’s and Jo’s letters got me thinking again about the genesis of the blog, about how all alone I felt, how very afraid I was, after the accident – particularly that first week – and about how writing to others about what was going on, while it didn’t relieve my anxiety, it eased it, a sense of shared burden, I think. The comments I get pertaining to the blog continue to make me feel like I’m not alone in this and keep my spirits up – good not only for me but for Gary, since we can give only from what we have, if you get my meaning. I’m certain things would be a lot harder on me if I hadn’t found this outlet and didn’t get the feedback. I admit I’m a little needy these days.

I had wondered how Todd had googled the blog, so I spent a couple minutes doing a search. I accidently used Yahoo! search instead of Google, filling in: “Gary Gruenhage” + accident. I didn’t get any hits, though I later discovered that, for some strange reason, the blog will come up if I remove the quotes. Anyway, before discovering that, I decided to fill in his name plus mine into the search bar. I didn’t get the blog, but I did come up with the following URL, which gives a photo (I assume taken by Ed Slaminka), of the math faculty and graduate students in 1982 (if I get permission from Ed, I’ll put the photo directly on the blog).

Here’s the URL: http://www.auburn.edu/~slamiee/NAMES.HTML

Aren’t we a handsome group? ;-).