Friday, July 28, 2006

July 27, 2006

I have put the pictures of Gary’s Shepherd graduation up on the blog. For those of you who receive these journal entries by email, go to http://drpeg2003.blogspot.com/ and scroll down to view the pictures.

I asked Gary how the Braves game went, and he said it was a good game, lots of home runs, and the Braves had won 6-5. I told him that was not blog material ;-). So he told me that there was an area of the stadium set up where seats could be removed to accomodate wheelchairs, and that’s where they’d sat. He’d found out that one member of their group, a man who works at Shepherd and is paraplegic, travels all around the world to fish at different locations, so Gary is going to get together with him next week to ask him questions about accessibility in different locations around the world, in this way hoping to get some useful information for future travel to math conferences.

Gary also said he was supposed to get his own hotdog, but a therapist volunteered to get him one, so he didn’t refuse. She brought it loaded with onions and catsup, and he got that all over his shirt.

Sorry, that’s all I could get out of him about his outing :-)

Gary’s last day in inpatient therapy was pretty light: an OT session, a seating clinic, and a PT session. The OT started her session with him by going through the ASIA test with him again, the one where they test him for sensation and proprioception. Her results showed that his ability to feel sensations stopped (or in certain areas, lessened) higher on his chest than they’d found when he first entered Shepherd, and that as a result he would be classified as a T2 not a T4 as they’d told him at the beginning. But as she pointed out, functionally speaking there’s not all that much difference between those designations.

At the start of this session with the OT, Gary had asked to try to transfer by himself to the mat. So the OT and I stood at ready – me in front of him, her behind – while he attempted it. Unfortunately, he landed on the edge of the mat and lost his balance backwards, which under other circumstances might have caused his butt (and therefore him) to slip off the mat. Both the OT and I grabbed him, so there was no mishap, but he can’t be “cleared” to do such transfers on his own yet. He tried again on the transfer on the way back, the OT hanging onto his pants just in case. She said she’d had to give him a little guidance during the transfer to make sure he landed in the right place. He was disappointed – he was certain he could do the mat on his own now; he hopes it was only due to nervousness that he still couldn’t do it today. I reminded him that he still has the two weeks of day program coming up to practice this, so hopefully by the time he goes home he’ll be able to do at least this type of transfer independently.

After the OT session, he went to “seating clinic” and got fitted for his loaner wheelchair (we don’t know how long it will be before the one he ordered will be delivered). This chair is the same model as the one he is getting, though slightly too wide for him. Gary found it more comfortable than the Shepherd chair he’s been in – mostly because the back is lower so it gives him more mobility, and also because the chair had less “dump” than the other one, enabling him to lift both hands up and even bring them both forward a little while still maintaining his balance, which he can’t do in the other chair. So he will most likely use this chair during day program unless some other difficulties with it arise.

The seating clinic guy went through with us how to inflate the cushion of the chair and how to test it to see that there is the right amount of air in it when Gary sits on it. The procedure was a little different than what we’d been told by the PT – easier, fortunately.

Gary wheeled back to his room in his loaner chair, and I brought the Shepherd chair along in case he runs into some problem with the loaner. Back in his room, he said he needed a nap – he hadn’t gotten back from the Braves game until about 11, and by the time he’d done his IC and the nurses had proned him it was midnight, and at four-thirty a.m. various routines for his roommates had begun, so as a result of all this he hadn’t gotten much sleep. Fortunately his session with the PT wasn’t for another three hours, so he and I did a transfer to his bed and got him settled in. His PT dropped by while he was asleep and told me he and I were officially cleared to do car transfers together. We’re thinking that for Day Program (starting Monday!) I may drive him over instead of us taking the Shepherd bus. That way not only will we get more practice at car transfers but we’ll have about another half hour of time in the morning to get him ready – and as we found, every second we can squeeze out will help!

Noonish, he did another IC and ate his lunch in bed, then relaxed a while longer before it was time to get up (he hasn’t had the luxury of relaxing like that in quite a while!). As we prepared for his transfer out of bed, I noticed he hadn’t re-tightened his binder yet, so I joked, “All passengers, fasten your gut belts!”

When I pulled his loaner chair over to the bed and angled it as we had the other one, we noticed he was going to have to transfer a farther distance than with the other chair – this chair has a wheel-to-wheel width about an inch and a half wider than the other one, and, additionally, there seemed to be something about the chair’s construction that prevented it from getting as close to the bed as we expected it to. Another thing we discovered to our dismay was that the tires of the loaner chair seemed to slip on the floor (the wheel locks were on, of course, but this still happened), and since Gary has one hand on the chair when he transfers, it often happens that he pushes against the chair slightly, which in this case would push the chair away as he was trying to transfer onto it. Because of these various factors, I helped with the transfer from in front of him instead of to his rear like I normally do (because if I’m in front it would be easier to catch him if he fell forward), and I put my hands under his sitting bones instead of on his hips. Plus, because of the slipping tires, I hooked a leg around a tire while kneeling on the other leg. (My chiropractor would not have approved of the position I found myself in ;-)) Between Gary giving a super effort to make the distance and me giving him extra help to counteract the various factors, we almost went too far the other way and I had to pull him back slightly while he was in midair to make sure he didn’t overshoot his mark!

So when we went to the exercise mat in the gym for the PT session, we mentioned to the PT these difficulties with transferring to this chair. She showed me how I could do the transfer standing to his rear, as I prefer, while still preventing the tires from slipping by keeping one foot on the handrail of the wheel (the handrail being where Gary puts his hands to push the wheels). She said that the different kind of brakes he has on this chair (“scissor brakes”) didn’t grip the wheels as firmly as the other kind, and if he was going to have this kind on his own chair (which he plans to, as they have the advantage of folding back out of the way), that someone could chisel notches onto the surface of the brakes so that they would grip the wheel better.

So then he and I did the transfer to the exercise mat. For some strange reason, when we set up for it, we didn’t notice any extra distance from chair to mat. Don’t ask us to explain this ;-). Anyway, the transfer went fine. I commented to Gary, “Of course it did. One of your therapists was watching.” I’d meant it as a joke, but he said there was truth in it – that when the therapists were there he had more confidence.

Once he was on the mat, she redid the ASIA test in the area near his right armpit. She too found that he had little or no sensation there (making him a “T2"), whereas when he first came they had recorded that area as having normal sensitivity. But Gary claimed he’d known essentially ever since the accident that that area had been affected. So the PT thought that maybe whoever had first done his testing had been extra lenient with him at the time.

After the ASIA, he practiced wheelies, the PT keeping the gait belt around his wheel axle and her hands lightly on his chair. Gary said that getting up into the wheelie from a stopped position was easier in the loaner chair, but I noticed he had a harder time when it came to actually popping the wheelie while moving. They next practiced taking curbs, and it seemed about the same as before, the PT giving him significant help. It’s fine with me that he is nowhere near being able to do these on his own ;-)

The PT interrupted her practice with Gary when some old hands at this paraplegia stuff set about demonstrating to some of the other patients floor transfers and wheelchair uprighting. Gary won’t even begin to practice these skills until his flap restrictions are lifted – and he would have to get a heck of a lot more flexible! – but the PT wanted him to see what is involved. The men demonstrating these maneuvers practically bent themselves in half in getting from a “seated on the floor” position back into their chair. Their moves looked smooth and easy; one had had lots of practice, having been a paraplegic since the late eighties, the other had arms and shoulders about the size of tree trunks. Gary’s got a little ways to go in that regard ;-)

The wheelchair uprighting, Gary’s PT explained, came in useful when someone’s chair had tipped over backwards and one needed to get back into the chair oneself. The demonstrator went through the maneuver, and it was obvious it would require a lot of flexibility and strength. I commented to the PT that I wondered how practicable this skill was – given how Gary had felt right after tipping over backwards, I don’t think he would have attempted getting himself back into his chair no matter how flexible and strong he had become. The PT gave me no argument.

And on this note, Gary ended his therapy sessions as an inpatient (tomorrow he is discharged and we move into the apartments provided by Shepherd for the Day Program). We went back to his room, and then I took an early leave until evening because I had my second session with the personal trainer to go to.

So now I am going to talk to myself again, and you can go wander off for a while if you like.

I got on the stationary bike (turned off) for ten minutes. The trainer came in while I did this, and we talked about how I felt after the first session. I told her I’d gotten sore and had been at my sorest last night, but that now, while still sore, it wasn’t too bad. She said we wouldn’t work legs today, and I immediately said, “Good,” as I certainly wasn’t up to a repeat of that workout!

But then what did we do? She had me do squats similar to the ones we did Tuesday. Only this time, I was to touch my butt back onto the exercise bench while swinging my arms forward. Though I had to go lower to touch the bench than to touch the wall, I found these easier. After twenty reps, she told me to do the same thing, only I was to swing a medicine ball diagonally while doing it, much as I had the stability ball last time.

She handed me an eight-pound ball. I handed it back. “This is too heavy,” I told her (gone are my macho days). She then handed me a four-pounder and that seemed about right. I did twenty of the squats swinging the ball in one diagonal direction, then another twenty swinging the ball in the other direction. Again, I found this easier than those we did on Tuesday – they didn’t require as much coordination. But I knew already my abs were going to be sore tomorrow, particularly because she wanted me to emphasize the twisting motion at the top of the swing. I told her I could see where this would be a functional move for me – when I help Gary with his transfers, I end up twisting from one side to the other while supporting some of his weight (of course, soon now, he won’t need me for that ;-)). She said that was why she had thought of this exercise as one I should do (I’d told her before about the kinds of moves I make in transferring him).

Next I sat on a 55cm stability ball, an exercise tube of least resistance secured underneath it, and used the tubing to do shoulder presses, 12 reps. She told me I could make the exercise harder by putting my legs closer together. She also explained that the reason for doing exercises while sitting on the ball was that in order to keep my balance I would be recruiting more of my lower back and abdominal muscles than I would if sitting on a solid surface.

Next I did rows with an exercise tube (one that gave more resistance), fifteen reps, this time me sitting on an exercise bench (she said that at home I could sit on the floor or wherever was comfortable).

Next we went back to one of the first exercises, the ones with the medicine ball. “You lied,” I said to her. “What do you mean?” she asked. “You said we weren’t going to do legs.” “Well, we’re only doing them a little,” she rationalized, then added, “You’ll find I often lie, making you do more reps than I say you will, and so forth.”

And I thought I’d been miscounting because of my CFS. I gave her the evil eye, but apparently it had no effect.

Next we did the shoulder presses again, and then another twisting exercise, that also mimicked the transfer motion: I sat on a 55cm stability ball, wrapped an exercise tube around a post at shoulder height, faced diagonal to the post, gripped the handles of the tube, and pulled from directly in front of me away from the post as far as I could go. I did twenty reps on each side. She told me the way to make the exercise harder was to bring my feet in closer, and that that applied to all other exercises done while sitting on the ball. She also told me not to let my arms go any closer to the post than the center point of my body, because that would allow the tension on the band to lessen too much and give my muscles a rest. We wouldn’t want that now, would we?

Next we did a ball placement exercise, which I told her was just another sneaky way to work in more squats. A six-pound medicine ball was on a bench in front of me. I was to squat down, getting the ball in the process of doing so, then put the ball on the floor, then stand up. Then I was to squat down and pick the ball up and put it on the bench. Twelve of those.

Then I sat on the stability ball and again did those twisting motions with the exercise tube.

And that was the end of my strength workout. It had taken a half hour, because we did some chatting here and there – intentionally on her part, so as not to overwork me (and hopefully she didn’t succeed in doing that anyway). One thing I found out during our chats was not only do we use the same massage therapist, but also the same chiropractor. She’d found the massage therapist through the chiropractor, and I’d found the chiropractor and her through the massage therapist.

I thought she would have me do stretches on my own, since our half hour was up, but she spent about fifteen more minutes doing them with me. I told her after the session that I was glad I’d found her, that I’d had fun. She said it was fun for her too, and she’d call me to let me know what time she could meet with me on Sunday.

I went back to the hotel feeling very happy with myself for completing another workout – I hope I can continue this with no ill effects. I told Gary, when I got back to the hospital, that I bet I wouldn’t have been able to do this a few months ago, that having to help him with his transfers and all the pulling and pushing and lifting I’ve been having to do have made me physically stronger than I was back then.

I did my routine with him, and then climbed into his hospital bed with him. I wondered aloud how the Plainsman (the university’s student-run newspaper) article had turned out. Janet Rogers had typed out in an email to us the editorial about Gary that had also appeared in the newspaper, and that editorial was wonderful (made me cry, and Gary said he read it about a half-dozen times), but we haven’t heard much about the main article on him yet (though I’m sure one or more of the math grapevine will send us the article before too long). Janet emailed us that the main article made the front page, that they used the publicity picture of him that I’d liked better than the one in the city newspaper, and that they’d put in the address for the blog. I told Gary I wasn’t sure the last was a good thing. I told him that when I finally “allow” him to read it (I told him long ago that I didn’t want him to read it because I thought it would inhibit my writing, and he agreed not to), he may feel terribly embarrassed and want to divorce me. “That won’t happen,” he assured me, continuing with, “Who would finish up my bowel program for me?”

Hmm.

;-)

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