Okay, this is the second entry being uploaded today, so you may not yet have read the one that appears below it (if you’re on the blog). In which case, if you want to stay chronological, you need to read the entry below this one, concerning July 2nd.

July 3, 2006

We had a triumph today, as you will see later in this entry. But I’ll start off chronologically (keep you in suspense awhile longer ;-))

When I went to leave for Gary’s this (Monday) morning, I couldn’t find my car key – it was not in the same place I always laid it. I checked all my pants’ pockets. Not there. Fortunately I had worried that something like this might happen and had had a spare key made when I was in Birmingham. I went out to the parking lot with that one, afraid my car wouldn’t still be there. But it was, no key in the ignition. I figured I’d either dropped the key on the way to my hotel room or absently laid it down somewhere in the room.

First on Gary’s schedule was the PT. She brought him a power chair to try out. We told her this was good timing, because Gary’s chair back had started to fall through on our outing last night. She said that she would take his chair down to maintenance to have it fixed, and that Gary could use the power chair for the entire day, since his own chair would most likely not be ready until sometime on Tuesday.

The two hundred pound power chair was controlled by a joystick, and Gary was like a little R2D2 run amuck (well, maybe that’s a tiny bit of an exaggeration, but . . .). I’m sure he’d get better with practice, but he kept toggling it too hard (or maybe the gears needed to be adjusted) and the chair would jerk in one direction then another. One had to be very careful around him, as he didn’t always let you know what direction he was about to head. Fortunately he ran over the toes of my shoes only once. Much more fortunately my own toes didn’t extend far enough out in the shoes to have gotten mashed. All day long we had to warn other people to give him space – I joked that we needed to put the sign “Student Driver” on the back of his chair.

He didn’t like the chair much. It sloped his feet too far forward, and as a result he couldn’t get very close to things. A consideration for later on was the fact that only way it could be transported would be by using a lift, so it wouldn’t be nearly as convenient as the power-assist wheels. And of immediate importance, it was harder to do weight shifts in it. The arms of the chair did not easily lift away, which made a side weight shift inconvenient. And the only place to hold onto the chair to do a depression shift were its arms, which were much higher than those on his manual chair, thus turning the weight shift into an exercise that rivaled doing dips (keeping his balance was the major problem).

After letting him get a little practice with the chair, the PT had him go out to the gym to practice transfers. I mentioned to her that Gary and I were scheduled for a “wet run” on Thursday, and that my understanding was we’d be doing it entirely on our own, with the PT and OT watching but not helping unless absolutely necessary, which meant that I would have to be the one helping him with the transfers. I asked her if I could practice doing transfers with him before then, rather than the first time being in the shower. She said we could practice right now. I had some idea of what to do – not only have I been watching the therapists aid in his transfers since the start of his therapy, but I’d actually helped with one of his transfers before – unofficially. One of the first times he’d tried doing a transfer from the exercise mat to his wheelchair without his board, he had come down way too short of his destination, and, fearful that he was going to land on the wheel or in the gap between his chair and the mat and thus harm his flap, I’d reflexively stuck my hands under his butt like I’d seen the therapists do and lifted him over. The PT, who’d been in front of him to lend aid, had looked at me in surprise, and I was surprised too – I’m sure my being able to lift him that way was due to an adrenalin rush, not something I would normally be capable of, comparable to those incidences of people lifting cars off of injured people.

She explained the proper procedure to me. When he is going downhill (like from the wheelchair to the gym’s exercise mat), I don’t need to supply any lift. I would be behind him (in the case of the exercise mat, I would be kneeling on the mat), and I would keep my hands on his rib cage to aid his balance, so he doesn’t fall over backwards – based on the therapists’ observation of him, there wasn’t much danger of him falling forward uncontrollably, as there is his chair to grab onto and he’s always done that successfully.

On uphill transfers, however, he needs actual help, sometimes just a little (maybe 20%), but other times a lot, depending on how tired he is or if his technique is off. So the technique for helping him uphill is different than that of aiding him downhill. She had me try doing the upward transfers both from a position of being crouched down in front of him and from a crouched (or sitting) position to his rear, to see if I preferred one position over the other. Because of my small stature, I seemed to be less in his way if I was to his rear. Neither position was kind to my back, so I hope he’ll soon have the transferring on his own down pat!

The technique for the upward transfers was to get my hands under his two “sit bones” (as I’m sure you can guess, these are the bones you sit on, located under the flesh of your butt), and then to provide any lift he needed. I wasn’t exactly sure how much help to provide, and because the goal is to provide the least amount of help that allows him to make the transfer, sometimes it turned out that I provided less help than the therapists would have done – which I knew immediately, because he wouldn’t make it square into the chair in one movement, as he always did with them, instead having to take two hops instead of one to finish the transfer. But even those times the PT said that I had helped enough – she said all I needed to do was to make sure he landed securely, that the great majority of his weight was in the chair, that he wasn’t on the wheel or stuck in the gap, things like that. If he needed to take two hops to get himself situated properly, no big deal. I told them I could provide him more help, and did so a few times, but they said that really wasn’t necessary.

So, I’m pretty comfortable with helping him with a transfer now, though I’m sure they’ll give me lots more practice, maybe having me do it from now on, which I think would be a good idea (though I’m not sure my back will). Gary said he was impressed with my being able to do a transfer with him the very first time I tried (not counting that adrenalin-driven heave through the air).

After his hour with the PT came an hour with the tech, who wanted him to start the session with his stretching exercises. First he needed to roll himself to get into position. He had just told me a couple hours earlier that between the tip I had given him about swinging his arms upwards and the tips his Saturday PT had given him, his rolls had really improved. Now he couldn’t do one again. We realized it was because he was wearing his shoes while on the mat, and on Saturday he hadn’t been – the friction of the shoes was stopping his roll. After I took them off, he got right over.

The tech had him go through his stretches, trying to get him to do them as independently as possible, more so than he and I had been doing. But neither Gary nor I really saw the point of having him take five minutes to try to get his leg in a certain initial position when I was going to have to be standing right there anyway because he wouldn’t be able to lift his leg up into the stretch. When he is a bit stronger and a bit more flexible, he should not only be able to able to lift his leg up into the final position but also be able to get into that initial position in a much less laborious fashion than she was trying to make him do for now.

Whatever!

After the stretching she told him to do twenty-five pushups. I wasn’t sure he was going to make it there at the end, but he did, collapsing to the mat afterward. “You did that easy, Gary,” the tech told him. “Next time we’ll have you do fifty.” He looked at her like she was insane, but he didn’t have the energy to mount a protest.

Next came a triumphant moment: in preparation to transfer to his chair, he rolled over, got himself up on his side, got himself moved over from the middle of the mat to the end, got his legs off the mat, and got himself sat up. ALL BY HIMSELF! The tech and I gave him big applause. This was the first time he’d done all that without any help at all, and we couldn’t stop talking about it all day. And for the rest of the day, anytime someone asked him how he was doing, he told them about this accomplishment.

He got out of doing dips, not as a reward, but because we’d run out of time.

In the afternoon he had a session with the OT, and she went over with him what her goals for him this week were. One was laundry, which they would do today. Another was to start him doing his own bowel program. You may want to skip reading this next little part, if you don’t care to know the graphic details of it, but since somebody asked . . .

Here it is in layman terms. Normally, when the bowel is full it sends a message to the spinal cord giving it that information, and the spinal cord send a message back for the bowels to empty. And at the same time that message is going from the bowel to the spinal cord, a message is sent to brain saying “I have to go.” The brain can then decide to allow the bowel to empty right then or it can override that message from the spinal cord to the bowels, instead telling the bowel to hold off (because you have to find a toilet first, or whatever).

With a spinal cord injury, the message goes to from the bowel to the spinal cord (“I’m full”) and maybe the message from the spinal cord to the bowel is sent back (“Empty yourself”) (this is called the “BCR reflex,” a reflex action because it doesn’t involve the brain), BUT the message sent to the brain telling it you have to go never gets there because of the SCI. So there is no conscious decision to be made – the bowels are going to move whether it is convenient for you or not.

To deal with this, that BCR reflex is made use of – if it works! Not all those with spinal cord injury retain that reflex, but Gary has, so I will not go into what has to be done for someone without that reflex.

To use the reflex, one sticks a finger into the rectum and rotates the finger around and around in circles. For twenty minutes! (Yes, your hand is probably going to cramp until you build up endurance.) Amazingly, this action tricks the bowel into thinking it is full, and that triggers the BCR reflex and the colon empties. So the idea is to do this technique at the same time each day, emptying the bowel on a schedule, so that the reflex isn’t triggered at other times of the day because you’ve let your bowel get full (resulting in an “accident,” or as they’re termed at Shepherd, an “involuntary”; inevitably though, involuntaries will occur, because if you have an SCI, you have no way of knowing when your bowel is full, just as you have no way of knowing when your bladder is full; one purpose of the scheduling of the bowel and bladder programs is to reduce the likelihood of “accidents”).

Okay, that’s probably enough of that. I’m sure if you think about it, you’ll come up with questions you could ask about it. But you may not want to think about it ;-)

Back to the therapy session. Another goal of the OT’s for this week was to do a “community IC” (no, not doing it with others, but in a public facility at Shepherd). Gary told her that he’d done one at the restaurant. She asked him how it had gone. He told her. She said they’d do the community IC on Thursday. “But I did one at the restaurant,” he protested. “Do you really think I need to do another one?” “After that story?” she replied.

I guess her question was meant to be rhetorical.

Next she had him do laundry. He started in his room, collecting his dirty clothes. She had him talk through how he would get the laundry from his bedroom to the washer. We went to the third floor washer. I had just put a load in a short time before this, and it had finished its cycle. He used his grabber to open the top of the washer, and then she had him use his skin check mirror to see if there was any laundry in the machine (which of course there was). Then he tried to use his grabber to set the controls, just to see if he could (this grabber, at least, wasn’t adequate to pull out the control to start the machine). She left to get a different grabber to try (which also didn’t work), and while she was gone Gary used the grabber to see if he could get the wet clothes out. But as even I know ;-), wet clothes in the washer tend to wrap around each other. Gary figured that at the rate he was going, it would take him an hour to get a load of his laundry out. So I think we’ll just stick with me having to do that for him, at least until we get a front-loading washer ;-). (Gary commented later that though they’d said that when he first returns home half his day would be taken up with maintenance tasks, he thinks that is an underestimate.)

(And before leaving the subject of laundry completely, let me share Gary’s discovery with you: it is not a good idea to use the grabber to prevent the lid of the washer from falling down; doing so will break the grabber.)

After the laundry task, the OT put Gary on the rickshaw, while she and I took the piece of foam Joe had brought up from our house so that we could try to make ankle pillows out of it. Unfortunately she couldn’t find a tool to cut it, so we decided to put that off until the next time we met. BUT, a short time later Gary’s team nurse saw me with the foam and asked what I was doing with it. I explained, and she said why not try making the ankle pillows out the foam quad pillows they use at Shepherd. For some reason I had thought the quad pillows wouldn’t be long enough, but when I wrapped one around Gary’s ankle it seemed perfect. We showed this to the OT; she’d already made velcro straps for us to keep the “pillows” on, so the plan is for me to wrap the ankle pillows around Gary’s ankles before I leave for the night (Gary will be lying on his side), and to have the nurse take them off him at midnight when she turns him into a prone position, at that time her checking his ankles for any negative consequences of wearing the ankle pillows.

Back to Gary in the gym. After the rickshaw, there wasn’t much time left (about five minutes), and the OT told Gary he could go if he wanted. To my surprise, he asked if he could do the hand cycle (maybe with his bad hearing he hadn’t heard her say he could leave :-) ?). He told her he could feel that the hand cycle really worked his back muscles and that he knew his back muscles were very weak.

I know the therapists are impressed with how hard he works – today, the tech referred to him as “the energizer bunny. He keeps going, and going . . .”

He got on the hand cycle. Every minute or so he would have to quit pedaling it in order to take a rest break. He again commented to me that the hand cycle was tough, but good for his back. One time after he collapsed face down onto the table for his rest break, the alarm for a weight shift went off, and since he was still in that power chair, it was going to have to be that more-difficult-than-usual depression weight shift. “Oh, shit,” Gary moaned to the table.

But he did it.

He so hated that chair by now that we went off to find the PT. No one had yet taken his regular chair from his room, and he was worried he was going to be stuck with the power chair for another day. After he pled with the PT, she took his other chair to see if she could find someone to fix it. She was successful and brought it back later. She tried to explain what had been wrong with it, but I wouldn’t be able to repeat what she said. Something about loose brackets and stripped bolts ;-). Anyway, she was certain it was secure now, but just in case told us to keep watch on certain latches that were supposed to be pointed in a certain direction.

In the late afternoon I went off to see the chiropractor. Today he planned to again run through those tests he’d done on me when I’d first seen him, in order to check my progress. I figured he would find I’d gone backward. I knew that at the moment my back felt worse than ever – lower back painful, upper back sore, no doubt due to all the pushing of Gary’s wheelchair the past few days, doing the transfers with him, practicing rolling, and so on.

These past few days I’d also been having another symptom which I figured (and hoped, actually, because alternative explanations could be scarier) were due to misaligned vertebrae: I’ve been constantly feeling like I’m walking on a rolling and dipping ship. I know that when I’ve knocked my neck vertebrae out of place, I get vertigo – I get up intending to go one way, and my body goes another. So I’m hoping this is a variation on that (and after telling the chiropractor about the symptom, he thought that was most likely the case, telling me he thought I could hold off until we got the current misalignment problem corrected before considering other possibilities).

Anyway, at the chiropractor, sure enough, my tests came out worse than the first time I had seen him. He told me that the results would have no doubt been even worse than they were now had I not been seeing him. And I believe him – I’ve been to enough chiropractors to know a good one, and I really think he is good. He asked me if I wanted to continue seeing him this month, and I said yes. He then said he would “bend the rules” and let me come in three times a week for the price of two, saying obviously twice a week just wasn’t good enough for the stress I was under. So I agreed to his offer, telling him I really appreciated this offer and his help.

After seeing the chiropractor I went to Ace Hardware to have another car key made. While there I happened to think about grabbers and bought Gary another one – this one seems much sturdier, though it doesn’t fold. Other nice features it has are that the “grabbers” can be rotated to any direction, and that after picking something up, the grabber can be locked in place.

When I got to my hotel room, I reached into my shirt pocket to get my hotel key. I pulled it out. I also pulled out my car key, the one I’d “misplaced.” It was then that I remembered that I’d thought last night that my shirt pocket would be a much “safer” place to keep my key so I didn’t absent mindedly put it down somewhere in the hotel room and then not be able to find it.

Oh well.

In the evening back at Shepherd, I went through my usual routine with Gary, and just before I left, velcroed the ankle pillows to him. Keep your fingers crosse.

To finish this entry, I will put on the blog at http://drpeg2003.blogspot.com/
an image of the sculpture I named “ It's been a tough day at Rehab,” and a closeup of the sign I taped to the sculpture at its lower right hand corner. At Gary’s instigation, of course ;-)

If you are getting to the blog from an email, you will have to scroll down the blog page to get to the image.

All for now.