August 2, 2006
Michel Smith, chair of the math department, has the answer to Janet Rogers' question of how many mathematicians does it take to change a lightbulb. I quote him: It takes one theoretician to prove that there is a solution to the problem, an applied mathematician to develop an algorithm to approximate the solution, and the chair of the department to figure out how to get the old (damn stubborn broken) bulb out – thereby reducing the unknown problem to the known case.
Thank you, Michel ;-)
Now to the day. I felt more rested, having gotten to bed around 10:40 after proning Gary and not having to help again until around six a.m. (except I woke up at two because his light went on and he has to move around in his bed to get to his IC stuff, but I fell back to sleep fairly quickly).
The bus that takes the people from the apartments to Shepherd has been about a half-hour late each morning so far. I suggested to Gary that we could go by car if he wants to take the trouble to do the car transfers. I’m not sure he’ll take me up on the offer – it means he’d have no excuse for missing out on part of his first class ;-)
His first class was a group fitness class, and I’m sorry, I just don’t think these group classes are very good – the exercises are done too fast, sacrificing form. I occasionally whisper in Gary’s ear a reminder for him to slow down (for one thing, so he doesn’t wreck up his shoulders, which he still has to be careful of). I also suggest things about his form, etc. The person in the wheelchair next to us commented to Gary, “She really keeps on you, doesn’t she?” Gary agreed I did ;-)
In the class he did punches, side raises, trap squeezes, front raises, tricep extensions, shrugs, lawnmowers, and wrist curls, 3 sets of 20 for each exercise. Gary uses a light weight, the limiting factor being his balance not his strength.
During the session, we got another flower delivery! Thanks go to my sister Janet and her husband John.
After that he/we had a session with the nurse on padding and positioning and on skin checks, working toward the goal of him being able to do this all independently down the road. For the padding and positioning, the nurse suggested ways he could position the pillows and get himself into the prone position. She had to help with the padding, and at this stage, both Gary and I are dubious of him being able to do it on his own for quite a while – but we can always hope to be pleasantly surprised. Right now, when it comes time for him to get into the prone position, he is too tired to go through the rigamarole of working at it on his own as much as he can before I step in to finish the job – when we get home and the schedule isn’t so hectic, I’m sure he’ll practice it.
After that session, as we waited for the PT to come for the next session, our inpatient case manager walked by. She asked if things were going better now, saying that we’d looked like dead meat on Monday. Gary told her we were getting more used to the routine (some of us more than others ;-)).
Gary had a different PT today – in fact, he hasn’t had the same one yet, as the one assigned to him is on vacation or something, but she communicated with the others what he is to work on. So, he worked on transfers, but without the board. I had commented to him this morning that it seemed clear he could do transfers with the board pretty well and therefore would probably be easily cleared to do those on his own, so maybe he should go back to the depression transfers without the board, which are harder because they require more strength and balance to make the transfer in one hop; the reason why those are preferable is because the goal is to perform as many tasks, including transferring, with as little equipment as possible, so you don’t have to lug around a bunch of things with you everywhere you go. Gary had been thinking the same thing, so this is what we told the PT and it is why she had him practicing the transfers without the board, her keeping her hands on him. He did well with her – she said she didn’t give him any help, even when he transferred onto the mat raised higher than his chair. She told him that she thought he had the strength aspect of it, that he needed to practice more on his balance, and that, like any skill, all he needed now was lots of practice. He told her it was also a confidence thing – that when someone had their hands on him “just in case,” he usually did good transfers, but he’d gotten too nervous the couple times the inpatient OT had had him try such transfers completely on his own.
After the transfer work, the PT had him work on getting his legs up on the exercise mat, then maneuvering on it (he gets a lot of practice at commando crawling!). She then had him work on getting from a side position to a properly padded prone position, her technique slightly different than the nurses, but not any easier – and it looked like he needed a lot more room than what is available in the hospital bed. The OT came by during this and told us she was going to write Gary a script for outpatient OT, and he will also have one for outpatient PT, so he can continue his therapy at home (we don’t know where, yet).
After lunch, Gary had a “proning session with his caregiver(that’s me ;-)).” Since he didn’t want to lay prone the entire hour, we turned it into a practice session for him maneuvering into the correct position on the mat. Once in the prone position, I suggested he do the terrible threes, taskmaster that I am ;-). He did them.
Next came an OT session, and Gary worked on dressing in the chair again. The OT had some good tips, showing him how he could scoot forward in his chair, grab one of his legs, and lean backwards in his chair to bring his leg and foot up so he could get his pants over them and also get a shoe on, then to lean way over in his chair katycorner to work on getting his pants up his thighs and hips and butt . Not that he did it all himself, but there was definite progress. She told him that the first time the “Been there done that” guy had put on his pants by himself, it had taken him 30 minutes, but now he could do it in 22 seconds.
Next a PT helped him transfer to the standing frame, which as you might guess, stands him up. He started in a seated position, his knees padded by the frame in front of him. Then I pulled on the lever arm and cranked him upright, though stopping slightly more than halfway (unlike the tilt table, it isn’t good to stay at the intermediary positions because of the awkward position it puts the body in, putting pressure on the joints). After a few minutes of being upright, he felt a little yukky, so I cranked him back down. After a few minutes break, I took him up again, and he was fine. A PT brought us a deck of cards and we played some version of rummy (no points kept; I conveniently forget who won ;-)).
He said he could stay upright longer, but I persuaded him to “come down” after thirty minutes. It just seemed to me he shouldn’t push it, as in the last four months he’s only been standing upright five minutes. I asked a PT, and she said he could stay up in it for an hour, but it was okay if he came down now, just to make sure the pressure of the frame hadn’t affected his flap negatively.
So, we finished a half hour before the end of the scheduled day. I suggested we go back by car, rather than having him wait another hour for the bus (although it comes at four, it is about four- twenty before it leaves Shepherd). Gary was agreeable, so we had some more practice in breaking down and assembling the chair and in getting him in and out of the car. His transfers into the car go smoothly, but the transfers out are still a bit rough and take awhile.
In the apartment, I put his vegetable kabob in the oven for him since he can’t reach the controls, then we got him onto the bed so I could check his skin and help him change his pants, then we got him transferred out again. During all this, the phone rang. I wasn’t going to answer it because I still had to get my own dinner started before leaving for a session with the personal trainer, but Gary told me to answer it. The person on the other end of the line asked if I was going to be there in the next twenty minutes, and I said I was going to leave in exactly twenty minutes. They said they had a delivery to make and would be there before then . They were, and I opened the door to a huge vase of twenty-five long-stemmed red roses. I said, “Wow,” and turned to Gary saying, “look what someone sent us for our anniversary.” I then asked the delivery guy who they were from, and he read the card and told me, “Gary Gruenhage.” I told him, no, that they were TO Gary and me, so – then I realized Gary had sent them to me! And what did I get him? Hagen Daz vanilla Swiss almond ice cream. (Hmm. Well, I had told him I’d make him a special pizza when we get home and that we’d celebrate later.) After that I had to run off to the personal trainer, and just before leaving I told Gary I was sorry I hadn’t gotten him anything special, and he said I had (and he didn’t mean the ice cream).
I told the personal trainer that my legs were a little wrecked up, so I didn’t want to work them too hard today. I also told her I was on the worn-out side, and she kept the workout relatively light. I did dumbbell side raises, while having one knee on a bench and the other leg on the floor (15reps, 5#). Then I put my hands on a stability ball and raised one arm and the opposite leg while leaning on the ball (the trainer had to steady the ball a bit), she cautioning me to use my glute muscles to raise the leg rather than momentum (20 reps each leg). Then I repeated those two exercises. Then I got to lie down over the ball to stretch out – but not for long. I then did knee pushups – 15. Then I flipped over and lay on my back to do an ab exercise where I kept one leg straight, then curled up from the top and brought my other knee toward my face (15 reps each leg). The I repeated the pushups and the ab exercises. I sure don’t know how Gary managed 100 pushups! My trainer had to hold me at the hips to help me crank out the last one so that I wouldn’t lose form and arch my back (it is so good she stays so conscious of it). In my defense, however, I get my nose down to that mat, and Gary was doing his pushups only partway – he said he did them that way because he knew he wouldn’t be able to do 100 otherwise.
After that, we finished up with stretching.
After I got back to the apartment, it was time to start the evening routine. While I stretched Gary, he talked to his mom, who had called to wish us a happy anniversary. He also talked to Joe, who had called for the same reason but also to warn us that we might not be able to get up the driveway of our home this weekend, which would mean we wouldn’t go home for our “test run” as planned (I did tell you we planned on doing that this weekend, didn’t I?), since there is no way I could push him up the steep slope of our grass. Even if people volunteered to help get him into the house, and out again on Sunday, he’d be essentially stuck in the house the remainder of the time, and we don’t think that’s a good idea as a safety issue. (Note: I got the message later from Janet Rogers that she and Michel Smith and Jo Heath were at our house and they thought getting into and out of the house very doable. Gary and I are still debating whether or not to come home this weekend; we’re extremely tempted to just stay here and veg out for once.)
The routine went as usual. The one glitch during the night was Gary dropped my cell phone, which he’s been using as an alarm, so I had to come out and pick it up for him at 2am. But I was awake anyway, because with my door open I am always awakened by the light he needs to turn on and by his moving around in the bed, plus I am subliminally listening for him to call, afraid I might not hear him (which is a silly fear, given how light I sleep). I will be glad when we get the walkie-talkies we ordered from Amazon so I can keep my door closed and not always be on alert listening for his call.
Michel Smith, chair of the math department, has the answer to Janet Rogers' question of how many mathematicians does it take to change a lightbulb. I quote him: It takes one theoretician to prove that there is a solution to the problem, an applied mathematician to develop an algorithm to approximate the solution, and the chair of the department to figure out how to get the old (damn stubborn broken) bulb out – thereby reducing the unknown problem to the known case.
Thank you, Michel ;-)
Now to the day. I felt more rested, having gotten to bed around 10:40 after proning Gary and not having to help again until around six a.m. (except I woke up at two because his light went on and he has to move around in his bed to get to his IC stuff, but I fell back to sleep fairly quickly).
The bus that takes the people from the apartments to Shepherd has been about a half-hour late each morning so far. I suggested to Gary that we could go by car if he wants to take the trouble to do the car transfers. I’m not sure he’ll take me up on the offer – it means he’d have no excuse for missing out on part of his first class ;-)
His first class was a group fitness class, and I’m sorry, I just don’t think these group classes are very good – the exercises are done too fast, sacrificing form. I occasionally whisper in Gary’s ear a reminder for him to slow down (for one thing, so he doesn’t wreck up his shoulders, which he still has to be careful of). I also suggest things about his form, etc. The person in the wheelchair next to us commented to Gary, “She really keeps on you, doesn’t she?” Gary agreed I did ;-)
In the class he did punches, side raises, trap squeezes, front raises, tricep extensions, shrugs, lawnmowers, and wrist curls, 3 sets of 20 for each exercise. Gary uses a light weight, the limiting factor being his balance not his strength.
During the session, we got another flower delivery! Thanks go to my sister Janet and her husband John.
After that he/we had a session with the nurse on padding and positioning and on skin checks, working toward the goal of him being able to do this all independently down the road. For the padding and positioning, the nurse suggested ways he could position the pillows and get himself into the prone position. She had to help with the padding, and at this stage, both Gary and I are dubious of him being able to do it on his own for quite a while – but we can always hope to be pleasantly surprised. Right now, when it comes time for him to get into the prone position, he is too tired to go through the rigamarole of working at it on his own as much as he can before I step in to finish the job – when we get home and the schedule isn’t so hectic, I’m sure he’ll practice it.
After that session, as we waited for the PT to come for the next session, our inpatient case manager walked by. She asked if things were going better now, saying that we’d looked like dead meat on Monday. Gary told her we were getting more used to the routine (some of us more than others ;-)).
Gary had a different PT today – in fact, he hasn’t had the same one yet, as the one assigned to him is on vacation or something, but she communicated with the others what he is to work on. So, he worked on transfers, but without the board. I had commented to him this morning that it seemed clear he could do transfers with the board pretty well and therefore would probably be easily cleared to do those on his own, so maybe he should go back to the depression transfers without the board, which are harder because they require more strength and balance to make the transfer in one hop; the reason why those are preferable is because the goal is to perform as many tasks, including transferring, with as little equipment as possible, so you don’t have to lug around a bunch of things with you everywhere you go. Gary had been thinking the same thing, so this is what we told the PT and it is why she had him practicing the transfers without the board, her keeping her hands on him. He did well with her – she said she didn’t give him any help, even when he transferred onto the mat raised higher than his chair. She told him that she thought he had the strength aspect of it, that he needed to practice more on his balance, and that, like any skill, all he needed now was lots of practice. He told her it was also a confidence thing – that when someone had their hands on him “just in case,” he usually did good transfers, but he’d gotten too nervous the couple times the inpatient OT had had him try such transfers completely on his own.
After the transfer work, the PT had him work on getting his legs up on the exercise mat, then maneuvering on it (he gets a lot of practice at commando crawling!). She then had him work on getting from a side position to a properly padded prone position, her technique slightly different than the nurses, but not any easier – and it looked like he needed a lot more room than what is available in the hospital bed. The OT came by during this and told us she was going to write Gary a script for outpatient OT, and he will also have one for outpatient PT, so he can continue his therapy at home (we don’t know where, yet).
After lunch, Gary had a “proning session with his caregiver(that’s me ;-)).” Since he didn’t want to lay prone the entire hour, we turned it into a practice session for him maneuvering into the correct position on the mat. Once in the prone position, I suggested he do the terrible threes, taskmaster that I am ;-). He did them.
Next came an OT session, and Gary worked on dressing in the chair again. The OT had some good tips, showing him how he could scoot forward in his chair, grab one of his legs, and lean backwards in his chair to bring his leg and foot up so he could get his pants over them and also get a shoe on, then to lean way over in his chair katycorner to work on getting his pants up his thighs and hips and butt . Not that he did it all himself, but there was definite progress. She told him that the first time the “Been there done that” guy had put on his pants by himself, it had taken him 30 minutes, but now he could do it in 22 seconds.
Next a PT helped him transfer to the standing frame, which as you might guess, stands him up. He started in a seated position, his knees padded by the frame in front of him. Then I pulled on the lever arm and cranked him upright, though stopping slightly more than halfway (unlike the tilt table, it isn’t good to stay at the intermediary positions because of the awkward position it puts the body in, putting pressure on the joints). After a few minutes of being upright, he felt a little yukky, so I cranked him back down. After a few minutes break, I took him up again, and he was fine. A PT brought us a deck of cards and we played some version of rummy (no points kept; I conveniently forget who won ;-)).
He said he could stay upright longer, but I persuaded him to “come down” after thirty minutes. It just seemed to me he shouldn’t push it, as in the last four months he’s only been standing upright five minutes. I asked a PT, and she said he could stay up in it for an hour, but it was okay if he came down now, just to make sure the pressure of the frame hadn’t affected his flap negatively.
So, we finished a half hour before the end of the scheduled day. I suggested we go back by car, rather than having him wait another hour for the bus (although it comes at four, it is about four- twenty before it leaves Shepherd). Gary was agreeable, so we had some more practice in breaking down and assembling the chair and in getting him in and out of the car. His transfers into the car go smoothly, but the transfers out are still a bit rough and take awhile.
In the apartment, I put his vegetable kabob in the oven for him since he can’t reach the controls, then we got him onto the bed so I could check his skin and help him change his pants, then we got him transferred out again. During all this, the phone rang. I wasn’t going to answer it because I still had to get my own dinner started before leaving for a session with the personal trainer, but Gary told me to answer it. The person on the other end of the line asked if I was going to be there in the next twenty minutes, and I said I was going to leave in exactly twenty minutes. They said they had a delivery to make and would be there before then . They were, and I opened the door to a huge vase of twenty-five long-stemmed red roses. I said, “Wow,” and turned to Gary saying, “look what someone sent us for our anniversary.” I then asked the delivery guy who they were from, and he read the card and told me, “Gary Gruenhage.” I told him, no, that they were TO Gary and me, so – then I realized Gary had sent them to me! And what did I get him? Hagen Daz vanilla Swiss almond ice cream. (Hmm. Well, I had told him I’d make him a special pizza when we get home and that we’d celebrate later.) After that I had to run off to the personal trainer, and just before leaving I told Gary I was sorry I hadn’t gotten him anything special, and he said I had (and he didn’t mean the ice cream).
I told the personal trainer that my legs were a little wrecked up, so I didn’t want to work them too hard today. I also told her I was on the worn-out side, and she kept the workout relatively light. I did dumbbell side raises, while having one knee on a bench and the other leg on the floor (15reps, 5#). Then I put my hands on a stability ball and raised one arm and the opposite leg while leaning on the ball (the trainer had to steady the ball a bit), she cautioning me to use my glute muscles to raise the leg rather than momentum (20 reps each leg). Then I repeated those two exercises. Then I got to lie down over the ball to stretch out – but not for long. I then did knee pushups – 15. Then I flipped over and lay on my back to do an ab exercise where I kept one leg straight, then curled up from the top and brought my other knee toward my face (15 reps each leg). The I repeated the pushups and the ab exercises. I sure don’t know how Gary managed 100 pushups! My trainer had to hold me at the hips to help me crank out the last one so that I wouldn’t lose form and arch my back (it is so good she stays so conscious of it). In my defense, however, I get my nose down to that mat, and Gary was doing his pushups only partway – he said he did them that way because he knew he wouldn’t be able to do 100 otherwise.
After that, we finished up with stretching.
After I got back to the apartment, it was time to start the evening routine. While I stretched Gary, he talked to his mom, who had called to wish us a happy anniversary. He also talked to Joe, who had called for the same reason but also to warn us that we might not be able to get up the driveway of our home this weekend, which would mean we wouldn’t go home for our “test run” as planned (I did tell you we planned on doing that this weekend, didn’t I?), since there is no way I could push him up the steep slope of our grass. Even if people volunteered to help get him into the house, and out again on Sunday, he’d be essentially stuck in the house the remainder of the time, and we don’t think that’s a good idea as a safety issue. (Note: I got the message later from Janet Rogers that she and Michel Smith and Jo Heath were at our house and they thought getting into and out of the house very doable. Gary and I are still debating whether or not to come home this weekend; we’re extremely tempted to just stay here and veg out for once.)
The routine went as usual. The one glitch during the night was Gary dropped my cell phone, which he’s been using as an alarm, so I had to come out and pick it up for him at 2am. But I was awake anyway, because with my door open I am always awakened by the light he needs to turn on and by his moving around in the bed, plus I am subliminally listening for him to call, afraid I might not hear him (which is a silly fear, given how light I sleep). I will be glad when we get the walkie-talkies we ordered from Amazon so I can keep my door closed and not always be on alert listening for his call.
posted by Peg Daniels at 9:29 AM
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