August 7, 2006
Well, after successfully making it through the weekend without waking for Gary’s 2am IC, I shot awake at 1:59am, and then drowsed and shot awake repeatedly after that. Just something about knowing we had to be on schedule for his 9am session at Day Program. Can we say overly conscientious?
First up was the (futzy) group weight-training session, the usual exercises: biceps curls, triceps extensions, shrugs, trap squeezes, lateral raises, lawnmowers, front raises. The group was much smaller than usual (just three patients and two caretakers, me included), because a number of people had “graduated” from the program on Friday; that gave the group a much more intimate feel, which I liked. They still went through the repetitions too fast though ;-). At the beginning of the exercises, one of the patients who has been here longer than we have, I believe (he started out in the Brain Injury unit), asked me if I was going to do the exercises with them; he and his wife (the other caretaker there) said they had found it very important for her to do the exercises too, since all the tasks involved in caretaking took a lot of physical strength – even just to catch the guy when he lost his balance. Don’t I know it! Fortunately, Gary isn’t nearly as big a guy as this man was – and fortunately for the man, his wife is a lot bigger than I am. Anyway, I couldn’t wimp out (though I didn’t want to overdo things because I have my own training sessions now), so I did all the exercises except the ones I had to hold Gary’s shoulders for. I also didn’t keep up with the official count ;-)
Next up was a session with the OT. Gary first practiced tub transfers with her, doing quite well. Then she had him do “bed work” (maneuvering in the bed) using the double bed in the gym. He has gotten much better at this than when he was an inpatient (just due to practice, he thinks), and she told him she saw no reason for him to use a hospital bed (as medically it is no longer necessary), and she urged him to work toward using a bigger bed, maybe having both in his bedroom and alternating between the two until he felt comfortable using the bigger bed all the time. The bigger bed would definitely give him more space to work in, but he’d have to give up his dependence on the rails and the electronic raising and lowering of the various parts of the bed.
She then taught him her way of what starting position he should get in (from on his side) and where and how he could place pillows and quad pads in preparation of getting himself properly padded off in the prone position. This went better than the other methods he’s tried, and it seems promising. It’s interesting, but disquieting, how each therapist has her own techniques she passes on – it makes it seem like it’s the luck of the draw whether or not you will get a therapist who will have the right technique for you.
After the OT session, Gary had an “IC check” with the nurse, so once again three of us crowded into a stall in the men’s room. The nurse commented that Gary was meticulous, and told him that his technique was excellent and that if he continued doing it the way he did, he should have not get any urinary tract infections resulting from faulty technique.
That finished the morning, and we got to lunch early, meaning we had nearly an hour “free” before his next session. I suggested he could go to the weight room and work out, since they really haven’t been giving him good strength sessions (no zillions of pushups and dips and rickshaw and terrible threes). He didn’t look thrilled, so then I suggested we could do balance exercises. He decided that sitting on the edge of the exercise mat and reading the newspaper would be a good one. Hmm, not exactly an exercise the therapists had had him do, but it did challenge his balance.
I noted that coming up a little later on his schedule was a “stretching and proning session with caregiver,” so I told him to get in the middle of the mat and circle sit while reading the paper (so if he lost his balance he wouldn’t fall off the mat), then I went off to the car to get his chain loops. On the way, I met his supplier, with whom Gary had left a message about the delivery of our bed table and about adjusting the back of his chair. I directed the supplier to Gary, and when I came back to the gym, the guy was working on the chair – Gary wanted it angled more so he doesn’t fall forward when he lifts his hands.
While this was happening, Gary’s PT for the day came, and she expressed concern about the back of Gary’s chair because his flap hasn’t looked as good as it did just before he got the loaner chair and it seems to have stopped improving since from what it looked like last Sunday night when I first noticed it seemed to have worsened (this is a terribly constructed sentence, but I'm afraid I don't have time to work on it ;-)). After some discussion a little later in the day with the OT, the therapists and the supplier decided the best thing to do might be to have Gary go back to a solid back on his chair, but one that isn’t as high as the one he had as an inpatient. These backs leave a gap between the bottom of the back and the seat of the chair, so that should mean nothing would be putting pressure on Gary’s sacrum, unlike the cloth back he is in now.
The PT also wondered, given the delicacy of Gary’s flap, whether he should be practicing the dressing skills he has been learning on Day Program. She got the skin PT (the one Gary had been seeing throughout his time as an inpatient) to come and check the flap out (so now there were three of us under a sheet in the gym looking at Gary’s butt). The skin PT had Gary get in different seated positions, mimicking what he would do to dress and so forth, and she decided that the positions themselves were okay, but that he needed to be careful about shearing the area with his clothing. So this puts off part of the dressing skills for now, since to get his pants up over his booty he ends up scraping the sacral area quite a bit with his pants as he shifts from side to side in the bed or in the chair trying to pull them up. So all he's supposed to do now is if he is sitting in his chair he can get the pants on up over his knees. Then he’d have to depress and I’d pull them up the rest of the way. It’d be easier for me to get them on him in the bed, but I suppose this depends upon whether or not he has taken a shower or something and we want to do the transfer back to the bed.
The skin PT also told me how to dress his wound over the next few days to see if we can get any further improvement. I sure hate going home with this still being a problem.
After this, the PT wanted him to practice – gulp – wheelies, with me being the one to hold on to the gait belt. I didn’t think we had an auspicious beginning – suddenly, when he was sitting on the edge of the mat talking to her, he lost his balance forward. I lunged toward him with an arm out to catch him at his chest, but it proved unnecessary as he caught himself. The PT remarked that that was “a good reaction from both of you guys.” I’d rather not have those reactions tested!
She took his tip bars off, and then she showed me how to put the gait belt around his axle and how to loop the other end around one of my hands and how I could keep my other hand lightly on a handle on the back of his chair. When he first popped a wheelie, I was scared to let him go back too far and held his chair up with the belt, but she said I needed to let him get to the balance point or he would never find it for himself. He and I were both very unzenlike, I’m afraid. He still couldn’t get very relaxed with his handholds on his wheel and he couldn’t stay in one place, and I was in constant tension, bent over peering at his wheels evaluating whether or not he was overbalancing – which he never did, by the way; I was always able to keep some slack on the belt. She told us we could practice this on our own at the apartment. Oh, yea.
We finished up that session by Gary asking to go back on his tip bars to make sure they would hold him, so we did that gradually, again me holding onto that belt for dear life. The tip bars held, we are both pleased to report.
After that, Gary and I went through his stretching routine, and then he practiced placing the pillows and proning himself. Again, it was promising, but as when he’d tried it in the morning, a pillow ended up right under his knees (which would put pressure on them) instead of below his knee (that, and the pillow above his knees would allow his knees to float); so, for the time being, when he practices this I will have to check to make sure his final position is satisfactory – neither of us would be comfortable with him doing this on his own until he positions himself perfectly say fifty nights in a row!
While he was proning, the nurse came by to go through some discharge procedures with him, mainly stuff like seeing his primary physician within a few weeks of going home and setting up follow-ups with his doctors here. He will come back to see his rehab doctor in about eight weeks, and he will see the “flap doc” during Thanksgiving break – at this appointment we will hopefully find out for how much longer his flap restrictions will need to be in place.
After this, Gary got in the standing frame for a short time. As before, he gets a little dizzy after a few minutes and has to be taken down, but then after a few minutes more he can go up again. The PT said that if he did some arm exercises while in the frame that would help keep his blood pressure up, and he will probably try this when he is in the frame again tomorrow morning. The PT also told us a standing frame is something we could buy for home use (so is the Nu-Step) if we want to spend the money on it or try to find some funding for it, but Gary wondered where we’d possibly put it (inside the new garage?).
We then went home by car, and the PT joined us to practice tub transfers (for places that don’t have roll-in showers). They went well enough, and Gary and I are now cleared to do them on our own.
After that (well, after getting Gary’s baked potato out of the oven and his soup off the stove) I ran off for another session with a personal trainer, this one again with the guy who gave me such an intense leg workout last week. But this time I found it really enjoyable – not being tired makes a big difference in my attitude toward everything, I find.
And on that note, time to quit writing this and go to bed!
Hah! Made it to 6:15am without waking. Yea!
Well, after successfully making it through the weekend without waking for Gary’s 2am IC, I shot awake at 1:59am, and then drowsed and shot awake repeatedly after that. Just something about knowing we had to be on schedule for his 9am session at Day Program. Can we say overly conscientious?
First up was the (futzy) group weight-training session, the usual exercises: biceps curls, triceps extensions, shrugs, trap squeezes, lateral raises, lawnmowers, front raises. The group was much smaller than usual (just three patients and two caretakers, me included), because a number of people had “graduated” from the program on Friday; that gave the group a much more intimate feel, which I liked. They still went through the repetitions too fast though ;-). At the beginning of the exercises, one of the patients who has been here longer than we have, I believe (he started out in the Brain Injury unit), asked me if I was going to do the exercises with them; he and his wife (the other caretaker there) said they had found it very important for her to do the exercises too, since all the tasks involved in caretaking took a lot of physical strength – even just to catch the guy when he lost his balance. Don’t I know it! Fortunately, Gary isn’t nearly as big a guy as this man was – and fortunately for the man, his wife is a lot bigger than I am. Anyway, I couldn’t wimp out (though I didn’t want to overdo things because I have my own training sessions now), so I did all the exercises except the ones I had to hold Gary’s shoulders for. I also didn’t keep up with the official count ;-)
Next up was a session with the OT. Gary first practiced tub transfers with her, doing quite well. Then she had him do “bed work” (maneuvering in the bed) using the double bed in the gym. He has gotten much better at this than when he was an inpatient (just due to practice, he thinks), and she told him she saw no reason for him to use a hospital bed (as medically it is no longer necessary), and she urged him to work toward using a bigger bed, maybe having both in his bedroom and alternating between the two until he felt comfortable using the bigger bed all the time. The bigger bed would definitely give him more space to work in, but he’d have to give up his dependence on the rails and the electronic raising and lowering of the various parts of the bed.
She then taught him her way of what starting position he should get in (from on his side) and where and how he could place pillows and quad pads in preparation of getting himself properly padded off in the prone position. This went better than the other methods he’s tried, and it seems promising. It’s interesting, but disquieting, how each therapist has her own techniques she passes on – it makes it seem like it’s the luck of the draw whether or not you will get a therapist who will have the right technique for you.
After the OT session, Gary had an “IC check” with the nurse, so once again three of us crowded into a stall in the men’s room. The nurse commented that Gary was meticulous, and told him that his technique was excellent and that if he continued doing it the way he did, he should have not get any urinary tract infections resulting from faulty technique.
That finished the morning, and we got to lunch early, meaning we had nearly an hour “free” before his next session. I suggested he could go to the weight room and work out, since they really haven’t been giving him good strength sessions (no zillions of pushups and dips and rickshaw and terrible threes). He didn’t look thrilled, so then I suggested we could do balance exercises. He decided that sitting on the edge of the exercise mat and reading the newspaper would be a good one. Hmm, not exactly an exercise the therapists had had him do, but it did challenge his balance.
I noted that coming up a little later on his schedule was a “stretching and proning session with caregiver,” so I told him to get in the middle of the mat and circle sit while reading the paper (so if he lost his balance he wouldn’t fall off the mat), then I went off to the car to get his chain loops. On the way, I met his supplier, with whom Gary had left a message about the delivery of our bed table and about adjusting the back of his chair. I directed the supplier to Gary, and when I came back to the gym, the guy was working on the chair – Gary wanted it angled more so he doesn’t fall forward when he lifts his hands.
While this was happening, Gary’s PT for the day came, and she expressed concern about the back of Gary’s chair because his flap hasn’t looked as good as it did just before he got the loaner chair and it seems to have stopped improving since from what it looked like last Sunday night when I first noticed it seemed to have worsened (this is a terribly constructed sentence, but I'm afraid I don't have time to work on it ;-)). After some discussion a little later in the day with the OT, the therapists and the supplier decided the best thing to do might be to have Gary go back to a solid back on his chair, but one that isn’t as high as the one he had as an inpatient. These backs leave a gap between the bottom of the back and the seat of the chair, so that should mean nothing would be putting pressure on Gary’s sacrum, unlike the cloth back he is in now.
The PT also wondered, given the delicacy of Gary’s flap, whether he should be practicing the dressing skills he has been learning on Day Program. She got the skin PT (the one Gary had been seeing throughout his time as an inpatient) to come and check the flap out (so now there were three of us under a sheet in the gym looking at Gary’s butt). The skin PT had Gary get in different seated positions, mimicking what he would do to dress and so forth, and she decided that the positions themselves were okay, but that he needed to be careful about shearing the area with his clothing. So this puts off part of the dressing skills for now, since to get his pants up over his booty he ends up scraping the sacral area quite a bit with his pants as he shifts from side to side in the bed or in the chair trying to pull them up. So all he's supposed to do now is if he is sitting in his chair he can get the pants on up over his knees. Then he’d have to depress and I’d pull them up the rest of the way. It’d be easier for me to get them on him in the bed, but I suppose this depends upon whether or not he has taken a shower or something and we want to do the transfer back to the bed.
The skin PT also told me how to dress his wound over the next few days to see if we can get any further improvement. I sure hate going home with this still being a problem.
After this, the PT wanted him to practice – gulp – wheelies, with me being the one to hold on to the gait belt. I didn’t think we had an auspicious beginning – suddenly, when he was sitting on the edge of the mat talking to her, he lost his balance forward. I lunged toward him with an arm out to catch him at his chest, but it proved unnecessary as he caught himself. The PT remarked that that was “a good reaction from both of you guys.” I’d rather not have those reactions tested!
She took his tip bars off, and then she showed me how to put the gait belt around his axle and how to loop the other end around one of my hands and how I could keep my other hand lightly on a handle on the back of his chair. When he first popped a wheelie, I was scared to let him go back too far and held his chair up with the belt, but she said I needed to let him get to the balance point or he would never find it for himself. He and I were both very unzenlike, I’m afraid. He still couldn’t get very relaxed with his handholds on his wheel and he couldn’t stay in one place, and I was in constant tension, bent over peering at his wheels evaluating whether or not he was overbalancing – which he never did, by the way; I was always able to keep some slack on the belt. She told us we could practice this on our own at the apartment. Oh, yea.
We finished up that session by Gary asking to go back on his tip bars to make sure they would hold him, so we did that gradually, again me holding onto that belt for dear life. The tip bars held, we are both pleased to report.
After that, Gary and I went through his stretching routine, and then he practiced placing the pillows and proning himself. Again, it was promising, but as when he’d tried it in the morning, a pillow ended up right under his knees (which would put pressure on them) instead of below his knee (that, and the pillow above his knees would allow his knees to float); so, for the time being, when he practices this I will have to check to make sure his final position is satisfactory – neither of us would be comfortable with him doing this on his own until he positions himself perfectly say fifty nights in a row!
While he was proning, the nurse came by to go through some discharge procedures with him, mainly stuff like seeing his primary physician within a few weeks of going home and setting up follow-ups with his doctors here. He will come back to see his rehab doctor in about eight weeks, and he will see the “flap doc” during Thanksgiving break – at this appointment we will hopefully find out for how much longer his flap restrictions will need to be in place.
After this, Gary got in the standing frame for a short time. As before, he gets a little dizzy after a few minutes and has to be taken down, but then after a few minutes more he can go up again. The PT said that if he did some arm exercises while in the frame that would help keep his blood pressure up, and he will probably try this when he is in the frame again tomorrow morning. The PT also told us a standing frame is something we could buy for home use (so is the Nu-Step) if we want to spend the money on it or try to find some funding for it, but Gary wondered where we’d possibly put it (inside the new garage?).
We then went home by car, and the PT joined us to practice tub transfers (for places that don’t have roll-in showers). They went well enough, and Gary and I are now cleared to do them on our own.
After that (well, after getting Gary’s baked potato out of the oven and his soup off the stove) I ran off for another session with a personal trainer, this one again with the guy who gave me such an intense leg workout last week. But this time I found it really enjoyable – not being tired makes a big difference in my attitude toward everything, I find.
And on that note, time to quit writing this and go to bed!
Hah! Made it to 6:15am without waking. Yea!
posted by Peg Daniels at 5:24 AM
2 Comments:
About airport accessibility--
Atlanta is one of the most user-friendly airports I have ever seen. It's all connected on the inside, so you never need to exit to get from one concourse to the other. Between 6am and midnight you have the option of the train, which is frequent, and the moving sidewalk, which I think operates all the time, to get from one concourse to another. Also, with the possible exception of international flights, you only have to go through security once, and if you are connecting you don't have to go through security at all (again, international outgoing may be an exception).
On the other hand, New York's JFK airport is the absolute pits. Able-bodied as I currently am, I wouldn't want to go through there again unless they allowed at least two hours for connections (allowing inter alia for half an hour delay getting there), and two and a half if you have to go through customs.
Delta, with which I flew domestic during my Prague trip, is in terminal 3, adjacent to terminal 4, which is for international flights. To make connections, you have to exit the bulding, which means going through security a second time. But that's just the beginning. I could see no safe way of walking from one termial to the adjacent one, and was even instructed to take the train that now seems to be the only connection between terminals. But that's still just the beginning...
To get to my connection to Prague, I had to cross a busy street just to get to the three not-so-big elevators that get you to the train. [Imagine two hundred people having to make connections in short order! Bedlam!] Fortunately there were only about twenty of us waiting, but the first elevator to arrive at street level had a jerk on it who decided he wanted to go back up, so before any of us could get on, he punched the button to go back up and we couldn't get the door to stop closing.
The second elevator went OK, and somehow I managed to figure out which direction Terminal 4 was in, but once I arrived there, I had to work my way through a maze of passages and up and down escalators to get to security. I had been issued boarding passes in Columbia, and the one for Cincinnati-JFK had worked fine, but I was told that the one for JFK-Prague had to be replaced way back at the Czech Airlines ticket counter. So I ran back up the escalator, into the huge jammed hall, with lots of parallel counters. Fortunately the first airport employee I asked knew where the Czech Airlines counter was, and there was no waiting line, and they got me a new boarding pass in under a minute, and I was able to dash back to security soon enough to make my flight with a few minutes to spare--after having arrived at JFK over an hour earlier!
But the return from Prague was even worse--I'll make a separate blog comment for that!!
And now, on to my return trip from Prague, which took me through JFK once more.
Customs took over half an hour, because it seems at least two flights had arrived very close to each other. For a while everything seemed to go OK after that. Exiting customs, I saw a prominent place for "Connecting flights" and there they told me
where to find the escalator/elevator to the train that would connect me to Terminal 3, right adjacent to Terminal 4 where I was, and I was even told to wait for the train on the left side of the platform.
When I got on the train, just as the doors were about to close, the red letters showed up on the monitor saying "Next Stop: Terminal 7." There wasn't a prayer of getting to the doors before they closed, so momentarily I had visions of getting off at the next stop and getting on a train going in the opposite direction. But fortunately there were some helpful passangers who told me the sign was stuck, it had been showing that even before the train had arrived at Terminal 4 where I had got on. So I stayed on, and sure enough the next stop was for Terminals 2 and 3.
Before I go on, an aside about Delta's airline magazine, "Sky". It shows the layout of most airports frequently served by Delta, or at least of the terminal(s) served by Delta. Surprisingly, all of LAX (Los Angeles airport) is shown, but JFK airport belongs to the second category. One vital item missing on all maps is the location of security check-in--perhaps for security reasons! Anyway, I cannot tell from it whether I would have been better off to go directly to Terminal 2, where the gate for my flight turned out to be, thereby saving myself close to an hour and an awful lot of walking and aggravation (as will be detailed below) or whether I would have had to go through security at Terminal 3.
Anyway, Terminal 3 was what my boarding pass said, and so I went down the one-of-three elevators I had gone up a week earlier on the trip to Prague. I crossed that familiar busy street at the bottom of the elevator, and started following the signs for "Departures Terminal 3" like just about everyone else was doing. [I could have gone into the terminal building directly, but the signs there only indicated baggage claim, and it wasn't clear whether I could get to departures directly from there.]
The signs directed us along a narrow sidewalk bordering a busy street in a kind of semi-tunnel. The sidewalk wound around the terminal building, past one "No entry" door after another. After breathing a lot of exhaust fumes a bunch of us finally got to a dead end to the sidewalk, but there was a pedestrian island on the other side of a street that ran into the one we had been moving parallel to, and some of the group crossed to it. I on the other hand could see a "Terminal departures 3" sign way ahead of us on the opposite side of the street we had been following, with no official pedestrian crossing in sight. So I turned back, and after about fifty yards I saw an inconspicuous pedestrian crossing that had been completely obscured on the way up by a big bus that was waiting for the cars in front of it to get a move on. Crossing this, I finally was able to walk uphill to the actual terminal 3 entrance to Departures.
Once inside, I saw a huge line at the Delta ticket counter. It took me a while to learn that this time I would NOT have to change my boarding pass before entering security. The TV monitors did not include my flight, so another thing I decided to find out before entering security was whether it had been canceled and if so, what my new flight would be. The first Delta employee I asked told me to wait in line to ask a ticket agent, but that would have been a disastrous loss of time, so I boldly circumvented the whole long line and told a ticket agent my problem, showing my boarding pass, and she graciously looked up the information and told me it would be at gate 22. They just had neglected to put the information up on the monitors, and with less than an hour to go it got put up there in short order, perhaps because of my bold action.
Once through security, I started down the long corridor past gates 10, 11, 12, ... I didn't have a copy of "Sky" with me, otherwise I might have tried to go in the opposite direction, because as it was I circumnavigated most of Terminal 3 before getting to the corridor to Terminal 2, and after passing down this I went almost to the end of Terminal 2 where Gate 22 was located.
It was too late to buy any food, what with the long lines at the places where it was sold. Also, I had been in too much of a hurry to get a drink of water since deplaning on the way to customs about an hour and a half earlier,
and the water fountains weren't working! I went into the men's room hoping to drink out of the faucets, but the water that came out was hot! So I bought a bottle of water at the one kiosk that did not have a long line in front of it. It was the most expensive bottle of water I have ever bought--a half liter of Fiji water costing over 3 dollars, but it tasted great and put me in good spirits for the plane ride.
A good thing too--we had to wait three hours in the plane at the gate, waiting for permission to leave the gate because Atlanta airport was closed due to thunderstorms and they didn't want us to be airborne until they were sure the plane could land in Atlanta. Then it took over an hour of waiting on the runway while all the planes ahead of us were taking off. By the time we arrived in Atlanta the last plane to Columbia that evening had taken off...
But that's another story.
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