Phase II: Range of Motion

This morning was my 5 week post-op visit with Dr. Greis.  I have officially graduated to the next phase of recovery!  Hello phase II, goodbye phase I! Here is what I get to do for the next month:

This is WAY harder than it looks.  My leg was shaking.

1. Wean crutches!

2. Walk in the pool or deep-water jogging. May use recumbent bike with no resistance. 

3. Full knee flexion and extension permitted, but no full knee extension coupled with hip flexion.

4. No strengthening or load-bearing on hamstring yet. 

5. Drive...and yes, I get a temporary handicapped parking permit. This is the happiest news for Barry, who has been the house chauffeur for the past 6 weeks!

     

     Unofficially, I started weaning crutches this last week which is going well. I am hardly using crutches in the house at all except for stairs, but uneven ground outside will be awhile before I feel safe without them. 

The muscle-free, skinny-fat left leg takes a dip!

     Curious about how it would feel, I jumped the gun a little on Sunday and walked in the pool for the first time. I have always enjoyed swimming laps for exercise so after 6 weeks of doing nothing, I couldn't wait to get in the water, even if it was only to walk around.  

     Did I say "Only" walk around? Ha! Walking in water with a weak leg was extremely challenging! Pushing my leg through the water felt like I was pushing it through molasses.  Since the muscle has atrophied, my skinny-fat left leg wanted to float to the top of the water while my piddly little muscles had to push it back down; even just standing while holding onto the wall was tiring. Unfortunately, my neighborhood pool is now closed this week for spring cleaning, but my goal will be to get in the pool at least 3 times a week when it opens again.

     I think anyone who is faced with prolonged inactivity has some concern about putting on extra weight. I am pleased that after 6 weeks, my clothes still fit me the way I like. I don't have a scale in my house, so as long as I slip easily into my size 6 pants, I am satisfied. My appetite, which has always been hearty, dropped considerably with my inactivity; applying the the basic principals of calories in-calories out, I break even.  I have Emily to thank for some of this.  She continues to be a very good breastfeeder which burns around 500 calories or more daily, all while sitting on the couch.  The left leg has lost a lot of muscle: though it looks good and fits into pants, there is the element of skinny-fat that will only begin to remedy when formal PT begins in a month's time.

6 Weeks Since Injury

Today marks 6 weeks since that fateful morning in my living room.  Four and a half weeks post-op, I admittedly have jumped the gun on my weight-bearing which is not supposed to start until 6 weeks per my surgeon's protocol. Some doctors say 4 weeks, some say 6 weeks. So with the insight of a wonderful, though small, online community of people all over the world who have sustained this injury, I decided to listen to my body and give weight-bearing a shot.

6 weeks toe-touch weight bearing atrophy on left leg.

     Last Sunday was the first day I really started planting my foot on the ground and it felt wonderful. As I hoped, just the act of putting weight on my left foot improved my circulation and got rid of the prickly neuropathy on the bottom of my foot.  Monday, I was sore.  It was not my hamstring that was sore.  It was the other muscles and joints in my leg that had not been used since March 11.

     As you can see from the photo, the left leg with the sock has no muscle definition in the quads.  Compare to the other leg that has done all the work or 6 weeks and you can see what the left leg is up against.  Since the leg has not moved, the other tendons are also tight.  A mild case of drop foot has shortened the achilles tendon which places a stretch on the calves just by planting the heel on the ground.  The other muscles and tendons supporting the knee are weak so there is little lateral knee support with effort. My hip flexor is also tight, not allowing my leg to hang back in stride, so right now my gait is more of a penguin waddle from side to side.

    Monday I noticed my calf was sore so I rested most of the day.  Tuesday, the pain in my calf resolved so I advanced myself as tolerated. By Thursday, I crutched around the the block with partial weight bearing two times and felt quite accomplished.  Not to mention, baby Emily was downright thrilled that mommy was going on a walk with her while my friend pushed the stroller.  Today left me with some medial ankle discomfort. Weird.  Though I should be proud of my weight bearing accomplishment, it is a sobering reality of the commitment it will take to get my body to work with my leg in a functional way again. To keep things positive, I will leave this post with a list of small victories.

1. Reading lots of books with Emily. There are two things she knows a mommy on the couch is good for: breastfeeding, and reading books.

2. Michelle reading to her sister to keep Emily out of trouble...and they both enjoyed it!

3. Crutching around the block in the sun two times with Emily.

4. Crutching by the rock wall in my backyard to yank out some bindweed...ALWAYS satisfying!

5. Riding with my mother in law today to pick up Michelle from school. It was my first after-school pick-up since the injury 6 weeks ago.  Michelle threw her arms around me and said "Mommy!  This is the best news ever! It means you're getting better!"

     

4 Weeks Post-Op Progress?

Where I should be, on the couch reading books with Emily!

Today marks 4 weeks post-op and thank God it's Monday!  I am noticing a trend of over-doing it on the weekends when I don't have my hired angel to keep me out of trouble. I didn't even go anywhere.  Just hanging out at home, trying to be a mom was enough. I had some little victories that likely motivated me to push a little too hard. First, I was able to sit in a padded chair or reclined adirondack chair for up to 20 minutes without significant pain.  Hooray! Then I discovered I could partially weight-bear without much pain.  Hooray! Today, the back of my leg is achy and my hamstring is twitchy. Boo!
     Though I am excited to know that I am healing, it is equally frustrating knowing how careful I still  need to be. But now, I am grateful for pain. Pain is my friend; my warning system that activates when I am doing too much.  If I listen to the pain signals at the earliest point, I will avoid pushing myself too hard too soon.
     So while others may begrudge going back to the weekly work grind on Mondays, it marks the point where I get five full days with the help of Leanne and Donna to rest up before I hit my weekend grind!

Adventures in sitting!

Our weekend backyard adventure.

Angels

I never knew how much I did as a mom until I had to assemble an army of people to take over my duties. Three and half weeks post-op, I could not be managing this without the Angels in my life who have swept in to help manage my household.  I will take this post to recognize those Angels.

Leanne.

Leanne is a neighbor and stay-at-home-mom of four kids who are all in school. She saw the paramedics outside my house the morning of my injury and quickly offered to be of assistance in any way she could. I had no idea at the time how important her offer would become.  

     It became clear after a couple of days that I would not be able to bend down and pick up my increasingly mobile 11 month old.  Emily turned one on March 29th.  She walked on her birthday. She is walking way better than me right now, but she also falls fifty times a day and like any toddler, she is into everything!  I cannot pick her up off the floor, put her in her crib (which happens to be downstairs...which is another hurdle), can't put her in her high chair.  All these activities engage the hamstring or offer a potential for injury (like stairs) that I cannot afford to take if I want to heal without complications. I cannot rescue Emily from herself which is necessary multiple times a day. You see, I cannot be alone with Emily. We both need a babysitter!

     On day 4 or 5 post-injury, I had a span of a few hours that my family was unable to fill-in and took Leanne up on her offer to help. She did more than I ever expected. Not only did her gentle, nurturing touch soothe Emily for naps and keep her out of trouble, but Leanne vacuumed, unstacked my dishwasher, cleaned my kitchen, and brought me books to read. That day ended up being somewhat of a job interview. She was so caring and attentive and wanted nothing in return. But her skills proved to be worth paying for. I offered her temporary employment until I can manage my sweet Emily by myself. Her companionship has also sparked a relationship of mutual support and friendship that will continue well past my recovery.

Donna.

Donna is my mother-in-law. My in-laws moved to Salt Lake City from Phoenix a year ago, just after Emily was born. The idea was that they would be closer to family in case either of them needed family near by for medical concerns.  Little did we know that it would be ME needing the help!

     Donna has stepped in wherever Leanne can't. Aside from watching the baby with me, she has prepared meals, bought groceries, baked muffins, picked Michelle up from school, and countless other tasks that we take for granted every day when able bodied. 

Barry.

Oh my, has Barry risen to the occasion!  My wonderful husband struggled at first. The stress of unloading my motherly duties onto him was overwhelming at first to say the least. He had to take over the nighttime duties when Emily woke up and was suffering sleep deprivation while she adjusted to the new normal.  The first nights after my surgery he woke me up every 4 hours to take pain meds so I wouldn't wake up in pain. He tirelessly cooks meals and has made my coffee every morning before I wake up! This injury has disrupted so many family processes, but last 2 weeks have improved greatly with the routine and he has not wavered to be sure that I protect my repair.

Tammy.

My aunt Tammy is the youngest sister of my deceased mother's.  She is 12 years younger than my mom was and 14 years older than me.  More a big sister than an aunt, she has stepped in selflessly just as I imagine my mother would have if she was alive.

     Tammy lives in Seattle and had already planned before my injury to come out for a visit to celebrate Emily's first birthday the first weekend in April.  When she heard of my injury, she immediately booked an extra trip to come and be of assistance for the few days before and after my surgery. She is a Physical Therapist turned Wellness Coach and kicked my butt into compliance. She was aghast the first day she arrived to find me hobbling down the stairs on my crutches and weight-bearing on my pre-surgical injured leg! She is also a lover of babies and found great joy in helping out with a giggly, sweet emerging toddler.  Her second visit 10 days post-op to celebrate Emily's birthday was equally helpful and I am ever grateful for her help.

Dave and Linda.

My dad is Dave.  Linda is my step-mom. My dad stayed with me tirelessly for 12 hours in the hospital the first day of my injury and has stepped in wherever he can in spite of his own health concerns.  He is 9 months post-op rotator cuff surgery and my voice of reason when I even think of doing too much too soon. Linda is the ultimate bookworm and baby-lover so she has provided me with a library of books for my idle time and taken the baby on Tuesdays throughout the first month of surgery.  My dad has also helped subsidize Leanne's help, insisting on paying her more than I could initially afford.  But he was right, she is completely worth it.

Irene.

Irene is my angel on the sidelines.  One of my best friends and mother of Michelle's friend Izzy, she has stepped in to help me manage Michelle.

    Michelle attends a charter school that is a 15 minute drive from our house. Irene lives a block away from school, an easy walk for Michelle, and has not only offered her home for Michelle after school, but has carpooled Michelle to various after-school activities and kept her for several mid-week sleepovers. It is painfully clear that I over-scheduled Michelle with after school activities now that I cannot drive, a mistake I won't make next year.  But as these activities prepare for spring performances and grand finales, Irene has made it possible for Michelle to continue participation.

The Cherubs.

The cherubs are my friends who have stepped in here and there to help where they can in the midst of their busy lives. My sister Cory and her husband Bill, my friends Taunya, Kim, Maysa, Ann, Sam, Izzy, and several others have brought meals, entertained Michelle, given me pedicures, and helped with the baby. 

Doug

     Yesterday I felt frustration and self-pity creep up on me. It kicked off after my shower when I was attempting to put my clean clothes away. When I carry anything, I have to hang my armpits on my crutches and move the crutch with my torso rather than my arms. I positioned my right crutch a little too close to center and crushed my right fourth toe (the good side) into my crutch while swinging through, which sent me to the floor.  I fell gently in slow motion and nothing felt tweaked or torqued on my left side at all. However, having a sore right foot now reminds me of how long I have to go and it is easy to slip into self-pity.  But pity is not active, nor a constructive emotion in any way.  So to draw strength from the experience, I think of Doug.

Mt. Rainer, October 2008

     

    Doug was a patient I cared for back when I was in nursing school in Seattle, working as a nurses' aid.  He was one of two patients I kept correspondence with when I moved on after graduating from nursing school. Though nursing school cautioned about blurring the line between therapeutic and personal relationship, it was impossible to avoid being Doug's friend![-] Doug was born with cerebral palsy, but inside his twisted body was a brilliant mind and absolutely the most caring, emotionally intelligent person you would ever meet.  Even while his body jolted in spasm, seemingly working against all his physical efforts, he maintained a playful sense of humor. He was realistic about his physical limitations but never let them limit him. He gathered the resources he needed to carry on practically, always flashing his warm and inviting smile along the way.

     As a classically trained singer, I participated casually with a group of singers that put on concerts a couple of times a year when I lived in Washington state. I invited Doug to one of these concerts when he genuinely showed an interest in coming to hear me sing. I asked if he had a way of getting there and he wrote saying "Of course, I'll take the bus!" The concert was at a church in Bellevue which was across the lake and in a place that seemed a little obscure to get to by car, let alone by bus.  I had doubts that he would make it. I never should have doubted him! As I looked around the audience just before the concert was about to start, there was his smile, cruising in on his electric wheelchair with his caregiver. Of all my friends who came, he was the only one who took 3 different busses and wheeled 1/4 of a mile on an electric wheelchair to get there. And he acted like it was no big deal. That was Doug. He transformed any potentially frustrating circumstance into a practical problem to solve without an ounce of self-pity.

     Doug and I were Facebook friends which became our primary form of communication when I left the pacific northwest in 2010. He was a fan of the Facebook "poke", which was playfully fitting for his sense of humor. Sometime around 2012, it occurred to me that I hadn't been "poked" in awhile and hadn't seen his posts in my feed. I knew it was not possible for him to "unfriend" anyone. When I went to stalk his page, it now read "Remembering Doug". In 2011, Doug was tragically killed in a hit-and-run accident while driving his electric wheelchair on the side of a road. The driver was eventually apprehended, but that is very little consolation to those who had been infected by his positive attitude, goofy sense of humor, and gleaming smile.

     In memory of Doug, I dedicate my recovery to banishing self-pity and addressing each problem with practical resolve; to solve what I can, and accept what I can't. 

In Sickness & In Health

Barry and me at Jackson Lake in 2012.  Michelle just turned 3.
This was the first trip we took alone together after her birth.

The power of partnership is using your differences to your advantage. When people fall in love, there is an element of projection they place on each other. We seek sameness to fulfill the fantasy of romantic love. Over the past 9 1/2 years, Barry and I have become more aware of how different we truly are. Learning to appreciate those differences as our romantic projections dissolve is the challenge of every marriage.

     When a disruptive event occurs in a marriage, we have two choices: adapt or deny. Denial is the monster that keeps us holding on to the illusion. Even with the best efforts, old patterns are extremely sticky and difficult to vanquish, even when those patterns disrupt the family system.  It often takes a disruptive event as the catalyst to change those dysfunctional patterns. If we let it, the event can be a powerful opportunity to adapt to a healthier state of normal. My therapist told me once that it takes 30 days for change to solidify into habit. Today marks four weeks since the injury and I am finally beginning to see a positive difference.

     Aside my injury which was spontaneous and unplanned, over past year and half we had two other planned life-events that are known to be on the top of the list for "most stressful": we bought a house, and had a baby. I'll be totally honest that the past year and half has without a doubt created a significant amount of marital discord. Though my postpartum depression lifted after resuming my anti-depressant medication, I watched moodiness and negativity take over Barry in a way that felt impossible to break through. 

    Then the injury happened, suddenly the man who was already the main bread-winner and family chef found his responsibilities double. The first couple of weeks were a challenge.  He is an introvert and prefers to keep emotional discourse to a minimum, but his non-verbal language was abundantly clear: "This sucks for me. My life just got that much harder. Kelly is why my life got so much harder." Physically he was picking up the slack by taking care of the baby, taking Michelle to school, and cleaning up where I couldn't. But emotionally, he struggled. He would ask me to do things he knew I wan't capable of and fall into a slump when I couldn't or wouldn't do it.  

    I noticed the change about a week ago. Barry's head began to lift above the fog of denial and begin the process of emotional adaptation and acceptance. Instead of coffee in the morning, he was juicing.  Instead of pouring a cocktail when he got home from work, he prioritized exercise. He stopped falling asleep in front of the TV at night and started reading until he felt drowsy. Over the past few days, I have finally seen the resentment melt away. He is falling asleep in our bed instead of the couch. He is patient, interactive, and proactive, facilitating opportunities for me to bond with the girls. His parenting with Michelle is more effective. And this morning, he was downright cheery! With his wife disabled, the strength required of him has left no room for unhealthy choices or habitual resentment. Silver linings everywhere.
 
     

The Athletics of Nursing

     On Monday, my brain activated the worry button when my surgeon updated my medical leave paperwork, changing the length of my estimated incapacitation from May 17th to June 20th. That makes sense. May 2 marks the point when I can begin weaning crutches and start gentle activity like walking in the pool or a recumbent bike with no resistance (as tolerated). 4 weeks later, I may begin PT.  So maybe that gives me 3 weeks of PT before returning to work for an injury that is known to take months to return to 80% of previous function.  With many jobs, this would be adequate. But there are days when my job as a Labor & Delivery nurse is an outright athletic event.
     When I was pregnant last year, there were days I could barely walk at the end of the day as my hips were expanding.  Just bending down to plug in a bed felt like a monumental task. And who designed those IV pumps we use? It was not a nurse who designed an IV pump that weighs 10 pounds plus up to four 2 1/2 pound pump modules added to make a 20 pound piece of machinery that you have to hold up isometrically with one hand for a solid minute or two while screwing in an extremely slow mounting clamp onto a pole...for almost every patient!
     Nurses are people movers. In Labor and Delivery, we move women with spinal anesthesia after a c-section, help women up to the bathroom the first time after epidural anesthesia, provide endless hours of counter pressure for labor support.  We twist, we turn, we bend, we lift, we sprint to emergency c-sections. Every once in awhile when I hear a colleague say "I really need to get back in shape!" I think, well, it can't be all that bad; you did just leap onto the bed pretty quickly to relieve that shoulder dystocia! And these activities go on for a 12 hour shift.
     To be clear, I am not complaining.  I am active. I love to move my body. I have loved that for the past 11 years (5 in Labor and Delivery), I have a job where I get to move my body in dynamic ways. I have worn the intensity like a badge of honor. I have kept myself fit so that I can effectively execute the demands of the job.
     The physical demand of bedside nursing is no secret. If you do a job search for nursing jobs at my hospital, any bedside nursing job states that you may have to do all kinds of physical movements including lifting 100 lbs.  Yes, it says that specifically: 100 lbs, though we move patients 2 to 3 times that weight! This is not like lifting 100 lbs at the gym. This is 100 lbs (or 250 lbs) that drops suddenly in a tight cramped space on a floor that maybe wet and slippery, as you are twisting your body around, banging your knee on a cabinet trying to figure out what the hell just happened.
     For the first time I have to worry that my body may not be able to meet the physical demands of a job I love and remain whole enough to keep up the other meaningful activities in my life. I cannot afford re-injury. When I went back to work after Emily was born, I cut back my hours substantially to 12 hours a week. How wonderful to spend more time raising my baby! But a 12-hr work week was the minimum my family could bear to keep our household a-float. As a part-time employee, that left me with no PTO (paid time off) and no disability insurance to help float us through this.  Add the medical bills to the mix and I am faced with a reality that I may need to go back to work full-time to recover from this injury financially.
     On the positive side, my hospital has a decent medical leave policy that does support keeping my job while incapacitated, even for part-time employees. My manager is supportive of my recovery and would love to bring me back when I am able. The questions is, can I afford to wait that long?

Gratitude

A friend of mine stopped by yesterday for a quick visit around lunchtime and made me a sandwich.  A little gesture that went along way.  I believe I illustrated the difficulty of taking things in and out of the refrigerator with 2 hands on crutches in a previous post.  As I told her my rehab plan and the length of time that I have to let the muscles in my left leg waste away, she commented:  "If your injury had happened to me, I don't know what I would do.  I have one tenth the support and close family network that you do!"
     It is true that a good chunk of my family lives in Salt Lake City. My sister, my parents, step-siblings and my husband's parents are all here. I have an aunt from Seattle who has flown out twice to help.  I am immensely grateful for the time and resources they have all pitched in to keep my household afloat!  But then more support popped out of the woodwork.  Friends brought meals. Since I can't be alone with now 1-year-old Emily, some have offered to stay with me for a few hours here and there. Friends and twice-removed family members have offered to transport Michelle to her various activities. One neighbor was so helpful to me one day, I actually hired her to help me for the next 6 weeks or until I am able go up and down stairs, perform light housework, and chase after my baby. All of these gestures large and small have accumulated into a network of support that was unimaginable the day of my injury.
     There is no doubt this injury is a great inconvenience to me. But I will make a full recovery. Four months from now, I can expect to be participating in all the activities I did before with little accommodation.  I credit the wonderful patients I have cared for as a nurse for the past 11 years for giving me clear insight into this.  New quadriplegics, stroke victims, pregnant mothers with cancer, babies with significant birth defects; the list is endless for people who have had to muster up more courage, strength, and perseverance than I could even fathom. These people have given me the gift of gratitude.

Grateful for the sun and this 1 year old cutie!