Thursday, October 28, 2010

Getting to bottom of things.

Today was an excellent day. I drove (that's right drove) to NYC to meet with a highly regarded shoulder specialist to get to the bottom of why my range of motion is still so limited and the pain continues in my left shoulder. I was very impressed with my new doctor who spent a delightfully un-rushed period of time with me listening to my story, examining my shoulder, reviewing a set of recent x-rays and explaining a few of the possibilities with me. The next step will be to get more information through additional tests. I need an MRI (to investigate soft tissue/muscle damage), a CT scan (to get a better sense of bone healing from various angles) and an EMG (nerve test). It will be some week next week but I expect to have a much better sense of the prognosis and treatment the next time the doctor and I meet.

The second reason my day was so enjoyable is that I made a pit stop on the way home at Helen Hayes to visit Bob, my former roommate, and a few other friends, therapists, nurses and aids. Things change fast in a rehab hospital. I knew that many of the patients I had been living with were discharged around the same time I was, but I was also able to see the dramatic progress the few who stayed had made in the past three weeks. It was also fun to see the nurses and aids who had known me only really from a sitting or lying posture.

One of the best things about the visit is that I was able to walk into the hospital without crutch or cane. I've had a real breakthrough over the past week. Through a combination of Feldenchrist work, massage, physical therapy and strengthening exercises, I am now able to walk without my crutch for sustained periods of time. While I still feel some sensitivity and weakness in the left hip, I have even been able to counteract the slight limp which had developed. This continues to be my focus as I build strength and balance.

The visit to Helen Hayes was wonderful for a variety of reasons. 1) I was able to reconnect with some amazing people, 2) the dramatic progress I saw in my friends reminds me of what is possible, 3) It was great to show my therapists how far I have come and 4) I was reminded that even the worst prognosis can be counterbalanced by love, determination and hard work.

Tuesday, October 19, 2010

Week Two at Home: Progress in several flavors.

Fully into week two after being discharged from the hospital, I am feeling more settled and independent each day. After getting some confusing and disappointing news from my insurance carrier last week, I seem to have navigated my way into a) an appropriate level of care from my therapists and b) an appointment next week with an outstanding shoulder specialist at Beth Israel hospital in New York. I also met with my GP yesterday to prove that I was still alive and he had no trouble granting me driving privileges. It's such a relief to both Jessie and me that I can drive!

I met with my new occupational therapist today who works out of the same office in New Paltz as my new physical therapist. I enjoyed the session (I really am becoming a masochist) and felt like it represented a very productive start. For example, after working with him for about 30 minutes, I was able to lift my arm farther than I have since the operation. Hopefully this is a good omen.

Finally, after therapy today, I took my iPod and crutch and hit the Walkway Over the Hudson. This time, I was able to make the full round trip to Poughkeepsie which amounts to about three miles. While the pace was slow and measured, it sure felt great.

Sunday, October 17, 2010

The Road to Recovery: Phase four has begun

It's been over a week since I was discharged from Helen Hayes and the thrill hasn't worn off yet. There is nothing like sleeping through the night in your own bed to make you feel like things are heading in the right direction. Of all of the things that hospitals facilitate, sleeping through the night is not one of them. For the first two weeks of my confinement, I was awakened by the nursing staff every four hours to receive medications and have my vitals checked and for the last four weeks I was awakened by pain, a suffering roommate and careless night nurses in about equal measure. But that's all behind me now! I'm free!

While sleeping is much easier, maintaining discipline with rehab is a bit more challenging. Unlike in the hospital where my rehab followed a rigorous schedule, I am in charge of most of my own rehabilitation now by working my way through an exercise plan outlined by my therapists at Helen Hayes. I also began the week with visits by occupational and physical therapists from a home health care agency. Each of these folks determined that I was safe and sound navigating the obstacles and challenges in the house and so I was promoted to outpatient care in short order. On Thursday, I met with a wonderful physical therapist that Jessie has worked with for an initial assessment and look forward to working with her at her office in New Paltz several days each week. I will have a similar meeting with an occupational therapist at the same office on Tuesday.

I also spent a considerable amount of time this week navigating the complex and logically-challenged world of US health insurance. This week, I found out that a) the orthopedist I saw as an inpatient at Helen Hayes is not covered for me to see as an outpatient, b) I cannot have physical therapy and occupational therapy in the same day despite the fact that I cannot drive and need others to bring me to receive care, and c) none of the expert shoulder specialists who were recommended to me are covered by my insurance carrier. Yikes! It's a good thing that I'm not currently working so I can spend the necessary time trying to get the care I need so as not to slip behind in my progress. Luckily, I've also tapped into excellent advice from friends and family and expect that I will eventually get the care that I need just so long as I can maintain persistence and focus. It's also a good thing that I'm an endurance athlete.

On a physical level, I am walking with a crutch without much pain as I rebuild the strength in both of my legs and hips. My left shoulder remains a serious concern as I am not able to move my left arm very much at all. Still no weight bearing there and a considerable amount of pain without intervention.

It's another beautiful fall day today - after some in-house shoulder exercises and a little lunch, I think I'l hobble across the Walkway to get in my daily walking practice. Hasta luego!

Friday, October 8, 2010

Heading Home

It's hard to describe what it feels like to be working through my final day in the hospital after six weeks away from home. From the time I woke up and had breakfast, it's been something like Christmas Eve, New Year's Eve, my birthday and the day before summer vacation all rolled into one. 

After receiving the good news about weight bearing from my doctor on Tuesday, I've spent much of the last three days walking and climbing stairs with my physical therapist. Trust me, it was truly bizarre to walk again after six weeks in a chair and bed. While it was not really painful, my legs have lost a significant amount of strength, so I was a lot more wobbly at first than I expected. Fatigue is more of an issue than pain, so I'm talking it slow and continue to spend most of the day in my wheelchair. Transfers are so much easier since I simply stand and pivot when I need to move from one place to the next. This makes me infinitely more independent which has not come a moment too soon. 

As you would expect, each day the work gets progressively more challenging. On Wednesday, I climbed the make-believe stairs in the therapy room, while on Thursday when Jessie came for a training and visit we climbed the full set of hospital stairs together between floors twice. While I may be slow, it wasn't too difficult and I'm very optimistic about about my transfer home.

My left shoulder, on the other hand, has turned out to be more problematic than I had originally hoped. I'm not able to bear weight on this limb because the clavicle has not yet fully healed. As a result, I'll need to follow up with a shoulder specialist after returning home. While I've made steady progress with my occupational therapists, my range of motion remains far below normal. This will clearly be my major rehabilitation need in the coming months. With luck, I won't need another surgery.

I feel so grateful to have received such a high level of care from the staffs in both hospitals. At a certain point, though, it's time to go home! Jessie is coming down in the morning to hatch me out of here. I could not be happier that we are scheduled for a weekend filled with ideal fall weather. In addition to the general hanging around the house with my family that I have craved so much, I hope to take a trip to the Walkway Over the Hudson with my wheelchair and crutch (and family!) to get an authentic taste of my normal life. I think I'll leave the bike at home, though, (this time).

Sunday, October 3, 2010

Recovery: Phase Three on the Horizon

I am poised to enter my fourth week at Helen Hayes and my sixth week since the accident. It also looks like this will also be my last week in captivity. I will have a full series of x-rays completed on Monday that I will bring to a meeting with my orthopedist on Tuesday who will assess my progress and determine whether my weight-bearing status will change at that time. I am scheduled to be discharged from Helen Hayes on Saturday, October 9th regardless of Tuesday’s outcome.

I’ve been making steady progress and will continue my recovery at home and my rehabilitation on an outpatient basis. My left shoulder in particular will need a lot of physical therapy to regain a full range of motion and activity. I have been doing research into physical therapists in the mid-Hudson Valley with an expertise in shoulders. Hopefully I will find someone as highly skilled as the staff here at Helen Hayes on the first try.

Since I will not be driving for a while, my therapy will either need to be based in the home or nearby since I’ll need to count on Jessie for transportation. This limitation is not related to my leg injuries, but rather the very limited mobility of my left arm and shoulder. One needs to be able to raise the left arm far enough to activate the turn signal in order to drive. My plea that most New Yorkers ignore the turn signal entirely fell on deaf ears here at the hospital.

Over the past week, I’ve also gained greater stability in my right leg and this had made transfers (from bed to chair, etc.) much smoother. All of that standing and squatting now means that I rarely need to slide across a transfer board. While still sore, I feel stronger and more ready to use my left leg and arms to aid in my mobility. I do need to get the all-clear from the doctor, though, so I don’t do any damage if the bones aren’t fully healed.

The attending physician’s strategy has been to wean me off the most serious of the pain medications over the past several weeks. Today is my first day without one of them and so, ironically, I’m feeling a bit more pain and discomfort than I did a month ago, but it seems reasonable that a person in my condition should feel pain and discomfort. Hopefully, this will lessen in time, too.

So, today I plan to read, write a few letters, watch a film or two and rest in preparation for my last week of physical torture/therapy at Helen Hayes. I also got a call from a dear friend who’s coming for a visit this afternoon with his kids. It's been great to follow my friendIt’s great to be able to see the light at the end of the hospital tunnel. Take it from me, six weeks is more than enough time to spend away from family in a hospital. Enough already! I hope the phase three of my recovery is as smooth as the first two have been.