Tuesday, February 7, 2012

A New Approach

I've learned bad lessons, it seems.

Over the past year, sitting in one place and not moving at all has taken on a more-than-zen role in my life. I find a comfortable position and that's it - I'm not moving until there's a really really good reason to do so.  The doorbell trumps the telephone, unless the phone happens to be right next to me on Douglas.  Comcast has this nifty feature where the caller's identification appears on my television screen before I even touch the phone.  Someone should tell the Arizona Opera that that's why I never answer their solicitations; I'm screening my calls so that I don't have to budge.

Comfort is a relative term.  I can feel the tendons and ligaments settling into their niches, lying on the protuberances and teeny malformations in what had been a totally smooth joint space.  I know that deep relaxation like that will result in complete stiffness when I try to budge.  I'll be standing on one leg, willing the other to join the party.  After a while - seconds... minutes... at its own pace - things begin to loosen up and before long I am moving along with alacrity.  It's often not a very pretty sight, but I'm getting from point A to point B and, for the longest time, that was enough for me.

TBG's pointed jibe - "You are limping really well.  Now, how about learning to walk really well?" - hit home over the holidays. Watching me waddle from side to side, seeing me favor my bad side and do a fairly good imitation of my father's Walter Brennan-like limp was impairing his ability to move on.  Every time I groaned, every time my left shoulder set itself several inches below my right, every time I hitched myself across the living room he was reminded of the bullets that created this mess.  I needed to recover so that he could do the same.

The pressure was a bit over-whelming.  We've always wanted one another more than we needed one another.  It's a basic tenet of our relationship.  I'm beginning to realize that aging may force us to reexamine this ... just a little bit, anyway.  I couldn't have recovered without his support - financial, emotional and physical.  Settling for a gimpy gait and regular sighing didn't seem like an appropriate way to repay him.  On the other hand, adding one more brick to the wall I was building between myself and a full recovery wasn't very helpful either.  Just what I needed - one more person to disappoint, one more set of expectations to meet, one more soul's burdens on my shoulders.

It took me a while to realize that it was love and not annoyance which was fueling the stream of "level your hips" and "use your whole foot"  and "stand up evenly" which flew from his mouth as he watched me walk.  There wasn't a mean bone in his body directing vitriol my way.  I knew that.  Yet, every time he corrected my stance that wall got higher and higher.  I hurt.  I didn't feel the discrepancies.  I was doing the best I could.  After all, I'd been shot.  What did he want from me, anyway?

What he wanted, I discovered, was what I wanted for myself.  I'd say that I am 90% of the way back to my old normal.  It's that missing 10% which brings the joy to life, though, and that's why I am morose.  I can walk around the yard and point out what needs to be done.  Bending down to pull that weed or lugging the extra-large size of Round-Up across the gravel, spraying extraneous sproutings as I notice them, carting the 20 pound bag of potting soil from the garage to the courtyard - those things are still beyond my capabilities.  I can walk from the car to the grocery store, but I'm very glad to have a cart on which to lean once I get there.  Lifting two 5 pound bags of sugar from the bottom shelf (why is sugar always on the bottom shelf?) and into my cart was never an issue before I was perforated; now it requires thought and ingenuity and a deep consideration of the direction I've placed my hips before I grab and turn.  What TBG wants for me is the fluidity I've lost.  He wants me to feel like myself again.

So, on my way home from the Cornell Alumni Leadership Conference last weekend in Washington, DC, I stopped at the Rehabilitation Institute of Chicago for an evaluation.  I wish I had done it 6 months ago.  I have a feeling that TBG would be much happier right now.

Physiatrists, or rehabilitation physicians, are nerve, muscle, and bone experts who treat injuries or illnesses that affect how you move, according to the American Academy of Physical Medicine and Rehabilitation's website.  Reading that definition made me laugh at myself; every one of those issues is relevant to me.  The website went on to inform me, in case I had forgotten where I worked for 5 years before my son was born, that physiatry's goals are to

  • Restore maximum function lost through injury, illness or disabling conditions
  • Treat the whole person, not just the problem area.
That was exactly the program I was seeking.  Thanks to the kindness of old friends, an afternoon with a doctor, an orthotist and a physical therapist was scheduled with no hassles on my end.  I have to imagine that a lot of shuffling and reorganizing of schedules went on in order to get three appointments in one afternoon scheduled 10 days in advance of my arrival.  Rebecca managed to do it for me, even though she was in Kuwait the week before I showed up.  She'd have come with me for dinner when I was done, but she hadn't been home for a long time and felt that tug more strongly.  Empty nest or not, home is still home.  

Instead, we bonded in her office where she introduced me to her colleagues and then escorted me to my first appointment, the one with the Interim Medical Director.  No one touches me unless there's Chief on his id badge, it seems.  

Elliot Roth, MD, wasted no time - he asked for my story after shaking my hand in welcome.  His questions were different than most.  Did I remember being hit by the bullets?  Did I remember falling to the ground?  What were the exercises prescribed by the home physical therapist?  He wasn't surprised that I was taking turmeric for inflammation nor that melatonin and I have had a long and profitable relationship.  Neither acupuncture nor massage nor pilates caused him to quake and quiver; the difference between his reaction and that of the orthopedic surgeon was stunning.   

His examination was different, too.  Strength testing (push up when he pushed down on a body part) and reflex testing (my knees really do have quite a kick, even after bullets severed some connections) preceded sensation testing - a delightful procedure akin to an eye test, where the examiner wonders which prick is sharper, #1 (ouch) or #2 (yoweee).  I was just as nervous as I am when the optometrist asks which one is clearer... it's hard to remember.  Unfortunately for me, the points which Dr. Roth was checking were quite easy to compare.  Being stuck with a pin is unpleasant enough to create a memory in the best of circumstances.  When that pin enters an area of nerve regeneration, lovingly referred to as hypersensitive by he who was wielding the pricker, fireworks explode in a radiating pattern from the point in all directions.  Up, down, right, left, inside, outside, without boundaries or end... until it stops ... like turning off a light switch.  

The human body is a remarkable machine.

Declaring the hip repair surgery a total success, he scoffed at the notion that a hip replacement would solve my problems.  It wasn't the carpentry that was causing my problems.  It was me.  Myself.  I.

Of course, he was more delicate than that.  He applauded my feeble attempts at self-directing my rehabilitation and promised to work with me to find someone suitable to take charge from now on.  He told me that I would continue to improve over the next few years.  I am on an upward trajectory, where comfortable and functional walking is the ultimate goal.  He made no promises about eventual outcomes, preferring to emphasize the effort which would be necessary to accomplish anything at all.  Somehow, it was all quite uplifting... energizing... encouraging.

Then he watched me walk.  The orthotist was watching, too.  I was consciously holding my core and balancing my hips and flexing my ankle but it still wasn't pretty.  Pronation wasn't helped by the flat arches and lack of support in my Converse, but that didn't change the professionals' opinion: my legs are the same length.  They only act as if they are not.

Right then and there I could have gone home a happy girl.  I am not shorter.  I did not have something taken away forever.  I am capable of becoming even.... level... smooth..... without the use of the orthotist's skills.  No building up of heels or soles, unless it makes me feel better in certain shoes in which case Dr. Scholl's inserts will serve me just fine.  

Yes, denizens, there I was in a medical institution and they were not hawking their wares.  No, I didn't need a fancy specially designed addition to my footwear.  I could listen to my body and adjust my behavior accordingly, but there was no reason for me to invest in hardware.  I could make the difference.

The good news plastered a smile on my face for the rest of the afternoon.
Tune in tomorrow for Adventures in Physical Therapy


  1. Gosh, I love doctors like the one's you visited. Real doctors that aren't trying to get you to more surgery or buy more products. I've never had a doctor tell me to just use inserts in my shoes and that will help my hip. Instead, I've been told you have to have PT and maybe cortisone shots. I have found with me exercising more the past four weeks, my hip actually isn't hurting as much. Who would have thought that would actually help?

    I'm glad you saw these other specialists. It's always good to get other opinions--and these sound like some of the best experts in the country.

    Have a great day.

    Megan xxx

  2. And then we bought my wedding dress. Successful trip all around, I'd say :)

  3. Yes, indeed! But I can't post about the dress.... SIR is lurking and he must be surprised :)
    a/b (aka Mama)

  4. Loved this post. That is all. (Well, except that I wish Nance were online to read it this week. Although who knows, maybe she's doing that magical Kindle Fire thing from the Left Coast.)

    There used to be a joke or urban legend or something, to the effect that cows in Switzerland had had to be specially bred in order to have legs on one side shorter than the ones on the other... because how else could they possibly graze on those Alpine slopes without falling and rolling downhill? In all your accounts of the after-effects of the perforation, I could never quite understand how you'd ended up with a shorter leg. I mean, you're you, so if you said it was then I didn't doubt that it must be so (not really). All I could imagine was that some combination of reworked innards was causing you to keep one foot higher, by bending to one side at the waist. But I could never quite... uh... hobble a mile in your Converse, y'know? I just had to take it on faith.

    So apparently, it turns out to depend on how you define "leg." The leg-as-limb was geometrically the same -- length, breadth, all that. (The BONES weren't any shorter.) But the leg-as-functional-device -- as used -- was simply (convincingly, perversely) mimicking the behavior of a physically shorter limb...


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