The View from Sports Center

How About Leaving First?

Chapter 16: May 2008 (First Half)

At the end of April, I hoped that I would be off the Coney Island Cyclone. Not so lucky. The first fourteen days of May were just as bumpy, one day feeling good and the next like someone had jammed on hot iron poker in my  spine. What I wanted was control. I wanted to know that I could control my symptoms, that I could determine what, when, and how I wanted to do something and know whether or not I would hurt or my leg feel numb, or whatever. But, my body had other ideas. It would let me know what was going on when it felt like it. I felt sort of like I was sculpting jello. Working really hard at making something good happen but ending up with a whole lot of nothing. I have come to the conclusion that the body and mind have minds of their own. And, somewhere in between is me. It's like there are three beings: body, mind, self.

I finally figured out the the culprit, the engine for all of this emotional and physical upheaval was sitting. I started sitting again at the very end of April. I felt like I was being very conservative: starting with just 1 hour; 1 total hour of sitting a day. And, 1 hour seemed ok. So, the next day I went to 1.5 hours. That night, my sleep tumbled to 5 hours and I felt awful the next day.

When I tell people that the hardest thing for me to do right now is sit, I see a quizzical look crawl across their face. "Really? I would think things like bending and lifting would be really bad for your back." Well, that's true - it just depends on how you bend, how much you bend, how you lift and how much you lift. But, sitting is worse.

Why is sitting so hard on the spine? Well, two reasons. First, your spine was built for movement; not sitting. Wherever you find a joint in the body, you can assume it's there to provide motion. You have 117 joints in the spine (if you count from the head all the way to the pelvis and include the joints for the ribs that attach).  When joints don't move enough, they deteriorate. In a sense, they get weaker the more stationary you are; the less you move. Weak joints lead to symptoms like aching, stiffness, swelling, and pain in and around the joint. As far as I'm concerned, sitting is one of the worst things you can do for your back. But, you have to be able to sit - at least some. You can't go to a restaurant and eat standing up (I've tried). And, going to the movies, well, yes, technically you can stand up but who wants to do that? Sitting is a necessary function but you should move frequently if you have to sit a lot during the day.

The second reason sitting is so hard on spine is that the pressures produced in the spine from sitting are quite high. In fact, sitting slightly slumped creates more pressure on the spine than standing in a stooped or slightly bent over position. You can think of the pressure as squeezing the disc and discs really don't like to be squeezed for very long. A lot like the rest of the body for that matter. The sustained pressure interferes with the energy delivery and waste removal systems of the disc and this gradually erodes it.

May 1-7, 2008
The really good news this week is that my overall pain levels went through the floor averaging 1.2 out of 10. Wow. I had a few days where I felt normal; completely fine. Zero. Null set. Nada. Like I had never even been injured. That's a problem though - at least for me. Without the pain acting as a governor, I just start doing stuff. Naturally. I'm not thinking to myself, "Oh, boy, let's run the vacuum cleaner!" I just do more bending, twisting, sitting without really being aware of it. And, that leads to a system crash usually at night. I hurt and wake up hurting and am immediately ticked off and then have to focus on not being ticked off but I don't really have the energy to focus and it goes on and on until I sleep again.

My sleeping also improved overall. I had two nights of 8 hours and three nights of at least 7 hours. I also had a couple of really bad nights too but, still, five out of seven, 71%, that's at least a "C".

I also turned 52 this week (I'm not sure what 52 should feel like but whatever it is, I don't feel that way). And, my brother called me to say happy birthday. In speaking with him, I learned that he had tried a technique using meaningless sound (things like ocean waves, thunderstorms, etc.) to help him sleep and he thought that it worked really well. (Oh, and I don't mean that the sound of ocean waves is meaningless it's just that we don't immediately attach meaning to them as we do, for example, with music.) So, I created a few sound files and dropped them on my iPod to try out the night before my birthday. I wanted to be really rested and feel good the next day.

Disaster. The ear pieces were annoying and I couldn't sleep on my side because it felt as if there was a penny stuck in my ear. And, the wires kept getting caught on my pillow or something else. So, I had to sleep or try to anyway on my back. I never have liked that posture so I couldn't relax. And as far as the meaningless sounds of the ocean crashing on the beach, well, all I could think of was going to Maui and then my mind was off flip-flopping down memory lane. I slept all of 3.5 hours.

On the sixth, I started some upper body exercise and added some lower body strength training at Sports Center - all spine friendly of course. It felt really good to use some muscles again and without worrying about whether I might be injuring my spine.

May 8-14, 2008
I thought my pain was low the previous week but this week, it dropped even more to an average of  .4 out of 10. I had four days in a row with no symptoms. I started sitting more during meetings and noticed that I had very few problems if any during or after. Life was really starting to feel more normal. But, an old nuisance dropped in for a visit in the middle of the night on the 8th and hung around all week: stiff, sore, tight thoracic and lumbar spine. I had these symptoms several years ago and they come around every now and then but I was really surprised to find them now. So, sleeping wasn't as good as I would have liked but not due to my injury. I averaged right at 6.5 hours.

The weekend of the 10th and 11th, I actually ventured out into the social world. I went to a party on Saturday and on Sunday went to dinner. It was the first time I had been out to dinner since my injury. We sat at the bar, which I actually preferred for the energy and activity plus I could get up and move around and even eat standing up and no one seemed to notice or care. It's a bar. I was very tuned into time though. I set a timer on my watch, got up when it went off, moved around a little. I didn't want to end up in the hurt locker over a dinner.

I was anxious about the weekend. Would I make it through without making my self worse? And, if I felt worse, how long would it last? It felt like I was standing on the edge of a canyon knowing I was probably going to fall off and wondering just how far down it was to the bottom. I never fell off the edge. I made it through the whole weekend and felt great.

Here's what I wrote in my journal on the 13th: " What an awesome day. Did my rehab at Ross' and felt great. Like I could run; felt really, really good. Great energy. No symptoms. Felt strong again."

At the end of this period, I felt mostly normal, slept most nights fairly well, and noticed an increasing sense of optimism. That was, until I started something new; an experiment.

Chapter 15: April 2008

If the month of March was like my dogs romping through the garden, April was like the Coney Island Cyclone. I had some symptom free mornings that teased me with the idea that the day would be a pain free one only to be followed by a thunderous crash of leg pain in the evening. I spent a lot of days in the fog of fatigue from too many nights of 4, 5, or 6 hours of sleep. I think I would trade pain for sleep. I think I would rather hurt than be so tired all the time. Of course, I may change my mind but that's the beauty of wishing for something you don't have.

Getting through a day feels like using a butter knife to saw through a 2 x4. Everything is hard. Everything is taxing. I can't think or read. I try to nap but my mind bumps and jumps around like monkeys in the jungle. I try to meditate - same thing. I think my mind wants to work, needs to work but just doesn't have the juice to keep anything going. A sputtering, chattering mind. Things that would not normally only mildly irritate me, piss me off. Things that would make me laugh, don't. About the only thing the seems to help is music. I listen to a lot of music. In the teeter-totter, walking with my dogs, just lying around. What would I do without an iPod? I feel like I should send Steve Jobs a thank you note.

I try not to drink more than about two cups of coffee a day even though some days I feel like I could just walk around with an I.V. drip of the stuff. Instead, and here's an interesting twist on handling things you don't like or, that bother you or, for that matter, pain, I try to just not fight the frustration of feeling so tired. I just try to accept it. I'm not very good at it though. I'm grumpy when I'm tired, terse,  and I find it incredibly difficult to mentally switch into a Zen Buddhist mindset of accepting the "now" even though to fight it is futile. I try to feel it, accept that what I am feeling is what I am, now, in this moment, but not what I will always be. The fear, and I'll bet a lot of people feel this way, is that by accepting something that frustrates you, you somehow are giving up or yielding to a lifetime of what you have in that moment- the very thing you don't want.  One of my teachers, Dale Goldstein, likes to say that suffering comes from failure to accept reality. I think he's right.

April 1-8, 2008
Sleeping averaged about 6 hours, and was interrupted by pain. Although the pain was less than the prior two months, it was still enough to prod me from sleep and force me up. I had some leg symptoms - numbness, pain, tingling - on and off through the week. The numbness freaks me out. It feels like I'm losing control of my leg.

I had a couple of days near the end of the week that surprised me with low to no pain - anywhere. And, on the 8th, I slept 7 hours - not straight through - but in total. This was a huge improvement but I still had low energy most of the day.

On the 1st, I had a follow-up consult with Christine - more on that in another chapter. The consult prior to this one, which I haven't published yet, was on March 12th. I've written about what happened in the consult but not about the details of what Christine examined / measured, why, what it meant, and how I felt about the info. So, that's coming up - sometime.

April 9-16, 2008
This week opened up with a very tough night: 4 hours of sleep with a lot of leg pain - like a 8/10 kind of leg pain. This level of pain really gets your attention. It's the Painster clawing and snapping, ripping and tearing his way up and down your leg. The Coney Island Cyclone. Just when I felt like I had made some real progress, my body crashed and along with it my head and my heart. The week didn't improve much. I averaged right around 5 hours of sleep a night. The Painster came back for a visit on the 11th dropping in around 6PM and staying for the evening like a guest who doesn't realize he should have left hours ago. But, I had also walked a lot that day - about 13 miles total. I usually walk 8-10 miles a day but I had a meeting - what I call a "walk and talk" that day. On the 14th, I woke up at 3AM with some mild leg pain - I call mild anything at a 3/10 or less - and was able to get back to sleep until 5AM when the pain returned and this time I had to get up. And, on the 16th, I ventured out for a real meeting where I actually had to sit down. I sat for 90 minutes - not continuously; I got up a few times - but had no residual symptoms from it. This was a major event but I didn't really trust that it would happen again or that I wouldn't have a visit from the Painster in a day or two. The week, overall was difficult with average pain levels around 5-6 / 10 and high levels of fatigue.

April 17 -24, 2008
Sleeping wasn't much better this week averaging about 6 hours a night but pain levels dropped to an average of 2.5 out of 10. I woke up on the 22nd with very low level of pain at 1/10, the kind you have to look around to find and by the end of the day, I had no symptoms. The next day was completely symptom free - April 23, 2008 - and on the 24th, I woke up to a symptom free morning.

But, the sleep issue persisted despite pain levels improving. Sometimes I'll wake up in the night, often because I'm uncomfortable, not what I would call "pain" but just stiff or maybe a really mild kind of soreness, and then it's off to the races with my mind like it shifts into a warp speed. Christine suggested that I try writing down things in my journal before I go to bed so I did. Nothing was in my head though. I was relaxed, not troubled by anything or at least anything new, and really just didn't have much to write about. Then, in the middle of the night, my brain suddenly turns on at full speed - like walking into a dark house and flipping one switch and the whole house lights up.  It's not that I gradually wake up. All of a sudden, I am wide awake. Mentally ready to run; physically ready to crawl.

April 25 - 30, 2008
I added sitting back into my life this week. The plan was to start with one hour a day and gradually increase it over the next several weeks paying close attention to my symptoms. I sat no more than two hours per day - total. This excluded any sitting I was already doing like driving to Sports Center. I used a 3 x 5 card and jotted down the time I sat doing anything. Two hours is not much time over the course of a day. But, I was happy to be doing it and didn't have symptoms. I learned that if I sat in a particular way, a specific posture, I could sit without any symptoms. I called it the "cello pose" because it reminded me of a cellist's position - minus the cello of course. You sit on the edge of the chair, legs apart with one foot slightly ahead of the other (the image is Paula Zahn playing cello). For clinicians, you'll recognize this position as an accentuated lumbar lordosis. This position reduces the amount of tension on the back side of my disc, where I injured it, but it also will increase pressure on the jopints of my spine. So, I can't or shouldn't sit like this for a long time.

I can also sit in my "second" office at home - where I have a bar with my Mac Air and my guitar stage stool set up. I can sit on the stool with my left side allowing the right side to be off and mostly straight. This shifts some of the load or force off the right side of my spine and allows me to carry some weight on the left leg and through my arms.

Pain levels averaged about 2.5 out of 10 but that was skewed by one day where my pain suddenly spiked. If I remove that day, the pain level was 1 out of 10 - a huge improvement in about ten weeks. I would like to also report improvement in my sleep but, as you might have guessed, it continued to plague me. I had two nights out of six that were fewer than five hours of sleep but, the good news, was that I also had four nights of seven or more hours of sleep. I started thinking that maybe the Coney Island Cyclone was coming to an end. And, on April 30th, 2008, I slept eight (8) hours! I hadn't slept eight hours in over a decade.

I continued my rehab at Sports Center and my visits with Trish throughout the month of April. You'll learn more about both soon.

Am I Really Scared or Just Stubborn?

I used to answer emails sent to me from this blog. I don't anymore (see LEGAL STUFF on the side bar). But, I used to.

Someone would send me their story, struggles, how do I fix this problem, what exercise should I be doing, is my therapist an idiot, should I get another opinion, etc. and hope that I can somehow solve the issue in a completely virtual way. I can't. I tried because somewhere inside of me is this "I need to help people" engine that runs on emotional fuel and helping people fills up my tank. But, I learned that to solve issues and struggles, I need a dialog.

Books, blogs, videos, and other media all help. Information about injuries, surgeries, exercise, mental or emotional adjustments, nutritional facts, can go along ways to helping you move forward; get better. That's the point of this blog - to get information to people who need it and help them as much as possible.

So, from time to time, if I think your email will help others, I'll post the email and respond to it here. You won't find a name or any other personal info in the post unless you tell me otherwise.

Below is an email I received recently about my hesitancy regarding spine surgery. There are a couple of questions in this email so I'll separate them out and respond.

FROM A READER:

I want to know your thoughts about what scares you about surgery.  You have seen patients that have been through the suffering and denial and those that have been through the surgery and that are ready for recovery in your hands.  There has to be a point that you say the time has passed, the work has been done and you are or are not improved enough to KNOW that you will or will not improve enough to have a quality life.  If you do not have an extrusion then the fragment will not shrink like a raisin., at least in theory. What is next beyond surgery?  Steroid injections?  I had a patient that had a 8 mm. HNP  with considerable compression into the cord and nerve root and a steroid injection "cured her after a month of therapy that failed to relieve the pain.  She is a MD!

I want to know your thoughts about what scares you about surgery

Well, honestly, a lot of things scare me about surgery: death, stroke, infection, paralysis, nerve root adhesions to mention a few plus there's no guarantee that after surgery I will be substantially better than before surgery. I think we, as a society, take surgery very lightly as if we're going in for a massage. Surgery is very serious business. Yes, a lot of people seem to do just fine. But, the risks are very real. Maybe I know too much or maybe because I have worked with people for whom surgery failed, I have a negative bias. It doesn't matter to me.  If I can avoid surgery, I will.

There has to be a point that you say the time has passed, the work has been done and you are or are not improved enough to KNOW that you will or will not improve enough to have a quality life.

This statement captures the real issue for not only me but a lot of people with a moderate to large disc herniation: when is enough enough? When do you say, "Ok, I give up. Sign  me up for surgery." ? For me, here's my list:

• Severe, unrelenting leg pain with nerve root symptoms (numbness, tingling) that has not responded to conservative interventions over a three month period.
• Loss of reflexes or severe suppression of reflexes.
• Muscular weakness in the nerve root distribution that has not improved and interferes with daily life activities.
• An Oswestry score in the moderate to severe category that has not improved over three months.

The tough part is adjusting your life to match your real physical capability. If you can't do this or won't do it, then you'll probably end up in surgery sooner than later. The thing to remember about surgery is that the long term studies show that both surgical and non-surgical patients end up in the same place, have the same outcome, but surgery gets you there faster. Both of the surgeons I saw said the same thing: "If you can handle the pain and disability, and your nerve function improves, you won't need surgery."

When I say "adjusting your life", what I mean is bringing the physical loads of everyday life down to a level that my spine could handle. The problem I have is that the nuclear material has ruptured through the annulus (the ligament of the disc) and is rubbing on the nerve. It's a bit like having a big, nasty pimple. As long as you don't push on the pimple, you don't hurt too much. Put a little pressure even on a small pimple and you can hurt a lot. Pressure on the disc is what makes the nerve react kind of like a pimple. And, when your nerve hurts (which by the way, nerves have nerves so you know when you're hurting it. Great design.), you feel pain in your hip, buttock, leg depending on how much of the nerve hurts. So, the first steps are to keep the pressure off the nerve and do whatever possible to help the injured tissue heal.  When I saw patients, I would give them a detailed list of the things they should and should not do. Here's the list that Christine and I created:

• Don't sit unless absolutely necessary and even then as little as possible.
  • So, no meals sitting down.
  • No eating out.
  • No movies.
  • Drive only when necessary.
  • If you must sit, use a substantial lumbar support to reduce the chance of your spine bending.
  • Stand or lie down.
• Don't clean house.
• Don't cook.
• Don't make the bed.
• Don't bend, stoop, twist, lift, push, or pull.
• Walk as much as you can.

Think about what your life would be like if you had to follow all of these rules. Could you do it? Imagine not sitting down at work or not playing with or lifting your children. What if you live alone? And, think of the impact that these changes have on your relationships. If you're married or in a committed relationship, this list can strain the relationship a lot and create all sorts of issues. So, I think the decision to pursue surgery is a very personal one with a matrix of factors and you have to be honest with your self. Don't try to just tough it out. Persistent inflammation around the nerve root can lead to scarring of the nerve. This leads to a lot of problems later because just about every time you move, you tug on the scar which tugs on the nerve (remember the pimple idea?) and you hurt. So, if you can't follow the rules, whatever they might be for you, fess up.

If you do not have an extrusion then the fragment will not shrink like a raisin., at least in theory. What is next beyond surgery?  Steroid injections?

This may be confusing because terms describing disc injuries get tossed around like a child playing with toys. A protrusion is an injury to the disc but the inner nuclear material has not leaked outside the walls of the disc. An extrusion is what I have, on MRI. The outer wall of the annulus has ruptured allowing the inner, gelatinous nucleus to seep out. A sequestration is a rupture of the annulus and the nuclear material has seeped out and part of it has broken off. Sequestrations typically shrink. Extrusions often do not shrink which is why people sometimes end up in surgery (although look at the MRI of a friend of mine whose extrusion shrank nicely). It takes a long time for disc material to "shrink". Basically, the body digests it. I plan on having another MRI in the future, assuming I skip the surgery step, to find out what happened to my extrusion.

My surgeons, Christine and I talked about steroid injections as a possible intervention short of surgery. But, in the interest of good story writing, I can't tell you about that just yet. It is on the list though of options.

I had a patient that had a 8 mm. HNP  with considerable compression into the cord and nerve root and a steroid injection "cured her after a month of therapy that failed to relieve the pain.  She is a MD!

Well, a month of anything is not very long. So, I wouldn't beat your self up over it. As I said before, lifestyle plays a huge role in recovery and some people don't have time, hurt too much, have too many demands to help and wait for their body to heal. The thing to remember about steroid injections is that the steroid acts as a massive anti-inflammatory (there's the pimple thing again) and can reduce pain a lot. But, you still have a disc that's banged up and can't do the job it's supposed to. You still have spine muscles that have atrophied and need reconditioning. The pain is the least of your problems for the long term.

So, I don't think I'm stubborn - if I end up in surgery, I end up in surgery - but I am still scared of what could happen. I pursue recovery without surgery recognizing that it may not work and if that time comes, I'll deal with it, face the fears, do the best I can, and hold on to my faith.

Chapter 14: March 2008

The month of March trampled over me like a one of my dogs romping through a flower bed. As I looked over my journal entries and a few of the earlier chapters, I could see that I was one busted up guy struggling to keep it together; keep working, keep showing up in life. I chronicled some of the March events in Crying with Christine and The Plan.

By the middle of the month, my daily pain levels were averaging about a 6-7/10 and sleep was between four and five hours a night. By the end of the month, the pain levels had dropped, although not a lot, to 4-5/10 and sleeping had increased to around six hours a night.

Below are a few more entries from my journal and as before, my comments are in italics.

Sunday, March 2, 2008

Right hip pain is still here...not sure how much better it is and it was a lot, lot worse yesterday...maybe I sat too much on Friday. Started wearing the V-Loc brace today. Maybe this helps...hard to tell right now...taking a few steps still hurts a lot. Really noticing the decrease in activity and how little I can do. When I read this, I thought, "Who is this guy? What is he doing?" Sadly, it was me.

Wednesday, March 5, 2008

OK, so the hip pain is better. I cut back on sitting. Started Celebrex too. Have more buttock than hip pain though. I set up a work station in the movie room at the bar so I can sit on the edge of a bar stool and get some work done. This seems ok. Still painful when I get up but not nearly as bad as sitting in the zero-gravity chair or a regular desk chair....feeling crunched by this sense that I should be doing more...working on something to get past this issue but not sure what else there is to do really. I can remember being surprised and feeling let down by how badly my good old zero gravity chair had failed me. I slid out of it onto the floor many times before I finally tossed a pillow in it and said good bye.

Thursday, March 6, 2008

Hip pain is definitely better...5/10. Had to sleep downstairs due to the flu, coughing, etc. Coughing hurts..a lot. So, having the flu right now seems like a double hit. I'm doing some drills in Sports Center but something's off...I don't feel much better.

I did two interviews re: the new project I'm working on. One yesterday and one today. Really tough to do because my hip hurts practically the whole time but I feel like I need to get these done..probably shouldn't be doing it...the car ride, the time sitting of the interview itself, the car ride home. Ok, so, this entry, when I read it, I laughed out loud. You know things are bad when you think a 5/10 pain is an improvement! And, the flu! I even had the flu shot!

Saturday, March 8, 2008

Really bad night. Woke up around 2:30AM with severe right leg pain..all the way down the leg. Got up and tried to walk around but I couldn't...got back in bed but couldn't get comfortable..pain was high 8-9/10...I laid down on the floor, prone but couldn't stay there. My leg hurt too much. Got up and put on the V-Loc brace. Felt a little better. So, I tried lying down on the floor again, prone. This time, I could do it and the pain only went into the thigh. So, I went downstairs into the movie room, climbed into the recliner on my right side and fell asleep for an hour or so. But around 5:30AM, the hip hurt too much and I had to get up....might be a really long day...

I had another interview yesterday and am supposed to have one tomorrow but I am going to cancel. I can't keep doing this.

Do I need to see Gordon? This was the start of just a crack in the denial armor.

Sunday, March 9, 2008

A better night, thanks to Vicodin. So far, the day hasn't been too bad. I don't sit at all and avoid bending, stooping, etc. Still wearing the brace. Christine came by and had dinner with us. We talked some about my injury, how I was feeling. She thought that I should open up more emotionally; that the more upset I became, the less I showed it. I told her how Ross had asked me if I was angry and that I wasn't or at least I didn't feel it. So, later I thought about it this some more. Am I really angry? Sad? - yes. Grief? - yes. Maybe even a little depressed - yes. But, while reading "Emotional Resilience", I learned that feeling depressed comes from the energy drain of unexpressed anger. So, where's the anger? Why don't I feel it?

So, I did some research on anger and found that frustration, irritation are mild forms of anger. And, the best way to process it is at the time it occurs..if you don't express it, feel it, anger turns inward...leads to depression and lowering of self-esteem.

Tuesday, March 11, 2008

I saw Gordon today. I felt really bad in his office. Seemed like it took forever to get out of the car and into the building. A couple of reflexes were really slow..maybe absent. One of the muscle tests hurt so bad I actually shouted and it wasn't anything elegant either...went over the MRI...herniation and it looked huge to me..we talked about options including surgery and I really don't want to go there...I was scared after I left his office. I think the magnitude of the disability really hit me right in the face when i couldn't complete the exam, couldn't put on my shoes, and almost couldn't get back in the car.

Saturday, March 15, 2008

I woke up at 3:30AM with right hip pain...had trouble getting back to sleep. I nicked my nerve yesterday at Sports Center getting off a piece of equipment and then again right before I went to bed. I leaned over to kiss Ellen good night and felt a jolt of pain run down my leg. When that happens, the pain lingers, it's almost like it's vibrating, for a long time; usually hours.

So, the pain in my hip is a lot worse today. And I have a lot of leg pain. The whole leg. I'm tired...trouble focusing...can't read or work on anything...my mind feels like it's got a ton of sludge in it. Finally realized, sitting is out. Have to make notes lying down.

Sunday, March 16, 2008

Feeling a little better this morning but leg pain woke me up again around 3AM. I didn't have to get up though; guess that's a win. I feel better mentally today like I can actually think. Not as tired and feel more optimistic. Might even try to get into a pool.

I still hurt but I noticed that I can bend forward while sitting in a chair and tie my shoes. Problem is I can't put them on; can't cross my legs and can't put on socks without hip and leg pain and it's a nasty pain too. So, I just wear slip on shoes - some might call them shower shoes - and they look like the lead character, The Dude, in the movie "The Big Lebowski". I'm not as cool though. I'm starting to make some more concessions - shower shoes.

Tuesday, March 18, 2008

Bad night again..awake at 3:30AM with right hip pain. Could not get comfortable. Had to get up. Good news is that the symptoms go away fairly fast but the bad news is, I have nothing to do. Just hanging out at 4AM is not fun. Giving some thought to the inversion table. Lower pressure on the spine, can do it anytime, and would give me something to do at 4Am. Could even meditate in it.

Wednesday, March 19, 2008

Tough night. Lots of pain. Stiff, sore, tight. Up at 2:30AM...not getting much sleep and that makes thing worse...the whole day feels lost, foggy, dull. Bought the inversion table. Spent 20 minutes in it. Feels good on the back and helps decrease leg symptoms.

Saturday, March 22, 2008

Bad night. Awake at 3:30AM with leg pain..had to get up...took a Vicodin and I hate that I have to do it but if i don't I feel like I might gnaw off my leg...I couldn't read in bed last night...leg hurt too much and it just got to me...I felt worn out, I hurt, and I lost most of everything I enjoyed and then some and now, I can't read. I cried....in bed. Can't remember doing that before...Ellen just hugged me and I cried it out. This was one of the worst nights for me. I didn't write much in my journal and even now it's hard to put into words what it felt like. It was a combination of feeling weak, vulnerable, fragile with despair or a sense of hopelessness.

Sunday, March 23, 2008

Horrible night. Leg pain was really bad. Got up at 2:30AM and then tried to go back to bed at 5AM. Have felt really awful all day...lower leg is burning, aching...lower back hurts...I have the chills...really tired. This day, combined with the night before, was the low point for me in the month. I was starting to really consider surgery. I wasn't sure I could take too many more nights and days like this.

Monday, March 24, 2008

Finally a better night..slept almost 5 hours. Had a second opinion - surgical - yesterday. He basically agreed with everything Gordon said except he thought if surgery was required, we could do a slightly less invasive procedure and he offered to assist with Gordon. So, I'm feeling better about surgery if I have to go that route especially having two surgeons in the room.

Wednesday, March 26, 2008

Slept almost 7 hours! Woke up with low level of leg pain...2-3/10...had a lot more leg pain yesterday because I sat too much. I had a two hour meeting and even though I got up some, it just is impractical to get up every 15 minutes when you're trying to make a point during the course of the meeting. I was basically selling a new concept I'm working on and you just can't do that by getting up and down..or at least that's what I'm selling to my self..maybe that's not true..but the thing is, I sat too much. The key to helping my spine heal is controlling the pressure on it throughout the day.

Sunday, March 30, 2008

I've had about four nights in a row now with better sleep...about 6 hours a night. It's not enough though...am really tired during the day...teeter-totter was a great idea...feels good while I'm in it and I feel like I'm doing something that will really help me and maybe it's the sense of control; that I'm doing it not someone or something else? My leg pain is better...around a 5/10 more often...and during the day, I'm able to control it fairly well...the night is the worst followed by sitting. I can control sitting; not the night.

For most of March, sleep eluded me. No matter what I did - medications, postures, supports, meditation - I couldn't get past 4 or 5 hours and those were not uninterrupted hours either.  Parents with young children probably know something about this - the sleep deprivation. Near the end of the month though I noticed an improvement and found that just one more hour of sleep made my day much brighter and enjoyable - but I'd be lying if I said things were great; that I was content with my situation and progress. I knew I still had a long way to go.

The questions in my mind were, "Will I make it? Can I get all the way back?" And, these questions were not at the front of my mind everyday. They were resting somewhere else in my head like a married couple on park bench smiling as they enjoyed the scenery. How did I discover this? Writing. Writing first about what I did that day, how I felt about it, and letting my thoughts just flow. Then, questions appear on the page as if I'm using some sort of Quick-Quote Quill from Harry Potter. It just happens.

The questions are still there but the answers are getting clearer.

Are You a Good Dancer?

These are a special pair of shoes that a parent wears while dancing with his or her child - from Finland.

It's one of those things that you stumble onto while doing something else (like working on Chapter 14 :-) and some part of your brain suddenly chugs into gear clicking and clacking away. Helping people overcome an injury, at least for some part of the process, is a lot like letting your kid stand on your feet while you dance. You need some regular sorts of movements, walk straight ahead, back, sideways, so you can once in a while throw in something unexpected. That's when kids laugh, right? They don't laugh much as you just plod along foot after foot. No. They laugh when you swirl, or surge, or hop, or take a huge, gigantic step.

And now that I think about it, isn't surprise one of the better things in life?

Are you working in enough surprising moments? Daily? Weekly? Monthly?

Chapter 13: February 2008

I started journaling, writing, regularly, almost daily, late last year after I read, "Journal to the Self" by Kathleen Adams (a great book by the way). Before then, I kept a digital journal of sorts, notes about what went on during a day, when I started my first rehab process for my other spine problem in 2003. But, I found that I just didn't enjoy it. It was hard to lug around a laptop and the medium isn't any good for things like an artistic rendering of how I feel about something - not that I am at all talented in that area, although it's on my list of things to do while I'm alive  - or if I just want to draw, in color, one word across the page in all caps. I guess I just don't want to be constrained. A lot of life is like that - constraining. You have to do stuff, go places, be a certain way, look a certain way. I just wanted some space to NOT be a certain way, think a certain way, talk a certain way. Just be. So, enter journaling.

Just about everyone I talk to about this has the same initial reaction: "Aren't you worried that someone might read it?" And, I guess that is one of the things you have to get past. But, let's be honest. If someone is reading your journal, there's a good chance that your either dead or very incapacitated so you can't do anything about it anyway. Besides, the benefits of writing completely outweigh the worry of someone reading my thoughts and ideas after I'm gone. But, it took me a while to get to that point though. While I was enrolled in a writing class a couple of years ago (you didn't think I got this good all on my own now did you?), I asked Ellen to promise me that if something happens to me that she wouldn't let anyone read anything on my computer because it has all sorts of unfinished, raw, ideas, stories, articles, etc., and I couldn't bear the thought of people reading unfinished work. She said, "Trust me - that's about the last thing I'll be worrying about. I'll be looking for passwords to all of our on-line accounts!"

Just in case someone stumbles across it though, I wrote in the front of my journal, in huge letters, "STOP. THIS IS PRIVATE AND AT THIS POINT YOU ARE EMOTIONALLY TRESPASSING. CLOSE THE BOOK NOW."

I even named my journal, "Probitas" - Latin for honesty. If nothing else, a journal should be a place where you can be completely honest without worry of retribution, abandonment, ridicule, or conflict, among other things. The more you journal, the more your journal becomes your friend and sometimes, the only friend you have.

Here's what I wrote in the opening pages of Probitas from last year:

"I strive to be honest with my self and others; to be kind when I'm honest; to be true to who I am. I want to be clear, confident, calm, solid, and fun to be around but always aiming to be true and honest."

I've learned that what I wrote is a really tough thing to do. But, I also learned that just by trying, by re-focusing your self to those things, you change. It's a moment to moment thing though. I know that I can be self-centered, clothed in layers of denial, hiding from the truth, afraid to feel and say what I feel but that is just a moment. Later, I can change and I change by facing and acting on my intentions - the things I stated above. The more moments I string together like that, the closer I get to being me.

To explain the process of healing, what was in my head, how I felt about things, I have included selected entries from my journal starting right after I returned from the ski trip and first felt symptoms. If I have added my thoughts or reflections, you'll see those in italics. I decided to use a daily entry just like my journal. If you've been following this journey from the start, some of the entries will sound familiar but before long, you'll be in entirely new territory.

The next several posts will be like these - journal entries with some interpretation or comments - leading up to the present day.

Monday, February 18, 2008

Since last Wednesday, have had right hip and buttock pain. Mostly when I sit and getting up to a standing position. I'm fairly sure this is from the fall I took skiing. Seemed to be getting better but on Saturday, the pain really spiked. I can't stand up. I'm crooked. Can't walk for several steps. Sleeping seems ok though which is weird. Haven't exercised since last Tuesday so I may need to go into Sports Center or over to Ross' place to get the loads right. Can you tell that I'm already living in denial? I can't walk, am crooked, can't stand up, and what do I do? Try to solve it on my own and without any idea of what I'm trying to overcome. This is a great example of how powerful denial is: it blocks you from reality. This gives you time to come up with answers and solutions but often the denial goes on and on.

Wednesday, February 20, 2008

Started some meds for my back issue yesterday..a Medrol Does Pak that I hadn't used for something else..an illness I think. I think I'm better...but I can't sit and standing up is just really bad, nasty.

Saturday, February 23, 2008

Right hip pain was worse yesterday. Cramping is bad, tight, sore, This sucks. Have to go to the clinic..get on the Newton...can't walk. Medrol hasn't helped much. Ok, so, this is a little over two weeks from the injury and oddly, on this same day, I met Christine up at Sports Center to talk about a possible project on helping clinicians deal with clients who are in denial and how to best manage the emotional elements of injury! And, I am smack in the heart of the very thing we're meeting about!

Later that same day: Cannot keep my mind present at all...totally consumed by pain...why is there...what is it..how long will it be there...as hard as I try, I cannot be present. My mind flits back and forth from the pain to something in the distant future...back and forth...

Tuesday, February 26, 2008

Sleep was fair. Right hip pain woke me up...couldn't get comfortable...had to get out of bed but really hurt...couldn't stand..had to hold onto the bed and just sort of wiggle my leg around and put some weight on it...not good. Another odd combination of events: I was also reading MINDSET by Carol Dweck.

Friday, February 29, 2008

Didn't sleep well last night at all. Got to bed later than usual...hip pain woke me up at 4AM...haven't exercised in a couple of weeks and I can already feel the worry monster about gaining weight...Maybe the right hip is better..not so sure...feels really in the joint though...maybe I hurt the hip too? Am starting Mobic. Went to the Sports Center Hall of Fame party last night...what a great time. It was just so awesome to hear the stories of how people's lives changed from the things they learned at SC...I stood all night...completely did not trust sitting, well, actually getting up from sitting, but standing isn't so hot either at least for three hours or so. As you can probably tell, I'm still not really seeing what is going on with me. I think I'm better but am worse at the same time. I'm just trying stuff - meds, positions, whatever. I can tell you that at the end of February, I was miserable. Not sleeping, hurting a lot, worried, but was also keeping all of that stuffed inside of me which I think, in retrospect, amplified the problem and the pain. My mind and body were ramping up the volume but I refused to listen.

When Less is More

I may be in the minority about this, but the kind of exercise you need for something like knee pain depends on why you have knee pain.

The kind of treatment you receive for heart disease depends on the nature of the disease; the kind of treatment you receive for a loose shoulder joint depends on why the joint is loose. Seems logical to me to conclude that the kinds of treatments (exercises) you receive or do for knee pain would then depend on why your knee hurts.

Like I've said before, pain is not THE problem; it's A problem. So, just because the front of your knee hurts, doesn't always mean that making your muscles stronger will solve the pain. It might, if you're lucky, but the less fit your are, the longer you've had the pain, the less likely that something like the exercises below will help for the long term.

One of the main problems is gravity. Climbing stairs, squatting, kneeling, sometimes walking, or practically anything where you apply force to your leg often turns into a frustrating and painful experience. The force or load of the activity on the tissues of your knee is greater than those tissues can take. The result is that you hurt.

Ok, so you might be thinking, "Well, then if I make my muscles stronger, then I should be able to take the force of gravity; the force of going up a flight of stairs."

Well, here's why just trying to strengthen your muscles often fails to deliver significant functional change; like climbing stairs, squatting, jogging.

One of the main reasons people have knee pain is due to osteoarthritis of the knee. This is a condition that causes a weakening of the cartilage that lines the end of the femur (thigh bone) and tibia (shin bone). The cartilage is weak, thin, frail, and fails to provide sufficient protection for the bone. It's like having lousy shocks on your car.

Now, some people don't believe that you can actually strengthen your joint (cartilage) despite the evidence that you can. What we have suggested for many years, it'll be over 20 for me, is that joints respond best to a load that matches what the joint can tolerate. For joints with osteoarthritis, the concept is No Pain, Gain. So, if squatting down to sit in a chair hurts, it's not the squatting that's the problem. It's the load that your knee joints must carry during the squatting motion. If you weighed less, and I'm not suggesting the solution is weight loss, although sometimes that would be a really good idea, in almost every case, your knees won't hurt. Now, something else that's very cool about joints is that when you perform squats at a level of force that the joints can tolerate and are consistent with the exercise (we like to use a Total Gym for this), the joints respond; they adapt, become stronger, sturdier, and can tolerate more force. Strength training for joints is a different kind of exercise regimen than strength training for muscle. When you try to use a level of resistance that muscles need to get stronger, osteoarthritic joints hurt and don't adapt. Instead, joints want less load, more motion and what you'll get is less pain and more strength and function.

Don't buy it? Well, this idea of reducing load during exercise to reduce knee pain in people with knee osteoarthritis was recently studied in two groups of patients: one group exercised in water while the other exercised on land**.

Care to guess which group had more pain relief and better function?

For osteoarthritis, less load, more motion will usually translate into less pain and more function.

P.S. Guess who else needs to know this.

References:

* Lu, Tung-Wu LU, Chien, Hui-Lien, Chen, Hao-Ling. Joint Loading in the Lower Extremities during Elliptical Exercise. Medicine & Science in Sports & Exercise. 39(9):1651-1658, September 2007.

** Jamtvedt, Gro, Dahm, Kristin Thuve, Christie, Anne, Moe, Rikke H, Haavardsholm, Espen, Holm, Inger, Hagen, Kare B. Physical Therapy Interventions for Patients With Osteoarthritis of the Knee: An Overview of Systematic Reviews PHYS THER 2008 88: 123-136