Getting Physical Again

Perhaps the thing I was most thrilled about when it came to moving back to Minnesota was the chance to ratchet up my physical therapy. While I had been going to therapy several days per week during my last few months in Mississippi, it had gotten to a point where I felt as if my progress had stagnated. I was slowly gaining more leg strength, and my shoulder was becoming more flexible, but it didn’t seem to be happening fast enough.

There is only so much medical knowledge out there (at least so much that medical insurance will pay for as conventional), so most of what I encountered was just more of the exercises I had been doing in Mississippi. I was somewhat disheartened that there would not be any magical apparatus to stimulate my muscles. However, one hope that was realized in physical therapy was that my therapist decided to actively transition me from a quad cane to a single-point cane.

This did not happen due to any prompting of mine. One day she just announced that we were going try a different cane. Then she walked over to where they kept the practice canes, selected one, and adjusted it to my height. When I started walking with it, I was nervous about balancing, but I quickly noticed that my posture was better. I was now using the cane as a guide rather than as a support. This allowed me to shift my weight under me instead of distributing it outward. It felt wonderful to be taller and faster again. The therapist had me to walk in a wide figure 8 pattern around two of the mats so I could become accustomed to turning in either direction.

By the time I had walked with the normal cane for two sessions, my expectations were very optimistic. I could tell that this method of walking was going to do wonders for my gait and balance. However, I still had considerable foot drag and muscle weakness on my left side. I felt great while walking was going smoothly, but I constantly feared what might happen once I would lose my balance. I began to focus on building strength in my left leg, powering through each exercise and always requesting to do extra sets of seated leg press. If I could build enough power to lift my foot high enough with thinking, it would eliminate the majority of my balance concerns.

Occupational therapy had become frustrating. I was getting far less response from my arm than I was getting from my leg. I could open and close my hand a little, but with the thumb and forefinger acting at a pincer rather than grasping with all five fingers. Making a fist was easy, but I would often have to pry my hand back open after it was closed. My therapists in Mississippi had suggested that I start using the hand more functionally in order to “wake it up,” but I lacked the ability to hold anything in it, so the advice was not of any use.

Early in occupational therapy, we tried using a TENS unit. This was done by placing two electrodes on the surface of the skin. Like a battery, you place a positively and a negatively charged connection on either side of the muscle group. When current is run through the muscle group, it fires. When placed on my forearm, it easy would open my hand. However, it had no effect when placed on my triceps. This was disheartening, because I would need to enlist my triceps in order to straighten my arm. I wouldn’t mind never having the fine motor skills to type with my left hand or tie my shoes again, but I wanted to be able to carry things and drive a car.

Since my unit was not having much effect, the therapist told me that we could try a larger unit that could penetrate my arm more deeply. He placed the heavy duty unit on my arm and turned it up gradually. When my left arm responded ever so slightly, I became elated. If there was any response in my arm, it probably meant that I would eventually be able to use it on my own.

After that session, I had another round of Botox injections to relax the muscles that are permanently contracted. This allows stroke victims to use the complementary muscles to the group that is being relaxed. My occupational therapist told me that using electric current would interfere with the dispersal of the Botox, so we could not use a TENS for two weeks. Instead, we focused on other tasks and exercises. During this period, he showed me how to put on my left shoe with one hand:

Create a larger opening by loosening the laces.
Sit on a couch or bed, resting your affected leg atop it in a right angle.
Grasp the shoe by the middle of sole.
Pull the shoe over your toe.
Once the shoe is covering most of the foot, pull the collar over you heel.

The therapist had me do this twice. Since that session, putting on my left shoe has never taken five minutes. Now, I could finally dress myself on days when I only had to wear sweatpants. On days when I had to wear jeans or khakis, I still needed someone with two hands to button them.

One day, while I was getting ready to go to physical therapy, I received an automated phone call notifying me that my ride was on the way. I was the only one awake in the house. My sweats were still in the wash, so the only pants available were my jeans. I couldn’t hold them up and attempt to button them at the same time, but there was no one to help me with them.

Rather than panic, I pulled my pants all the way up, then I fastened my belt tightly. Now that the pants were being held in place, I was able to find the button with one hand and work it through the buttonhole. This was surprisingly easy, and I ended up with a few minutes to spare. That evening, I tried this same method with my khakis. It worked! So it became my method for putting on pants that needed to be fastened. I no longer needed help with basic dressing.

Most of the gains in therapy took place from November of 2016 to January of 2018. After that, it really just became a matter of practice. Part of the deal with therapy was that I was supposed to be continuing to do some of the exercises at home. But I was unable to perform them in my living situation. Most of the exercises had to be executed while lying or sitting on a bed or a mat. I was using an air mattress, so I wasn’t even sleeping that well.

Most mornings, I woke up drowsy, and I often had backaches. When I arrived at the hospital for therapy, I’d still be stiff and groggy. I could plod mindlessly through the session of occupational therapy because I could do it from a seated position. Sure, I might yawn half the time, but there was no risk of falling. Physical therapy was different. I had to maintain balance while using major muscle groups. I was frequently unstable or out of breath. It constantly felt as though I was disappointing the person working with me.

I had very little energy those days. In the morning, I seldom wanted to climb out of bed. After one or two hours at work or rehabilitation, all I would want to do was go home. Once home, I would eat, watch a few hours of TV, and climb back into bed. On days when I didn’t have to work, the only reason I would get up before 11:00 was to let Mary out. As someone who had always been active and a morning person, this was disorienting and depressing. I could not tell whether I genuinely needed sleep or if my mood was suffering. Of the two people I was living with, one was jobless, the other worked nights, and neither was a morning person nor lived on the same level as me. As I could not safely use the stairs yet, I was left to my own devices until noon most days.

By April, my therapy progress notes stopped indicating that therapy was helping. Quite naturally, the insurance company stopped authorizing more visits. I was discharged from physical and occupational therapy at the beginning of May. Since the stroke, I had never gotten to a point where the health care providers had effectively declared that I was on my own. Now they were sending the message that there was nothing more they could do for me. I was horrified.

Was this how recovery would end? I had often thought of myself as more physically resilient than the average person. I was the one who had defied the odds when I wasn’t supposed to make it, when I was supposed to have been a vegetable. People who worked with me had often expressed amazement at my willpower and endurance. I had displayed none of this in 2016. I felt like a fraud. Maybe I deserved to be let go.

I realized that I was approaching the second anniversary of May 18, 2015 in two weeks. Through all of that time – from the days I couldn’t walk, to leaving the hospital, to moving back to Minnesota, to physical therapy – my one sustaining wish had been to lift weights again. I knew that my body would never be the same, and there would be a plethora of things that I could no longer do. But lifting weights would go a long way in restoring my quality of life. In fact, when I had been given the option of insurance plans, I had selected the Silver Sneakers plan expressly because it came with a free gym membership.

I wanted to be back in a fitness club environment. If I could expect newer equipment and fewer kids, I would probably get a safer and more effective workout. Since I lived ten blocks from the southern border of Minneapolis, L. A. Fitness in Richfield seemed like the closest club. I called them and they averred that they participated in the Silver Sneakers program. I called Metro Mobility to set up a ride for that Saturday.

Imagine a severely disabled person getting on a bus for people with special needs, his left fist involuntarily clenched so tightly that he must hand his cane to the driver. It was 9:51 in the morning, and I rode down to Richfield unsure of what I would be able to do. Once I got on the floor of the weight room, I found that my body was very tight. I had someone to help me pry my hand open and get it around the handle on the row machine. I had very little range of motion, and even then, my shoulder hurt every time I extended it. Because my grip was so weak, I could only work out with 25-pound weights.

Next, I decided to try strengthening my shoulder. I hobbled over to the weight rack and selected a 10-pound weight, then I sat down on a bench so I could have more stability. It was all I could do to hang onto it and raise my shoulder a bit. I so missed the days when I could shoulder press 80-pound dumbbells. After I did a couple of sets, I asked someone to hand me a 15-pound dumbbell, because I dared not try to stand or walk too much.

I was so self-conscious of everything in those early days back in the gym. How weak and infirm did I look? Was I in people’s way? Was I just wasting my time? How much muscle function could I possibly hope to gain back? There were so many questions, and this was a long, long process. But it was May 13, 2017 – less than two years since I had slipped into a near-fatal coma – and I was lifting weights again.

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