Distracted by Disappointment

I assumed my cataract surgery would give me 20/20 vision.  Unfortunately, I can see better with my right eye that has a cataract than with my left eye that has a $2,500 lens.  This lens was supposed to improve my distance vision which I need for driving.  Now I have to close my left eye to read road signs because the lens makes the edges of every letter fuzzy.  I saw my optpmotrist yesterday and she is going to talk to the eye surgeon to see if they can come up with a solution.  I am struggling with stopping a disaster script from taking over my day.

My "New Normal" Does Not Make Me Sad

I want my deficits to disappear.  This requires remediation.  But current science cannot give me complete recovery so I also use compensation, which is a modified way to do a task.  I value compensation because I would lose my will to live if I had to go to a long-term care facility.  For example, I would resent having my daily routine dictated by the 3 times I must meet a nurse in the dining room or snack area because "seniors feel safer when a nurse gives them their medicine."  Can you spell c-o-n-t-r-o-l?  Being independent is a core value that makes me who I am.

Here is one way compensation helped me live alone in my home.  For the 1st year after my stroke
I experienced crushing fatigue, but energy conservation gave me clean dishes.  I divided this task into 3 steps.  Step 1)  Empty dishwasher.  Repeated bending to grab dishes and turning to place dishes on a kitchen cart was exhausting.  Finish Step 1 and rest.  Step 2)  Put clean dishes away.
I pulled the loaded cart to the appropriate cabinet and then bending down or reaching overhead to put the dishes away.  Using the cart meant I did not have to repeatedlty carry heavy stacks of dishes from the dishwaher to each cabinet.  Finish Step 2 and rest.  Step 3)  Load dishwasher.
I have a double sink so I use one sink as a staging area to place dirty dishes throughout the day.  Leaning down to fill the bottom rack was the only challenge.  My endurance gradually returned so I no longer use 3 steps to get clean dishes, but I still need compensation for showering, cooking, etc.

Therapists who do not see the value of compensation may do a disservice to clients with chronic conditions.  For example, having clients with a chronic lung condition (COPD) walk on a treadmill for 5 days while they are in the hospital is not a long-term fix.  Clients with COPD need to learn energy conservation so they can stay active instead of letting fatigue and shortness of breath turn them into couch potatoes when they go home.  Perhaps this is why OT had a significant effect on reducing hospital re-admissions for clients with COPD while PT did not (1).

1. Rogers, A., Bai, G., Lavin, R., & Anderson, G. (2016). Higher hospital spending on occupational 
     therapy associated with lower readmission rates. Medical Care Research and Review, 1- 19. 
     https://doi.org/10.1177/107755876666981.

What My Hemiplegic Hand Does When I Drive

When I drive on long trips my hemiplegic gets tighter and tighter from the constant vibration the car produces.  Initially I put a piece of non-slip shelf liner on my thigh to keep my hand from sliding off my lap, but my fingers were still bent.  Now I use pieces of foam that are designed to slip over the handle of a large utensil that needs a 5/8ths inch diameter hole.  I cut the foam into small pieces that fit my 3 worst fingers.  I keep them in a cup holder so they are easy to find.  My fingers initially may try to bend so I may not be able to slide the foam all the way up my fingers.  As you can see in the photo my hand is not relaxed enough to lie flat, but at least the foam provids traction that keeps my hand on my lap so the weight of my arm is supported.  Body heat trapped by the foam eventually relaxes my finger muscles.

It is nice to arrive at my destination with a relaxed hand and a shoulder that does not ache.

Organizing My Purse is a Vital Shopping Strategy

Jupiter, Mars, Venus, and Mercury line up every 50 to 100 years.  This is how low the chances are of me trying to find something in my purse by digging around with one hand.  Organizing my purse reduces frustration when I go shopping.  Every woman organizes her purse differently so my examples are intended to help stroke survivors realize a purse does not have to be a buzz kill.

I put a round green wrist coil on my car key to make it easy to retrieve.  I grab the wrist coil instead of searching for the key.  I learned to put the flexible coil on my wrist while reaching for an object in the car.  I made the mistake of setting the key down and then locking and shutting the door.  Seeing my car key on the dashboard was agony.  AAA car service came an unlocked my car after I waited for an hour.  When I made this mistake a 2nd time I knew I needed the sensory cue of the coil around my wrist.                                                                                      My house key is on a straight flexible coil that is hooked on my purse.  I pull on the coil to make my house key slip out of its pocket.   

I handle credit cards quickly because I keep them in a zippered compartment that holds ONLY a driver's license, one credit card, an ATM card, and a library card.  While sitting in the parking lot I place the card I need vertically so it stands out from the other cards which are horizontal.  Cards go back in this zippered compartment in a flash.  Less frequently used cards like my health insurance card are in another compartment.  I do not want to hear the people behind me in line moan because I am struggling to find my credit card.

Irritation I can cross off my "it's disgusting" list

Stroke survivors who use a cane know we transfer "gunk" from all the environmental surfaces we touch to the handle of our cane.  When the "gunk" builds up the handle feels sticky.  For years I have tried to clean the handle by soaking it in hot water with Dawn dish washing detergent.  I was sure Dawn would solve my problem because people who rescue animals after an oil spill at sea use it.  But a little while after I rinse and dry my cane, more "gunk" oozes out of the material that covers the handle.  What a disappointment.

Recently I got the idea to generously coat the DRY cane handle with Dawn detergent.  After letting the Dawn soak in I put the handle under running water and use a washcloth in my sound hand to vigorously rub the handle.  I hold the cane still by trapping it with my hemiplegic hand as it rests on my bathroom counter.  It works!

P.S. Dawn drys the skin on my good hand so I don a rubber glove before I start smearing Dawn on the handle.

Problem Solving Never Ends After a Stroke

Here are things I must do after cataract surgery.  I will rehearse because I do not handle failure well when I am feeling stressed.  I would rather fix mistakes before there are any consequences.

1.  I was concerned about my poor balance making it difficult to walk out of the surgery room after the operation.  No need to worry - I must get undressed and wear a hospital gown.  So when I call to learn the exact time of my surgery I will tell the nurse I need a wheelchair because I cannot walk without my leg brace and cane.

2.  After surgery the doctor expects me to squat down with a straight back instead of leaning over to pick up an object.  To tie my shoes I lean down with my breasts resting on my thighs for one minute.  So I moved my shoes to the living room where I have a really low couch which reduces how far I lean over.  The nurse will not know how to tie a shoe that has only one free end.  Elastic shoelaces?  Arg!

I moved kitchen objects I use every day from lower cabinets to over-head cabinets.

I put a folding chair so I can sit while taking clothes out of the dryer with kitchen tongs.  I am leaning over a little, but nothing like when I stick my head in the dryer to reach for clothes at the back of the dryer.

3.  I will have to put 1 drop in my eye 4 times a day.  I will try leaning my elbow on my tall chest of drawers which keeps my hand steady when I look in the mirror to put on mascara.  However, getting my eye to stay open will be difficult.  I expect to spill a lot so I am practicing now with non-prescription eye drops.

Cataract Surgery May Be a Fall Hazard

My cataracts have grown significantly in the last year so my optometrist referred me to a surgeon to have them removed.  The problem that worries me the most is only vision tells me if I am vertical.  My brainstem stroke damaged the pathways that carry information from the semicircular canals in the inner ear to the part of the brain that controls balance.  Visual input has prevented many falls since my stroke.  Here is one example.  If I see the distance between my body and a kitchen counter increase, I know the counter is not moving away from me.  I have started to lean back behind vertical.  This has happened hundreds of times so my brain created a program I call "step back - step back."  This program fires automatically so I no longer have to think  "take several small steps backwards until my feet are under my body again."  When I see the surgeon again I will tell him I am concerned about what may happen when I get off the surgery table and start to walk.

The good news is that a stroke taught me the brain can rewire itself.  The bad news is rewiring the brain in an older person with brain damage can require hundreds of repetitions.  However, I am committed to another laborious round of learning how to use my new vision because poor vision has affected my driving.  I can see people, vehicles, and traffic lights, but the edges of letters on traffic signs are now blurry. 

Health insurance only pays to have cataracts removed.  Implanted artificial lens are an out-of-pocket expense clients have to pay.  However, lens are cheaper than paying 5,000 to 10,000 U.S. dollars every month to a long-term care facility because I have lost the ability to drive safely.

Back Pain + Stroke = Disaster

I herniated a disc in my back and had sciatica 20 years ago so I have been stretching my back for years.  After my stroke I was worried my back pain would come back.  It did.  Freezing like a statue when a back spasm hits and then walking slowly to sit down without dropping my cane is scary.  This experience showed me that stretching my back every morning is not enough.

In PT I learned that I arch my back because abdominal muscles on my paralyzed side are weak.  When I  went home I discovered I arch my back when I reach down to get a pot from a bottom cabinet, to get milk from the bottom shelf of the refrigerator, and pick up something from the floor.
I arch my back when I wash a dish because I am leaning my stomach on the edge of the counter for support.

My PT taught me to strengthen my abdominals by doing leg lifts with bent knees.  I decided to intensify the workout.  I clasp my hands together and lift my head while twisting to the left until my right shoulder blade lifts off the bed.  Before I start doing a leg lift I press my low back against the mattress and take a deep breath.  I slowly let my breath out through pursed lips as my hands reach the position in the photo.  Holding my breath while straining can increase my blood pressure.

I was dismayed to learn my NDT certification course did not teach me that raising an arm to use a hand requires strong abdominal muscles.  l did not realize how heavy an arm is until I had a stroke.

Good Luck Instead of Textbooks

As an OT I know many solutions cannot be found in textbooks.  So I am grateful good luck has helped me as a stroke survivor.  Here is one example.  My tap water tastes awful.  Buying five pound gallon jugs of spring water at the grocery store and carrying them from my car to my kitchen is too much for me. 
So I bought a Brita water filter to put on my kitchen tap.  However, opening the device to put in a clean filter inside is sdhgfj.

One day my dish drainer was empty as I was changing the filter.  I do not know why I put the filter in the dish drainer.  The lid is very tight so I decided to use a piece of blue Dycem to give my hand better traction.  As I was unscrewing the lid I noticed the end of the filter stopped moving when it hit the side of the dish drainer (see arrow). 




OMG.  Instead of dreading this task I feel smug because I know I will succeed.

How I Stop My Brace from Rubbing My Calf Raw

Long socks that reach the knee reduce skin chafing caused by the top part of a leg brace as it rubs the top of the calf (see arrow).  But sock manufacturers make tall knee-high socks only for men.  These long, large socks do not fit my woman's short calf and small foot.  The only knee-high socks made for women are brightly colored socks for soccer.  I am one of the least fashion conscious people I know, but even I will not wear gaudy colored socks that clash with my outfit.  A stroke taught me to appreciate every opportunity to appear as normal as possible.

Then I got the idea to cut the top off a man's tube sock so it covers only the top my calf.  The Velcro strap keeps this short section of sock from rolling up (see arrow).  I washed them many times to see if the cut edge would fray.  They do fray eventually but they hold together for a long time.  I use one sock from each pair so a package of 12 has lasted me a long time.  What people see on my feet is black socks with black shoes and beige socks with beige shoes.