April 28, 2019

How to Empty a Bedside Commode One-handed

One problem I worried about before my knee surgery was stress incontinence.  While waiting for surgery I learned sudden knee pain can start a small urinary leak that turns into a flood after about 60 seconds.  This set off alarm bells.  I regularly get up in the middle of the night to go to the bathroom and was worried about losing bladder control if I felt sharp knee pain.  I was freaked out about having to clean urine from my carpet.  A bedside commode would solve my problem but I live alone so who is going to empty it??

I cannot carry the bucket in my sound hand because I need that hand to hold a cane.  I was saved by serendipity.  Before surgery I moved a laundry basket so I could put dirty clothes in it as I came and went from the bathroom (see door on right side of photo).  While rehearsing I asked a friend to put some water in the bucket.  Feeling the liquid slosh around made the problem real and something made me look at the laundry basket.  I know the bottom of this basket is smooth so it slides over carpeting like it is on ice.  I put the commode bucket inside the laundry basket and slid it into my bathroom. My sound hand carried the empty bucket to the shower for cleaning while I slid the heel** of my hemiplegic hand on my bathroom counter to keep my balance.  My friend suggested I put the bucket on my shower chair and use the shower hose to rinse it rather than risking a fall by leaning down to put the bucket under the water spout.

I never needed the bedside commode.  Yet I felt triumphant because so many health professionals have told me to get a bedside commode.  I also felt humbled because I arrived at the solution through sheer dumb luck instead of my OT degree and clinical experience.

** heel of hand = palm of hand near the wrist

April 18, 2019

Bumpy Rode to Joy

My success is due in part to my ability to identify the cognitive and motor skills needed for each step of an activity.  Here is what I learned when I went to a concert at Princeton University.

-  Google Earth photographed the parking lot from above so I did not know it was built on a hill.
    It is the steepest hill I have climbed since my stroke.  This balance challenge made me nervous.
-  Google Earth did not show the road repairs being done which produced some slippery fine gravel
   on the road I had to cross.  My ice strategy of taking tiny steps worked but I was still nervous.
-  I had to take a freight elevator to the 2nd floor.  The elevator did not work after the concert so I
   had to walk down 50 steps.  I had mild knee pain the next day.  I do not have the confidence to
   repeat this strength and endurance challenge if the elevator is not working next time.
-  The auditorium had no hand rails to help me walk down to seats closer to the stage.  My strategy
    of arriving 30 minutes early allowed me to take a seat in the last row at the top.
-  I took a short-cut to get back to my car when I left the auditorium which forced me to walk across
   8 feet of grass.  My balance is challenged by walking on uneven surfaces.

+  The outdoor lighting was excellent which made me feel safe that night.
+  Three strangers helped me find my way on this unfamiliar part of campus.
+  I come from a family of musicians so I appreciated the wonderful acoustics in the auditorium.
+  The concert was free.
++  Successfully walking down 50 low-height stairs has given me more confidence when I
      encounter stairs in the community in the future.

April 10, 2019

Linking New and Old Habits = Success

A PT helped me understand why walking and climbing four steps to my front door does not maintain strength in muscles that straighten the knee and bend it.  These muscles need to be strong to keep my arthritic knee in good alignment.  Despite this awareness I did not consistently do exercises at home after PT ended so my muscles got weak and my knee started to hurt again.
It has been 16 years since my stroke so the days of scheduling my day around a home exercise program is over.  However, pain motivated me to incorporate knee exercises into my daily routine.

I link a new habit to an old one and set goals I can do until I die.  For example, I sit down to don my shoes so I placed a leg weight on the floor next to my shoes.  After I tie my shoes I put the weight on my ankle and straighten my knee.  Twenty repetitions takes about 90 seconds so it is hard to find an excuse for leaving my bedroom without doing this exercise.

I was also did not do a knee flexion exercise.  So before I go to bed I put my purse and TV remote on the chair where I sit to use Theraband that is tied to a heavy piece of furniture (see arrow).  Walking to get the TV remote or get my purse before I leave the house is something I do even if I do not feel like exercising.  Since I am standing next to the chair I sit down, hook the Theraband on my ankle, and bend my knee for two sets of ten.

Incorporating exercises into my normal routine reduces my anger about having a chronic disease that will always require accommodation.  Linking new habits to old ones also provides memory aids (e.g. shoe, purse) so no thinking is required.  It is a relief not to feel guilty at 3 p.m. because I have not done the exercises I promised I would do. Twenty reps distributed throughout the day are not as effective as a long PT session, but life-long compliance is better than letting myself go down hill.

April 2, 2019

Why I Both Refuse and Accept Help

I refuse help when I know I can do a task myself.  If a stranger offers to help I say "I can do it but thank you for offering."  Refusing help from friends and family is also important.  I do not want to be the sister or friend who repeatedly pulls the stroke card to get special treatment.  People know when they are being taken advantage of. 

I need to be independent when friends are not willing to change their habits to accommodate my needs.  My friends want to arrive just before the movie begins when most seats are taken.
I have to arrive 30 minutes early when the rows are empty.
I cannot creep past the feet of seated people.  With their feet hogging the narrow aisle, I have no place to put my cane tip on the floor.  Holding my cane off the floor puts me at great risk for a very bad fall.  Waiting for friends to arrive at the last minute forces us to climb up to the empty seats in the nose-bleed section.  So I drive myself and save seats for friends who want to join me.

However, I do not want my fierce independence to create a mess that other people have to clean up.  For example, on the rare occasion when I eat steak, I ask my brother or a friend to cut it up for me so it does not fly off the plate and land on the floor.  Even my best rocker knife is too dull to cut through dense meat fiber.