Keeping My Christmas Spirit

This is a photo of the artificial Christmas tree I put up every year since my stroke.  After I fell on my patio I looked for ways to reduce my risk for falling.  When denial faded I was able to let myself think about what would have happened if I had broken my hip. 

I had already made myself safe by keeping furniture sliders under the big reclining lounge chair next to this window so I can move it out of my way.  Moving the chair allowed me to place a folding chair next to the tree so I could sit down when decorating the bottom half.  However, decorating this six foot tree is tiring. Fatigue is one of my triggers for falling so I ordered a small table top tree.




I am happy  the figures of the magi and shepherd visiting the Christ child create a Christmas tableau in front of the small tree.  I made these figures years ago when my hobby was needlecraft.  I also love the tiny Christmas tree balls.  I am always amazed by how happy small things make me.

After two years I gave the decorations for my big tree to my church for the annual sale that raises money for local charities.

My Computer Died

I was forced to buy a new computer when my old died unexpectedly.  I will finally have to learn to use Windows 10 and Office 2016.  ARG!  I hate updating my computer skills. The only good news is that I got a discount because I bought the new computer on cyber Monday.

Snow Shoes for a Stroke Survivor

Since my stroke I am careful about venturing outside when it snows, but I am not trapped inside until spring comes either.  I never walk on snow covered concrete because slippery surfaces are a fall hazard.  Once streets and sidewalks are clear I wear boots over my shoes to protect them from the slush and give me better traction when it is icy.  Boots also help when my car is covered with snow.  Dragging snow off my car dumps snow on my boots instead of my shoes.  Boots I tried on at a shoe store would not fit over my leg brace.  My leg brace does not allow me to point my toes which is a pre-requisite for donning boots.  On-line I found the Neos overshoe with a Velvro opening that goes all the way down to my toes.  The Villager model is lightweight and designed for occasional use which is perfect for me.

A video at www.overshoesonline.com shows how to don this boot.  Warning #1: I do not put the boots on while standing as the video shows because I do not have good standing balance.  My boots go on safely while I am sitting.  A trick the video does not show is to make the ankle straps as long as I can before I put on the boots.  After I snap the straps closed I pull on the ends of the straps to make them tight.  Warning #2: The first set of boots I ordered was too big so they flopped around when I walked.  I walk more slowly with boots on, but that beats not being able to get to the grocery store or keep important appointments like a visit to the doctor.

Freaked Out by Snow

I have driven in 47 of the 50 states.  Traveling by car makes me happy because it lets me change plans when I travel, but a freak snow storm only brought fear.  When I left to get blood pressure medicine there were only a few flakes of snow that did not stick to the ground.  By the time I came out of the pharmacy icy slush was covered by snow.  I decided to go home by a well traveled road but traffic quickly came to a stop when an accident with a bus blocked both lanes.  The police diverted all traffic to a narrow side road that meandered through fields with no homes.  Several people got stuck as their cars slipped on a low hill.  Thank God learning to drive in snowy Chicago taught me to keep my car rolling slowly in snow.  I felt fear as I carefully went around them on this deserted two-lane road.  If I had gotten stuck there were no cross streets to tell a 911 operator or the AAA towing company my exact location.

It took an hour to get home so two inches of snow had accumulated in my parking spot.  Snow storms begin in January so I was not wearing my snow boots with the grippy rubber soles.  I had a cell phone, but if I fell I did not know how long it would take the police who were dealing with many accidents to come help me.  It was 2 p.m. so all my neighbors were at work.  To manuever around my car and get up the brick path to my front door, I took tiny steps the way able-bodied people do when they shuffle across ice.  The evening news told stories about people being stuck in their car for hours.  What a nightmare.

Distracted by Another Set Back

About a month ago I suddenly felt excruciating pain in my sound knee that made me collapse back onto the couch. After that I could get up safely only by placing my sound hand on furniture to push myself up to standing and wait for the pain to subside before I start walking. Now the only way I can get out of my house is to go down the stairs backwards very slowly. This decline brought back scary memories of being confined to a wheelchair when I was in the rehab hospital.

I saw my doctor who ordered an x-ray of my knee. I have osteoarthritis and small bone spurs.  The pain is pretty intense at the end of the day whenever my pedometer says I take over 1,000 steps so I managed my pain by sitting a lot.  Switching from Tylenol to Aleve has reduced the pain so I feel ready to go to PT.  I need help to increase safety when standing up and increase my walking endurance to communty distances.

Finger Exercises

When I grasped thin objects like a zipper tab my thumb and index finger used to bend ferociously.  Trapping the zipper tab against my thumbnail made the zipper tab slide out of my hand.  After analyzing the muscle imbalance in my hand, my OT gave me exercises.  Caution: Doing exercise incorrectly can strengthen muscles that are already too strong.

The photos below illustrate the kind of individualized exercise program an OT can create for you.  

The 1st exercise is touching my thumb to my index finger.  The vibrator stimulates the weak muscles at the base of my thumb that were not working (see black arrow).   





The 2nd exercise is straightening my fingers against a rubber band.  Initially my middle finger straightened more than my index finger (see arrow on left). 

To correct this muscle imbalance my OT added a 3rd exercise. Tendon stroking is pressing firmly along the tendon from my wrist to the 1st knuckle.  For me this sensory input stimulates both index finger and thumb extension.  

Muscle Memory Finally Kicked In

I am stunned.  Eleven years after a stroke my muscle memory still works.  I have been doing abdominal exercises to prevent back spasms.  But I still arched my back so I could lean my stomach against the kitchen counter to maintain my balance while reaching.  To stop this bad habit I had to used a memory aid.  1st I leaned my sound hand on a piece of Dycem (see black square). Then I put my hemiplegic hand on the counter for support.  This creates a space between my stomach and the sink.  After lots of repetition I stand up straight without having to think about it. 

Athletes call the ability to execute a practiced movement muscle memory.  But muscles do not remember - the brain remembers.  A part of the brain called the cerebellum stores motor memories so it can automatically tell muscles what to do.  Relearning movement is mentally exhausting because stroke survivors have to tell their body to do every little movement.  Muscle memory is a blessing because it lets me move without thinking just like I did before my stroke.

Frustrated by a Right Handed World

I was right-handed until a stroke paralyzed my right side.  Now that my left hand is my dominant hand I learned the world discriminates against left-handed people.  The aggravation goes beyond right-handed scissors (1) and can openers (2).  (3) The shutter button on cameras is always on the right.  When I hold a camera with my left hand a finger often covers the lens when I  depress the shutter button.  (4) Computer labs make sure there is room to maneuver a mouse on the right side, but do not leave room on the left.  (5)  Left-handed drivers have to reach around or through the steering wheel to put the key in the ignition which is always on the right.  (6) Many credit card machines put the slot that you swipe your card through on the right side.  Left-handed people have to reach across their body and cock their wrist at an uncomfortable angle to use their credit card.  The plastic stylus you use to sign for a credit purchase is frequently attached to the right side with a very short cord.

(7)  Before my stroke my right hand used to close a jar by turning the lid clockwise and the back of my fingers used to get closer to my forearm (photo on left).  Now when my left hand to turn the lid it is my thumb that gets closer to my forearm.  It took me three years to stop making a lid tighter when I wanted to loosen it.  Arg!

The only advantage left-handed people have is the QWERTY layout of a keyboard.  You can type thousands of words on the left side of the keyboard with only the left hand, but right hand can type only a few hundred words on the right side of the keyboard (Wikipedia.org).  Left-handed people have to decide which hand to use until the day they die.

Disturbing Use of Health Statistics

Knowing how favorable an outcome a client can expect (prognosis) is valuable information.
For example, one drug may shrink 60% of tumors while another may shrink 80% of tumors.
These are helpful statistics when deciding a course of treatment.

However, health statistics can be used in a distrubing way.  One study concluded that stroke survivors who could only lie or sit soon after admission had only a 12.7% and 58.2% chance of gaining the ability to use a walker. (1)   The author concluded that an early discharge would "reduce avoidable length of stay in the hospital."

Here is the problem.  These percentages represent a group.  YOU MUST NEVER FORGET that it is hard to tell if a client will fall in the group that improved or in the group that did not improve.  Using group statistics to justify sending clients home early will save the hospital money, it but takes away the opportunity for some clients to have a better outcome.

A fairer way to determine how long to keep a client in the hospital is to measure progress.  Going from being unable to sit to using a walker can have huge effects.  As a stroke survivor, I know that being confined to a wheelchair can have a significant effect on quality of life and later cost of care.

 1.  Chung, BPH. Stratification of stroke rehabilitation:Five-year profiles of functional outcomes.
      Hong Kong Physiotherapy Journal. 2018;38(2):1-7.

Our Stories Change the Illness Experience

Humans are not like animals who react to a situation and then move on.  Humans create stories about what happened to them.  For example, if I think I failed because I do tasks a different way than I did before my illness, then I am primed to grieve about what I have lost.  But if I see compensation as a way to achieve something I really care about then I have beaten the bad luck I was dealt.  When I complete a task that is a high priority for me, I think about the goal instead of the process I use to get there.

Unfortunately, health care providers focus on the short-term process and leave long-term goals to clients.  Long-term rehab goals are like trying to save money.  Saving money is good, but where do people get the motivation to sustain their committment to a goal that is so far away?  This is why banks create Christmas accounts.  When people create a story about an action (e.g. I will have money to buy presents), they are more likely to follow through because they will get something they want.

When I forget to follow my own advice, experience helps me recognize that once more I have fallen into the trap a story can create.  I still suffer, but not for as long.