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Archive for the ‘Medical And Surgical Matters’ Category

Five days after carpel tunnel surgery I have:

Walked along the waterfront using a gutter frame, twice

Transferred independently from the bed to to wheelchair and back

Transferred independently from the wheelchair to the gutter frame and back

Transferred from the chair to the floor for a bit of crawling

Stood up from the wheelchair to stand up at the bathroom vanity

Emptied the leg bag myself

Done standing exercise ….

Plus all the other things that anybody can do after carpel tunnel surgery:

Used a fork and spoon easily

Tied my shoelaces

Taken off my socks and shoes

Placed the Odstock electrodes after having retrieved them from their ziplock and zipped bag, then remove them and put them away

Squeezed and pinched my fingers and thumbs

Made a fist … And heaps of other things like cleaning my teeth, wiping my face, combing my hair, putting on moisturiser

Every day everything is stronger, but there are a few goals that will be a little way off, like being able to put my all weight down through my hands on to the crutch handles – that will likely be the final challenge!

Whew! So far, so much better than I had expected!

My surgeon didn’t refer me to a hand physiotherapist or give me exercise to do after the surgery so I found some good web sites to help me.

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Life is short. We’re only here once. You never know what’s around the corner. Life is for living. Make the most of every day. The universe conspires in your favour, look for the signs. When ine door closes, another opens.

So many cliches. Yet right now, the universe is conspiring in my favour and I am taking what seems an obvious, if outrageous, action.

I have spent a good part of this year worrying about surgery. Waiting months to know the outcome of earlier surgery – was it successful? Then as that resolved itself satisfactorily, I faced the uncertain prospect of surgery on my wrists. Very minor surgery for which my spinal cord injury turns into a major exercise in managing aftercare.  Plus, I have to be fully recovered for my son’s wedding, plus I want to be of some use when my first grandchild is born inNovember.

The uncertainty of the timing of this

surgery, was driving me nuts so I took control. I took control. I asked the surgeon if there might be a four week window that would allow me and my husband to go to Europe! He agreed this was reasonable. I had control over my life again.

I am no longer focussing on surgery and trying to second guess how it will impact on the things I want to do. Instead I am working on an itinerary that will take us to Prague, then Tuscany, and Istanbul. My husband and I asked ourselves, which are the places we would regret not seeing. There’s a long list, but these came up top.

I’ve already missed the wedding of a young friend because I’ve been waiting for issues around surgery to resolve themselves. But things don’t resolve themselves. We resolve them.

It’s been a hectic week or two.

Carpe diem. We leave in less than ten days!

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One year ago today, electrodes were applied to my lower left leg in an attempt to flex my ankle sufficiently to swing my left leg through in a normal gait pattern.

I had been using a dictus band to keep my left ankle flexed but I had to go up on tip toes on my right leg, and swing my left leg around, rather than through, to walk. I was causing damage to my lower spine and right hip, increasing spasm in my right leg, putting my entire body out of alignment – but it was better than being in a wheelchair.

The results from using the Odstock have been amazing! Initially, it was exciting just to be able to bring my left leg through straight rather than swinging it around and through. The Odstock electrically stimulated my muscles to flex at the hip, knee and ankle. The flow on effects from being able to walk like this have been profound. My spine is straightening, my posture has improved, I stand straight and I rarely experience pain in my right hip. Muscles on my left side from my core down are becoming enervated and are getting stronger.

(An earlier post, Wired To Walk, has a video showing how the Odstock works.)

With the help of a personal trainer who seizes every opportunity to reconnect muscles, I have developed lower abs, internal obliques, glutes, quads and knee control.

Over the last month I have been able to rotate my left hip. Now this may not sound like a big deal, but it has taken my walking to new level. My left hip flexor used to collapse, but now my hip extends, rotates, and my left leg is in a good position to take the next step. (Another plus is that as my internal obliques strengthen, I’m getting a waist!)

My balance is still awful, but the downward pressure I put on my crutches is much, much less as my legs take more and more of my weight … Fewer shoulder problems, twisting of joints, and maybe an easing of carpel tunnel syndrome, as well as walking faster and further. I still have to do lots of stretching – it’s like keeping the muscles oiled and moving smoothly.

So it’s been a good year …

Reach For The Stars

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Since I first tried walking by electronically stimulating dorsi-flexion and a little knee and hip flexion (see Bionic Woman)in my mostly paralysed left leg, I’ve made amazing progress. Particularly given that I have a spinal cord injury at T7/T8 and I was told I’d never walk …

I had been using a dictus to lift my drooping left foot off the ground (drop foot) – a dictus consists of a cuff around your ankle with a thick rubber band looped around hooks on the bottom eyelets of your shoe:

To walk I went up on the toes of my right foot, leaned over to the right and swung my left leg around. My spine was twisting and everything was out of alignment.

Now, using the Odstock to stimulate the muscles of my left foot, I walk with a normal gait, if a very slow normal gait. There is a switch in the heel of my right foot so that when that heel hits the ground, an electrical impulse travels up a wire to the small pocket sized computer on my belt, then down another wire to one electrode placed on my skin over a nerve that travels from the knee to the ankle, and a second electrode placed behind my knee. A micro second later my ankle, knee and hip bend and I am propelled forward. MAGIC!

Odstock Computer Unit


The image below provides an idea of how it works, except that it shows a male walking without sticks, with the heel switch on the same leg that’s being stimulated, and the second electrode on the calf rather than behind the knee. I’m a female, I walk with two elbow crutches, the switch is on my other heel, and I place the second electrode behind my knee (although I can place it on the calf but the response isn’t as good). But you get the idea.

Odstock stimulates walking

Even better is the U tube clip that shows <a href="http://“>how the Odstock works.

But here’s the catch. It’s not a sudden cure for spinal cord injury or stroke or multiple sclerosis. It’s a walking aid. And to get to this point of walking tall and straight I spend lots of time stretching and exercising the muscles that abused to be able to walk. I exercise weak muscles that I need to recruit to work with the Odstock. I spend hours repeating small movements that I need for endurance. I work hard to reconnect and reprogramme nerves that have learned a pattern that has to unlearned, corrected and relearned.

It’s intense. Determination, persistence, commitment is my mantra to which I’ve added creativity. Creative thinking. I discipline myself to follow precisely the instructions given to me by a clever personal trainer who thinks laterally and is always coming up with ways of tricking my brain so I can learn new, better patterns of movement.

Last week I walked two kilometres around a walking/running circuit at a local park. The expansiveness and wide open space encouraged me to stand tall. It took me 80 minutes, and apart from a few lapses of concentration I think my gait was fabulous.

Is it good enough? When will it be good enough? I’ve no idea, but this is good for the moment.

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Surgery I had a couple of days ago required general anaesthesia. It was the third time I had required surgery in six months to repair a fistula. (I have previously posted about how I have avoided surgery through exercise and stretching, but sometimes a slice of the knife wins … c’est la vie …)

Each time the anaesthetist spoke to me about the procedure he used the term “putting to sleep”. But it isn’t like going to sleep, and it isn’t like waking up. It’s better. It’s like time travel, and/or like transporting through space. And for some reason it’s not alarming, it’s fine, even pleasant. One moment someone is telling me that I’ll feel a rush to the head, and the same moment my eyes open and i’m in a different room, with different people, and at a different time. Note that I wrote “at the same moment”. And that’s the interesting thing. When you go to sleep naturally it’s a gradual thing, and when you wake up naturally you become aware of your surroundings over time … Even if you wake suddenly you are aware of time passing. When the anastheatic wears off it’s not sudden or slow or instantaneous … It is the same moment that the anaesthetic was administered.

I can see why Michael Jackson might have liked using propofol – it’s an hypnotic drug used in general anaesthesia. The benzodiazepines he used with it are muscle relaxants. I wonder if he became addicted to the sweet sleep, that rush as the anaesthetic is administered and the not unpleasant sensation of alertness at what you register as being the exact same moment despite time having passed.

The aim of anaesthesia is to induce various states of hypnosis, amnesia, analgesia, relaxation of skeletal muscles, and loss of control of reflexes of the autonomic nervous system.

I take a great many drugs to manage pain and spasm, and some of these drugs are very valuable on the black market because of “chill out” properties. I seem to be immune to these effects, because, as my family will testify, I’m not chilled out. Also, I don’t experience any pleasant sensations other than the relief of pain.

But general anaesthesia is quite nice. (I understand that for up to 0.2% anaesthesia is not “quite nice” and is not completely effective, some poor buggers even remaining conscious in their paralysed bodies, unable to tell anyone they can feel the pain of the knife – unimaginable terror)

I had always thought, like many others I have spoken to, that anastheasia produces a pattern of deep sleep, the delta waves.

I did a little research and found that scientists don’t write of anaesthesia as sleep, most refer to it as being in a coma.

Even up to a few years ago scientists used to associate unconsciousness with being under anastheasia because of the shared delta wave readings.  Many scientists are now reluctant to use the word unconscious because that would imply an understanding of consciousness which they don’t have. Just like scientists no longer believe they can map the mind … That’s still in the philosopher’s realm.

The most recent research indicates that the drug concoction used in anastheasia stops areas of the brain from “talking” to each other. The significance of this is the potential insight to damage to areas of the brain whether through physical trauma, medical condones or ageing.

My interest lies in the fact that the brain and spinal cord are the central nervous system, and an understanding of the central nervous system has implications for understanding and treating spinal cord injuries … Blatant self interest, but at least it’s a healthy interest, not one based on the pleasure of a sweet sleep.

Sweet sleep - Anasthesia

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Spinal cord injuries (sci) are complex. No two injuries present in the same way. However, it can be helpful to compare symptoms and to try treatments that others have found useful. I believe that exercise and stretching are critical to successfully managing the nasty symptoms that I experience – pain and spasm. The older my injury (it’s been over eighteen years since I damaged my cord at T7/T8) the more fervent my belief in the power of exercise becomes.

And here’s why.

List of recommended Surgery:

Lengthen my Archilles tendon
Insert baclofen pump in my spine
Treat trigger thumb
Treat carpel tunnel syndrome

Actual treatment:
Instead of surgically lengthening my archilles tendon the surgeon injected botox into the gastroc and soleus muscles (muscles that make up the back of the calf). He did this four times over a year, providing a window during which time I could intensively stretch, exercise and stimulate these muscles, with the help of a physio, personal trainer and osteopath. These muscles had progressively shortened because of spasm and tone, and I could no longer put my heel on the ground – not good for the small amount of walking I can do and would quickly reduce my mobility. That was about two years ago and as long as I continue to stretch these muscles every day I’ll be fine. I also walk on a “stone board” every day to continue to stimulate the sensory nerves in my foot. Exercise 1, Surgery 0 (The surgery and after care in hospital would have cost ACC $70,000)

Instead of inserting a baclofen pump in my spine the same surgeon changed and added to my medication to manage spasm, and injected botox into my left quad, right hamstring, and both adductors. The injections in my hamstring and adductors were one offs, I have had three injections into my left quad and no more are planned. My spasticity is complex and extensive, but the botox and on-going medication allow me to stretch and exercise so that spastic muscles no longer pull my body out of alignment and mask and prevent any voluntary movement I have. I now walk using an Odstock rather than a dictus (a brace to lift my foot into a flexed positiuon). I walk for an hour on a treadmill every day, exercise at the gym to improve my posture and alignment, and frequently stretch shortened muscles every day. I religiously exercise and stretch every day. Exercise 2, Surgery 0

The surgeon in both these cases works in the Burwood spinal unit and I have found that people who work here take an holistic view to treatment and surgery is considered one of many tools. Not so other surgeons …

Instead of surgically lengthening the tendon in my thumb I independently embarked upon a programme of intense stretching and massaging my thumb. A physio later endorsed this. The trigger thumb was probably caused by my using crutches. Surgery would have meant that I would have lost my mobility for months, and that I would have needed help with personal care. This particular surgeon was adament that surgery was the only treatment if I wanted to straighten my thumb. Turns out he was wrong. (I subsequently spoke to two men whose surgery was unsuccessful and were having to have it repeated, one for the second time.) Exercise 3, Surgery -2

The same surgeon has recommended surgery for carpel tunnel in both my wrists. He says that without surgery the nerves to my hands and fingers will die. However, surgery will for months prevent me using crutches and I will require 24 hour care including someone doing all my personal care for me. Not if I can help it! An osteopath has given me exercises and stretches to help release constriction of nerves through the carpel tunnel; I have found web sites that show how to do other exercises; I have a dynaflex to exercise my wrists; the Odstock I use reduces the pressure I put through my wrists onto the crutches.

So, hopefully, Exercise 4, Surgery 0

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Well, well, well … I saw the surgeon on Friday so he could assess the damage and review repair options to my nether regions.

It’s difficult to believe that I am writing about an aspect of my health that would usually be firmly locked away in a figurative box but I remind myself that this is the beginning of a travel blog. So now you have the first clue that, yes, we are going to Europe, albeit with a very tiny risk.

Everything is healing, so no surgery for at least three months, if ever. The surgeon said, “Go to Europe. You’ll be fine, and if you do need any medical help, the procedure is so quick and easy it’ll cost you just a few dollars if your insurer excludes it from your policy. Go.”

Well, the bad news is the insurer has excluded this as a pre-existing condition because further procedures might be required. So if anything does happen to it while we’re in Europe, we have to pay for treatment ourselves. The good news is that the surgeon is confident that i’ll be fine. The really good news is that the insurer has maintained cover for my spinal cord injury as a pre-existing condition.

So in four weeks we expect to be gone … First stop, Berlin!

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