April_May 2016 Motto: plus pleased to be back at physical and occupational therapy

Before January, I published mottoes regularly. Now, I return with explanations. Expect abrupt transitions.

Walking (even with a harness) on the parallel bars after 21 years as a paraplegic. Invigorating.
Walking (even with a harness) on the parallel bars after 21 years as a paraplegic.
Invigorating.

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From “Out on the Rim” by Ross Thomas

The pretender to the Emperor’s throne [1] stood in the innermost sanctum of the deposed ruler’s palace [2] and listened, beaming with pride, as the younger of his ten-year-old twin daughters finished  reading the framed poem aloud. The poem had been left behind on the wall when the deposed ruler fled into the night.

“‘Yours is the earth and everything that’s in it,”‘ she read, “‘And–which is more–you’ll be a man, my son.'”

 The ten-year-old girl had read Kipling’s “If” with what  at one time was called expression. The Filipinos in the line behind her applauded enthusiastically. She turned, curtsied prettily–despite the jeans she wore….

“Very, very nice,” said [her father] Artie Wu who stood six foot two and three-quarter inches and weighed 249 pounds….

His younger daughter made a face at the poem on the wall. “God that’s dumb.”

“Mr. Kipling had an unhappy childhood,” Agnes Wu explained. “To make up for it he sometimes became a trifle optimistic and overly sentimental.”

Her daughter nodded wisely. “Mush, huh?”

“Mush,” agreed Agnes Wu….”

The older of the twin daughters (older by 21 minutes) turned on her sister. “It wasn’t as dumb as ‘Invictus’ that you got out of and Mrs. Crane made me memorize last year. You want mush? ‘Out-of-the-night-that-covers-me-black-as-the-pit-from-pole-to-pole-I-thank-whatever-gods-may-be-for-my-unconquerable-soul.’ That’s mush.”

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Did Rudyard Kipling (the first English-language author to receive the Nobel Prize in Literature https://en.wikipedia.org/wiki/Rudyard_Kipling) really have a rotten childhood?
Did Rudyard Kipling (the first English-language author to receive the Nobel Prize in Literature https://en.wikipedia.org/wiki/Rudyard_Kipling) really have a rotten childhood?

Footnotes

  1. Ross Thomas created Artie Wu to be the kind of hero who runs away from a Methodist orphanage with his self-respect so firmly in tact that he humorously refers to himself as next in line to be Emperor of China (even though China does not have an empire).
  2. This scene takes place in the Presidential palace of Ferdinand Marcos, a garish dictator of the Philippines who was removed from office in 1986. After Marcos fled, tourists (as in this vignette) flocked to his palace to see how he lived.
  3. I know. Footnote three does not refer to anything.

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Getting from there to here is an abrupt transition. The transition is easier with planning and intention. Yet there is where I was grateful to Ross Thomas for making the packing to HealthSouth easier. Now here I am, my goal posted on a chart in my bedroom. Have to scoot quickly. This photograph posting is a lunch pit stop between physical therapy in the morning and occupational therapy in the afternoon.
Getting from there to here is an abrupt transition. The transition is easier with planning and intention. Yet there is where I was grateful to Ross Thomas for making the packing to HealthSouth easier. Now here I am, my goal posted on a chart in my bedroom. Have to scoot quickly. This photograph posting is a launch pit stop between physical therapy in the morning and occupational therapy in the afternoon.

Regarding:  Pleased to be back at physical and occupational therapy

This is the abrupt transition I warned you about. I was reading Ross Thomas as I packed and prepared to arrive at Health South, a for-profit hospital in Pleasant Gap, Pennsylvania nine miles northeast from my apartment. I began writing this post after checking in to my mountain view room on Sunday night April 24th.

I took this photograph from my hospital room at dawn on Monday.
I took this photograph from my hospital room at dawn on Monday.

I have been in a state of physical decline following my return home to State College, Pennsylvania after spinal surgery in New York City. This state of decline (despite periodic ups and downs) has persisted from December to the present. My admittance to HealthSouth, I hope, marks a new beginning.

Background: My Previous Hospitalizations at HealthSouth

This is my third hospitalization at HealthSouth in the last 12 months. Below is a video I made in October. I spent three weeks in hospitals that month. My first stay was a consequence of breaking my left ankle. Mount Nittany Medical Center transferred me to HealthSouth where I learned to transfer from the bed to my scooter without putting weight on my foot. Essentially, I was hopping as I saw the rabbits do on Monday night while scooting around this building.

[youtube]http://youtu.be/-X_VQoeB2P8[/youtube]

My second stay at HealthSouth followed my hospitalization for a dangerous MERSA infection.  At Mount Nittany Medical Center [where the food–surprise surprise–is superb] the doctors saved my life. They did so my draining the puss from oozing wounds on my body and providing massive doses of antibiotics (first through an IV; then pills).

The drive from State College to HealthSouth.
The drive from State College to HealthSouth.

Susan Hartman is the C.E.O. of HealthSouth at Pleasant Gap. “As chief executive officer… for the past nine years, Susan Hartman oversees the day-to-day operations of the 70,000-square-foot, 73-bed inpatient rehabilitation hospital,” writes Town & Gown Magazine. “Located at 550 West College Avenue in Pleasant Gap, HealthSouth Nittany Valley serves patients across the region, offering comprehensive inpatient and outpatient rehabilitation services designed to return patients to leading active and independent lives.”

I met Susan on the last day of my first stay at her hospital. I suggested that HealthSouth consider working with companies constructing housing for the elderly and disabled. I was impressed by the skill of occupational therapists (OT) on her staff especially in their use of activities of daily living (ADL).

Following my hospitalization at Mount Nittany for MERSA, I was released from the hospital, but was unable to bandage my wounds adequately. At a loss for how to take care of myself, I wrote my children expressing pessimism. I copied Susan in my email. The following day, a HealthSouth administrator called to tell me that my admittance had been approved. What a relief!

Digression: How Healthcare Expertise Is Useful in Designing Housing

Here I will digress on the significance of activities of daily living. In the kitchen, for example, ADLs are useful for breaking down into definable units how to make breakfast. With my work with Dr Sonali Kumar using virtual reality for elderly and disabled  residences. ADLs are essential for building design.

“Experienced-based design” is the term of art for an approach to architecture where the residents requirements determine how a building is constructed. I am hopeful that a consequence of my meeting with Susan that HealthSouth will form an alliance with the Penn State Department of Architectural Engineering where I work.

Today (April 28, 2016) Occupational Therapist Diann Dougherty helps me understand how ADLs can be useful in my writing a chapter on designing a kitchen accessible to residents with a mobility disability.
Today (April 28, 2016) Occupational Therapist Diann Dougherty helps me understand how ADLs can be useful in my writing a chapter on designing a kitchen accessible to residents with a mobility disability.

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Yes it helps me to know that in HealthSouth’s occupational therapy kitchen, the distance from floor to sink is 36 inches. My experiences during my three times as an in-patient have ranged from the useful to the dramatic. It was dramatic for me to have a near-death/out-of-body experience when my second stay at HealthSouth came to an abrupt end.

I had awakened on a  Thursday morning with chest pains. HealthSouth’s compassionate Medical Director Richard Allatt ordered an ambulance. Doreen, my nurse held my hand until the attendants came with a gurney.  As I watched (mistakingly believing I was going to die from a heart attack), I felt myself to be a third-party observer as I was being loaded onto the ambulance en route to the emergency room. I marveled at the beautiful early morning mountain scene saying to myself, “This would make great video.”

At the time I had been making videos. At first I produced elaborate architecture videos as enhancements to my column for e-architect UK.  At HealthSouth, I made cinema verite videos (yes, I know this sounds pretentious) to provide short unedited perspectives on the mobility disability experience.

[youtube]http://youtu.be/4kW3p26RfZQ[/youtube]

Leaving HealthSouth, I was thinking about Megan Brown, the “star” of the above video. I was filled with a sense of profound gratitude to Dr. Allatt, Doreen, Megan, and the other physical and occupational therapist and staff at HealthSouth. Consequently, months later after I found my health to be in distress. I was pleased to be back here.

My April 24th to May Second stay at HealthSouth

The single most significant aspect of my stay is the time I have been spending on the parallel bars.

On the second day of my stay, I published the following on Facebook: "These are the parallel bars in the East Wing Therapy Gym. I photographed the bars early this Tuesday morning hoping the picture would provide the sense of excitement these bars evoke. Yesterday, attached to a harness, I "walked" upright. The pain I feel this morning evokes hope. I am here at HealthSouth to manage the crippling pain in my spine. The pain in my muscles is a different kind of pain. A good pain when transformed into strength will help me defeat the bad pain. It is too early to discuss good and evil--not before breakfast. Suffice it to say, I look forward to this day because I will be walking upright again."
On the second day of my stay, I published the following on Facebook: “These are the parallel bars in the East Wing Therapy Gym. I photographed the bars early this Tuesday morning hoping the picture would provide the sense of excitement these bars evoke. Yesterday, attached to a harness, I “walked” upright. The pain I feel this morning evokes hope. I am here at HealthSouth to manage the crippling pain in my spine. The pain in my muscles is a different kind of pain. A good pain when transformed into strength will help me defeat the bad pain. It is too early to discuss good and evil–not before breakfast. Suffice it to say, I look forward to this day because I will be walking upright again.”

Standing is special for me. So is “walking” upright, even if walking simply consists of moving between two parallel bars–using the strength in my arms to keep me upright and get from here. I wrote that I hoped my stay at HealthSouth would reverse the decline in my physical health. Central to achieving my goal is a broader range of mobility and the necessary strength.

In the report I have been writing on designing housing for the mobility disabled, I emphasize the notion of transparency. Access in the home should be so readily available that the resident is reminded as little as possible that she or he has a disability. For example, for a two-story house an elevator or a wheel chair lift is far preferable to a stairlift.  For a stairlift one has to transfer, and the less transferring the better.

This plastic brace (a.k.a. orthotic device) is evidence of my laziness. Twenty years ago it was prescribed for me to use in conjunction with fore-armed crutches. However, through neglect I have lost the arm-strength and balance necessary to use crutches safely. This is something with training and persistence I can do again. The photograph shows how my muscles have decreased in size through lack of use.
This plastic brace (a.k.a. orthotic device) is evidence of my laziness. Twenty years ago it was prescribed for me to use in conjunction with fore-armed crutches. However, through neglect I have lost the arm-strength and balance necessary to use crutches safely. This is something with training and persistence I can do again. The photograph shows how my muscles have decreased in size through lack of use.

Transparency relates to my physical therapy goals. For the past 21 years as a paraplegic, I have managed to compensate for my disability by relying extensively on mobility devices such as scooters and power chairs. These are extremely helpful tools. When I first used a scooter I was in my forties. Working was essential for paying the mortgage and supporting my family. The speed and appearance of the scooter made my disability seem less disturbing. My employers, co-workers and children regarded the device as a neat technological solution.

A few years ago, I teamed up with a local supplier of mobility equipment to show disabled members of my synagogue the freedom  these devices provide. One elderly woman expressed concern. Her inability to walk trapped her in her home. She worried that dependence on the scooter would result in her losing what mobility she had. I pointed out that while exercise is important fatigue is counterproductive.

Four years ago Alicia J. Spence at Phoenix Rehab helped me walk using fore-armed crutches to walk. With the proper movement performed religiously each day (and the use of a device that directs electiricity to my ankles (see footnote 12) I might be able to walk someday. First, however, I have to master the pain. Alicia suggested a wonderful exercise that slowly reduces spinal pain when I lie on m stomach.
Four years ago Alicia J. Spence at Phoenix Rehab helped me walk using fore-armed crutches.

I was correct (of course). Mobility devices do provide freedom. Any physical therapist will tell you that fatigue is debilitating. Yet my argument was fallacious because I had failed to be moderate. I was lazy. I did not exercise. Twenty years ago, a year after I lost the ability to walk, a physical therapist prescribed fore-armed crutches (above) and braces (photo above crutches).

Through lack of use, I have lost the strength and balance to use the crutches. The braces prevented my toes from dropping–I had dislocated my right shoulder when I tripped over my toes. The braces also kept my legs steady. As the photograph shows, through lack of use my leg muscles have shrunk.

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My major accomplishment at HealthSouth is the

 

 

Senior Physical Therapist Steven Uberti
Senior Physical Therapist Steven Uberti

HealthSouth’s Pleasant Gap facility has a number of excellent physical (PT) and occupational (OT) therapists.

Steve took this photograph of me holding myself upright on the parallel bars.The absence of a harness means that Steve observed that it is safe for me to move along the bars without concern that I might fall.
Steve took this photograph of me holding myself upright on the parallel bars.The absence of a harness means that Steve observed that it is safe for me to move along the bars without concern that I might fall.

Hic Haec Hoc

Orientation for new patients

This sign was prominent when I checked into my hospital room on Sunday night.
This sign was prominent when I checked into my hospital room on Sunday night.

To be discussed is the especially significant “happy wheels” designation.

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Meanwhile, in an unrelated event, nurse Sydney pushed me in a wheelchair and weighed me. Minus the weight of the wheelchair, I weigh 143 pounds. I have lost over 30 pounds in the past year. Dinner will arrive shortly. Then a friend. Tomorrow is another day.]

This is tomorrow

Tomorrow is today--Wednesday; 6:30 AM. I am sitting on my scooter waiting for it to begin charging. The doctor came and went promising to discuss the muscles in my thigh with the therapist--muscles than require strengthening
Tomorrow is today–Wednesday; 6:30 AM. I am sitting on my scooter waiting for it to finish charging. The doctor came and went promising to discuss the muscles in my thigh with the therapist–muscles than require strengthening.

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The nurse came by dispensing medicine. The breakfast tray is next.  It is early morning still; yet it feels late. Too late to finish this post which is becoming more ambitious in planning as its execution… You know what I mean.

I do not want to wait too long before posting what is in effect a cash register. I am requesting donations so I can recover–have the time required to earn my own way.



ASSISTANCE REQUESTED

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How I plan to recover and earn my own way is a subject for later–after I obtain strength on the parallel bars and on the exercise mats for three hours today.

[Editorial note: Transition language is required to orient the reader. The writer would likewise benefit, but….]

The “Road to Recovery” board (above) contains my goal

My goal is  “Develop My Hip Muscles So My Legs Do Not Wrap Around Each Other.”

Unaware I am doing so, my legs wrap around each other. It is as though my left leg thinks it is my right leg and vice versa.
Unaware I am doing so, my legs wrap around each other. It is as though my left leg thinks it is my right leg and vice versa.

When I sleep, my legs frequently cross each other causing considerable discomfort. This is most noticeable when I awake to find my legs pretzel-like requiring that I pull them apart. Over the course of the day, I find that I have unconsciously crossed my legs. In the long term, there is danger that hip damage will result. There is cause for optimism because the problem can be solved by strengthening my abductor muscles–the muscles that move my legs away from my body.

This exercise requires me to move my legs apart. While doing so, I stretch the band. The band is there to make the movement more difficult therby strengthening my muscles. Currently, my ability to move my legs apart is severely limited. Slow and diligent work and patience are required.
This exercise requires me to move my legs apart. While doing so, I stretch the band. The band is there to make the movement more difficult thereby strengthening my muscles. Currently, my ability to move my legs apart is severely limited. Slow and diligent work and patience are required.

Before moving on, now  is a perfect time to show you hip abductor muscles.

Courtesy: www.athleticquickness.com
Courtesy: www.athleticquickness.com

Moving on

Moving on means looking back to provide an overview of my situation. In other words, I am a paraplegic. How I lost the ability to walk is key to understanding how to fix my current physical problems.

 

One thought on “April_May 2016 Motto: plus pleased to be back at physical and occupational therapy”

  1. I cannot wait to read Out on the Rim. I even have a copy. But I promimsed my nephew I would read The Fountainhead first. What kind of nuttiness is that? But with Out on the Rim before me as a reward, I will START The Fountainhead, anyway, and what is more, I’ll be a man, my son.

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