Adhesions

Adhesions
(Equivalent to mechanically being rusty and seized up??)
~no anatomical terms included!~

Who would have thought that after 3 plus years I'd still be so seized up. By that I mean that muscles that once moved freely and smoothly still don't. I don't know how much neurological feedback might play in this (ie. is the body sending messages for muscles to constantly contract) or how much has still not been recovered from disuse after this length of time. In spite of my attempting to move soon after surgery by pulling myself around in the hospital bed by grabbing the rails and twisting, and physiotherapy initiated soon thereafter, the muscles have become tight.

One of the first changes I noticed post-surgery was that when I coughed, I felt like my chest was wrapped in elastic bands that resisted expansion. Each time I coughed, I felt a tightness and a pain from the chest wanting to move but unable to. This tightness was outside of the rib cage so thankfully it had no effect on breathing.

Today, three and a half years later, I still have that sensation although not quite as intense. Muscles have shortened and don't seem to want to respond to stretching and exercises. In fact it almost feels as if they actively resist returning to normal. After exercise and stretching it feels as if the muscles rebel and want to tighten more. I would have thought that after a number of stretches, the muscles would slowly return to a normal state. Unlike a runner that stretches out prior to running, stretches don't seem to have very much of a lasting effect with this injury. Everything wants to rebound back to the contracted state!

In daily activity I suspect I sit up and lie down more than I twist side to side. When an extended stretch is initiated by twisting the torso 90 degrees while seated forward, there is noticeable resistance and it is difficult to turn more than 45 degrees to the side. Repeated isometric, stretching and twisting exercises have probably helped but comes nowhere near returning to normal. When in the pool, this is quickly noticed when lying on my back (with floatation neck collar and foam 'noodle' supporting the ankles). On my first attempt to lie flat on the water and raise either arm straight up into the air, I would roll over like an 'eskimo roll' in a kayak. Over a period of months, the muscles slowly responded and I could raise the arm perpendicular to my body and not roll over sideways.

Increased walking has also developed the muscles in the back. I was amazed as to how important these muscles are to overall stability and walking. As a result these muscles have developed and I can sense this not only from the increased control but also from the discomfort of tearing discussed below.

Other sensations noticed are that my calf muscles are not very pliable but feel as hard as rock. Standing and stretching gives a distinct feeling of the muscle sheaths moving and even sticking as they slide against another. It's a very unnerving feeling! Massage therapy may have helped somewhat.

Adhesions (and Calcifications & Contractures)

So that brings me to the title of this post. I don't quite recall where I heard the term "adhesions" but it must have been from some physiotherapist along the way. When muscles are not used for any period of time, it is my understanding that they become sticky and don't slide smoothly against other muscles and supporting flesh. At times this even gives a ratcheting feeling as if the muscle slides and catches and slides and catches very quickly and repeatedly as it is used. The end result of this might be as severe as adhesions being formed where actual bonds are developed between the various tissues layers and they become fused together, perhaps permanently. In some cases and areas the body may lay down calcium and form boney "calcifications". I've also heard the term "contactures" used where tissues are so fused together in some position that only surgery can separate them.

Now, if any health care professional stumbling upon this blog can correct me on the physiology and terminology, I would be grateful.

...anyways, for what it's worth, this is my impression of my condition. I have no "muscle atrophy" as I would define it. However, as I use my muscles more vigorously and in positions I haven't used in a while they do develop further - with that increase of strength comes an increace in mass and size. (a normal person who is just starting a weight training program does not have atrophied muscles, just underdeveloped ones - which is how I see myself)

Sensations:

Again, as above, I often have that "ratcheting" feeling, particularly in the legs (hamstrings and calves) - where the moving muscle seems to repeatedly stick and release during their movement.
The calves feel hard in spite of repeat walking, standing and stretching.
My back and chest still feel tight and the exercises have helped but who would have thought that they would be this tight after 3 years.
The muscles in my back are strengthening and developing from exercises and walking and as a result they are increasing in size. As this happens I feel the surgical scars periodically tear from the expansion and increased range of movement. I also feel what can only be described as a tearing of flesh sensation (micro tears) in areas where there were no scars. - a quick, sharp tearing sensation! I take this as being an adhesion that lets go. While immediately disconcerting, I accept this occasional and often startling discomfort as being a positive sign of change.

So, like some rusty car that hasn't been driven for a while, it take a while to loosen up the workings. Who would have thought three years and more.

Accessibility Issues

Accessibility Issues

(Being Disabled In an 'Abled' World)

Being ambulatory one can never comprehend the challenges encountered by those physically disabled. While society tries to accommodate those physically challenged either through genuine altruism or simply to comply with laws and regulations, efforts often fall short.

In my short time bound to a wheelchair I have encountered numerous frustrations with those claiming to be wheelchair accessible. The problem is often not discovered until on site and perhaps too late to turn back or make alternative arrangements. Time is wasted, frustrations mount and damage can occur to both the chair and the environment.

Situations encountered have included;

• automatic doors that are frequently broken. The alternate entrance may at the top of some stairs and not an option for a wheelchair.
  
• Automatic doors that are too narrow to accommodate the width of a width of a wheelchair without skinning ones knuckles .
• Doors that open into a narrow vestibule or breezeway and then take an immediate ninety degree turn to another inner door. Difficult if not impossible make the sharp turn. On entering one door, it starts to close before the inner door can be opened - smashing into the chair with the wheelchair often being lodged between two half open doors - unable to move forward or backwards.
• Power closers on outer doors meant to keep the weather out or inner doors such as on washrooms, meant to assist the disabled by automatically closing the door for the user. The power mechanism (electric, pneumatic or mechanical-spring loaded) is often so powerful that it becomes a challenge to hold the door open wide enough and/or long enough to get through. Often becomes a fight with the door before getting whacked by it or having it scrape along the chair as you pass through. Regardless if you're right or left handed, if using an electric wheelchair with a joystick controller, the controller will be on the wrong side either on entering or exiting. You become a contortionist using the controller with one hand while reaching over your own head with the other hand to attempt to keep the door from crashing into the chair. Both the chair and door can be damaged in the process. In a manual chair the door slams on the hand propelling a wheel. Both hands are needed to propel the chair in a straight line and cannot be used to hold the door away from the chair.
  
• Well meaning but misplaced automatic door actuator switch. Door is against an adjoining wall so it can only be approached from one side. The door actuator switch is located so close to the door that when approached to press it, the wheelchair leg rests protrude in front of the door. The door on opening hits the leg rests and on sensing an obstruction, it's safety mechanism triggers it to close prematurely. A slapstick comedy routine ensues of pushing the switch and trying to back out repeatedly before the door strikes the chair. In the end I only escaped by backing up to the switch, pressing it, then wheeling about at full speed to pass through before it timed out and shut again. I actually encountered this situation in a hospital that specializes in spinal cord injuries!
• My doctor's office has narrow doors and hallways. I cannot even get into an examination room to have a dignified private consultation. Modern architecture and construction is functional, attempting to maximize the number of rooms in a given space which also maximizes the developer's price. Easy to suggest just changing doctors however in Canada it is currently difficult finding doctors accepting new patients - leaving one that you have developed a rapport with . Older buildings are more spacious but often are not wheelchair accessible by virtue of the era they were constructed in. Newer buildings are intended to be wheelchair accessible but hallways and rooms can be small to maximize space utilization especially with the current trend to go 'green'.
  
• Stores, theaters, churches and most recently, a funeral home (etc.) that claim to be wheelchair accessible but can only be entered if the proprietor comes out to lay down a ramp or have you enter through the loading dock. Trouble is, if on your own how do you get a hold of the staff/manager/proprietor etc, if you are stuck on the outside and they're inside? Well meaning but may not always be the most dignified way to gain entrance.
• Store aisles that are frequently too narrow to start with, display racks that protrude into the aisle, contents that protrude which the chair can snag and pull over, destroying the display. Shopping carts, stocking pallets, dollys and movable step-stools/ladders which are abandoned, askew in the aisle, thereby blocking them.
• Perhaps most frustrating of all are people who block an aisle, perusing the items, chatting with staff or companions or just loitering while the spouse shops - when rolled up to with the wheelchair they look down upon you with a blank dumbfounded stare - like a deer caught in the headlights refusing to move. Sitting there at their knee level, repeated "excuse me's" fail to get them to step aside and let you pass. A look of confusion or sometimes even indignation follows with your inconvenient request to pass. Are people stupid or just rude? Cut off, stepped in front of, passed by in a turnstile door and just plain ignored like a non-entity. I am no longer considered a person but rather an obstruction. Happens more often than I care to mention.
  

In My Workplace;

As mentioned in a recent post, I've returned to work for the first time post injury. An ergonomic consultant was called in to assess the workplace as to my needs, however they could have saved their money and relied on common sense. (Legal issues probably required the assessment.)

First off, after the medical reality, one is only as disabled as you yourself and those around you allow you to be. If changes are made so that I don't have to stretch, reach, bend or navigate to perform my duties, I won't. Maybe I'd like to. I feel this is different from the situations I mention earlier in this post. Automatic or assisted doors, the size of hallways, the placement of actuator switches and the behaviour of people towards the disabled frustrate me as general problems, which should be regarded as problems for people with a wide variety of disabilities, often more challenging than mine.

In my workplace, I think an initial assessment of what might constitute physical barriers preventing me from doing my job and what might be safety issues, would be all that is necessary. Other problems could be dealt with if and when encountered. I would far prefer to figure out how to do a task as it has been set up and as performed by all my co-workers rather than to be catered to and have exceptions to the rule made to accommodate me. In other words - let's see if a problem actually exists before we start changing things!!!

Working in a hospital laboratory, clutter seems to be inescapable. Work always expands to fill the area available. Every laboratory I've ever worked in was filled to capacity with equipment immediately on occupation. There is little room for expansion and items are often stacked upon items. In my situation, aisles are narrow, biological discard bins hover around the floor, migrating to where needed. Colleagues sit on the edge of their desk chairs to lean into their work with the rest of the chair projecting into the middle of the aisle. When co-workers stand up, the chair is usually abandoned in the middle of the aisle until their return. Pushing the chair back in under the bench is only common courtesy towards all workers but of course it often falls victim to human nature and the hectic workplace pace. Minor nuisances and all forgivable.

Still, the laboratory workplace is a minefield of obstacles when navigating the floor. All other issues I believe I can deal with without additional aid. As I can stand and reach, no item is beyond my reach and need not be moved down to chair level.

Below are a few pictures of the floorspace I have to navigate with my wheelchair to maneuver around.

Narrow aisles with protruding chairs and biological discard buckets

Ditto - picture the chairs abandoned in mid aisle

Chair legs protrude out even when rolled under workbench

Chairs and Step stools

Abandoned Chairs, Garbage Bins, Recycling Bins, Carts and Boxes

When in their proper place, these items shouldn't present themselves as obstacles but as many items slide or are on wheels, they tend to migrate around the room where needed and often are left abandoned or protruding from the workbenches. A minor inconvenience but does slow things down particularly if I'm carrying items in one hand while operating the joystick with the other. Have to kick things out of the way or free up one hand to deal with the obstruction. Where others can turn sideways and squeeze through, I cannot.

Colleagues have been very accommodating, but this is the real world and chaos often triumphs over order. Regardless, it's great to be back!

Return To Work

Three and a half years post injury - one year almost to the day since I started to inquire about returning to work, I finally have returned and have actually received a paycheck I can live on rather than the paltry disability insurance (~60% of take home pay).

The return to work schedule which I agreed to with my doctor last January was outdated and so the days and hours of my return were fast tracked. Returned the week of September 8th for 3 half days. The next week (last week), I was to work 3 six hour days, however even though I've been with the same employer for 20 years, I was sent for a full day of orientation on the Monday making it a 4 day week. Next week (week 3) will be 6 hours Monday thru Friday. The following week will be the same after which I'll return to a full 8 hour workday, 5 days a week.

As my private insurer discontinued my disability pay on April 3rd of this year, I'm coasting on whatever savings remain and the assistance of family. This was one reason I wished to be fast tracked back to full time work. I've grown fond of eating...

I was unaware that not only did the pre-injury vacation hours remain, but vacation hours continued to accumulate during my 3.5 years absence from the workplace. I returned to work with about 165 hours of vacation time. This was a lifesaver as my employer suggested I take the remainder of the partial days I worked as vacation time, thereby giving me full weeks of 8 hour days. Because of this arrangement, I received full pay for my first pay period back at work.

Virtually all of my colleagues have remained at my workplace and I found them welcoming and accommodating. Few alterations have been made to the workplace such as table legs and braces recessed in my work area to accommodate my wheelchair, an ergonomic computer keyboard tray which I find more of an annoyance than a help. Other than that, the workplace remains the same.

As I work in a hospital laboratory, regulatory bodies have banned cloth chairs/seats from the lab as a precaution against biological/chemical spills. The wheelchair seat and backrest are cloth covered foam so in order to return I had to cover them with some impermeable material. My wife picked up some black leatherette/naugahyde material which she sewed up as covers for the exposed chair cushions. So far this has worked out well. I had concearns about the material not breathing thereby retaining body heat & perspiration which could contribute to skin issues. My reduced mobility has not been detrimental to my skin and to date, the seat cover has not been an issue. I'll see if both the seat material holds up to daily wear and tear and my skin holds up to the reduced breathability and adjust accordingly. I might argue to the regulating bodies that my seat is not a "chair" but rather "medical equipment" which should be exempt and allowed into the laboratory area uncovered.

The only fear I have remains - the neurogenic 'pins & needles/burning' leg pain remains 24/7 and can be distracting. With the reduced motion while sitting and legs dangling over the seat, the pain may even be accentuated. Also, the sciatic nerve pain in my left side butt continues to flair up every few days, again, making it hard for me to sit without figiting. I worry about my ability to concentrate on my work and not being distracted by constant pain. If I can work around the pain and not be distracted, I should have few other problems.

There are very few, if any places in my workplace where I might go during breaks and get off of my backside to releave pressure and regain circulation.
I guess I'll take it one day at a time...

Pleasant Insurance Suprise

Somewhat to my surprise, my private insurance covered the cost of the replacement 'joystick' controller unit for my electric wheelchair - at $1200.00+, a significant amount!

If only they could actually advise me when I call their customer service desk inquiring about specific coverage (chair parts, botox, etc). As I previously griped, the scenario is almost always the same. Call up to ask if and how much reimbursement or coverage I can expect and I get put on hold as they go to find a supervisor. After about 10 minutes, if I don't get disconnected and have to start again, I'm told to send the claim in and the amount will be determined. Trouble is, if not covered, I may wish to find another solution or do without. Anyways, I'm delighted that the private insurance I paid in for decades now actually provides coverage when needed.

BoTox Therapy - Repeat

My gait seemed to get shorter about 3 weeks before my appointment to see the physiatrist for an assessment and possible repeat course of Botox injections.

As it turned out, on Sept 8th, returned to work for the first time in three years and in the afternoon received a second course of Botox injections.

House is too small - have to find someplace outside, in the community to practice walking. Sidewalks, park trails, parking lots will do while the weather remains favourable. Will have to find some shopping mall before the stores open when the snows come. Not much time left in the day after a full workday and from having to rely on public disabled transportation. Yet another challenge!