Week 7 Update – Rehab Begins

A week full of good news and forward progress.

Here’s the best news: my intuitive sense for my recovery plan probably is valid from a physiological sense. I have been assuming that my first, most immediate priority should be to re-build the muscle mass I lost in the ICU. I found some studies which demonstrate that, especially in the elderly (I qualify), it is common to lose 10% of muscle mass in the first 3-5 days of hospitalization. Since I weighed about 10% less when I got home than on the morning I went for my last bicycle ride, I seem to fit the pattern.

I am a very vain person, and did not like what I saw in the mirror when I weighed 131#. Also, I knew I was weak, and easily tired. My plan was to start lifting weights as soon as my neck could handle it, as well as load up on the calories, protein and sleep. But I was still worried that I might never get back the muscle I had lost, that I would be gaunt forever.

Yesterday, I read a little blurb in Triathlete Magazine which gave me hope. A Norwegian researcher has demonstrated (in rats) that muscle nuclei do not die, even in the face of up to 40% muscle atrophy. Those nuclei carry the information needed to rebuild the muscle fibers. It makes sense, as most athletes who break a bone or otherwise can’t train for several months usually return to competition looking just like they did before the layoff.

So, I have now been in the weight room 4 times in the last week, and have already noticed a distinct increase in my strength from one session to the next, without any tenderness or feelings of impending injury. I hope to get back to the same weight lifting strength levels I had before the accident by the end of the year, and my progress is on target for that. With the strength will come more size, more stamina, and a better ability to swim, bike, and run when I do ramp up those activities.

For now, I have swum three times, biked once on the trainer, and ran (a minute at a time) several times in the last week, all at embarrassingly slow speeds, tiring easily. So be it. Again, I’m just doing this to “prime the pump” at this point. Not expecting any improvements, other than ability to sustain the slow pace for longer and longer each session; right now, I can swim for six minutes without stopping, bike for ten minutes, and run for ??? For now, I will stop the running until I’m sure my “broken” back and neck can tolerate the stress.

I am finally seeing some progress on the weight front – gained 3.5 pounds since the Sunday after I came home (5 weeks ago). Like everything else in my recovery, I don’t know how far I can progress, but I will keep pushing the calories, protein and weights until I start to get “fat”. For now, my body fat %age is somewhere below 5%, as far as my scale will go. I used to be 5-7%, depending on the time of year/training. I certainly get cold more easily!

I have also started to try at least one new food every day. For example, my breakfast is now Frosted Mini-Wheats and Honey-Nut Cheerios. I can eat bread, fig bars, cookies, pie crust, apple pie, risotto, cheese, crackers, salmon burger, and, for fun, french fries from a fish n chips place (Ivar’s), and Cheetos. Two weeks ago, I was able to take about an ounce of a Jamba Juice Pumpkin Smash; now, I can drink 24 oz in less than fifteen minutes.

This is not to say I have returned to normal as afar as eating is concerned. It still takes a long time, can be a struggle, and occasionally I cough up something which just doesn’t want to go down. But, as with almost everything else, I see forward progress. What do I miss most at this point? Nuts, granola, peanut butter, hamburger (made with bison meat), apples, and, oddly, salad. And, I wish I could eat faster!

On Monday of this week, my dentist took the impressions for both my temporary partial plate, and for the oral surgeon to design the surgical plan for bone grafting and permanent implants. Tomorrow, I will see the denture builder (who happens to be my daughter Annie’s old kayaking coach, so I know him well), and hope to get the fitting done with him, and have some teeth within 7-10 days!

I also saw Speech, Physical and Occupational therapy this past week. I have a raft of swallowing exercises, a stretching program for my neck (which was in a collar for six weeks, and got a little stiff), and LOTS of activities with rubber bands and therapy putty to strengthen the small muscles of my hands and forearms, which are incredibly weak from the ongoing nerve damage in my spinal cord.

That same nerve damage continues to give me “pain” and un-nerving (heh-heh) sensations in my index fingers and less so in my hands. Temperature sensitivity (hots are too hot, colds are too cold), CONSTANT pins and needles, and deep numbness at the tips of my index and middle fingers. Every keystroke hurts just a little bit, and my forearms ache after just a little bit of typing – much more than my brain does.

My trach site remains scarred and stiff. And my PEG tube site has not yet healed, ten days after removal.

Finally, last week, I remembered that no one had told me anything after my second day in the ICU about the vertebral fracture I suffered at T 12. So I asked my FP to look into it, and got some follow up spine films. Yep, I have a T 12 compression or “wedge” fracture, with nearly 50% difference in height between the front and the back of that vertebral body. All sorts of scary things are written about this on the internets, but I’ll wait to see what my doctors have to say about it this week. Still, it brings the total number of broken bones I have to 5. Along with 9 teeth lost, 15 hematocrit points, 15 pounds weight lost, 9 days in the ICU, etc, etc. The numbers add up to a lot more work to do to get back to whatever my new normal will be.

A key element of my recovery has been getting more social interaction. Just in the last week, Cheryl and I had dinner at a newly widowed friend’s place (he lost his wife to cancer this summer), then attended another friend’s 60th birthday dessert party, and just last night, were able to spend more than four hours around the dinner table with two other runner/biker/triathlete couples.

I went to my work office several times in the past week, to show the flag, and start the re-entry process. I got some surgical tools and suture from the OR, which allowed me to face my biggest fear – could I still tie knots? I tie surgical knots with my left hand, and was worried the small muscle dysfunction would affect that. NOT! (heh-heh again) I can tie just as well as ever, with suture material of all sizes. Now, I have no fear of returning to the OR, but I intend to re-enter there in January, and with good supervision at first. I’m hoping to get back into the office sometime in the first two weeks of December.

The fact this simple listing of my rehabilitation activities is so extensive should remind me of how far I fell and have to recover. But it is futile. No matter what steps of improvement I make, I can only see the next one up, and have a hard time celebrating the progress I’ve made. Luckily, I have a wife who insists on reminding me just how far I’ve come, and how good I look.