Live From Toronto Western Hospital

Today is September 27, 2016, one month and ten days since I had my surgery. I'm sitting in the pleasant atrium of Toronto Western Hospital.

I have an appointment with my surgeon, Dr. Mahomed, in about 45 minutes. I got here early so I could avoid the crowds on public transit. 

As they never have before, able-bodied people who take the seats on the streetcar reserved for disabled people really piss me off.

This wasp covers graffiti that covered the original mural painted by Nick Sweetnam more than a year ago. Behind the wasp are the container gardens photographed to accompany the Hot Dry Summer post.

I'm here so my surgeon can check on my progress and take the requisite sacrificial vials of bodily fluids - blood and urine I think.

I will ask him the following questions:

What is my hip made of (for the curious)?

Will it really set off metal detectors at the airport every time?

What are future signs of trouble with the hip that I should be on the look out for?

I hope to never need this kind of surgery again, but if I do, can I give your office a call?

I will give him the following feedback:

The information provided about before, during and immediately after surgery was welcome and really helped me understand what would happen.

But, I would have found it very useful if there had been perhaps an equal amount of information about post-surgery rehabilitation.

The "don'ts" I was given - don't turn your feet in or out, don't bend your hip past 90 degrees, don't cross your legs, don't reach toward the bottom of the bed to pull your covers up - seemed focused on issues I didn't have.

I would have liked to have been told when I could safely stand on my feet and walk more than tens steps without doing myself more harm than good.

I had to estimate how much time I would need to take off work long before the surgery. I made that decision with almost no information. 

It's fortunate I'm a good guesser.

Check future posts for the answers to these and other questions, and for the good doctor's reaction to my feedback.

Thanks for reading!

Karen

Back To Work Week After Next

Time flies. I have only a bit more than a week left in my hip holiday.

Before my surgery, because no one told me about the likely progress of my rehabilitation, I thought that by this time post surgery I would be in my second week of a short-term membership at Curves, riding a stationary cycle to get the strength back in my legs, and working with weights to bring the rest of my body back into shape.

Nope.

That is not to say that I am doing badly. I used the morning of my birthday this past Friday to see my physiotherapist, Mariam, and talk about how I was doing and what I was going to do next.

She was very pleased with my progress and said I was doing fine. She wants me to still walk with a cane so that the muscles continue to build strength the right way.

She mentioned that it was nice to see that I was so motivated. 

I understand how some people might not be motivated to do their therapy, but it is absolutely out of the question that I wouldn't be. 

I am happy that I am out of pain, but I also want to be active again. There's only one way to do that.

***********

The Ruler of a small but pleasant realm is pondering her next steps after a disastrous showing by the Wordsmiths.

Stay tuned.

Thanks for reading!

Karen

While We're On The Topic

I imagined those two girls who bothered me about my shoes were more more popular than me because I spent many years not being popular.

Mine was an armed forces family. We moved a lot. So I was always dealing with new groups of kids, kids who had lived next door to one another since the day they were born.

I was born and spent my early childhood in British Columbia. Then we moved to Winnipeg and I attended kindergarten in the basement of a house on Ness Avenue and grades 1 through 3 at Strathmillan School. 

Then we moved to Edmonton and I attended grade 4 at Prince Charles School, grades 5 and 6 at Prince Rupert School, grades 7 to 9 at McDougall Junior High School and grade 10 at Victoria Composite High School. 

Then we moved to Trenton and I attended grades 11 to 13 at Trenton High School.

I remember it was always a little tough finding and holding onto friends no matter where I was, but Edmonton was the worst. I don't recall being bullied in Winnipeg, and all that was behind me by the time my family moved to Trenton, but, from grades four through nine bullying was just part of my day.

I recall with neither rancour nor trauma, only crystal clarity, one spectacular example.

For our first year in Edmonton, we lived in a house on the corner of 120th Avenue NW and 122nd Street (see here for another story at that address) which put us in the catchment for Prince Charles Elementary school. I think it was the only school that all four Clark girls attended at the same time.

I'd made a friend with a girl whose name I can't recall who lived right across the street from the school, but she moved away. I then made friends with Heather whose house was on my way to school. I would call on her and we would walk the rest of the way together.

But, I had a rival. Bambi, another of Heather's friends, couldn't stand me. There were many fights and a final falling out. 

I had been on the outs with Heather and Bambi for a long time when, on the last day of school, they came skipping (seriously, skipping) up to me in the girls' playroom. They said they wanted to be my friend. All was forgiven.

I was completely happy.

I joined arms with them and we skipped together out the playroom door, across the asphalt tarmac and out onto the large turf playing field surrounding the school.

Suddenly, Heather and Bambi relinquished their hold on my arms, gave me a push, and ran like hell away from me. I managed to keep my feet and turned around, confused.

Right behind me were two of the big boys in my class (they were a couple of years older than the rest of us, having been held back a time or two). The biggest one grabbed me by the arm and socked me in the face with his fist. Then they both ran away.

There were no repercussions. It was the last day of school. I'm not even sure I told my parents.

Bambi and Heather's planning, however, was impressive. This bullying was scripted, choreographed, strategically timed and included accomplices. 

Six years later, I saw Bambi again. She was working in the coat check room at the Bonanza Restaurant, the place where my friend Jill Parry and I used to hang out on Sunday afternoons, eating bacon cheeseburgers, drinking banana milkshakes and smoking Players cigarettes. 

I recognized Bambi right away. 

She did not remember me at all.

Thanks for reading.

Karen

How To Be Unpopular

With lots of time on my hands, I find stray memories bubble up from the depths. Like this one:

Many decades ago, when we lived in Edmonton, my Dad took me and my older sister shopping for shoes. This was against the natural order of things. Mom did the shoe shopping, usually with all four of her girls in tow. When mom shopped the watchword was cheap. We couldn’t spend a lot of money because we couldn’t afford it.

Why Dad took me and my biggest sister shopping, I can’t completely recall. We may have had a Brownie ceremony to dress for. Father was a military man. He would have cared about how we looked in our Brownie uniforms.

We went to Woodwards in the Westmount shopping mall. I remember finding a pair of women’s shoes my feet were just big enough to fit into. They were tan loafers with a two-inch heel and a brass-toned decoration on the vamp. They were $16 – a serious amount of money for a pair of shoes. 

Dad was magnanimous. If I liked the shoes, he said, I should get them. So we bought them and took them home.

I was very proud of those shoes. I thought they were beautiful. All my friends heard the story of how my dad had bought them for me.

One day, I was walking home after school when a couple of girls from my class came up to me. I knew who they were but I did not hang out with them. They were more popular than me because I thought everyone was more popular than me.

They said they liked my shoes. 

My thoughts went to the story of how I had got them, how my Dad had broken all the rules and how expensive they had been.

They were not on that wavelength at all.

They completed their taunt – and it was a taunt – by saying that they had given a pair of shoes just like mine to the Goodwill the week before.

Here’s how clueless I was. I did not follow them.

I was only dimly aware that there was such a thing as Goodwill. I had not been taught, as those two girls evidently had been, that it was shameful to be poor.

It dawned on me later, after they’d walked away from me, disgusted at how dense I was, that they were trying to pick on me. 

The Goodwill joke must have been a favorite of theirs because, not long afterward, they came along and tried it on me again.

I gave them their own back. I said my mother had the week before dropped off to the Goodwill the coats they had on. 

They were enraged. They shouted at me for being mean and rude. They walked away, even more disgusted with me than before. Those girls never spoke to me again.

Overdoing It

There's a difference between being physically active and being athletic. 

Physically active was what I was from shortly after my forty-fifth birthday in September 2002, when I took up yoga, to March 2015, when arthritis put an end to all that.

Athletic is what I have never been. 

Athletes have talent. They are brilliant with their bodies. 

I am the opposite of body brilliant. I am a klutz. Clumsy. An accident looking for a place to happen, and famous in the family for being so. It was one of my father's last jokes as he lay dying from liver cancer. When there was a crash in the hospital corridor, Dad asked, even while under heavy sedation, "Is that Karen?"

Hilarious.

Anyway, the combined effect of my desire to get back to being physically active and my talentless body is that I think I have overdone it. I'm in a lot of pain right now from too vigorous physio and too much walking. Phooey.

**********

The Ruler of a small but pleasant realm was in her chambers with the Wizard, her most skilled improvisor. With them were the five Wordsmiths, all looking tan and rested from a week in the dungeon.

"What have you got for me?" said the Ruler to the Wordsmiths, making a show of her low expectations, despite discovering the week before that the Thing coughed up, at the rate of once every twenty days according to the Wizard's calculations, a gem of surpassing beauty and unfathomable value.

This good news had travelled all the way up to the Ruler's boss to the fifth power, The Greatest Ruler. 

Our friend the Ruler had received much praise for her part in the management of the Thing. She had to work hard to hide her good mood from the Wordsmiths.

"I think you'll like what we have to show you," said Hank, the head Wordsmith.

"The Pokemon concept tested well with focus groups. We've done a complete profile for the Kingdom's new mascot."

"And you've had time," asked the Ruler, suddenly over her good mood, looking at the illustration handed to her, "to hold a children's drawing contest?"

"Um, no," said Hank, "That's Dorf's concept sketch of the Thing's public image."

"Ah," said the Ruler.

"We'll clean it up," said Hank. "This is just a draft."

"I see," said the Ruler. "Is it impaled?"

"No, ma'am," said Dorf, leaping to the defence of his work. "The black parts are his wing and his tail."

"His feet are webbed?" asked the Wizard.

"No, sir," said Dorf, "those are stylized bird feet. Like a cartoon character."

"Of course," said the Wizard.

Hank thought he could still save the meeting.

"We call it 'Diggifly.' That's because it can - or will - dig and fly. It has the capacity to learn new moves as it grows. 

"We have already given it quite a few: Sunny Day, Hyper Beam, Frustration, Dig, Bulldoze, Rock Slide, Swagger, Hidden Power and Secret Power, and there's more where those came from.

"With these moves, Diggifly will be able to defeat all the other monsters in the kingdom."

"Defeat all the other monsters," repeated the Ruler, gathering her thoughts about what else she might say. 

"Is that what it does? Fight other monsters? 

"What about the gems? What about its song?," she asked.

"Didn't test well," said Hank. "People get Pokemon, not that other stuff."

"At least we have a name," said the Ruler. "Butterfly did you say?"

"Diggifly, ma'am," said Dorf.

"Right," said the Ruler, showing the five Wordsmiths the door. "Thank you all so much for your hard work. We'll review these materials more closely and get back to you."

To be continued ...

Thanks for reading!

Have a great week!

Karen

Benchmarks and Notes on Physio

Benchmarks

I went out for a coffee yesterday with my friend Sherree. I met her at the Rooster cafe on Jarvis Street, across from the big Rogers complex. 

I walked there, with no lurching.  

This feat - which Sherree calls the Karen Olympics - gives me information to set some benchmarks.

My pre-arthritic daily walk included the distances to work, to yoga and then back home, about 7 kilometres total. Depending on the traffic lights, it would take me about 20 minutes to walk to work,15 minutes to walk to yoga and then 30 minutes to walk from the yoga studio back home. My approximate average walking speed was 6.5 kph.

Arthritis made me stop going to yoga by March 2015, so my post-arthritic walk was to and from work only. My daily distance was 4 kilometres. Total walking time was about 55 minutes. The walk home was slower because I was tired and the pain killers had started to wear off. My approximate average walking speed was 4.4 kph.

My post-hip-surgery walk to the Rooster and back was 3 kilometres. Total walking time: 85 minutes. My approximate average walking speed was 2.1 kph.

While it is possible for me to walk 3 kilometres, I pay for it the next day, and have to retire to the "Fortress of Comfy-tude," which is what Bruce calls the configuration pictured below:

That's four pillows for my back and one for my knees.

Notes on Physio

My three times a day set of seven exercises entails both repetitions (15, as illustrated) and holds (5 or 10 breaths). It is hard to count both. So I have made myself a repetition counter made out of a six-folded piece of paper. It is lightweight, recyclable, biodegradable and comes in any colour you like. When it wears out you can make a new one for the price of a single sheet of paper. 

This is how it works: Hold the counter in whichever hand seems most comfortable. Put your thumb over the number 1. After you've completed a movement, move your thumb down one number. When your thumb gets below your target number, you're done and can move onto the next exercise.

Two of the exercises are worthy of note. One is the standing squat. It is most like the yoga pose called fierce pose or Utkatasana if you're a yoga teacher. This is the one where I lift my arms in the air and don't hold onto a support like I'm supposed to.

This exercise, the standing leg side lift, is the one most likely to make me burst into tears.

Thanks for reading.

Karen

On the Other Hand ...

Some of my readers may have noted that it will be my birthday, September 23, when I next go to see my physiotherapist at Toronto Rehab.

When she proposed the appointment, I said so to Mariam.

She said, "Oh, we can reschedule. People never want to have a physio appointment on their birthday."

Mariam's take is that people hate physiotherapy, and, especially on their birthdays, would really rather not do it.

I didn't reschedule, but Mariam has a point.

The morning's the worst. My body's had a whole night to rest, but also to stiffen up and grow sore where the muscles unaccustomed to such treatment have had time to lodge their complaints.

So I procrastinate. For example:

• I'll take a very long time to make my bed. Gotta get those hospital corners on the sheets just right. And arrange the pillows.

• If it's a nice day, I'll open all the windows.

• I now have blog readers in Pakistan, so I'll check and see if they have visited the site in the last four hours.

I do eventually get around to it. I do the easy movements first to warm up. Once I get going, I'm committed to doing the whole set. But some of the exercises are tough.

So I give myself little pep talks. Out loud.

• "Keep the weight in the leg!"
• "Tuck that right hip in!"
• "Good job!"

When the physio session is over -- seven different exercises, which now take about twenty five minutes to do -- I write it all down in a chart. This feels scientific.

The midday and evening sessions are never as tough to get started on as the morning. I make them harder: I hold the poses for ten seconds instead of five. I lift my arms over my head instead of holding onto a support like I'm supposed to. I pretend I'm in yoga class.

At the end of the day I decide whether I will increase the next day's repetitions. If I waited 'til the morning to decide, I'd still be doing 5 of everything.

Thanks for reading.

Karen

The Miracle of Physiotherapy

In my pre-osteoarthritic days, the small exercises I now do three times a day to rebuild the muscles laid waste by surgery and bed rest would not have warmed me up for a yoga class.

Given how difficult it is for me to do these small movements, it tells you just how much work it takes to come back from hip surgery.

The miracle is these small movements work. I got my new exercises on September 6 - this past Tuesday. The first time I tried a couple of the tougher ones - the ones where I have to bear my weight on the operated leg and hold the other leg out in front, or to the side - I could barely do two repetitions. This morning's session I graduated to ten. I have to be up to twenty reps by the time I see my physiotherapist again on the 23rd. I think I can do that.

My operated leg feels stronger with every physio session. I feel the blood circulating more freely around the joint. The site of the operation feels less congested, less tight.

Every day I have more faith that I can be normal again. I can believe that I haven't just switched one malaise (osteoarthritis) for another (surgery-induced disability that saves me pain but leaves me limping for the rest of my life).

My surgeon understandably emphasized in my pre-operation education the dangers of blood clots and infections, the importance of pain relief and weaning off opioid pain killers. All of that was useful information, but it would have been good, too, to hear things like: "You will need to learn to walk again" and "You can restore yourself to your pre-arthritic level of activity, but you will have to work like a bastard to get there."

*******

"Can you give me a reason," asked the Ruler of a small but pleasant realm, failing to contain her temper this time with the head Wordsmith, "why I should not just order your execution?" 

She paced angrily back and forth in her chambers, waving her arms to channel her rage, knocking things off her desk and shelves with the long fabric trails of her sleeves. Everyone crept back a bit to get out of her way.

"You have been wasting my time for weeks now. First you said you could not possibly name the Thing because you did not know what it did. Now you are saying the Thing shouldn't do anything because that would wreck the brand you are developing. And a stupid song!

"I did not ask for a song. I did not ask for a brand. I asked for a NAME...." The Ruler pulled on the bell cord that summoned the palace guards.

"O great Ruler," said the Wizard, likely the only person then in the room who could speak and still live to see the next day, "the Wordsmiths have been working on the name, but nowadays a name is not enough. You need a backstory, a context and an appealing public image. The Thing needs a narrative that helps people understand it, like it, and believe it is useful. 

"I think the advice of the Wordsmiths is that they need to work these details out before we set the Thing out in the world to do whatever it is that it does." 

All the Wordsmiths nodded at what the Wizard said though none dared speak.

The Ruler stopped pacing. At that moment, five members of the palace guard filed into the Ruler's chambers. 

"They can work out their details in the dungeon," said the Ruler. "Guards, take these five and lock them up."

Griping and whining, the Wordsmiths were taken away by the guards.

"Hank," called the Ruler to the head Wordsmith as he went out the door, "you have one week to get your brand in order and your stupid little song."

Hank, terrified, did not reply.

"That's a bit harsh, don't you think," said the Wizard to the Ruler once all the Wordsmiths and guards were gone from the chambers.

"They won't have any distractions in the dungeon, and I'll make sure they have all the food and light they need to stay productive," said the Ruler, "but the slow pace is wearing me down.

"I want that Thing," she said, pointing to the Thing, "named, branded, whatever, and out of here. It smells bad and the noises it makes are irritating."

The Thing had sat through all of the drama in the Ruler's chambers without reacting. But now the Ruler and the Wizard saw that it seemed in some distress. It was choking and gagging, like a cat struggling with a hairball. After one big final cough, the Thing spat up a sizeable, perfectly clear, stunningly gorgeous gem.

The Wizard reached into the Thing's pen, grabbed the gem and held it up for the Ruler to see.

"Holy cow," said the Wizard, "so this is what it does." He handed the gem to the Ruler. 

She weighed it in her hand, impressed.

"Even the wretched Wordsmiths should be able to do something with this," she said.

To be continued ....

Thanks for reading!

Have a great week!

Karen

Live From Toronto Rehab

I've got a half an hour before my second appointment at Toronto Rehab, so I'll fill you in about post-operation rehabilitation.

I've just spent an hour with a very nice young physiotherapist named Mariam, who said that while I have made good progress in three weeks, I really have to work on my ass.

I had noticed that my ass had fallen off in the time between when I went into the hospital and when I started standing on my own two feet again. I look like my dad used to: one straight line from the shoulder blades to the heels.

Mariam says there is actual research on this. It shows that two days or more on your back can contribute to significant loss of mass in the gluteus muscles.

This means that my butt muscles are dwindled and are not strong enough to support a proper gait. 

All the lurching I've been doing has not helped me as I've forced my stronger muscles to compensate for the weak ones.

Nor was giving up the cane inside the house a good idea.

I have a fresh new batch of much more difficult exercises to do and unambiguous instructions to walk with my cane no matter if I'm inside or out.

Mariam assures me that this will all take some time, but will get me to where I want to be.

Stay tuned.

Thanks for reading!

Karen

Milestones

Happy turtles; Allan Gardens greenhouse, August 30, 2016

The toe incident:  I think I dislocated rather than broke my baby toe on August 22. Although I feared the worst, the toe has not added to my pain. I keep it immobilized with medical tape. It does not bother me. That's just the first piece of good news. 

Stairs: for the first week post-surgery, I used both hands and a cane to make it up and down the stairs, one step at a time. Twice in one day was a major accomplishment. I could carry some things - a water bottle, books and electronic devices - in a bag slung over my shoulder. I ate at the counter if no one was around to carry my food to the table for me. Now I go up and down stairs without the cane - still one step at a time, but now so many times a day I don't bother to count. I now have one hand free, so I can carry things without a bag. I eat at the table, even when I'm on my own.

Walking: For moving around inside, I stopped using the walker after August 23. I have a mummy-like lurch in my gait.  By Monday August 29, I was lurching with my cane outside: first 300 metres (to the corner), then 400 (to the Allan Gardens), then 600 (to my doctor's office) and now 850 (around the block). I tried to do the 850 metre lurch three times yesterday - but that was too much. 

Cooking: On Wednesday, August 24, seven days after surgery, making a salad for lunch exhausted me. Yesterday, Friday, September 2, I made for supper pork shoulder braised with onions in beer with honey and dijon mustard, basmati rice and a fresh summer tomato and peach salad. Bruce is very happy.

Pain: I reacted badly to the pain killers in the hospital -- severe nausea and dizziness. So I stopped taking them after the first day and a half. The lingering effect of just thirty six hours on the opiates is that I even now have not quite got my appetite back, and feel faintly nauseous and dizzy after meals. The only pain I feel, easily controlled with Tylenol, is when I overdo my physiotherapy (see note on walking too much, above). As for the pain I was in before the surgery: the pain that shot down the inside of my leg, the pain that pulsed at night and made it impossible to sleep, the pain that overcame me if I walked further than 100 metres .... that's all gone.

The next milestone in my recovery is my appointment at Toronto Rehab on September 6. They'll do an assessment, tell me if I need to return to them and provide some counselling.  

I feel like I'm making good progress. Let's see if we can say the same for our friend the Ruler and her Advisors.

******************

The Ruler of a small but pleasant realm was in her chambers meeting for the umpteenth time that week with her most skilled improvisor, the Wizard, and the Wordsmiths, the people in charge of all the NITs (necessary and important terms) in the realm.

Their topic of conversation was as always the Thing, the half-groundhog, half crow hybrid that was the apple of the Emperor's eye.

The week before, they had chanced to discover that the Thing ate money. Since then, they had been feeding it different coins of the realm.

Trial and error had led them to a diet that seemed to please the Thing, kept it thriving, but did not cause it to grow too much: ten copper pennies for breakfast, two silver dimes for lunch and one small (one 20th ounce) gold coin for supper.

Fed these coins, the Thing had grown to about one and a half times its original size. Each meal would make it sing a short sweet song reminiscent of flute music. Once it had metabolized the metal it ate, the Thing would squeeze out from the end furthest from its mouth a small alloy ingot that, though comprised of almost equal amounts of what it consumed, it would shun and try to bury under the papers lining its cage. 

The Wizard rigged an ingenious device that fished out the ingots, melted them down, separated the different metals and stamped new coins.

"The net loss is just under one percent," reported the Wizard at the meeting, "The Thing costs almost nothing to feed. 

"The magic startup is a little costly," he averred,"but we should be able to recoup that over time if we can get the Thing to do more than just eat, sing and poop.

"It's supposed to be a digger," the Wizard went on, "but it will never dig in that cage. We need to take it outside."

The Wordsmiths started at this suggestion. 

"You'll wreck everything if you do that," said Hank, the most senior Wordsmith.

"Hank," snapped the Ruler, never patient with these people for long, "your riddles weary me.  What are you talking about, wreck everything?"

"I mean this," said Hank, "What you have here is a fresh new image for the kingdom. Our artists are working right now to create an appealing public persona for the Thing. We're thinking Pokemon. It's a natural.

"And we can use the noise the Thing makes as a new national song.

"We've got the makings of a great new brand here. You don't want to blow it by taking that Thing outside and letting people actually see it."

To be continued ....

Thanks for reading!

Have a great long weekend!

Karen