I think I can

Have you ever had to start an exercise regime or return to one after a break and found yourself lacking the motivation or inclination to do it? I had a horrible head cold last week and it had me on the couch for a good number of days and feeling sick for a good number more afterwards. In the lead up to this winter bug, I had been exercising nearly every day and was feeling great for it but then I got sick and the momentum broke.

Even after all my years of working at physical recoveries and developing a will to exercise, I still find myself each morning this past week wondering if today will be the day I get back into it – but I haven’t, despite the guilt inspiring self-talk and you know what, that’s normal.

Us humans are such creatures of habit yet we are also highly adaptable, we wouldn’t exist as a species if we were not but some habits (usually the healthiest ones) are harder to get back on track than others after a disruption of our routine.

Despite knowing all the benefits of returning to exercising, I have simply not been ready and thankfully after years of practice, I no longer have a melt-down thinking it’s the end of the world because I’m obviously NEVER going to exercise again because I’m too weak-willed. I am what I like to call a recovering perfectionist and life used to be quite black and white to my mind. I was, as my husband liked to say, an “all or nothing kinda girl”.

So if you also find yourself being internally berated, please try to breathe and take stock. You can do it; it just might take having a plan of attack rather than simply hoping you wake up one day with your exercise-will restored (or newly created).

As I have thought about my current break from exercise, I have tuned in to hear what my body has to say and initially, I was too tired after illness to jump straight back in and now after a longer break I am beginning to experience an increase in physical pain and discomfort. In the past, I let this pain grow to the point where I am spending so much time thinking about it and treating it, that I realise I need to start exercising again so it all settles back down and isn’t a huge part of everyday.

In more recent times, I have learnt to anticipate this ridiculous dance and come at it differently. If you find that you are bemoaning the fact that you haven’t exercised (even just internally) try to catch yourself at that moment and ask yourself, “What can I do now for the next 5 minutes that will count as exercise?” That may not sound like much but if it gets you up off the bench (or couch as it may be), that’s a good thing.

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The last couple of days I began with stretching and although it didn’t take long I felt better in my body and it shut down the nagging negative voice in my head, allowing me to feel pleased that I had at last done something. Yesterday as I was feeling more energetic, I added in one set each of my lower limb rehab exercises. Today I actually got myself to the basement (my exercise space) and did a series of stretching and strengthening exercises. So now when I think about this week I can honestly say I have started back and know I will continue to build back up to my pre-illness levels of exercise.

Obviously for fitter people you can start with a longer exercise interval to get you started but for anyone recovering from illness or injury, you start where you can, be it seated arm and leg exercises, walking laps of your home, stretching, mobilising your joints, climbing the stairs a couple of extra times, or enjoy a stroll in the fresh air. Any movement is better than none. Taken a day and then a week at a time, with realistic incremental increases, you will find yourself developing an exercise routine that suits you, a routine you can be proud of.

Rehab Reverberation

I’ve seen such an improvement in my ability to exercise in the last few months and at six and a half months post-op; I’m feeling remarkably able bodied. The comparison between how I felt after the first craniotomy and this one is telling and it is only now that I truly appreciate how unwell I was for the two years following the first surgery in 2014. I had been reduced to managing my entire life around debilitating head pain and migraines with little relief in sight. Every time I attempted to exercise, I found I could only manage short (10 minutes) sessions and it is impossible to build yourself up with so little exercise tolerance. I would jump on the treadmill and despite not going at it too hard, my shoulder and neck muscles would tighten then pull on my jaw and scalp muscles until the sore spots on my skull (where the metal brackets and screws were) became aggravated, triggering a migraine that would knock me out for up to three days. It got to the point where just thinking about exercising became demoralising, not a good thing for anyone, yet alone someone trying to regain physical strength and function.

Since having the metal removed from my skull, that cycle has mercifully been broken and I have found myself willing and able to exercise again.

So it is that I recently had a review with my rehabilitation physical therapist (that’s what they call them here in the US; at home they are called physiotherapists).   I have been working on strengthening my legs and getting all my muscles groups switching on and working properly. This takes a while as the first few weeks of doing the specified exercises, you are just reconnecting your brain and the muscles and reminding them of how to work, eventually they start to switch on at the right time and then the exercises work on strength and coordination. It’s a process I have been through a few too many times for one lifetime but it has taught me to have patience with the process.

I have also worked on my overall fitness as after the stroke and now two brain surgeries close together, I have struggled to re-achieve cardio fitness, a fact my resting heartbeat has screamed for years, as it never drops under 90 beats per minute (unless I’m meditating).  Fitness has been a much-cherished goal but it has eluded me for a long, long time and I had, in fact, begun to give up hope of ever achieving it. Due to the physical deficits inflicted by the stroke and then brain surgery, I have to work ever day continuing to exercise and practice motor skills I initially lost but have regained. If I stop, it doesn’t take long for the deficits to worsen.

I am nine years out from a brain stem stroke (basal ganglia) and have worked harder than I ever imagined I could to regain as much function as possible, to the point now that on my good days even experienced Neurologists have difficulty picking the signs (my ‘tells’ I call them); those sneaky little weaknesses I can’t conceal. Add two spinal injuries (lumbar) and surgeries and really, it’s a miracle I can even walk.  What can I say? I’m stubborn. I’ve also experienced Jason’s idea of motor- sports-racing wheelchair pushing and I am not doing it again!

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At the recent rehabilitation review, I was pleasantly surprised to see my therapist both impressed and a little shocked at some of my achievements. Okay, so was I but it’s what I’ve been working so hard at for months. I obediently reported my status with the leg exercises I’ve been doing and the exciting fact that I have dramatically increased my treadmill speed, added an incline and am routinely doing 30 minutes a day.   So it was straight into the walking speed test to judge the results of this effort.   Whilst only a short timed walk from one side of the gym to the other at the fastest but safest speed I could manage, the improvement was noticeable immediately. As the therapist compared my new time to the old and looked up the average speed per age numbers, she turned to me with surprise on her face, and said, “You have increased your walking speed significantly and just walked at the average speed for your age group”.  I haven’t been able to do that in decades!   She kindly added, “Given all you have been through, achieving that is remarkable and a sign of the effort you’re putting in”.

I’ve been going through a bit of a rough patch emotionally the past two months but hearing this was like a balm for my worries. Sitting perched on the edge of an exercise table, I felt myself sit a little straighter, a grin slowly worked its way onto my face. We sat, looking at one another for a moment, a sense of shared camaraderie and pride in these achievements; then it was onto the rest of the review. That’s the cycle of rehab: test, find the weaknesses, set exercises, do exercises, review, momentarily celebrate any improvement, and then repeat with more challenging tests and exercises. Victory is often times a very short-lived thing in the rehab gym but gee it feels good.

We Can Rebuild Her

In amongst the angst of the past weeks, there has still been physical improvement for me. I realise that in my funk I have failed to celebrate these milestones.  I would like to share a few with you, so you know I am still improving despite my lagging emotional state.

When I manage to take myself out into the Alice winter days (beautiful compared to much of the country just now), I am now able to walk 2.5 kms.  The first time I reached this distance, I felt as though I might just die, thankfully that feeling passed.  Walking this distance has become much easier with repeated effort and a friend walking with me last week commented on my speed, saying it was much faster than he anticipated.  It’s always nice to get positive feedback.  I have been tracking my exercise progress with help of an app on my phone and it really helps to see how far and in what time I complete my walks.  Highly recommend using one, if you don’t already.

While still having headaches every day I have a plan with my GP to slowly come off the morphine and then the other pain medicines, once the headaches reduce more in their intensity.  The cocktail of drugs I am on currently is likely causing some side effects like reduced motivation, lethargy, mood issues, food cravings etc., etc.  All the things likely to undermine recovery but without them I would be in debilitation pain, unable to do much of anything, thus I persist with them.

My friends, whom visited this past week, helped so much around the house and provided much needed laughs and company and baked goods (thanks M).  In addition to fixing a chair for me, Mr. Engineer R, also attended to my poor old, battered Mirror Box.  When I had the stroke in 2007, a Psychologist friend read about Mirror Box therapy now being used to help stroke survivors regain hand function.  He proceeded to build me one using a beer carton and it worked a treat.  It didn’t travel well in our move here but I didn’t know how to revive it, but my friend did.  He gave it a complete makeover so it is useable again.  By leaving it sitting on the dining room table, it is easy now for me to just sit and use it a little each day.  This will help settle the finger curling I have and improve my fine motor skills in the left hand.  www.mirrorboxtherapy.com

Rebuilt Mirror Box

Rebuilt Mirror Box

Inner Workings

Inner Workings

 

 

 

 

 

 

In my desperation to find motivation to do my rehab exercises, I scheduled time with my physio to develop a program using their clinical Pilates gym.  I kept the appointment (an achievement in itself) and was put through my new program.  I am deceptively weak.

At first glance, I look fit and healthy – this is a mirage. My physio was surprised at just how weak my left side is but was equally pleased to see that not once in the 45 mins we worked together did I say, “I can’t”.  It was great to find that when someone sets an exercise for me and at the first attempt, I cannot perform it, I can still dig deep, focus, breath, and try again and again and again.  It was monstrously challenging and my balance so bad that during one exercise, I fell off the equipment.  Luckily for me, my physio used to play rugby and caught me around the hips, in something resembling a tackle, before I could hit the ground.

I decided to work with the physio rather than on my own because he is very interested in rehab and this way, I have to attend a physio-supervised class once a week and am accountable to someone.  Next week we are working on my pool program – let’s hope he knows how rescue someone from drowning.

Next up is my eye which is now showing fantastic improvement.  A number of weeks ago I was doing the exercises given me by the Guide Dog mob when it occurred to me, that rather than just doing the exercises three times a day, and wearing the patch the rest of the time, wouldn’t it be better to actually give my eyes time working together?  So I began leaving my eye patch off in the mornings, slowly increasing the time as my eye dictated.  At first, the swelling around my eye was a restriction as it pushes my eyelid further down than usual meaning my distance vision was still double, so I only left my patch off when I was sitting down and not moving about constantly changing the field of view.  This worked well and I was able to start at 30 mins without the patch and gradually increase it as tolerated.  My eye was always the guide in this experiment as it had a definite limit, at which point it would ache badly, my vision would begin to double again and I experienced shooting pains behind and around the eye – time for the patch to go back on.

I continued with this approach over weeks and gradually began making my breakfast without the patch, walking from room to room, slowly getting the eye used to changing fields.  It was a slow start but I persisted, convinced this was the way to ‘get off the patch’.  I have continued to do this, experimenting with different activities and was able to add in an hour at night, watching TV.  I felt nauseas constantly in the first few weeks and there were definitely days when the nausea had me re-patching before any eye pain.

I gradually increased the number of hours each day when I could go without the patch and my eye was getting stronger and stronger.  The swelling at the side of my head (below the temple) also finally began to reduce.

Last Sunday, I decided I’d had enough of wearing the patch and went my first full day without it.  The only time I experienced difficulty was the following day, in a taxi returning from a physio appointment.  I could see out the windscreen and found myself becoming extremely nauseas.  I realised I was having difficulty looking into the distance and spent the rest of the trip looking at my hands in my lap, to avoid vomiting in the taxi.  I refuse to do that sober.

Long story but I have now gone three and a half days without the patch and largely, am managing fine.  The eye still fatigues in the evening and if I stay up too late, my vision begins to deteriorate but this, I am sure, will also improve with time.  Friday morning will see me attending my eye review with the hospital Ophthalmologist.  I will walk in there without the patch; hopefully, I won’t walk into anything or throw up.

Rehab Challenge Two

Here’s another balance test for you to try.  In a space where you can walk safely, note a point on a nearby wall or draw an X on a sticky note and put it on the wall or door at eye level.  Now position yourself at least 10 to 15 steps away from said wall.  Keeping your eyes on the X walk towards it whilst turning your head slowly from side to side.  Imagine you are walking down a street looking at house numbers. Remember though to keep your eyes on the point of focus.  Repeat.

If you experience any wobbles or feel dizzy or are unable to keep your eyes on the mark, you may benefit from doing this a couple of times each day for a few weeks.  It will make you more stable when walking, particularly in busy environments.

As I mentioned last challenge, this activity may be easy for you, but for me it brings on almost immediate dizziness and when I repeat it diligently, I become nauseas.  I know from experience that balance exercises that challenge my brain’s capacity, enable me to push my tolerance to the point where I will no longer experience the uncomfortable side effects and will be able to walk and move my eyes and head normally, improving both my mobility and stability.

In preparation for the next challenge, you will need a deck of playing cards.

Rehab Challenge One

I thought I would offer the opportunity for you to participate/support me in my rehabilitation efforts by sharing some of the exercises in my program.  It is my hope that you will have no difficulty attempting any of these for your self and will wonder what I am on about.  Trust me – these activities are challenging for me and require focus, patience and perseverance.  Should you find an exercise difficult, you may want to continue practicing it to improve you capabilities in that area.

Today’s rehab challenge is: Maintaining Balance With Eyes Closed

Find a safe space to stand in, with something nearby to grab hold of if you lose balance.  Stand on one leg for a count of 30, then swap legs and repeat.  Now do this again but with your eyes closed.  Make sure you have your balance prior to closing your eyes.

If you can do this without wobbling or losing your balance that’s great; if not you might get some balance benefit by practicing this each day for a while.