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Friday, April 3, 2009

PT Free!

I am officially PT free! It has been a long and bumpy road.
Despite many obstacles in my path, I've finally achieved
my goals. I have now been discharged from physical therapy.
Since my illness eight years ago, I have attended multiple
rounds of physical therapy by several different providers.
Each one had different goals and different styles. No
matter what, I always worked hard and gave it my all.
Here's a look at my PT history. It's another long story.
I began a home PT program soon after leaving the hospital.
I was still in bad shape. I had severe nerve damage in my
limbs and muscle atrophy. My feet were twisted from nerve
related "foot drop." I couldn't feel my hands, legs or
feet. I couldn't stand or walk.
This early round of PT involved stretching muscles and
encouraging movement. It was rough. The physical therapist
moved and rotated my libs around in different positions.
They cracked and popped and only moved a little.
I performed exercises so simple that all I was really doing
was lifting my legs or flexing my arms. Leg kicks were the
hardest. Even though I was sitting, I'd still struggle to
kick my legs forward ten times. That's how weak I was.
Eventually I was able to add weights to these exercises.
By strapping a weight band around my leg or arm, I could
lift a few pounds at a time. We started with one pound and
slowly moved up to five.
At the same time, the physical therapist worked to get me
back on my feet. I would stand a few moments at a time,
while holding onto a walker for balance. Once I had braces
on my legs to stabilize my ankles, I began taking my first
steps. The physical therapist move the walker for me while
I shuffled around the house or out in our cul de sac. I
didn't go far, but I was walking. What an accomplishment!
I thought the therapist was crazy when she suggested I walk
up the stairs. However, I did it. Soon I was able to walk
up and down the stairs instead of crawling. It was hard
work but worth it. It made me feel more like a normal
person.
The trouble with physical therapy is that most insurance
companies and medical assistance programs limit the number
of sessions they will cover. Despite my success with PT,
I was forced to abruptly stop the sessions. My physical
therapist wanted to save what I had left for in office
therapy. I wasn't strong enough for that yet. For the next
several months, I worked on exercises myself to build
strength. When I was ready, we set up an appointment for PT
round two.
The in office physical therapy was a bit odd. My
father-in-law, who was also my doctor, called in some
favors to have me become a patient at his friend's PT
office. This group worked with sport injuries. It wasn't
the best place for a person with nerve damage.
They began with massage and electrical stimulation
treatments. I can't really remember the purpose of the
electricity. It hurt but it was bearable. I did like the
leg massages.
I guess these treatments worked because they moved me onto
phase two. They had me working on machines to strengthen
muscles. I pushed and pulled with my legs and walked on the
treadmill. Looking back, I'm kind of shocked at how hard
they pushed me during this period. By the time I got home,
I'd be so tired I couldn't even walk.
Just as I began to feel this therapy was working, I had to
stop again. I had run out of allotted sessions. Although
I was able to arrange for my state's rehabilitation services
to pay for more PT, the office kicked me out. Oh, they said
I had reached a point where they couldn't help me. I'd
need to work at home, they insisted. "You'll be more
comfortable there." Yeah, right. I think they didn't like
that Rehab would be paying less than insurance so they let
me go. Once again, I was on my own.
I did the best I could over the next three years. I was
alone in my attempts to improve myself. I wasn't getting
support from my husband and my father-in-law wasn't doing
anything to get me medical treatment. I had weights and an
exercise ball. I walked up and down the stairs or used a
counter or wall for support while doing balance exercises.
Sometimes I was diligent about doing exercises. Other times
I put it off for months. I did what I could during a hard
period of my life.
Finally, with the assistance for a volunteer helper, I was
able to return to PT. This time I was seeing a doctor who
specialized in pain and physical problems. His office ran
their own physical therapy department. All patients had
serious conditions. This was very different from the sports
center I had gone to before.
We spent half of each session on a mat doing exercises with
weights, rubber bands and balls. It was slow and careful
work. The rest of the session was at the parallel bars. I
would do standing exercises, steps, stretches and the
trampoline while holding onto the bars. The physical
therapist made sure I was stable while doing these
exercises. The bars made it easier to keep my balance.
Then it happened again. It was only April when they
informed me I had just nine sessions left for the entire
year. I was so discouraged. How could I ever improve
myself if I had to keep stopping like this? We decided it
was best to save those sessions for later in the year. I
was back to doing home exercises by myself.
A few months later, I moved to a different state to live
with my parents. Once settled in my new home, I was ready
to work on physical therapy again. Round four was at our
local hospital. They have an excellent Rehabilitation
Center. There's even a pool. By this point, I no longer
had insurance. Medicare would have to pay for the therapy.
There's a little Medicare clause that worked in my favor.
If the therapy center is part of a hospital, you are allowed
unlimited number of sessions.
My goals this time were strength and flexibility. My
physical therapist performed extensive stretches on my legs.
She finally got them moving and began to increase my range
of motion. We also did parallel bar exercises, including
forward, backward and side ways walking, march, trampoline,
and balancing on a rocker board. When the weather was
nice, she'd take me outside for walking. I use my long
white cane but she'd still have to guide me. I wasn't
stable enough to walk on my own.
Unfortunately, my goals were low and I soon met them all.
The therapy center completes monthly evaluations. Once you
meet your goals, you are discharged. I would need to go
back to my doctor for another referral with harder goals in
order to return to therapy. My physical therapist suggested
I take the summer off and return in the fall. In the
meantime, I worked hard on my home exercises.
Life got in the way, as it so often does. First my brother
died. Then it was the hectic holidays. Finally, just as
we were beginning the process to get me back in PT, I
injured my toe and needed time to heal.
It was eight months before I returned to my final round
of PT. Once again, I was at the hospital so I didn't
need to worry about the number of sessions. Kristen
and Andrea were my physical therapists. They worked
together as a team. Kristen is careful and great with
stretches. Andrea pushes hard. I didn't like her at
first but we later became good friends.
I was amazed at the goals they wrote for me. This including
walking safely on my own, navigating around an environment
and moving around corners. Are they kidding? That would
take years to achieve! I thought it would be impossible.
But I'm a fighter so I was ready to give it a try.
This session of PT was a little of everything. I did
stretches, parallel bars exercises, exercises on a ball,
biking and other machines, and lots of walking.
We walked inside and out. I wandered around the hospital
corridors. At first, I was staggering about with two
support canes. I had no control and no idea where I was
going. Soon we switched to one support cane and a long
guide cane. I felt like a confused mess of limbs and
canes.
They had me try a forearm crutch. I immediately fell in
love. The crutch gives me more stability. If I could use
two of them, I think I could just about fly. But I do need
one hand for the guide cane. That's the hard part about
being blind and physically impaired.
I also like the crutch because it stays with me if I let
go. This is useful for communication or if I need my hands
free for something. No more dropping my support cane or
fumbling to hold two canes in one hand so I can sign.
I remember those first days of walking with the crutch and
guide cane. I leaned so heavily on the crutch that my arm
would hurt. We were trying to come up with a pattern for
stepping and moving each cane. We had to find the best way
for balance, stability and guidance. Not an easy task.
I went to PT twice a week and pool therapy once a week. I
loved being in the pool. The water was heated and felt so
good. We did many of the same exercises in the water:
walking, marching, kicks and steps. With noodles wrapped
around my body, I would float in the deep end and "bike"
with my legs. It was exhausting but fun.
They brought in an ortho specialist to fit me with new
braces. It was a challenge because I have multiple
problems. My ankles needed support. My right foot twists
weird. My left toes are severely hammered. Most braces can
address one issue but not all. It took several tries and a
lot of customizing. My new braces keep both feet in proper
position. This gives me more stability and helps with
strengthening muscles when I exercise.
So the months passed... I continued PT. There would be no
summer off this time. Three hours a week, every week. I
complained for fun but I still worked hard. I didn't even
notice the improvements. We found a good walking pattern.
My gait stabilized and I began to walk a little faster. My
feet actually move more like normal feet. How did that
happen?
After 15 months of therapy, Andrea gave me the shocking
news. I had met all my goals. I was done. I was being
paroled.
I still don't walk normal and I probably never will. I have
major balance issues since I can't feel my feet. But I am
walking and I'm getting around on my own. I finally
achieved success. With my head held high and a smile on my
face, I said goodbye for the last time. It feels so good to
be PT free.

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