Assisted Living, Part II

(This is a continuation of a previous post, Assisted Living Part I).

If your parent is going IN to assisted living right now/today/really really soon

  1. Take a copy of your parents living will and any instruction they gave you about how they want things to be. Take your power of attorney with you. You’re going to need it. let the facility scan it, or make a copy of it, but keep the original.
  2. You’re going to sit down with an intake nurse and probably another specialist – one for the business end, and one for the medical end. Watch what they write like a hawk. Remember that “no feeding tubes” story? Yeah that’s a thing.
  3. Be super-clear on expectations:
    1. If they’re doing your parents laundry, make sure everything is labeled, and inventoried.
    2. If you’re doing it, make sure it is clear where dirty laundry goes (it helps to provide the hamper if you can) and how often you’ll be coming to get it, as well as where the clean laundry goes.
    3. If your parent has instructions that they only want to eat dessert if that’s what they ask for, make sure the nurse (and the kitchen) is clear on that. (Mom pretty much ate just egg salad sandwiches and then just dessert and then opted out.)
    4. If your parent has instructions that if they don’t want to do PT they don’t have to, make sure that the nurse (and the PT) is clear on that.
    5. If your parent has instructions that hygiene is important to them, make sure that the nurse (and the bather) is clear on that.
  4. If your parent has any cajoling tricks you can use with them if they are reticent, like TV time, or getting to use their own conditioner, etc. etc. , let the right folks know! The “right folks” are the head nurse, the person who cleans the rooms, the person who delivers the food, the person who bathes your parent, etc. — in short, *everybody*.
  5. If folks with long hair have specific rules (e.g., please use lots of de-tangler/conditioner, please braid, do not use elastics) let those folks know and make sure it’s written down.
  6. Bring lots of familiar stuff:
    1. Their own toiletries (including any electric conveniences like shavers, toothbrushes, etc. that the home will let you).
    2. Their own blankets, clothing, linens, etc.
    3. Paintings, pictures, albums, alarm clocks (if they’re the punctual type), puzzles, craft/hobby things
    4. Knitting needles and sewing scissors may get taken away from folks if they’re in memory care.
    5. If they are technologically savvy, a e-reader or an tablet is a great thing, too. You can load it up with books, pics, etc., and you can facetime.
      1. Most places are really good about security, but I’d also get it labeled.
    6. Some places will let them bring their credit cards and ID, but maybe quietly cancel them – or replace with a dollar-affixed debit card or pre-paid card if those are actually usable in the facility (e.g., vending machines).
    7. My mom’s window had birdfeeders outside it, so whenever I visited I filled them with birdseed.
  7. Ask if you can bring outside food – bringing in a special treat on admitting day can help relieve all the newness.
  8. Re-define/nail down the visiting hours, when you get to meet with the doctor, and what the next few days look like. Use the whiteboard or posting board in the room to write down the date and time you plan to visit next if you know that.

When your parent is in assisted living

  1. When you visit, sneak in Starbucks gift cards for the folks who do the heavy lifting – bathers, laundry folks, food deliveries – they aren’t supposed to accept them but they will and your parent will benefit. YES, they’ll be awesome to your parent even if you don’t or they don’t accept them – but the gesture goes a long way. And you’re going to feel helpless so that can help you feel like you’re doing something. Alternatively, bring in a bakery tray or something for the nurse’s station. Or a box of candy.
  2. Bring food, if your parent is eating, that they like – treats, chocolates, snacks, soda.
  3. Bring things to read (if they are readers, magazines are good because new content) and share news (focus on the positive if you can). Unless they’re the type that loves good drama in which case, share the drama. 😃
  4. Eyeball their care—is their bathroom clean? If they are incontinent does it smell like they need to be changed or does their room smell fresh? Ask what they got to have for dinner last night/breakfast that day, and if they liked it.
  5. If your parent has doctors appointments outside of the care facility, the care facility usually sets up all of the transportation to/from the appointment, as well as the appointment itself – so if mom or dad has an optometrist, or an oncologist, or a cardiologist, etc., make sure they all know where mom or dad is going/has gone, and that they can coordinate with the care facility.


If your parent is having any major medical procedures as part of this process (surgeries)

  1. Many assisted living facilities do NOT have staff on hand to support things like wound care (which you need if you’re recovering from surgery). So your parent may have to go to a different facility to recuperate. That will be one of the more expensive ones, but good news! Medicare covers 20 days of the recuperation part (including room and board) for 100% (or near enough), and then the next 80 days at 80% (near enough).
  2. You should know that the medical community wants to make everyone better, either because they are that way by nature or because most medical care is for-profit by nature. But telling your parents’ doctor to knock it off, that mom or dad doesn’t need another surgery when they’re already going downhill, is hard. You need to evaluate if the thing the doctors want to do will prolong the life and what kind of life it will prolong. If your parent has written any decisions about THAT in their living will, take heed of that.
  3. My mom was on hospice – which is what happens when you have six months or left to live, and offers all kinds of palliative care benefits (that are covered by Medicare, by the way) – and her doctors were insisting that with just one more surgery they could Do a Thing. We had to tell them it didn’t make sense to put her through that risk, and that pain, for dubious benefit. We asked them to honor her hospice care and keep her as comfortable as possible. “Hospice” is not a specific facility, but rather a layer of care on wherever the patient is (even if the patient is at home).

Last but not least – this whole process will be frustrating, abstruse, process-laden, and generally a pain in the ass.  Find a friend who has bandwidth and use them to vent, do NOT vent at the healthcare professionals as it won’t help you (or them). 

Assisted Living, Part I

I’ve thought about writing this blog post off and on, for about the last six months; the only thing that prevented it is that it’s going to be long. There’s too much to encapsulate in a few paragraphs, so this is part 1 of 2. Know that while this entire thread is using “parent”, this could hold for a sibling, aunt, uncle, grandparent, etc. We’re all going to need some kind of help at some point.

If you want to skip to the part about “what you need to do now” without the backstory, skip down to “What you should do right now“.

I’m part of Generation X, and our parents are elder boomers (for the most part). Aside from the political and socioeconomic differences (particularly heightened recently what with the elections and COVID) between our generations, I also find a difference in willingness to ask for help, and to talk about health issues. My mother was the perfect case in point: she’d announce she visited the doctor and then just as quickly announce that it was no one’s business what the doctor said. (Or she’d lie and say “everything’s fine.”)

It comes to us (the kids) to try to have these conversations with our parents about preparations and planning and wants and preferences for when they (and we) need help; what that help looks like, who administers it, and what happens when it’s not enough. I would love to say that for all four of my immediate parents — and six parental units total — we had these conversations with grace and aplomb. Unfortunately, we lulled ourselves into a sense of security because “dad says it’s all taken care of” or “mom has a will and living will and healthcare power of attorney and gave us copies”. The basic checklists that I found online, after the passing of my father in law (vowing to have the conversation with all of my parents to make sure this sort of cockamamie bullshit didn’t happen again), didn’t cover what I should’ve been looking for. I found this out just about a year ago, the day after Thanksgiving 2019, with my mom.

My mother was a drinker from at least the time I was 7 — and drank more heavily as she aged. For me it was noticeable as “more than just mom’s generation of drinkers” when, after she retired and became incredibly sedentary, she’d start drinking at noon every day and her glass would drain and refill until 10pm (every day). I later discovered she would drink up to the equivalent of 3 bottles of wine a day. A lot of erratic behavior (including falls, repeating herself, etc.) would get swept away under “mom had too much again”, and despite multiple attempts to reason with her she would not stop. There were other signs I did not get to see and that were not shared (to spare me), things like hallucinations and incontinence, and on Pearl Harbor Day 2019 Mom was admitted to the hospital with hallucinations and, it turned out, a need for near-immediate surgery due to complications from her drinking. She was discharged to a recovery facility shortly after Christmas, diagnosed as not-really-recoverable shortly after New Years’, and lived four more months in the facility as vascular dementia, successive mini-strokes, and a general disinclination to cooperate with anything or anyone accelerated. COVID struck during this period and we weren’t allowed to visit for about six weeks, by the time they granted us a special exception we knew why.

This process was a lot more painful than it had to be, because there were things I didn’t know and questions I didn’t know to ask; and so as with most things legal and health care in this country there were added hoops to jump through when I was already dealing with complicated things. Which is what brings me to write this all down, so hopefully if and when someone else needs it, they don’t have this added layer of administratea (or are better equipped than I was).

What you should do RIGHT NOW (regardless of stage)

  1. Get a healthcare power of attorney.  Most attorneys have this as boilerplate with a bunch of questions you answer to get it done, but the thing is you have to have this.  No one will talk to you about your parent, or not really, without it.  And no doctor or nurse will listen to you unless you do. (If your parent wants the other parent to have this, fine. Make sure they do. And then make sure there’s one for that parent. And make sure there’s a backup).
    1. True story – mom had specifically written DO NOT USE FEEDING TUBES in her living will. The nurse checked the box for using feeding tubes if needed (right in front of me, her having read that NO FEEDING TUBES directive in moms living will, and having had me point it out) in front of me anyway.  I made her re-do it. Her explanation was that she “always checks that box”. If I hadn’t had power of attorney, I could not have spoken for my mother in that situation.
  2. If your parent still has their marbles:
    1. Have them write a living will about what happens while they’re still ALIVE but otherwise incapacitated (mentally and/or physically)
      1. Do they want to be resuscitated?
      2. Do they want to use feeding tubes if they can’t (or won’t, because they’re “not hungry” for days on end) eat? (This is common!)
      3. Do they want to just eat junk food if that’s what they’re asking for?
      4. Is hygiene important to them? Do they want their hair washed regularly and their nails kept trim, even if, in their crazy-state, they say they don’t want it?
    2. Have them write a will about what happens when they’re not still alive:
      1. Do they want a funeral? An obit? Cremation? Spread ashes somewhere?
        1. Believe it or not, a lot of people specify cremation but not “what next”. 
      2. Walk through all the steps.
        1. It helps to use a story (real or fake) about someone else’s experience about a parent who didn’t have one or more of these things and then how the family didn’t know what to do and gosh isn’t *that* awful?
        2. Feel free to use mine. My mom *had* a will and a living will; but she didn’t say what to do with her ashes when she went, she didn’t say what to do if she refused to have her nails trimmed or bathing, she didn’t say if she refused anything but dessert that that should be okay, she didn’t say what to do if she refused physical therapy. We spent months “guessing” what mom wanted because we couldn’t decipher between genuine obstinance, dementia, and what was best.

If your parent clearly needs help and you’re running out of the ability to provide it for them

  1. First, *objectively* assess your parent:
    1. When faced with authority – specifically, medical authority like doctors, nurses, pharmacists, therapists – are they compliant? Friendly? Acquiescent? Combative? Do they shine it on and do whatever they want anyway?
      1. This is important to address realistically, because any prospective healthcare environment (read: assisted living, etc.) will evaluate your parent – usually a nurse practitioner or therapist (or sometimes both) will both interview your parent *and talk to existing caregivers*.  And they take notes.
      2. If you have the combative/argumentative type, do they have an easy “key” – e.g., they can be bribed with food, or TV, or such?
    2. Do they have substance abuse issues? You must be clear about those, because it can impact medications and can complicate transitions.  A beer or glass of wine here or there is not really a problem.  A bottle of wine every day is a problem.  Most care centers do not allow alcohol at all.
    3. Do they get along with others?
      1. This will help you determine if, going to a facility, they need one that has lots of “community” events, or ones with lots of alone time or “anti social social events” (e.g., TV room).
      2. It will also impact how likely they are to receive the idea of having a roommate.
  2. What kind of care do you think they need?
    1. If they need someone to check on them once or twice a day, to make sure they took their meds, ate, bathed, etc., then you can probably use home health care – someone who visits (usually a team).  Sometimes they do Physical Therapy as well.  This may be more cost effective than a home, and can help out folks who are already living with mom or dad but just can’t do it all themselves.
    2. If they need more regular care – they have incontinence they can’t self-manage, they are a fall risk, they are in later stages of dementia, or a couple of visits a day just won’t cut it – consider Assisted Living. There’s a lot of varieties of these:
      1. Ones where the parent gets what looks like an “apartment” of their own, with some furnishings but can bring some from home, and they get “visitors” to check up on them. (Some of these facilities have in-house doctors, others have docs that visit but in-house nursing). They get to go to a cafeteria for food (restaurant style), there’s group TV and crafts and  posted schedule of things, there’s field trips, etc.
      2. Ones where the parent gets their own *room*, but it’s more in a corridor situation, with a private bath.  In this case they get a specialized bed (usually), nurses visit daily and take vital signs, they are on a special diet, etc. etc.
      3. Ones where they share a room (usually a function of cost of #2 above)
      4. Ones where they are in effect in “lockdown”, aka memory care; they have their own room but they have a monitoring wristband or such that means they can only move in certain areas of the facility, and people check up on them more often.  This is for the later stages of dementia.
        1. You might start with home health and branch slowly into assisted living, depending on what’s better for mom or dad, or what’s more cost effective.
      5. A doctor may recommend one or the other based on medical condition (do they need physical therapy? Are they hooked up to an IV? Do they have post-op healthcare they need to heal up from?) and the ability of the person living with mom/dad to physically lift them in an emergency (for example, my stepdad could not lift my mom, so she could not come home, because if she fell – and she had a history of doing that – there was no way to get her up).
  3. How much do you/they have to spend?
    1. Medicare does NOT COVER ASSISTED LIVING (or home health care)
      1. Medicare will cover specific physical therapy and post-operative recuperation stays at a rehabilitation clinic, for a max of N days (I think it’s 100), and only the first 20 are covered 100%
      2. And, if Medicare declines things that should be covered, you get to fight them (a lot) by using an appeals system (like described here).
      3. Most insurances do not cover assisted living (or home health care)
    2. Medicaid covers assisted living, but you usually have to blow through half (or more) of your cash assets FIRST.  Some elderly couples have divorces of convenience so the wife can keep the house so the husband can go to the assisted living place.  Medicaid’s coverage varies by state.
    3. Assisted living costs vary wildly, depending on what the facility offers and (frankly) how well-trained their staff are.  We wanted to get my mom into a really nice place, but they didn’t have wound care (she was post op and because of her vascular disease wouldn’t ever really heal). The really nice place was about $5500/month.  Where she ended up staying was about $11k/month, because they had wound care (e.g., the right kind of nurses available). 
    4. Home health care visits vary wildly as well, but it’s basically an hourly rate for two people and can range from $60-100 per visit, depending on what they do per visit.  That sounds like a lot, but as compared to $300/day, it may not be.

Next post: when it happens NOW.

In Vein: The Vein Strikes Back

“If you’re going to see any reaction, swelling, or pain, it will happen somewhere likely between day 5 and 10.”

For me, it happened on Day 9.

Day 8 I had spent with the Sammamish Troop 571 Scouts in the annual Christmas Tree pickup event (you leave your tree on the curb with a donation, they take it away and chip it). As navigator my job was to sit shotgun and tell the driver where to go for a car with 4 scouts (who collected trees). Essentially I didn’t move much on Day 8.

On Day 9, my leg started itching. Not much. Just a bit. Around noon I got that naggy itch you get when there’s a hair or something in your pants leg, and you find it annoying. It wasn’t much until about 6pm, when it started to increase — first my calf was itchy, then my inner knee, and then up my thigh. Investigating, I found a thick red stripe from entry point to leg crease, and it started to hurt.

The on-call doctor informed me that I am/was now part of the 5% of the population allergic to the vein glue. They had asked if I had ever had acrylic nails and I answered yes, as there was a period of time in my life — roughly four years–where they were de rigeur. The ensuing fifteen years has provided plenty of time for me to formulate an allergy. The advice was to take some antihistamines and see how that goes.

That didn’t go so well. The next day I was on the phone with my doctor, and the day after that I saw Dr. Pepper (I am not making that up, that is his name, and he has four family members who are also Doctors Pepper), who took one look at my leg and said, “Yep, wow, that’s really bad, you’re having an allergic reaction.”

(For those who like data: my left thigh at its most swollen was 3.5″ thicker than my right thigh, and my calf reached almost 2″ thicker).

Onto the Steroids I go, which if you haven’t had a Prednisone Pack ever, are you in for a treat. It’s a tapered pack for six days, but on the FIRST day you take 6 doses. And if you get the pack at the end of the day, for the first day, you take all 6 doses at once, “before bed”.

I say “before bed” because you won’t sleep. In my case I got four loads of laundry done, some detailed analysis, updated some documentation, did some filing, did some housecleaning, emptied the dishwasher, reorganized part of my spice cabinet and half of a dozen other things I’m sure to remember later. For the record I was offered Ambien, but I’m not a fan and figured I’d make it productive.

The next day I had my regularly scheduled check up with Dr. Gibson, who indicated it looked like the steroids were working (Dr. Pepper had put a dotted outline to the swelling from the previous day, so I had a visual measurement aside from my tape measure), and I asked her if it was okay to run all or part of my half marathon. She asked when it was and I said “Sunday” (my time with her was on Wednesday). Verdict: I could walk the half marathon. Maybe run if I really really felt like it, for parts. She also cleared me to fly and did a quick ultrasound to ensure no DVT was present (there shouldn’t have been but hey I was in and the machine was right there).

Today is Day Four. The remaining days’ doses were a normal taper (1 in the morning, 1 at lunch, 1 at dinner, 1 or 2 at bedtime) and the swelling continues to go down, even though I spent most of yesterday afternoon walking around Disneyland.  This morning there isn’t any soreness, but I’m still a bit swollen. I think this little episode has passed, so I’ll check in with another update (for those of you interested in the process) in about a month (with pictures).

 

The Illusion of Control

It’s a testament that my Cardiologist remembers my father when he asks me why I’ve come to see him and I reply by saying “this” and hand him my laptop with my Cholesterol charted over the last 9 years. The chart was full-on Excel, broken out into the different types (HDL, LDL, Triglycerides, Total Cholesterol, and my ratio on a 2nd series). I am not the only one in my family to chart a bunch of things in Excel and come armed to a doctor’s appointment with data. “Ah,” he said, “You’re discovering that your cholesterol is going up in spite of what you do to make it not.”

I had explained about the diet and the exercise, I had explained about seeing it go down back in 2010 and in 2012 when I undertook larger physical activities (namely the Ride to Conquer Cancer and the STP), and how with Ragnar (last year and this) there was no downturn. With a restrictive diet there was no downturn.

I was prepared for him to tell me it is genetic (it is, both of my parents and their families have related histories) and I was prepared for him to tell me that short of “drastic changes” I wasn’t going to be able to make my LDL go down without help. I’m not a drastic person so I didn’t want to ask what “drastic changes” were, although I should have just for comparison.

Naturally, I expected him to whip out the ol’ prescription pad and prescribe a statin.

Nope.

“With young healthy people,” he said, and I could have kissed him for the “young” part except I had already figured by the waiting room that I was a good 20 years younger than his usual patient, “I don’t like to put them on statins.”

There’s another reason he’s not putting me on a statin, and that is because I have osteoarthritis in my joints. I’m able to run because I have a fabulous physical therapist, orthodic inserts in my shoes, and I use Hokas. But statins tend to cause joint pain, and I already get joint pain if I’m not careful, so statins, for me, right now, are not the magic bullet. The plan is to take 3 additional supplements, for 3 months, and come back for another round of lipid panels. The 3 supplements? Vitamin D (5000 IU, rather than the 1000 I’m already taking), CoQ10, and Cholestene.

(Can we just take a second to have three cheers for a Cardiologist who is Director of Cardiology for the hospital chain and has been practicing some 30+ years, offering an initial alternative medicine approach? Usually you have to seek that out. )

So, here we go. We’ll give this a try and see if it works; I feel like I’m in good hands.

Next up: The Great Protein Shake Challenge!

 

Choices and Consequences

I have struggled with my weight pretty much all of my life.  I remember being roughly eight or nine, seeing that I had skinny calves — what 8 or 9 year old doesn’t? — and despite my chubby belly, thinking I was skinny and resolving to eat *more* to fill out the calves.

I remember being in high school and feeling overweight and the solution then was to just not eat (or more accurately try to skip lunch or replace lunch with diet pepsi). What I wouldn’t give to have the body I had in high school (okay, okay, minus the acne).

I remember being just back from the student exchange, freshman year of college, and weighing 230 pounds and knowing that the reason the random guy in Statistics class asked me out was because he knew I’d be grateful. (Sweetly verified by his friend in a side comment).

I remember going to the gym with  my friend Colleen — the person who introduced me to gyms and I wish it had been sooner — and by virtue of a hairy-chested trainer named Vinny and a spreadsheet of exercises, losing all of that weight and getting into the best shape of my life.

I remember thinking that was that and I wouldn’t have to struggle with my weight anymore. Then I got married at 200 pounds. I remember getting our wedding pictures and crying for two hours.

I remember eating nothing but Slimfast and Lean Cuisine when my then -husband (USMC) would deploy, walking 3 times a week and thinking I’d finally kicked it.

I remember moving back up to Washington in 2000, having gained it all back.

I remember deciding that if I was going to have a baby — my son was very, very planned — that I was going to need to be healthy if not for myself then for him. And so before I got pregnant (2002) I lost the weight again, and for the most part have kept it off (I have fluctuated by about 10 pounds here and there ever since). I have been in and out of gym memberships (the current one is the longest lasting) and signed up for random events (half marathons, a triathlon, a couple of double-century bike rides and a couple of Ragnars), and for the most part have been doing okay, weight-wise.

Here I am at 42 and the issue is not weight. I recently lost a little and that’s fine, but my goal has been health — being able to run, and trying to be good about what I put into my mouth. At my annual exam in April I got my blood tested and my cholesterol had eeked up; having a family history of cardiovascular problems I took it as a warning bell and tightened up: I quit dairy (except for nonfat greek yogurt and lowfat frozen yogurt). I quit red meat (ok, I had red meat twice in 3 months). I kept up the running (training for Ragnar helped). I took fiber daily. I haven’t had anything to drink since May 1st. Protein shakes for breakfast nearly every morning, with berries and bananas using soy milk.

Three months later I’m back at the doctor’s office, back giving blood, and my triglicerides went down but my LDL shot up 20 points. I have been tracking every bit of food I eat since February (I’ve been using MyFitnessPal off and on for about six years) and I couldn’t figure it out… until I looked at breakfast. My protein shake, the most virtuous thing about my day, has 25% of my daily recommended cholesterol. I wouldn’t have thought it — why would a *protein shake* have cholesterol (I mean, they engineer the crap out of the contents so why not engineer that out?). Vigilance, ever vigilance.

I have an appointment with a cardiologist this Wednesday. You know you get to sit at the big kids table at Thanksgiving dinner when you can not only chip in on the political debates and discussion about the markets, but you also have your own set of health issues to contrast and compare in on, and you officially have a Cardiologist (to go with your other specialist doctors).

So here I am: nearly 43. Weight-stable (losing a little still and that’s fine). Active. I have arthritis and high cholesterol, low blood pressure and Raynaud’s. I have three of those in check. Now I just have to lock down the fourth.

Once more into the breach, dear friends…

Sticky

I freely admit it has been quite a bit of time since I’ve last blogged, a fact which was hammered home to me this morning when I logged into the site and had to hesitate a few times before remembering my login and password. I have already locked myself out of a bank account this morning for the lack of correct memory, and I’m having to wait until 8am Eastern Standard Time tomorrow to correct that, so you can see how there was some trepidation there.

“Things have been busy”, or words to that effect, come to mind; but that phrase and those circumstances are the point of a different post. Given how long it took me to write this one I think you can safely return to the site in April.

In the meantime, I wanted to talk about tape.

Up until yesterday late afternoon, I had spent some five days with an eighteen-inch strip of K-tape diagonally across my back, left shoulder to right kidney. Its purpose was to keep my posture corrected, as when I had gone to the doctor on Tuesday she discovered that if my feet/knees/hips were straight and forward, my torso and shoulders were not. They were angled slightly to the right. While this wasn’t immediately noticeable to me (nor, do I think, it was noticeable to those around me, otherwise I’m pretty sure someone would have mentioned it), it did mean that when I attempted to run I was doing so in such a fashion as to cause myself some pain and definite damage.

Yes, I’m running again.

Having once again signed up for an event (well, two now) because I seem to have a disconnect between what I want to do and what I can do, I set myself to the doctor with a clear and concise goal: Her job is to get me running again with little or no pain. My job is to do exactly what she tells me to, however ridiculous.

This has led to some uncomfortable and odd things, and an 18-inch piece of bright blue tape across my back was the least of them.

Up until now those exercise balls you see at the gym — or sometimes people at work sit on them, they’re supposed to help your core — have been something for me to toss out-of-the-way whilst I put down a mat and did “real” exercise.  Now, I have to do things like balance on them, on my shins. Currently this looks like me kneeling on the ball, with the ball under my shins, and my hands along the equator of the ball, so I am hunched over. One could forgive themselves for thinking I was praying, because there is quite a bit of muttering going on. My original goal was to reach 8 seconds (note to self: much safer than riding a bull) and then my next goal is to do this without hands to steady me. I though she was off her nut until an acquaintance of mine, who just had open heart surgery 3 weeks back, posted a picture of himself on an exercise ball. He was on his shins, but the rest of him was bolt upright. Touché.

I have also had to modify the way I run. The original method of running was to go to the gym, get on the treadmill, and set a speed. I’d zone out to some music and/or to the work problem of the day (I do better running if I don’t have to think about it) and the treadmill would effectively “run” me.  The problem with the treadmill running you is that it does exactly that — it forces you at a certain pace and it may be that your body wasn’t ready to take that next footfall at that particular split second. Ow. Ow. Ow.  So, I need to run outside now. In the Puget Sound Area. In Winter. (NB: today’s run was fine, thanks to an unseasonably warm patch, but I’m not looking forward to the typical mid-forties — or lower — cold and rain that will greet me Tuesday morning).

Then there’s another bit of tape I need to have every time I run: Leukotape, McConnell-taped across my lower left knee. Effectively it creates a pocket of the swollen, damaged tissue that is my left knee (viscosupplementation has not done that knee long-term favors — I haven’t had an injection in a year and I’m going to try to stay away) and smashes it into the space between my kneecap and the right of my left kneecap. It’s precisely that weird flesh color that band-aid uses and that no one’s flesh actually is, except possibly Speaker Boehner’s. It also leaves a very unattractive grey adhesive outline when removed, and if you do it too often you can get a nasty rash. It works well for hair removal, though.

As a result of all of this activity my FitBit and EveryMove think I’m awesome and are suitably praising me with little icons in the typical fashion of gamified fitness. I’m having to mark my actual success, however, in distance increase (now back up to 2.5mi after a small detour) and reduced visits to the PT.

Someday I won’t have to use tape to hold me together properly, either.

Hot Yoga: Confessions of a Reluctant Convert

I had spent probably six years wanting to look down my nose at hot yoga, with all of its purported smelliness, its special gear, its special words (Namaste, indeed), and the trendiness of yoga pants that you could or couldn’t see through. How could it be real exercise when it’s just extrapolated stretching? How can anyone take it seriously in that gear? Then I took up cycling and the gear argument went out the door. After you shamelessly go to the Safeway in clippie shoes and chamois-padded bike shorts, any sense of dignity in costume is gone.

The kicker for me was about a six months ago when my dad told me he had taken up yoga and it did wonders for his back.

I have inherited many things from my father, good and bad. I am stubborn, I can be very black and white, I am very plain-spoken. I dislike mayonnaise, I can be extremely pragmatic, and my knees and back are increasingly problematic. I didn’t get the piano playing skills, but I got the good hair and straight teeth. When I got to my mid thirties we started comparing knee injuries, back injuries, and what color of therapy bands we were using.

So when my dad said yoga really helped him with his back, I listened. I didn’t march right down to the gym to go try a class, because that would take actual effort, but I did listen. And then I did attend a class at the gym and it was pretty much everything you think of when you think of “hot yoga”: a 15×15 room filled with various bodies in yoga-esque clothing, a calming instructor, seventeen or twenty painful poses, everyone dripping sweat, and I could tell who was a fan of garlic and/or cheese. It wasn’t awful but it wasn’t great.

I left yoga to its own devices; I didn’t look down my nose at it but I assured myself it was not for me.

My best friend and I were chatting a couple of months ago and, as I pointed out the new Hot Yoga place just down the hill from me, she pointed out she had been going and she found it better than meditation to calm her mind. As someone who also suffers from chronic insomnia, this sounded like a good idea. The new place had a deal: 6 classes for $10 in two weeks. For the price of three lattes I could scientifically test the benefits of yoga! That this coincided with the last week of my old job, and a week off, made for an excellent test bed. And so I signed up.

It’s been a month now. I haven’t had back pain in that time. I have had only two (2) nights of insomnia. I am inelegant in class, I am not the lean-and-limber yoga Barbie; then again there are many in my class who are not. I have seen progress in my flexibility and balance, but frankly, the fact that my back doesn’t routinely go out, and that I can run again without pain in my knees, is selling point enough.

Then there are the personalities: I try to go every Thursday night (for a variety of reasons) but it seems I’m of a minority with a regular schedule. In six weeks of attendance I have seen maybe one or two people in any two classes, the rest of the cast members change out regularly. There are a couple of yoga Barbies — and they know it — but hats off to them because not only do they look it, but they can do that one pose where you balance on the ball of one foot while in lotus with your hands up. Or the other one where you fold yourself in half, and bend over (I think it’s called “sleeping eagle” but for me it’s called “impossible”). Then there was Tatooed Yoga Jesus: a man who looked like the Oxford-Christian Jesus picture but in yoga pants, no shirt, and tattoos all over his arms, back, and chest. Again, the inclination is to mentally tease him, but Yoga Jesus knew his stuff too. Even the inflated, gym-rat-football-player-looking-dude could get some of the more difficult versions.  And then there’s plenty of people like me: not quite with-it, but improving; dripping sweat and forcing muscles to do things they aren’t used to, secure in the knowledge of a pain-free back and a good night’s sleep.

That is worth any amount of self-imposed awkwardness.

The Ultimate Driving Machine

Just warning you: this post is a rant, mixed with a little bit of a whine.

On my way to work there is a nice stretch of straight road, maybe a mile long, that toddles along at 55 miles per hour, before it kludges up with traffic. It provides a nice counterbalance to the 25mph crawl I have through the suburbs before I get there, and it offers an opportunity to relax.

This morning as I drove along I let my left hand drop and it rested on my knee, the same one that I went in to get visco yesterday on. It felt damp so I looked down, and discovered that the injection site was seeping. Oh, joy. Back to the house to change bandages, change jeans, apply detergent to the stain, etc. Such are the joys of medical maintenance.

(Editor’s note: I asked for it. Now with an ultrasound machine and another six months of technique improvement, I was able to walk unassisted after the injection and by end of day my knee felt totally normal. So I didn’t exactly follow the instructions and went to the gym. I’m not a total idiot, all I did was upper body stuff, but clearly I had pissed something off.)

In the meantime, I’m struggling with a “decision” I need to make: my lower back. Arthritis isn’t uncommon in people over 40 (or, in my case, 39) and the PT should take care of the pain I have. Up until a week ago I would’ve said “what pain” because when I run, or indeed do pretty much anything else active, it’s not my back that hurts. My upper right leg hurts. Figuring that this was my body’s way of insisting I get a full set of x-rays, one body part at a time, I went back to the doc.

“So, my back is all better, but my upper leg is hurting, particularly when I run. The PT thinks it’s my psoas.”

“I think it’s your lower back.”

“No, no, my lower back feels great.”

“Yeah, I still think it’s referred pain from your lower back.”

“Well, okay”

Here she had me lay down on my stomach, flipped up my shirt, and started poking at my spine.

“Does this hurt?” (poke)

“No.”

“Does this hurt?” (poke)

“No.”

“Does this hurt?” (po-)“AAAAAAAAAARGH”.

“Yep, it’s your lower back.”

After brief consultation, here is the treatment plan: Go back to Physical Therapy (more time with my friend Dan, I see) and, if that doesn’t solve it in another month or so, start thinking about spinal injections.

Spinal. Injections.

I have no problem with needles (blood donation, tattoos, piercings, etc.) and I have no problem with my spine (apart from it being in pain) and one time in my life I didn’t mind having an injection into my spine (hello, Epidural!). But the idea of ongoing annual (or semi-annual) pokes into my trunk does not sound good, for a variety of reasons.

Being handed the ersatz ultimatum, such as it is, that if I do NOT get better with PT in about a month then we need to “look at this”, puts undue pressure (I feel) on the viability of the PT. This last two months’ worth have succeeded in radiating the pain OUT, in half that time we need to radiate the pain back in and start making it go away. It’s like being handed an assignment you’re likely to fail at. If I had that kind of control over my body I wouldn’t be IN this position.

This whole process feels a bit like my commute… slow crawling progression, nice coasting parts, followed almost immediately by infuriatingly gnarled systems.

An Open Letter to My Personal Trainer, David

Well David, it’s that time again, where I’ve done something rash and signed up for something I probably shouldn’t do. There’s a timeline involved, and some frankly optimistic requirements; I figured I’d apologize now and get it over with.

You see, I let the Ms.Krieant sign me up for Tough Mudder, and I have a little under 13 weeks to get ready. It has some impressive obstacles, most of which have me scared out of my mind, but as you know once I’ve said I’ll do something, I’ll do it…

…as long as I get to whine a lot about it.

So I realize that up until now your charge has been mostly to try to get me stronger while avoiding the injury of the month; in our short tenure together this has meant occasionally avoiding my knees, my neck, my upper back, my lower back, or my right hip. Now we need to ignore all of that, because I will need all of those parts working and functional.

I also realize that this means that the chattiness of our sessions will have to reduce, that we can no longer freely evaluate others in the gym as you hand me five more pounds of something or have me do 15 more push-ups. It means that you’re likely to give me homework, that I will need to actually do weight work more than twice a week, and that I will be very, very sore these ensuing weeks.

But David, I’m turning 40.

I realize this isn’t much to you — I think 40 hit and flew by for you about a decade ago, not that you’d notice, being an ex-Marine and all. I realize this isn’t much to most of our early-morning compatriots, as I think the average age at the gym at our time of morning is mid-50’s. It isn’t technically even much to me in the sense that I’m not having a huge to-do over it, nor do I want to see black balloons, nor do I think the day after my birthday I will suddenly fall apart or feel older. The fact is, David, I’m tired of having my body feel older now.

Five years ago I entered into a half marathon, having never run, because someone told me I couldn’t do it. (Actually, he laughed and said, “yah, right”). Three years ago I entered into a 2-day, 160-mile bike ride because someone said I wouldn’t want to do it. Last year I did the STP pretty much under the same auspices. And each time, I injured myself either in training or in the event itself. But each time, I did the training without any professional help.

You’re here to fix that, David, because at 40, I’ve decided I’m tired of injuring myself. And this likely means I’ll have to do a lot of things I was heretofore unprepared to do, like go to the gym more than 4 times per week and maybe, actually, you know, stretch. Perhaps even do my regular PT exercises. I have a support group in my friends — one lent a very pertinent book (Supple Leopard, indeed), one gave me tips on how to deal with the electric shocks (or at least a realistic impression of what they’re like). But your job is to make sure I’m ready, and so I really do hope you’ll understand the bullet-pointed list you’re going to get when next we see each other.

I still reserve the right to whine, though.

AGAIN with the Injury

Point of clarification: I have NOT entered into any major sporting event (yet) (I may or may not have been conned into doing Tough Mudder thanks to Ms. Krieant), I have done nothing out of the usual in workouts lately, and yet I’ve managed to muss up my hip flexor. This doesn’t take any particular talent, other than having a crap-tastic lower back, because (fun fact) the hip flexor runs from your lower back and wraps around the front, down into your inner thigh. F-ing with your hip flexor feels rather like having a pulled muscle right where the cut of your leg is, and I can tell you from personal experience it 1. doesn’t go away after a few days (we’re working on two weeks, here) and 2. it is really awful to get PT for it.

Mind you, my PT is for my lower back (hello, arthritis, so very wonderful to see you there too) but suddenly that felt fine and this other area started hurting. As I associate visiting the PT with a massive amount of whining, I added that in for good measure, and Dr. Dan arched an eyebrow (never, ever a good sign) and started asking questions. Since the 3 people you should never lie to are your doctor, your lawyer, and your self, I told the truth… and found myself lying back on the table and having him digging his hands into my pelvis.

I am not exaggerating.

Because your psoas (aka, hip flexor) is so buried and deep, the only way to get it to chill the *F* out is to dig in between your gut and your hip bone, quite deep, while extending and contracting the affected leg. This feels appallingly like having someone dig into your pelvis to clean out the inside of the bone, much like you take a spoon to the inside of pumpkin mash when making Jack-o-lanterns. It doesn’t SCREAMING hurt, but it is one of the least pleasant things I’ve let another human being do to me.

Today was my second session in PT for this (actually, for the lower back facets issue but apparently this gets grouped under that) and I can walk without limping but I’m still not allowed to run. This weekend I’m off to cub scout camp so we’ll see if a Hobbly Mom is okay.

Advil, take me away…