Jan. 17th, 2011

coffeebuzz: (Default)
I don't do New Year's resolutions.

Everyone who knows me knows this. The idea just seems silly and pointless to me. I mean, how on Earth is January 1st some magic date when you can make a stronger commitment to something than you could on, say, September 20th, or June 3rd? Oh, sure, there's the whole idea of starting a fresh new year, beginning with a clean slate, etc. But if you can show me someone whose slate is actually clean on January 1st, I'll show you someone who's never had a utility bill, car payment or revolving charge to worry about.

In any case, I don't do the annual resolution ritual. But I am making some promises to myself this year. I've been formulating them since before Christmas; actually, since the day in November when I realized my dad would be going from his most recent hospitalization into a nursing home because his physical and mental needs had finally outstripped my ability to meet them and I had to admit to myself that I couldn't do it anymore.

I've spent four years as a full-time home caregiver. Four years of increasing responsibilities, and decreasing social and intellectual life. I don't regret doing it, because someone had to. As the only child, there was no one else to do it. And there's a part of me that feels vaguely guilty about the sense of relief that washed over me once I realized that I could hang up the accoutrements of that job and move back into the normal everyday world of most middle-aged adults: gainful employment, a steady paycheck, a daily commute, and time spent with other adults who have full command of all their faculties, both mental and physical. A social life. Some private time, too. Because I don't have children, I'd been accustomed to more of that than some of my peers before I took on the task of caring for my father. And while I didn't mind giving up some of it, I really do crave a certain amount. Everyone needs that now and then.

I know I really shouldn't feel guilty. When you spend all your time taking care of others, who takes care of you? I need all those things I've just mentioned. I also need some time to finally take care of my own mental and physical well-being.

Perhaps a year into my stint as a caregiver, I managed to injure my left knee rather spectacularly. Surprisingly, I don't even recall exactly how or when I did this, and suspect it may in fact have happened in stages. I did several small things to that knee over time, culminating in an inability to walk without limping, sometimes rather severely. Now, I happen to have the pain tolerance from hell, and kept telling myself to just "walk it off". I even went camping like that, hobbling all over Cooper's Lake Campground in Slippery Rock, PA and ignoring the pain in my knee because dammit, I was having fun. Someone else was caring for Dad for a few days and I was taking some badly-needed "me time" with friends and the outdoors.

My friends made me promise to see a doctor when I got back. One GP visit, one MRI and one visit to an orthopedic surgeon later, I learned that I was the not-so-proud owner of a completely torn ACL and a partially torn meniscus. The surgeon said I didn't need surgery, and opted to send me to physical therapy instead. No objection from me. So for weeks I attended my PT sessions, did my exercises, swam in the pool at the YMCA, and took anti-inflammatory medication. I lost the limp and most of the pain, and was discharged from PT just before Christmas with permission to "return to normal activities". Hah. My normal activities involved keeping house and caring for an elderly man with dementia who required supervision and quite a lot of help with tasks. I'd never actually stopped doing any of that. But it was nice to know that I now had permission.

Not quite a month later, I was taking a walk. I'd been told to make sure I got regular exercise to keep my knee in shape. You don't have to tell me twice; I pretty much have to get out and do something like that every day or I don't feel physically right. It can be hard to do that when you need to supervise someone else who can't go out and do that with you, though. But on this day, Argues_With_Objects was home with Dad, and I went walking. It had sleeted and snowed over the preceding several days (Cleveland winters, yay) and as I made my way along the sidewalk in my suburb's business district, I chanced upon a patch of very icy sidewalk in front of an antiques dealer's shop. The shop owners hadn't bothered to do anything about the ice, not even salt, and down I went with a broken right ankle. I felt a snap inside my Timberland boot and knew I was in trouble.

At the ER, the ankle was x-rayed, strapped into a backslab (temporary) cast, and I was given a set of crutches and the diagnosis of a broken fibula. Now, I'd used crutches before, when I'd sprained an ankle in college. But back then, I'd had one good leg that was willing to do the work along with the crutches.

I didn't have that this time. Clearly, my left knee felt it was too soon to be asked to do that much work, PT notwithstanding. I barely made it into the house and up to the second-floor apartment that AWO and I inhabited (Dad's was downstairs, and he and I routinely spent most of our waking hours together in one or the other) before collapsing on the couch. "I don't know about this," I said to my best friend Samantha, who'd accompanied me to the ER and home again.

"You'll be fine," she said. "It just takes practice."

I soldiered on, even venturing back out with her to our SCA meeting that night. By that time, I needed the distraction. The next day, I went back to the same orthopedist who'd just discharged me from PT for my left knee, to get the ankle put into a proper cast. "You again?" he joked.

I got some 'crutch lessons' while I was there, had the crutches adjusted better for my admittedly insignificant height, and went back home, where I proceeded to lose my balance several times and nearly fall as my left knee refused to cooperate. Eventually I did fall, my head narrowly missing the edge of the dining-room table as I went down.

"I really think this is going to be a problem," I said. Another conversation with the doctor ensued, this time by phone, during which we agreed that the risk of compounding the injury with another was too great. I would have to use a wheelchair while my ankle healed.

Take a normally highly-active person and put them in a wheelchair for several weeks, and it's a sure-fire recipe for trouble. I was stressed, depressed, annoyed, fidgety as all-get-out, and figuratively climbing the walls. On top of that, I developed complications.

I'd had a blood clot in my right calf several years earlier, and spent not quite a week in the hospital while it was treated. No testing was done at the time to determine the actual underlying cause, as I'd been new on my job and my health coverage hadn't kicked in yet. The attending physician surmised that the clot was the result of a combination of a muscle strain and the estrogen in my birth control pills, coupled with exposure to secondhand smoke and the fact that I was 37 years old. Now, after spending several weeks confined to a wheelchair with my right leg encased in a cast from just below the knee to the beginning of my toes, I developed a clot in the thigh. This time I had full insurance, and while I spent another week in the hospital getting the clot dissolved through the magic of intravenous heparin, the same doc ordered a series of tests, including a genetic assay.

Turns out I'm a mutant.

No, seriously. I have one bad copy of a gene that codes for a clotting protein called fibrin. So half my fibrin chains lack a specific spot where they can be cleaved by an enzyme designed to help the body break them down and recycle or eliminate them. A simple but erroneous substitution of one amino acid for another on the chain leaves me with a higher-than-normal level of fibrin circulating in my blood, and hence, at a higher risk for clots.

Thing is, a broken bone can also lead to a blood clot, even in a person with completely normal genes. So it was still a toss-up as to what the real cause was for my particular clot.

I came home from the hospital minus the cast and the wheelchair, and wearing a walking boot on the injured ankle, armed with a walker and, yes, crutches again. The physical therapist who'd worked with me on stair-climbing skills before my discharge was nonplussed when I responded to her instruction to put my good leg forward in going up the stairs with the question, "Which one is that?" She consulted my chart, eventually decding that the one with the recently-fractured fibula was the "good" leg, a situation completely opposite from what normally would have been the case. That was interesting.

I also came home with prescription anticoagulant medication, warfarin. (Frighteningly, this same chemical is also a major ingredient in commercial rat poison.) Some people can take it and feel just fine, but I'm clearly not one of them. Over the next almost six months, I endured waking up every morning feeling like I was eighty years old instead of forty-three going on forty-four. Three rare but possible side effects of the medication I was on are reactive hypoglycemia, auto-immune disturbance and joint pain, and in someone who already has had joint injuries, that last one represents a real problem, even with my high tolerance for pain. I suffered all three side effects and barely made it through the physical tasks of the day, keeping house and caring for Dad. I got no exercise, and no relief from the pain because you can't take aspirin, ibuprofen or other NSAIDs when you're on anticoagulants. Tylenol does nothing for me, and while I was offered some of the opiate-based pain meds, I refuse to take that stuff on anything resembling a regular basis. So I just had to live with constant pain.

My weight shot up, my mood hit rock bottom, and I was miserable in every possible dimension. I finally went to the doctor again and demanded a better way. "I won't keep taking these for the rest of my life," I told him. "I'd rather risk another clot. This is a quality of life issue."

Thank goodness for doctors who actually listen to their patients. We had a long talk, and he decided that because I'm so very in tune with my body and my health -- I'll recognize clot symptoms early enough and get myself to an ER if I have them -- and because I normally eat a diet rich in foods that are natural anticoagulants, like garlic, capsaicin and other things, my clotting risk could be minimized by a combination of diet, exercise and an overall healthy lifestyle. Basically, the very same things that had most likely prevented my having a clot prior to the age of 37 despite my risk factors. There's actually every reason to believe that I'll never have another clot, as long as I take care of myself and follow basic, common-sense precautions like not flying coach, and not sitting around on my butt for hours on end. None of this is difficult.

Once I was free of the drugs, the hypoglycemia vanished. My joint pain leveled off and finally disappeared as well. I was still faced with the momumental task of getting back to where I'd been before all of this happened, however, and with the constant need to look after Dad, I had almost zero time available to exercise. Housework won't do it alone, no matter how healthy my diet is. Not to mention that the medication I'd been on can interfere with thyroid production in some people (apparently this is part of the autoimmune effects) and it doesn't always return to normal once the medication is discontinued. I know I've had several of the symptoms of hypothyroidism since then, but when you're constantly busy taking care of someone who can't even really function, you tend to just muddle through and be grateful for whatever level of functionality you may have that allows you to do so.

But that's all changed. Now I don't have to take care of anybody but myself. I've got time to track down what's going on with my own health, and I'm going to get it straightened out. I was what one of my friends referred to as "disgustingly healthy" before I got hurt, so why should I settle for anything less than that now?

Also, while it isn't a New Year's resolution, I've purchased a gym membership. I'm going to make this happen. It may take a while, since pushing too hard too quickly could well result in yet another injury, which I don't need. But I don't mind taking the slow route, as long as it gets me where I need to go.

Time to go buy a new combination lock and some sneakers. Oh, and a coffee mug I can take to the gym.

July 2017

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