A Super-Bendy (Hypermobile/EDS) Recovers From Joint-Replacement Surgery; Chapter One

This is, in fact, Day Seven Post-op of having a joint replaced in the left wrist, or an arthoplasty CMC . ***If you cannot abide reading medical descriptions, skip to the next paragraph and cute dog pics. The trapezium bone was removed, replaced by a tendon graft and the bones hitched back together with a tiny tightwire. I always dreamed I'd do acrobatics and tightwire stunts. Fancy this being the first one.

I'll start here and in future chapters work back to when this hand first became a problem, but fresh things first. I am accompanied by a warm weight pressed up against my knees in the form of woman's most faithful friend (until the mailman shows up), Tuxy Pup. He desires nothing more of a morning than for his person to stay put for the duration of his morning nap.

 

We are back in a comfortable position, pillows in place under left elbow, ready to chronicle recovery as I live it. But earlier I did a very easy-going set of stretches. I am not going to get all stiff and old because of my left thumb. I am drinking as well, as much water as I can remember to drink each day. Recovery hinges on a balance of all three. Move. Rest. Hydrate.

Surgery Day, as you might imagine, was woozy, fuzzy, and tired until it wasn't. There was a good deal of meditation on gratitude and some silent cussing. My rambling notes, scrawled on a tablet with my Apple pencil went something like this, "Think of everything that is pain-free. Toes? check! left leg, right leg, torso, right arm, right hand, neck, eyes, nose, whole head? Check, check! I am so fortunate!" I even used pretty colors. And no cussing.

How could I complain when my husband had rearranged his day, his month around this to take care of every detail, meal, animal, and child? What's more, I was not going to whine about a choice I made freely. 

Nevertheless, the truth is, when the nurse tells you, "take a pain pill when you first start to notice pins and needles," it is a good idea to do just that. They know what they're talking about. I blame timing and a chronic low-pain tolerance for what happened. 

They said, "a nerve-block can last for up to 24 hours, if it hasn't worn off before you go to bed, take the meds to be safe." That was my plan. But, the pins and needles warning sign came two hours after surgery as I was being bundled into the backseat to head home. I thought it might just be the new positioning of my arm or imagination. I have a bright and vivid imagination that goes into overdrive for anything with the smallest hint of the catastrophic. When the pain began vaguely in the heavily-bandaged region of the joint that had been gussied up, I knew that this time it had to be my imagination. There was no way I could have any feeling at all in this arm when the nerve block was so clearly still at work. 

How did I know this? Remember when the fake wizard professor, Gilderoy Lockhart, casts a spell that eliminates all the bones in Harry Potter's arm? When it goes all gooey and limp right there on the Quidditch field? Yes, well, that was the exact appearance of my arm too. Like jelly, zero control over it, made you queasy to look at. The nerve was blocked. For real. Fingers could not wiggle. And...weirdest of all, I could not get a grasp on its coordinates. 

My arm was still in the position it had been in just before they jabbed me with the magical nerve block needle. This was the oddest encounter of the day, not the half-remembered conversation I had as I woke up still in the freezing cold operating room, nor the loopy happiness of seeing my darling still in my hospital room as though he'd never left, even though it had been almost two hours but felt like 3 minutes. No, what my brain could not wrap itself around was where it believed my arm to be and where my eyes said it was, stretched out and bandaged up, way off to the side.

But still it hurt in a dull, aching way. The wiggling capacity returned suddenly, and then it was too late. I accepted two ibuprofen. They did not seem very effective. One pain pill an hour later did not much help either, but I didn't know what other side effects the drugs might have...like vomiting. Who wants to vomit when clean up will be someone else's duty? I would have to breathe through it. Until around midnight when I gave in and chose to take TWO pills. Best solution ever.

Speaking of decisions, this whole thing was not undertaken lightly. I have been present for too many limb surgery recovery visits as an interpreter (nine years worth) to believe in the always happily-ever-after of opening up body parts and making it all like new. It does happen and surgeons can be miracle-workers, but it is science, not magic. In science there are variables. 

My major variable is hypermobility (or super-loose joints), a form of Ehlers-Danlos Syndrome which has meant many things, as those of you who are familiar with it, (fellow zebras) can recount in detail. A few years ago, I wrote that surgery was not an option. What changed?

That is a topic for the next post. Suffice it to say that the arthritis pain could no longer be dealt with to my satisfaction in an alternative manner.

Today I will focus on recovery.

Day One following surgery, ugh, the barf I had avoided and feared appeared. Pain and nausea...typical post-op misery I knew, how many times had I seen patients in similar straights? Was it due to tacos for lunch or the pain medication? Hard to tell. I ended the day with tea and rice crackers.

Day Two, I sleep until 9, which is noon in my normal world.

-I read, clean up left-over invoices and emails, read and sleep.

-I get dressed, professionally, and work for two hours plus over Zoom. I thought I was going to be ready for this. It was a long and emotionally taxing interview. Once finished, I am wiped. 

My thoughts on Day Three, still mainly resting sitting still but off the strong stuff, down to a couple NSAs twice a day:

-Marvel at what a gifted surgeon can do today so that a person will be able to move; lift, drive, type and knit tomorrow. And wince, just a teensy bit, from time to time.

-Contemplating the terms Arthroplasty CMC and mini T-rope fixation, which serve as a reminder NOT TO USE THE THUMB. The only admonition from the doctor.

-Fortunate indeed to be free to swivel my head from side to side, to feel I lack no flexibility of body or inferior limbs (did this hypermobile human really say that?)

-Even luckier to have scrumptious food brought to my side at any hour of the day or night. Thank you, sweetie doing all the cooking and cleaning and thank you to the friend who showed up with a whole beautiful meal.

Day Four, in which I wake up and get up and moving.

-Yesterday I moved, allowed to go up and down the stairs on my own finally. OK, the instinct to protect me from myself is not necessarily out of line, I am ever-so-slightly pone to running into things. I also went for a drive to see the river because I know it was missing me.

-Today though, the garden beckons in the fall air and sunshine, it is irresistible and being outside feels healing. I garden, or rather, I spend an hour picking disgusting bud-eating caterpillars off my geraniums, one-handed, being extra careful not to splash the cast as I drop their squirming forms into a blue ceramic bowl of soapy water. At least I grant them a somewhat noble end. 

-Rest, tea, snack then a stretch. As usual, when there is pain, I go to a pain-relief Essentrics slow video. It feels good to gently, gently stretch every body part, minus the thumbs. 

-This is the end of not resting for the day. It feels better to have my hand raised and cushioned. 

Day Five

-We take two walks, one with Tuxy Pup held in place by my sweetheart, one alone, just to make the most of yet another beautiful autumn day.

 -I feel much like normal; I even wake up before 7. The pain definitely is more apparent with exercise in which my wrist is free and blood can flow into it rather than away. Back up we go.

Day Six

-There is no one free to supervise a walk until evening and it feels like a betrayal to go out without dog, so I work all day, with no fatigue, then break at 5:30 for another Essentrics video, this one is called a connective tissue workout.  After the first two minutes of warm up exercises, it slows way way down for the rest of it. I adapt for this heavy thumb I'm toting around by doing the warm-ups in halftime and instead of reaching for a feather, it becomes a fluffy white kitten. For others who have EDS, you might want to remind yourself that "pull your shoulder right back, stretch it way out" may need be be modified to "gently, ever so gently extend whichever body part we're stretching today," lest the helpful exercise become less helpful.

-Remarkable for today: no pain medication until early evening, no fatigue, a little achiness and twinges, both of which have been present since surgery.

Day Seven, Eight, Nine...

The week is a holding pattern of waiting to heal and have the next visit with the doctor. The pain is completely manageable with rest and one small dose of an NSA each evening. I always wait until the end of the afternoon so that the pain, if any, can be a reminder to slow back down and let this heal properly. 

I have a couple of remote assignments, but mainly I study to learn how to teach more effectively. This has been an exciting week as I go back through two online classes on better consecutive interpreting and do all of the exercises myself there and in Note-taking for Consecutive Interpreting. This freedom of having time to study and plan has been a great gift. I was looking forward before to teaching a class on interpreting for a local college, but now I am super-psyched about what we will be able to accomplish in that classroom and beyond, in our community.

What we all want to know is...how does it turn out? Will I knit, type, drive and lift weights again? We shall discover it all together. 

More details also on the decision-making that went into this and the options offered and tried.

In the meantime, let me entertain you with strange tales of travel and encounters as a French interpreter, à tout de suite!

 

Connective Tissue Disorder (EDS) and Exercise

Neighborhood kids would call each other over to see me do the splits, all the way, without effort, when I was four years old. 

That ability remained, along with the weird, bend my thumb back around to the other side of my arm thing, ankles that could twist, doubled over and around, over nothing and go right back, but it was not until many years later that I discovered these were the result of a debilitating condition that meant that the springy parts of my youth were now the cranky parts of my body. 

Hypermobility Ehlers-Danlos, Sugar, and Working Out Anyway

Say "au revoir" to feeling that limitations are greater than possibility, but also to thinking it will all one day be figured out, nice and tidy and conquered. When what is in front of you, blocking your path is you, there are ways around, under and over yourself. Playing mind games helps. Long, deep conversations with good friends, a good husband and one's children help. Being the helper helps; the people I encounter in my job, in my life, who are living through difficult situations with dignity, never losing their gratitude for what is in front of them today, is a great motivator as well.

This applies to getting one's posterior up and off of the sofa too, even if you suffer from hypermobility of the sort that makes injuries more likely than not, as I do. Movement is the goal, now that the cold and snow have set in and things are just too cozy next to the fireplace or in the sun by the window. So many reasons not to ever go out again. 

As to the mind games; my mom was the first person in my life to use a timer as a motivational tool. If I had to use it today, I would do it backwards for results. As a child, I was a picky eater. Mom would set the timer, exasperated, for the time limit for me to finish my dinner. Granted, this was when everyone else had finished and left the table, after everything but my plate and fork had been cleared away. Today, I mark out days on the calendar and promise myself to avoid sugar or alcohol for X number of days. Thank you, Fly Lady, for your contemporary timer suggestion. If I set a timer and do nothing but the planned activity for that period of time, I fool myself into all sorts of activities of an indeterminate nature (that was today's synonym for "stuff"); like exercise, paperwork, and yes, even de-cluttering. Going to an exercise class, hemmed in by other individuals and with a teacher right in front of you is helpful too, like a super-charged timer.

Healthier and active makes for a better life for me. It means an easier time moving, easier to feel good about myself, and about the whole rest of the world that continually seems to be breaking out of its mold to fly into a million messed up pieces. If I wake up and move, it starts the day out right.

It can be hard to start when the journey looks so forbidding and strewn with obstacles large and small. If it is the sheer number of pounds overwhelming one, I do understand. If I count the weight gained and lost (with difficulty) over a lifetime, I could easily be obese. Here is the math, offered as proof of my own struggle; after one year abroad as an exchange student; 25 pounds, five children; 40 pounds times 5, and one major weight gain at age 41; 30 pounds. That makes me plus...hold on, let me mulitply and add a minute...over 275 lbs.

During pregnancy number four: (and not at the end, either!)

 
As we grow older, it is the physical limitations that can easily discourage us from exercise. I have had many times when it did not look like my long-term fitness had a gnat's chance in a barrel of honey. 

 

Due to some serious hyper-mobility of my joints, I have always injured easily; I might pick up the market basket the wrong way and my wrist will hurt for three weeks. 

 

The advice, and logic, was to "rest until it no longer hurts to use it." Once I finally had to quit everything I had so valiantly (in my opinion) managed to incorporate into my life; running, weight-training, long, daily walks with the kids, because my foot was broken from simple overuse, I knew I needed a new plan. It was the sports medicine physical therapist who helped me find ways to modify activities to accommodate and protect the injured part while still keeping active. Brilliant. Necessary. Strongly advised. Don't stop moving.

High-achievement comes naturally to humans, and I seem to excel in things that might be an excuse not to exercise, including skin so fragile that it can locate a rash floating in the air and cover itself with it in about two nano-seconds. If you have this sort of skin, you know I am not joking. I began my new gym-going life in long sleeves and white cotton gloves, with a pair of biking gloves over them, for  protection and to hide the eczema. Six years later, with the rashes mostly departed, I still wear the gloves, with the fingers cut off, under my weight-lifting gloves, for protection from the leather and synthetic mesh that would make me break out afresh if I sweated with this directly touching my skin. I keep my hair up off of my neck, because I seem to be allergic to my own hair too; I can develop angry, red welts in a fifteen-minute sweat session that will last for two weeks.What this means, is that sweating can seem like a really bad idea. How's that for encouraging the gym or a walk in warm weather?

The prognosis I am able to accept does not include; (as encouraged by some most informative websites) giving up weight-lifting, contemplating surgery, resorting to cortisone in any form, or sitting around with my booty on a heating pad for hours a day. I DID just buy my first heating pad since our hermit crab and lizard days; they needed it under the aquarium, I prefer it behind my shoulders.

Recently, things that kept me up and going; seeing a chiropractor as needed, a little acupuncture, a massage or two and a physical therapist for specific misbehaving body parts. I have pt-assigned exercises for my wrist and foot, and instructions from her for modifying certain movements in the weight-training class. For now, I am using lighter weights and some excellent gloves that support the wrist and thumb, Trideer is the brand I found, there are others, these have a wrist strap attached that offers excellent support.

On the other five days, I walk, jump on the trampoline and do Essentrics. A few times a week, Thierry joins me in the cardio cinema (this room in our Y with treadmills, bikes and elliptical things), and we watch part of a movie while working out. We rent our favorites for date night so we can see the whole thing.

And diet? More vegetables and good fat, no sugar. (BEEP: Lecture beginning, NOW. Only continue reading if you want to feel better and look better than you ever have.) Sugar is a factor in injury and failing to heal; see article links below for more information. I read a life-changing book this summer on the topic, but it has not been translated into English, from what I can see. It is called "Zero Sucre" by Danielle Gerkins. I read of her one-year, sugar-free experiment, and how she felt healthier, lost weight, and had skin that did not age a day in that year. Besides that, she details what sugar does to a body at a cellular level, damage I had not imagined possible, diseases no one would have if they only knew the price they would have to pay beforehand. (This has not necessarily always been able to convince me to put that mini-Snickers back in the trick-or-treat bowl right away, but it is good to have in the back of my mind as I  make choices.)

I have nothing but compassion for anyone attempting to establish your own fitness and wellness routine, with or without the addition of a connective tissue disorder. Maybe the journey has not even begun, it may be towards weight loss or weight gain, nevertheless, movement is life. I choose not to let anything keep me from moving, most days. My biggest impediment is simply inertia, the feeling that creeps across you when you are under the covers and the wind is howling outside, or you have a warm dog in your lap, a good movie on the laptop and an easy knitting project, all of which seem to be adroitly not whispering to go outside. 

 

Even housework or family can be non-incentives; there is too much to do, too many people to take too many places, or the sweetness of an afternoon playing games by the fire, sharing a newspaper over a cup of tea. It is easier for me to get out of bed and go early, than to fight the call to stay, under the rising level of conversation, needs and necessities keeping me here later. If the kids can't see me, they can't ask me a question that might lead to an answer that involves me dashing down to the basement to look for a missing sock, or to the computer to print out a form for school, I know you know, and you have your own reasons. These are mine, simply put, to let you know we are all on a similarly-shaped river or sea-worthy vessel. If yours are more compelling, please share below, and I promise to address finding a way around them. But before writing back; take a walk around the block, then tell me how you feel.

http://ktar.com/story/712965/the-surprising-link-between-sugar-and-chronic-pain/

https://www.health.harvard.edu/heart-health/the-sweet-danger-of-sugar

https://www.spinemd.com/vtfc/news/this-just-in-over-consumption-of-sugar-contributes-to-muscle-joint-pain

Minimalist Winter Fitness

The Midwest, like many places, is not the best place to get in a good daily walk or run, or even play in the backyard, in the winter. If there is snow, it is glorious for sledding, skiing and building forts for hours on end. Provided the wind chill is not in the "you will freeze within 5 minutes if you do not find shelter," range.

But a woman's gotta move if she does not want to go crazy around here (things have been on the wilder side of nuts).  My sweet, active, normally very helpful husband was down with a knee injury, one kid is in a wrist brace after multiple appointments with the same orthopedic people husband saw the week before). The immediate need for restructuring of a scout troop after the death of my sons' beloved scoutmaster, a very important sanctuary project getting underway at our church, preparation for one kiddo's audition for a creative arts academy, and show choir season beginning for another. And the flu; did I mention the flu? 

They are not all on a par, but they do have one thing in common; they are part of life's messiness that sucks time out of a day and leaves you flabby and cranky because you did not take a nanosecond to exercise. Bodypump is a class my husband and I normally do together, and the inspiration to get up all alone at 5 is lacking when the warm body next to yours is still slumbering.

The plan; DO IT FIRST and put the basement/living room/bedroom space to good use. Did you think that was simply a spot to house your recliner and telly?

One mini-trampoline, one screen and two DVDs. Cardio: 30-45 minutes on the mini-trampoline while watching the only tv I ever take time to watch, or listening to an audiobook (yesterday I tried to read a novel I'd unwisely gotten caught up in...it slows one down, or makes you nauseous as the words jump around a bit), and a half-hour or so of Essentrics to stretch it out, relieve pain that can come with intense exercise or because of hypermobility and make my day more comfortable. There are days when I cannot do both, and days when I spend more time on one or both. The only real secret is to do it. Go. Turn off the screen. See you later.

Spin on Fitness: and Caution for the Hypermobile

Oh...my...word...aie...gasp...ugh...taking my fitness challenge to a new level with a cycling class. I am 99.9% sure my derriere will not be functioning tomorrow. Not to sit on, not to move my legs, nothin'. But just as I start to think maybe one track will be sufficient for my first day of class, the smiling face of my Body Pump teacher stops by; "hey, are you taking up cycling?" -"Yeah," puff, wheez, "just starting, gasp, "think my butt will be sore tomorrow." "Good for you! Buy yourself a pair of padded shorts, that's less weird than a padded seat, right?" "Huh?" Bottom line; I stayed until the end of class; I had no idea whether or not my instructor was lurking in the shadows, waiting to see if I made it all the way through.

...that was a few short days ago, and incredibly, my tush suffered no lasting damage, but I am icing my knee for the 3rd day in a row. It quit. I hate that. Hypermobile individuals are more prone to osteoarthritis.

That knee injury may either be because of the running (just intervals I began again a couple of weeks ago), or the cycling or the crazy elliptical spree I went on for 15 minutes before class on Saturday. Hard to tell. (Update from the physical therapist: it was probably the running, or the standing up while cycling. Serves me right, show-off.)

The point is; I am trying new things, shaking up the routine, upping the ante, and in the process, breaking the barrier of the pounds that would not part ways with my middle. You have to try this once in awhile.

But please: proceed with caution!

Sadly, your body is not as young as it once was, it may take a minute to adjust to a new demand on the joints. So why do it?

Because: it feels like you are starting all over, it is motivating and fun...and even having to ice your knee has advantages; more knitting time! I have lost some weight; that last 15 lbs. I would like to see gone has begun to melt away; ha! That sounds way too easy! It is a process; I'll say healthy food choices and more exercise has been chipping away, very slowly, at it. Keep the faith, change your routine, share your journey below!

                                                                

Mama Fitness: Don't Stop: Pain or No Pain!

Advice from the doctors when wondering what to do about pain, be it joint, muscle, tendon: keep exercising! Really. See here: When it's OK to Run Hurt.

I had heard this from my GP and also from a rheumatologist, who says even if I have arthritis in my foot, knees and elbow, the best counsel she can give me is to keep going with my weight lifting, walking and biking, "at least 60 minutes, 3 or 4 times a week." Yes, ma'am.

As my elbow bit the dust badly two weeks ago, I had my doubts. I added painting the walls to my list of activities, when it already hurt to knit, and...my elbow was so stiff and sore it kept me awake at night and kept me from straightening my arm or even picking up the car keys without pain. I asked the teacher after class yesterday about modifications in Body Pump and CX Works (my latest add-on to classes). She told me to lighten up, to use free-weights instead of the bar or tube when it helped, drop all weight if need be and just do the movements, but she did not say to stay home and sleep an extra hour.

I think I was sort of hoping she would say to go home and sleep an extra hour. But not deep down.

I went back this morning, followed all of her advice, and I felt BETTER after my morning workout.

As for my questions about why we weigh more in America, I found a super blog post here; DoctorMama, confirming much of what I've suspected and going into more depth on the topic.

Don't let pain or lack of results that the scale can measure keep you from getting out and staying active. You will feel better with each extra step you take, each 2lb.weight you pick up. I promise. And if you don't feel better right away, be patient with yourself. You will. Go slowly, and if that fails, go more slowly, but don't stop, don't ever give up.