Summary: Most miserable day of recovery. It was not a function of over-exertion in anything in particular but rather a failure to recognize the important and significant excercise in simply sitting upright in one degree of gravity. The stranded Astronaut recover on return to Earth are an extreme example of the recovery necessary after a zero-gravity period only a few months longer than the enforced bed-rest my surgery required.

Medical evaluation: I will start with the bad part of the 40-minute trip for the exam by Dr. Nguhen. She was the neurologic surgeon who performed the intrusive operation in January. I began with the medication delivery at 04:00 and the realization I was supposed to be moving for the early appointment, and commenced a sustained and periodically intense six hour period of discomfort. It was important to be seen by a busy doctor on a short leash. I will address lessons-learned in the second half of this situation report .

Nuero: Good report on healing and the last sutures removed from right leg with good circulation reported in both legs. Soime concern on feet which should be addressd with podiatrist as a SECONDARY issue.

Other Wounds: Not related of some concern is abrasion of heels and bedsores. Tleft heal abrasion and pain which resulted in dramatic bleeding yesterday was the key to this portion of the superficial exam of legs, upeper thighs and buttocks. Specific recommdations were passed to Wounds team as last sutures were removed from right leg. Padding was directed for left foot at bed rest and to protect against further abrasions on rehab equiment like the stationary exercise bike. Walking strongly recommended.

Transport. This was source of the perioidic sharp and sustained problems which arrived with Ibrahaim the driver, a wheelchair and the breakast tray. I waved that part away and tried to help Iberahaim tranistion me from bed to chair via walker. Then, chair wheeled to lobby to board sedan with rear ramp, roll on and mounting drill performed with crashes to attach chair to car, then patient to car.

Personnel: Ibrahaim was one member of the two-man team who managed the stretcher visit to George Washington Hospital on Monday. Advice is to attempt to have skilled trade person support in addition to medical.

Upon completion of slow but successful transit into the District at diminished (but still onerous) rush hour across the Potomac, Ibrahaim produced a phone number and said to contact his company when the appointment was complete, obviously not intending to wait.

Overwhelmed by the number of other events occurring in an unfamiliar venue, I knew it would be an issue but Paula had not yet arrived and the big disconnect of the morning-and what could have been a disaster if my personal phone had fully discharged by inadvertent skin contact through gown occurred. The opera that had provided background tones was un-noticed in the slow once-familar drive past the gentle hill where the now-demolished Navy Annex was,

It is appropriate I may be buried there near the Pentagon where I spent two tours of duty.

LESSONS LEARNED: Pre-brief and coordination of ALL new forms of motion is necessary. Accident or surgery are common things, but making over-stressed limbs work properly requires keeping things simple.

Therapy prep for vehicle entry on small sedan referenced yesterday was useless, since travel-by-wheelchair made sitting up in cramped quarters the key preparation drill that would have been useful.

If bedridden and if urinary tools or other intubation attached devices permit, practice getting out of bed and sitting upright. Even in a relaxed manner with legs extended. I my first recovery a RELAXED yoga routine was followed without the urgency associated with regular, dedicated work-outs. I started with getting upright, the most important.

LET’S GET SEATED: That involves as full an extension possible in the bed with therapist present a first. to grab the upper armrest and extend the lower leg to roll slowly to a seated position with getting into a seated position on the bed with had weights available in two, five or ten pound weights. In a slow and natural manner, I would lean forward, using the weights as a means of encouraging no forced extension.

When arriving at the extension point where full foward pressure from hips would be required for more extension, a gentle motion extended in time would translate to. A left-right dip if the arms permit, but gentle and loosely in time with dance music on the phone. I had a ten dip rotation that ended gently to see if further extension- without forcing- was possible in an almost Latin motion

I would then slowly return to a sitting upright position, holding the weights in close to the chest and extending over days or weeks. When comfortable and WITHOUT forcing, extend the arms from the upward sitting motion. When comfortable, add the light weights in the degrees of comfort. The goal is comfort in motion, not striving for personal bests. Those will come.

This transitions to a modest upper body routine are more akin to stretching than weight lifting. A comfortable stretch forward including going to full arm extension parallel above the head continues a comfortable stretch wit a little resistance.

Follow-ons can bring the arms level to shoulders, weights increasing with comfort level, to a “washing the car” gentle movement alternative hands. I found small circles increasing over time to twenty almost automatic once started.

Don’t forget to stop if it starts to hurt. I am a veteran like you of “No Pain, No Gain.

That is not the point When comfortable, use the walker to prepare even for a relaxed standing or gentle gyration with walker locked or use it for slow purposeful walking to the restroom for first necessities then kitchen or front door.

Having an assortment of weights in a little rack by the bed or upright seating area can give some relaxed exercise into otherwise completely relaxed times or talking on the phone.

Relaxation, checking the phone or watching the flat screen or tablet can be added as exercise times in the way people used to smoke.

Conclusion: In my case, making this relaxed but structured activity, slow and smooth, to be a refreshing alternative to shouted commands from some real (or imagined) authority figure. Crunched muscle groups in rapid time can be useful, but we are talking about being able to walk and live and a useful component of Rehab and Recovery.

I had completed a regimen of lightweight yoga before the blood clot event that provoked the crisis that brought on the highly invasive event to save my leg to be another reminder that relaxed maintainance of all the muscle groups to be useful in both general health and and return to it.

That is it for today. It was a memorable one in the work-up to what the Smart Guys Across the Potomac (SGAP) are talking about in a week. I am thankful he left the one for fools to us!

V/R,
JR