Back on the ice.

Last weekend diaristdaughter and I decided to return to the scene of my crime, the Bowie Ice Arena, for the Sunday 2 to 4 pm public session.  I went to my bedroom closet and dug out the two tote bags which held my skates and various bits of gear.  I hadn't looked at this stuff since the 7th of July: padded shorts, knee pads, bunga sleeves, elbow pads, wrist guards.  It all seemed so alien, so disconnected from my recent existence which featured emergency rooms, CT scans, operating rooms and IC units.  I found myself wondering if I really wanted to do this.  I didn't seem to have the same drive that I had after recovering from breaking my radius three years earlier.  I idly wondered if since my latest injuries included my brain, that perhaps my brain was making me hesitant in the attempt to protect itself from further injury.  Sort of like HAL trying to prevent Dave from interfering with the mission in 2001, a space odyssey.   I also struggled with the inertia from a wife who was not keen on having me resume skating.  After getting dressed I paused at the door for one bit of new kit: a green skateboard helmet.

We arrived at the rink later than I normally would since I normally like to get in every possible minute of ice time.  Value for money kind of thinking.  This time I figured I might have the gumption to skate for a half hour, so a few lost minutes wouldn't matter.  Was this my brain still trying to influence the outcome?

But once I walked into the lobby it seemed like every other person I saw was a skating pal and I'd taken them quite pleasantly by surprise--sort of like a surprise visit from a minor celebrity like the Keebler Elf.  I must admit it was good seeing some of my familiar peeps.  My hesitation started to evaporate.  The young woman at the counter smiled, gave me an ice pass and refused my money.  One of the rink directors came out of the office and half joking, asked me if I'd brought a release form from the surgeon clearing me to skate.  I told him I'd already given that form to the HR folks at work.  He asked me to not louse up his ice with blood again as he returned to his office.  It was good to be back!  I took my skates out of the bag and laced them up.  The session had started five minutes earlier and it was time to find out what skills I had retained before the ice got too chewed up.  I removed the terry cloth soakers from my blades and stepped through the entrance.

The first few glides told me that I hadn't lost everything.  After perimeter skating for five minutes I started to explore t-stops, 3-turns and inside Mohawks.  I still could do them and still had the annoying bias against left side/CW direction elements. For some reason inside forward 3s didn't want to happen at all (I eventually got them to work) and I also couldn't remember how to enter a single foot spin from an outside forward 3.  Little by little things started to come back.  Forward edge pulls were weak even on my normally good side. As I mentally took stock I decided to leave jumps to another day.  I finally remembered the entry for a single foot spin and after doing a couple, I fell out of a awkward slow spin and I think the entire ice rink exhaled as I quickly got back up on my skates. 

Mid way through the session I spied my dance coach.  We briefly exchanged hellos and she said she'd been watching me and I didn't look too wobbly.  Since she had another student in lesson I told her I'd be in touch about lessons once I'd knocked some of the rust off.  I tried to skate a couple of the low level pattern dances that I had known well only to discover that I couldn't recall the entire series of steps--most annoying since just before the fall that took me off the ice, I'd been very close to testing those dances.  Another thing to add to the "they'll come back"  department. 

After the session ended (I skated the entire session rather than the thirty minutes I'd planned) I called my wife to ask if we needed a bottle of wine for dinner.  I think she appreciated the call.  It served two purposes: she didn't have to wonder if she'd get a call from an emergency room, and we did need some wine.  No doubt about it, living with me leads a woman to strong drink.

A Favorable Outcome.

So, where am I?  Back on the 10th of September I had my two weeks post-op look-see.  I was hoping to be permitted to drive again and to be told that I could return to work--actually I had already gone back to work, being driven to and picked up afterwards since the Tuesday after the Labor Day holiday.  I was taken aback when I was told that it would be another 4 weeks before I could do either!  I decided not to reveal the fact that, in the absence of a spelled out restriction, I'd already been back to the lab.  I was told that the brain heals very slowly.  On the positive side I could stop wearing the compression stockings, that I could readopt my old habit of crossing my legs and that I could have a small glass of wine or a beer with dinner.

Last Thursday, the 8th of October, I had my six week post-op examination and this time both the driving and work restrictions were lifted.  This is a good thing since I've blown through all my accumulated sick leave and have been covering my absence from work with annual leave (Fed Gov speak for vacation) for the last two weeks.  I can tell you sitting around watching day time TV and going for short walks makes for a lousy vacation!  I can now add back activities as tolerated, including skating.  A session with the Chiropractor revealed that my balance is OK but not as good as before my fall.  Reintroduction of skating will be slow.  I know I've gone backwards skill and ability-wise.  Yesterday I went back to my yoga group for the first time and was able to hang in for the entire hour rather than just camp out on the floor in corpse pose after the first ten minutes.

This leads me to thoughts about protective headgear for skating.  As some readers know, there are no industry or government standards for ice skating protective headgear.  I contacted the U.S. Consumer Product Safety Commission and they stated a need to be impartial and wouldn't name brands or models.  They suggested that I contact the manufacturers in question and ask if a given product is compliant with the following voluntary standards:  ASTM F1447,Snell B-90A, Snell B-95, Snell N-942.  

The ASTM info (which one must pay for) can be found here: http://www.astm.org/Standards/F1447.htm

The info for Snell (free) can be found here: http://www.smf.org/stds

I had previously purchased a Bern (Watts model) helmet with an EPS foam liner.  I planned to wear it when my skating got to the point where I was doing more demanding elements such as back threes.  In hindsight that was a huge mistake!  The EPS foam liner is good for one impact (which includes being careless and dropping the helmet on a hard floor) after which the helmet must be retired.  Although the Bern Watts EPS doesn't comply with the standards mentioned by the CPSC above, it does comply with the following standards:  ASTM F2040 and EN 1077 (for snow and ski sports) and EN 1078 (for bike and skate). The "skate" refers to skateboarding not ice skating but at least we're talking a standard which is deemed adequate for concrete sports.  More about EN 1078 can be read here 

This is what I plan to wear until I can learn more about the headgear which is marketed to figure skaters, like the Ice Halo and Crasche Middie.  So far I have found no mention of any of those products complying with with any standards at all.  If this is not so, please leave a comment with a link directing me to the standard(s) with which these products comply.

Week Six. A revolting new development.

I'm six weeks out from the date of my big Swan dive.  My shoulder is very much turning the corner for the better.  However, as I went for my lunch time walk I noticed that I had a "drop foot"  walking gate (unable to lift the toes of my left foot).  Over the ensuing week, this has not gotten better on its own, so I'm back to enriching the pockets of my band of medical professionals--how they must love the sport of figure skating!  My chiropractor wants another lumbar MRI to compare with my previous one done five months ago to the day.  My primary care physician suggested a trip to the neurologist for an EMG (Electromyograph).  The two techniques provide different information about nerve impingement/damage.  I'm hoping that whatever is going on can be treated conservatively (i.e. rest and PT) rather than surgery.  I'm beginning to realize that this blog it getting to be more and more about neuromuscular and skeletal disorders and less and less about figure skating and ice dancing.  Bear with me--I'm hoping all this will bottom out soon with, if not my triumphal return to the ice, at least no more alarming news.  For those new to the blog, earlier installments of this little tale can be found under the labels heading "insults and injuries".

Update: Sorry, More Bad News.

   I did have a second MRI of my lumbar spine.  It was more or less identical with the one I had in March, so additional disc compression (from the fall) on adjacent nerves was not the answer.  I never did have an EMG.  Meanwhile my drop foot progressed to the point where I needed a cane to walk.  Over the weekend I lost my footing and fell in the middle of the front lawn and just like that old TV commercial for "life alert" I discovered that I couldn't get up.  I thrashed around on the lawn, almost able to regain my footing, but kept falling to the ground with heavy impacts.  I told myself I had to stop before I re-injured my right humerus.  It took the combined efforts of  my wife and daughter to get me up and get me inside the house.  I probably scared the neighbor's kids--old man down.  I know I frightened my wife.

The following Monday I had an appointment with my orthopedic surgeon.  My mother-in-law drove me to the office which is housed within the Anne Arundel Medical Center.  He took one look at me as I hobbled towards him with the cane and immediately said "this isn't your normal gate or balance mode-- hell, you're a figure skater."  He also noticed that my speech was slightly slurred.  I was wheeled down to the ER and I told the physician that, in addition to the new MRI, earlier I had been referred to a neurologist and he had ordered two additional CT scans (one without and one with contrast).  However, I had not received any follow up comments from him.  Luckily those scans were done by the hospital's affiliated imaging center, and so the ER doctor was able to directly pull them up on a computer.  Once the images appeared, there was a period of silence followed by a low voice level discussion between the ER doctor and my orthopedist and the next thing I knew, I was being prepped for the OR.

Recovery

My original brain hemorrhage was either a slow leaker or I re-injured it.  My drop foot was a symptom of a subdural hematoma.  The excess fluid was placing pressure on the right side of my brain and if you read the symptoms via the link, you will see that slurred speech and difficulty with balance and walking are numbers 1 & 2.  It took five + weeks for the hematoma to cause me to present with symptoms.  In order to deal with the hematoma I had a crainiotomy. I have a scar in my scalp and a very trendy disc of  titanium to replace the disc of skull which was drilled out in order to access the hematoma (it's non-magnetic--I won't cause compass deviations!) but mercifully no exposed bolts a la Dr. Frankenstein.  For the next two days I had a tube coming out of the extra hole in my head to continue the drainage process.  Yes, I am at a very slight increased risk for bacterial meningitis but I'll take that over the very real probability that without timely intervention I would have spent the remainder of my life as a cripple.  I was very, very lucky to have a positive outcome.  Pressure from a hematoma, if left, quickly causes irreversible nerve damage.   So here we start with the good news:  immediately upon regaining consciousness in the recovery room I realized that I could move my left leg "normally".  After the nurse had me go through some foot flexion and extension tests of my toes and strength tests of my legs I knew without actual confirmation that the foot drop thing was probably in my rear view mirror--however, I was in no position to directly test it. 

I spent the next two days in ICU.  The day after surgery I has another CT scan before seeing my surgeon.  He came by soon there after (about 6 am!) and said that I appeared to be ahead of schedule.  That pleased both him and me.  On Wednesday the neurosurgeon's PA (physician's assistant) came and removed the dressing (and a lot of my hair with it--they had used a glue to close the long opening to the port rather than sutures).  She was satisfied that the drainage had stopped; the remaining fluid coming out was clear spinal fluid and so the drain tube could come out. This last is a tricky decision:  they want most of the fluid out before closing the hole but the longer the tube is in place the higher the risk for infection (I was given "MERSA" scrub downs each evening while in ICU).  She cut the single suture holding the tube in place on the outside and told me to get ready.  She then pulled the tube out of my head.  It felt so good when she stopped.  The hole itself was sealed with the titanium disc plus a thick layer of skin with a dissolvable suture.  She indicated that it would seal overnight and with that the PA departed.  

Soon a physical therapy person asked me if I wanted to go for a short walk in the corridors to test out my legs.  I can report that the foot drop thing was no longer part of my lifestyle!  It felt so good to be able to just walk normally again.  We tried several balance tests including walking up and down stairs (our house is a two level house so this was an important test to pass).  I did fine.  My normal gate was back but I was at times a bit wobbly.  My strength will return with use of my legs and recovery from the surgery.  That evening I was moved out of ICU and into a "normal" room within the neurosurgical department.  This move meant that I was no longer hooked to monitoring devices tracking my blood pressure (the cuff automatically inflated every hour, and then after the first night every two hours--which made sleep very elusive) and other vitals.  They still monitored me, but at least it was every four hours rather than every two.

Thursday morning I had yet another CT scan (I'm sure that over the last two months I've received a life time of exposure but at least the current machines expose one to a lot less radiation than the early instruments).  My surgeon stopped by later and told me I'd be released towards the end of the day.  I had exceeded his expectations.  So figure skating gave me a serious injury but figure skating, as part of my lifestyle, without doubt contributed to my overall conditioning, which in turn allowed me to quickly bounce back.

My wife picked me up about 5 pm that day.  We stopped at the grocery store to have prescriptions for ACE inhibitors (basically a blood pressure medication--my BP is normal but they don't want any spikes during recovery) and a pain med.  I found a chair and waited for my prescriptions to be filled.  While waiting I saw a woman pulling a cart behind her.  She waked with the unmistakable gate of an individual with drop foot.  It was painful to watch her pass, realizing that I very nearly could have become just like her.

So I'm home now, wearing very fashionable "old man's" compression stockings (to minimize blood clots in my legs) and going on numerous prescribed 10 minute walks.  People in the houses which I pass who don't know me probably think I'm casing their joints.  I have a follow-up appointment in two weeks with the PA.  No driving until she says so.  It will probably be a few months before I'm back on the ice.  It remains to be seen how much of the skater I was before the fall reports back for duty.

Here are a couple of pix for the Skating Club bulletin board (your diarist--a picture of health).  Don't expect this costume at the rink.

The thin tube containing red fluid, coming down from my head, across the right side of my neck is the drainage tube from the craniotomy.  There's a small receiver bottle in the pocket of the gown.  Every now and then a nurse would give the soft plastic receiver bottle a half-squeeze to create suction--not too much, just a tad.  There are lots of cables monitoring lots of functions which we take for granted.

Not a good hair day.  Lots of liquid sutures matting down my hair.  I'm still in ICU at this point.  I can wash my hair with shampoo which contains no conditioners or oils.  They want the glue to remain intact for a while and at some point it's supposed to slough off like a scab.

Want to improve your working memory? Go climb a tree (but not while wearing your skates).

Press Release for Wednesday, July 29, 2015

UNF Researchers Reveal Climbing a Tree Can Improve Cognitive Skills

Media Contact: Joanna Norris, Director
Department of Public Relations
(904) 620-2102

Climbing a tree and balancing on a beam can dramatically improve cognitive skills, according to a study recently conducted by researchers in the Department of Psychology at the University of North Florida.

The study, led by Drs. Ross Alloway, a research associate, and Tracy Alloway, an associate professor, is the first to show that proprioceptively dynamic activities, like climbing a tree, done over a short period of time have dramatic working memory benefits. Working Memory, the active processing of information, is linked to performance in a wide variety of contexts from grades to sports.

The results of this research, recently published in Perceptual and Motor Skills, suggest working memory improvements can be made in just a couple of hours of these physical exercises. “Improving working memory can have a beneficial effect on so many areas in our life, and it’s exciting to see that proprioceptive activities can enhance it in such a short period of time,” said Tracy Alloway.

The aim of this study was to see if proprioceptive activities completed over a short period of time can enhance working memory performance. Proprioception, the awareness of body positioning and orientation, is associated with working memory. It was also of interest whether an acute and highly intensive period of exercise would yield working memory gains.

The UNF researchers recruited adults ages 18 to 59 and tested their working memory. Next, they undertook proprioceptively dynamic activities, designed by the company Movnat, which required proprioception and at least one other element, such as locomotion or route planning.

In the study, such activities included climbing trees, walking and crawling on a beam approximately 3 inches wide, moving while paying attention to posture, running barefoot, navigating over, under and around obstacles, as well as lifting and carrying awkwardly weighted objects. After two hours, participants were tested again, and researchers found that their working memory capacity had increased by 50 percent, a dramatic improvement.

The researchers also tested two control groups. The first was a college class learning new information in a lecture setting to see if learning new information improved working memory. The second was a yoga class to see if static proprioceptive activities were cognitively beneficial. However, neither control group experienced working memory benefits.

Proprioceptively dynamic training may place a greater demand on working memory than either control condition because as environment and terrain changes, the individual recruits working memory to update information to adapt appropriately. Though the yoga control group engaged in proprioceptive activities that required awareness of body position, it was relatively static as they performed the yoga postures in a small space, which didn’t allow for locomotion or navigation.

“This research suggests that by doing activities that make us think, we can exercise our brains as well as our bodies,” said Ross Alloway. “This research has wide-ranging implications for everyone from kids to adults. By taking a break to do activities that are unpredictable and require us to consciously adapt our movements, we can boost our working memory to perform better in the classroom and the boardroom.”

For more information about the study, visit http://www.ncbi.nlm.nih.gov/pubmed/26029969.

UNF, a nationally ranked university located on an environmentally beautiful campus, offers students who are dedicated to enriching the lives of others the opportunity to build their own futures through a well-rounded education.



-UNF-

Week five. Yes, I think it's getting better, a little better all the time.

My arm still hurts, mostly in the morning after I've slept on it, but with each passing week I can do things which were off the table the previous week.  In the too much information dept: last week's little victories included being able to once more have enough rotational range of motion to cut my toe nails.  I can now also hoist an ear of corn up level with my chops and gnaw the kernels off the cob.  This week I can put on ( and just as importantly, remove a Tee-shirt unaided)  People occasionally ask me how the broken humerus compares with the broken radius (at least in terms of my right arm I'm becoming something of an oracle).  Let me review;

When I broke my radius I wore a series of casts.  The first one extended from my elbow to my knuckles and pretty much took my right arm and hand out of commission for the better part of five months.

As time wore on the cast got shorter and lighter but my right hand was useless until the final cast went away.  At that point my right arm had lost a lot of strength and it took lots of PT to gain that strength back.  Additionally, with casts bathing and showering are a bit tedious due having to keep the cast dry.  If one is a broken bone novice, as I was, one quickly goes up the cast learning curve with kitchen trash bags, then plastic wrap and duct tape until finally discovering that drug stores stock form fitting cast sleeves with water resistant elastic cuffs.  When the final cast was removed I had one weak, smelly arm.

With the broken humerus I didn't get a cask.  Instead I started off with this soft sling, courtesy of the ER. 

But quickly graduated to this semi-rigid "clam shell" (for lack of a better descriptor) brace.  My orthopedic surgeon supplied this during my first office visit after I got home from the hospital.  As long as the fracture doesn't require surgical reduction most orthopedic surgeons allow gravity and mother nature to take care of the task of bone mending with just minor immobilization.  After the first week I didn't have to wear this contraption while sleeping (not like one gets a long stretch of unbroken sleep, yawn).  Unlike the broken radius, the fractured humerus didn't completely take away the use of my right hand.  I could still write with that hand provided the angle of the document didn't require movement in a painful direction.  I quickly learned to elevate the pad of paper to a comfortable level with my left hand/arm.  I also learned to stand over the keyboard when pushing complex key combinations such as "control alt delete".  I did revert to shaving left handed.  I'm now reintroducing my right hand to that task so far without loosing too much hide. My dancing skeletons shirt once again is proving to be quite popular with x-ray technicians.  I'm now weening myself away from this brace--just have to be careful not to bump the shoulder into things or it's straight to the moon, Alice.

This is the pose that my guardian angel (and long suffering wife) adopt when I start talking about my return to the ice.  Today I had my first session with a physical terrorist therapist.  I'm already at 90 degrees with a lot of the assigned exercises but I have a long was to go before I'm pain-free over the full range of motion.  I'm hoping that the inflammation in my supraspinatus muscle/tendon doesn't lead to a level of impingement requiring rotator cuff surgery. Been there, done that with my left shoulder.   How's that for motivation to keep up with my PT "homework"?  I'm hoping to have a functioning right arm/shoulder by mid-September so that I can race a boat at the Classic Moth Boat Association National Championships.  I'll attend even if I can't race.

Tough start to the new season.

"Risk" indeed.  You don't want to wake up in the ER wearing this wristband.

The new skating season for Bowie Ice Arena always starts with the rink's early July reopening after the annual two month maintenance shut down.  This year that meant Monday, the 6th of July.  Looking at the rink's schedule, there were no convenient times that date so daristdaughter and I deferred until Tuesday's 6:45-8:45p.m. public session.

I hadn't been able to skate much during the shut down so I emailed my coach to indicate that it would probably be good if I skated solo for a session or two before resuming lessons just to knock the rust off.

I can tell you all about the various skating elements I worked on up until "the lights went out" but there's a 15 or 20 second long section of my memory bank which was scrubbed clean.  I doubt that I was doing anything heroic--probably I was just clumsy and tripped over my picks.  Anyway, I "came to" on my back next to a small pool of blood.  I knew the blood was mine.  I was carted off the ice and into an ambulance for a short ride to the local health center ER.  After an x-ray and a CAT scan the attending physician told me he had good news and bad news.  The good news was that although I had managed to fracture the top of my right humerus, it didn't appear that I'd need surgery.  The bad news, which he delivered while putting eight stitches in my head, was that I had a minor brain hemorrhage and that he was going to pass me on to Medstar Washington Hospital.

Medstar put me in a room in their neurological wing. The combination of aching body parts plus a chorus of beeping monitors did not add up to a restful night.  The next morning a second CAT scan revealed that the hemorrhaging had stopped.  I was provided with an anti-seizure medication, some pain pills and instructions to follow up with my primary care doctors and orthopedic specialists.

Now just to add an extra layer of complication to this tale, my wife had a plane ticket for Sweden, leaving that same afternoon.  She was going home to help her mother, who had sold her apartment, with the packing up.  She didn't like the idea of leaving me to my own recognizance but I reminded her that she had $1500 dollars invested in the ticket.  She needed to go help her mom, and she could always deal with my carcass upon her return. Besides, our son is a registered nurse and our daughter is also in a position to help her old dad.  And so, in the end, our son drove her to Dulles airport that afternoon and then collected me from Medstar on the rebound. 

Enough time has passed that I can report that the stitches are out and my orthopedic surgeon (same one who patched me back together when I broke my right radius  three years ago) concurs with the ER doctor's assessment that surgery will not be necessary.  What is left is a six to eight week recovery period before I can return to the ice. I'm mildly annoyed with all of this because at my last lesson way back in June my coach told me that I was very close to being test ready for the three dances I've been working on for what seems like forever.  Some of that progress will surely be lost by the time I return to skating.  Also, unless I find someone who saw the fall I'll never know what caused it or how to avoid a repeat.   Finally, from now on my non-skating bride will be nervous each time I grab my skates and head out the door.

On the plus side, unlike the episode with the broken radius, this fracture does not require a cast.  Instead I alternate between a removable hard plastic splint and a soft arm sling.  The downside is that the marginally supported fracture immediately lets me know when a given movement doesn't suit.  This includes when I turn in my sleep.  Currently I wake up with a sharp jab about every thirty minutes or so.  Hopefully I'll be less of a night time whirling dervish by the time my wife returns or I may find myself relegated to the sofa!  

Timing is everything

I had my finally lesson of the "off season" over at Piney last Thursday.  Dance Coach and I will reconvene when Bowie reopens after the 4th of July.  Things being what they were, I hadn't skated a lick between one Thursday lesson and the next.  I figured this would be the skating equivalent of me having to tell my Coach that, um, I'm sorry but the dog ate my homework.  Oddly enough if turned out to be one of my better lessons.  Coach said the pattern, timing and even the tuck behinds for the RB were much improved.  So, is less really more?  Maybe someone should tell all those elite kids who skate twice a day, six days a week to just go to the beach or goof off or do something completely different every now and then.

But back to the title of this post: timing.  One thing the became apparent when we skated together is that every now and then my timing for the first tuck behind would be off.  Coach had me skate the dance solo and said "when you count you're getting confused at the inside swing rolls."  The swing rolls in question come immediately after the lilt step sequence in the dance:

 

If one looks at the dance pattern, the lilt sequence starts at step 5 which is held for two beats; steps 6 & 7 are one beat each and step 8 is held for two beats.  So, if you're counting 1, 2, 3, 4--the lilt sequence goes 1,2,3,4,1,2.  This means that the two inside swing rolls (steps 9 and 10) start off at the 3, 4 count--as in you start the swing roll at the 3 count of your 4 count beat rather than starting the beginning of the swing roll on the 1 count which is how most other dances (granted I've only skated the first three dances) treat the next new skating element.

This little anomaly repeats during the second swing roll (step 10) and finally resolves itself at the progressive (steps 11 through 13), just before the first tuck behind.  But until my Coach pointed this out I was getting thrown off course--I think the times I actually got the dance correct were the times I miscounted beats!  Somehow I'd not picked up on this.  But that's why coaches are so valuable!