Sunday, May 29, 2016
Transverse Myelitis and Falls
I remember the first time I fell. It was in the first weeks of my TM when I was coming to the end of my month at the Spinal Unit, and beginning to get mobile on a walking frame. The physio was teaching me how to get off a softish couch and use the frame. Given I could not just use my quadriceps to straighten my legs to stand, he wanted me to shift my weight forward onto the front edge of the couch, and get my stance correct before standing. Not understanding that I could not put my whole weight on the walking frame I leaned forward, the frame fell forwards and so did I. Luckily there was a gym mat under the frame, and my fall was cushioned. No damage physically. Just my pride… From Karate teacher to fallen idol in seconds.
That is the point. When falls happen, they happen very quickly, and you fall as if with a dead weight. There is a sense of unreality, as if momentarily your mind is out of gear. It is not that you are stunned by hitting your head (unless of course you have hit your head); not a loss of consciousness. I have not had a spinning sensation, but there is an unpleasant feeling of being totally out of control.
I had a couple of falls in my last two years of work in private practice. In the first, I had finished a consultation with a family in which the daughter had played happily with the doll's house, its contents, and almost all the Lego out of a plastic bucket. I had a few minutes to tidy up before the next patient. I must have over-reached myself bending forwards to pick something up, and within seconds I was laying on the floor. Somehow I had turned side on and broken the fall with my arm and shoulder. Luckily the floor was carpeted, and I did not fall on too many small objects. So I lay there for a minute or so, shaken, cursing my stupidity, and checking myself out for damage. Then I carefully got to my knees, and holding onto a table, pulled my self up. I sat for 5 minutes and then went on with the day.
About two months later, there was another lesson. I was entering my consultation room, and someone called my name. I turned to answer, and found myself on my behind and back. Again, unconsciously I had partially used a ‘break fall’ technique with my arms; again it was onto carpet. A couple of colleagues helped me to my knees and then my feet, I sat in a chair for 5 minutes and then went on with the day as if nothing had happened. No obvious bruising later; just my pride. I suspect it was the quick turn to answer the question that prompted the problem. I do not remember any dizziness. To be honest, I think I probably crossed my feet as I turned. As all of you know, that is an absolute ‘no-no!’
So one lesson was to do things a bit more slowly, and make sure of a secure base before grabbing objects off the floor. Behind this lesson is another: “Think it through!” It is almost as if you have to do a ‘micro-plan’ to ensure secure steadiness. The second lesson was “Never turn to answer someone quickly…” Always take your time, and ensure a steady base using all the skill you gained from physio. Another lesson might be to ‘Ask for help…’ I have never been any good at this. I have always seen myself as a ‘can do’ person, and sometimes even a ‘go to’ person. So it has been hard to learn to ask for help. A couple of blows to my pride. But then as we all know, “Pride comes before a fall!”
My most recent fall cost me two weeks of recovery, and a slowing down in my exercise program, as well as loss of pride (again). I have been using an office chair on wheels at the dining table. It is the one I took from work when I retired in December. It has always been very comfortable, with tons of give in the backrest. Of course there is the advantage of some movement across the bamboo flooring of our dining room. Well, I had always seen it as an advantage…
I had been to the loo, and was returning to the table to continue a discussion with my daughter, home for a few days. I guess I was distracted, and excited by our daughter being at home, and thinking about the conversation rather than my safety. I had always had a routine in using the office chair, ensuring I had both armrests held firmly and also that I was well into the chair before actually sitting. Sadly, on this occasion, I did neither. I had not really fully grasped the arm rests, and as I went to sit, the chair moved backwards on it wheels, and I sat straight down onto the bamboo floor. In addition, my torso went backwards following the chair, and the nape of my neck hit the edge of the seat of the chair. This time I was stunned, for a moment or two. Once again, I spent time working through whether I had damaged more than my pride. My behind was definitely sore, and I knew I was in for some bruising. My head ached, and my neck was sore - if fully functional. Eventually I turned over got to my knees, and with some help stood up. I then grabbed the chair and sat down properly to finish the precious conversation.
This time, I was physically damaged. The bruising to my gluteal muscles meant that I had immense problems walking, and putting pressure on them to climb stairs. It would catch me unawares, and would have to stop, wait, and then try again. I suppose I was exceedingly lucky not to have had a worse head injury.
But two weeks later I was still struggling to get back into the rhythm of our lives. And I lost more pride. And I lost some confidence – which has been hard to restore.
There is another problem. I wondered often during those two weeks whether I might have shaken up or otherwise damaged my spinal cord inside my spine, which I had soundly jarred. I certainly have had an increase in my recurrent right-sided T6/7 referred chest pain, and had to use the TENS machine several times.
This fear of recurrence is something we all live with, I guess. But it is a story I will tell next time.
In the meantime, I guess you all have stories about falls...