The Exercise Release & Act 2 Curtain Call
This was a first for me. After surgery, the physical therapist’s direction was not to exercise. It seems a little counter intuitive but no exercise for four weeks. The logic behind the order makes sense. Coming out of the first surgery, five of the seven incisions were in my abdominal and pelvic region. Therefore, any upper body exercise would stretch the skin in the core and jeopardize their healing.
For an active person, not being able to exercise is a tough order. The four weeks felt like a long time. It’s amazing how much is lost and so quickly. The last week of 2017, I was released for light exercises. With nice warm weather in Florida, I decided to take a stroll in a park having an array of choice neighborhood parks featuring fitness trails. First time out, I wheeled for a mile. Feeling pretty good, I proceeded for another mile. That might have been a mistake, I felt that second mile. Prior to surgery, I was conditioned to cycle and wheel for several miles. Now, two miles was tough.
To be fair to the physical therapist, I was, however, encouraged to exercise my legs using the implanted stimulator and my established electrodes. The external control unit was programmed to do various exercises. One is called “Extends All”. This exercise turns the electrodes on for 10 seconds and off for 20 seconds. It is designed to build the endurance fibers of the implanted muscles. I use it to calm my muscle spasms and it has become an evening ritual allowing me to sleep. I was also released to exercise the hip and back muscles as well as the quads, but not against gravity.
Exercise had to take a daily priority if I wanted to get my endurance and strength back with only three weeks before the second surgery. But it is a delicate balance; push to get back what was lost but not too hard while the incisions heal.
It’s now five weeks after the first surgery. The glue over the incisions have all shed away, leaving red lines in the skin. The maintenance of bandages turned into scar care. There are lots of over the counter treatments for scar tissue but aloe vera is my treatment of choice. Plus, it’s free. I just go in the backyard, cut off a sprout from our aloe plants, wash and apply.
The second surgery is scheduled for January 16. The first surgery was focused on replacing parts while the second surgery is focused on installing new equipment. Act 2 will involve implanting four new electrodes and they will ‘plug into’ the newly replaced IST-16 receiver via the jumpers that were installed during the first surgery. The desired functional assignment of the new electrodes is to lift the foot up and point the foot down. The desired result is to help with standing transfers and balance. An added bonus may be to get rid of the ankle-foot orthoses that currently keep me from dragging my toes during transfers and moving short distances.
There always seems to be a frenzy prior to surgery. Aside from the pre-op testing and the preparations for being away, this time there was more. First, with the cold weather in Cleveland a water line broke at the Z-house, the guest house for clinical trial participants. The resultant damage will require some repair and the house will be closed during my stay in Cleveland. The back-up plan, a hotel room and rides (mainly provided by Mom) to and from the hospital.
Then there is the skin integrity, the status of current incisions as well as the status of the locations of the new electrodes. Photos need to be sent to the research team for the status of my skin. The team is looking for any small cuts, abrasions or rashes that are located in the sterile field during the operation. Adding to this is the need to remain vigilant to stay healthy, take care of my skin and not catch a cold.
Add on top of that, the NCS and EMG test. This is a Nerve Conduction Study and an Electromyogram test. Five weeks earlier, the team used surface stimulation to test the responses in my left and right calves in preparation for the new electrodes. All was well, except the right leg had a poor response on the tibialis anterior to flex the ankle. Since that time, I have been using the surface stimulation at home attempting to recondition the muscle. A few days prior to the second surgery, my local SCI doctor conducted the NCS/EMG test.
The NCS measures how fast the nerves send electrical signals to the muscle, which indicates the health of the applicable nerve. Surface electrodes are placed on the skin and stimuli are delivered via a small rod with gel. The rod is set at measured locations. When the stimuli are sent, the electrodes sense the nerve activity. The right TA was the focus and the test was for the peroneal nerve that controls the TA. First was a low frequency. A jolt of electricity and the screen shows nothing. Mid-frequency, nothing. High frequency, there was a little response. We tested the left side which gave normal responses at each level. This indicates that the nerve is working, just more slowly on the right.
EMG measures the electrical activity of the muscles at rest and during contraction. Since the focus was the right TA, my doctor inserted the sensing needle and turned up the volume so we could listen for the electrical activity. It sounded like a squelching radio. There were a few spikes in the sound, which meant there was some electrical activity, albeit not very loud. No surprise. This indicates that some of the muscle is still there for the TA and working but it is just weak.
What does all of this tell us in preparation for the second surgery? Since some activity was detected on the right TA, we will still proceed to implant the electrode. The results from the NCS/EMG tests do set our expectations for motor response. When the electrodes are implanted, we should get a good response for ankle movement on the left side but we will probably get a marginal response on the right. The reality of the situation, we really don’t know until the team dissects the nerve, installs the electrode and tests the performance directly.
With that in mind, we clean up, take final preparations and wait for the Act 2 curtail call.
