Two years since, and still moving forward

Yesterday, July 8th, marked two years since my Spinal Cord Injury, since everything that I knew about the world, about myself, about my body, and my life was turned upside down in an instant and launched me on this whirlwind of a journey that is recovery.

I wasn’t entirely sure if I was going to post about this strange date as its relevance is quite insignificant to me now. I remember last year, as my one year anniversary approached, I was stressed out and anxious (read my posting here if you’d like). Because the traditional thinking in our medical system says that most or all of recovery from SCI will occur in the first year or, if you’re lucky, in two, it was disheartening to think about the magnitude of that date and all that it implied. Oh how so much has changed…

Shortly after that day, I stopped counting the months since my accident. The eighth of the month, which had always been so present in my day-to-day consciousness especially as the calendar changed and a new month would arrive, became irrelevant. For the last many months, I actually completely forgot about the eighth of the month as I realized how unimportant it was. I told myself from the beginning that I was going to engage on the path to full recovery and that I would give everything I had to achieve my goals. Therefore, why should an antiquated way of thinking – an outdated medical approach that has been proven wrong repeatedly by those around me, one that quells and limits the spirit of recovery instead of encouraging it to flourish – why should that define my recovery? It shouldn’t, and it won’t.

I fully believe, as I have since the day I was injured, that with perseverance, diligence, unwavering commitment and by keeping my dream alive within me, that I can and will get back on my feet, no matter how long it takes. Also, I can’t overlook that an exceptional amount of my healing and breakthroughs have occurred only in the last few months! Maybe my spinal cord and my body did need a longer period of time to process and accept that initial trauma, but what started as the weakest me that me has ever known, has transformed into a period of continuous recovery and accomplishments.
Although it has been two very hard years, more trying, devastating, arduous, and insurmountably difficult than most anyone can imagine, I have learned tremendously during this time. I have challenged myself to an extreme I could never imagine and I have witnessed how much love surrounds me on this fight of mine. For that, I’m grateful. For the opportunity to continue on the path to realize my dream of walking and running again, I am hopeful and I continue to fight.
So thank you two year anniversary, thank you meaningless calendar date, thank you for reminding me that the human potential is not defined by 12 month cycles or doctors’ prognoses. If the spirit to heal is present, then the healing will persist. And further forward I push, looking forward to the next breakthrough and the next stage of recovery.

Major Progress in Maui

As I’m wrapping up my time in Maui, I want to share a quick update on the incredible progress I’ve made through my work with Alejandra. This is going to be short and sweet as I’m going to let the videos do most of the talking.

We spent a good chunk of time everyday working on a specific exercise that was meant to target my glutes, hamstrings and calf muscles, areas of my lower body that I had very little connection to prior to my trip to Maui. In addition to the variety of other exercises and movements that have all been crucial to the development of these muscles, this exercise was consistent as Alejandra felt that it was necessary for my ability to establish new cerebral mappings and create mental connections to the back side of my lower body.

We started like this, with me standing on the Core Align, a machine with wooden, ladder-like beams in front of me, foot plates that slide back and forth, and with Alejandra crouching in front of me, bracing my hips and pelvis in place, and manually moving one of my legs using her hands while I held on for dear life:

About 10 days later, we had moved on to me bracing myself solo against the Core Align, maintaining pelvis control on my own, and extending my leg back on my own! I could only kick back in a short burst, and let the foot plate pull my leg back into place. This lasted for 2-3 minutes per leg before I got fatigued:

Today, only a week since the last breakthrough, I was kicking my leg back like before, only this time, I was able to control the leg against the resistance of the foot plate and slowly bring my leg forward to resting position. No loud slamming of the foot plate, no short bursts, but more leg control both extending back and coming forward. Although one leg was certainly stronger than the other, I was able to do this for 15 minutes per leg, which means a HUGE increase in endurance.

It’s been so satisfying for me to see the progress so clearly and so quickly as it’s a true testament to the value of the work I’ve been doing. I’m just sad for it to end, but already looking forward to the next time I can come back.

If you build it, will it come? And when? And how? And….

One of the most memorable movie quotes of my childhood was from “Field of Dreams” where Kevin Costner is told, “if you build it, he will come” in reference to building a baseball diamond in his cornfield which will summon his beloved baseball players from the past to come and play ball. A pretty straightforward cause and effect statement. Do this, and that will ensue.

I find myself thinking of this quote a lot recently, in the context of my recovery and dealing with all of the questions and doubt that arise and try to throw me off track. I’ve been “building it” for over a year now. This time last year is when I felt strong enough to ignore the lifestyle of adaptation and flat out laziness that the medical establishment was providing me, and took the initiative to start an aggressive routine of rehab, exercise and physical and mental hard work.

Up until my accident, I had always understood that the causal relationship between hard work and reward was reliable and relatively short-term, particularly with physical improvements (I wrote an entire post about this subject). Now, after a year of working so hard everyday, of literally channeling so much of my energy towards recovery and healing, I’m often left wondering…ok, can someone throw me a bone here? I need something to happen already!

Yes I’ve had improvements, yes my health and overall strength has improved, yes I can still wiggle my toe, yes I can sit taller, push further and continue to challenge my capabilities and improve upon them, but all of that said, I have to put this out there: I need a breakthrough.

I’m reminded of the conversations I’ve had with friends so many times about being single and wanting to find a girlfriend. Or of changing job paths and furiously job hunting and the advice we would always give each other when frustrations would hit new highs. “You’re looking too hard for it. Sometimes these things happen when we ease up on searching or expecting them, and then all of a sudden, boom! it happens.”

I have no doubt that this applies to my current situation. I want improvement badly. I want validation for all of this hard work I’ve done and I want it to be more than a toe I started wiggling nine months ago or gradual strength that I’ve built up over time. But I’m looking so hard for it! I wake up every morning and wonder if this will be the day that I’ll have that breakthrough. I’m trying not to expect it, but I expect it. And then I try to rid myself of the expecting of not expecting. And so it goes….

I wish this injury was more forgiving in this way. I wish there was a formula and even if I knew it would take a long time, I could find peace in knowing that the next breakthrough would indeed arrive. But that’s not the way this injury is. It rips you apart and takes away everything and leaves you with more doubt, uncertainty and ambiguity than you could ever imagine.

I can hear the advice from everyone already: Get rid of the expectations. Cultivate patience. Find peace with the situation. Make the most of the present moment without any consideration of the future and what it will bring. Life is too short so enjoy what you have right now and relish every moment.  I say, easier said than done. 

The funny thing is, I’ve actually been able to do all of these things but only to a certain extent. Much of my efforts recently have revolved around patience and letting go of expectations, and I’ve certainly gotten better at this. I have no choice but to continue doing these things and physically continuing to work as hard as possible but I still can’t help thinking that because I’m building it, it will come…

Flash Forwards

I’m boarding a train in a foreign country. As I scan my ticket to confirm my destination and its tricky spelling, I sling my backpack over my shoulder and step high up onto the train as it starts to rumble out of the station. 

I’m walking through my old San Francisco neighborhood towards the tall trees of Golden Gate Park swaying in the gentle but persistent coastal breeze. I see my old neighbor on his way to work and wave at him as he walks on by and greets me from across the street. “Been a WHILE since I seen you man! How ya doing?”

I swing open the door to the restaurant and hurry excitedly up the narrow stairs. I enter into the dining room and see my friends gathered towards the back, ready for the birthday celebration. I can’t help but notice the tantalizing cocktails neatly handwritten on the chalkboard behind the bar. I decide that after months and months of preserving my recuperating nerve cells by avoiding alcohol, it’s time to order a drink…

We all know what flashbacks are, memories from the past of a specific moment that we remember clearly that are brought back into present consciousness. Similar to flashbacks, I have “flash forwards” that I’m sharing here now. Much like flashbacks (which we remember for certain reasons), my flash forwards are complex, rich in detail and as vivid as any memory. Thinking of them places me in those exact moments, my senses come alive with what I’m surrounded with and I feel as though I am experiencing that moment in real time. My smell (the sense that is most linked with memory) is heightened with the scents that I take in and I can realize the absolute realness of my flash forward.

Having studied psychology in university and always being interested in how the brain functions, I have read a lot about the damage and difficulty of painful flashbacks for some people. With or without a trigger, someone may relive a particularly challenging memory and become traumatized by the larger impact of that flashback. It’s not to say that all flashbacks are negative memories, far from it in fact, but I suppose I just don’t hear of many people talking about their flashbacks of positive memories very often.

My flash forwards are incredibly helpful for me. They fuel my recovery, they give me something specific to work towards, and they represent a light at the end of the tunnel in some ways. They show me what life can look like when I’m not on the dark side. They provide specific details of situations that I can’t presently experience. They remind me of what is most important to me and why I’m fighting so hard everyday to regain the physical abilities that I lost in my accident. Instead of trapping these experiences into history and saying that they’re a part of a past that I won’t ever see, I place them in front of me, in my future, with the utmost intention of realizing these flash forwards.

They are NOT wishes, they are NOT dreams, they are NOT aspirations or hopes. For these reasons, I can’t tweak them and change them around as I see fit. Much like memories which are based on facts of how things happened, flash forwards are structured the same way, as inherent truths, based on facts of how things WILL happen. That’s why they come to me organically and vividly and I have little control of how I see them. I just choose to accept them and see them as a glimpse into a definite future.

I’ll leave you with one more flash forward. As I have mentioned on this blog, just three days before my accident, I had one of the most amazing experiences of my life on a backpacking trip in the mountains with friends. For months, I have struggled many times wondering if I will ever have an experience like that again, if I’ll ever feel the joy of carrying all of my material needs on my back and venturing into the beauty of the high mountains…

The weight of my backpack feels heavier than it used to on previous trips but here I am again slowly hiking up the narrow trail surrounded by the majestic Sierra Nevada mountains of Eastern California. I’m definitely putting more weight on my hiking poles than I was expecting but I’m still stepping up the gravel path in anticipation of the alpine lake at the top. My steps are a bit crooked as it becomes apparent by looking at my footsteps that my left leg is still a bit weaker than my right, but I feel strong nevertheless. The air two miles high is thin and cool and I’m panting regularly but the sun radiates through my entire body, warming me through from the inside. I’m enjoying each step I take in my rugged hiking boots and I smile and realize I never knew that this moment would come again.

Video Update – Parallel Bars Walking

I’ve been using the parallel bars for quite some time now and just a few days ago I had a relatively small but significant breakthrough that I wanted to share. The following video (from March 1st) shows a great development in my walking exercises and reminds me that progress does occur, even when it doesn’t feel like it. As you watch, please keep the following things in mind:

  • Don’t be confused and think this is the big thing: I’m not walking on my own….YET. It’s hard to see but the therapist is holding my core steady with the strap around my waist and she’s also using her leg to lock out my plant knee because I can’t do that yet. That said, it’s still pretty cool.
  • I recently started doing this exercise without shoes because I can slide my feet with socks. Maybe it’s cheating a bit but it’s helped me initiate the movement from my hips and actually pull my leg through with more strength.
  • Previously, the therapist always had to move my legs for me but this was the first time I was able to shift, move and slide my legs forward on my own.
  • Yes I’m rocking a pink shirt. Real men wear pink. End of story.

Spurts and plateaus or a slow and steady climb?

How do you measure progress? How do you know how much better something is than it was one day before? There are many things that can be measured and captured quantitatively but when it comes to matters of health or the body, how do you know if you improved more this month or two months ago?

I’m constantly being asked:  “How are you doing? You noticing any improvements? What’s new with the recovery Arash?” These reasonable and seemingly straightforward questions can be nearly impossible for me to answer. On a basic level, I would assume I’m doing better that day than the previous day, but on a deeper level it’s sometimes really difficult to understand if and how much I’m improving. This is one of the most frustrating elements of dealing with such a devastating injury that has damaged me in so many ways.

One of the earliest posts I wrote on this blog was about being on A Crowded Battlefield and how overwhelming it can feel to deal with so many parts of my body being damaged and the challenges of focusing on one thing and being presented with another challenge. In the same way, when I get asked those questions, I have to do a quick analysis of about 37 different body parts and functions and assess if and how much each of those has improved and if that’s more of an improvement than the last time I checked (probably just a few hours before).

In my head, it may go something like this: “How am I doing? Well, let’s start with the obvious: still can’t move my legs. My feet dangle as limp as they have since I began the hospital adventure seven months ago. I still can’t use a fork and knife because I don’t have enough strength in my core to sit up and use both of my hands freely. Speaking of hands, funny you should ask… yes I can type and hold a glass of water and push myself around in my wheelchair (have I mentioned how much I hate my wheelchair??!!) but I can barely squeeze the shampoo out of the bottle and forget about unscrewing an unopened jar or holding anything heavier than a book in my hand. Ahh but the toe, yes alas I can still wiggle my pinky toe. But wait wasn’t that a while ago that I started to wiggle my toe and thought that it was going to snowball into other major improvements, and oh yeah, that hasn’t happened quite yet…” It goes on and on but you get the picture.

All of this brings me back to my original motivation behind this post, how do I measure progress in this post-injury/still unfamiliar body of mine? Maybe the hardest question for me to answer is whether my recovery goes in spurts and plateaus or if it’s a painfully slow and incremental process. There are moments (like today and a majority of the last couple weeks) where I do feel like I’ve undoubtedly plateaued. Some of the exercises I did today don’t feel much stronger than they did last week, or even last month. My hands are so incredibly slow to improve and there’s little I can do to expedite their growth. Standing and walking on my own seem as far away as they ever have been.

But just when it seems like I’m unimaginably stuck on this plateau, I think about one thing: my body is constantly changing. Whether I feel stronger today than I did yesterday is hard to determine but I might feel ever so slightly different than I did previously. And maybe that’s the answer, maybe improvement isn’t always obvious or clear to me, but maybe I have to accept that change is the substitute for progress. After all, if my body was actually stuck and didn’t want to get any better, why would there be so many changes, so many tingles and burns and spasms and unfamiliar sensations and sore muscles? In that case, then maybe my recovery is more of an incremental climb, a barely upward sloped line glacially moving towards the top and signifying a very slow but consistent progressive process. I suppose I still can’t make up my mind on how to measure or explain my progress so just bear with me if I stumble or mumble a bit the next time you ask me how I’m doing.

Sharing the story of an inspiring friend

Video

I want to take a moment and give a shout out to a recent friend and his outstanding achievements after suffering a Spinal Cord Injury of his own. I was introduced to Grant Korgan just weeks after my accident while I was still in rehab at the hospital and I remember talking to him and instantly feeling better knowing that someone else out there could possibly understand what I was going through. “You have a new best friend bro, feel free to call me anytime you want” is what he told me. Grant suffered his accident almost three years ago and was given the same uninspiring prognoses from his doctors about his chances of recovery.

Despite the challenges he faced, he worked his way out of his wheelchair, became much stronger, started walking with canes, and became the first adaptive athlete to hand-ski to the South Pole in Antarctica. This effort was chronicled by a documentary film crew and Grant has also written an inspiring book about the first year of his life after his accident entitled, “Two Feet Back.” I read his book and highly recommend it to anyone interested in learning of a person who has approached his recovery with unwavering optimism and positivity.

I want to dedicate this post to sharing Grant’s talk at a recent TEDx event. Check out his video and if you only have a few minutes, feel free to skip to 16:08 and watch and listen to the song about his story and recovery. I am continuously inspired by him and discover so many similarities to my own recovery. Madluv to you Grant

TEDx Grant Korgan: The Goosebumps of Life

“As independent as possible…”

If there is one phrase I’ve heard entirely too often during my recovery it’s, “We have to get you to be as independent as possible.” This may not sound so bad at first. Why wouldn’t I want to be independent? Is there something wrong with taking a situation in which almost everything I do involves help from someone else and empowering me to do things more independently?

Now I have to provide some context so you don’t think I’m just being hyper sensitive or overly scrutinizing of a seemingly simple statement. The entire seven weeks I was in the hospital I would hear nurses, doctors and therapists say this to me, usually as a way to motivate me – as if I needed extra motivation – to learn a particular skill or maneuver. Just days after suffering the most horrendous injury that debilitated me to an unthinkable extent, I was being told and retold that my “independence” (can you sense my sarcasm??) was hinged on the need to move my body a certain way or learn a seemingly impossible task. For example, before I could achieve any basic efficiency with my hands (unable to hold a pen or cup) I was being told, almost threatened, that I should try really really hard to do a particular thing because I had to be “as independent as possible”.

On my first day of rehab, just ten days after my injury, I was asked if I had thought about what my goals were for rehabilitation. I simply responded, “I want to walk.” Once I saw the quizzical expression on the practitioner’s face, I followed up with, “Look I understand this is going to be a long road but I can’t think of anything else that would motivate me so tell me what I need to do to get me closer to my goal of walking.” More confusion on his face. It was as if I was speaking Mongolian or stating that I wanted to flap my arms, spin around three times and fly to Saturn. I think they expected me to say that my goals were something like wanting to sit up without falling over or feeding myself or rolling over in bed or strengthening my arms enough to lift my body from wheelchair to bed. The truth is I badly wanted to do all of those things! But here’s where it gets tricky, and where I start to get frustrated with the way Spinal Cord Injury (SCI) is treated in our medical system.

I learned that until 10-15 years ago, someone who suffered a SCI would stay in rehab for months at a time. But now, insurance companies recognize the exorbitant cost of keeping someone in the hospital that long, not to mention the hours of physical and occupational therapy involved, and the model has changed dramatically. Most patients in this well-known rehab facility I was in (treating SCI, stroke, brain injury, and other serious neurological injuries) averaged 2-3 weeks in rehab. I was one of the “luckier” patients because I stayed for five weeks. In fact, my discharge date from rehab was determined just three days after I arrived! Let me recap: just days removed from seven hours of spinal surgery, after arriving in an ambulance with towels and tape strapping my head down and protecting my badly damaged neck, unable to move most of my body or perform everyday functions, the medical insurance system had the magical ability to set a date to get me out of the hospital. Now it all makes sense…

Becoming “as independent as possible” had little to do with my goals or long-term recovery. Rehab was meant to be a boot camp of sorts for me to obtain the minimal strength and capabilities to go home and not be a swaying, falling, broken, soaking wet mess of humanity. In a country abundant with bogus lawsuits and fervent medical malpractice scandals, the priority of my medical insurance wasn’t to heal my body to its greatest capacity – they had experienced, knowledgable therapists and state of the art equipment after all – it was to protect their legal liability and preventing me from saying that they didn’t teach me how to move from my wheelchair or wipe my own ass.

Moreover, rehab isn’t about rehabilitating the body to what is realistic or what one may desire. It is about functionality. Everything they taught me was with the purpose of how I could function when I wasn’t within the safe, happy walls of the hospital. Every time I brought up the idea of a full recovery, I was given the same quizzical look I saw that first day of rehab. Each time I mentioned that I was going to walk, I was politely dismissed and told to focus on my task at hand. Since I left the hospital, I have been given a grand total of ONE hour a week of physical therapy. Oh wait, actually it’s technically 45 minutes but sometimes she does me the favor of staying with me for an entire 59.824 minutes before scurrying off. And each time I see her the focus continues to be on function – not rehabilitation – and I’m continuously told to learn to be (you guessed it) “as independent as possible…”

A six-month reflection

It has now been exactly six months since I suffered my Spinal Cord Injury. Six months in which everything I knew and did in my life dramatically changed, six months in which an outstanding community from near and far came to support me consistently and with arms wide open. I’m not sure exactly how I feel about this moment.

On the one hand it feels like an absolute eternity that I’ve had to live with a severe disability, unable to walk, unable to work, unable to do all the activities that contributed greatly to my mental and physical well-being, and battling everyday with the uncertainties of my injury. No one tells me if and when I will recover or how much. Doctors, physical therapists and medical practitioners seem so obsessed with liability, lawsuits and the fear of giving me false hope that they barely show excitement at my accomplishments. Of course for me, any major development (i.e. a wiggling toe) is a tiny step closer to my ultimate goal of full recovery, but all I hear from the medical establishment is to accept the current situation and “become as independent as possible”. They don’t push me to challenge my limits or boundaries, they don’t encourage me to take part in other therapies and treatments, they don’t encourage me to keep hope alive; I’ve done all this through my own will and volition. It definitely feels like I’m a lone fish swimming upstream against a relentless current that says to accept things the way they are.

On the other hand, in some ways it does feel like time has passed rather quickly. I’ve found a rhythm and schedule that work for me. No less than six days a week, I’m driving to different parts of the Bay Area to access the therapies and treatments that have contributed so much to my improvement thus far, and filled in the enormous hole that my medical insurance (and their approach) has left for me. I’m shocked by how quickly summer changed to fall and now to winter and the new year. I’m astonished that I’ve already been through so many mornings having woken up and been angry at not being able to jump out of bed and onto my feet. Or how many evenings I’ve endured with a sore butt from sitting in a chair all day.

I have purposely set my goals high, because I know that compromising how I set my goals compromises my potential accomplishments. So I will stick with my goal from the beginning, that on my birthday this August (over 13 months after my accident), I will be on my feet and walking. Everyday can and does often feel like a struggle, but if I’ve made it six months already and improved so much, I can only hope to exceed my expectations for the next six months.

Wiggle wiggle pinky toe!

I’m laying in bed, slowly waking up and adjusting my eyes to the winter sunshine as I glance out the window, when I decide to do some visualization exercises with my legs and feet. I go through the usual exercises that I’ve been doing as frequently as possible in my free time: flex my feet, bend my knee, rotate my legs in and out. Since my accident, I don’t get any movement in my lower body when I do these exercises but I’ve stubbornly and consistently kept at it. The reason why everyone – from the nurses in the ICU to my spine surgeon to my acupuncturists – has emphasized the importance of visualization is the belief that there is enormous value in sending a signal from the brain to the lower body and by thinking and trying to move those limbs, one can repair the neural pathways and reestablish that damaged connection.

This time though, something feels different. I lift myself up to sitting with my legs straight ahead of me on the bed and I throw off the covers to get a better view. Something just feels different, like there’s movement and it’s not just a spasm or reflex (which I have frequently as well). I stare at my right foot and see that my pinky toe is slowly moving in and out. To make sure this isn’t a fluke, I stop and do nothing. Pinky toe doesn’t move. I try again and there it goes, immediately responding to the signal I’m sending. This can’t be right, it’s been months and months of having my legs and feet dangle lifelessly as I’ve dragged and lifted and bumped and dropped them from place to place in this strange new world of life post-Spinal Cord Injury.

I do it again, this time to confirm that what I thought I had been seeing could actually be real. “Wiggle little toe, wiggle”. Wiggle wiggle it says, as it dances back and forth, proving to me that for the first time in almost six months, I have regained motor control of a part of my lower body.

What a development for the new year, what a way to show me that 2013 really will be a special year, one in which I hope to achieve all of my recovery objectives and kick this damn injury’s ass! It’s only one pinky toe, on only one foot and it’s still a long ways to go I’m sure before I can move my legs around like I used to, but that pinky toe gave me so much hope for the future of my recovery. To go from feeling that moving any part of my lower body is the equivalent of moving a table with my mind, to then finally seeing a flicker of hope in a tiny little pinky toe is an indescribable moment. Now, I can move this toe 10,000 times if I have to until it leads to me being able to control my other toes and then my foot and then my ankle and then my legs… My fire of recovery has been fueled, my conviction has been confirmed and my dream to reach my ultimate goal has entered into the realm of reality.

Want proof? Here it is: