Not a Hand to Stand On

Usually, when we have an injury, we look for ways to adapt our actions in order to continue to take care of business. If the injury is one arm, we have another arm that can usually be substituted, though often more clumsily. I am in a situation where both arms/hands have problems. My right arm (my dominant one) has had a recent recurrence of a pain that surrounds my shoulder blade on that side when I use that hand unsupported away from my body.

The instinct would be to decrease use of that arm, and to use it cautiously. This would require increased use of my left hand, and therein lies the problem. I have developed trigger thumb in my left hand, for which I will be having surgery on January 12. The tendon at the base of my thumb has a knot in it, which causes my thumb to snap whenever I try to bend or straighten it. It is painful, especially if my hand has been resting. Opening jars and grasping large items is out of the question.

So what to do? I have been planning ahead, doing ahead of time some tasks that I know are coming up that require 2 hands. I have also been looking at simple adaptations that make two handed tasks possible for a one handed person. Items such as shampoo, soap and hand lotion in pump bottles are an example. Pull on clothing, without buttons or zippers are easier to get on and off, such as sweats and t-shirts. Looser clothing is also easier. There are slip-on shoes, or shoe laces that are elastic. My favorite kind are coiled. You lace them into your shoes instead of regular laces, and they make your shoes into slip-ons that don't require tying.

This topic is complex, and too big for one blog post. Here are two good references with more info on how to do things one handed:  Wiley Library; Stroke.org.au.

So back to the issue of how to do things when both sides have problems.  This takes some individual assessment and problem solving. I have issues with my left hand and my right upper back.  As long as I don't have to grip anything in my left hand, I can use my left arm to hold or carry things.  I can use my right hand, as long as I don't have to do anything sustained with my arm unsupported.  Most tasks can be done with some combination of these limitations.  For tasks that can't be done, there are always the assertive skills of asking for help or delegating. Some tasks can be postponed or just skipped.  My three questions for determining this are: 1.  Does it have to be done?  2. Does it have to be done by me?  3.  Does it have to be done now? 

Most activities can be resolved using the ideas above.  I am still working on how I will wash my hair without getting my left hand wet or keeping my right hand raised above my head.  

Small Changes, Big Payoff

I'd like to wake up one morning (the sooner the better) with no pain, no fatigue and no dryness. I am realistic enough to know that that is not likely to happen, no matter what I do. There are things I can do to make the life I have more comfortable, and some of those things are very small changes.

My husband and I like to lie in bed and snuggle for a few minutes before getting up in the morning. He has a beard that feels like sharp sandpaper when he lays his head on my shoulder. It leaves a red irritated area on my skin that lasts for a few hours. I had a brilliant idea yesterday morning, after 14 ½ years of marriage. I folded a piece of Kleenex and put it between his beard and my shoulder. Voila! Small change, big payout- my skin did not get irritated.

Too often, when we don't like our circumstances, we complain and argue, cry or sulk, or suffer in silence. Instead, we can step back and look at the situation, and try to find a small change or two that would make things better.

Here is another example. One of the tasks I do when we are at our cabin is maintain a trail I built on our property. In the past I used to try to keep it clear of growth. I would spend several hours a day out there, then be sore for days after. I worked on the trail about 1 ½ hours Sunday, for the first time this season. Rather than trying to clear the trail, I just pulled up the taller plants. Monday was in the low 90's and humid. I did not work on the trail at all that day. I don't tolerate heat well these days, and a cleared trail was not worth the soreness. The change? I am less obsessive about the trail. The downside? The trail is not as clear. The payoff? My body is much happier than it would be, but the trail is still passable. Definitely worth it. (This example also fits with my recent post on giving yourself permission.)

Jars have been getting more and more difficult for me to open. I no longer try to open them with my bare hands. First, I went to using a rubbery square thingy that gives me better grip. Now I use a jar opener that is shaped sort of like a nut cracker, that has 4 semicircular rubber lined sections in graduated sizes. You fit the jar lid in the size opening it best fits, and the opener gives not only traction with the rubber, but also leverage. Jars open easily with the help of this device.  There are other styles of jar openers available.  I still use the rubber square to hold the jar itself sometimes, but usually don't need it. The change? The right tool for the job. The payoff? For a few dollars, I can do a common task much easier, with less strain on my body.

Now its your turn. Pay attention as you go through your day. Is there something that annoys you? Frustrates you? Is difficult for you? Hurts you? What can you change about it? Remember that asking for help and saying 'no' are legitimate ways to change a situation. So is learning to accept that there may not be anything you can change, other than how you let the situation affect you. (With the trail, a big part of my change was accepting that: a. I could physically no longer maintain it as I used to, and b. That was okay.)  

Pilates

In my Pilates (pronounced puh-LAH-tees) class yesterday, it occurred to me:  I have not yet written about Pilates!  Pilates was started in the early 20th century by Joseph Pilates in Germany.  It is an exercise system that especially works to strengthen the core (abdominal) muscles in the body.  When these muscles are strong, the rest of the body is more supported, and can function better. All movements are controlled and smooth, with emphasis on keeping the abdominal muscles pulled in the whole time.  Breathing is done in proscribed patterns, exhaling on exertion, and for some exercises, multiple breaths in, then multiple breaths out.  Though some of the exercises are difficult for me, I always feel looser and taller when class ends, and I have more energy.
In class yesterday, our instructor said, as she often does, "If it causes discomfort, don't do it."  My first thought was "Everything causes me discomfort."  I caught myself, because I am trying not to focus on negative thoughts.  So I reinterpreted what she said to mean "If it causes excessive discomfort, don't do it."  Even for a healthy body, some discomfort is acceptable, and muscles don't develop as much if you always keep them in their comfort zone.
For bodies like mine, which hurt no matter what, it is important to learn its signals. I know that with certain exercises I can push through the pain, and I will feel better afterward, others I need to back off.  Some days I push more than others, depending on how I feel that day.
One of the things I really like about this instructor is that for many of the exercises, she will give a variety of options of difficulty.  This allows each participant to do the exercise at a level appropriate to their own needs and abilities, and also gives us permission to back off if we need to.  Not that we really need the instructor's permission, but many people think they do. I sometimes start an exercise at a higher difficulty level, then switch to a lower one part way through the series, as my body requests.
There are a number of things that can be gleaned from my experiences with my Pilates classes.  First, it is important to know your body, what it can and can't do, when to push and when to back off.  Listen to your body's signals, and stay alert to them, they change often.  If something causes excessive discomfort, or you know you will have to pay too much for it later, don't do it. 
Second, all of us need exercise, look for classes or other opportunities that are right for you.  If you are lucky, you will find an instructor like mine, who gives options, and encourages everyone to work at their own level of comfort and ability.  If not, learn to adapt the moves yourself.  The basic rules for adapting something is: 1. Figure out what you are trying to do.  2. Identify why you can't do it the regular way (too fast, too intense, too long a time, etc.). 3. What can you change to eliminate or decrease the problem issue? (slow it down, less intense, shorter length of time, reposition so your body is more supported, etc.) 4. Decide which option to try, if that one doesn't work, try another).  For more on this topic, read my post, 'Adaptation 101'
Third, give yourself permission to do what you need to do, no matter what others around you are doing.  This goes for all areas of life, not just exercise. You don't need anyone else's permission to take care of yourself.  You live in your body- You are the only one who knows how it feels, and the  one who must look out for its needs.
I know there are many people with Fibromyalgia who go into a flair from the slightest extra exertion.  For you, exercise is important, but go very slowly, and increase at very small increments over a long time (your doctor or occupational/physical therapist can guide you on this).  I am lucky in that I don't have this problem.      

Adaptation 101

I am an occupational therapist (OT). I am trained to look for ways that an activity can be adapted for differing abilities.  That really comes in handy when my body parts are complaining or my fatigue level is high. I have had alot of practice over the past year, trying to figure out how to take care of business with tennis elbow in my right arm flaring up at the least bit of exertion.
I have been going to a physical therapist for my arm, and have been having her give me exercises for my knee pain as well.  Several of the exercises she gave me to do I have had to adapt.  One of them is a stretch for the quadriceps muscles, he muscles in the front of the thighs.  The traditional way of doing the stretch is to stand next to something you can hold on to, lift one foot behind you, and grab onto your ankle with the hand on the same side of your body.  Point your knee down toward the ground, with your foot behind your butt, sole of the foot toward the ceiling.   You can increase the stretch by pushing your hip forward, and/or your foot back away from your butt.  (If you can't grab your ankle, you can grab your pant leg.)  I can't do this exercise the 'normal' way with my right leg, because it puts strain on my right arm.
I came up with two adaptations. The first one, I can do in my recliner chair.  I sit with my weight mostly on one hip, and bring the other foot up next to/behind me.  I then twist so that the foot is behind me, my knee is pointed away from my head, and push my hip forward and foot backward to get a good stretch.  As you might expect, I feel a bit like a pretzel doing this, and my other body parts ask me what it is I am trying to do.
The second adaptation is more creative, and also safer and more comfortable.  I discovered that our washer and dryer are just the right height to put my foot up on to do this stretch.  I simply turn my back to the washer, lift my foot up behind me, and balance the top of my foot on top of the washer, sole of my foot to the ceiling (my hand helps keep it in position, without undue strain on my right arm).  I do make sure I am wearing cushy shoes to do this, so the top of my foot doesn't hurt.
Occupational therapists are trained to adapt things, but you don't have to be an OT to do it.  I know that most, if not all, of my readers have chronic illness or chronic pain issues, that is what drew you to my blog in the first place.  Business as usual is not usual for us.  There are often things that we can't do, or can't do the 'normal' way because of the pain, fatigue, or whatever other symptoms might have cropped up that day.  Knowing how to make adaptations takes creativity and practice, but can be readily learned.
The formula for making an adaptation is as follows:
1.  Know what it is you are trying to accomplish.  In the case of an exercise like the one above, what muscle are you trying to stretch, and in what direction.
2.  What is keeping you from doing it the usual way?  In this case, it was my arm pain, so I needed to find a way to position my leg to do this stretch, without using my arm to do it.
3.  What are some options for accomplishing your goal, bypassing the problem area?  I outlined two options for doing this exercise above, each of which is feasible, one of which is better than the other.
4.  Decide which option seems the best, and try it.   If it doesn't work, try another option.
Not everything is adaptable for every situation, but you may be surprised and pleased with how many things you can do, just by adapting some of the factors to fit your needs.