Lisfranc Injury and orthopedists

Dear Cindy,

I'm sorry you're upset by my interaction with doctors. In your situation, it's literally vital for you to be able to trust and follow the advice of your doctors, no matter what horrible things you have to go through, and I don't want to say anything to make you doubt them or regret your trust in them. You've had a bit of bad luck (I'm thinking about the gyn who didn't notice the tumor), and a bit of good luck (the pcp who suspected it, found it, and started treatment immediately)... and it sounds like you have a team now that you can trust. Follow their advice!

As for me... shall I tell you my long history of bad interactions with doctors - or shall I limit myself to orthopedists?

To a man with a hammer, everything looks like a nail. To an orthopedist with a scalpel, everything looks operable. (I have the scars to prove it.)

To begin at the beginning: I was born with an incomplete hip socket, which my parents noticed when I started crawling -- on two hands, one knee, and one foot, with the other knee up in the air. The orthopedist in whose office I ended up proposed pinning my leg in place - to which my father objected: As a child he knew a girl who'd had her hip pinned, who spent her life as a cripple as a result. My father won out; our family doctor gave me a brace to wear in bed (to keep the legs in position), recommended teaching me to ride a bike as soon as I was old enough (to strengthen those leg-positioning muscles), and told my mother to keep me in oxfords rather than letting me wear fashionable shoes. The result of disregarding the ortho's advice: the hip socket eventually grew in normally. Until other problems hit me, I had normally-functioning legs, and even now my hips are in better shape than a 60-year-old diagnosed with MS nearly 25 years ago should expect.

My next run-in with an orthopedist was in my late teens. I've probably told you the story of my parents' complicated marriage. One day my mother was driving my brother Matt, a friend, and me from Queens to Poughkeepsie, where the friend lived and where the rest of us were to visit my father. I was sitting in the back seat, behind my mother, when I saw a red light approaching... and noticed that my mother wasn't slowing down. I turned to my friend, at my right, to say, "Isn't that a red light?" - and at that moment, we crashed head-on into the car that had the right of way. I was thrown so hard against the back of the driver's seat that it knocked the breath out of me. There were real injuries to others: a broken jaw, a cracked kneecap - but it looked like I had nothing seriously wrong.

Not long after, though, I began to feel funny in the shoulder that had hit the back of the seat... it felt vaguely out of position. Knowing what I know now, I would have seen a chiropractor, masseur or physical therapist, but I was in the hands of my mother, who felt guilty for the accident and was ready to do anything to help her darling daughter. So first she took me to an internist (who played with my nipples and gave me a prescription for valium... but we're not getting into my general medical history here), and then to an orthopedist. The ortho announced that it was important to operate to cure the shoulder injury. So he removed the acromioclavicular joint - a treatment, as I later learned, usually reserved for athletes in severe pain who need to keep playing. (It's supposed to be followed by PT, but this guy never mentioned that - he just cut, collected his pay, and left.) The result of following the ortho's advice: I have a hole in my shoulder, a scar, and chronic pain worse than I had before the surgery. *

Wait! - there's more! A few years later I was in a college show. The student set-designer, who had no training, designed a bridge that we all had to dance over. There was one stress fracture, at least one sprained ankle, various other problems... and I developed shooting pains in my feet that ended up focusing on my big toes.

Trustingly, I saw an ortho. "I think I've injured my toes" I said, assuming he'd come up with a solution for the pain. So he examined me, and x-rayed me, and finally gave me a diagnosis: "Yes," he said, "you now have osteoarthritis in your toes." I was glad for the dx, and eager for more information: "What do I do now?" I asked.

"You pay the receptionist on the way out," he said.

I was too stunned to ask any questions. I picked up and left the office (paying the receptionist on the way out.) I've never known if this was his idea of a joke, or if he really was that much of a bastard...

Years later I fell into the hands of another ortho, who proposed to improve the state of my chronically-painful toes. I agreed to let him operate on one toe. So there I was in surgery, all ready for the operation, and he hands me a form to sign: I was to agree that if the operation doesn't solve my problem, I wouldn't sue him. I should have gotten up and walked out right then... but I was still a trusting innocent. I let him remove a bone spur from the joint. So now I have a slightly-more-flexible toe, which hurts more than it did before, as well as a scar. (...and the ortho has his fee.)

I found myself in the hands of another ortho recently, who informed me that the best way to ease the pain would be to freeze both toe joints, to *prevent* flexibility. I had learned my lesson by then: I thanked him and left his office.

So that's where I am with orthopedists: I trust them only as far as I have to.

You say, "As long as you want to do things your way, including persuading the doctor against his best judgment, you will have to deal with the consequences. Why go to him if you're looking for reasons not to do what he recommends? " My answer: I went to him because the ER folks said I had to. I went to him because, when I emailed my pcp about the injury and said the ER was sending me to this guy, she replied, saying she suspects I'll just need short-term treatment, and "Dr Troy is fine for this."

I trust *her.* A couple of years ago, when I contacted her in distress to tell her my neuro (whom I usually trust) wanted to give me a picc line for extra treatment of the Lyme disease that was already cured, she responded by refusing permission for the treatment. She will provide treatment if it's even vaguely needed - but she's my true partner in limiting unneeded treatment.

Note: I did not set out to "persuade the doctor against his best judgment" - I simply set out to explain my situation (with the backing and advice of my friend Gisela, who's a PT and knows my limitations), and to request any possible flexibility in his recommendations. After he viewed the new x-rays and saw that my injury had not been exacerbated by my activity, he told me to go ahead and do what I've been doing.

Come to think of it - maybe it's time to send my pcp a short description of my visit to Dr. Troy, and see if she thinks (as my lawyer brother does) that I need a 2nd opinion - or whether she agrees with Dr. Troy's ultimate decision.

Anyway - thanks for your concern and offered help! I've started a shopping list - that will be my next email.

Marion



* from the web:
http://orthopedics.about.com/cs/generalshoulder/a/acarthritis.htm

"How is AC arthritis usually treated?
Treatment of AC arthritis depends on the severity of symptoms and the presence of other shoulder problems including impingement syndrome and glenohumeral arthritis. If the symptoms of AC arthritis are mild to moderate, anti-inflammatory medications and physical therapy are the most common conservative measures. If the symptoms do not respond to conservative treatment, or if the pain is too severe, then surgery may be necessary. The surgical procedure involves removing the end of the clavicle (collar bone), and allowing the AC joint to fill with scar tissue. This allows for normal movement of the AC joint (which is minimal even in normal shoulders), but removes the rubbing together of raw bone ends."

The Old Prince and the Old Princess

I wrote this a few years ago, after getting involved with Jim E. Maybe I don't need to feel sorry for the Prince after all...

The old prince and the old princess

The old prince
bears burdens for
young squires.
She watches from her grotto.
Wise, noble, strong, she thinks,
Where is his kingdom?
A prince of his years should be a king.

She watches from her grotto.
Her face is wet.
So is her hair,
her arms, her torso,
her green tail sparking in the sea.
She watches young merfolk dance, hears them sing.
I will never join them, she says,
never again.

She sings alone in her grotto.
The young ones bring her toys
to mend, hear her sing an old song
they have forgotten,
and will forget again.
I am nothing now, she says.
Her face is wet.

He has never seen one like her, never heard
a young, a strong, a perfect of her kind.

Her spell is strong enough for him.

She pities the old prince. What will he do, she thinks,
when he sees
that I am not complete?

Nu? So what's my problem?

Elizabeth has ulcerative colitis, has recovered from several flavors of cancer, and may be starting lymphoma again.

Her husband is comatose in the ICU, tentatively diagnosed with Creutzfeldt-Jakob after months of increasingly demented activities (including actions that have put both Elizabeth and his mother in financial danger).

Cindy had a huge cancer removed from her uterus, and is starting to lose her hair from chemo.

As for me... I'm depressed.

I have a whole house and a lovely yard (with flowers and a veggie garden) all to myself. I have a shy cat who loves me. I successfully made yogurt and bread yesterday, and attended a meeting at MIT (where Jim sought me out, stayed beside me & helped me, and accompanied me to my car, where he kissed me, when I left). I rode my trike to the gym, where I had a good work-out... and the NMSS sent me another check to encourage me to continue what I've been doing at the gym...

It's going to be very hot today, but my house is still cool because it's so shady here. If it does get hot, I'll drive (in my air-conditioned car) to the library, where I'll pick up the audio-books that are waiting for me... and I'll bring my laptop, in case I can work there. Oh - and maybe I'll try the local computer-help store to see if they can fix my external disks... if they can't, I have the NMSS check that can help me buy a new back-up disk...

But I'm depressed. I'm scared. I'm lonely. I don't like this symptom of mild palpitations: they have no cause, and they feel like fear.

Well, I'll keep trying to ignore them. I'm tired of enriching doctors.

Not insomnia after all...?

This just came via LinkedIn:

The myth of the eight-hour sleep

http://www.linkedin.com/news?actionBar=&articleID=5578062617768894472&ids=d3ARc3oVc38Te3ASd3kSdjsRdiMOczcPcPkPdzcMejcScj4OdPkRb38Td3gVe3wSdPsNdz8Sc3wTdjkIdjoNd3kOd3AQdzkRcP0UdPsRdiMUdzATc34Mcz0N&aag=true&freq=weekly&trk=eml-tod2-b-sum-2&ut=1FvaGhiX01gR81

The Royal Hunt of the Cockroach

Let's see... My years in Manhattan (long ago, my children) were an exciting and happy period. I dropped out of grad school (/long story), took a low-paying and undemanding day-job, moved into my own little rent-stabilized apartment on the Upper West Side (remember when barely-employed people in Manhattan could afford an apartment?) and took over the kitten that a friend found himself stuck with when the roommates who brought her home moved out and left her behind. 

I was taking voice lessons and singing lots of Gilbert & Sullivan, a bit of opera, and some seasonal religious music... what more could I want out of life? Nobody thought about the price of oil back then. 

My apartment was on the 5th floor of a 9-story building, and the super kept the heat blasting so that it would make it up the pipes to the top story - so to keep from melting, I left all my windows open all winter. 

One day I was greeted at the door by a very excited cat, who kept rushing to the window, then back to the door, then back to the window. Sure enough: a pigeon was inside, perched above the sill. I'm afraid Kitty was pretty disgusted with me when I trapped the bird in a shirt and pushed it back out the window. 

We were reconciled the day the giant flying cockroach flew in. Living across the hall from the trash chute, I was pretty used to roaches... but this was HUGE, and it FLEW. 

I was nervous, but Kitty turned out to be a Mighty Hunter. I never knew cats pointed, but Kitty tracked that creature, found it, and showed me where to get at it, like the best-bred English Pointer. I flushed it out, it flew and hid again, Kitty tracked and pointed, I flushed again... until, with team-work, we got it trapped in a corner and I made the kill. 

Then it suddenly hit me: that was one flying roach. What will I do when its mate seeks revenge? 

The day came, and soon. There I was in the tub, naked, reaching for the soap, when I looked down to see a huge roach just like the one Kitty and I had killed, there in the drain at my feet. 

I could kill it with a sponge - but the sponge was on the sink, and the sink was forward and to the left... could I reach it without either stepping on the Fearful Flyer, or setting it flying into my face? 

Clever creature to attack me in the shower: no chance to call on Kitty for reinforcements. (I've had cats who don't mind water, but Kitty was not one of them.) I knew I couldn't spend the rest of my life standing in the shower turning into a prune - so I took my courage a deux mains, reached for that sponge, and succeeded: I found that the roach's mate, softened, no doubt, from grief, was an easy prey, even in my solitary state.

Adonai, l'shana sh'natata bi t'hora hi...

People go on about "Jewish guilt", but it's the Xians who go on about "original sin" and think they need special help to win G-d's love & forgiveness... while Jews wake up every morning and sing, "Adonai, l'shana sh'natata bi t'hora hi..." That is, "Lord, the soul you gave me is pure. You made it, you shaped it, you breathed it into me - and as long as it remains in me, I will praise and thank you!"

I'm working on a song by Brahms based on the Ecclesiastes verse that can be translated "futile, all is futile." It says we're no different from the animals; who says we go up and they go down after we die? - we're all made of dust, and will return to dust... and so we should just do our work, because that is our life.

I think Brahms, being Xian, wants us to think this is depressing and wants us to lament, but I think it's fine: I'm ready to be recycled or used for compost when I die. The body & soul S/He made is good, and they aren't just for me - I'm here because G-d put me here, and wherever / whenever S/He puts me later is OK too. Meanwhile, like the folks at the end of Candide, I'll cultivate my garden - because that's what I'm here for.

So - it's soy milk...

This week I slept through the night a lot, and woke up in the mornings able to think, and got a lot done. Even Tuesday, when I made the mistake of going out to lunch with LizBlu and her group - I was out for too long, and spent several hours flat on my back afterwards. But I finally did get up and accomplish things... and I slept that night, too.

So today, when I took my last sip of that soy milk I got last week, I worried a bit, because I'd found a note in an old diary that suggested soy milk helped me sleep... so I walked (!) to CVS to see if they had any, but they didn't.

That's okay, I told myself... I'll go to Stop & Shop tomorrow and get some.

Well, here it is again - 3 AM. At the computer.

Fear of fatigue

It's after 11 and I really want to go to bed... but I'm afraid. I'm afraid I'll get into bed, and it will start all over again: I'll lie there waiting for the sleep that never comes.

That was a nice yawn... OK, I'm going to start to try.

Fatigue reply 2

Sent 1/22/12

Hi, Rachel

The rest of your questions are still waiting for my responses... so here at last are my attempts at answers.

You say: "No other materials on fatigue mentioned the risk to driving" and compare my experience to narcolepsy.

I keep trying to write about Fatigue, but instead I find myself writing long stories about how much I've accomplished in my life in spite of Fatigue... so I'm trying again: What does Fatigue feel like? That should bring me to your answers.

I wake up in the morning. I know it's morning, because the sun is shining, my cat is begging for breakfast, my bladder is calling for relief...

I roll over and hide my face in the pillow.

After a while, I can't deny my bladder's call, so I get out of bed and hold myself with one hand (important precaution - I've wet my nightgown on the way to the bathroom more than once), while I hold on to the walls and furniture with the other. As I pass the clock, I note the time. 7:30 AM? 11 AM? How many hours did I spend in bed? (The question isn't "did I sleep" - my sleep is erratic, which adds to the Fatigue problem.) It's mostly idle curiosity - I'm rarely ready to start the day when I wake up, however long I've slept - but if it's 11 AM, I might find myself more nearly rested, while if it's 11 and I know I have to leave the house by 12:30, I have to take drastic measures.

After the bathroom, I'm ready for the morning ritual:
- set the tea kettle (which I filled last night) to boil; put the tea-bag in the teapot
- open the curtains to light the house-plants
- feed the cat (at last!)
- fill the birdfeeder
By now the kettle is boiling, so I fill the pot. Time to save steps to save energy: The oatmeal & sugar are on the counter between the stove & the microwave, below the bowl shelf and above the cutlery drawer, and the measuring scoop is in the oatmeal bin. Sitting at the counter, I scoop oatmeal into a bowl, measure sugar into the teapot, & then slide along the counter to the fridge, where I can get lemon for the tea and milk for the oatmeal... and so the breakfast ritual goes: all automatic, no mind required. Gradually, with tea, the mind-fuzz clarifies enough that I can think about what's scheduled for today:
- perhaps it's the cleaner's day & they'll arrive any time between 10 and noon - do I have time to do my morning stretches before they arrive?
- and/or... Meeting on-site at 1 PM - will I be awake enough to drive there by 12:30? Will I have time/mindfulness to prepare?
- or... Two - no, three voice lessons today: 12:45-1:45, 2-3, 7:30-8:30... Am I awake enough to vocalize now so I can give examples? Will I have time/energy to get my on-line work done in between?
- or... work projects have been coming due; am I ready yet to log on to "virtual work" and work a long day?
- or... other mid-day, away-from-home, time-sensitive projects; things I must do by a specific date, if I can get it together; things I just want to do some time soon... what gets done today? What gets put on hold?

In any case, after breakfast come morning stretches plus morning prayers: it's a soothing habit, as close as I get these days to yoga. Sometimes I finish feeling ready for the day; sometimes the mild work-out (including leg-lifts, push-ups and a couple of other weight-bearing activities) is enough to send me back to bed for a couple of hours... in any case, it's worth doing, so it stays in the morning ritual.

Then there are frantic days: I like to go to Sabbath services on Saturday at 10 AM. (I can go to Friday night or Saturday AM; I don't have the stamina for both, and although I hate mornings, I prefer the morning service - so I don't do my AM stretches on Shabbat.) But it snowed this Saturday! My wonderful neighbors usually shovel for me, but it's Saturday - I guess they assume I'm sleeping in - so I try to shovel, hoping to have enough energy left after for services. What a hope! By the time Reynaud's has numbed my fingers, I know it's time to give up. I drag my stiff, over-used legs to the bedroom, lie down flat... and stay there for most of the rest of the day.

Fatigue is worse if I overuse something that's already limited in function. When I was being diagnosed, they ran an "evoked potentials" test, and told me there were problems with my legs and eyes. Sure enough: as my MS ripens, leg and eye problems have grown. I can walk, I can stand... but I pay with fatigue that leaves me flat on my back and brain-dead for hours. As for my eyes... thank G-d for computers, where I can enlarge text! I used to be a real print-junkie, the sort who'd read every word in the blurb on the cereal box... but now, between life-long myopia, age-based presbyopia (I'm 60) and MS-based diplopia, reading has become an exhausting process of covering one eye (to see only one image), and choosing between wearing reading glasses over my distance glasses, or taking off both glasses and squinting. (I asked my ophthalmologist for help, and she laughed and told me "Thousands of people would *die* to be able to read as well as you do!"... I'm looking for a new eye doctor... but I don't have much hope.)

A work problem: My team has decided to join an on-line class to learn a useful program. The problem? - the on-line course comes with a real book that we have to read in order to take part in the on-line course-work. This used to be my life! - but now, going back and forth between a tiny font in a badly-designed book and on-line, resizeable text is exhausting.

Other exhausting activities:
Longwood Opera in Needham, MA holds concerts every Tuesday night in the summer. I've been the Gilbert & Sullivan concert organizer for years. I know G&S and singers; all I need to do is gather singers from the company roster, suggest suitable music & put it into a nice order, get them together with the accompanist for one rehearsal, prepare one song for myself, and have fun on concert night.

But one Sunday a few years ago I barely woke up in time to drive down to Needham for the mid-afternoon rehearsal. I was there for maybe 2 hours, interacting with singers (which calls for keeping one's eyes open and remembering things, like names and who's-singing-what), standing and walking on those easily-tired legs... By the time I could leave, I really wished I were in bed with my eyes shut and my mind at rest.

That's the first time I almost fell asleep behind the wheel: I had tired already-limited nerve sets. My legs wanted to lie still; my eyes wanted to close, my cognitive system wanted to rest. I thought it was a one-time problem, and drove to Needham a month later to take part in a G&S audience sing-along... and again, was too tired to feel safe driving home. So ever since, if I have to go to Needham or anyplace else that involves driving on a highway for 1/2 hr or more, I arrange for a ride.

I'm worried now about my job: I have on-site (1/2 hr away) meetings once or twice a month. When it's just me and my supervisor for an hour, I know that I'll have to lie down when I get home, but I'll be able to get going after an hour or so of rest. But a few months ago I attended a quarterly all-staff meeting involving a couple of hours of talks by colleagues... and I almost fell asleep listening. Worse: I headed home, was distracted and responded slowly - and rear-ended a stopped car. The other driver didn't see any problem and drove off without leaving his name; I eventually found I had $2000 damage to my own car. I'm lucky nobody was hurt: a friend with health problems and a lot going on in his life rear-ended a truck a few weeks ago. He's dead.

I'm called for another long meeting this Friday. Thank goodness a colleague will be driving me! But do I feel safe about other meetings?

That's how Fatigue can cause falling-asleep-behind-the-wheel: When your eyes and your mind want to rest, it doesn't matter where you are.

... OK, I needed a break and I needed groceries, so I went out. As usual, I aimed for more than I could accomplish: I had to stand to brush snow off the car before setting off; the store was crowded, which makes navigating hard (I can't move as fast or turn as sharply as others in a crowd wish I would); on the way home I stopped at the library to pick up a book-on-tape (I don't read for pleasure any more, I listen with my eyes shut), and it was crowded there, too, so I had to stand on line waiting for help. That's a lot to accomplish on one afternoon! - but I thought perhaps if I got home in good enough shape, I could pick up my gym bag and head back out for a work-out.

Of course not. I made it home, put things away, and found myself arguing with the radio. Aha! Warning symptom - what I've started to call "cranky baby syndrome." When I'm tired and don't want to give up, I get cranky, like any tired baby who refuses to go to bed. If I don't lie down and rest, I get really nasty, and/or I cry and start thinking of what I prefer to refer to as "apoptosis." (That's a bit less forbidding to my psyche than the term "suicide.")

So I turned on a different radio station, lay down flat next to the cat for an hour, and accepted the fact that, although I usually make it to the gym twice a week for a good, sweaty work-out, this is going to be another week when I'm lucky to make it once.

More about Fatigue? You ask: "Do you know of others with MS who report this problem?" (falling asleep behind the wheel) - and I have to reply I haven't looked into it, but I'd be surprised if it isn't a common problem.

You ask, "How much is this affecting your ability to get out and about, and are other alternatives available in your area?" - The answer: I signed up for The Ride, but I hope I never have to use it! I remind friends that I have a handicap placard, and if they drive me to events, they can get a parking space. I explain to others that I can't attend their far-flung activities unless I can get a ride, and ask if I can bring a guest (driver).

If an activity will last several hours, I balance whether I can afford a day or two of rest to catch up; if it's not something special, I usually say no. I no longer travel casually to several-day-long events. That said, I've taken part in some demanding activities lately, with lots of help: I went to a wedding in NYS a year ago, but everyone knew I'd have to get there early, stay in the motel and rest a lot, and rest for a week when I got home. Last summer I gave in to a friend's urging that I take part in a play he was directing, but I needed rides to all rehearsals, I sat back-stage with my eyes shut during the performances, and I was very glad the production was an on-book reading (my memory isn't dependable). In fact, I attended several demanding activities last summer... but I weigh things carefully and take vacation time before, during and after... and I depend entirely on rides.

I'm comparing this to the years when my husband and I spent "vacations" visiting my sick mother in Poughkeepsie and his sick mother in Erie, sharing the driving - and I often did more than my half because the driver had control of the music! I'm comparing this play to the years when I found it impossible to sit at all backstage during a show, because my adrenaline was so high, and I knew everybody else's part as well as my own. I'm comparing it to all the operas and operettas and plays I've directed, going from production meetings to auditions to rehearsals to tech week to final dress to the cast party... and I note that the good times I'm comparing with took place *after* my MS diagnosis. Things have gotten much harder and Fatigue much more of a problem since a) my legs gave out and b) my husband left me - which happened at about the same time. I have to do a lot more for myself, at a time when doing things for myself has become harder, so there's a lot less energy for others.

You ask:
"...what things other than walking do you try to stay in shape?  Walking is highly recommended for people in all conditions, but what else do you enjoy and how does it interact with/help with fatigue?" I get furious when "experts" tell us all to walk! Walking is an activity I have to be very careful with... walking requires coordination among lots of parts and systems, and can be exhausting. If my legs get tired, my whole body and mind become tired, and I can't do anything but cry or sleep.

That said... I was introduced to a wheeled walker with a seat a few years ago, and it turned out to be wonderful! I had agreed to go with a group to Israel, and was afraid I'd spend the whole trip alone in a motel room, unable to do anything but sleep, since so many activities are inaccessable to wheelchairs or scooters. With my walker, I could go almost everywhere everyone else went; when we were going too fast or too far, my companions competed for the priviledge of pushing me while I sat; we spent so much time in a tour bus that I was able to nap as much as I needed... so walking turned out to be possible. I got home with the idea that if I could walk holding on to my walker, I could walk on the treadmill at the gym - and I do! I've gone from a starting speed of .25 mph to 2.5 mph - with an occasional 1/2 minute of running as fast as 6 mph! (I can't run any longer; my legs go into spasm.) At first my goal was to walk for 15 minutes; now my goal is to see how quickly I can travel a mile.

In addition, I've used almost all the other weight machines at the gym (not the ones that call for standing!) since my legs made it impossible to take part in my old favorite exercise: walking up and down the basement stairs for 1/2 hr, carrying hand weights. Working out at the gym definitely reduces fatigue: I take my mind off my problems, I'm in a better mood, I sleep better... It's extra-frustrating when I'm tired enough that I don't trust myself to drive to the gym to work out, but when I'm a "cranky baby," I'm really better off at home.

I have other non-walking exercises that still use my legs: About a year after my legs weakened and went into spasm, I was delighted to find that I could still do jumping-jacks. Another experiment revealed that I can still jump rope! (I can't *skip* rope, because that causes the same problem as walking: it calls for standing on one leg at a time and coordinating the actions of two independent legs.) So if I can't make it to the gym, I'll try to jump rope for a while... it doesn't give me a full-body workout, but it's good for aerobics.

I've been a bike rider since early childhood, but I can't ride a bike now. I ride a trike instead - no balance problems, and I can sit and rest when I need to. When the weather is good, I ride my trike to the gym, or to the PO, or for other errands... or just for the pleasure of being out in the sun.

Singing is an aerobic exercise, too - breath control is key. I still sing operatic works, although having to sit while singing high notes limits what I can do.

I wish I could swim.. but although swimming itself would be fine, the difficulties of getting from a locker room to a pool, then from the pool to a shower, and - totally impossible - standing in the shower to wash the chlorine from my hair, leave me swearing that when I finally win the Publisher's Clearing House sweepstakes, I'll purchase a lap pool for my own house and swim at my leisure.

Finally, you ask: "When you're tired, how do you ensure you get exercise regardless?" Oh - that's hard! I do my morning stretches and mild work-out every day, but if I'm too tired to go out, that's usually all I do. Knowing the emotional danger that comes with Cranky Baby syndrome, I choose to rest until I'm sure I'm emotionally as well as physically safe.


I'm sorry your New Year's Eve was a loss - I hope you've already had lots of other fun activities this month, and foresee lots more in the year to come. The Mozart party was satisfying and fun, and I have other musical events coming up that will also be fun... for which I need to keep in good shape.

All the best -
Marion


PS: What does Fatigue feel like? An MSer whose site is no longer on-line explained that he once found out that he had mono - and it was a complete surprise, because he didn't feel anything different from his normal MS Fatigue. No surprise! I've had both Mono and MS Fatigue, and they're about the same.

Fatigue reply 1

Sent 1/19/12:

Hi, Rachel-

The first question is easy:  Arlington, MA

The second is so hard that I spent all evening on it and finally gave up!  Basically:  I've rarely in my life worked a 9-5  "full-time" job... and my "full-time" jobs (what artists call "day jobs") were boring and ill-paying.  My *career* is a whole other long story:  you can't make a successful career as an opera singer/stage director/teacher when you didn't learn piano as a child and didn't study singing 'til your 20s... I was doomed to failure from the start.  (I'll tell you more if you're patient.)

Third: I can send you more on the topic later, but the short story is, once I finally accepted the fact that I can't run rehearsals or work much on music to sing (no stamina, unable to drive distances to rehearse), or edit/publish an international newsletter (no stamina), I looked at the part-time "day job" I'd managed to snag (great luck! - long story) - and it's a really good one!  I do creative things, I'm respected, I get full benefits for my part-time hours... and they recognize & are supportive with my health limitations.  When my legs gave out, they were having trouble finding office space for me anyway, while my job is almost entirely on-line (I build web pages), so letting me telecommute is a win-win.

I work part-time/flex-time. I can complete my work when I'm able (e.g. 3 AM if I can't sleep!), as long as I meet any deadline for a general project. I'm not allowed to work more than 17.5 hrs/week for my main job (although I have a couple of more flexible side-jobs that are administered through the main office), so I do my best to get my tasks done within the hours I have... but if I go over, I have required vacation time the next week!

Fourth: This is a complicated spin-off.  I had a "day-job" for the university in a different department, which was okay while it was part-time... but when they decided they needed a full-timer in the position, I tried, and got sick.  I thought I'd never work for the U. again.  Taking advantage of things I'd learned in that job, I took a course in web design - and found myself back at the U in a different department, in my current p/t flex-time job.  MS fatigue was on the table from the start; telecommuting & flex-time were selling points on both sides... although once I'd been working for a while, someone found a Federal law that said people in my position have to work on-site under supervision - a real problem for everyone!  So my leg problem actually helped everyone:  they were glad to send me home again, with help from the U's disabilities office.

Change fields?  I can't do all the musical /theatrical things I used to do, and I miss them... but I manage to do a bit (for instance, read about my annual Music to Cure MS concert ).  It's hard when people ask me to direct shows and I have to say no; it's hard when people ask me to sing things I'd love to sing and I don't trust my ability to work long enough to "get it into my voice" (singing is really a sport, and singers are athletes... and this is an athlete who can't work out as she used to).  But the web-design "field" was growing along-side the music/theater "field", and they overlap... so I still do web pages for opera (for instance, see http://longwoodopera.org ) and for my abandoned newsletter (see http://negass.org , a site I designed & still maintain, even though others edit the newsletter).  And I still have some voice students... who, again, overlap with other parts of my life.  I really can't answer the "spinoff" question... my life has been a series of spinoffs, or a series of changes, and MS is just one more thing in the mix.

Fifth: Advice?  Stay flexible, enjoy whatever good comes your way from any direction, reject anything that causes a problem...  Here's something a friend sent me that I have to remember all the time:
http://www.leedscarroll.com/Misc/images/resisting-a-rest.jpg
Rest when you need to!

Taking my own advice, I'm going to log off now; I'll send you more later!

- Marion

==================================

Fatigue

Rachel first wrote:

Hello. Gary Sullivan of the MS Society forwarded me your note, as I am writing the story about MS and fatigue. May I send you a few more questions
about your experience, especially as it has affected work and daily activities
such as driving?

Thank you.
--
Rachel Adelson

And then, when I said yes:

Thanks.

- First things first, where are you located?

- How would you describe the career you had when you were able to work full time?

- Now that you telecommute, what kind of work is that? Do you need to be available during set hours,
or is it work you can complete when you are able, as long as you meet a general deadline?

- Is this a spinoff from prior employment, or something new? Did you need to change fields to
obtain this more flexible P/T setup? Did you broach the subject of MS/fatigue with your employer?

- What advice would you give someone deciding to make a similar transition in employment?

As for driving, this is interesting -- sounds almost like narcolepsy, falling asleep at the wheel.
No other materials on fatigue mentioned the risk to driving, so can you say a little more
about this, is sleepiness the main issue, mental fatigue, combination? Do you know of
others with MS who report this problem? How much is this affecting your ability to get
out and about, and are other alternatives available in your area?

I hope you had fun at that New Year's Eve party, by the way. I actually was home sick myself!
(too-powerful antibiotic - overkill)

- Finally what things other than walking do you try to stay in shape? Walking is highly recommended
for people in all conditions, but what else do you enjoy and how does it interact with/help with
fatigue? When you're tired, how do you ensure you get exercise regardless?

Thanks so much for your help.

So - that's a lot to answer!

Next 2 postings will contain my replies.

3 AM again

I'm always afraid to go to bed. No matter how tired I am during the day, I know that I'll lie down... and lie there...

So I listen to a book-on-tape that I've listened to over and over for months. It's useful: I don't feel the need to stay awake to catch every plot twist, because I know the story by now. I can tell when I've succeeded in dozing, because I can hear when I've skipped a chapter or two.

But... Kitara climbed on my belly and purred... and she was sitting on my bladder. So I had to get up to pee. And then I had to drink some tea (which usually puts me to sleep)... and some more tea... and then I was hungry... And she asked for food... which she didn't eat, and she wanted to go out, and she wanted to come back in and eat the food she'd begged for before, and then go out again...

... shall I try again?

60?! (imaginary conversation)

- -- you *can't* be 60!

- Yes, I can. I've been able to do that for several months - since September 17, 2011, in fact, which happens to have been the sixtieth anniversary of the day I was born.

I expect to retain and build upon that skill (I might go so far as to say, that *talent*) for approximately another nine months. At that point, my plans include an upgrade to a new skill: the ability to be 61.

Elohai n'tsor l'shoni mera

Lord, guard my tongue from evil
and my lips from speaking deceitfully
To those who curse me,
may my soul be unresponsive
and let my soul be like dust to all.
[but to those who bless me,
may my soul be responsive.
May my soul be full of gratitude
and may I remember to express gratitude
to all the many who bless me.]
Open my heart to your Torah
and may my soul pursue your commandments.
[and may I leave the rest to you!]
And all who plan evil against me,
quickly annul their counsel
and frustrate their intention.
[and all who plan good for me and others,
quickly allow me to aid their counsel
and to support their intention.]
Aseh l'ma'an Shmecha...

Randy's last lecture

I was feeling sorry for myeslf - so I had to revisit this:
http://www.youtube.com/watch?v=ji5_MqicxSo

Knee Relief

Yesterday was such a frustrating waste, and I had things I needed to do today - so I took the little pill that isn't supposed to help with fatigue, but does.

Linda N., who was approaching knee replacement, introduced me to Knee Relief a few years ago when I was having lots of shoulder pain (before Susan Lattanzi, that wonderful phys. ther., got me to improve my home-office set-up and turned me on to a rollator). The super-pain-killer didn't help my shoulder - but something in the combo of caffeine + anti-inflammatories cut down my MS fatigue to a bearable level. I'm afraid to use it too much - what if it stops working?! - but now and then...

So I took it this AM, and successfully
- did all my morning blessings & exercises
- attended the Social Action Committee meeting (only a little late)
- drove (alone) to Neville Manor for the annual sing-along with the BETC crowd
- shopped for milk & other needed groceries
- took a 1/2 hr walk (& run-a-bit) while it looked gray indoors but the sun was still visible outdoors

Okay, supper time - and then let's see how much I can still accomplish today. (I hope I've earned a night's sleep for a change!)

3 AM

Yes, there's a 3 o'clock in the morning, too.

Why am I up? I don't know how to deal with this: I lay in bed most of today -- and it was a gorgeous day, too! - 60 degrees and sunny... I'd love to be out on a day like that....

Instead, I was flat on my back, unable to move. When the sun finally went down I got up and ate something. Then I got on-line and blogged about the difference between pleurisy and the MS "hug" (I was curious... but no, that was probably really pleurisy back in '86)

... and then I watched crime shows on TV, and then I went to bed and listened to music... and then I got up and ate a whole lot more, and then I got on-line and prepared the content for an e-mail I've been trying to write since last Friday, but just didn't have enough brain-power to gather the simple facts needed.

Am I a vampire? Am I a cat? Why can't I function in daylight; why do I wake up after dark?

OK - back to bed, to try again...