21 October 2005

I woke up in the morning feeling really tired. I only had massage and didn’t do much exercise yesterday so I suspect it’s the accounting work that tired me out. I’m still madly trying to finish all the accounts, BASs and tax return for Tim. I hate being an accountant!

I went to my usual physio session at Epworth. Ruth was not there when I got in the physio treatment room. I didn’t think it matters very much because I know what I have to do anyway. Gary came in in his electric wheelchair. He has been assigned to Elise while Gavin is away. I think Elise hasn’t been there for very long, probably only 3 or 4 months. She reminds me of Abby from NCIS ( a TV show on ten). I know she worked at Caulfield Medical Centre before she came to Epworth. I never asked her what’s that place like. Actually, I don’t think I’ve ever spoken to her. Maybe it’s the fact that she worked at Caulfield Medical Centre somehow puts me off because Fary Khan, my consultant at MECRS, is also a consultant there.

I started with my walking practice in front of a mirror and Ruth came in when I started to wonder what I should do next. She said she found my exercise card. Apparently Gavin has written up my program on it except I’ve never seen it before. Ruth showed me the card and it’s just my arm and shoulder exercises. She said sometimes in physio sessions the physios concentrate too much on the legs and neglected the arms. I think that’s quite true. She suggested that I spend about 15-20 minutes doing those exercises on a physio bed first and then I can do my running practice. She set me up on a physio bed and handed me a 1.5kg dumb bell. I told her I thought I should use the 1 kg dumb bell. She said Gavin must have upgraded it to1.5kg because that’s written on my exercise card. Damn, my plot didn’t quite work! My arm was still very sore from yesterday’s massage and my triceps feel really tight so I thought maybe I’ll take it easy for a few days. No such luck!

I noticed the room was actually very quiet without Gavin. Gary was chatty as usual but not very loud. Elise was speaking very softly and I could hardly hear her. I didn’t have to put up with the ‘background radio’ while doing my shoulder exercises. I had to take little breaks between sets because my triceps were really sore. I remembered what Judy told me yesterday so I thought I’d better do some stretches as well. The only way I can stretch my triceps is doing it against the wall. As I was doing the stretches, Ruth came in to check on me. I told her I was just trying to stretch my triceps and she told me to lie down on the bed and she’ll help me to do that. As she was helping me to do the stretches, she noticed that my triceps were very tight. She also commented that I have very long armsw and told me to move up the bed and also to the edge of the bed so she can stretch it out more. I know I have very long arms but I didn’t realise that until I was training for ballroom dancing with Tim. I think our coach pointed out that my arms are much longer than Tim’s. I told Ruth that I just saw my orthopaedics on Monday and he said my shoulder is doing well. She looked a bit confused so I had to explain to her that I was referred to the orthopaedics because I had subluxed shoulder. She asked me which rehab hospital did I go after my operation and how long was I an in patient for. I told her I was at MECRS for 10 weeks. She asked me what did I think of the physios there. I didn’t know what to say but now I know the health care industry is not as bitchy as the accounting firms I had to be diplomatic about this. I thought for a moment and told her that the physios there were very gentle and it’s probably because most of the patients there are elderly. She said yes, Epworth is quite unusual because it tends to get a lot more younger patients and there is a difference on how you treat the elderly patients. Just from doing the stretches she said my shoulder is actually pretty good. Gary was also saying that in the background. I thought maybe I could ask Prema to help me stretch out my shoulder every time I see her. I know it’s probably not enough but it’s better than nothing.

After the arm stretches, Ruth noticed that I still haven’t done two of the exercises on the card so she sent me back to finish those before my running practice.

My arm was feeling very heavy by the time I got on the trampoline. When I was doing my running practice, the ‘background radio’ was switch on. I could hear Elise and Gary talking about pays. Elise was complaining that they don’t get paid very well and Gary was saying that they should get paid more. I have no idea how much physios get paid because I’ve never had any physio or allied health clients. I would hate to think that they get paid less than accountants or even worse, financial planners. After months of treatment at Epworth, I really admire what the physios do for people and I have a lot of respect for them. I hate to think that they get paid less than financial planners. But then again, most people don’t get paid as well as financial planners because most people don’t work on commission basis. I remember many years ago, I went to a seminar for financial planners and the car park was full of Mercedes and BMWs. I remember a collegue of mine was really impressed by that and said you can tell how successful they are by the sort of cars they drive. A very shallow comment. Thinking about this reminds me of the movie “American Beauty’. I remember the character Carolyn Burnham, played by Annette Bening, who is a realestate agent, said ‘to be successful, you have to be perceived to be successful’. I know that’s the reason why many chartered accountants drive luxury cars. One of the partners in the last accounting firm I worked for was like that. He has a holiday house in Sorrento, drives a BMW four wheel drive, sends kids to private schools but in reality, was deep in debt. He had to borrow to fund his lifestyle. I have to say that I chose to study financial planning because I found it interesting but I was disgusted by it after I found out how the industry operates. I guess I’m just a little upset to find out that physios don’t get paid very well when I think they have done a lot more for me than a financial planner would ever have. Another point to mention is that I read a survey on the Internet the other day and the Americans think the most respectable jobs are: fire fighters, doctors, nurses and teachers. The least respectable jobs are realestate agents, financial planners and accountants. I’m not surprised by this at all.

Ruth came to check on me and got me to try to run on land. She thinks I’m doing better but I think it’ll be a while yet before I can master this. I remember it took me a while to be able to jump onto my right foot because it involves pushing off my left leg. When I first started, Gavin used to get me jump off a box and eventually I can push off through my left leg.

17-20 October 2005

I feel quite guilty that I haven’t updated my diary for a few days. The truth is I have been extremely busy these days. Tim’s BASs and tax return are due pretty soon and I somehow have to fit in my physios, personal trainings, massage and grocery shopping as well. There is only so much time in a day and I hate to think what it would be like when I start working again.

I had three sessions of personal training this week – Monday, Tuesday and Wednesday. It all started quite well on Monday and as time went on, it started to go downhill again. I had doubt in my mind whether I should continue personal training last week and is quite keen to try out this other personal trainer recommended by Gavin. When I went to the gym on Monday, I wasn’t expecting much because I didn’t think the last few sessions I had with Mary were very good. To make the situation worse, I always feel I’ve been short changed in the session. One of the things I’ve picked up from many years of working in accounting firms is that I tend to notice how much time I spend in meetings so I know who to charge to when doing my time sheets. I noticed that my personal training sessions have been cut short lately. I always make sure I’m there on time but sometimes Mary arrived late so we started late but I found she always finished early so I didn’t actually get my 60 minutes workout. I know it makes me sound a bit petty but I just don’t like feeling that I’ve been taken for granted. Mary was away from last Wednesday night and she arranged for me to have a session with another trainer, Ann-Marie. I had a session with her in the past and I think sometimes it’s good to have a change and I was able to convey message to Mary from Ann-Marie. Basically, I told Ann-Marie the exercises Mary set me were too easy and I asked her if that’s what’s usually the case in personal training. I think She must have told Mary about this because sine then Mary has changed my program a bit to make them harder. When I had the session with Ann-Marie last week, I found that I had the full hour.

When I went there on Monday, Mary was in a really good mood. Maybe it’s because she just got back from her break. Over the months that I worked with her, I found her mood varied a lot. There were days that she was really enthusiastic but there were also days that she was a bit slack and just wanted to finish our session early. I know I should not compare her with Gavin because she is not meant to be a physio but I think Gavin is a lot more consistent and I don’t have to put up with his mood swings. I thought about how to tell Mary that this is just not working for me but when she was all nice and enthusiastic on Monday, I just couldn’t tell her. I had a pretty good session on Monday.

I had an appointment with my orthopaedics, Martin Richardson, on Monday afternoon. I know he has a habit of running late so I was taking my time in getting there (by taxi). While I was sitting there waiting, I picked up some trashy magazine and read something interesting (at least I thought its interesting). The heading is Jessica Simpson’s Daisy Duke workout. Apparently she had a personal trainer to work with her for two hours a day to get the figure. When I looked at her exercises, I was surprised to find that some of them are similar to the ones I used to do when I first started personal training such as squats against the wall and step back onto a step and down. I found it pretty hard to believe if that’s all she did because I found those exercises not intense enough for me after a while and I get better results by using gym equipments. I was surprised that Martin was pretty early today – I only had to wait for half an hour as opposed to the normal one hour. He checked my shoulder and again was happy with my progress. I told him that I still cannot do a full abduction with my left arm. Again, he said it’s to do with strength. I asked him if he was sure because I couldn’t do that in the pool where there is no gravity. He ordered some X-ray for my shoulder just to be sure. Apparently I could just do it downstairs and come back with the film later. About half an hour later, I came back with the film. Now I know why he is always running behind schedule – he has to fit in those patients who go for a scan or x-ray again. In a way, it’s like double booking some patients.
Martin looked at the films and told me that my shoulder is all fine. This is more reassuring than just telling me without looking at the films. He said I need to build more strength in my shoulder. I guess that means I need to work out more at the gym.

Tuesday was a busy day for me. I had personal training in the morning, physio in the afternoon and grocery shopping after that. In that personal training session, I worked mainly on the arm and the shoulder. In the afternoon, I went to Epworth for physio. I got there just before 1 pm and the physio treatment room was still closed so we all had to wait in the hallway. Megan, another patient of Gavin’s, was in her electric wheelchair waiting. I have seen her around before but haven’t actually spoken to her before. I started talking to her and found out that she’s only been here for four weeks. I didn’t ask her what happened to her because I know how annoying it is for me when someone asks me that. I thought she will also be treated by Ruth, another physio, but she told me she will see Sarah.

The physios came back from their lunch break around 1 p.m. so we could all get in the treatment room. I started with someone walking practice while I was waiting for Ruth. When Ruth turned up, she told me there has been some reallocation of cases and she won’t be treating me but instead, I’ll have Katie instead. She then introduced me to Katie. Katie seems nice but I wonder if she has enough experience. I haven’t seen her before and somehow she reminded me of Emily, the junior physio who treated me when I first got to MECRS. I think there must be some reallocation because Megan has Katie as well. I continued on with running practice on the mini trampoline but was a bit annoyed with all the change and started to wonder if there is any point for me to go to physio there at all. I wonder if I should just increase my personal trainings and skip physios until Gavin comes back I was thinking maybe I should just send Gavin an email and let him know that there is no point for me to waste my time while he is away and I can continue with physio when he returns. Just as I was thinking about this, Ruth came in and told me that she has just spoken to Gavin and he wanted her to continue working with me instead of allocating me to Katie. I felt more relieved. I noticed that the treatment room was a lot quieter when Gavin is away. When he is around, the treatment room is always crowded. I don’t know how he does it but he can actually treat a few patients at the same time. Maybe this is due to experience or perhaps he is just very efficient. I couldn’t help but thinking he is such a ‘cash cow’ (in marketing terms) for the Epworth Hospital. My accountant brain just couldn’t stop ticking. I don’t know how many hours he actually works there but say it’s a standard 8 hours day with one hour lunch break. If he sees two patients per session (a conservative estimate), that will be 14 patients a day. I think most of the patients there are covered by TAC, Workcover or private health insurance. He told me the hospital charges $50 per session if the patient is not covered by any insurance but more if the person is covered. Say if the average charge is $100 per session, then he would bring in $1,400 per day. Based on a 228 days working year (excludging public holidays and annual leaves), he would bring in $319,200 for the hospital. I don’t think I’d ever billed that much in one year in my years at accounting firms!

I spent the rest of the physio practising running on trampoline and on land. Ruth has given me a few tips on the sort of things I need to work on so I think I’ll practice them at home. One thing i have noticed about Ruth is that she is very gentle, almost like the physios at MECRS. She came up to me a few times while i was practising on the trampoline and asked me if I was tired or if I felt pain anywhere. I guess maybe it's because she doesn't know me and she is worried that I might work too hard and get too tired. I don't recall Gavin ever asked me if I was in pain. I know he often ask me if the exercise he gives me is hard enough and if I tell him no, he'd work me harder. Come to think of it, maybe he is the odd one out. I think all the other physios who treated me before are not as pushy.

I had personal training again on Wednesday morning. I was a bit annoyedd with Mary when I got in there about 10 minutes early. She said it’s good I got there early so we can finish early. She said her next client always turns up early so if she finishes early with him as well she can have more time to go to her boxing class. That’s fair enough except I was concerned that we’ll finish early at my expense. We spent most of the time on abs and then a little bit on the calf raises. I think my calf is a lot stronger now because she added more weight on while when I first started, I found it hard even when there was no weight. This time, I thought it was too easy when there was no weight on so Mary added 2.5 kg and then another 2.5kg. I think my concern was valid because we finished early again. I know I got there a bit earlier but we finished before my 60 minutes was up. I’m not sure how to tell her that I’m not happy with the way she operates but I thought this would give me a better excuse not to continue with her if I find the personal trainer recommended by Gavin better than her. Gavin said I can tell her that I found someone better but I think that’s a bit confronting and I don’t want to burn my bridges since she also works at the Melbourne Uni gym. Tim thinks I should just tell her that I’m unhappy with her and unless she can operate the way I want it to be, I’m not going to sign up more sessions. I have to think about this so I can handle it diplomatically.

I had massage with Judy this morning. She actually broght her photos to show me – when she was in the Army and the time she was a Qantas pilot. The earlier army photo was taken in 1971. I couldn’t believe that her uniform was a dress and she had to wear gloves. At first, I thought she looked like a flight attendant because the dress was quite short. I just didn’t think they would wear uniforms like that in the Army!

I told her about my appointment with the orthopaedics and that I had an X-ray and the orthopaedics said I need more strength in the shoulder. She was very upset. She said he should have ordered an ultra sound, not an X-ray. She said my problem would not be in the bones, but possibly in the ligments and an x-ray wouldn’t show that. I told her I didn’t know that as it’s not my area. She said this makes her so angry because those specialists can just say whatever and get away with it because patients usually wouldn’t know. She thinks I need to stretch out my ligments more first and then strengthen the muscles.

14 October 2005

I didn’t update my diary yesterday because I was busy doing grocery shopping on the internet. Tim thinks we should have a disaster plan for a flu pandemic. He thinks we should stock up on storeable groceries enough for a month so if it does happen, the best thing we can do is to just stay at home and don’t go anywhere that has any chance of people contact (like in a store). It’s pretty scary to think about such an event may happen in our lifetime but with all the news on this avian flu virus, it looks like it’s almost inevitable and it’s probably just a matter of time. I already made a mistake by not acting quick enough when Tim thought we should get some Tamiflu just in case if there is an outbreak of avian flu. Tamiflu is an anti-viral medicine. A month or so ago, Tim had to take Lillian to the GP to get a certificate that says she doesn’t have conjuctivitis (in order to go to childcare)and got some prescriptions for Tamiflu as well. Since I wasn’t there, he could only get the prescriptions for Lillian and himself but not for me. He then took it to the chemist but had to wait for a while to get the ones for Lillian. I got the prescription a bit later but I sat on it for a while thinking it’s a bit waste of money because it’s quite expensive. When Tim took it to the chemist for me last week, it’s already too late. Due to the recent outbreak of avian flu in Indonesia, all the pharmacies have run out of stock so I have to wait till the next batch of stock comes in. I guess the lesson for me is if there is something to be done, do it straight away, don’t sit on it. That’s why I was maddly ordering the grocery online yesterday.

It’s actually very hard to think what to stock up on in the case you cannot go out for a month and in the worst case scenario, no electricity, water or gas. Tim said we are ok with water because we have a water tank in the backyard. In terms of gas, we can probably cook on the gas BBQ. It’s pretty scary to think of all the possibilities and plan for an ‘apocalypse’.

On a brighter note, I had personal training yesterday and Rosemary walked me home after that. I think not only she is a good upper limb ‘therapist’, she is also a good counsellor. I found that she is someone I can talk to when I have some issues and she is always for sensitive and understanding. I remember that I used to feel very self concious when someone stared at me and told her about that and she was very empathetic. I guess one good thing that came out of my ‘drama’ is that I have gained a good friend.

I had physio at Epworth this morning. Today is Gavin’s last day before he goes on long service leave. I actually have a lot of questions for him but I’m not sure if I would get a chance to ask him all of them. When I walked in the rehabilition centre, I saw Gavin putting a patient on a bike. He was in his Hawaii shirt. Looks like he is ready for his holiday already.

I set up a mirror and started doing some walking practice. I noticed that Nick, another patient of Gavin’s was sitting in his wheelchair. He is actually looking a lot better than when I saw him on Monday. He seemed to be more alert today. Gavin came over and got him up from the wheelchair and tried to help him to walk. He is actually walking quite well now with Gavin’s assistance. I wonder if tramatic brain injury is less severe than having hemiplegia because I was at MECRS for 10 weeks and I only started to walk just before I came home. I don’t think Nick has been here for that long but he is able to walk with some assistance. I can’t help but started to wonder if my progress was slowed down by inadequate physio treatment.

When I was in the taxi, I noticed that when people on the street walk, I can actually see the soles of their shoes from behind. I don’t think I have much plantar flexion like that when I walk so I thought I could try to practice that. When I tried to do that, to my surprise, I almost lost my balance. I don’t know if Gavin has noticed that. He set me up to do some shoulder exercises first on a physio bed. I told him I have a strange question to ask him. One I was a bit embarrassed to ask him earlier. He was probably a bit curious what sort of strange question could that be. I asked him if his other patients have problem with the weights when they go to gyms. I told him that at the Melbourne Uni gym, the minimum weight is 5 kg but I found there are a few things I can’t do – like the chest press and the leg curls for hamstrings. At first, I thought maybe because I’m so weak and unfit so I can’t lift the minimum weight. To my surprise, he said a lot of them started like that and that’s why he and Chris, an exercise physiologist, do gym visits all the time just to check the equipments and work out a way to modify the gym programs for patients. He mentioned about doing a gym visit with me a while ago but I kept putting it off because I haven’t actually joined the Melbourne Uni gym. I only go there for personal trainings. I asked him about the personal trainer he recommended as well. I told him I would like to try out this person before I decide whether I’ll swap my personal trainer. I remember a few years ago, I signed up a short course in tennis when we were still at Trinity College. The coach was always yelling at us and was very abusive, too. I improved very rapidly mainly due to the fear of being yelled at. I only found out later that he’s deaf. He had a hearing aid but it’s hidden well so I didn’t notice until towards the end of the course. I don’t think I want a personal trainer yelling at me in front of everyone in a gym. I need someone who would push me hard but not abusive. Gavin said he can organise that in a few weeks.

While I was doing my shoulder exercises,Gavin introduced me to Ruth, another physio who will be treating me in his absence. I have seen her around before but didn’t know who she was. She seemed quite nice. I commented to Gavin that I guess I’ll have to resume learning to run after he returns. He said he hopes I should be able to run by the time he comes back because Ruth and Chris will be teaching me how to run in his absence.

After my shoulder exercises, Gavin set up a trampoline for me to practice running. While I was practising on the trampoline, he was treating Gary, the patient who is quadriplegic. I wasn’t really listening to their conversation until Gary mentioned that he’s been taking Tamiflu. I almost fell off of the trampoline when I heard this. I barged in and asked him what on earth is he doing that for. He said it’s to prevent flu. I thought he meant avian flu so I told him that you cannot prevent it by taking it now. You have to wait till you’re getting the symptoms and then take it. He said his parter has a flu for weeks and is very sick so his doctor prescribed Tamiflu so he can take it to prevent from getting one. He then went on and said you can’t get them in the pharmacies now but he’s got repeats. I cannot believe what I just heard. His irresponsible and idiotic doctor will probably get us all killed!!! From my understanding, Tamiflu is the only affective antiviral for avian flu. If Gary starts taking it now, there is greater risk that the flu virus can build up resistance to it and when there is really an outbreak of avian flu, there may be nothing that can save anyone. It makes me so angry when people abuse antibiotics this way. If everyone is like this, I think we are really doomed.

I had a massage session with Judy in the afternoon. I normally see her on Thursdays but yesterday was a holy day in the Jewish calendar so she moved me to today. I complained to her about Gary taking Tamiflu and she said she wouldn’t take the antiviral even if there is an outbreak. I didn’t understand why. She said he hasn’t been sick for over twenty years and it’s because she never takes medicine and she eats very well. I think if everyone is like her, we wouldn’t have to worry about the possible flu pandemic.

11 October 2005

I had personal training with Mary this morning. My leg was very sore when I woke up this morning. I think it’s from the running and jumping I did in physio yesterday.

It’s kind of strange not going to my hydro on Tuesday mornings since I’m so used to it now and I think my body actually misses the warm water. I know I can just have a hot bath but it’s a bit different in a hydro pool because I can move around and do a bit of swimming as well.

On my way to the gym, I was really concentrating on my arm swing. Gavin said people don’t actively swinging their arms when they walk, the arms just swing when they walk. I notice that my arms tend to swing normally when I walk if I can relax my left arm. As I walked passed the Trinity Foundation building on our street, I noticed there were a couple of guys standing there discussing something about the building and pointing at it. One of them saw me coming, smiled at me and said:”you duffer, what did you do to yourself?” I think he probably thought I broke my leg because I was wearing my ankle brace. I know he meant well but I didn’t think it was necessary for me to tell him my life story so I just told him it’s not very exciting and walked off.

Going across the road was a bit challenging this morning – only because this person thought I was going too slow and decided to overtake me. That alone is ok but then he decided to stop when he got to the other side and I almost bumped into him. I had to stop and start again. I found my gait and speed changed as I stopped and started again. I guess Gavin is right in saying that outdoor walking is better than walking on treadmill because it’s uneven surface and in this case, I had to adjust for other people’s unpredictable behaviour. These days, when I cross the road, I always press the button with my left hand but sometimes I wonder if people notice that something is wrong with my left arm/hand.

I didn’t look at my watch until I got to the gym – it’s just about 10.50 a.m. My watch is usually a bit fast and my appointment with Mary was 10.45 a.m. I didn’t think it matters even if I’m 5 minutes late because from experience she is rarely there on time. To my surprise, when I walked into their office, they were all there – Mike, Ann-Marie and Mary. Mary said she’s starting to get worried (because I was running late). I think ever since Gavin told me what he thought of her, I found it’s almost becoming like ‘self-fullfilling prophecy’ because even a comment like that tends to annoy me. She told me that she’s got some new exercises for me. She took me to the downstairs area of the gym. I don’t actually like going there because the stairs slow me down and I think we waste a lot of time in our session just walking around. The new machine she mentioned a few weeks ago has arrived – a hack squat leg press. She said she wanted me to try it and see how I feel. I tried it and found my it really works my quads. She also got me to try a machine that works the calves. We tried this a while back but it was too heavy for me back then. Now, it’s a lot easier for me to do the calf raises on this machine. In fact, it was getting too easy for me that she had to add some weights on.

I met up with Rosemary after personal training and she walked me home. When I got out of the gym, Rosemary said I looked so perky she almost didn’t recognise me. It was so nice to see her since I haven’t seen her for a while.
When we were crossing the road, she pointed out to me that I was so much faster than before and I could cross the road quite comfortably without using the strategy I was using before. I think that’s true because I can’t remember the last time I used my old strategy in crossing the road. The problem I have now is sometimes I get caught in the middle of crossing the road because the green light has been on for a while and just as I start crossing the red light starts flashing and it’s quite stressful trying to quickly walk to the other side.

I picked up some mails in the mail box when we got home. There is a letter for me but no sender details. The writing and the ink look really familiar but I couldn’t tell who is it from without opening it. I put it away and thought I’d open it after Rosemary has gone. I really enjoyed catching up with her except Jill, the social work from ARBIAS, turned up on time for our appointment at 12.30 pm. I told Rosemary before Jill came that I had this appointment but it’s probably ok because Jill is usually late. For once, she is actually on time and for once I wished she wasn’t so I could talk to Rosemary a bit longer.

Jill came to talk about closing my file. She thinks I'm doing so much better since she last saw me and doesn't think I need them much longer. I managed to persuade her to get someone to catch the tram with me a few times. It's something I want to practice doing but a bit scared to do it on my own. As we were talking, she mentioned something about she can spot people who had ABI from alchohol abuse. I asked how and she told me they have special gait. I was intrigued. I thought all people who have had brain injuries would walk like I do but apparently not. She said these people tend to have their knees turned out when they walk.

After Jill has left, I went back to open the letter I had collected earlier. To my surprise, it was actually from Rosemary. She described it as ‘an email by post’. It’s so nice of her to send me a note with comments on my blog. I think it’s always so nice to know that people actually read it. I know she and Neil and also Neil’s mother in the US have always been reading it. The letter was written in a true ‘Rosemary style’ – with it’s grace and elegance. I don’t know how to describe it but I think it’s just the very refined mannerism makes it very ‘Rosemary’.

10 October 2005

I was quite excited this morning because I had an appointment with Skye, the hand therapist, after my physio session wth Gavin this morning. I wonder if she’ll be able to tell me if there is anything else I can or should do with my upper limb.

I went to my physio session an hour earlier than one usual time because I had to see Skye after my physio session. I had to get up a bit earlier than usual and I’m starting to wonder if I can cope going back to work yet because I felt quite tired even before I left the house. I found the traffic a lot worse this morning. Maybe it’s just towards the end of peak hour traffic.

I already know what I would be working on in physio today – more running practices. I know I’ll be doing this every time until I can actually run. I actually tried to do a bit of practice on the weekend but still couldn’t land on my toes when I run – something I’m aiming for. When I spoke to Tim, he thought it’s a bit strange because he said when he jogs he lands on heels and only in sprinting you land on your toes. I don’t know the logic behind it but that’s what Gavin got me to practice last week.

The physio treatment room was pretty quiet when I got there. I guess it’s probably because most patients have the sessions after 10 a.m. and I got there just before 10 a.m. I warmed up with some walking practice and Gavin set up a trampoline and asked me to practice running on it like last week. The room was extremely quiet without Gary. I know he is in a session with Skye so when Skye finishes with him, she’ll see me. There were other usual patients of Gavin around – Nick, a guy who had car accident and Meg, I think she is quite new because I have only see her a few times. They have both improved a lot since the last time I saw them. One thing I noticed about these patients who had car accident is that they are usually very quiet. I’m not sure if it’s because they have problem with their speech or they are just quiet. I guess not everyone is as loud as Gary.

I think the running practice is quite physically demanding because I got tired quite easily when I haven’t been on the trampoline for very long. Gavin asked Libby to help me with practising running in the middle of the room and in the hallway. They put a belt around me so Libby can hold it when I run – it’s supposed to be a safety measure so she can grab me before I fall. I’m not sure if the devise will actually work in the event of someone actually falls because Libby is very pettite and I wonder if she is strong enough to catch the patient if he/she actually have a fall.

Gavin still tells me that I need to land on my toes when I’m running. I asked him about what Tim said and he said that’s right that when people jog, they land on their heels but for people who had brain injuries it doesn’t work to teach them to land on their heels. Something to do with weakness in the extensors. He said the only way I can learn to run is to teach me to run on my toes first and then later I can land on my heels. Sounds very complicated. In a way I feel guilty that I get to learn to run again from someone who specialises in high mobility while the patients at MECRS don’t have the opportunity to do so.

I practiced running on the floor a few times but still couldn’t land on my toes. Gavin told Libby to get me to start with standing on my toes first and then run again. When I was standing, I could sort of stand on my toes but as soon I took a step, I was back on my heels again. Gavin told me to sit down and grab hold of some tapes. I thought he was going to tape my ankle so I told him I actually have my ankle brace in my bag. He said he’s going to tape my right foot. I didn’t understand why he would want to do that. I didn’t see but he had a heel of a shoe in his hand and he said he’s going to stick the heel on the sole of my shoe to make it higher so I can feel what position my foot should be in. It’s a bit like wearing high heels. I told him that he should just tell me earlier because I have plenty of high heel shoes. He said high heel shoes are banned in physio. I thought they might be worried about the floor in the physio room but he told me that high heels are bad for your feet. I know that already. I think years of wearing high heels have caused lots of damange on my legs already but seriously, how would I know that before? Before I had Lillian,, I didn’t even own a pair of flat shoes. It’s not till late in the pregnancy that I started to have back pains and had to get myself a few pairs of comfortable shoes with lower heels but still not completely flat. Come to think of it, I used to be able to run in my high heels – especially when the tram was coming and I was running late for work.

When I was back on the trampoline practising with the newly attached heel, I overheard Gavin telling someone about his leave. I know he is going to take two months off but I didn’t know why. He explained to someone that it’s actually his long service leave but next year he wants to take up some fellowship and do some research so he’ll only be here on a part-time basis and if he doesn’t use up his leave, he’ll loose a lot of it as it will be pro-rated or something like that. I’m not sure if this has any effect on my physio program when he goes part-time. I guess I’ll worry about it when the time comes. I’m quite lucky already because orginally MECRS was planning to discharge me back in May and when I came to Epworth, Gavin was working on the basis that my insurance will pay 50 sessions and it would last me till around September. Whatever session I’m getting now is just a bonus.

After my physio session, Gavin took me to see Skye. Her office is upstairs. I actually haven’t been to that part of the building before. When Gavin got me to practice going up and down the stairs in the past, I didn’t go all the way up to the OT area. I was surprised that I actually got away with using the rails as we went up the stairs. Skye was still with Gary when we got there. She left Gary with Gavin and took me to another room. She asked me to give her a brief history of what happened to me and what I’ve done so far as there is not a lot in my file. She got some notes from my Bobath course but I told her I didn’t work on upper limb in the course. She said that’s right and apparently she was at the course as well except I don’t remember seeing her there. She said in Bobath course they worked on core stability because once you have strong core stability, the arm part will become easier. This is just like what Prema said. I told her about what happened and that I didn’t really have much treatment on my upper limb when I was at MECRS. I told her that Neil and Rosemary visited me at hospital every day and worked with me on whatever exercises they could think of and when I got home I was doing their exercises every day for quite a while. She was quite amazed how well my upper limb has recovered with little physio or OT treatment.

She checked my hand and thought there is really nothing wrong with it but she thought I probably could work on the co-ordination a bit more. She showed me some exercises and it’s just the basic thumb opposition exercises. She said I could add theraputty in the exercises if I want to.

She also showed me a few shoulder exercises – mainly the ones I’m already doing with Gavin and also Mary. She also thought my left shoulder is very tight and I need to stretch it out a bit more. She’s shown me some stretches as well. My session didn’t actually go for an hour because there’s nothing much she could help me with. I asked her about whether she’ll be able to help me to find a way I can look after Lillian more independently. She said Gavin has mentioned this to her but she thought she will need to talk to him about referring me to a community based rehab service because she doesn’t normally see out patients and I’ll need someone who is close by .

7 October 2005

I don’t know what happened to me yesterday because I just felt tired the whole day and had no energy. I did a little bit of running and jumping practice in the morning before I saw Judy, the massage therapist. I felt much worse after my massage. My whole left side was aching (which is quite normal) and I couldn’t and didn’t do any physical exercises. I spent the rest of the day fixing up a corrupt MYOB file for one of Tim’s entities – probably not the most exciting thing to do. I actually felt a lot worse in the evening and even Tim thought I felt a bit warm and I probably had a tempature. I took some panadols and went to bed early. I think sometimes it’s hard for me to tell if my muscle aches are due to exercises or a sympton of flu because there has not been a day that I don’t get muscle pains from exercising or even just walking.

I went to my physio session at Epworth this morning. I’m panicking a bit because Gavin is going away for two months in less than two weeks. I have all these questions that need to be answered. I actually made a list of them in my notebook just so I don’t forget:

1. I need to confirm with him that my the research I’ve done in relation to my hip weakness is correct. Ie. Is it because the weakness in my hip abductors and external rotators (gleutus medius) that my knee tends to internally rotate when I’m on the leg press or on the trampoline?

2. I tend to circumduct (swing out) the left leg when I go upstairs and is this also linked to the weakness in the hip, gluteus medius?

3. He mentioned that my calf is not shortened, it’s just I don’t know how to release the muscle so when I’m sitting, if I put my leg back the heel is not touching the ground. Judy said I should find out how do I release the muscle.

4. My left knee tends to buckle when I shift weight on it but I can actually straighten my knee when I’m standing on a wedge (for calf stretch). Why is that the case.

It might make me sounds like I’m full of questions but I truly believe that I’ll recover better if I have answers to all my questions. I’m not sure if I’ll have a chance to ask him all the questions but if I write them down I can probably ask Prema when I see her next time.

When I went to the physio treatment room, I was surprised to find Gary was there already. I don’t actually mind him that much these days. I asked him if he watched Catalyst on ABC last night. I didn’t think he would, I think it’s a bit too intellectual for most people. There was an interesting segment on it last night – about nerve regrowth in people who had spinal injuries.

I was doing the running and jumping practice today – on the trampoline, in the walking rails and in the middle of the room. I actually noticed something today when I was doing my running practice on the trampoline. I think I might have been too harsh on Gary in thinking that he has a big mouth and doesn’t shut up. I noticed today that Gavin is quite a chatter box as well. He would get Gary to do a few stands and then some rest. When Gary was resting, he just wouldn’t shut up. At one stage, I was very tempted to tell him to shut up so I can concentrate on my practice. Fortunately, I was able to switch off after a while so it becomes like having radio in the background.

I told Gavin that I saw my neurosurgeon, Prof Kaye, a few weeks ago and he was very happy with my progress and he thought my physio had done a good job. I then went on and told him something I probably shouldn’t have – I told him this incident at MECRS when Prof Kaye came to visit me and questioned the physio, Jane, about what has been done about my arm and Jane was so upset that she lodged a complaint against him. I thought he may have heard about this from Fary Khan and then John Olver anyway but apparently not. I’m not sure if this has upset him because he said that even if my neurosurgeon thinks he’s done a bad job, he doesn’t care. I thought the comment was a bit arrogant. Maybe he is empathetic about a fellow physio. This is quite different from the accounting culture. Accountants usually bag other accountants from another firm – we tend to blame the client’s previous accountants for ‘stuffing up’. He said he probably knows Jane but cannot remember her face. He asked me what I thought of Jane. I really don’t have anything nice to say about the staff at MECRS. I told him that I didn’t think she was very good and worse still, they were all so negative about my recovery. Gary joined in and said he felt the same about Royal Talbot that the consultant there told him that he’d never walk again. We then went on about how they shouldn’t kill people’s hopes and bagged all the ones who did. I complained to Gavin that Jane told me it would probably take me two to five years or maybe never to be able to drink a cup of tea with my left hand. Thanks to Neil and Rosemary that I can do that in Five months or there about. Gavin said it’s more of a culture thing and at Epworth the therapists don’t usually say that. I wonder if they think that way though. He then turned around and said to me that John (Olver) usually tells people that it’s hard to tell rather than ‘never’ because it is often hard to tell with brain injuries. I actually had something nasty to say about him but was able stop myself from saying it. John was the one who told Tim that people who have brain injuries can ‘never’ have normal gait again. I think I’m in this ‘business’ long enough to know when to switch off and filter out all the negative comments.

I didn’t actually have a chance to ask Gavin all the questions I had (as I predicted) because he was rushing to go to a meeting. I have to find a way to have all my questions answered next week.

5 October 2005

I had another personal training session with Mary this afternoon. Prior to my session, I did some research on the Internet about hip weakness and knee internal rotation because when I told Gavin about my problem he said it’s due to hip weakness. I just want to find out more about it. Ie, which muscle groups in the hip are weak so I know what to work on.

I got to the gym a bit early so I waited for Mary in their office. Mike, Mary’s boss, is there. He asked me how my training is going and whether I’m happy with Mary. I didn’t know what to tell him. I do have some issues with Mary but I thought it’s prbably best that I talk to her directly rather than through her boss.

I told Mary about the research I’ve done on hip weakness and knee rotation. According to the articles I found – mostly in the area of sports medicine, the knee tends to rotate internally when the hip muscles – esp hip abductors and external rotators such as gluteus medius are weak. I told her about it and she went on about how my medial knee muscles are stronger than the lateral muscles. I now understand why Gavin said there is a lot of problem solving skills required in physio. I think Mary doesn’t know what she is talking about because if the medial muscles are stronger, my knee should be turning outwards not inwards. I actually found the exercises that I need to do on the Internet but thought there is no point talking to her first. I thought I’d better check with Gavin first if what I read is correct before I tell her. Otherwise, I just waste a lot of time talking instead of working.

Sometimes, i think maybe I'm a bit too harsh on her. Tim thinks her role should be pushing me hard so I would work harder and she is not meant to be a physio. The only problem is that sometimes I just don't feel anything in the muscles that are supposed to be working and when this happens, she doesn't know what to do. I suspect as my muscles get stronger, I can actually feel more when it's worked. I know my quads are stronger than my hamstrings and I found that it's easier for my quads to feel it's been worked than the hamstrings.

4 October 2005

I had my last session of hydro at MECRS this morning. I don’t think it matters much whether I have hydro or not but I like the warm water and it’s always good to check out my inversion in the water. If I want to swim, I think I’ll have to find another hydro pool elsewhere because Judy told me that she’s worried that I might give my muscles a shock if I go to a normal lap pool as the water is much cooler.

I had personal training in the afternoon but it was a bit disappointing. Mary said she is very tired today because she woke up at 3 a.m. When I heard this I thought “Oh, no. Don’t tell me it’s one of those ‘push the personal trainers’ sessions”. The only machine Mary got me to use was the leg press. She was trying to get me to push through my heel instead of fore foot but in doing so, somehow it made the exercise much easier for me so I didn’t feel I had done much work. It was all downhill from that point on. She tried other exercises for me but I didn’t feel anything in the targeted muscle groups at all. She couldn’t figure out why this happens because she said when I did the same exercises I actually felt it in the right muscle groups. I told her that it’s possible that my muscles have become much stronger now and I need harder exercises to feel the muscles have been worked. She said she’ll try to set harder exercises for me next time. I think it’s very hard for me to think that she is a good personal trainer after what Gavin said. Tim thinks a personal trainer’s job is to push me hard so I’ll be working harder than I would otherwise. I think that’s pretty hard to achieve these days because these days I don’t feel anyone push me very hard, not even Gavin. I think he doesn’t do that because he knows I’m motivated enough to do my exercises at home. I think he tends to push me to overcome my fears such as in the beginning, walking without my stick and now, walking up and down the stairs without holding onto the rails. Another client of Mary’s who I usually see before my Tuesday session, thinks Mary pushes her really hard and often tells me how hard Mary drives her. I’m not sure if she knows what she’s talking about. When I saw her yesterday, she started going on about how pushy Mary is and she thinks Mary is less pushy to me because of my condition. I was very tempted to tell her that she’s got no idea what pushiness is. If she thinks Mary is bad, wait till she meets Gavin. However, I tend to agree with her on the second point. I suspect Mary is a bit worried about my condition and doesn’t drive me as hard.

I met up with Neil after my session with Mary and he walked me home. One thing I mentioned to him and he said I should put in my blog is that I think these days I feel a lot better about myself . There was one stage that I wished I never had the operation even though without it I would probably be dead by now. I always thought living like this is a life not worth living and for a long time I had been quite ungrateful in thinking that I’m better off dead. I didn’t always look like this and I hated the way people stared at me when I walk. The only thing that kept me going is probably Lillian – knowing that she needs a mother and I have to keep alive just for her. I told Neil that I haven’t been feeling like that for a while now. I don’t know if it’s because I’m more used to the way I look now and people staring or it’s because I’m getting a lot better than before and although I still have a long way to go but I can finally see a light at the end of the tunnel.

3 October 2005

Can’t believe it’s October already. Time seems to go so quickly (even when you are not having fun). I did lots of walking over the weekend. We took Lillian to the zoo on Saturday and we walked around quite a bit in there. Yesterday, we went for a long walk in Royal Park.

One very exciting thing to mention. I finally met Mary Galea, Professor of Phsyiotherapy at the University of Melbourne , on Saturday. It turns out that we go to the same church, St Carthages on Royal Parade. I remember seeing her before but didn’t know who she was. It was only through Tim, I was introduced to her. I have heard so much about her and her experiment on the monkeys. When I was at MECRS, Jacqui,the OT, told me that I should not expect full recovery. I didn’t agree and told her about Mary Galea’s monkeys. She asked me if I know that Mary’s monkeys were left with some deficits. She thinks that the monkeys were left with some impairments and a full recovery is unachievable. I mentioned this to Tim and asked him to ask Mary for me but he said I should ask her myself. It’s easy for him to say because I’ve never met her before. Now, I finally have an opportunity to ask her in person. I was glad to find out that her monkeys were all recovered with hardly any deficits. She said another group did the same experiment later but provided training to the monkeys and the monkeys recovered much quicker than the previous group. She mentioned again that it’s only by using the effected hand more that I can get better.

I went to my usual physio session at Epworth this morning. My legs are still a bit tired from yesterday’s walking. I actually had a lot of questions for Gavin. I know Carr & Sheppard recommended using treadmills for stroke patients and when I was at MECRS Fiona used to put me on treadmills. I haven’t used it ever since I came to Epworth. I borrowed a treadmill from my parents a while back and to be honest only used it once. Tim thinks it’s taking up too much space and wants to return it to my parents. I just need to find out from Gavin if there is any benefit for me to use the treadmill. Also, when I was practising jumping on the trampoline last week, I noticed that I was jumping on the trampoline, it has a lot more sping/bounce than if I jump on the ground and I just wondered what produces the spring/bounce feeling. Sometimes, I wonder if other patients have as many questions as I do. I haven’t noticed other people asking so many questions. I feel that it’s bit like dance training, I need to know the theory and technique to become a better dancer.

After a few laps of walking practice, Gavin told me to practice running on a trampoline. I told him that I was going to practice this on the weekend but have forgotten the pattern already. He said there is no particular pattern, all I have to do is to move the left leg faster. Gary came in when I was practising. I was curious to find out how he felt after the Botox on Friday. He said he didn’t feel any difference. After practising running on the trampoline for a while, Gavin told me I can try practising running in the walking rails. I asked him about what muscles generate that spring/bouncey feeling. He said it’s the calves. I don’t know if other patients have as many questions as I do. I asked him again which part of the calf muscle does it, is it the gastrocnemius or the soles that does it? He said it’s both but gastrocnemius is more dynamic and is used in jumping. I don’t know if any other patients bother to find out all this but I actually find it interesting. I thought since rehab is my full time job, I might as well make the most out of it, including learning as much as possible.

I think my ankle inversion is a lot better these days because I can actually do jumping and running practices without taping or ankle brace.

While I was practising running in the walking rails, Skye, the hand therapist/OT, came over and tried to schedule an appointment for me. Since she also needs to see Gary, I will have to see her either before or after he sees her. Gavin said I could come to physio an hour earlier so I can see Skye after my physio. My appointment with her starts next Monday. I’m quite looking forward to it. Hopefully, she’ll do a full assessment on my upper limb and let me know what I need to work on.