Tuesday, September 1, 2009

Beware the Rehab Doc (Part II: The Unique Breakdown of the Tests)

Picking up where I left off in the previous post, to get my FES bike groove on my new rehab doc’s marching orders were for me to get a bone mineral density (BMD) scan, blood work, and a creatinine test – the latter two “as long as we were at it.”

I made the BMD scan appointment first because it was the most involved. In its simplest terms a BMD scan, for the purpose I was getting one, consists of hopping up onto the exam table and laying on your back while the scanning mechanism takes BMD pictures of your hips and lower spine. That’s how it breaks down normally at any rate. I was told that wrist scans can sometimes be supplemented if doing a scan on the core of the body is too challenging.

But when you’re a c-6/7 quadriplegic who uses a wheelchair full time the terms aren’t so simple, and what’s “challenging” takes on a whole new meaning. In general, any exam that involves getting from my wheelchair up onto an exam table can get hugely challenging. A lot of times in the past I’ve asked my mom to tag along just so I have an ally who I'm very comfortable with to help out if we need to start throwing my body around. If I'm lucky the exam table is wheelchair seat height, or can get lowered to my wheelchair height so that all I need to do is tuck a slide board under my butt and slide over onto the table in similar fashion to how I get in and out of bed. But rare are the instances where exam tables can be lowered to about 2 feet off the floor. Sometimes, with some assistance, utilizing the slide board to transfer can still suffice if there’s less than a half foot height difference between my chair and the exam table. Of course, it was much easier to pull that off about 30 pounds ago. In the vast majority of cases, though, the height difference is between a half a foot and a full foot (or more), which means some sort of lifting is required to get me up there. Moreover, most often the lifting involves a tag-team job because paralyzed lower limbs are very heavy (i.e. dead weight).

So in the case of my BMD scan all that was factored in, as the table was at least a foot and a half higher than my sitting height. So that was a major hurdle right off the bat. Another slight challenge was that I showed up by myself. I didn’t think that it was worth my mom’s time, effort, and expense to drive the two hours from Eau Claire to Minneapolis to join me. And I wouldn’t want to subject my almost 60 year old mother to some significant muscle or joint injury by taking on a brunt of the lifting duties. I don’t have that go-to-my-medical-appointments-with-me relationship with my PCAs, nor do I choose to go that direction with them (Do they ride with me? Follow me there? Do I pay for their parking expenses?), even though if I asked I'm sure they’d be fine with it. But in this instance neither of my regulars would have been any help with the heavy lifting anyway.

Thus for the first time in my post-SCI life I just made the appointment, enlightened them ahead of time as to my physical situation, and let them deal with it. And it was a bit of a calculated risk in doing so. Too many lessons learned from too many times in the past where the medical staff looks at me in my chair and either assumes a) I can just do a little hop step (huh?) or b) they panic (or in at least one past case get mad) because they don’t know what to do with me has always led me to bring someone as a backup. So making things clear before I arrive is always a good tactic to employ when I fly solo, not to mention crucial to my own sanity in those situations.

As is common in many medical facilities these days they had a ceiling lift attached to a rolling track to cater to overweight patients, etc. for this very set of circumstances. Again, in typical fashion utilizing this piece of equipment involves putting a hard cloth sleeve thing under one’s butt, clipping it onto a rack that looks like a clothes hanger, which is in turn attached to a belt, lifting the person up, rolling them over onto the exam table, and lowering them back down onto the table. But once again, with someone like me simple execution was not so simple.

As mentioned, the first step was getting that hard cloth thing under my bottom to cradle me from below as I get lifted. The best way to describe it is if you picture an open palm of a hand with only two fingers making the “devil/metal horns” or a stretched out “peace” sign, then the “palm” goes under my butt and the two “fingers” go under my thighs from the outside and come up in between my legs. Two loops on the back and a loop on each of the “fingers” gets clipped to the “hanger” rack. What that typically involves in this kind of situation is that I lift up on my wheelchair armrests while others work the cloth (towel, graduation gown, what have you) under me bit by bit. It doesn’t give us too much more room underneath but at least I get a clean lift off my seat cushion. What always aides that process quite a bit is if someone helping can lift my legs one at a time while I lift up so that the cloth thing can get worked from back to front a lot easier and with a lot less effort (factoring in heavy dead leg weight, recall). The immediate challenge in that regard though was that both the BMD scan technician and her assistant had back issues. So relying on them, as planned, for even some of the necessary, small lifting duties was out the window. That made placing the hard cloth thing under my butt much more difficult. After about a dozen lifts, not to mention a nice triceps and shoulder workout later, and we were mostly set with that part of the process.

The attaching, lifting, and rolling over the table part was pretty smooth. But it was a bit daunting looking up at the mostly plastic lift mechanism and skinny belt wondering if it will hold my weight or come crashing down. “I assume this will hold me,” I said. The assistant replied, “Don’t worry, we’ve had people bigger than you on this thing before.” Which is one of those things where at first you go “Whew, good” but then a second later you’re like, “Hey wait, what does that mean?” You trying to say that I'm fat but not “fat enough” to be concerned about equipment failure? Nice. I’ll just assume she meant that I was in the weight class that had nothing to worry about.

So up we went with me clutching the hanger, my bottom drooping, my legs dangling, feeling like a human jockstrap, trying not to think about if “my boys” were getting squeezed out from down below in an “impolite” display, staring at the ceiling and studying the tiles for any signs of distress. Thankfully we only had to go up about two feet and over about three, so from start to finish it happened pretty quickly. A pretty decent little ride I might add.

Going back over and down off the table again after the scan was easier, if not a little fun by then due to the fact that I am very rarely out of my wheelchair, let alone swinging around over top of it. I made a comment about how interesting this all must look and the assistant replied something about if only I had a picture of it to show others. I then added that I had a camera on my cell phone and we could snap a good pic pretty quickly, but the technician had no sense of humor about it whatsoever. And I don’t blame her either, as it was probably much wiser to get me safely back in the chair with little delay. Getting the cloth thing out from under me was much easier than shoving it under was as well. But in doing that kind of maneuver it always gets a little tenuous when they’re trying to yank from behind because if they rip it out too hard and fast then I could faceplant forward; it’s a simple matter of physics and gravity. After a few slight personal adjustments it was all over with and out the door I gladly went, hoping to never have to be a part of all of those shenanigans ever again (I was wrong: more on that later).

My next stop was the hospital lab and on to the creatinine test. For those unaware, a creatinine test is a urine test. At this point some people may be saying “gross, why in the heck would he dish the dirt on that?” Well the answer is that it provides another example of me having to work around what would normally be a menial task for others. Now when my doctor prescribed this test she said that they would give me a can that I would take home with me and have to urinate in throughout a one day period. Still in her office at the time I thought, “Ok no big deal, a little tinkle here, a little tinkle there, throughout the day, whatever.” Like if Old McDonald had a farm, and on his farm was sporadic urine samples. That kind of action. However, what she failed to mention, and what I didn’t realize until I showed up to pick up the “can” was that the test involved me collecting ALL my urine over a 24 hour period. Jaw dropping surprise. So instead of picking up what I thought was supposed to be a smallish sized collection can I left with three 3500 milliliter canisters, which are a little bigger than a gallon jug of milk.

Why so many jugs you may be asking? Well the simple reason is that I drink a ton of water. In general. But in the summer my average water intake is typically increased incrementally. With my specific level of spinal cord injury I don’t sweat so it’s real easy for me to get overheated, sometimes without realizing it. So along with sitting in front of a fan or air conditioner, drinking cool water is the most effective way for me to keep my core cool and keep me properly hydrated on hot days.

Now on that particular week the weather was between 80 and 90 degrees every day so on average I was putting down around 1.5 gallons of water per day. So when the lab staffer gave me one canister I quickly recalled how many trips to the bathroom I made each of the few days prior and said “That won’t be enough.” A little surprised she said “OK I’ll give you another one then.” I said, “Yeah…better make it three just to be safe,” which according to the look on her face was even more surprising. I just shrugged and muttered that I drink a lot of water in the summer. Then she said, “Do you think you’ll need four?” I replied, “I should hope not.” Taking three was embarrassing enough as it was. And out the door I went cradling my three huge urine sample jugs in my arms.

Logistically, the 24 hour collection thing was a major issue for me to do properly. First, it’s far from easy for me to collect every drop of my urine during the day because I can’t just stand up and take a leak in a sample canister like normal. Second, I had to somehow keep those huge jugs of pee cool at the same time. It took me like five days to figure out how to get it done. I’ll save you the details, but I cleared room on the top shelf of my fridge and I collected it on a day I knew I wasn’t leaving my pad, and also knew that I would have no visitors to stave off the awkwardness. (Although fun fact: the night that I got stuck by my desk in my new wheelchair? (see my Permobil, We Have a Problem post) It was that same night.) The punch line is that I filled two jugs to capacity, which for the record is a lot of piss. And technically I could have filled almost a quarter of the third jug too but decided enough was enough. I was going to have enough trouble delivering those two big specimen jugs back to the hospital lab as it was.

Which leads me to the more intriguing part of the story, wherein I, a wheelchair-bound quadriplegic, executed the successful delivery of two, full, heavy, milk gallon size jugs of urine to the hospital lab by myself. That took some thoughtful planning too. Sitting them in the back seat of my van was out because they’d possibly roll around, and worse, spill. Approximately two gallons of pee soaking into my backseat? No thanks! I thought I could possibly seatbelt them in the passenger seat but a) I can’t connect the passenger seatbelt myself, b) my PCA leaves in the morning so I couldn’t have her help because they’d sit down there until I left for my afternoon appointment, and c) that way I’d have to make multiple trips to the lab to deliver them – assuming I could carry them on my lap one by one – which wasn't an option if I could help it because my chair is too old to make unnecessary and lengthy extra round trips.

So I needed something secure, capable of containing both jugs, and easy to transport solo. Thus relying on my Eagle Scout skills I devised a transport module consisting of my empty laundry basket stuffed with one of my pillows to keep all the jugs snug and secure. See the picture below for visual evidence of this handy device. (Note how I mindlessly tossed my water bottle in with them. Oh well.)

It’s in those moments that I definitely feel much more handi-capable than handicapped, and more abled than disabled. Off to the hospital I went very carefully pulling the whole, heavy thing onto my lap, very carefully sliding it off my lap into the back seat, very carefully making sure I didn’t break too hard on the drive there, very carefully pulling it back onto my lap again after I parked. As I toodled down the hallways with my pillow basket full of pee I was grinning quite proudly of my quick fix ingenuity. The fun part was the variety of looks I got that ranged from curious to surprised to dismissive – clearly a total package of a scene rarely seen each day. By the time I got to the lap the exterior jug condensation started to make the label droop and blur my name. I couldn’t tell if they were surprised I filled two full jugs or not. It was just nice to get rid of them while having avoided a whole series of spills and other related disasters.

As for the bloodwork, no big deal. First, I’ve never had a problem with needles, contrary to my sister who is fully entrenched in the freak out category. I worked at a Boy Scout camp in northern Wisconsin for two summers in high school and she tagged along once when I drove up there to get one of a series of three required shots for hepatitis or something like that. While they prepped my arm and were getting ready to give me the shot I was filling out some paper work and was pretty much paying no mind. I remember my sister was wide-eyed that I wasn’t bracing myself for the horror to come and she slid closer to me, grabbed my hand, and said “Do you need me to hold your hand?” because she always needed that done herself. I found it unnecessary and didn’t but it’s a quick, fun story to demonstrate our different outlooks towards shots. She still hates them but it's worse now because she has to take my one year old niece in for her shots as well, who not unlike her mother screams and cries the whole time; they're both wrecked emotionally afterwards.

But I became practically desensitized to needle pricks when I was in post-accident rehab because I used to have my blood drawn every morning between 5 and 6am for like 4 straight months. I quickly dubbed them “the vampires” because they gladly took my blood every morning and always left needle pricks behind that resembled little fang bites. Although when I transferred to Craig Hospital for more extensive rehab, on my very first morning vampire visit she asked me if I preferred that she draw my blood from my arm or my foot. I was like, wait, what, you can do that? Why wasn’t this option ever presented to me in the previous two plus months of daily early morning needle prick torture? My arm where I could feel it, or my foot where I couldn't…hmmm...yeah let’s go for the foot please! Thus I had much less condescension for the Craig vampires.

I’ll get into the surprising results of the bone mineral density scan in the next post.


  1. Clear & copious…you weren’t kidding! Patent pending on the basked pillow device…


  2. Clear & copious…you weren’t kidding! Patent pending on the basket pillow device…