Sunday, September 27, 2009

Bring It On!!!

As I was waiting for my que to come up for surgery, I remembered an ESPN show on Picabo Street, an Olympic-level skier. About a decade ago, she ripped up all 3 of the ligaments in one knee in a high speed skiing crash. After the surgery, she wrote down a date and kept it close: it was the date of the next Winter Olympics. As soon as she could move even a tad, she began rehabbing. Even down the hospital halls, bands around her legs, bandages around the knees.

I have nothing that severe, luckily. But as I found out post-op, being cut up changed everything. I learned why, after the staples come out, I'm being put on 6 weeks of light & limited duty - - - essentially, medically ordered to not lift anything too heavy or too strenuous, and to keep my activity easy.

I realized how much my abs are used in even the most innocuous tasks. I needed help to sit-up, much less get up. It took me 5 minutes on one occasion to take a pee, and that left me slightly winded. It is recommended that you try to walk within 6-8 hours post-op, to begin strengthening the abs: after nearly 10 minutes of slow walking, I felt wiped out. I'm mainly a side sleeper, I can't sleep well on my back. Thanks to the morphine there, because I couldn't turn myself or sleep on my side even when I could. For a guy who just a week before could easily run 2 miles and do pullups and lift heavy shit to be reduced to this was frustrating. But, like Picabo, I had a date and a goal. I also had milestones I had given myself. Things like sitting myself up, walking an extra lap a day, turning to the side, getting off the IV, etc. I'm pretty damn patient. I also remind myself that had I not already been in pretty good shape, that things would have been worse.

They also gave me a breathing apparatus with a ball in it with adjustable resistance (fancy that). Inhale, and keep the ball levitated as long as possible. I was to do this 10-15 times an hour. That sucked, too. Like the walking, this was to strengthen my lungs. After surgery in the abdomen, ab muscles are asleep, the diaphragm weakens and it hurts to breathe so one begins to breathe shallow. Do this long enough and your lungs weaken, fill with fluid, and pneumonia sets in. This will either lengthen your hospital stay or increase your chances of not walking out of the hospital at all. I caught myself thinking that I was a weakling there, too;)

The other stuff was just manageable inconveniences. I was on a liquid diet for the first few days, again, gentle and clear. A couple of days post-op and I had my sister get me a can of Sprite, which I thought was safe but that bloated me up pretty bad so I learned sodas were not part of the plan. So there went my plans to have my brother get me a Coke Icee at Burger King! The fruit juices seemed almost too sweet and they scrambled my stomach up. Between the IV and all the liquid, I was wizzing a couple of times an hour: this I guess meant getting up a lot. They also had something attached to my calves to massage them, to prevent blood clots from forming. Not bad, and it felt great, but it added steps to me getting up because it was attached to a machine with hoses.

I didn't lose my humor or wit, and that kept me smiling. I would joke that one day I would con the nurses into getting me a cheeseburger (never did get the cheeseburger, did get cookies as I got better). In phone conversations, I was still silly. I watched a lot of German TV and Comedy Central. Phone cards were free. The morphine made my pain tolerable and my sleep possible. And thanks to my laptop, everyone was either a chat or email away.

And sure enough, milestones started to drop. 2 days post op and I was turning myself using the rails, my arms, and my back (thank god for chins and pullups, eh?). Next day, I was standing up by myself and my intestines were starting to wake up. Then came solid food (low fat diet) and the occasional cookies. The evening of the 26th, I was removed from the IV and the morphine, I only get hooked up for antibiotics. Tomorrow, September 28, the drain tube comes out and I become an outpatient for 5-6 days to see how I do. If that goes without a hitch, I'll be back in Africa to finish things up. I am now about 203 pounds, 16 pounds lighter than when I was admitted to EMF in Djibouti. Not the way I wanted to lose it, but I'll maintain.

Which brings me to the 6 weeks of light & limited duty. I tried to find ways to incorporate weights  but nothing big to start getting back in shape.  Ab stability training.  Submaximum weights with a 4-6 rep range.  But what I am starting to lean towards is just using the elliptical a few times a week, walking in the mornings, maintain the low fat diet I have here, and doing mobility work.  Might not sound great and it would be boring to blog about but what are 6 weeks of getting my body recovered and ready compared to what might happen if I rush things?  Sure, I might be skinnier and a little less strong but I know how to get that all back and then some.  And I don't need more, or worse, setbacks.

Besides, the 6 week thing amounts to a Navy order once the physician issues it.  Nice to not have choices, sometimes;)

Someone To Watch Over Me

I had a pain somewhat like this earlier in the year. It took me a little over a week to get rid of after hitting it with Cipro and some other drugs. So, much like last time, I thought that this was another bad case of food poisoning. After dinner on September 11 (beef stew and rice), it started with a little tightness and indigestion and I thought it would pass.

Then came a pain like I had never felt before. I couldn't even stand straight, and after an hour of waiting for it to go away, I went to EMF (Emergency Medical Facility). Since it was after hours, they were gonna give me a GI Cocktail until they asked me what my allergies were and one of the active ingredients was one of them. They gave me some medicine for my stomach, and told me to come in at 1300 the next day, when they were open. I went back to the office and felt so bloated and sick but couldn't puke. Still thinking it was food poisoning, I stuck 2 fingers down my throat and made myself puke. No relief.

That night, the pain was so bad I couldn't sleep in any direction, not even sitting. I now understood what some people mean when they describe a pain that only death could take away. I was scared and anxious, and I think that exhausted me enough after a while that I fell asleep - - - sitting up in bed.

September 12, they gave me some antibiotics along with Prilosec and an anti-emetic and told me to check in for a follow-up the next day. I bought some Mylanta, had a protein drink, and tried to get some sleep. At night, my temperature was starting to creep up. In the middle of the night, I had the antibiotics and a protein drink and seconds later barely made it out the door before I projectile puked it all out. On the follow up, after a battery of tests and an ultrasound, they admitted me and put me on an IV drip and antibiotics, and started giving me morphine. Based on the ultrasound alone, they saw swelling in my gallbladder and had decided that it needed to go.

Now, I could sleep. The one thing about morphine is that it doesn't cure your pain but it effectively disassociates you from it. Seconds after injection, after the rush, I felt like the pain was somewhere else. I still needed Tylenol for the occasional headache, but the morphine took a large edge off the pain and I was still lucid.

Just one hitch. Several blood tests indicated a rising bilirubin count, and my eyes were starting to yellow . The surgeons were now telling me that there was the possibility of a stone elsewhere, maybe even near the small intestine or liver that was causing that. Now, there was the possibility that I would have to be medically evacuated, which would mean a military flight to Landstuhl Regional Medical Center in Germany (via Ramstein).

The one other thing I learned from all of this, from the doctor here at EMF, was that the last episode was probably my gallbladder acting up, too.  But since it went away quickly, I might  have had some function left and nothing much may have been thought of it.  Looking back at this and other incidents where I ate something bad, I think I know enough now that if my kid gets something like this, I know what to look for.

All this time, too, I couldn't eat or drink anything by mouth, which sucked. I was told that since I would be intubated for the surgery, that my stomach needed to be empty to reduce my risk of aspiration. When the surgery was delayed, they did give me some light clear liquids but still no solids.

On the 15th, my surgeon talked to me and told that that I would be medically evacuated to Ramstein. Djibouti had the technology to get the gallbladder out but that was it. After consulting with Ramstein, it was decided that they would go in laparascopically, look for the other stone, get it, clean up, then take the gallbladder on the way out. Nice and neat. I was looking at a 30 hour flight. I know: Germany is 7-8 hours away. This plane would make a few stops and get some other people, too.

That got better. The flight scheduling was not going to work. so they found a C12 (kind of like a Lear jet) that could get me there direct and would be leaving at 2:30PM on the 16th. So after preparing all the meds that the medical staff would need on the plane, and having me pack (1.5 weeks worth of clothes and my laptop bag), they wheeled me onto the plane and off I went. To all the staff at Djibouti EMF who took care of me and kept me safe and comfortable (and even smiley) during this time, thank you. And thanks to my own department (J4-JMC) for checking up on me daily.

My sister Magali, oldest brother Israel and his son Antonio were on their way from New Jersey to see me, too. For financial reasons, my wife and son stayed at home. My wife basically coordinated things with my sister and brother via email and phone. The fam made me smile, and my sister even had some skills in home nursing that she used to help me move around with no pain (she was even able to show some of the female nurses to the point where they made it look easy to move someone almost twice their weight.). Thanks, guys.

I had barely landed when they got me a room, got me on IV fluids, antibiotics, and a morphine pump with a button I could press to dose myself (to a point, it wasn't buffet style). Few hours later at around 6AM on the 17th, I got an MRI and an ultrasound with less than an hour break in between. Next day in the early afternoon on the 18th, a slot opened up (Note: Landstuhl receives patients from all war theatres across the world so there are people here from Afghanistan and Iraq, some with unimaginable injuries essentially making this place one of the biggest trauma centers in the world) and up I went. Nervously.

After a wait, the anaesthesist showed up. I asked him what it would be like to be unconscious. He told me how anesthetics kind of wind time back a bit, that I don't dream, then told me that this conversation would be the last thing I remember. Sure enough, I don't remember even getting anesthesia. Next thing I knew, I was awake getting ready to be wheeled back to my room.

Turns out, from what was explained to me, that they had to cut me open after all. I was intubated, of course, so that a machine could breathe for me (that went well, I didn't even awaken with a sore throat.). They puffed my abdomen up with CO2, to give the laparascope more room to maneuver (that left me sore after the anesthesia wore off, but not so much). When they got to my gallbladder, it had no function left and was now gangrenous: it could no longer be "sucked" out. So they cut a 4-5" incision, cut it out, took out whatever else they needed to (including some tissue for analysis), cleaned and sanitized the area, then sealed and stapled me (16 staples) up and attached a small plastic container to drain the region out.

The next thing I will write about is therapy. Let's just say, I won't be lifting for a while but that may be a good thing.

And to the nurses and medical staff at Landstuhl Regional Mediacal Center, thank you for fixing me up and taking care of me. It almost seems like clockwork, how they go about their business, even with what they deal with here on a regular basis. Or maybe, they are just as brave as we are!

Wednesday, September 09, 2009

5/3/1: Round 2 Wave 2 Workout 2

This picture was taken in my office (J4-Joint Movement Center) here at Camp Lemonier, Djibouti.  That's Corporal Dull, U.S. Marine Corps, representing.

Add to the list of hardcore things, like chalk in supermarkets, this.  Over the weekend our USMC colonel, LTC Sexton, had the Seabees build him a chinup station out of wood, metal, and tape wrap and then install it in the office.  This is what Marines do, I suppose.  We joking tell people now that when they enter the office that this is the tax that must be paid;)

So as a challenge (and, when in Rome . . . . ), I told LTC Sexton that by the time I leave here in December, that I was going to try to do as many pullups as he could do right now.  He then threw down the gauntlet by cranking out 28 pullups and almost a 29th.  Yeah, this is what my big mouth has gotten me into;)

I've dropped the chinups and pullups from my weight days.   Instead, on the days I work, at the top of every hour, I crank out a set to failure with bodyweight (about 11 sets).  One day is pullups, one day is chinups, and so on.  And if I should happen to pop in to hang out, as I do just about every weekend, I have to pay the tax and crank them out.  Today, I did pullups in sets of 3.  Towards the end, it got down to 2 reps.  Today, it's chinups (so far, 2 sets of 3).  I'll try to add a rep per week: coupled with trying to lose some weight, we'll see how close I could get.  The Navy will represent!!!

This was yesterday's workout, deadlift day of 5/3/1 (All Notation: Weight x Reps x Sets):

Sumo Deadlift: 135x5, 150x5, 165x5, 195x3, 225x2, 255x3, 270x3, 285x5 (Rep Out Set)

Conventional Deadlift: 315x3x6.  Not exactly as bad as it looks.  Thanks to all the rep work I've been doing, this didn't leave me lying in a heap.  But after spending a good part of my day doing pullups (see next blog entry) and after the sumoe deads, I had little grip or launching strength left so I was really having to power these up.

Leg Extensions: 120x3x6

Hanging Leg Raises: sets of 5, 5, 4, 3, 2 reps
Decline Situps: sets of 17, 12, 8, 6, 4, 4 reps

Leg Curls: 150x3x6

Monday, September 07, 2009

5/3/1: Round 2 Wave 2 Workout 1 (Slight Return)

Last week was very hectic week.  The last of my best friends here was leaving, and she wasn't even packed nor was her room cleaned yet.  So aside from spending a lot of time together, I was also helping her get rid of shit, clean, shit, and pack shit.  Guys, it's like giving a woman a big suitcase for a weekend trip only this was like a studio flat.  Shit, I've been here almost 2 years and you could put all my possessions into 1 sea bag, a carry-on, and 1 Tough Box.  After she left on Thursday, I caught up on a lot of sleep, and blogging.

Today, I began this workout all over again, as originally intended.  Didn't have to work, so I woke up at 1PM, worked out, and even started doing NEPA walks.

All Notation: Weight x Reps x Sets

Flat Bench Press: 65x5, 85x5, 105x5, 125x3, 145x2, 165x3, 175x3, 185x5 (Rep Out Set)

Smith Machine Behind The Neck Press: worked up to 125x3, then did 135x3x5.  Every bench near the dumbbells was taken, as was the bench press benches, and the shoulder press station.  (Did I mention that Monday is always Bench Press Monday?) So I did these.  Not bad, but I don't get the searing burn that I do with DBs so next week I will do the 70x3x6 that I should have waited to do.

Bodyweight Chinups: 5 sets of 3 reps.  I could always do at least 2 reps clean with no kipping but usually have to kip on the third rep.

Hammer ISO High Rows: 120x3x6

Trap Bar Shrugs: 196x3x6

Walked for over an hour.