Don't Kid Yourself, Push Yourself

I just got back from the pool again, but instead of swimming for two hours, I only swam one. 2,100m in an hour, breast stroke, isn't too shabby for a brain damaged old fart like me, but I would rather have been swimming lengths for twice as long without pause.

Alas, it is a sunny day and right in the midst of resolution season, so at noon the pool filled up. I've mentioned before that I become extremely intolerant in the pool, and that does not seem to be something that is changing. I'm not trying to change it, either. I spent much of the hour I did manage to swim dodging the pair having a leisurely chat while ambling up and down the pool, mostly keeping out of the way of the guy who swam, turned and repeated (me).

In the middle of this, ungenerous thoughts filled my mind, often along the lines of "get out of my damn way," with a sprinkling of "your screw kick is horrible" for good measure. One thought is applicable to anyone gripped by resolution fervor but feeling the drudgery of slow progress, or the gradual sapping of their will, and it was exemplified by the slow pair in the pool: "stop kidding yourself!"

The duo were maintaining a steady and unfettered chat throughout their 'exercise.' They were not short of breath (they were nattering for England), and if they were warm at all, it was because the pool is too hot. They might as well have been having a cup of coffee instead. They certainly don't deserve any plaudits for working.

It's an easy trap to fall into: "it used to be difficult, but is easy now, it must be enough". Complacency is a surefire way to stop making any progress, though. If you have enough breath to maintain a conversation while swimming you are either phenomenally fit or you are deluded and doing it wrong.

As we get fitter, what was once hard becomes easier. Great! That means we have to work harder to get the same effect. It should never be trivial, it will always be hard work. Deal.

Sabotage!

On Tuesday, my roommate left for Gen Con, where he'll be showing off his excellent new game, Torchbearer, and hanging out with a load of people I would love to see. I'm a little jealous, but quite glad I am not there because right now I can live without the punishing schedule and lack of a gym. 

I have been exercising more again, after gaining a bunch of weight when depressed earlier this year, and fighting to remind myself that "good enough" is no such thing when it comes to my recovery. It gets easier to accept compromise and not recovery, so I have to actively remind myself first, that I want to recover physically as much as humanly possible, and second that such a recovery only happens if I take exercise. 

To build up my overall endurance, I swim laps of a pool that is miraculously on my block, but is a bit skeevy. Fellow New Yorkers will know how unusual it is to have a pool right there, so the skeeve is a minor hindrance. I go to the pool on weekdays, typically, and to the gym on the weekends. Since swimming in a straight line requires concentration, my vision is poor and the pool has enough chemicals in to be murky, those are the times I can go and hope for fewest other people to collide with.

Anyway, on the Tuesday, I was primed and ready to go to the pool, when Thor set off, and a naughty thought popped into my brain: I could stay at home, not go the pool, and nobody would ever know! Never mind that this is not true, because I log all my exercise on Fitocracy, and that it makes no appreciable difference to Thor whether I swim or not, there was the delicious temptation to get away with something.

It didn't matter that I would, in the long run, suffer for not going, nor that after the first half dozen or so lengths I settle into a pleasant rhythm; the opportunity to pull a fast one was almost irresistible. Almost, but not quite: I told my brain to go screw itself and went to the pool. 

Unfortunately, my brain had a few tricks lurking in the grey matter. When I got to the pool, I discovered that I had left my fancy new swimming watch behind. I went and got it. Back home, I was again tempted to be all huffy about being jerked around by my brain and just not go, but I quashed the temptation, and set off again. 

I got about two steps out of my front door, before realizing that my brain had made one last desperate attempt to skive off: I had left my walking stick behind. Happily this all had the reverse of the desired effect: I was more determined than ever to go swimming, and I did. 

My brain has had the last laugh, though. This morning, I took my time getting up, and faffed around on the Internet, until my brain gleefully remembered that I have an acupuncture appointment today. There's not enough time to go swimming and to make it to happy fun needle time. Bugger.  

Taking Fatigue In My Stride

Last week, I worked quite hard: I swam on the five weekdays, for a total of a hair under 10km, and then went to the gym at the weekend. I went to acupuncture twice, and managed a few social engagements as well. After each bout of exercise, I felt 'good' tired; my muscles felt like they had done some work, but not sore. I might be a bit achy the next day, but I hadn't overstressed anything.

I have to watch my overall level of tiredness as well as, though. If I do too much on one day, then I'm often much less effective the next day, sometimes to the point of being a total spud.

Having to watch my fatigue is often counterintuitive, because I'm gauging neurological tiredness, and we've evolved to be better judges of muscular states. Pumping a bunch more adrenaline out is not going to help me escape the hungry lion, if it's my brain that is not going; my legs are still going to flail about.

The problem with taking too much rest is figuring out how much is 'too much'. If I don't stress my system just the right amount, then it will take longer to recover. I am already comfortable with the notion that it will take years of work to get better, but if I can shave months off that time, I want to.

So, yesterday, on Monday, I had to decide whether to go swimming or not. It was a crappy rainy morning, which definitely influenced my mood, but rain often makes the pool less busy. Muscularly, I was a little sore, but I expected that after working out my upper body on Sunday. However, I felt tired yesterday morning, and decided not to go, full of misgiving that I was just being lazy and self-indulgent. I spent much of the day feeling itchy to go swimming, but tired enough to take a short nap.

It was the right call. I'm sore today from the Tui Na massage I had yesterday, but I just swam two and a half kilometers, and I feel 'good' tired again. Sore, but ready to go again tomorrow. It wasn't the first time I've had to make that call, it wasn't even the first time I made the right call, and it won't be the last. I'll be making those calls for years to come. I just hope that I get a little better at balancing efficient recovery with living a real life.

Morning Sickness

For a brief moment this morning, just as I woke up, I felt a pang of longing to awake for real and be normal. To see with my usual myopic single vision, particularly. But there is no going home again, so I stamped on that thought pretty quickly and went swimming. It hurt, though.

(Looking back, as I transfer these posts from Google+, the warning signs are very clear: I was just about to sink into a profound depression. At the time, it was not obvious.)

State of the Newman

I had my strokes starting four months ago today; time for a round-up of what I think is happening in my brain and body at the moment.

Apart from, the problems common to most strokes, I have three principal deficits: left side facial paralysis, vision and right side weakness. The change in side (at the base of my neck) is because I had several strokes: different strokes, different deficits.

The left side facial paralysis has undoubtedly improved since I was last in New York, nearly three months ago, but slower than it did initially. I expect it to keep improving, but over months, rather than weeks, and it would not surprise me (and no longer horrifies me) that it might take years to effectively eliminate. One of the difficulties is in activating the many muscles of the face. I find I focus on muscles that I feel responding, often long before they visibly respond, and exercise those, there being no other way to get facial muscles to move independently.

One thing that helps get the paralyzed side moving unconsciously is conversation. Although it is hard to get stuck in to a good chat when much of my side is limited to the somewhat boring topic of me, my stroke, and my recovery. Anyway, if you see me in a hangout, or with video chat enabled and have exciting news, are morbidly curious, or just feel like saying hello, then do so!

My vision can be broken, think, into two discrete deficits: double vision(diplopia) and "one and a half syndrome." They're obviously related, but from where I'm sitting, can be addressed separately. The diplopia has been enormously debilitating: unaltered, I can't see well enough to walk without falling over, or even read, which has been a keystone in my life. To function, I've had my left eye occluded for most of the last few months: I can see a blurred, misty version of the world form my left, which my brain has got quite comfortable at rejecting, in favour of the sharper, more consistent and usually more reliable image that my right eye generates.

I'm starting to see signs that the diagonal diplopia is resolving. With many brain-related injuries to the sight, though, it can be hard to tell. I have never understood quite so well that the brain sees, while the eyes provide data. Nevertheless, this is on target for the ophthalmologists, who essentially said"wait 4-6 months and call us after that." It turns out that most visual problems resulting from stroke resolve themselves, although that's not guaranteed. I should add that to say they "resolve themselves" is to ignore the fact that I have been exercising particularly my left eye as best I can: what recovery is possible is, in my opinion, accelerated by effort if not initiated by it. Note that it is quite difficult to engage paralyzed extra-ocular muscles.

Which brings me to the one and a half syndrome which turns out to be really quite rare. Rare enough that I was asked if I would mind being in a database of patients with conditions that could be used for live neurology exam questions! Again, this seems to be improving with hard work: my left eye tracks past the midline now, where once it did not at all. Even if it doesn't resolve, I now find that this isn't so bad a thing, by comparison to the diplopia. It's far easier to compensate for, and would be much easier to live with. In other words, my vision overall is troubling me a lot less.

Finally, there's my right-side weakness. Recovering from this goes hand-in-hand with gaining cardiovascular fitness, because it's impossible to do the strength and endurance work necessary without being a lot fitter than a stroke and hospitalization left me. For pure CV fitness, recumbent cycle, rowing machine and treadmill are my staples. The elliptical walker / cross trainer is too hard--for now. With the treadmill, I've been increasing the incline rather than the speed to get an increase in heart rate, keeping the machine at a pace where I can still concentrate on my gait, and not limping. Re-learning how to walk before I run.

Almost all of the work to date has been focusing on walking and balance, somewhat ignoring my right arm. Part of the problem is that my arm is fairly strong--or seems that way with a traditional neurological assessment. But it's not nearly as strong as my brain expects it to be, and it's not strong enough for me to write smoothly. Added to which, my grip strength is greatly reduced, and my fingers are still less sensitive, leaving me clumsy. It's a bit like having two left hands, only the right-hand one is feebler. I've added in seated row, shoulder press and chest press to start working on the arm and shoulder, and next week more grip exercises shall ensue.

Swimming seems to allow me to address the right-side more holistically. Maintaining even buoyancy is instinctive and uses many more muscles of my body than anything else. Added to which, it's almost impossible to hurt yourself just by swimming. So, lots of swimming which seems to be having a generally beneficial effect. 

All in all, I'm definitely feeling better. Today I felt, I think for the first time, more like someone recovering from a stroke, than like someone surviving after a stroke.

(For the non-USians, this was a heeeelarious pun on the President's State of the Union address. A pun I am likely to perpetrate again.)

Gym, swim and nap

Exercise after a stroke is a funny thing. Initially it's unbelievably tiring, quite literally: I found it very hard to believe how much a short walk would exhaust me, and often needed a nap shortly afterwards. Even in rehab (in Hackney), it turned out to be easy to do more than I was ready for or indeed capable of doing. This resulted in a period of exhaustion that provoked depression, which made it hard to do anything. Less than ideal.

Since then I've been more cautious, but I'm getting less and less so. At the moment I'm finding that the more I do, the more capable I become. Which is why it's even feasible that I've been to the gym four times and had a half hour exercise in the pool after each. This week, I'll comfortably meet the recommended minimum for getting fit (at least 30 minutes, 5 times a week, a little warm, a little sweaty throughout), and I'm no longer so concerned that I'll be a total wreck a day later.

Apart from the general goal of improving my cardiovascular fitness (and substantially reducing the chance of death), one of the challenges is making sure that my right side is doing at least its share of the work. This sometimes means using less weight than I can manage, because too much makes it too hard to get my left side to let the right do the work. It sometimes means painstaking adherence to form, as well: When walking on a treadmill, avoiding a limp; when in the pool rigorous symmetry in my breast stroke. 

For now, it always means that my right side has worked harder than my left, and aches because of it. And because the whole of my right side below the neck is weaker, it often aches in unusual and uncomfortable places. At some point, I'll be able to exercise hard enough that I ache evenly, but I expect it to be quite a while.

One of the oddest things I've found, though, is that my memory of myself in hospital three months ago doesn't include anything like the experience I now have of my hand's relative weakness; nor does my memory of being in rehab. I must have been compensating so thoroughly with my left hand and so far in denial about it, that I couldn't even see it. Just another weird experience from the land of brain events.

A Minor Mystery and a Small Success

It was slightly puzzling me why I tended to turn left. At the moment, the left lens of my glasses is obscured so I avoid the worst of my double vision. I would have thought I would instinctively turn the other way, rather than into what is, effectively a huge blind spot, but I observed the opposite. (Yes, incidentally, I can now turn around without immediately falling over!)

It transpires, quoth my physio, that the left eye and left inner ear are more associated with equilibrium as one turns right. Since that's the side that has damage (above the neck, at least), turning right is slightly harder and so I automatically turn left. Something more to work on, of course, but mystery solved.

The small success I have enjoyed today was getting into a swimming pool. I've been gradually increasing the amount of times I can go to a (first hospital, then regular) gym, but hadn't yet ventured into the pool. The problem was my balance: Apparently it would not have been surprising if I did a roll onto my side or back and then had enormous trouble with the relative buoyancy of my left and right side. Since I was really quite a good swimmer, I found the prospect of having it taken away from me quite frightening.

Fortunately, although I could clearly tell my equilibrium was off, I was able to swim several lengths learning interesting things. Not only are my right arm and leg obviously weaker, so maintaining good form and swimming in a straight line are hard, but my right hand struggles to make and hold a slightly cupped shape. As a result, I generate less lift (we're talking breast stroke), so it's harder work to breathe smoothly. All of which says that swimming is good exercise for parts that are not otherwise being worked.