A while ago, the teenager suggested that I needed a mobility dog and someday she would train me one.
Well, with all the mishaps and falls I’ve had since April (mallet finger, smashing into a brick wall, almost breaking my glasses falling literally on my face, falling into the bathtub and whacking my head on the ceramic tile wall and my personal favorite falling through the screen door), I did some research and thought the beautiful, dog-loving teenager might be right.
I had previously blogged about why I thought a dog would help me and I also thought a first dog should come trained and the teen, approaching young adult, could learn from this one. Just like I would.
I requested an application from two organizations. The closest to me was Susquehanna Service Dogs near Harrisburg. They sent me an application today. I have three months to fill it out.
The flow chart of initial steps for a service dog
The application requires my demographic, medical and lifestyle information, plus the financial statement saying that I will pay the $5,000 necessary if I get into the program. I need two letters of support— they need to come from people who support me having a dog and promise to support me and the dog together for the life of the dog.
I also need three references.
And a statement from my doctor.
I just thought I’d document my thought process and journey here. Because I’m hopeful, and doubtful, excited and afraid.
Do I want a dog? Can I handle the commitment? Am I the right kind of disabled to benefit from a dog? Can a dog help me be safe? Can I maintain an active lifestyle? Will they see how a dog would protect my independence?
The wounds I acquired last Monday falling through the screen door (yes, there is a blog on that) have mostly healed, except where Bean Dog accidentally scratched off my scabs. The teenager tells everyone it looks like I had a fist-fight with a bear. And we had a family debate over Indian food– the teenager, her father and I, over whether I won or lost. Consensus was I won. (The Indian food came from Nawab in south Bethlehem, who were gracious hosts despite us not knowing that had converted to reservation only for dinner.)
On Saturday, I went to the gym and hit a new personal best with Andrew at Apex Training. I think it was 110 lbs on the barbell for three reps in box squats. My torso, my thighs, everything could take the weight well, except my knees. My knees kissed as I stood up with each rep. It didn’t hurt. It quivered a little, but I definitely had to plant my feet, balance the weight, lead with my thighs and hips and force those knees slowly out. The weight didn’t bother me. My own knees terrify me.
On Sunday, I performed 111% at the Stitch Fix Bizzy Hizzy, which means I shipped 555 items. Goal is 500 for a ten-hour shift, but as I reached higher numbers and saw that 555 was possible, I went for it. After all, both 111 and 555 are lovely numbers. Three prime numbers in a row, twice. Patterns and numbers comfort me. They offer a reminder that while a million permutations might exist, that there is underlying order in the world.
Yesterday I started my shift with refixes at the table in QC that has been assigned as mine for about three weeks. My table, line 4b, table 6, has a manual conveyor line on my left, which is great for my balance but bad for my finger. I hit 162, the daily minimum expectation, but barely.
I was achy, with sore feet and a sore spine, but nothing unusual for a person standing for 10 hours a day. I notice on my phone that around 4 p.m. that my walk was asymmetrical by 1%.
I have averaged six hours of sleep lately, with borrowed kittens and the high heat, so I opted to take a muscle relaxer and sleep versus push myself at the gym. My chiropractor has suggested my recent issues with falls and lack of control in my right leg might stem from overdoing it.
Between the heat wave, the full 10-hour shifts, the general aches and stiffness and the inappropriate levels of sleep, I opted to postpone the gym, take one of my muscle relaxers and sleep. I slept much better, but I could use a solid 8 hours or more.
I’m slowly learning just because I can push myself doesn’t mean I should.
That’s the thing about disability— it like a kaleidoscope of worry and health and what you can and suddenly can’t and then can do. It’s a revolving door of chaos and bodily revolt.
Don’t get me wrong. I know I am lucky. Every damn day I get up, take care of myself, go to work, pursue my side business, go to the gym, and try to do what’s right for the teenager and the pets.
I can walk, even if I may never run that 5K I dream about. I work in a warehouse, even if sometimes it’s hard. I try to listen to and take care of my body. And I am grateful.
But despite all the doctors, the physical therapy, the personal trainer (thank you Apex Training), the vitamins, the stretching, the medication and the regular visits to my lovely chiropractor, Nicole Jensen of Back in Line Chiropractic and wellness center, I still “randomly” have accidents.
I trip over my own two feet and have hands that look like this:
And I fall through the old screen door in the garage.
I burst a tendon and spend 12+ weeks nursing mallet finger from taking off my socks.
I’ve broken bones, smashed teeth, fallen down stairs (most recently at the hospital).
I did this at the hospital
I’m getting older and I’m falling more. In a few more years, the teenager will be a full-fledged young adult and won’t necessarily be here to babysit me.
So I filled out a pre-qualification questionnaire. I probably won’t be disabled enough to warrant a dog, but I have the means to pay for it. I live independently and my condition cannot be mitigated with medication.
But I can walk and function you say, and I do. What could a dog possibly do?
Help me take off (and put on) my shoes and socks
Help me retrieve objects from the floor when I can’t bend.
Help me retrieve objects when I fall.
Help me get up when I fall.
Help me up and down the stairs.
Bark to alert neighbors or people in the household that I need help.*
And I wonder if a dog could “nudge” me if it notices I am unstable and get me to fix my gait or rest.
* this one is apparently controversial — some trainers claim barking in any form is a nuisance and that a service dog should never bother/impact the general public.
Like any topic within disability, it’s complex. But with each fall I take I feel progressively more vulnerable and fragile. It feels like another option to consider.
Monday. I slept pretty decently last night despite the oppressive heat. I had performed 105% in Freestyle on Sunday in the Stitch Fix Bizzy Hizzy warehouse, folding and shipping clothes while dreaming of new sundresses for myself.
I came home a little stiff and achy, a trend that seems to be back-sliding on the recent physical progress I made but the finger held up to its first day out of the splint at work.
I also came home early, as the Teenager planned a movie night for blind friend Nan to watch How to Train Your Dragon, a movie I have not yet seen despite the fact that I made a Toothless stuffed animal at Build-A-Bear.
Nan and I were to stop and pick up dinner at Wawa and the Teenager had made homemade ice cream (that honestly was on par with Cold Stone Creamery). And everyone got their desired dish from Wawa— except me— as I wanted a pre-made salad from the grab and go cooler and apparently the cooler was broken. The employees were removing all the food and the floor around it bore wet floor signs.
So I ate leftovers out of my fridge.
The audio-described version of the movie was intense. The poor man doing the description didn’t have time to breathe.
I was in bed by 8 p.m. The cockatoo had issues at 2 a.m. But all-in-all a good night.
At work today, I was tired, hot and a little bored at my regular table in QC. I did 101%.
I’m still have issues with a strange burning and tightness in my right thigh, and dealing with that is causing lower back pain.
I got home from work and tentatively poked my head around the corner in the garage— checking to see if dog was in the yard. She was not.
I walked up the stairs from the car bay to the main room of the garage. Walking across the big open space in my garage, I tripped over my own foot and fell. I did some sort of corkscrew dive and fell backwards through the screen door to exit the garage then skidded across the floor. I scraped my hand, my knuckles, my elbow and I think my leg and knee.
But then I still went to the gym. Under Andrew’s careful eye at Apex Training, I did my workout. I felt better than when I arrived, even if I am still a little stiff and achy, but such is life with cerebral palsy.
This week marked my 11th week in treatment for my mallet finger. Almost three months caring for this injury. 9 weeks in a cast. About 9 days in a splint 24/7. One week in a splint most of the day, taking it off 5X a day for an hour.
This morning was my third had rehab appointment since the cast came off. They also did the casting so I had two previous visits with them.
Typically, I go in, they make me bend my fingers and they measure everything, tell me the following week’s directions and send me on my way.
Today I went in, the had me heat my hand for 15 minutes and then I got a finger massage. The therapist measured my finger and made me a new night-time splint and told me I no longer need to wear the splint during the day.
Because I do so much work with my hands, if it starts to droop or just bothers me, I can splint it here and there for an hour.
I have another appointment with my hand surgeon July 27, so although the general guidelines say I only have to splint at night for 2 more weeks, it is recommended that I wear it until I see my specialist.
Other wisdom from my therapist as we chatted today:
Completely immobilizing a mallet finger for six weeks is the minimum in his opinion.
The finger can continue healing for an additional six months after splinting is complete. He recommends using individual judgment and awareness of the finger to decide how long to splint at night.
Massage the finger, especially the joints for five minutes several times a day.
Understand that the finger may never resume its former shape/posture/movement but that the end of the finger itself doesn’t have that big of a role in hand function.
Keep bending the fingers several times a day, gradually working into a fist.
Today was my last official day working with a disability accommodation in the Stitch Fix Bizzy Hizzy warehouse. It’s Sunday, tomorrow is the Fourth of July, and I had a helluva time getting out of bed when the alarm went off at 4:15 a.m.
So I didn’t.
I was in the middle of an anxiety dream where I was with an old friend that cut off ties with me a decade ago… and I think a few people I’ve lost were in that dream.
I reset my alarm for 4:45 and started my day a little off and then the Keurig decided I only deserved half a cup of coffee. As. If.
Today was my first day working in my new splint. (If you didn’t know I lost the first one in my car, you can read that story here.)
I’ve suspected since Friday afternoon that my new splint was too tight, but I didn’t confirm it until I started to see marks on my finger, deep ridges, yesterday.
During work today it got pretty unbearable— so when they let us out early I came home, heated the teapot and dropped the custom splint into a bowl.
I poured the boiling water into the bowl and reshaped the plastic. It’s not nearly as perfectly molded as the professional job, but it doesn’t pinch my finger.
I had an 8 a.m. appointment with my occupational therapist at The Institute for Hand and Upper Extremity Rehabilitation. I cannot say enough nice things about them.
I arrived around 7:50 a.m., and ended up walking into the building with my therapist. The receptionist wasn’t there yet. My therapist grabbed my file and started my appointment before her computer fully engaged for the day.
I told her the story of losing my splint. She made me a new one and I didn’t even have to pay extra.
The finger is “holding up” and this week, when I take the splint off to do my exercises five times a day— which I might do seven, just based on my routine— I can leave the splint off for one hour five times a day.
It sounds like if my finger maintains its posture through this week that I am more-or-less out of the woods. It’s very exciting.
Why do I do my exercises seven times a day? For exercises like these— physical and/or occupational therapy exercises that require little bits of effort multiple times a day— I find attaching them to logical parts of my routine helps.
So in my case:
I left my appointment at 8 a.m. They are so efficient!
4:15 a.m. Wake. Remove splint. Use bathroom. Wash hands. Start coffee. Do exercises. Replace splint.
6:15 a.m. Use bathroom at work. Check hair. Remove splint to wash hands. Return to main cafeteria to chat with friends. Do exercises as warm-up for the intense folding of clothes to come. Retape splint. Head to time clock.
8:50 a.m. Remove splint. Go to bathroom and take morning break. Do exercises. Have morning yogurt. Replace splint. Fold more clothes (about 175 pieces of clothing every two hours). Yes, I fold and package clothes. I work for Stitch Fix doing Quality Control for the subscription boxes. My side hustle is my book company, Parisian Phoenix Publishing.
12:10 p.m. clock out for lunch. Remove splint. Use the restroom. wash hands. Do exercises while heating lunch. Eat. Replace splint.
3:10 p.m. Final 15. Remove splint at work station. Go to wash hands. Do exercises while enjoying a cup of coffee or snack in the main cafeteria.
5 p.m. Clock out of work, remove splint, wash hands, stretch fingers, replace splint.
5:30 p.m. Get home from work. Fight off very excited large dog. Remove splint. Wash hands. Do exercises. Replace splint.
7:30 p.m. Remove splint. Shower. Gently use fingers to wash hair. Do exercises in shower. Dry off. Replace splint with fresh tape.
And this way if I miss one, it’s okay. Or if my hand isn’t doing as much in one session we make it up in the next.
I wept tonight. I nearly wept myself into a panic attack. My guts are still fluttering. And I flung things down the stairs.
But that’s the end of the story. Let’s start at the beginning.
On Monday night, after the teenager’s car accident, I went to Apex Training for my 100th session at the gym since I started about ten months ago.
Because it was my 100th session, the my trainer picked out 6 exercises for me to do 100 times, at my own pace, breaking them into sets as I saw fit.
I was a little stiff the next day, which was yesterday, but I still managed to do 100% according to the metrics at work. But my the end of the day my right leg was unsteady.
Today I woke up very stiff, with my muscles in my lower body so tight I struggled to bend and I had even less control and stability in my right leg.
I only made about 90% today.
By the end of the day, my right quad had this dull burn to it, but it didn’t really hurt. But it was getting more and more difficult to control as my stiffness dissipated.
But the teenager and I still made it to my 101st session at Apex and celebrated by trying the new strawberry Frosty at Wendy’s. Which, by the way, is much tastier with a Wendy’s sugar cookie.
I took my custom splint off— today marks one week of wearing it and taking it off every 3 hours for occupational therapy exercises and when needed “for hygiene.” And the finger is looking steady!
I removed the splint to wipe down my hand with a wet nap before eating. I set it down carefully in my lap. And then it just disappeared. I checked the take-out bag. I checked my bra, the car compartments, the seat.
The teenager told me to stop wiggling around that it had to be in the car and we’d look at home.
We didn’t find it at home.
So I went to the kitchen and started to cry. my finger had looked so good wrapped around that Frosty cup as I smeared the Frosty on my portion of the cookie the teenager and I shared.
I checked my local CVS’s website: no splint in stock. So I checked my local Walgreen’s: no splint in stock. And so it went.
Still upset, I found a piece of wood my cockatoo had stripped from her toy and taped it to my finger.
My splint. Hopefully I’ll find a better solution in the morning.
So, as directed by my doctor, I went to see my friends — the occupational therapists at the Institute for Hand and Upper Extremity Rehabilitation.
They fitted me with a custom splint molded to my finger (for $50) that despite my doctor’s recommendation that I wear the splint at night only, they want me to wear the splint 24-hours a day for the next week, which for me will be nine days because that’s the day I can get there again.
I am to remove this splint when I bathe, when I wash my hands, and five times a day to do physical therapy exercises.
The exercises are 10 reps of basic hand gestures: straightening the hand, lightly bending the top of the hand, and making a loose fist.
If the hand loses progress instead of gains it, then the cast will be reapplied.
In pondering this, I realize several opinions of mine that may be greater truths:
Had I accepted my doctor’s solution of “cheaping out” and reusing my stinky cast as a splint, my recovery from this mallet finger would be more direct versus gradual. I believe gradual, supervised steps toward healing are better and I wonder if there are statistics about patients and the long-term success rates with these injuries with various treatments. How many patients would hear that insurance won’t cover it and end the conversation there without considering that the $50 might provide more than just a splint, but also guidance and expertise.
Are my occupational therapists just over-cautious or it is a case (as I think it is) that the therapists see more of this injury and in the same manner than nurses often know more than doctors, do occupational therapists understand more about function than fancy specialized surgeons?
I was very apprehensive and so excited to see my doctor at OAA today to get my damn cast off for an evaluation of my mallet finger.
The teenager texted me as I sat in the exam room.
“Free the finger!”
They had a devil of a time cutting it off— apparently after even five weeks in the same cast it was firmly on.
Both the hand/orthopedic specialist and the hand rehab office it’s unusual for patients to maintain a finger cast for so long. That doesn’t make sense to me, because why wouldn’t you do everything in your power to maintain agility and strength in yourfinger?
Free the Finger!
the Teenager
And don’t give me that “it’s too hard” or “I need my hand to do stuff.”
I work in the Stitch Fix Bizzy Hizzy warehouse folding clothes. And after my brief stint on short term disability to deal with my balance and hip issues stemming from cerebral palsy (and made more complicated by now not being able to rely on the left side of my body with this temporary injury), I went back to work and performed at 100% and higher with my finger in a cast and restricted hand movement.
That finger had so much caked dead skin and here’s the really fascinating part— my knuckle no longer has wrinkles because it has not bent.
In the beginning of my treatment, I found my doctor cold and impersonal but as he gets to know me I like him more and I get more personable interactions from him.
He told me I should gradually increase my finger flexibility with care not to hyperextend it (otherwise known as don’t bend it backwards) and splint it at night. For the splint, I could take my cast back. And tape it in at night.
“It’s cheap, but it’s dirty,” the doctor said.
Yeah, no thanks. I lived with that grimy thing long enough.
“The other option is to return to the Hand Institute and they’ll make you a splint.”
(Which, coincidentally Cigna, my insurance, does not cover. But as I do not cheap out on my medical care, I will pay for. Because right now my HSA is empty because having a disability and doing everything you can to keep yourself ahead of that disability is expensive. So please, consider this and how lucky I am that I can support myself because if I had to really on family and government benefits to subsidize my care, I’d be crippled.)
I imagine there’s a third option— buy an over-the-counter splint. And I was going to consider that. But to me, the cost of the custom splint comes with the knowledge and enthusiasm of the people at the Institute for Hand and Upper Extremity Rehabilitation. These people love and know hands.
And if I can only teach others one concept about your health, it is this: invest in yourself, meaning, find the right medical providers for your team that understand your needs and share your personal philosophy and concerns. This requires being vulnerable in a way that might be uncomfortable and it might mean having difficult conversations with people you don’t like. But it may also lead you to better understanding of yourself and of those people who seemed like callous know-it-alls disinterested in you.
I peppered my hand specialist with questions today— rapid fire as he typed my splint referral into the computer. And he respected them. The questions.
How much movement is okay? What should I watch for? I pack boxes and fold clothes and put things on conveyer belts. Should I splint the finger at work if it starts to feel weird? Is there certain motion I should avoid?
“There are no rules,” he said. “Just be careful and the occasional splinting wouldn’t be bad. I’ll see you in a month.
He made eye contact with me as if to say, “you know your body. Follow your gut.”
But he also knows I’m the patient who kept a finger cast on longer than the average Joe. So maybe, just maybe, he trusts me.
For previous installments on my finger injury: click here.
Angel Ackerman 