Wellness Wednesday: How Being Strong Can Get You Well

Millions of COVID-19 survivors struggle with physical and cognitive disability long after they’re released from the hospital. Those who were strong before getting sick have the best chance of making a full recovery.

Long Hospital stays weaken the Body

Survivors of critical illness experience marked disability and impairments in physical and cognitive function that persist for years after their initial ICU stay.

CHEST, the official publication of the American College of Chest Physicians

Nearly half of those who survive a stay in the Intensive Care Unit find themselves impaired or disabled by ICU-Acquired Weakness. In 2019, I was one of them.

I had Icu-Acquired weakness

I was struck down by a ruptured arterial aneurysm while on vacation in Amsterdam in May, 2019. OLVG Hospital saved me by quickly clamping the rupture, and kept saving me as my body crashed for the next four weeks. When I finally came out of the fog of illness, I had lost nearly a third of my body weight and the ability to move. After a brief dance career and a lifetime of teaching exercise, I found myself marooned in an inert body. What I didn’t yet know was that I might not have awakened at all had I not been so strong going in.

Physiotherapy got me moving

My iPhone, my 10# weight

My Dutch caregivers began giving me physiotherapy right in the ICU. A bed-mounted bicycle moved my limp legs. A cushioned harness and ceiling pulley lifted my sagging torso upright for a few minutes. A speech therapist coached me in chewing and swallowing before the feeding tube came out, and an occupational therapist gave me hand exercises so that I could grasp of silverware and cups. It was weeks before I could hold my iPhone, which felt like a 10-pound weight.

Doing my exercise in the hospital

When I left the ICU to complete my recovery in the hospital’s gastroenterology unit, I added daily sessions in the physiotherapy fitness center. Being in a gym was familiar territory, and eventually it felt good to move. The muscle memory came back. I stood. I shuffled. I walked. I got on an airplane and came home to continue outpatient PT with the goal of being able to climb the stairs to our daughter’s apartment. It took me months, but I made it.

Get strong now

When it comes to survival, exercise may be the best weapon we’ve got, and any kind of movement counts. Do squats during TV commercials and hamstring curls while washing the dishes. Toss in a few standing pushups as you’re wiping down the counters. You’ll have a cleaner kitchen and a stronger body.

better in, better out

Holland is among the countries paying special attention to the physical capacity of incoming patients. They call it “better in, better out:” the stronger you are going into a major hospital event, the sooner you’ll make it out. Care IQ, a Dutch healthcare consulting company, markets the concept as BiBo™, encouraging physicians to introduce pre-surgery exercise for their more vulnerable patients. As people are living longer, we all stand a greater chance of becoming those frail persons. 

Next week, I’ll begin a true “better in, better out” story you don’t want to miss: how a friend of mine prepared for elective surgery — a hip replacement! — and what happened.

Spinning

There are no problems, only opportunities.

Old budget analyst adage

I spent my working years as an analyst in the New York State Division of the Budget. Making a solid case for a position was highly valued. When I spoke about our work with other State government managers, I’d say that if you could argue successfully that the ceiling was the floor and the floor was the ceiling, you were budgeting gold.

There is making an argument, and then there is spinning. The difference is facts.

In his recent column in The Washington Post, Greg Sargent highlighted Vice President Pence’s telephone conversation with governors, citing increased testing as the cause of more cases, and characterizing the explosion in the number of coronavirus cases as “embers.”

President Trump and his advisers have plainly decided they have no hope of truly defeating the novel coronavirus and getting the nation on track to meaningful, sustained economic recovery in time for his reelection. So they’re spending far more of their time on the next best thing: creating the illusion that we have already roared most of the way back to victory on both fronts.

Greg Sargent, The Washington Post

Coronavirus tests don’t create cases. Florida Governor DeSantis tried to explain away the overnight doubling in cases — from 5000 to almos 9000 this week — as a data dump. Yes, it’s data, but I smell a different kind of dump. Bullshit.

And embers? Where there is smoke, there is fire. And we are a nation on fire. We should be stopping, dropping, and rolling home.

The Wizards have spoken, but we must pay attention to the man behind the political curtain.

In his recent conversation with Terry Gross on Fresh Air, University of Minnesota epidemiologist Michael Osterholm said that Americans can handle the truth, but only if we have not been lied to in the meantime.

This virus will not follow public rhetoric. No amount of wishful thinking is going to change the fact that we have many more months of this. We’ve got to figure out how to live with this virus.

Michael Osterholm, Center for Infectious Disease Research and Policy

The Coronavirus timeframe is untouched by Election Day. Its scope is much, much longer. There is no amount of spinning that will change this reality.

It feels overwhelming. So, how do we proceed?

With leadership that tells the truth and gives us a path forward. My old boss Andrew Cuomo has set the bar.

But the long-term view is challenging. We won’t have a vaccine for many months, and that means that the virus will continue to infect people. How do we stay the course?

My personal experience with resilience shows me that, while the moment to moment reality of our lives may be challenging, it is possible to forge ahead with confidence. Again, it’s about leadership.

When I came to myself after almost six weeks in the Amsterdam ICU, I was thrilled to see how slim — skinny, even — my legs had become, until I realized that I couldn’t move. Anything. How did I not fall into despair at that moment?

The constant encouragement of the amazing medical staff at OLVG Hospital kept me on track. The loving support of my husband, daughter, sister at my side there in Amsterdam kept me going. The small gains gave me traction and slowly led to larger gains and milestones. Being able to swallow real food. Being able to hold a fork. Being able to peel a tangerine, never mind that it took an hour.

The OLVG staff had high goals. When I first met with my physiotherapist, I just wanted to be able to lift my hips off the bed so that I could graduate into a more independent set of diapers. “Well, okay,” Gemma said, “But I’d like you to walk.”

I walked.

That’s what leadership does. But only if those people have the right tools.

I was in the hands of a different physiotherapist one day when I collapsed. I was shocked, but not just by the fall. It was the woman’s terrified reaction that really unnerved me. Needless to say, I stayed away from her for the rest of my recovery, and Gemma had me walking independently by the time I flew home. Yesterday, I ran two miles.

Be well, wear your mask, don’t touch your face. And hold Washington leadership accountable by electing someone who has the knowledge, skills and abilities to lead us during this terrible time.

The Patience of an ex-Patient

My brain rushes through all the things I think I must do today, or tomorrow, or should have done yesterday: paying bills; cleaning house; making, changing, and keeping appointments. I’ve already done a mile walk and 20 minutes of squats, planks, and leg lifts. My daily crossword and cryptogram are complete. It’s too early to play my three hands of Solitaire.

None of it matters. Not really.

Six months ago yesterday, my normal world ceased to exist when I fell ill suddenly and nearly fatally in Amsterday. I didn’t die. I survived. I recovered. I came home. It took three months in a hospital bed and another three months of physical therapy, slow shuffles, and pool walks to get to today.

With our daughter’s dog Pancho.

I didn’t know I had that much patience. I didn’t know I had that much determination. I didn’t know would have an enormous global community rooting me on.

I didn’t know that our daughter and my sister would fly to my side and hold Ray up. And that the two of them would figure out how to get me home.

When I was in OLVG hospital, a sage doctor advised me to give myself time as I recovered to appreciate the journey.

“Don’t push to get back to where you were. Set small goals, and celebrate small victories. Take time to rest. Relax. After a few months, you’ll realize how much you’ve gained. And you’ll be where you need to be.”

So, these are my small victories.

Peeling a tangerine; twisting the cap off a yogurt drink; shuffling cards.

Bending one leg; rolling to one side; bending both legs; rolling to both sides.

Sitting up in the wheelchair at the park.

Learning to count to 10 in Dutch. Understanding that OLVG was gezellig.

Standing on legs that felt like hollow cardboard tubes. Taking that first step in my physiotherapist’s embrace. Taking a step without her.

Getting my own wheels and soloing down the hallway. My iPhone notifying me that I wouldn’t get calls while I was driving.

Getting prize foods for being a patient patient.

Going to a jazz concert in the OLVG chapel. Getting wheeled down for church by a volunteer. Finding the music of Tom Löwenthal on Apple Music that still lulls me to sleep.

Discovering I could manage without a catheter even on the long flight home, and that sausage, grits AND muffins for breakfast at Shands Hospital was part of the new normal.

Sleeping in our guest room, where the bed is low. Climbing into our own bed with my husband, falling asleep holding his hand.

Lantana Beach, Palm Beach County

Stationary biking. Treadmill walking. Squatting. Stretching.

Walker-walking. Cane-walking. Walking. Striding. Marching.

Graduating from FYZICAL physical therapy on Halloween.

I did end up paying a few bills, getting my nails done, and writing this piece today. I’m on my way to Shands for a status check on my previously aneurysmed arteries and embolismed lungs hoping to get off some medication and to be sent on my way.

My husband is driving, our daughter will meet us there, and my sister and brother-in-law will be here next week. That’s all that matters, really.

And you, dear readers.