Physio for the Frozen Shoulder

Paolo was as direct and merciless with his words as he was with the pressure he brought to bear on my shoulder, neck and back. It was the first time that I had met him, but he was already talking to me like he had known me for a lifetime. He was unapologetic when challenging me, "why are not you making the lifestyle changes that you know you need to make?", "why are not you getting exercise 3 times a week?", and "when are you going to start taking care of yourself?". Good questions. Too bad I did not have any good answers?

At the time I made my first appointment with him my shoulder and elbow were a little sore and stiff, but I could not isolate the cause. Was it the PD?  These days I immediately identify almost any physical, cognitive or imaginary change to my bodily functioning as being attributable to Parkinson's. However, my second response is to pooh-pooh that first response for fear of the label "hypochondriac" being put on my business card. By the time I made it in to see Paolo the physiotherapist today, the range of motion in my shoulder, elbow, and then neck, were becoming more limited everyday. I have been wearing an arm brace just below my elbow, as it seemed to help with daily tasks. But the pain streaked down my arm whenever I put my arm/shoulder in the wrong place or position.

Despite the pain of the probing by Paulo this morning, it was evident afterwards that my range of motion had increased thereby validating his diagnosis and making his prognosis quite likely: if I do not work on the "frozen shoulder" now I will run the risk of rendering my right arm of limited use. I am already becoming a virtual left-handed person due to the tremor, and this would only speed up that switch.   My elbow pain is apparently from acute tendonitis.

I suppose it is only appropriate that today, the 4th anniversary of my "PD Diagnosis Day", I should receive a wake-up call from someone I had never met. After all, that is what happened 4 years ago. Maybe I need the feedback from a distance instead of those close to me. Change must occur. I must do a better job of shining a light into the future and responding now to what I can discern there.

So tomorrow morning I climb back on the "wagon" with my personal trainer and recommit myself to exercise at least 3 times a week for an hour, focusing on aerobics, core and stretching (yuck, how boring).

The Right Arm Swinging - Saga of Stiffness

As with many people dealing with Parkinson's disease, the arm of my affected side does not swing naturally. I must make quite the strange picture. I usually walk quite fast. My left arm soldiers on in fine form with enough momentum to propel me in circles, while the right seems to have forgotten the cadence altogether, standing at attention like one of the Queen's Guards at Buckingham Palace. Recently, it seems to have forgotten how to do a number of things that it would normally. For instance, casually throwing my arm around the shoulders of my wife while out for a stroll on one of these recent cold nights would have been natural and easy only a few months ago. Now it feels as awkward as when I was a 12-year-old in the movies on a first date. Suave and sophisticated I was not. Furthermore, the sudden pain is like someone is wrenching my shoulder out of its socket. It appears that the stiffening is setting in like Jell-O in the refrigerator; imperceptibly slow but nonetheless noticeable from time to time.

Fortunately, the “bradykinesia” (a medical term for slow movement) or “akinesia” (absence of movement) does not affect much else. In some people with Parkinson's this problem can evidence itself in an expressionless face or even "freezing" in place, both constituting awkward and embarrassing social occasions. But for me, this right arm-swinging trouble constitutes nothing more than an inconvenience.

In the great scheme of things, this is hardly a major issue. But, as with the rest of life, learning the little lessons prepares us to take on the big ones. So what can I do about it? This is a question I believe we all need to ask when faced with challenges, in my case related to my mostly silent partner, Parkinson's.

First, when I notice my right arm absentmindedly failing to keep up with the left, I can be more intentional, forcing it to perform its normal duties. Second, I can get back to exercise and stretching (yuck!). Starting tomorrow I will climb back on the exercise wagon that I fall off so easily and regularly. Third, I can see a physiotherapist about doing the right things to offset the onset of stiffness. That I will do in early January. And fourth, despite all of the Olympic fervor and fever in anticipation of the upcoming Winter games here in British Columbia, I can abandon the idea that somehow I need to adopt the pursuit of going "faster, higher, farther".

As I have stated before, most battles begin with how we think about them. We are not defeated when we cannot do what we used to do, only when we cease to do what we can do.

Torture for Beginners

The vice grips tightened and the serrated pincers dug deeply through the flesh to the bone. The everyday tool, a cross between pliers and a screw clamp, became an instrument of torture. Applied to the big toe of the right foot, its jaws increased the pressure from a gentle squeeze to a numbing crushing force. The toe curled under in response. Slowly the whole body and everything else was forgotten as the discomfort increased to a radiating pain. First the remainder of the foot, then the calf and knee, stiffened in sympathy. But like muscles always do when left clenched too long, they began to tremble and could not stop. Trying to get the vibration to stop by willing the right leg to relax proved futile. It only refocused attention on the tightening muscles in the foot. It too mimicked a steady oscillation as the logical extension of the leg's reaction to the pain. And so the cycle continued from toe up to leg, back to foot, which resulted in a rhythmic motion on the gas pedal.

Parkinson's has an extremely varied menu of diverse and strange symptoms. Unfortunately, knowing the menu does not allow one to make the meal choices. The establishment delivers each course unannounced. Portion size and speed of delivery are almost totally unpredictable and, for the most part, out of control of the customer. The total meal is usually a pot pourri of undesirable physical, psychological and emotional items dished out without a set sequence or severity.

Dystonia was being served up Friday as we drove towards the Olympic Peninsula for a weekend with the family. It is the contortion and cramping of muscles resulting from mixed up neurological messages. My big toe on my right foot is the recipient of the term. Mild in my case, but unmistakable. Have I over-dramatized the introduction to today's post above? Certainly, but someday it may not be. And for some the description above would be understated.

Driving a car (not motorcycle, thank goodness!) brings on the mild dystonia in my right toe. I used to enjoy road trips, but now they represent a reminder of a PD symptom that may be painful in the future.

So how do you handle pain? I don't manage it well. But I am learning, and it is a valuable lesson. Pain is often the ultimate teacher and tests one's priorities like little else. It is an experience we cannot really share. Complaining accomplishes little and sends the wrong message.

My own attempts come down to first trying not to fight it. In the case of dystonia, relaxing is the only actual remedy. Rest is the second antidote. Third, I try to reorient my attention, distract myself with music, a game, discussion or whatever. Finally, I remember that many others live with greater pain and I need to keep away from self-pity. Feeling sorry for yourself is the real prison guard and torturer. By focusing on the big picture takes our eyes off of ourselves. We can prevail over pain. Positively.