Whining About Typing Again

I have been very frustrated about my inability to get my right hand again cooperating with my left hand at typing.  I just purchased an ergonomic keyboard in the hopes that it might help. It is certainly a little easier.  I did find this set of exercises:

Many times when therapists or stroke patients work on hand function, they focus on gross grasp or pinch activities with the index finger. These activities are good for learning to pick up objects or hold something like a pencil but aren't the most effective for learning to improve an activity like typing. During typing, the fingers have to be able to work independently of each other. This is often difficult for the stroke patient due to tone or possibly stiffness from disuse. 

Exercises I would recommend to improve typing:1)Place the hand flat on a table and try to lift each finger independently while keeping the other fingers on the table.2) Drum fingers on table3) Practice touching each finger to the thumb4) Pick up small object like peg or screw with the thumb and index finger, then thumb and middle finger, then thumb and ring finger, and lastly the thumb and little finger. 5) Push each finger individually into theraputty.6) Use Digiflex to exercise each finger individually (see below for product).7) Pick up marble and transfer to inside of hand (same hand as picking it up). Then while keeping marble inside hand, pick up another marble. Keep doing this until you can't pick up anymore then put each marble back down one at a time.8) Use Chinese balls or take two golf balls and rotate them in the hand.9) Play the piano or just hit keys individually with each finger.10) Place a piece of paper on a table. Use the weak hand to crumple the paper into a ball then try to uncrumple the ball with on the table with the same hand.11) Use online typing games to practice. There are many online typing games that teach kids to type that would be great for stroke patients wanting to practice typing.

I have started to do exercises 1-4 using 1/4"-20 bolts for #4, and I think they are helping.  All of this is touch typing, albeit very slowly and done very deliberately.  Hitting the backspace key, which I have traditionally done with my right ring finger, requires a lot of very deliberate thought, but it seems to be coming back, sort of.

And when I do those exercises, I can feel muscles at work in my wrist telling me that they have not been used much in many years,  I still do not have the coordination to consistently hit only one key at a time or hit the key that I am aiming at.  For exajmpel, and trying to hit t and hnot hitting 6 as well.  But it took many years, starting in sixth grade to develop the coordination to do this well.  Trying to get this back now is really depressing.  I really wish there was some way to tie Control-H to backspace.  Originally, that was the backspace character, and I suspect that it might be easier for me  to use, but with use, that backspace key is getting easier.

Brain Fatigue

I have mentioned in the past that very demanding mental work like debugging even fairly simple programs seems beyond me now.  But even relatively simple tasks if done long enough seem to fatigue my mental capacities.  When I tax my brain too many hours in a row, my speech slurs more severely.  My wife has been insisting that I do less because by the end of the day I am not very understandable.  She says it is like living with an alcoholic, a painful subject since she grew up in an alcoholic home.  I now have to limit myself to about five hours a day, and spend the rest relaxing, or reading light materials, such as The Collected Stories of Sherlock Holmes.

Trying to Use Both Hands to Type

One of the most long lasting consequences of my stroke is inability to touch type.  The right hand is still not very coordinated, so I often can't figure out how to get to characters off the home keys.  (That apostrophe in the last sentence was a struggle!)  I am trying to get that coordination back by touch typing again.  Like all such rehab, it is slow and frustrating.  I am going to try and resume touch typing when I blog (or bog, as the case may be).

My neurologist told me that I was fortunate to be left-handed because in lefties, speech is often in the right hemisphere, and my left hemisphere stroke pretty well left my language capacity alone!  Left hemisphere strokes cause right side paralysis, which is what I experienced!

There are times that fatigue just overwhelms me

Arthritis

I have been having pain in my right shoulder, hand, and wrist for some months, and I assumed it was strokr related.  My physical therapist says the shoulder pain is a stiff deltoid muscle, and she is working on loosening it, and gave me some exercises to do.  But the pain in the fingers and wrist she thought was arthritis, and my doctor confirmed this, pointing to Heberden's nodes in my right hand.

I suspect this pain plays some part in difficulty regaining my touch typing skills.

UPDATE: A reader mentioned that there is research showing a connection between vitamin K deficiency and osteoarthritis.  This study:

The PRs for OA, osteophytes, and JSN and adjusted mean number of joints with all 3 features in the hand decreased significantly with increasing plasma phylloquinone levels (P ≤ 0.03 for all). For example, as plasma phylloquinone levels rose, the PR for hand OA decreased from 1.0 to 0.7 (P = 0.005). For the knee, only the PR for osteophytes and the adjusted mean number of knee joints with osteophytes decreased significantly with increasing plasma phylloquinone levels (PR decreased from 1.0 to 0.6, P = 0.01).

and:

Results: This ancillary study had 378 participants (193 in vitamin K arm, 185 in placebo arm). There were no effects of randomisation to vitamin K for radiographic osteoarthritis outcomes. Those with insufficient vitamin K at baseline who attained sufficient concentrations at follow-up had trends towards 47% less joint space narrowing (p = 0.02).

 and many others.  One problem is that vitamin K increases blood clotting, and I am on warfarin to reduce clotting as a stroke preventative.  I need to talk to the anti-coagulation clinic before I increase consumption of green leafy vegetables (which I hate, so the arthritis is no surprise).

Feeling A Bit Better

My doctor upped my Prozac to 37.5 mg and Lamactil to 100 mg.  Theoretically, the increase should not have an effect so quickly because Prozac takes a couple weeks to reach therapeyutic levels, but I seem to respond faster than average to it.  Today I actually felt pretty darn good! 

I also finished getting the Sherline operational.  The replacement stepper motor for Z-axis arrived yesterday, and worked perfectly.  But Y-axis suddenly started grinding in one position.  After discussion with Sherline support, I disassembled the Y-axis and discovered an aluminum chip had occupied a thread on the lead screw (which is not unknown) prenting the anti-backlash nut from moving down the lead screw.  So I used some channel locks to remove the nut, lubricated the lead screw and reapplied the nut.  But, you say, that can't work, the steel leadscrew will just damage the brass nut.  But the real issue was the aluminum feposit in the thread.  The brass knocked it right out.  All axes are now working.  Tomorrow, once Idfinish one order and a mac hinig project for one of my readers, I can resume what I bought this gadget for.

Exhaustion

Whenever I wonder if I have recovered enough to return to software development, I have days like yesterday. I spent the day writing gCode and C to produce gCode, and by the end of the day, I was utterly drained.  Something similar happened Friday, getting the mill operational.

Arms Sore

Workout at gym is making me stronger, but there are costs.

Things I Hate

This cardiac monitoring gadget that I am wearing.  Unlike the one that is implanted surgically, this one sits on my belt.  At night, it is annoying.  The leads to the contacts are just short enough that putting the box under my pillow never lets me roll over without entanglement.  Just short enough that dropping your pants on the toilet tugs on the contacts pulling your skin.

headed home

The doctors were unable to determine why I had two recent small strokes, one of which was asymptomatic, but they narrowed it down to:

1. There seems to be a small growth on the end of the aortic valve which is either a clot or growth that causes clots (it looks like a guitar pick from the side, but I don't eat guitar picks, so...).  This was determined with a procedure that makes colonoscopy seem pleasant.

2. I have a heart defect called a PFO which is a small opening between left and right atria.  After birth blood goes from right ventricle to right atrium, then to the lungs then back to left atrium, then to left ventricle then to body.  Before birth, the heart doesn't bother sending blood through the lungs, so the PFO is an efficiency gain.  About 30% of Americans fail to have the PFO close after birth, and blood (and clots) from elsewhere in the body can pass through the PFO causing strokes.  (The lungs filter out clots if you don't have a PFO.)  Coughing and straining on the toilet can increase the amount of blood passing the the PFO. My PFO is small enough not to justify surgery, and might explain why only small clots are going to my brain.

3.  It is possible that I have an irregular heart rhythm called atrial fibrillation (also quite common) which throws clots to the brain.

As I said earlier, not as neat as an episode of House in terms of puzzle solving.  But the solution to all these is warfarin, a blood clot preventer, and less coughing and straining.

Clayton

not quite as satisfying as an episode of House

 my cardiologist says that they are not sure exactly what is causing the clots that are causing the strokes, because it could be atrial fibrillation, or a clot from somewhere else in my body gets loose, but the solution no matter what the cause is warfarin.

things that make you look forward to a colonoscopy

Trans esophageal ultrasound.  my doctors can see two recent strokes in my MRI.  since I am not in a high-risk category they need  to figure out what are causing these.  My horse aortic valve has a growth that looks like a guitar pick (although I don't ordinarily eat those). It might be infection which means antibiotics or a clot which means drugs that dissolve clots or it might be atrial fibrillation causing the clots.

Trans esophageal ultrasound starts with three lidocaine gargle then a 2 inch tube down your throat  into  your esophagus  so they can ultrasound your heart.  It is as unpleasant as it sounds.

back in the hospital

 I had another stroke. Not very severe, but it caused slurring of my speech and sagging on the right side of my face.  The E/R doctor  doesn't  see any reason  for another stroke so they are holding me over for to look for a cause.

More Frustrations About Blue Cross & Physical Therapy

Blue Cross covers 20 physical therapy appointments per plan year: even for post-stroke recovery.  When I started at St. Alphonsus Rehab Services in October, they knew that and scheduled just that many appointments, and I trusted that they knew what they were doing.  But it turned into 26 appointments, and of course Blue Cross won't pay for >20 visits.  So I have an extra $1500 in bills showing up.  Never trust your medical provider to get this right!

Pool Therapy

In the pool this evening my wife put a couple foam noodles under me (I don't float as well since I lost all that weight) and worked on strectching my right arm. I can lift it straight up and to the side without pain!

Self-Pay Physical Therapy Well Worth It

I mentioned a couple of weeks ago that I was starting to pay for physical therapy out of pocket because my insurance plan is limited to 20 visits per plan year.  I think it is worth it.  This post was about 80% left hand and 20% right hand.
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And:

When I resumed therapy, the right arm would go shoulder high and that's all.  I still have a way to go before the right hand works well, and the right deltoids still scream when I do this.  My right leg still remains slightly impaired, and I am still struggling a bit with depression.

The Right Hand Is Beginning To Type Again, Sort Of

The keys above the home row on the right uiop, are beginning to respond like I am just learning to touch type.  The o and p are still getting confused, and the keys below the right home row are still uncooperative.

It may be time to start phasing down the Prozac

Today, I am feeling full of mental energy, but my body feels a little doped up still.  I think tonight I will start titrating down from the 20 mg dose, and see how I feel tomorrow.

Whevever I Start Wondering If I Am Really Disabled....

I have a day like today, where I had to lay down for a nap about 1:30, and I didn't wake until 4:15.  My brain is still busy repairing itself.

Rehab Isn't Cheap

Blue Cross limits physical therapy to 20 visits per plan year, and I have run through them.  Feeling rich, I decided that I would pay out pocket as long as I was improving.  Bu these 60 minute sessions cost about $300 each.  I'm not that rich.  I am still making progress with my various exercises for this locked up deltoid muscle.  Maybe when the new plan year starts in July.