Rosalie Richards
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My Thanksgiving--How to Drop Foot Drop!

11/25/2015

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It is Thanksgiving!  Funny things are worthy of thanks, for me, now that I have lived with MS for a few years.  Here is one--I have learned a method to walk long walks, miles---though I have had walking issues brought on my foot drop.  It  is something we can all learn.  That is what this blog is dedicated to.

I'll tell you why drop foot is a favorite learning for me.  Before I ever was diagnosed, before I began to think about being diagnosed, I had a drop foot incident.  Now that I claim the MS title, drop foot is a part of my life.  I want to learn about it.  Two physical therapists have taught me ways to diminish it.
I will start with what I learned recently.  This information comes from Herbert Karpatkin, who presented an online teleconference on walking, balance and flexibility in October of 2012 (http://msfocus.org/article-details.aspx?articleID=511). 

He stresses a three-part regimen. Here is the rationale:  If there is a loss of range of motion or flexibility in one part of the body, the opposite part is week.  For drop foot—the calf needs stretching AND the muscles raising the toe up off the ground need to be strengthened.  The regimen is this:  Stretch, flex, walk.
  1.  Stretch.  If you have foot drop the minimum he suggests is five to 10 minutes a day, 365 days a week.  A prolonged gentle stretch is better than a one-time shorter intense stretch. 
Here is a sample stretch that he suggested for a person with left footdrop.
Place your right foot about 12, 18 inches in front of your left. Place both hands on the wall and bend your right knee.  Keeping the left knee straight, lean forward until you feel a pulling in that left calf.
  1.  Make the muscles that lift the toe (the dorsiflexors) stronger.  Flex the toes and release them.  You can do this standing, sitting, lying down, there is about no time you can’t do this, so, Just Do It.  Now, make it count.  Pull the toes up, hold them for maybe 3 to 5 seconds.  Then release:  releasing is important:  let the flex go slowly, slowly, slowly.  The slowness is an important part of the release.
  2. Practice a particular sort of walking.  Walk with intention:  make sure the heel lands first.  Focus on pulling the toes up and landing on the heel on every step.
Here is another, very similar plan, a simpler one.

My own physical therapist heard my complaint about drop foot and gave me an assignment.  “Set a timer for 10 minutes, and walk continuously while consciously holding your toes toward you (flexed) as you step forward.  Walk for ten minutes this way, then walk normally the rest of the day.  If you can do this for ten minutes, you will find that you can remind yourself to walk this way more and more of the time, until the drop foot is no longer a problem.”

She was right!  I still have drop foot, but I can walk miles a day, something that was way beyond me before this exercise. 

Note:  I have to keep my mind on keeping the toe up, because it doesn't happen instinctively any longer.  Sometimes when I walk I am like the man with autism who had to remind himself to smile in public because it wasn't instinctive for him, to smile.  I remind myself to hold my toe up.  We MSers find ways to accomplish our goals, this is mine!
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The Challenge --Get the Muscles Moving Too!

11/19/2015

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There is movement on the horizon to ‘fix’ MS!  Myelin repair studies completed on our friends the mice (ick) (http://www.nature.com/nature/journal/v526/n7573/full/nature14957.html).  MS has a limited shelf life, and the end date keeps coming closer. 

All the more reason for us to keep our bodies ready not only to (#1) survive in the best style possible, given our diagnosis—but also to (#2) be ready to reclaim our bodies when this happens. 

I am working on #1. 

This month I am in Virginia, finishing a writing project.  Dilemma—I am not exercising like I do at home.  At home if I twist an ankle I work out on the rowing machine till my leg is better.  Here I don’t have Plan B equipment.  It is me and the road—walking.

The goal of this blog is to get me outside today, tomorrow every day—away from the computer!  I am talking to myself.

To get my energy level up I read articles about exercising—specifically walking, and walking when you have MS (that is in next week’s blog).

Why exercise 

I need to be reminded of the benefits of exercise.  Exercise results in improved muscle strength, and there is more.

 Aerobic exercise is the form of exercise that has been proven to increase cognitive abilities—for the young, the middle aged and the elderly (https://www.psychologytoday.com/blog/the-athletes-way/201404/physical-activity-improves-cognitive-function; http://www.researchgate.net/profile/Arthur_Kramer2/publication/10833611_Fitness_effects_on_the_cognitive_function_of_older_adults_a_meta-analytic_study/links/0fcfd50da2a5b0ae48000000.pdf). 

For balance…tai chi is known to help (http://www.nationalmssociety.org/Living-Well-With-MS/Health-Wellness/Exercise/Adaptive-Tai-Chi). 
Mood improvement—exercise increases endorphins and results in a better mood. (http://www.health.harvard.edu/mind-and-mood/exercise-and-depression-report-excerpt).  I am psyched.

Don’t make a Big Plan--Just Do It 

The studies make it easy to get started (http://lifehacker.com/5950484/how-to-motivate-yourself-into-an-exercise-routine-youll-actually-stick-to).  They say—just walk—inside, outside, don’t worry about making it a major hike.  Get started.  (This can be done via wheelchair—it is called moving.)  

Walk down your driveway.  Walk down your hallway.  Walk through the rooms of your home.  Try moving in different ways, to challenge muscle groups and develop strength and balance—walk on your heels (yes, this can be done in a wheelchair, what you do is focus on movement), on your toes, sideways, backward, up and down hills.  Try doing unique and strange military marches.  Look at this utube presentation for inspiration (https://www.youtube.com/watch?v=7WqIDqWOJ0A ).

Two tricks to make yourself move more every day--
  1.  Invest in a pedometer.  Studies say we walk farther when that little contraption is measuring us (http://www.sfgate.com/health/article/Pedometer-users-walk-farther-get-healthier-3300697.php)Now I find a remote parking place at Walmart—I want to get my miles in.
 
  1.  Intermittent exercise—if you get tired, take a break; get back to your exercise when you are ready. 
 
The first place I heard this was from someone who heard the Olympic ski champion Jimmy Huega, who became a motivator for people with MS after his own diagnosis in 1970.  At the time of his diagnosis the general wisdom for MSers was to dial back life, sit, lie down, be sedentary.  He didn’t ascribe to this regimen, instead encouraged people to push themselves to the limit.  “Take breaks,” he said.  “Then keep going.”
 
The trick is the newly coined phrase “Intermittent Exercise.”  You CAN take breaks.  It doesn’t have to be done in one long exercise regimen.  Even ten minutes at a time results in improvement in strength, stamina and positive results (http://www.todaysgeriatricmedicine.com/news/ex_092210_03.shtml
 
The important thing is to get up and move.  It worked.  I’m out of here!
 
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What's New Part II--What's it Really Like?

11/12/2015

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A friend read the blog and said, “That’s interesting, but what is really going on with you and MS?”

I realize that when I write a one-on-one email that more personal descriptions of the road happen, because that’s what friends share.  I will try to share the first section of the road with MS, because that reaction was a lifetime ago and I thought it would last the rest of my life. 

A mentor told me, when I first was diagnosed:  “This is your initiation.”  Initiation sounds really romantic to me—Rosicrucians, ancient mystical rites, shamans—all these brought up exotic and tantalizing images.  Multiple Sclerosis brought up an image of a doorway being slammed shut in my face.  But just the concept of MS as initiation encouraged me.  It didn’t make it go away, but it gave me a different way to think about it.
She was right.  MS taught me something I hadn’t come to terms with before.  The ancient mystical rites included a near death experience, which left the initiate with a sense, with a recognition, that the concrete reality which we accept as permanent is not at all permanent, it is as changeable as sand structures when waves wash across the beach. 

I more clearly see that now. 

Time passes, and my body will serve my goals as long as it can and no longer.  I do not believe that concrete reality lasts forever.  I do believe that this moment is precious.

That is what my initiation taught me.

It came with a truth that feels like a double edged sword—I think of it as the sword of Damocles.  It is ready to fall.  My physical ability is not what it was 11 years ago—believe it or not I was training for a marathon.  Now I realize that with training I can do other things, but that the window of strength and opportunity will close if I don’t take advantage of what I can do now.

I want to do a part of Camino Santiago.  With drop foot that makes it a dicey proposition.  Drop foot is an invitation to sprain your ankle, or twist it and fall on your knee, or something that makes this Camino chancy. 

But if I wait another 11 years it won’t be in the realm of reasonable hope.  Now is the time.  THAT is what my initiation teaches me.

There is a headiness in knowing that I can take hold of what is possible now, and that I had better do it now because time shifts abilities and strength—and I am not on the young side of those things.  MS pushed me a little faster on the far side of what is physically possible, but the result is that I go for life now in a way that I didn’t before.  I grasp opportunities, I do what it takes to experience those items on my bucket list. 

What does that have to do with initiation? 

In my mind initiates had a message for people who were still living under the illusion that concrete reality is permanent reality.  Through my initiation experience brought on by MS I have a message to share, something I have learned:
​
This moment is unbelievably precious.  The current reality will change time.  The present is what we, me, all of us, any of us, have.  MS brought that reality home to me.
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​What’s New!  Part 1 of 2

11/5/2015

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What's new?
 
How did you answer that question when the news was your diagnosis?  I would love to know that. 

My own response has gone through a few changes.  At first I hated the diagnosis so I didn’t talk about it.  Then I decided to “be strong” and face the diagnosis by telling people.  The reactions were always hard to take. 
Anybody not going through my confusion and fear were on another side of a prison wall, and it just felt awful.  I felt like I was in prison, a life sentence.  People who visited me could, at the end of the visit, get up and get on with their lives, but I was stuck—a life sentence of MS. 

That wasn’t the worst of it.  I began to internalize the feelings and reactions that people had to my disastrous news.

Whatever wind of opinion blew my way caused me to enter that energy.  I was vulnerable to other’s takes on my MS. 

That made an impact on who I wanted to spend time with.  At first I guarded my appointments with a commitment to boundaries that I never have known in my life.  I needed to spend times either with myself or with people around whom MS wasn’t the end of life worth living.

I don’t know the answer for any of us, on any side of illness or health.  We all are on our own journeys, and the events that affect a friend or family member become events in our own lives.  We may react with anxiety, with relief, with denial, with all the things that the person carrying a diagnosis experiences.  Speaking from the ‘inside’ of MS, our own confusion doesn’t always give us the resilience to receive well-meaning expressions of sadness, discouragement, even of hope.  We may not flow as easily with the thoughts and energy of people around us, and to make it even more complicated, our bodies are not as reliable as before—at times we experience pains, limitations, exhaustion. 

Speaking as an MSer, I can say that sometimes we, the significant people in others’ lives, may choose, out of necessity, to draw boundaries around interactions.  If we can, we explain the reason why we need to give ourselves space to adjust.  If we can, we do that, because it helps give our loved people a sense of patience, of trust that the friendship is still there, but on a different road, one that is a little more inward, and trust, on all of our parts, is the best thing we can offer.  If we can’t put words to this need, we can only hope that somehow that message gets across.  

​But the answer changes.  More on that next week.  
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    Author--
    ​Rosalie Richards

    MS keeps coming in stages.  The first 'maybe' diagnosis was in 2004, the next 'for sure' one came in 2011.

    I thought that was the end of the story, but life with MS keeps unfolding.  

    I'd enjoy reading your posts.

    If you like this blog, check out my books--
    Beyond MS  Your Best Life and 
    Beyond MS--Get Moving!

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