Sunday, April 26, 2015


When I began rehab, my case manager decided to set me a goal of losing 5 pounds. I cut out chocolate and practiced putting down my fork between bites, and soon I had lost a few pounds and then 8.

I set myself the goal of riding my bike to my 4-month follow-up with the cardiologist. I did that yesterday. I was afraid I might run into my case manager, who had been quite adamant about enforcing the podiatrist's order to stay off the left foot. When I saw Joan in the parking lot, she didn't make any fuss at all. Just said 'Hi.'

The cardiologist has nice eyes and a good bedside manner. I had told him ahead of time that I was interested in reducing my meds as much as possible. I argued that my cholesterol and blood pressure had been OK within the guidelines before the event, so there must be something else, such as genetics, that accounts for my heart attack. Well, actually, once you have had a heart attack, you are in a different statistical group, and the odds change. Besides, the medications have specific effects on the stents and on the likelihood of plaque attaching to them or to the vessel walls; so he want me to be on the highest dose I can tolerate, not the lowest.


Today I got the official pronouncement that the wound on my foot had healed. I can walk using a special insert and I can bike cautiously.

Here are my questions.

- Is there a structural anomaly in my foot that could only be fixed by surgery? No.
- Do I need special-made orthotics? Let's try the home-made solution first.
- Can I make my own inserts like the ones the podiatrist made for the boot? Yes.
  Check my feet after an hour of biking to be sure the wound has not recurred.
- Should I use a pumice stone to clear away dead skin? Sure. Be careful.
- Do I need the crutches or the boot? No. I returned the crutches to Ann Naumann at Physical Therapy. She had replied to my post on GMBC-L in about 5 minutes with the offer of her crutches.

No barefoot walking.

Modify the Spenco insoles with a relief hole located by inking around the wound and stepping on the insole directly in the proposed shoe so it is properly located. That worked well. But when I hauled out some old New Balance 998s that had been in the closet, the outer sole separated from the body in a way that left granulated foam so that it was impossible to glue the sole back on. I looked on the New Balance site and found a lifetime replacement policy. I emailed this photo. We shall see.

Linda and I took our traditional walk around the neighborhood for the first time since the heart attack in December. That felt good.

Since then I have taken a couple of bike rides. One effect of the meds is that my hands stay cold after an half-hour riding, even if the air temp is in the 50s. But it feels right to be on the bike in time for Bike Month in May.

Thursday, April 9, 2015

Following Advice

I just saw again a funny video about advice. The woman has a nail in her forehead and the guy gently suggests that she take it out, but she just wants him to listen to her and not make suggestions.

Many of you have given me advice. Some of it is good. The podiatrist gave me very strong advice -- to stay off that foot. I should take it, but you know how it is. It is hard not to try to rush back to normal.

Muffet's advice: Write about it. Just start writing and see where the thoughts flow. They may wind up in a very different place from where you started. So, here goes.

Muffet's advice 2: Imagine a very visual block to your perfect happiness. It should be an image -- maybe a creature, or a black blot. Ask it to please move out of the way. I have tried this kind of mental imaging and it is helpful. The cognitive-behavioral approach is one of the only effective psychological interventions for getting through emotional problems. The VA uses such techniques in stress management of PTSD, and we can use them too.

After going through the mental exercize of picturing each part of your body from feet to top of head and relaxing each -- while conscious of your breath -- until you are quite relaxed. Imagine then that you are on a beach and you came there on a beautiful path through a woods and underbrush. Imagine looking up and down the beach and feeling the warm sun on your heart. "You can come here to your own private beach whenever you choose."

This is a brief description of the exercize we went through in Stress Management #5.

Podiatrist's Advice:

"Stay Off It." That's good advice, of course, but as I am finding through Stress Management, I have a lot of Type A behaviors. We aren't calling it 'Type A Personality' anymore, because that implies some rigid, fixed trait of character. Behavior is amenable to psychological intervention, such as relaxation and Mindfulness practice. In any case, my last visit to the podiatrist showed that the wound has almost healed. We can imagine an orthotic for bike riding which has a cut-out below the wound which will protect the newly-repaired skin and make sure that leg pressure goes to the ball of the foot, right over the pedal axis.

My challange is to deal with "time urgency." I need to be on time. This morning I made sure to get to Panera's to meet Duncan Admanson near 7:00. But I neglected to check the email correspondence which would have shown that we postponed the get-together until next Tuesday because I had an ophthalmologist appointment today. Executive function malfunction. Still, I was on time. "Time Urgent" is a description of another Type A behavior.

As is Shpilkes.

By the end of the Mindfulness session, I had modified my behavior so now I was sitting calmly and relaxing rather than stretching and bouncing around. Maybe I can follow advice once I see that it is addressing a pattern. I always thought I was pretty laid-back, but I do approach stuff in a compulsive sort of way.

Jonna's Advice: Exercizes from the back -- Air Bike and Ab Crunch. (Of course I will complain at the phrase "Lay back...") You really do get a workout with these.

Now I am in the long slog part of recovery and have been for a while; so much so that I haven't felt like writing about it, despite Muffet's advice. But this morning I had a cup of dark coffee, so I feel a bit energized, and here you have the followed advice.