"You put your right foot in , your put your right foot out.."

       "Legs come with a high price...  The motors controlling a leg have to alternate between keeping the foot on the ground while it bears and propels the load and taking the load off to make the leg free to move..All the while they have to keep the center of gravity of the body within the polygon defined by the feet so the body doesn't topple over"

from HOW THE MIND WORKS by steven Pinker

      I love this quote. Its a miracle that we walk without toppling over.
     "I was just getting out of the shower when the next thing I knew I was on the floor." is what I hear from so many people I visit in the homes. I often see the words "FALL RISK" on many patient  history reports.   What is most humiliating is when it is tactlessly posted on the  wall of an inpatients room in an effort to communicate to all other medical personnel that this patient is not safe to walk alone. When I was very new in Physical Therapy,  I  thought the sign meant that  I  risk falling by entering into the room..like maybe the floor was slippery or something...
         One of the hardest things to tell a patient is that they have to continue to use a cane or walker eventhough they think they are ready to go solo. Didn't  we all love to utter: "Look Ma no hands"  when we were children and realized we could walk without holding onto anything!!!   Its still a mighty thrill when one can leave crutch, walker, cane in the dust and take long solid strides by oneself.
Maybe that is what the hokey pokey was all about... you know that dance that we learned in kindergarten.  We celebrated each part of our bodies.. Remember?
"You put your right foot in
You put your right foot out
You  put your right foot in and then you shake it all about
You  do the HOKEY POKEY and you turn yourself about
Thats what its all about!

The leader or teacher would then call out various other body parts like: finger, toe, nose, chin elbow.. of course we all loved the bottom the best... especially the shaking it all about...

Trust me... Its almost alway best to put one foot in front of the other,.look ahead to where you are going and  as Nat King Cole said: "  Straighten up and Fly right"

    
    
              
  

HE JUST KEEPS ROLLING ALONG....

  Ah gits weary am sick of trying
am tired of livin'
am skeered of dyin"

I was told by the nursing supervisor that the 89 year old man was even too scared to sit up at the edge of his hospital bed.  It had been 4 months since  he had taken his third fall in a year and was recovering from a broken hip.   The first time I ever peeked in on him, he was all one big head,  his body  skinny and shapeless underneath the heap of blankets.  Classical music was coming from his bedside radio.  
        "You cannot make me walk today,"  he said, "Absolutely not,  I know I am not ready...My body is not strong."
  As I approached the bed to greet him and introduce myself, he kept his gaze straight ahead.     "I had one of you guys try to help me walk recently and the guy looked away for one second and I slipped and fell on the floor now I am worse than ever....that was in another one of these homes.  No way am I getting up.  "
      After he realized, I was not mentioning walking, he somehow got into lecturing about music,his family, his newfound 90 year old companion that he had met in the retirement home and how they  had both  discovered they could play piano duets.. on two pianos.. He could not wait to get back to that.  They might even get married.
       As he talked, I prompted him to move his ankles, lift his legs straight out and show me that he coud roll from side to side. 
      He told me all his kids were musical and that they would be coming to visit him tomorrow.  He loved when his oldest daughter sang to him.... show tunes mostly but she could sing opera too.  Then he began to sing:  "Old man River,   Old Man River...
     When I came back the next time, he was in his wheelchair.  Two of the nursing aides had told me that it was really hard but they had transferred him into the chair by heaving him up under his shoulders and muscling him into the chair.  He wanted to be out of bed when his children arrived.
      "I'll wheel you down into the exercise room ," I said matter of factly and began steering the chair forward while his long legs dangled way over the leg rests since there never is the proper size equipment for the proper sized human.. but hey!!! he was UP! I was determined to try to walk him but had no idea how it would go.
       His kids arrived with the over -the-top exclamations of astonishment each one trying to outdo the other: "Oh dad, you look fantastic,"  or "Dad... you'll be out of here in  no time."   or the one heard in nursing homes across America:  "Wanna race?"
     He greeted them with the tune he had been humming;  "Old man River,  he just keeps rolling, keeps on rolling along...
       Within a few seconds his kids chimed in along with  him and started singing the song in  large voice sending this man into complete excitement and I could see something was about to happen so I grabbed my gait belt and cinched it around his waist and said: "Go ahead stand up..please"   and then with the Showboat chorus trailing behind and me holding onto the belt.HE..RISES UP and takes one step for each line as they sing:
                                      
You an'me, we sweat an' strain,
Body all achin' an' racket wid pain,
Tote dat barge!
Lif' dat bale!

Old man river he just kept on rolling and just kept rolling along till the very last line of the song.   
                            
      

WHEN YOU GOTTA GO... YOU GOTTA GO

      
    I would say that aside from the freedom of no longer being able to drive, the freedom to no longer be able to walk to the bathroom and "go"  in the privacy and comfort of your own throne just stinks. (no pun intended) The subject of toilets is under the heading: BATHROOM SAFETY in the catalogue I use when patients need to order equipment for home.

   Little did I know how dangerous toilet talk can be.There is The Big John toilet seat, the Uplift commode assist, the three in one (can be used as a shower chair or bedside commode) the best value: the economy elevated toilet seat,  and my alltime favorite:  The TOILEVATOR described as "an aesthetically pleasing alternative to raised seats adds height at the base of the toilet..3 1/2 inches to the heights of standard 14".  

       Between the strengthening and stretching and ambulation, there is almost always the talk about ones intestinal tract and all that goes with  it: which toilet the pts insurance will pay for,  when is it time for the adult diaper pad, how many times is one up during the night, what is the best laxative,  how come one pt can leave the house all day and not have to go only to return to her front door and not be able to "make it without an accident"  and then  there is the real danger  of getting stuck. Yes.. getting stuck.
     I was working at a hospital in a small agricultural town in California on the orthopoedic floor helping an obese man get up out of bed to his bedside commode.  As soon as the man stood up, I could see the magnitude of his posterior reached way beyond the size of the porta-potty.  I ran flying out of the room with my assistant standing gaurd by patient while asked anyone and everyone if they knew where I might find an extra extra large bedside commode.   I shortlly flew in with the larger equipment in tow and helped the pt accomplish his first order of business.  What comes down, must come up right?  Well..yes and everything that comes with it!!!.. because right before my very eyes stuck to this mans bottom was this bedside commode and he was just about to start walking when I yelled out:  "Don't move, we have got to get the toilet off your butt!.  Keep breathing,  bend over, breathe.. , "  I was yelling out orders as my helper and I huffed and puffed and yanked this  hard plastic surface away from this mans behind till thankfully we heard a slight popping noise which almost set us flying across the other end of the room.   When I gained some sort of sense of what had just happened,  the patient had moved so quickly to get himself back into bed, you would never have known he had just come from getting a total knee replacement and I was just glad that this bathroom trip did indeed end safely.