Sunday Stroke Survival: Caring for a Spastic Hand

Now,  I'll admit that my spasticity is severe. Most stroke survivors do not have spasticity as bad as mine. But for those who do, this post is may help you.

Even with my severe spasticity, the therapist , with electro-dry needling and working her hinny off, can stretch my fingers out to almost full extension (straight) and my wrist to almost neutral position (straight). The electro-dry needling is my word for it. I imagine there is a technical word for it. I just can't remember the term right now. A battery operated device causes the muscles to contract and relax through a sequence electrical shocks. The electrodes are attached to the various acupuncture needles inserted into my muscles. It basically saves the therapist time, and wear and tear on herself. It can tire the muscles in ten minutes versus an hour of manipulation by hand.

At times, the spasticity in my hand is so bad my nails will bite into my palm enough to draw blood. As I said my spasticity is severe and most severe spastic sessions can last hours (think spasticity on overdrive). Yes, it's very painful. I've described it here and other places as a cramp on top of a Charlie horse.

Grossness Alert, but it's honest

The normal shedding of skin cells pile up in the palm, creases in the wrist, the crease in the elbow, and between the fingers. As you can imagine this with normal sweating...the smell of this dead skin is awful. The old saying of it will gag a maggot fits perfectly to this. While many therapist will say that ice reduces spasticity, but remember I'm the Queen of Abby Normal. It takes moist heat and a lot of it. I've got a 40-gallon water heater and when I bathe, it takes every drop of it to reduce the spasticity enough to relax the muscles enough for me to marginally wash these places. Most times, it's by brute force shoving the washcloth in there. At times, I've even resorted  to a Scotch-Brite green scrubber part that the sponge has worn off to exfoliate my hand. Yes, I'm sold on Scotch-Brite as I said in an earlier post. A simple washcloth just doesn't do the job. The worn out green part is thin enough that it will fit wear a loofah will not. Even with all of that, there's still dead skin left in the nooks and crannies. I know because I can feel the slimy mess when I dry off. My spastic, inverted foot isn't as bad because the skin is exposed for the most part.

All this slimy goo building up on my arm, besides the smell, can cause skin break down if not removed. Most days, I can manipulate my fingers by myself, but with my wrist in a fixed 90 degree flexed state makes it impossible to cut my nails as I once did. So what do I do? I pick at them. Yes, they aren't pretty, but most of the time they are curled into my palm anyhow. My nails, from constantly being in a warm, moist environment, are now thin and soft. For this, I'm thankful. Madge, from Palmolive dish detergent fame, be hanged. Notice she only puts the finger nails into the Palmolive to soften them before a manicure. Yes, I know. I'm aging myself referencing a 1960-70s ad. By hey, I'm an older person. Get over it. It's hard to imagine that with all that goo constantly in my hand I still have dry skin to boot, but I do.

Now my hand isn't always spastic in a fist closed fashion. Since the fingers will move, sometimes I become spastic in a witch's craw. Every joint hyper extends in the opposite of normal. Yes, I had the ability to do this before my strokes at will. Every couple of months, the hand will relax as pictured like this morning. Although the spasticity will persist in the wrist, the fingers are pliable and I can voluntarily move them a little. Oh happy hours~ because at the most that's how long it will last. It's a mini spa day at the Murphey Saga house. I'll break out my soft loofah and being careful not to touch the center of my palm, I'll scrub everywhere else. Touching the center of the palm reflex will cause the hand to close into a fist. I am also careful not too extend my wrist too much because this will cause the spasticity to return. It will be awkward trying to get at places but it sure beats a closed fist. I'll immerse the hand in warm water to rinse the dead skin and sweat away. Oh heaven! The hand is actually clean!

Reflexology-hand

Next, after drying the hand, I'll apply lotion. I'll put a big dab on the back of my affected hand and up my arm so I can go to it easier than trying to squeeze it out of the bottle every time I need some more. I know time is limited before the spasticity curls the hand shut again. As I apply the lotion, I'm using a massaging action. At the base of the fingers where they connects to the hand, the tendons are usually tight like piano wires. I'll massage these first and make my way up each finger with a kneading motion, it's a reflexology massage stretching them out one by one. I hit all the trigger points pictured. I save the center palm and the crease of the wrist for last. I know the reflexes and spasticity will return with the manipulation of these areas so I work quickly until I can no longer access the area. But, it's heavenly while it lasts.

I have mentioned several fields of study in this blog. I'm an expert of none of them. I do watch, read, question, and learn what works and what doesn't as it pertains to me. I've been in occupational and physical therapies for over half my life with this or that ailment, or it seems like it. I've never stopped and added up all the hours. There's also a limit to what I can do for myself with one functioning hand. I'll do what I can and ask others for help if needed. The other more questionable practices like acupuncture, massage therapy and reflexology have is garnered knowledge from licensed, holistic healing persons over the years. I say whatever works, do it. It really can't hurt. Even my PT follows my suggestions because it alleviates my pain and helps with my range of motion while she works. Now that's team work.

Nothing is impossible.

Thursday's Tumbles and Stumbles~ The Ongoing Saga...

The past couple weeks has been mild in comparison here at the Murphey Saga household. I kept waiting for the terrifying drop of the roller coaster that I knew was around the next bend. It didn't stop me from enjoy some semblance of normalcy by saga standards...barring my hubby dearest's bout with pneumonia and a slight return of his congestive heart failure. Yes, even these occurrences have been deemed slightly frantic after a year of dealing with with them.

Well the dip started Sunday with a choking episode on his part. It's a regular happening with me, due to my aphasia after my stroke, so it's hardly worth mentioning. That episode was followed by eight more over the rest of the day into the next. This was a sign of trouble and needed to be addressed.

Almost every meal became a quick dash of me to the assisted rescue. He has been on a finely chopped meat diet or soft diet for a several months. We have now entered the realm of semi-pureed foods. Nothing overly spicy or seasoned and ground to toddler food consistency.

Now we are not talking about a huge amounts of food in any one meal. I'm still measuring quantities in an eighth of a cup servings for him. Try as he might, he can't eat more than that at one sitting so we have gone to six meals a day trying to maintain as close to 3,000 to 6,000 calories a day. That's including chocolate. I am now making cake pops for him the other way, crumbled cake and frosting mixed together because he has to have a source of liquid to swallow it.

His weight loss has stopped for the time being. He now weighs 90 lbs. His hospice nurse and I feel that he has lost all the weight he can. Any more will be the loss of organ tissue weight. He gains and loses the same half a pound dependent of bowel movements and when the weight was taken, but his Spirit is good.

Now for me, I had a rough time in therapy this week. Ever since last week the muscles in my right (affected) arm has been on the verge of cramping. You know that feeling where you feel like if you move it, you'll get a Charlie Horse. Although when I moved it the arm never locked down into a cramp, but the feeling was there.


I knew my stretching by the therapist would either rectify the problem or cause it to totally cramp up. My next series of Botox isn't until mid March so it probably wasn't the Botox wearing off yet. Yes, it kicked back in after my kidney infection resolved.

I usually scheduled my massage therapy on one day  and my OT on the next to optimize both. As luck would have it, I broke a strap on my AFO over the weekend. My ankle was twisting inside my AFO just like it did in my old one. Monday and Tuesday, my local Hanger Clinic was closed. Wednesday I couldn't be seen until the afternoon. A pressure sore developed. ARGH! It wasn't to the point of rupture, but still very tender and swollen.

I hobbled into the office and while they were fixing my brace, the receptionist informed me that my new shoes were ready. Hot Dog! a twofer. I was beginning to feel the luck of the Irish was smiling at me. I waited to be squeezed in between other patients. The clock slowly ticked off an hour before she ushered me into an office. The shoes fit perfectly! God Bless Keith, my ortho guy. He's now retired and will be sorely missed.

I missed my massage therapy appointment, but rescheduled for after my OT session. It's kind of neat that my massage therapist and my OT talk to each other (with my permission) about my treatments. Now, keep in mind they are two separate practices. My OT will tell my massage therapist to work on certain trigger points after our session and vice versa. That's what I call, continuity in care and therapist going the extra mile for my sake.

The next day, I was really sore after two treatments in one day. In fact I was in PAIN!

While the arm moved fairly freely, the pain had me not moving it. After a shower (yes I finally got one), I looked in the mirror at my right side. I didn't really expect to see anything even though I had two bruises the size of a half dollar at my wrist. But there they were...bruises on other painful points. One about midway on my clavicle, another under my arm on the chest, and another at the cap of my shoulder. Now, I'm not sure who is to blame for this or if it's both of the therapists. I do know that it was not done intentionally, but never the less, I spent four miserable days until it eased up. It was days of reaching for my pain medicine, but deciding to grin and bear it.

So that was my week. How was yours?