Sunday Stroke Survival: Decision Making Process Post Stroke

 Some cognitive decline is expected after a stroke. While I had little difficulty with prioritizing tasks that need to be done. When faced with tasks that need to be done while my foot and AFO impairs me is a different story. It just takes one more thing to upset the apple cart, now I have two- healing broken bones and increased spasticity. 

I know before getting up I have to put my AFO on first or I'll fall with the first step I take with my affected leg. The spasticity has gotten really bad since I was unable to get my scheduled round of Botox injections in June. My foot arches downward and inward. You'd think I'd be able to walk on my tip toes, wouldn't you? But no, the inward rotation increases with weight bearing so it would be foolhardy to do so because the foot would roll farther inward. Not to mention when it does a hard spasm on top of the spasticity the shoe and brace have to come off or more bones will break. There's no denying the spasms nor controlling them. Unfortunately, it will get worse before I can get into the neurologist for my injections. 

After I prepare dinner each night, I usually get a hard spasm in my foot and ankle. Most of the times, my daughter (unless she's working late) will come in and put the finishing touches and serve the plate while I'll painfully hobble to my chair, take off my shoe, and AFO, massage and prop my foot up. It's that last half an hour of standing and moving that gets me. It's now to the point of almost an hour before I can don my brace and walk again albeit with a manageable amount of pain, instead of two hours of spasms like it will be. I can at least get to the bathroom and back again. This is how I'm managing my day now. Fifteen to twenty-five minutes of activity to an hour rest, but I am doing. I can no longer wear my new AFO with the spasticity so high. I'm stuck in my old AFO that allows for the swelling and the spasticity, and the straps need to be replaced. Come on PCP so I can get an appointment with a brace maker!

Wednesday night, I was just finishing up dinner when a spasm hit as usual. Nothing spectacular, just my butter fried chicken (my mother's recipe), boiled potatoes with herbed butter and corn on the cob. I called for my daughter to help. She drained the potatoes and tossed them in the herbed butter. She prepared the plates and brought me one at my dining room dinette before taking two plates to her husband and her into the main dining room of the house. I do so miss eating at the big table  with family. It'll be better when my granddaughter comes home from the west coast next month. She's my cook's helper. She's becoming quite a cook.

About an hour later, the rain started. The skylight in the kitchen started dripping. I hadn't put the pitcher down before because it wasn't raining. I shrugged off the sweater I'd donned. I'm just not used to air conditioning anymore. My daughter keeps the thermostat at 68℉ which is a little chilly to me since my blood pressure and pulse rate took a nose dive after my Baclofen removal surgery in 2019. That's even with the meds to raise both. *I digressed, sorry* I donned my AFO and headed to the kitchen. The pain was manageable as I hobbled across the distance. I grabbed a couple of paper towels to wipe up the water and placed the pitcher on the floor to catch additional drips. Come on two days in a row without rain so my son-in-law can recaulk the skylight and have it cure!

Of course with the dripping sound of water, the urge to pee hit me. There was no way I'd make the thirty odd steps to the bathroom. I'd just have to gush into my pad. Then, I noticed that my daughter had not put the extra fried chicken away. A quick reach under the sink to get a container so I could make chicken salad for the kids' trip out of town. I had bought croissants for the sandwiches. Just the thought of buying them still irks me, but some things just have the wait until I'm back up on my feet again. The gush had bought me some time. Another gush on the way and I was sitting on the commode.

Relieved, I hobbled back into the kitchen to run a sink of washing water in the sink. I was putting the last dirty pot in the sink when a twinge just above the ankle told me it was time to take a load off so I grabbed what little bit of trash there was to throw it in the trash can as I went. I hobbled back to my chair. The dishes would wait until the morning. I'd noticed that my bathroom trashcan was full but I'd save that chore the next time I'm up and so it goes. It's a good thing I can see a sequence of events when needed/

Prioritizing tasks has been my blessing living post stroke. It doesn't always go as smoothly as this, I wish it did. There are still times, after nine years of living post stroke, I forget to don my AFO first before getting up. All it takes is standing up to realize my mistake. Luckily, I haven't fallen in my hast of having to pee. Or, have to back track to get things done. It is what it is.

In other matters, I started a new blog. It's focus is on senior living self reliance and how tos from a disabled view point. I'll eventually start a YouTube channel along the same lines. Just because you are older, single, disabled, and living the senior living community life style doesn't mean you can't help yourself along the way. You ain't dead yet! You can find it here.

Nothing is impossible. 

The Spasticity Won

 I spoke too soon last week when touting the laurels on my newest AFO. It worked as advertised. Finally! It needed some tweaking, but that wasn't unexpected. A nonslip pad needs to be placed on the heel, the bottom strap (across my toes) to hook tape half of the closure was too long, the and something about the top strap was causing shin pain. The shin pain is alleviated by loosening the strap just a hair. The nonslip pad on the heel enables me to walk to the bathroom without having to wear a shoe without slipping. For me, this is very important to keep me from peeing the bed. I flood the pad otherwise. Just putting on the AFO is pushing the limit. Nothing seriously wrong with this AFO. No undue pressure anywhere, my foot was almost straight, and I could walk without constantly watching my foot placement. In other words, it worked like it was supposed to unlike the other four AFOs they tried to fit me with.

The AFO worked so well that my PT mentioned starting balance training after I come back to therapy after the new series of Botox kicks in about the second week in March. To save rehab hours, we suspend treatments and stretches until then. The pain in between is only about a 5 or 6 so it's manageable. Unlike before when I hit 8 or 9 between sessions.

That lasted for almost a week. I felt confident enough to fill a 55-gallon trash can with kindling. Not only that, but I dragged the filled container up the ramp and into the back porch. Between my AFO woes and my T-CAR procedure, it had been over a month since I felt like I could do that. I got up one morning at 4 AM and had to pee very bad. I donned my AFO over my socks and headed to the bathroom ten steps away. I just barely made it. It took a minimal clean up. I noticed my AFO strap was kind of wonky. It still held me up, but it wasn't right. While seated on the toilet, I tried to correct it when I noticed the problem. The fuzzy side that was supposed to be fastened onto the plastic side of the AFO was still attached to the strap. I half-assed affixed it back into position and hobbled back to the bedroom where my old (#3) AFO was. I sat on my desk chair and tried to no avail attempt to fix my new AFO. 

I ended up telling and giving it to Mel to try with some Gorilla glue later. After she got the old adhesive off the piece of Velcro and the AFO, she was ready to try and fix it. EXCEPT her cat found that small piece of Velcro was something neat to play with while Mel scrubbed the adhesive off the AFO! When Mel returned to the table, it was gone! Her cat had gone outside. So much for a quick fix.

My Hanger rep had the foresight of scheduling a follow up appointment so I'll have to wait another two weeks before I can get it fixed. HARUMPH! I'm not a happy camper, but at least I won't have to wait a month and all my issues will be taken care of. I actually got to wear the same shoes for almost a week and I'll get it fixed in time to do my physical therapy again.  And, in this instance the spasticity won.

Nothing is impossible.

Sunday Stroke Survival: Action/Reaction

With the virus still active in places and being in the high risk category, I've put off the idea of having the baclofen replaced. It's still simmering on a back burner. It would have been off the stove entirely if it hadn't worked so well.  I've got to do something about the pain the spasticity is causing.

Sitting around and waiting has never been an option for me when there's another action I can take. I've decided to take another round of Botox. It's scheduled for September 11th. It's been three years since I've voluntarily injected the poison into my body. While I'm looking forward to it/not looking forward to it, it is some relief to the immobility and pain. At this point 45 days out of 90 is better than nothing because three muscle relaxers aren't touching it.

In talking to the nurse yesterday, I'll be back to the 300 units for injections into my muscles. Since there has been a break in the cycle of injections, we discussed whether my body would reset back to square one was possible. It is entirely possible that the lower unit dose will hold for the entire 90 days between injection cycles for pain control and improved mobility with PT like it did 7 years ago. Here's hoping.

Others have told me that they don't understand my pain with my spasticity. They have spastic muscles also, but it does not cause them pain while mine seems off the charts. While the contracted muscles causes a tightening sensation, it's not what technically causes my pain levels to shoot me into space. So, I have been evaluating where exactly the pain is and what causes the pain to increase so much. I have discovered there are several sources.

Although I consciously try to minimize the actions that intensifies the pain that only accounts for less than 50%.

1. Movement of the affected arm or leg while episodes of increased tightness is present. While the tightness or high tone is always present, sometimes are worse than others.
2. Cramping of already tight muscles. Not just rhythmic waves of cramping (tolerable) but the sharp, "Charlie horse" cramping that accompanies a movement the spastic muscle does not like (weight bearing, leg in full extension, or moving it an inch this way or that) . Once started, the Charlie horse cramp takes on a life of its own. It demands the arm or leg be held in a certain spot or the cramp increases in intensity. This cycle can last two hours, takes a break, and then starts up again.
3. Incident muscles and joints trapped between two spastic muscle groups. My trapezius, shoulder, and neck instantly come to mind. I recovered my shoulder muscles range of motion early after my first stroke. In spite of injuries, I still have that range of motion.  But its range of motion is limited by spastic bicep and pectoral muscles. So it wants and needs to move but can't. 
4. Psuedo involuntary movements of spastic muscles like with coughs and sneezes cause additional contractions of these muscles and cause pain. Even the simple acts of of blowing your nose or clearing your throat takes the contraction affecting these muscles.

Then there's my list of 'try not to do. that cause pain. Things like hitting a chair with my affected arm's funny bone, which is decidedly unfunny, causes a rippling effect into spastic muscles. The dead weight of carrying a spastic limb also causes its own level of pain. I try, when seated at the table, to keep my elbow supported on the table. The brunt of the weight of my arm is no longer carried by my shoulder. But with movement, like taking a drink, my arm will slip from it's perch causing a jarring pain in my shoulder and bicep. While walking when the spasticity isn't too bad, I can hook my thumb into the waistband of my pants to relax or help support the weight of my arm. All bets are off when the spasticity is very bad and my arm is drawn up into my chest. All six or seven lbs of dead weight rely on my shoulder to carry it. Don't think that's not too bad? Try carrying a half a gallon of milk around all the time and you'll see what I mean.

So it's back to Botox for me again. One step forward and two back. Sigh! It's like my mama used to say, "There will always be an again."

Nothing is impossible.

Sunday Stroke Survival: My AFO AGAIN!!!!

Okay, I got my new AFO. I did the swap out of time 1 hour a day, 3 hours a day, and 6 hours a day so my leg and foot become used to the new alignment. After that, it's twelve hours of wear, but I never made it that far. Somewhere around the 8 hour mark I noticed how swollen my foot was. Taking my shoe and sock of I noticed how ugly and red my ankle was. You guessed it, another pressure sore formed just under my ankle bone.

I took the AFO and threw it across the room. This was a huge mistake because I had neither of my old AFOs within reach. I had to call Mel to retrieve one out of my closet before I could tend to the wound. Yes, in just 8 hours the sore had formed and actually partially ruptured. Needless to say, Mel threw the chuck steaks and Vidalia onions on the grill, and made the salad to go along with it. I was down for the count.

I called Hanger the next morning for an appointment on May 5th. As usual, it's mid June! So I'm back to switching AFOs again between the three I have. The oldest one causes stress fractures, a pressure sore on the bottom right side of my foot. The new/old one causes a pressure sore at the base of big toe and puts way too much pressure on the bone spur at the pinky toe. Both of these older braces do not hold my foot straight anymore. My foot rotates inward about 78 degrees inside the AFO which makes walking precarious. Now this newest one puts a pressure sore at my ankle. I've spent the past month juggling three AFOs

I had half jokingly said to my old orthotic specialist, it would be easier to amputate the foot and fit an artificial foot than it is to get a good fitting AFO. During the COVID-19 break in service, my regular specialist was transferred to another branch. So I had to break in a new one. I asked if I didn't like this new one could I get another one and was told yes. My old specialist and I butted heads once too often towards the end over which was more important (her) proper alignment and (me) comfort (no pain nor pressure sores) and the ability to do. So the prospect of a new specialist didn't break my heart one bit. An AFO, no matter if it gave me a proper alignment or not, didn't work if I spent more time off my feet and facing yet another pressure sore. The first thing I asked the new specialist was what was more important. She agreed with me. Okay, that's a step in the right direction.

The fact is I'm combating worsening spasticity. While not technically a diabetic anymore, I'm still dealing with diabetic neuropathy and poor circulation in both feet. I'm actually doing battle (or Hanger and my PCP is for me) with Medicare and my BCBS because I need to be fitted with a NEW AFO in less than a year. This makes my sixth in 8 years.  Am I wrong to feel like this is getting ridiculous??!!

The good news is that Medicare will pay for a new pair of shoes to go with my new AFO. The new specialist versus the billing person found the loophole that was used every other time I'd ordered shoes that they used. Repeated calluses and pressure sores qualifies me under both Medicare and my BCBS. Darn billing person cost me $120 out of pocket buying my own shoes last month. I should charge her. Did I mention they had a new billing person too? GRRR! But then again, I'll have two pairs of shoes if the rockers stay the same.

Whooosa! If you haven't seen Bad Boys 2 this will be lost on you. Suffice to say, breathe, this too shall pass. I don't know when I'll be casted for the new AFO. So until then, I'll be juggling between my three AFOs while I continue to plant and harvest my garden, tend the critters, go through treatments, and just carry on with life.

Nothing is impossible.

Sunday Stroke Survival: More After Effects of Baclofen Pump

Sigh! You'd think I'd catch a break every now and then from Murphy's Law. This post isn't one. I told you that the spasticity was back after my pump was removed in July. My arm slowly drew up into it's greater than 45 degree angle to my chest again. The spasticity pain levels, which for me, is constant with peak activity bordering on excruciating. The constant pain with it stationary is now a 5 out of 10 with spikes up to 7. Still it is still livable. I mean, I was much higher before the pump placement. I'm still managing to work around it with an occasional verbal ouch or grimace. So far, I haven't streamed tears in silent agony. But it's still early yet. Believe me I'm not looking forward to the progression. Hopefully, I can have a new one implanted before I hit that again before the end of the year. I'm crossing my fingers and toes.

Right foot spasticity

I haven't spoke about the spasticity in my foot and ankle, I don't think. But the spasticity has returned in that area too. It's a strange type of spasticity when I compare it to my arm. It has to have a trigger most times, like a weight bearing step before it really kicks in. While building up my stamina with walking, I noticed that the area where I used to get pressure sores was getting tender. But with a good night's rest, the foot would be good as new. My right foot without my AFO is as pictured except my big toe points towards the sky and all the other toes curl under.

Well, the spasticity in the foot ankle are putting up a serious fight with my AFO. I can't stand or walk more than an hour before my foot becomes rounded with swelling. This could also be because of the heart functions. But with the swelling, more pressure was exerted on the right side of my foot resulting in yet another pressure sore developing in the same old spot. So this week I've been dealing with it. It hasn't ruptured the skin yet and blown off the callus. For the last four days, it's just sore, gushy under the callus, and an angry red color. Not even eight hours being off my feet, sleeping with my leg elevated hasn't helped. I can barely walk more than ten steps without pain. Once those ten steps are reached and the pain starts and after that EVERY STEP is painful. Talk about putting a crimp in my style.

Usually, this lasts two days before the area becomes an ulcerated sore. Not that this isn't painful, it is but there's an ointment that helps the healing and deadens the pain somewhat. Still there is a treatment for healing the sore. In the current stage, it's basically stay off it. That's nearly impossible. I do have to go to the bathroom, get a drink every now and then, and eat. To do these things I have to walk. Sure Mel could and would help with some of these things. She has helped when I've asked her. She even remembered something I had forgotten (sort of). We started nightly warm foot soaks with Witch Hazel and Apple Cider Vinegar. Both have astringent/antifungal/antiseptic properties to combat the swelling, soften the callus, and disinfect the area. It can't hurt. Besides the warm tingling sensation feels good.

I have an appointment with my PCP tomorrow, if it hasn't ruptured or resolved by then, I'll have him lance and drain it. He may or may not do it. If he does, the ointment I have will work and it can begin the healing process. It usually takes less than a week for the pain to go away even though it's so much longer for it to heal totally. My options to prevent this from happening again are options that may not be possible for several months. A new AFO- this will be my 4th in 7 years.Foot Reconstruction surgery- ugh! more surgery that might have to wait or carry over until next year, Botox injections- done that, didn't work well, Baclofen pump- waiting to heal from last surgery, radioactivity, and whole body scan to see if it spread...cancer trumps all. I still have a rotor rooter procedure on my carotids.

It seems the more I get done the more things pile up behind it. But then again...

Nothing is impossible.

Sunday Stroke Survival: Baclofen Pump Update and More

Well, it's been three weeks since the baclofen pump was placed, but only two weeks since the pump was filled with the baclofen. The results on a whole was results thus far has been lackluster except for pain relief. I'm still on my oral baclofen while the 25CC of the saline works it's way out of my spinal fluid. I was forewarned about this. But I'm still chomping at the bit wanting to get on with it.

I have noticed that the rigidity in my elbow is less. I keep having to work at holding my bunny greens basket from sliding off my arm. This was the same arm that could carry 5-7 splits of firewood a couple of months ago without budging. So that's progress.

Another issue I had was with the elasticized binder placed around my midsection after surgery from bra line to mid hips. While it's not uncomfortable it does shift and bunch up as I move around. The added support is quite comforting while I'm moving if it didn't shift so much. The neurosurgeon's assistant did say I could take it off when sedentary. There is a major malfunction with this. While affixing the velcro with two hands is easy. But I only have ONE functioning hand. So I lay on my back tugging at the edges until it's halfway unbunched but I can't fasten it. Of course, I could always ask Mel to help, but the timing is always off when it's at it's worse.

Yes, I'm just in a griping mood, can't you tell?

I was told I could drive again. Considering I drove myself to three Atlanta doctor appointments not withstanding. (Grin) I wasn't on narcotics. I'd only taken 3 of the prescription of 12 morphine tablets, and had reduced my Valium intake from 4 to 1 a day, I thought I was safe enough to drive. Coughing, sneezing, and a good old belly laugh are PAINFUL. Off times they are without warning so I can't brace for it. Other than extreme fatigue from big city driving. No other ill effects. I got home and took a nap, but I did. The neurologist's assistant  gave me permission to drive. Doh! When I explained that it was planting season and we had 1/4 acre to plant, she grudgingly gave me permission to bend and lift ten pounds within reason. If I experienced pain, I was to stop and rest. You gotta love doctors that work with you.

I have to admit that I over did last Saturday and paid for it with extra pain. I did take an extra valium at bedtime to compensate for it. Ever since my drug addiction problem 30+ years ago, I'm strongly against any habit forming drugs. I have to be really bad pain before I take any form of these drugs. Drug withdrawal aside, it's just an aversion to all things habit forming.

 An exciting bit of news, I saw Dr Daly, the orthopedist. His plans for releasing the contractures to allow movement to the wrist and fingers is awesome! Of course, I'll need a higher dose of baclofen via the pump first. He was surprised at the lack of contractures in the elbow. He had high praise for my PT and their dry needling therapies. His hopes for recovery of strokes and spasticity was contagious.

After almost two years of going through the motions, I've finally hit the right combination of doctors. While I absolutely loved my previous rehab team, I'm hoping this new team will be just as fabulous.

Hope and possibilities abound once again. Stealing back increments of success from spasticity is worth it.  Recovery is worth it. Being on the forefront of new and innovated treatments for survivors living post can, with positive results, give another option to survivors world wide.

Nothing is impossible.

It Seems Like Just Yesterday...

 It seems like yesterday I was telling you about my Baclofen pump trial. Wait a minute, it was just yesterday.What a difference 24 hours can make!

In a flurry of phone calls this morning, I am now set for the surgical implant of the baclofen pump THIS Friday!!  It's it fabulous the way God works? What I thought two weeks ago was an impossibility is now going to be a reality in a few days.

I have even better news, hold onto your hats, I'm going to be part of a spasticity study between neurology, orthopedics, and the rehab team for post stroke intervention.

Dr. Au Young, God bless him, was chatting with some colleagues from orthopedics over lunch. They were telling him about a new multidisciplinary study they were undertaking regarding post stroke spasticity. They wanted to know if he'd like to come on board. He jumped at it. He told them that not only was this a close to his heart interest that he also had the most excellent candidate for them. Of course, he was talking about me. He went on to discuss my case with them. They in turn got excited about me too.

I've been open to ANY possibility to help me recover from my strokes and the damage that they caused for almost seven years now. My first call this morning, 9AM, was from Melissa, Dr. AuYoung's assistant. She wanted to know if I wanted the pump. I told her yes. The next question was I available for surgery this week. I answered in the affirmative. She said she'd she'd pass the message along  to Dr. Au Young.

Within an hour he called me back. I could hear the excitement in his voice. He told me about the other orthopedists, the study, and what they wanted to achieve. He hoped I didn't mind him talking about my case to them. It was a clear HIPPA violation, but done for our mutual benefit. I forgave him. I told him discuss me away if it would help me regain a portion of my life. He asked me a few more questions and we hung up. Both of us thoroughly excited for the hope and the possibility.

He called back within an hour telling me that he had an opening this Friday as his first surgery. Yes, it will mean, for us, rising at 0 dark 30 to make the drive into Atlanta. Mel can just drop me off and drive home. She shouldn't run into any huge traffic snarls because the major flow should be going into Atlanta not out.

I'll be in the hospital for a few days at a minimum so I'll be spending Easter there. That's okay. Christ arose on the third day to bring hope to all mankind. I'll be spending Easter with a renewed hope of another kind. This one personally  for me. It seems kind of appropriate. The fact that it'll be done prior to my birthday, makes it even better. Now begins the rush to prepare for surgery.

Nothing is impossible.

Sunday Stroke Survival: Getting Ready to Go Under the Knife

No, Not really. No scalpels involved this time. It's more like an epidural you get during childbirth. The only problem with this is that all five of my children were born via natural childbirth and no drugs. I have no idea what an epidural feels like although I've assisted in a few.

On the other hand, I've had slews of steroid injections and four back surgeries. It can't any worse than those. But still, I can't help being a little nervous even after discussions at length with the neurosurgeon last week. Even though this procedure has been done since the 1960s and my surgeon has done thousands of them, there's always the oops factor.

The fact that this trial is done with a local anesthetic is comforting to me. I'll be awake to hear what's going on. For some people, they take the attitude of wake me when it's over. That's not me. I've wanted to be awake for all my surgeries even though the surgeons wouldn't let me. Darn! I've just have this thirst and curiosity for medical knowledge. I have this uncanny ability to recall what was said and sounds while under anesthesia usually within two weeks post op. I've shocked more surgeons at my post op visits by telling them their music choice and snippets of conversions during my surgery. This time I'll be awake for the full hour. I'll even be talking to him and the tech. I like that.


From what I've read, the worst part of the whole trial is the tape (and removal) and not being able to shower. Honestly, I can handle the no shower. I regularly do birdie baths, pit stops, or sponge baths during the week and fully shower for my Saturday night (afternoon) bath. It just takes too much energy and time to shower more often unless I get truly filthy. With the advent of spring, that time is upon us again on the homestead.

I expect to be a little sore the morning after. I usually am after the shots in my back but nothing I can't live with. It's minor if it relieves the constant pain and spasticity I'm dealing with now. I'll spend the week playing with the programs for pain relief and stimulation settings. Then about a week later, I'll give my results to the doctor. Whether a permanent, implantable device decision is up in the air until then.

I'm ready to take my life back!

Nothing is impossible.

The SCS Trial Surgey is Set

 🍀HAPPY ST. PATRICK'S DAY🍀

TO Y'ALL!

 

Well after playing phone tag (for over a week) with Emory neurosurgery in Atlanta, I've finally got some dates to share with y'all. My pre-op visit (the final one) before the Spinal Cord Stimulation trial is April 1st.

When the team nurse called and I actually got to talk to a real person, I asked her if it was an April Fool's joke because of the date. I told her that I'd been dealing with Emory for almost 18 months trying to get relief for my post stroke spasticity.

She laughed with me and told me that was the appointment. The appointment time is manageable at 1:30. But the surgery time is 7:30 AM on the 8th. I'll have to leave the house at 5 AM. Normally, this isn't a problem for me because I'm usually up at 3. But, Mel is a night owl. She normally doesn't wake up until 10 or 11 and she'll have to drive me or at least drive me home afterwards. She's going hate driving my van, but there's no way I'm going to be able to manage getting in and out of her truck afterwards. She's going to hate it, but she'll do it.

Puppy Update
Kassity is doing well. She knows her name, come, sit, nap time, and look at me as well as the hand signals for these commands. She accepts the collar and leash. The puppy even heels to it now. She especially likes praise and the treats I made for her.

Kassity is still have bouts of hiccups. You know what they say about hiccups, don't you? Well in the three weeks we've watched her grow from fifteen pounds to twenty, and become as big as Herbie except not as rotund. She's a head shorter than Nnyus. The older dog is having trouble fitting the puppy's head in her mouth. This is Nnyus' reprimand.

She now patrols the property with Nnyus. Nnyus has introduced her to the neighbors, etc. She's learning the difference between good and bad predators although she loves to watch the chickens run away from her. When outside, she's always on a mission. Her nose is always going. She wants to play with the cats, but they are having none of it. They still haven't laid into the puppy with claws yet, but it's coming.

I know I'll be alright with the surgery. I just pray that it works.

Nothing is impossible.

Sunday Stroke Survival: Test Results Are In for the SCS Trial

The test results are in. I actually passed my psych evaluation as normal or within the normal range. This is a shocker to me. Me, who I've dubbed the "Queen of Abby Normal," passed with flying colors!

All joking aside, I knew I was pretty well adjusted mentally. I have a positive outlook on my life in general, but not a rose colored glasses view. I tend to be firmly grounded no matter what comes down the pike. Most of this faith based, but whatever works. Although like most folks, the initial shock value does rattle me a bit. I do rationalize with research and facts over time. It's a logic component of my brain that still works overtime.

The MRI was acceptable for placement. My blood thinner stoppage letter is still good although my stroke risk jumps to 75% chance of having another stroke while off my blood thinners compounded daily.

As much as my stability centers on faith, I've learned over the decades to research worldly experiences to converse intelligently with care providers. Most of whom are not believers, but base their beliefs on facts and figures. Not everyone lives a purposeful, faith driven life like I do and I understand this. When researching a subject, in this case SCS, I balance both good and bad results to get the bigger picture of what I find. This is logical, right? I don't focus on the glass half full or empty reviews or experiences. In this case, I'm also research the various different devices (companies) and their research and results too.

Yes, it's a lot of research, but I want the biggest bang for my bucks. I want positive results or as positive results as humanly possible. Even if I'm not "paying" for it. Y'all long time readers know my views on this. Would you be any different?

This surgery will be covered by my Medicare and my supplement. Believe me, I checked and also researched the prerequisites. On a fixed income that's stretched to squeezing pennies into dimes, this is an important consideration. Of course, I'm talking about ROI (Return On Investment). Pain relief, return to premoderate spasticity and duration versus other medium functioning alternatives.

Example:

Botox injections, for me, every 90 days at $7K an appointment with only 45 days out of 90 pain control, and 14 days of functionality. Plus, PT with dry needling every week to twice a week for mobility (contracture prevention and pain management at $45 a session). Times this by the five and half years, I've done it.

RX bill is $240 a month without Botox with poor pain relief, zombified lifestyle, falling asleep when still for 15 minutes without heightened stimuli, and no functionality improvement. Plus, PT with dry needling every week to twice a week for mobility (contracture prevention and pain management at $45 a session). I've been doing this without Botox for 18 months now.

Versus 

A one time charge of $35K with battery replacement every 5 years, a 50%-75% pain relief, improve muscle strengthening, a minimum 50% functionality restored, possible reduction of muscle relaxers and no additional pain medicine.

For me, a 5 out of 10 isn't worth mentioning. It constitutes a good day with low pain. I can pretty well function normally I've been living with it for so long. So a 50% pain relief would be fabulous. At 75%, pain? What pain? If I complain of pain at a level 2 or 3, it would be heavenly.

To have 50% of functionality restored nonstop is way better than to backsliding into nonfunctioning that I've been doing with my worsening spasticity. With the combination of strengthening stroke paralyzed or weakened muscle, is gravy to top of recovery. There are very few case studies on this because this application is still in the result gathering stage. This is in its infancy.

So all I'm waiting for is the neurosurgeon's stamp of approval. I should hear something next week or my fingers will do some walking. All the pre-surgical hoops are jumped through on my end.

Nothing is impossible.

Sunday Stroke Survival: Oh, the Aches and Pains

As some of you may have realized, I have a pretty high pain tolerance. Why is it as we age, your aches and pains grow and multiply? Why is getting out of bed during winter is twice as hard as doing the same thing in summer? Why does it twice as long to combat these aches and pains during winter? Yes, winter is once again upon us.

You'd figure once the winter solstice (Dec 21st)  has passed and the days are getting longer that you wouldn't feel so bad as much. But I don't. The weather outside is frightful. Cold, wet, rainy, sleety with snow mixed in,and windy. This is one time living down in the hollow is not advantageous. The winter will freeze any exposed body parts even here in north Georgia, and I thought it was bad in Michigan. I will say we have more moderate temperatures because we rarely experience below zero temps. Thank God!!!

Still, the cold has a way of creeping into my bones. Metal rods and screws in my back don't help the situation.  I took my temperature upon rising yesterday...it read 98.6 degrees, normal right? I threw off my comforter, and roll to rise up out of bed. My back screams at me while it does its snap, crackle, and pop routine.I'd slept too long in one position again. I donned my t-shirt, heavy flannel shirt, and a sweater. The overnight low was 36 degrees. Inside by my thermometer was 52 degrees with the fire in the wood stove burned out. I can feel the coolish air on the tip of my nose and my fingers. It doesn't take long for me fingers to freeze up and refuse to move. With the cold, my spasticity and arthritis kicks in hard. Neither one likes the cold.  I chug my morning pills down with our spring water knowing it'll be 20 minutes until it kicks in. Meanwhile, I'm hunched over.

I start up the wood stove, it takes a while to get the fire bricks to warm up enough to radiate heat. I take my temperature again...98 degrees. By now, after 4 splits of wood are blazing, I put the kettle on the stove. A quick trip to the wood pile on the porch, let's me know that the temperature outside is about 40-ish, but the wind blowing across the porch makes it seem much colder. I grab 6 splits of wood (about 30 lbs) into my tote and manhandle it up the two little steps into the house. The tote full of wood sits almost perfectly on my spastic, affected arm.

I make it through the door and pivot to close the door when a handle slips off my arm. CRASH! BANG! BOOM! All the logs sill out onto the floor. They scatter so bad that I cannot close the door. I take the other hadle off my arm and lay the totes flat on the floor. I hurriedly pick up the pieces of wood and then loop it back on my affected arm. Then comes the real challenge, a dead lift from the floor of 30 lbs with a back weight limit of 20 lbs. The medicine is still trying to kick in. I manage to do a hunched over, crab walk to the wood stove. Stooped over like I was, there was little difficulty loading two more pieces of wood into the fire box. Only a mild string of curses words emitted from my mouth as the hot, firebox door hit my affected arm as it closed.

The good news was I was finally able to straighten my back. I walked almost normally to the kitchen. I placed my arm under the cold water tap. I swear it gave out a sizzling sound as the water hit the now black, bubbling skin  where the door made contact. These are my winter battle scars. I have umpteen dozens of them by winter's end. Getting my forearm to the faucet is a sight better left to the imagination. Let's just say that a change of top garments is necessary after this feat. Because of the spasticity, pain accentuated spasticity, my arm drew up into my chest. But it was in the perfect position to spread the aloe vera leaf onto the burn.

The rocker soles on the bottom of my shoe almost causes a hyperextension of my knee when I walk on my affected side. It's an artificial patella which doesn't like it at all. So now my knee aches when I walk. The lateral ligaments also voice their complaints. "Okay. Okay." I sit in front of the computer.

Not five minutes go by and Nnyus, the dog, wakes up and talks to me about wanting to be fed. Now, Nnyus doesn't bark at me. A bark is yelling and she's too polite for that. She does this growling woo-wooo-woo sound repeatedly until, for my sanity, I get up and do what she wants. "Alright! I'm getting it." I'd reached my five minute tolerance of this noise. I bend down to grab their bowls. My back now that it's straightened all the kinks out of it, now protests bending.  I straighten up and carry the bowls to the end of the counter by the pantry. My back thanks me a bit too soon. I'm bending again to take the lids off the dog food bin, I pivot to fill the bowls, and straighten my back to carry the bowls to the pot of leftovers on the stove top. Their daily goodies are always our leftovers from the night before, in this case, it's beef stew. I run hot water from the top and pour it over the mixture. Nnyus likes hers soupy. Herbie not so much. I grab the bowls and bend to set them in place. "Come eat."

My back muscles yell at me, "Quit that!" To emphasize their point, they spasm hard. Now, I'm truly bent over unable to stand up straight. I hobble over to the wood stove. I'm in the perfect position to poke the fire and load some more wood into the firebox. That done, I hobble the five feet back to my chair and sit at my computer again. My back sighs with relief and relaxes. Now, I breathe a sigh of relief. The medicines are finally working full force, but with the full force working, I'm drowsy. I'm sitting not ten foot from the wood stove so I'm warm and comfortable.

Now's the time to get busy. There's angora does to blow out, chickens to feed, mulch to spread, and our daily meal to cook, but all I want to do is doze by the fire. My aches and pains have finally abated. My spasticity has other ideas. I'm jerked from my doze by a painful spasm. My hand is up under my chin with this one. I careful reposition my arm into a more comfortable 7 of 9 pain level. I place a small pillow under my elbow for support as I wait for the spasm to reduce in severity. A tear squeezes its way out of my tightly closed eye. It eventually stops so fifteen long minutes later. I put on my sling to support my arm and get busy with my day.

Nothing is impossible.

Sunday Stroke Survival- Neurosurgeon Update

Well, I had my appointment with the neurosurgeon this week, but the news wasn't what I expected. The surgery for the cervical rhizotomy has been tabled for a year. His schedule is already booked for 2019! Talk about frustration and being irritated.

Why have me jump through the hoops for months when surgery was not a possibility for a year? I'll just have to redo the same tests all over again before surgery can be scheduled again in a year.

To make it worse my PBA kicked in. Instead of losing my temper and yelling, I bawled like a blubbering idiot. I have done everything they've asked, waited fairly patiently for appointments, and I was cast aside like a worn doll or at least that's how it feels.

This specialist did say he had a new partner. Great! A small glimmer of hope. He would discuss my case with him. It might be possible to have a Baclofen pump installed until the rhizotomy can be performed. Huh?! Isn't this why I jumped through hoops months ago and was deemed unqualified for? I was told not necessarily. I had been deemed unqualified for the dorsal/lower back Baclofen pump to reduce the spasticity in my leg. This was different it packs a greater punch to the brain and arm. But it will be up to his partner. Of course, being now after 5PM, they will have to call me back with an appointment. GRRR! They called while I was typing this. I have an appointment on February 4th.

Am I crazy to want to be out of pain? Am I crazy to want to stop my post stroke spasticity? Would I be certifiably insane to continue chasing this rhizotomy? I'm beginning to think I am. I've spent dozens of hours driving back and forth the Emory. Added wear and tear on my van, and burned 5 tanks of gasoline. Spent money I really didn't have for parking fees and meals on the road. And, it's been over twelve months with NOTHING to show for it. I'm in the worst, constant pain than I have been in years with no end in sight. I'm continuing to lose function. I'm no where closer to the end than when I first started this journey eighteen months ago.

The fact is, I'm frustrated and tired. I really don't know which is worse at this point whether never hearing back from Shepherd's Center or the run around I've gotten from Emory. I'm seriously thinking of getting Botox again. Even 45 days of being pain free out of 90 is better than the never ending routine I'm going through now. I might even be able to reduce my Baclofen/Dantrolene/Valium dose. Lord knows, I'm at best a zombie now on these maximum doses and still in pain 7 out of 10 on good days. I'm learning to live and function at this level through squinting eyes and grimaces.

I can actually function quite well with my arm bent at a 90 degree angle if it wasn't for the pain. I can hook two gallons on milk (about 18 lbs) or 6 splits of wood in a tote with the arm. My arm doesn't budge. With 8 splits of wood (about 35 lbs), the arm may lower a couple of inches. I'll have to use my functioning arm to help support it so the tote handles don't slide off. That's not too shoddy. My back is another story with the stooped lifting with too many repetitions. I just have to watch for skin break down at the hand, wrist, and elbow. The tote was a new purchase this year. It is better than hauling in firewood one or two pieces at a time. Why I didn't think of this two winters ago, I'll never know. But from one moment to the next, my arm will go from 90 degrees to in my chest in a hard spasm. Any movement when my arm is in hard spasm shoots the pain level to 10. I can't scream. I can only shed tears.

If I don't hear something positive from Emory, I'm calling my regular neurologist to put me back on the schedule for Botox. I'm tired of jumping through hoops and getting no relief. This isn't living... it's hell and I've been patient.

In the meantime, I've made two different fudges. One chocolate made with semi sweet, bittersweet,and milk chocolate (think death by chocolate) and a peanut butter one with crunchy peanut butter. Sometimes you feel like a nut and sometimes you don't. I've also got my gumdrop cakes in the oven for eating and giving. Later, it will be cookies. I made cinnamon gingerbread men ornaments for the Christmas tree. They smell yummy but they're not to eat. They taste yucky. Pop over to the Cockeyed Homestead blog to find out how I made these. Nothing perks me up after a totally bad day (months) like preparing something yummy in the kitchen.

Nothing is impossible.

A Rant and I'm Pissed!

Be warned. This is far from my usual type blog. I'm so angry that I could chew nails and spit them out like a machine gun at a certain medical specialist!

I just got back from Atlanta's Emory Orthopedist.  I spent two hours driving to this appointment. Going 10 MPH on I-85 once in Atlanta on the six lane roadway. The office was in mid-town, of course. I spent a total of an hour and a half in the doctor's office and got an X-ray of my foot and ankle I didn't need. I went to the orthopedist for a lengthen of my Achilles tendon that had contracted. Tendons do not show up on x-rays. Doh!

I met with the doctor's resident first. Pretty well standard for university hospitals. No biggie. Then, the doctor came in and we chatted a bit. He asked how I came to his service. I explain my journey of months to him through this and that specialist. This doctor just shook his head and said I should ghve seen him in the first place to get my foot and and ankle fixed.

He talked about lengthening this lateral tendon and shortening that one, releasing the Achilles, and rebuilding my foot and ankle to get me out of the AFO permanently and walking normally again. Finally, something we could agree on! I asked him when and he flat told me he refused to do the surgery! Nothing like giving someone a lollipop and snatching it away!

I checked my temper and asked him why. He said he won't operate on anyone who smokes any substance.

Yes, I smoke tobacco cigarettes. I smoke around 5 a day (1/4 a pack) for a very good reason. Thirteen years ago my family practice doctor told me to. At the time, I had gone through my fourth bout of cancer. He knows all the times I've quit smoking for more than a year, I've developed some form of cancer. He actually begged me not to stop smoking again and he set the limit. Call it a cop out, or not believe it. For thirteen years I've been cancer free by following his sage advice. It's the longest period of time that I've been cancer free. Now this doctor wants me to quit smoking for six months before he'll operate?

That's not all that upsets me about this. Couldn't someone have told me his position. I dunno like when the appointment was made? A simple question like do you smoke? When I first talked to them would have let both of us know this was a waste of energy. I mean I haven't lied about my smoking with any of the doctors. It's been on my paperwork for the last four I've seen at Emory since May. I could have not wasted five and a half hours (my total time), half a tank of gas (round trip 220 miles), and the aggravation of driving in the rain in big city and interstate traffic! Oh, and fifteen minutes of HIS valuable time.

I spent the hour and a half driving home (wohoo! still raining but less traffic) fuming. Why tell me that they could fix me only to say they won't? Even if I put the cigarettes down today, it will be six months before I'd get this surgery. Oh, he added a barb to the end of our visit. He told me that the neurosurgeon probably wouldn't do my rhizotomy because of the tobacco use also. If he did, he was nuts. GRRRR!

I mean, wouldn't the neurosurgeon told me he wouldn't operate when I saw him in May? Self doubt is creeping in. This orthopedist has planted his seed of doubt. I'll have to call his team to be sure tomorrow. I can stop smoking. Putting them down and not lighting up has never been a problem for me. I went a whole month without cigarettes while hospitalized after my stroke with no ill effects.

So since May, I've been spinning my wheels on an action plan that didn't work! It's wasted my time and energy with no results. I've exhausted every avenue of hope and still in pain with no relief in sight. This doctor was cruel in his matter of fact, smug way. He dangled the lollipop and then snatched it away. It's now been six hours since I left his office and I'm still discombobulated! I really dislike people who make me feel like this. Now, I have to pray it away to get my peace back. Tomorrow is a new day. Thank God!

Nothing may be impossible but jumping through all these hoops can be exhausting.

Sunday Stroke Survival: Up All Night

Remember back when you were a teenager and had slumber/sleep over parties with your girlfriends or the guys?  You had games like whoever fell asleep first awoke in the morning to a frozen bra or some such nonsense. My Daddy would shake his head at us "gaggy girls" as he called us. We talk about everything...mostly boys, gossip, movie idols, and just stuff.

Light 'cause we were counting calories

 Even when I turned thirty, my adopted sister whose birthday was a week after mine, had a different type of slumber party. A get drunk and be miserable slumber party to commemorated the end of our youth. We ordered a large Domino "garbage" pizza, a pizza with everything thing on it, and then dousing it with hot sauce before taking the first bite. We ran out of beer at some point and went to the store for more. No, we didn't drive... we walked. We were two sheets in the wind by that point, being thirty we knew better than to operate a motor vehicle while intoxicated. The clerk at the store bagged our 24-pack and rang us up. My sister had to beg him to card her. Yes, it was truly an end of an era for us.  Now at 60, I get carded at the grocery store when I buy wine for my roommate and her cat. I have grandchildren old enough to legally drink alcohol. Go figure. I guess I don't look my age or something.

This week has been a long one. Mainly due to lack of sleep for both of us. I wish I could say we were having fun, but I can't. Mel was having one of her insomnia jags, She's had these since her TBI (traumatic brain injury) as a child. The longest she's stayed awake, since I've been here, is four days. She'll try all her usual things to sleep that doesn't involve medicating herself. She will usually collapse from exhaustion after that. Then she'll have her regular seven-hour sleep schedule back until the next time.

For me, it's been a combination of things. I've really been in a funk all summer. My stroke anniversary was compounded by the waiting for surgery dates. ARGH! Don't let me get started on this again. The anniversaries of my beloved's and my mother's deaths have really hit me hard this year. Fibromyagia and arthritis flares compounded by two ill fitting AFOs, and having to switch back and forth between them is getting old.

I missed my last therapy appointment meaning my pain levels have increased to the point of almost the screaming memes. I mean I stopped going once a week to save insurance points which was optimal for pain relief to go every two weeks for marginal pain relief. By the time I get in there again a month will have passed. It's my own fault, but still it's painful.

It's hard to find a comfortable sleeping position when my foot is inwardly cocked at 30+ degrees and one arm is glued to my chest because of the spasticity. Because of the arm being locked in this position, my shoulders, neck, and spine muscles are all pulled into horrible angles trying to compensate. So when the cramping spasms start, there is no sleeping. My sleeping schedule is nodding off while watching television or at the computer. It's a viscous cycle of 20-30 minute nod offs snatched from my pain.

My Valium and pain medicine (Tramadol) have failed me. I don't need possible seizures added to my long list of problems. I refuse to go on a higher dose of both of them. My previous drug addiction issues not withstanding, I just refuse. I only use them when absolutely necessary to begin with.  I mean 30 tablets of each will last me six months to a year. That's how sparingly I was taking them. Not so much now, I've gone through an entire prescription in two months trying to reduce my pain enough to sleep. I took them only as a last resort, but even so I'm not sleeping like I shouldn't continues. I've opted for a higher doses of my Cymbalta, Baclofen and Dantrolene instead with a renewal of all their side effects. I'm now at the maximum prescribed dose on all three.

Does it sound like I'm whining? I'm just tired. This is the downside of living post stroke. All I know is this can't continue.

Nothing is impossible.

Sunday Stroke Survival: Is Fear Holding You Back?

A couple of weeks ago, I mentioned about fear holding me back from having surgery sooner. I also posted this picture with it. The words are actually words to a song. If you listen to a Christian radio station, you might have heard it. Zach Williams, the artist who recorded this song, has a couple of songs which hit home for me. I'll post both the songs that spurned me into action and this one later in this blog.

This song strengthens my resolve to continue waiting for the surgeries that may fix the spasticity and the pain that accompanies it. These three lines of this song reminds me that God is in control.  Theodore Roosevelt said it best when he said, "Nothing in the world is worth having or worth doing unless it means effort, pain, difficulty" even waiting.

But waiting isn't without its own trials. Fear creeps back in. Is this interminable wait because it's the wrong decision? This is the biggest one for me because I'm always questioning my decisions. Yes, you are not the only one thinking this in whatever choice you make. Conquering the effects of pain from the spasticity on my body and on the emotional front is another huge trial. The spasticity in my arm causes my trapezius muscles in both shoulders to strain causing unbelievable headaches, and my spine to contort as I try to find comfort. Which, in turn, causes more muscle aches from poor posture. But the worst, is Mel asking me all the time, "What's wrong? Are you mad at me?" Because my happy, smiling demeanor has changed to a frown or scowl most days because I'm dealing with this pain. I actually look haggard and tired as I go about my daily routine. I find myself doing the bare minimum to get by which is totally out of character for me.

Combating these fears and concerns is exhausting! A small voice keeps reminding me that God is in control and He has not forsaken me. Thus fear is abated for a time, but it returns. Yes, even for me a minister, it does so don't beat yourself up about it. Hey, I'm only human! God understands this through Christ.

In the previous blog, I mentioned my fear of dying as a reason for not coming to a decision sooner. You have to admit that there's not much worse than death. Although, some people say death would be easier than living post stroke. I don't feel that way. Now after years, first with the Fibromyalgia  and in combination with the spasticity, I can honestly see their point. Don't worry. I still don't have a death wish. At what point does your desire to be pain free overrides your chance of death? I reached that point, and then some.

 So what is fear holding you back from doing?

Now as promised above the two songs that spurned me to action and give me the strength. Enjoy. May they touch your soul as they did mine.

Nothing is impossible.

Neurosurgeon Update

At long last,  I had my consult with the functional neurosurgeon. I've only been trying to get in to see him for 8 months! If you remember I had to go through Emory's Stroke team first.

I spoke at length to his assistant. He in turn spoke to Dr Boulis before he came in to see me. Dr Boulis and I reached common ground very quickly. I could see the gears turning in his mind for the best possible outcome. His assistant had already performed the spasticity assessment and preliminary exam. To nobody's surprise, I was ranked severe. I've been this way for months. I'm now 10 months since my last Botox injections.

I simply said, "I'm broke. Fix me." In my mind, I was doing my Austin Powers imitation. "I want it all. Yeah, Baby!" I wasn't afraid of the pain of recovering from surgery, nor hard work entailed to get what I wanted. I never have been.

He nodded his head and asked me which was more important pain relief or recovery. I answered back
with both. The only way to fight spasticity is to strengthen the weak muscles and I wanted a fighting chance. He said he was impressed by this answer. It proved to him that I had given this a lot of thought. I explained to him that I'd read almost every report on spasticity in the past three years including some of his. I even mentioned his TEDMED talk in Washington, DC. It was about the battle that goes on between the neurosurgeon, the patient, biotech, and the FDA. Pretty interesting stuff, but I digress.

The thing about the rhizotomy is the prolonged recovery time, at least a year between the surgery and  reteaching the body. So if he did a dorsal rhizotomy to my lumbar spine, it would be a year or two before he could do the cervical/thoracic one and vice versa. Especially since I'd already spent six years in this fight. I had confessed to him that I was tiring of the fight for recovery post stroke. I'm still in physical therapy and looking for answers after six years post stroke, for God's sake!

He first did the "do no harm" speech and explained he didn't want to make it worse. I lifted my affected arm the 4" away from my body for emphasis. That's how much voluntary movement I have in my affected arm with the spasticity. "Worse than this?"

He had to admit that it couldn't get much worse. That left the leg. While I've lost the ability to dorsey flex and evert my foot at will because of the spasticity, it still keeps me ambulatory. Sure, I'll stumble over invisible lint, or fall, but I'm still moving under my own power. The new new AFO is correcting my odd gait issues. I again imagine I'm seeing the gears move in his brain and the light bulb goes off. A Baclofen pump for the lower limb would work better than the oral medicine. Both surgeries could be completed within a year.

Then I dropped the bombshell. First one, and then the other. I told him about my aneurysms and about how my heart reacts to anesthesia. I half expected him to run out of the room screaming, but he didn't. Now, it was my turn to be impressed. No sense in doing the rhizotomy before the aneurysm is fixed. If it blew, I'd be dead. That would have to wait until after cardiology gave the all clear for me to be off my blood thinner for three weeks. But the Baclofen pump trial could be done to see if it works on my ankle and foot spasticity. I would only have to be off my blood thinner for a week prior to that surgery. I would also have to be cleared by the Emory heart team prior to the rhizotomy. It's just Emory covering their butts, but I understand it. They don't know my cardiologist or my vascular surgeon.

Tomorrow, I'm calling my cardiologist first thing. It's time to get this ball rolling. My hope is renewed and very much alive after this appointment. At the very least, it's a positive action plan.

Nothing is impossible.