Monday, 29 September 2014

Coping with a broken shoulder - Part 3

In a curious way the post-surgery is the most difficult stage of the procedure dealing with a broken shoulder.

My General Practitioner sent me off to see the specialist who looks over such injuries.

After taking all the necessary X-Rays, he in turn gave me a list of physiotherapists to initiate the necessary practice.

Choose one from the list, in my case a convenient five-minute walk from home, and on with the exercises.

A nice European touch to this particular story was the fact that the young lady, who was asked to take care of my initial therapy way, was French - from Lyon. So here you are, a British national living in Germany (but who also used to teach French for a living), dealing with a Frenchwomen working here. Language of choice for communication? German of course (this is Frankfurt, not Humberside, Manchester, Lyon or Corrèze (UKIP / EXP supporters would just love that!)).

The sling was unfastened but not removed for the early exercises. The first problem was that, due to wearing the sling and the results of the operation, the lower arm had badly swollen around the elbow, and was badly marked in a hue of purple and ochre. So fist clenching at regular intervals was recommended as a cure (works - don't ask me why!).

There were at first three visits a week to see the therapist. The intensity of the exercises increased as the swelling went down, the shoulder became more used to the fitting, and the nerves and muscles started to work more freely.

Sleeping at night remained a problem though, and painkillers (prescribed at two a day) seem to work only during the day. Sitting, walking, standing still - there were no problems. Lying down was uncomfortable, though, and waking up in the night with your arm proverbially screaming at you .... Yes, well.

After two weeks it was possible to remove the sling, the swelling in the arm had subsided, and the bruising had diminished considerably.

Apart from the exercises actually during therapy, you were expected to exercise at home. Important at the same time was to recognise the fact that you would not be advised to cross the pain barrier, or go that much beyond it. The warning signs serve a purpose. Cure not achievement - the fundamental consideration in cases like this!

Over a period of six weeks the number of exercises increased considerably so that you had some eight exercises to carry out over a five minute stretch three to four times a day (in my case that has become at 10:00. 12:30, 16:00 and 18:30). You were not recommended to try too much too early in the morning or too late at night.

After eight weeks my therapist left to take up a job in Strasbourg, and this has now become a wonderfully funny lady whose German accent I have not yet pinned down (refined Hessisch?). The number of weekly sessions is down to two from three, and the visits to see the specialist are now at 6-week intervals.

Wharrever else you do not stop exercising. It has been mentioned to me that a number of patients expect the therapist to do everything for them, and they have no responsibility to improve things themselves. Not to be recommended.

As of today (12 weeks to the day after the accident), the arm will extend both horizontally and vertically almost to its full extent unassisted, the pains in the shoulder are almost non-existent, and the capacity for movement is close to normal - over short periods of time.

Expecting too much too soon is a danger to avoid, though. There is still some way to go before everything will become quasi-normal (the metal plate will ensure that total normality will never again be the case), and there is no point in becoming overconfident. Work, exercise, constant monitoring of progress - all remain significant. And there is once in a while a severe nervous pain which wakes you up at 03:00 .... The muscles and nerves are still learning to adjust, and it takes time and requires patience.

The more you exercise, the better the results that you will achieve, but patience is a necessity, and it is always to be remembered that the shoulder is a significant contributor to all arm movements and the fundamental junction point between the arm and the rest of the torso, so potential complications abound.

I remain though thankful to all the people in the German medical system at all levels who have guided me through the last 12 weeks. Everyone has made a positive contribution and helped my progress significantly, and I would state my full satisfaction with all the services which they have offered.  

Sunday, 28 September 2014

Coping with a broken shoulder - Part 2

I suppose that if you have broken a leg they would have no choice but to admit you to hospital immediately. When breaking your arm or your shoulder though, going home with the injury is a more likely option, so on the Monday evening after breaking my shoulder I returned home late (at 23:15 - 11:15 PM if you insist) and managed as far as possible to sleep with it.

After discovering that the hospital was on a convenient bus route, the following morning we returned by bus rather than taxi for an appointment at 09:30.

Pretty much on time the interview started with a lady who was at once highly personable and highly knowledgeable (and extremely reassuring). A diagram was already available on the wall, but she improvised a sketch with what was due to happen as she went along.

I fancy myself as being knowledgeable myself on a whole range of issues, but exact details of the human anatomy do not fit into that category, so I tried to learn from her explanation.

The human right shoulder has two cone shaped objects at the top (I have since learned that in English these are called tubercles, I have already forgotten the German!). Apparently one of these was broken. It was a simple fracture (thankfully). The operation would require removing some pieces that had fallen into a cavity beneath (I think ....), fitting a lightweight metal plate over the tubercle, fitting in some screws and attaching the appropriate nerves and muscles to them.

It would be a simple enough task for an expert surgeon, the whole operation would last some two hours, I could expect to stay in hospital for six days, and after that there would be a recuperation and therapy period lasting 3-4 months (shoulders being complex objects upon which a whole load of other anatomical features depend).

Suitably impressed we went home, returned upon the Wednesday to collect all the information that we needed for the hospital stay (what to bring usw). My wife then had to sign the appropriate document for me (interesting situation - her ability to read German is not word perfect, while I was not capable of using a pen!).

You then were expected to arrive at the hospital at 07:30 the following morning (Thursday). As the operation would not be expected to take place until approximately 11:00 this seemed a bit early, but they have their methods and procedures and like to stick to them.

One thing that I learned the first time I was in hospital for any period of time (see 2008) was to behave as if you're in jail (not that I have ever been in jail NB). Do what you're told, when you're told and how you're told. Misbehave and you lose remission.

My first three hours were spent waiting for the operation with my wife in attendance, and the only other person in the ward (usually equipped for 3 people) was a very quiet guy who was due to be released, and the only time he ever seemed to speak was when he needed to make or receive a business call on his mobile 'phone (note - when I was in hospital for the heart operation in 2008, mobile 'phones were not allowed. Either times have changed or the casualty departments and the heart attack wards work on different principles).

On cue at 11:00 someone arrived to wheel the bed with me on it to the operating theatre. Whispered goodbye to my wife before they pushed me to the point of no return, and exited through a set of automatic closing doors into the hallowed area.

They emptied me off the bed gently onto a solid green platform / table (difficult to describe it really) and was greeted by a young man who wanted to know whether I preferred German or English (German, this isn't Manchester or Humberside), asked if I were alright (silly question, really, taking into account my broken shoulder), smiled when I answered "yes" ....

I had one concern before this operation - if you have some sort of dreadful nightmare, how might it impact proceedings? During 2 of the 3 operations in 2008 I had had some awful dreams, which I can still remember to this day.

This time round though - nothing but three hours of peaceful sleep. I woke up and found another very pleasant lady staring into my eyes (the German medical system seems to have loads of these very pleasant ladies). Once again I was asked (in German) whether I was OK, again I answered "yes" (in German), and they then proceeded to wheel me back to the ward.

My wife reappeared from nowhere, and I spent a quiet remarkably pain-free afternoon learning the in-house rituals and being fed. The toilet and bathroom being directly opposite and my legs being in perfect shape, any need to use them I would happily have made unassisted - but as the nursing staff and my wife wouldn't hear of it, assistance was either requested or supplied without question.

The only real problem was lying down and where to put your arm. It was more comfortable sitting up, and even walking. They also fitted you out with a sling, which, although helpful in a way (and necessary for recovery), could also be a confounded nuisance. At night you had to improvise some way of lying on your back without the sling getting in the way, and without falling over on to the side where the operation was.

Painkillers appeared to work. Sleeping drafts did not. As a chronic insomniac, this was the most difficult activity involved. The night nurses were always very friendly and helpful, but the nights were long.

And when the quiet patient left to be replaced by an old guy who had broken (quite badly) his arm in two places and was in obvious pain .... All night .... And was constantly telling everyone he wanted to go home (for these complaints he lost remission!).

Every morning the team of doctors came round, checked the results of their work, congratulated themselves that progress was as expected, uttered surprise that a British national could actually speak German (they got French and Dutch thrown at them as well - I need to show off occasionally, see the previous piece), and gave me an A+ for conduct.

After a couple of days you started to be able to feed yourself, and use the toilet unaided (carefully and always depending upon your left hand to help you sit down and stand up). Which was as well as my wife was back at work for three mornings of my stay. The food was not at all bad, the nursing staff very helpful and friendly, and when you could actually work out how to turn the page of a book with the same hand with which you are holding it, reading helped passed the time.

On my final two days on the ward, I had a second neighbour in the ward who had fallen and broken his thigh bone in two places (seeing the other patients in that place reminded me how fortunate I had been to get such a simple break). He helped me also translate some of the pure Hessisch my elderly companion tended to use.

You get a chance to move round the whole area also - a coffee and reading lounge was available for example.

Not a bad experience all told, given the circumstances. Not that I wasn't keen to go home, which they allowed me to do a day early (extra remission - obviously behaving yourself works!).

This was to lead to the post-surgical procedures - a long process (I am still actually involved with these) - and these will be detailed in Part 3.

Coping with a broken shoulder - Part 1

Let us start with an apocryphal story.

Back in 1981 I had a whirlwind courtship with a lady who lived in a suburb of Manchester (England, not New England).

She was into astrology - well sort of. She had this book by a lady called Linda Goodman (?) which she used as a sort of Bible. When she first met me, she decided that I was a Leo. Out comes the book, all the references checked etc. She should have known this lot already - her ex-husband was a Leo, as was her 10-year-old daughter. I finally got round to reading this guidebook on how to divide totally accurately the world's entire population by 12. I remember one punchline which read along the lines:
"If your Leo boyfriend tells you he has no money, he has probably gambled it all away".

The fact that I had no money resulted from the fact that I had changed careers 2 years previously, relocated (to a more expensive city), retrained (which cost a fair bit), and walked straight out into the Thatcher revolution - one of the basic rules of which was that the people of the North of England were supposed either not to work for a living (why else did the government need dole queues?), or were supposed to work for wages that would be less than what people were earning in China.

I did not, at that time, gamble at all. Even now an occasional investment of 9 Euro 25 Cents on the German lottery is as far as it goes.

One of the few things in this section on the Leo male that did sound right (give it a score of 3 out of 10 for trying) was that they have a tendency to show off (well if you've got it, flaunt it, but don't lie or exaggerate!).

As our relationship cooled, she went back to the guidebook and reinvented the script. I was not a Leo, I was a Cancer. Oh, good, that explains everything. Really?

Read the chapter in the book, discovered that I was a very private person (true, nowt to be ashamed of), and very secretive. Huh? Very typical of many people from the North of England - get straight to the point, spell out the facts, be blunt and to the point. What's to keep secret? Just ask, you'll get told. That chapter got 1 out of 10. Apart from the bit on privacy, there was nowt which fitted.

The relationship fell apart (thank you, Ms Goodman (?)). We met accidentally 6 months later and tried it again for another 3 months. Eventually our personalities and expectations just did not mesh, even if we were physically ridiculously well suited.

Anyway this mixture of being a private person with an occasional need to show off was to reappear (painfully) on July 7th this year. Monday evening, just after 18:00 (6.00 PM if you insist), I got onto an S-Bahn train, noted an empty seat, and made for it before anyone else got there. Someone should have told me that the floor was slippery for some reason. My extremely comfortable shoes also had heels which were worn down, and the combination (along with more than a bit of slapstick and Hollywood) led to me flying through the air with the greatest of ease ....

And landing directly on my right shoulder. No time to get anything else in the way. If I had got my hand down to stop the fall, what I might have done to my hand or my fingers - no good ending was possible.

Maybe I had expected a Hollywood film producer or a German TV producer to be on the train and I wanted to show off my prowess in taking a fall. No such luck!

Three very kind people picked me up, put me down in a seat, asked if I needed a doctor (I refused). Then maybe thinking that I must be drunk (I never get drunk, I don't even drink alcohol that early in the evening)  or totally crazy (no comment!), they quickly wandered off down the train.

15 minutes to get near home on the train, 5 minutes to walk home from the station, the pain was obvious but not excruciating. In 2008 I had survived two days at work including trekking across Paris both days, getting a suitcase to the station and a train back to Frankfurt, and three days obstreperously refusing to admit that I had owt more serious than chronic indigestion before giving way to my wife's imprecations to go to  the hospital to be checked out. A heart attack requiring a triple bypass? Come on, I will lose my job, my income, I will end up totally broke!

My wife won the argument, I had the operation, I lost my job, my income and ended up totally broke .....

This time though I decided upon a more subtle approach. On getting home, my introductory line was:

"I think, dear, I may have to go to the hospital". Not quite blunt and and direct to the point, but getting there!

I must check out Ms Goodman (?)'s chapter on the Cancer female some time. After she had wasted three minutes asking silly questions like why I hadn't gone directly to the hospital (the answer - that I was already on the train coming home, so going to the hospital would have meant getting off it usw. It was as quick to come home  - did not impress her one bit!), we headed off to get a taxi. The driver, a Pakistani immigrant, selected the most convenient hospital, and spent the rest of the journey pointing out how he had become a successful entrepreneur in Germany (even employing his own son) and most other immigrants here were far too lazy usw .....

It took about three and a half hours to get through all the rituals. As I am normally pretty cynical, if not downright pessimistic, my often blasé attitude to my health problems irritates my wife no end. She had already been down this road in 2008 - being told that it might be nowt serious usw. Still convinced that it was probably nowt more than severe bruising, being struck by the reality that the shoulder was broken did not cheer me up at all.

Perhaps being a pessimist makes sense after all. Even the lady doctor's wonderful reassuring tone when telling me did not ease the mental agony, which was considerably greater than the physical pain at this point.

My wife at least seemed reassured. She took me home in another taxi, had the fun of having to undress me (NB - old men like me are definitely NOT sexy!), wash me, and .... even brush my teeth for me. It is interesting after 60+ years of  brushing my teeth with the toothbrush always in my right hand how clumsy it seems trying to use your left hand for the purpose!

The following morning I also realised that I could not write at all (my left hand had never been trained for that purpose), and the computer keyboard could be only manipulated very slowly, typing one letter at a time with my left hand. Eating, holding a coffee cup, slicing the cheese .... Where have I been all my life making limited use of my left hand? Suddenly I need to do absolutely everything with it!

And as for trying to spread margarine on the toast! Now that was funny!

To be continued in Part 2

Sunday, 21 September 2014

Another excuse for skipping school

Back in the days when I was teaching for a living you were supposed to report kids who were missing from classes. They were obliged to attend school (British law), they had a timetable of lessons which they were due to attend (school rules) usw usw ....

Some wicked teachers like myself would often look round their classes, note that the inattentive, disruptive elements, who were known to make teaching the rest of the kids difficult, were absent, cheer quietly inwards, and get on with actual doing summat positive for once.

Report a disruptive child for being absent ..... no, just assume that they were absent for some legitimate reason and don't bother checking them out.

Some legitimate reason?

How about skipping school to go to Iraq or Syria and fight for jihad?

I read on the Internet yesterday that a sizeable number of kids of school age in Nordrhein-Westfalen have done just that. IS/ISIL/ISIS (wharrever it calls itself in English these days - or wharrever the translation from the original Arabic now is) had become such a lure that these kids would rather go and fight for the cause (as foreign fighters) than learn algebra or chemistry or .... (well if you are a fanatical Muslim, science tends to contradict your belief system, so why study it?).

One of these kids is, apparently, 13 years old.

I have previously commented on this blog that I cannot imagine a grown adult wanting sex with someone of 13 or 14 - they are too small, far too immature, and simply not ready.

Not ready for sex but old enough to carry a Kalashnikov?  Or behead an infidel (usually another Muslim actually - in political terms, infidels can be the wrong shade of the belief system). Or commit other acts of wanton violence that aren't allowed by the school rules (or the laws of most sophisticated modern nations).

You would imagine that if IS/ISIL/ISIS did have intentions of becoming a legitimate (i.e. non-rogue) state at some point, it would discourage kids that young from serving militarily? Not so (and more on IS/ISIL/ISIS further down the page). A few weeks ago (and you can check this out on the Internet as well), a 14-year-old boy served, along with his father (great parenting, huh?), as a suicide bomber in an attack carried out by them.

In the above article there was also a reference to four young Muslim women from Germany heading to Syria for romantic escapades with young jihadist men whom they had somehow or other contacted.

Young unmarried Muslim women? Romantic escapades? Even moderately liberal Muslim believers (that sounds like a contradiction in terms - "moderate", "liberal" and "Muslim" do not fit very well together, at least in a social context) would have a problem with that, and given the austere Salafist version being pushed by IS/ISIL/ISIS? The likelihood sounds like less than one in a trillion (or maybe they have been living in liberal Germany too long and mixed with too many infidels!).

Anyway at the moment there appears to be a generational divide when it comes to IS/ISIL/ISIS. This week, for the third time in as many months the German Central Council for Muslims (Zentralrat der Muslime in Deutschland) came out yet again and condemned IS/ISIL/ISIS as a terrorist group which was carrying out actions which are incompatible with Islam.

Similar comments have emerged in recent weeks from the Grand Mufti of Saudi Arabia (the head of Muslim teaching in that country - if he were a Christian, he would probably be an Archbishop or similar). And other (Sunni - and that is important) religious leaders.

I have also read numerous reports of parents trying to stop their kids from supporting this war in Iraq / Syria, and advising them in vain not to go. I have read of elder brothers telling their younger siblings that the excessive violent conduct being perpetrated is in fact Un-Islamic.

Water off a duck's back, I am afraid. These people have their own literalist version of the Koran (the one that critics of "Islamisation" in Europe like Geert Wilders also use to take pot shots at the belief system) and are not prepared to listen to any other interpretation of it. 

You may not expect these kids to be that mature or that intelligent (though one story of a 20-year-old dropping out of medical school in the UK to go and fight in Syria puts that theory in doubt), but there is a very dangerous movement afoot which will take some stopping. And on a day when a potential genocide of Kurds in Northern Syria sounds ever more likely, the need to reverse the trend is both vital and urgent.

We may not like them being in school and being potentially disruptive, but we need them back there and learning something other than how to carry out pre-medieval barbaric practices with modern weaponry. 

Postscript (January 3rd, 2022). Fortunately the genocide of the Syrian Kurds did not occur. The world at large owes a great deal to the bravery, guts, determination and massive sacrifice of the Kurds whose actions more than anyone brought ISIS/ISIL/IS to its knees. For which the Trump administration abandoned them to the whims of the thugs of the Erdogan government in Turkey.

It is time that the Kurds in the 4 countries into which they are divided (Turkey, Syria, Iraq and Iran) were given a say in determining their own future.