Rachel Manke plays the ukulele
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The Injury Blog: Part Four

7/30/2018

4 Comments

 
PictureThis here...is a pose that I have not been able to do in a year.
Alright!

Neck, sorted, shoulder.....sigh.

Here is a link to explain the science of "Frozen Shoulder"
https://www.webmd.com/a-to-z-guides/what-is-a-frozen-shoulder#1 

My experience:
I could not buckle my seat belt with my left arm, I couldn't pull a shirt over my head, I couldn't wash my hair with both hands, I couldn't make my bed, I couldn't reach with my left arm in any direction, I had to sleep precariously with pillows pinning me in one position.  If I broke these parameters...I'd get shooting pain down my arm.  It would subside, but it was like electricity that had to work its way out.

A very elementary explanation of the science is this: the neck issue left my left arm and shoulder rather immobile for months.  I'm a female fast approaching 40.  You add these things together, and according to my research, it's not unlikely that a frozen shoulder will be the result.  The capsule/soft tissue around the shoulder joint becomes rigid, seizes up.  And so you cannot physically reach up above your head or behind your back.  

You ladies might imagine how not being able to reach behind your back could affect some other dressing issues.  I went to Goodwill and bought a bunch of button up shirts.  

You see the misery the injury is....now add to this my further reading that the shortest time to full recovery is ....six months....and that it could be up to two years.  I tried not to imagine two years, too much.

My physical therapist and I set out right away to be aggressive in treating it.  You see the most extreme treatment (which was NEVER GOING TO HAPPEN) involves knocking you out under general anesthesia and ripping things free...for there is no way you could tolerate the pain and remain conscious.  We weren't going to go there.

Right off the bat we got into stretching, mobilizations, ice, electrical stimulation (tens unit).  The first appointment with PT, she had me standing in a doorway, above me was a chin-up bar.  I reached up and grabbed it with my right hand, no problem.  She wanted me to get my left hand up there.  To do this, I had to get on my tip-toes, her short-self was under my elbow supporting it and with much consternation I grabbed it.  It was not pleasant.

Other visits, she'd lay me down as she worked to physically pull things in directions that they did not want to go.  It's worth noting at this point...after all of these things, that I have a relatively high threshold for pain.  I should have been yelling when she did this....but I'd just groan.  She knew me well enough by now to tell when I was in real pain.  At one point or another she'd say, "I know this hurts, I'm sorry."  and I'd say through tears in my eyes, "You're just doing your job.  I know."  

I don't know at what point it happened, but I started rewiring to the point where when I had pain like this, I'd start laughing.  Laughing at pain.  I mean, why not.

At the very least, and I said this to her a few times, with this injury at least we knew exactly what we were dealing with.  With the neck, it was so confusing and weird.  But this, would have clear goals and milestones.  And it did.  There are three phrases to frozen shoulder: freezing, frozen, thawing.  A few weeks in we began to notice incremental improvement.  I cannot tell you how encouraging that felt. The tiniest change was a huge victory.

We had the goal of being good enough by May so that I could confidently fulfill my commitment to teach and perform at the Las Cruces uke festival in New Mexico. That was the goal.  And my PT focused on my ability to move my arm up and down the ukulele neck.

Slowly, some range would come back.  There came a point where the shooting pain stopped but what then developed was myofascial adhesions, scar tissue, micro tears.   This was the result of muscles doing double the work for the ones that we stuck.  I discovered how valuable having a skilled massage therapist was.  I had found a favorite at the center.  He's an actor on the side...in fact he played a Death eater in one of the Harry Potter films.  This big death eater, gave me life! :)  And we had a great time being geeks and talking about Star Trek and other such things each session.

This brings me to the human element in all of this.  The caregivers at this wellness center, the office gals taking my money and making appointments...they all knew me, they all were rooting for me.  They'd happily greet me and ask (really wanting to know) how I was, how the uke thing was. They'd ask how much time I had til the next one, if I'd be ready.  Can't tell ya how important their support was.  People who were strangers a year ago and now....who I would love to keep in touch with.

So as May approached...things continued to slowly improve.  I decided that come hell or high water, I'd be there and I'd teach and perform as best as I could.  I decided that it would work.  And as May crept up, I started to believe it.  A week before I flew down to Las Cruces I met up with a second massage therapist who specialized in this sort of thing.

She was a lovely and calm woman...who spent an hour working on me like nothing else.  For the next 48 hours I felt really sore, just as sore.  Then I woke up that Sunday morning....feeling the best I had felt in over a year.  Amazing.  I was ready to go to New Mexico!

Off I flew, staying with Gordon and the Mrs., who were lovely and supportive.  I stocked up on ice packs and my favored arnica ointment.  I dosed a bit on the advil too.  And it went well.  It really did.  By the time I was done playing and teaching...I was SORE AS HECK.  And I chose to share this with everybody from the start that weekend.  Everyone was so, so lovely.  A few folks handed me a sample of their favorite pain rubs.  Others offered encouragement from other injuries.  And the best of all...was the attendee who is...a massage therapist!  She was in my last workshop and while I was selling CD's, she gave my neck and shoulder some work.  Amazing.  I wasn't sure how I'd be able to physically get home..carrying my bags and sitting in a cramped plane..but that sure helped.

Craig Chee, Sarah Maisel, Marc Revenson and Mark Baker, my dear colleagues were amazingly sweet and supportive.  They knew just how scary something like that can be.  At some point or another, everyone deals with injuries of various natures.  And we give sympathy and support, we wish well, and we remember our own experience.  I am grateful for those who've known all along and stuck it out supporting me...and for everyone along the way.

Now...May was good, I did more than I'd done in a year.... I could get my hand on that chin-up bar buy getting on those toes, and I started to be able to bring my feet flat to the ground for a little bit at a time...but we aren't there yet....

More to come...



4 Comments

The Injury Blog: Part 3

7/27/2018

1 Comment

 
Did I mention my alternative pain medication?  Pizza, ice cream and beer!  More on that later.


So I took a train up north to spend Christmas with the family.  It was far more comfortable than sitting in a plane seat, or dealing with all that flying involves.  Certainly better than driving!  I could walk around. A nice young man (how am I saying that phrase????) helped me put my things in the overhead.  Had a lovely time with my family.  My brother told me how his neck issue was SUPER helped by a chiropractor.  Alright, hmm.  I felt pretty okay for most of the visit but the last day or two before I left I woke up with full-on 9 or 10 pain.  What the living hell.

I got home after the new year.  I discovered, wonderfully, that the new ACA option in Virginia was accepted by NO ONE.  But...out of desperation I talked my (now former) primary into shooting cortisone into me one more time.  I was desperate. 

It took things down a few knotches.  Now here's the thing about cortisone...you don't want to keep doing it.  This is why I am still working on getting muscle tone back in my shoulder and arms.

So I was ready.  I had never been able to think that going to a big strong guy and asking him to snap my neck, for money, would be a thing.  But it was.  I asked my PT if she thought I should try it.  She was all about doing the things.  So I went to the desk and told the office gals, who at this point were my best friends and my entire social life, that I wanted an appointment.  They put me in with the most sarcastic guy in the house...because they knew me well. 

Such a mental game.  I came in and was evaluated.  He was actually out with the flu for this part (a colleague filled in), but his assistant had so much fun with me that she refused to let the other chiro have me.  My second visit was my first adjustment.  I came in and told the assistant how nervous the whole thing made me....but I trusted him too.  She smiled and made fun of me.  I told the doc the same.  He had me lay down, he felt around, looked at things.  He had my whole head (which is big, kids) in his massive hands.  He had turned me slowly in one direction.  And he said, "Can you cross your ankles a minute?"  as I did that CRACK!!  He tricked me...and I loved him for it.

That was the only trick he had, so I had to do mental gymnastics for a few more adjustments to relax enough so he could do anything.  It took a few weeks of going in but kids, what we figured out, is I just needed some help aligning my spine.  Would that I had the courage to visit him sooner!

So very quickly my pain level was brought down to the midway point.  In my neck, that is.  After my second adjustment what I realized (and this was unrelated as I thought back to symptoms leading in weeks before) that I had already developed what is known as a frozen shoulder.

One injury for another!  Neck pain gone, shoulder injury to take its place.  This is February now.  I will tell you more than you ever needed to know about frozen shoulders....in the next installment.
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The Injury Blog: Part 2

7/26/2018

1 Comment

 
Okay, guess I left suspense there.  Don't want y'all to get too worried.


So, I had actually stopped in on my GP when I'd woken up with sore thumbs.  My mind went a number of places with that.  My doc asked me the usual diagnostic questions.  She then wondered if, perhaps, I was texting too much.  I assured her that I was terrible at thumb typing and was a big fan of the voice-to-text feature on my phone.

So we ran blood tests.  Test for RA, Lyme, whatever else would be standard.  All negative, thankfully.  Once I came back from my weekend in Maine, however, I could tell we were dealing with actual injury.  She asked more questions.  This is the first time I got the request to name a number for the pain level (1-10) and because I had a lot of numbness it was hard to pinpoint.  She called in a colleague who was also a sports medicine guy to take a look at my spine/shoulder.  I was sent off with a script for muscle relaxers and told to go to physical therapy.

First thing we learned, muscle relaxers are not for Rachel.  Wooooo.
Something that became very apparent, however, when I got in to my office job that week was this, the desk I was working at was very poorly set up, in terms of ergonomics.  I sat at an old 50's typewriter desk, too low.  The monitor was practically in my lap.  The old chair had me leaning on it regularly to talk to people. This was a big part of my problem!  Thankfully, my staff let me order all the things that I needed to fix the situation.  

Here's tip number one for you in preventing injury...sitting at a desk can be the worst thing for your body...especially if it is set up poorly.  Here's a link with info on how to have a healthy desk set up.(https://www.mayoclinic.org/healthy-lifestyle/adult-health/in-depth/office-ergonomics/art-20046169)

Basically, my noggin-of-unusual-size only needed to be leaning forward a bit to pull down on my shoulder and neck muscles.  It's amazing what that can do to you!  Eventually, they brought in a convertible standing desk and OH! the difference standing an hour each day makes.  Amazing.

So, physical therapy.  This was June now.  My doctor's office was eternally slow with referrals so I found my own, off the recommendation of colleagues and friends.  This was a center that also had massage therapists, acupuncture, and chiropractors.

And there I began, with my small but mighty PT, a year of figuring out what the hell was going on.  We were going on the assumption that the desk and sleep posture might be the culprits.  Stretches, deep tissue neck work, etc. were the order of the day.

The following months are a bit of a blur.  I had great trouble sleeping at night.  I started to get up earlier and earlier each day.  The minute I was awake at all, I had to get out of bed.  The numbness morphed into pain.

Every uke gig was high anxiety and stress.  I could not rehearse anymore than I absolutely had to.  It was painful to play.  My fingers did not do all that I asked of them.  It was painful to do dishes, to do laundry.  It was painful to sit, painful to lay down.  I couldn't think straight for pain and lack of sleep.  I stopped going out for fun.  I just sat, however I could, and watched tv.  Not something that's my usual hobby.

At least one uke event that I attended I felt I did a horrible job at.  I was scatter brained, couldn't sleep there.  My playing was iffy, my teaching was iffy.  Finally I went back to the doc, this time to the sports medicine guy.  He gave me a shot of cortisone in each trap muscle to help relieve the muscle spasms.  That helped some, it brought the pain down from a 9/10 to about a 6.  Remember I mentioned the pain scale? I would stay above a 6 until just a couple months ago.

About the only thing that would touch the pain, was the arnica gel!  I was taking a fair bit of advil.  That had helped my brothers and dad who all had some neck issue.  Thing about advil (or other nsaids), is that they're not so great for your stomach!  They're not meant to be taken for long periods.

I poured over articles and talked to people, to find how I might support the relief effort.  I started taking turmeric as a supplement.  My doc had given me magnesium.  These helped some.  The turmeric especially helped a regular sore knee that I have.  The magnesium relaxed the muscles some, it's sort of like epsom salt for your insides.  Beware how much you take!  It relaxes ALL your muscles (wink, wink, look it up.)

Still, I had good days and bad days.  At one point, with more bad days, someone had told me about something called "CBD" which is a legal hemp extract.  It's gaining popularity and is hard to find in many states.  It's closely related to cannabis..but all that it shares effectively is pain relief (and for cancer patients it's said to help with nausea and appetite).  I was ready to try anything!  The only form I could find was in these edible gummies.  It felt so illicit.  I ate half of a gummie and went to bed.  Two hours later I woke up and my neck did not hurt...thing is...I could not feel my face very well either!  I definitely had too much.  I never tried it again orally, but I did share my experience with friends who had friends and relatives in chronic pain.  It has helped at least one person sleep at night, and it is safe...and not addictive like the opioids that we all hear about.

So my go-to relief combo was this: turmeric, magnesium, topical arnica gel...and soon when I could find it (10 times the cost of the arnica) topical CBD ointment.  I tried to walk for 20 minutes to a half hour each day to be upright.

The diagnosing would continue for months as I ebbed and flowed from almost feeling like I was getting better, and straight up to the 10 on the pain scale.  I had an MRI (which on ACA cost more than I made in a month, nearly two month's salary).  It showed two minimally bulging discs but neither were actually touching a nerve.

I tried acupuncture.  Manke doesn't do needles.  So you KNOW I was in dire straights to try paying someone $90 to stick me with needles.  I respect the practice, I know it really helps some people.  For me....it worked a little and the last time I tried it, it sort of set off more spasms.  In fact, the last time was just before the New Jersey uke fest...which I had to cancel.  I felt AWFUL having to do that but there was just no way I could drive there and perform.  I could barely stand just staying put.  I got a second round of cortisone in my shoulders after that.

By this point, I'm sure you can see what a merry-go-round the year was.  I tried dry needling (look it up) to the point of having a consult and letting them stick one needle in a pressure point.  That was enough for me...and it made me worse for another month. (An expensive mistake!)  Again, some people swear to have had great relief from the practice, but not me.

I reached a point here where I started to feel like I would never be without pain again.  That I'd have to give up the ukulele, at least in any serious way.  It was pretty durn depressing and scary.  My greatest coping mechanism for when I'm having rough times is to play and sing my heart out.  I could just look at my ukes and feel worse.

My apartment looked like a bomb hit.  I couldn't keep up with house work.  Reaching and bending were things I was super hesitant to do.  People kept asking me how I was doing, figuring that by NOW I surely would be saying "BETTER"!  Not so much.  And it was all I could talk about.

I manage to muster a good week to have a great time at the festival in Panama City, FL in October.  I was still dealing with the pain and the numb but I used my mechanisms to relax what I could and mask what I could.  And this brings us up to about Christmas time, with no real change to my situation.

In the next installment, we'll get to what finally helped the neck pain.  Don't fret....it gets better...then worse...but then better...
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The Injury Blog, part 1

7/25/2018

5 Comments

 
The deal:  For over a year now I have been dealing with a crippling injury that has affected my playing and my everyday life.  It's drained me mentally and financially.  Thankfully, I am very much on the mend and on the road to being "normal" again.  A dear ukulele colleague suggested that I share my experience with injury and rehab in a blog so that others might relate or gain knowledge from my experience.  What follows is the story, in installments.


I woke up one morning, a year ago around Valentine's day.  I'd woken up with a sore neck before.  It's why I'd bought myself a memory foam cervical pillow.  Which seemed to help for years.  This time felt different.  My neck hurt.  And it didn't sort itself out after a day of stretching and standing.  I couldn't catch a minute of relief.  So odd.  And so, I bought my first tube of Ben Gay.  It helped, I could relax.

A month later, I woke up and my thumbs were sore.  Both of them.  Odd, I thought.  Why were my thumbs sore? What did I do?

Fast forward to Memorial Day that same year...I was in Maine for a ukulele festival.  My neck was sore again.  I woke up the morning that I was flying to Bangor, and my left forefinger and thumb were a bit numb.  Odd, I thought.  Late that night, after being so wonderfully welcomed by the crew of the ukulele club running the festival, I was in the guest room of my host.  And as I lay down, I couldn't feel my ear lobe.  I had numbness in odd places stemming from the left side of my neck. I could not sleep, I could not get comfortable, I was scared.

I dozed, off and on, wrapped in a blanket on the couch in the guest room.  I was terrified.  I had to play and teach the next day and my hand...was not working right.

I persevered.  I told my host and his gal friend about my issue.  They offered ointments, rubs and beer.  I tried to relax...work through my set and figure out what I could do in case...I couldn't play.  My Smeck pieces were shelved.  My singing, my jokes; I'd have to rely on that.  It seemed to me that I was dealing with a pinched nerve.  So I shared that in the workshops.  I wanted people to know why I might not be my best.  Someone kindly said, if that's you with a pinched nerve, I'm impressed.  

I got through my set.  We had a great time.  We are our own greatest critic, are we not?  This concert proved the value of entertainment and connecting with a crowd....but things were not okay.

There was an osteopath in the crowd who took a look at my neck and my shoulder and could see that things were not okay.  She suggested that I go to the co-op and buy a tube of "ahh-ni-kah".  Being Maine, I asked her to spell that, "arnica", a homeopathic pain reliever.  We'll get back to that later.

At any rate.  Kind people, shared ointments, an Epsom salt bath, and a flight home later:  I felt, as I had many times before, the kindness and love of the ukulele world.  I also felt, like I had a major problem brewing.  And I had a full summer of ukulele commitments.  

In my next installment of this story, I go and visit my primary doctor.
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So far, so good!  An explanation and a blog

7/25/2018

0 Comments

 
I have had a great time so far this year in the limited engagements that I have booked.  In May, I joined my pals Craig and Sarah, Lil Rev and Mark Baker at the Las Cruces festival in New Mexico.  What wonderful people, natural beauty and a great time!  In July, I was in Forresthill, CA at the California Coast Music Camp.  It was fantastic to spend a week with instructors and students of all variety of acoustic instruments.  I got to spend time with old friends and meet some new old friends.  

Upcoming, I have the Tampa Bay Ukulele Getaway!  That's coming up in November and I'll be working on some new songs between now and then.  Looking forward to seeing my old pals, Jim and Liz Beloff as well as Petey Mack and other faboo folks.

So why such a light season for me?  Well, I've had a rough year physically.  In fact, my pal Craig suggested that I blog about my experience with injury and rehab from it.  And so I have!  The first installment of my injury blog is following this....
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    Rachel Manke

    When I have concerts, workshops or other appearances I'll post it here!

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