06 April 2017

Annual Spinal Cord Injury Re-evaluation

Recently I went back to Craig Hospital for an annual spinal cord injury re-evaluation and the results were very positive. It was really nice to see some familiar faces of the people for whom I have such deep admiration like my doctors, physical therapists and administrative staff. My doctor and therapists were quite surprised to see how well I am doing, especially given that I'm still seeing improvements three years later. Mainly because so many spinal cord injury patients have serious issues even years later. I am so lucky to no longer be taking any medications and to be walking again.

It has also been nearly one year since I have been back to Craig Hospital and it seems like such a different place to me now. Being back there again feels odd for a couple of reasons. First, due to the extensive construction/remodel, the amount of change to the hospital makes it seem like a different place entirely. It used to be much smaller which encouraged more close interaction between patients and staff. Now the place is so big (i.e., big hallways, larger individual rooms, etc.) that patients can have more privacy if they want or even avoid some forms of interaction. Second, although I am comfortable being around so many folks who have been so severely injured (not everyone is), I have noticed that some folks are confused by me. I can tell the way they look at me that they are wondering what I am doing there because, outwardly, I do not appear as someone who has experienced a spinal cord injury. I have been lucky enough to make it out of the wheelchair and to walk on my own. Though my feet are still paralyzed, I wear flexible, carbon fiber AFO braces on my legs and walk with one arm crutch, the braces are covered by my pants so it's puzzling to many people.

The folks who I wish I could see more are the nurses and techs. These are the folks who helped me the most when I was so vulnerable and confused and to whom I grew very attached. To understand just how attached I was, simply moving to a more independent room as I was getting better was upsetting to me because I was so emotionally attached to them. I learned that these people are cut from a unique cloth and possess very big hearts to do the work they do every day. Because they are so involved with the acute care of in-patients, they are very busy during the day and not available for much socializing as past patients come through. Luckily, there was one of my nurses who I ran into and was able to spend some time speaking with him. I really enjoyed catching up with him and hearing about new adventures in his career. He was one of the folks I was attached to at the time and he really made a difference in my experience. I will be eternally thankful for having met these wonderful people during such a traumatic time in my life.

Today I am walking nearly 100% of the time with the leg braces and have been for over two years. I am working to rebuild my calves and my glutes, but this is a very, very long and slow process due to severe muscle atrophy after not being able to move my glutes for five months and my calves for two years. Although my feet are not responding yet, we will see what the future holds. I still feel so very lucky to be alive and continuing to make progress.

Although I cannot run at all or cycle the way I did previously, I am very thankful to be able to work out as much as I can. I am now riding the stationary bike regularly, using my Total Gym (yes, I have a Chuck Norris Total Gym) to build my calves, using a Bosu to work on balance and strength in my lower body, doing ab roller workouts and walking as much as I can both indoors on a treadmill and outside. I'd like to make time for swimming laps again, but all of this can be time consuming (and tiring!). I am not nearly as fit as I was at the time of my injury, but I continue to work hard and to see noticeable improvements for which I am truly thankful.

Thank you to everyone who continues to stay in touch and check in on me from time-to-time. You may not think it's much to send a quick message, but these messages have meant a lot to me through this process. The support from family and friends has been what has truly kept me going. The patience displayed by Bailey, Jade and Janene is pretty amazing.

Later this month, I will mark the three year anniversary of my injury. It seems so far away and yet it continues to affect my life every day. My life will never be the same but I do believe I have found peace with this entire ordeal.

20 March 2016

Martyn Ashton Is Soooooo Inspirational For Me! :: Bruce Snyder's Status

Imagine for just a moment, if you will, you are going through your day and everything is routine -- you take the kids to school, you collaborate with some co-workers, you eat some lunch and then you head outside for a bike ride. You are enjoying the weather, riding your bike and suddenly something goes terribly wrong. You don't understand, you hear someone screaming but you can't figure out what is happening. Then you realize... the screaming is you.

Blinding pain, you are bleeding, breathing is getting increasingly difficult, you are physically unable to move your legs, paramedics telling you things you don't understand, doctors and nurses running frantically and then blackness.

When you regain full consciousness in the hospital a couple of weeks later, you are confused and scared, still unable to fully comprehend the situation. Then reality sets in like a swift blow to the head as you become aware that the last two weeks were not a horrible, dark nightmare.

This is what I lived through from my cycling accident. Nearly two years later, I am now making it out the other side of my injuries and this video of Martyn Ashton back on his bike is the most inspirational thing that I have seen so far! Thank you, Martyn! I recommend watching it in full-screen mode with the volume turned up so you can hear the laughter of these friends as they help their buddy get back to the sport he loves.
'I am now making it out the other side of my injuries and this video of Martyn Ashton back on this bike is the most inspirational thing that I have seen so far!'
The joy on Martyn's face at getting to ride his bike again is amazing and seeing his friends set him up on his bike and careen down the mountainside together bowls me over every time I watch it. I dream of doing this again one day!

Martyn Ashton has been a professional mountain biker for over 20 years and in 2013 he experienced a spinal cord injury while on his bike. Martyn is now wheelchair bound, his life changed forever. To understand why this video has such a dramatic efffect on me, check how talented Martyn was on his bike before his accident in this wildly popular video of him (nearly 1.2 million hits!). This is truly inspirational for me and I wish Martyn continued success!

For an interview about the main video I posted above, check out this interview with Martyn.

28 February 2016

We Have Movement! :: Bruce Snyder's Status

After nearly two years of no movement below my knees, I was pretty surprised to discover recently that there is movement in the achilles tendons on both my legs!

Back in late January, I went back to Craig Hospital for the annual re-evaluation of my spinal cord injury. During the four days of poking and probing my body, just like last year, they told me again, 'According to your internal organs, we can't tell that you have had a spinal cord injury.' This does not mean that I am unaffected, it means that I do not have the deterioration of internal organ function that they commonly see in the kidneys, liver, etc., etc. after such an injury. Many paraplegics are in a very bad way internally due to a whole host of issues that arise as side effects to the nerve damage. For example, I still have to deal with bladder and bowel issues from the nerve damage. These issues have improved significantly from the time of the injury nearly two years ago, but I am also lucky enough that my injuries were not as bad as they could have been. (I could go on an on about the degrees of damage here but I will spare you the details.)

There were two really positive discoveries during my re-evaluation, improvement in sensation and some new movement. The first discovery that I have much more sensation in my hamstrings, lower legs and feet than I realized. Nerves heal at such a slow rate that it's difficult to gauge the level of improvement on any given day. But if you have a baseline against which you can measure, then you can quantify the amount of improvement. I knew that the sensation had improved, but it was difficult to tell how much it had improved. Additionally, if you know anything about nerve sensation then you know that there are different flavors of it -- basically soft/light touch to heavy touch to sharp touch (and everything in between). Interestingly, damaged nerve sensation can go from numb at one end of the spectrum to hypersensitive at the other end. So they tested much of my body for nerve sensation and compared my current results to the results from one year ago as well as against the initial injury. The result was that the improvements were rather significant.

If you look at the two images above of the nerve dermatomes, pay attention to those from the waist down related to anything L3/L4 or below (the vertebrae in the lower spine including L3, L4, L5, S1, S2, S3, S4 and S5). Right now I'm dealing with sensation issues in my feet, lower legs, hamstrings, tailbone and crotch areas. The great thing is that my body is still healing and nobody knows how far it will go over time.

The second discovery was that the achilles tendons in both legs have some movement! There was just barely movement there, but it's movement nonetheless. It is very similar to the way that my butt/glutes returned. This new movement in my achilles tendons was such a minor amount of movement that I did not believe it at first. However, as my glutes have recovered and rebuilt, I have also learned that even minor movement can snowball over time into much more movement as the muscles are rebuilt. My glutes have largely returned, but they are still not 100% and won't be for some time, so I continue to work on rebuilding them. The same will be true for my calves. Right now my calves are basically gone due to the muscle atrophy. But, over time, I will enlist my calf muscles more and more and they will rebuild. In fact, in the 30 days or so since the movement in my achilles tendons was discovered, I can now feel that my calves are just beginning to engage. But only just beginning. It's going to take a lot more work over a long period of time before I can visibly produce dorsi- or plantar-flexion of my feet (which is driven by the calf muscles and the tibialis muscles).

As I have been telling everyone for the last year, in addition to waiting for my nerves to heal more, the big focus of my physical therapy has been fighting back against the severe amount of muscle atrophy that occurred as a result of my injuries and immobilization. It took me a while to realize that the muscle atrophy was something from which I could recover (as long as there was movement). At first, I was so weak from the immobilization after the emergency surgery and spending nine months in a wheelchair that I just assumed that the weakness was caused by and part of the paralysis. To a certain degree this was true, but what I have learned over time is that if I have movement I can rebuild the muscle. There is such a thing as having the movement return but perhaps not having 100% of the sensation return. Another positive thing is that I have experience dealing with muscle atrophy. Having dealt with it way back in high school with my first couple of knee injuries, I understand the dedication and hard work required to recover from muscle atrophy. It takes a lot of consistent, deliberate, difficult work to rebuild muscles that have shrank away. As many people have asked me, 'Are you still going to PT?' and my response is, 'PT is a way of life for me, it won't stop for years.'

Anyway, because the movement is starting to return, I was fitted for a new kind of braces (this is the third type of braces now). The type of braces I need are called ankle-foot orthotics or AFOs. The first type of AFOs I had were rigid hybrids comprised of aluminum struts with plastic foot and calf beds. The second type of AFOs I had were rigid plastic with some carbon fiber reinforcement around the ankles -- rigid meaning no flexion whatsoever. I am now on the third type of AFOs and these are known as dynamic response AFOs and they are made of carbon fiber.

See the image to the right and notice that there is only a thin strip of carbon fiber along the back of the achilles tendon area. This strip is flexible for two reasons:
  1. To enlist the calf muscles in the stride
  2. To rebound or spring back once it is loaded from the ankle flexion providing a more natural stride 
Just like the switch to the previous AFOs, these new AFOs changed my stride again. It's much more natural and I don't need to pick up my feet as much because my ankles are flexing naturally. The downside is that I am pretty damn wobbly right now due to my lack of calf or foot muscles, but this will improve over time. Also, my feet and lower legs are pretty sore from the new material (carbon fiber is not very forgiving -- I know this from owning several carbon fiber bikes). I have already had a couple of adjustments to them and I will need more. But it is also a matter of your body getting used them, kinda like a new pair of shoes but much worse. This will all improve over time.

Someday I will post all of the videos that Janene has made of me walking at the different stages throughout my recovery. It's pretty amazing to see the progress so far and I'm not even done yet. As I tell myself quite often, never give up.

08 August 2015

Vacation in Germany

At the Neuschwanstein Castle outside of Munich
Last month my family and I traveled to Germany for vacation and had a wonderful time. With so much history to see and things to experience, there was no shortage of activities to keep us busy.

We started in a city where we had never been, Berlin. With a population of 3.5 million people, Berlin has an incredible number of activities to choose from which made it difficult because we only had a few days. We took a hop on/hop off bus tour around the city which was challenging for me but nevertheless pretty fun. When we realized that buses were basically staying in the same general area, we just decided to walk around the city and had fun checking out the city. We saw many sites around the city including Brandenburg Gate, the Memorial to Murdered Jews of Europe, the Topography of Terror and much more. One day we took the train and bus across the city to Waldhochseilgarten Jungfernheide. This place consists of a ropes course high in the forest that you climb and traverse while wearing climbing gear so that there's no chance of falling. Janene and the girls really enjoyed this adventure while I took many photos from the ground beneath them. Although it was very hot and we stayed in a hotel with no air conditioning, we still had a wonderful time relaxing and letting our curiosity drive us to sites and cafes all around the city. After Berlin, we took a train to the city of Halle about 1.5 hours south.

Halle is where our au pair from about 10 years ago named Henriette and her husband Franz were both born and raised. We were lucky enough to spend some time with them and their little boy Gustav and also attend their wedding where we met many of their friends. We had such a good time and were so happy to see their wedding in-person rather than only view the photos after the fact. We also visited many historic places in Halle. Of course, no visit to Halle is complete without a visit to the oldest chocolate factory in Germany, the Halloren Chocolate Factory. Not only does it have amazing chocolates but it also has an interesting and varied history. We even ate döner kebab for the first time and even though we are not big meat eaters it was pretty delicious! We were also able to visit a friend of Henriette's named Franzeska, her husband Daniel and their little boy Johann. Franzeska was an au pair for some close friends of ours while Henriette was with us and so we got to know her during that time as well. After several days in Halle, we took a train about five hours south to Munich.

At a cafe in Berlin
After a long train ride we arrived in Munich, a city with which I am somewhat familiar being that my company is located there. Munich is such a different city compared to Berlin and we were told by many people that this is due to the differences between the old Eastern vs. Western Germany. Just as in Berlin, Munich is full of things to see and do. One day, we took a bus tour south of Munich to see Neuschwanstein Castle -- and Linderhof Castle, both of which were incredibly opulent and somewhat amazing for the time in which they were built. We did a tremendous amount of walking on this day around the castles. Despite my leg braces and using both arm crutches the whole time, I kept up with the tours pretty well. We also spent time in Munich just hanging around the city to see the sites. This also involved a lot of walking but I actually didn't mind it. I took breaks when I needed to and enjoyed the sites. One night we took the train across the city to the Osterwald bier garten in a different area of Munich to meet a friend for dinner. It was wonderful to see her and visit for the evening.

Osterwald bier garten in Munich
There is nothing like a true vacation where you unplug completely, forget about all of your responsibilities and don't worry about anything. This was one of those vacations. 

After my spinal cord injury, it was really difficult for me to enjoy very much for a long time because I was so uncomfortable all the time. Taking this vacation was a true test for me both physically and mentally. I am happy to say that I did not feel left out, though I was jealous that my family got to spend one afternoon taking a bike tour around Munich. Still, this made me think that I can do many things that was not sure would be possible. Yet again, I feel so lucky to have the love and support of my family who have always stuck by me.

17 May 2015

Check Out My Latest X-Rays :: Bruce Snyder's Status

On Friday, I paid a visit to my neurosurgeon and I have x-rays to show off! 

My neurosurgeon was happy to see me because it was the first time that he had seen me walking. He happily greeted me at the front desk which doctors almost never do, he just happened to be there when I walked in. It made me feel pretty good that my surgeon was so happy to see me. After all, this guy sees lots and lots of people who have had surgery. He said he was happy to see me walking because when I last saw him in November I was still in the wheelchair. 

Below you can see the two sets of x-rays -- one from the back and one from side. From both vantage points, you can easily see the hardware that was inserted. Even though I can feel the hardware in my back, it's still crazy for me to actually see it. Especially when I see how deep the screws go into each vertebrae. In the view from the back, you can also see the curve in my spine because the hardware is crooked. Oh well, I've been told that spinal surgery is more art than science -- sounds like writing code. 
Also, if you look closely you will see some little dots in between the L3 and L4 vertebrae. This is a plastic spacer and the dots are metal so it will show up in an x-ray. It's typical for the surgeon to insert a spacer in between the vertebrae in place of the disc that had to be removed (the disc was so badly damaged that they had to scrape it out). The spacer keeps the vertebrae the proper distance apart as the bone grows and fills in the space. According to the surgeon, the bone growth between the two vertebrae looks really good.

Based on  my recovery and the state of healing in my spine, the surgeon told me that he doesn't want to see me for a year! He said that he feels that I'm ahead of the curve and that I should keep doing everything I'm doing. Yay! 

09 May 2015

One Year Since My Spinal Cord Injury :: Bruce Snyder's Status

On April 24th, my family and I marked one year since my spinal cord injury and I was so totally shocked and very humbled by the surprise that Janene arranged for me. What an amazing wife!

We had made plans to go to a friend's birthday party at a place here in town. That afternoon my youngest daughter had a track meet and afterward I had to pick up my oldest daughter from her school in Boulder. These activities kept me busy until just after 6pm when I showed up at the location for our friend's birthday party.

As I crutched to the door and opened it, I saw my youngest daughter holding a big sign for and a huge crowd of our friends from the community screamed, 'Surprise!' It took me a second to realize that all of these people were here for me. I was so shocked by this thought that I almost lost it right there. Even now I get emotional thinking about it. I was so humbled that all of these friends showed up for me. I have been on the giving end of such support for others in the past, but I have never been on the receiving end.

It's hard for me to believe that it has been a whole year since this horrible accident took place. Early on, my good friend Greg, who has experienced two spinal cord injuries in his life, said to me:
'Just make it through the first year and everything will seem so much better.' 
He was right and this advice was poignant, though it took me a long time to really put it in perspective.

At the time, this seemed so far away that it was difficult to imagine. For a while, I even had this perception that I would actually return to what used to be normal for me. But, over the last year, I have come to realize that I need to get used to a new normal. The most difficult adjustment is my inability to run and cycle like I used to do so often.

Current Status

At this time, I am still paralyzed below the knees but I am hopeful that my body will continue to heal. I have so much more feeling in my feet after one year and I'm very hopeful that I will regain movement over time. Because of the paralysis, I wear leg braces to be able to stand and walk, and I also use arm crutches for balance. I am lucky enough that I can get around at home without using the crutches and at I have even started using only one crutch in places that are level and familiar to me.

Most people have no idea that a lower spinal cord injury like mine (L3-L4) often affects a patient's bowels and bladder function. Your digestion slows down due to the nerve damage and your ability to empty your bladder on your own can be affected. I still deal with some issues in both of these areas, but not to the extent that I did through the first eight months. I'm lucky that my body has healed the way it has and that there is medication to help things along otherwise.

For some time now, I have been riding a stationary bike, doing lots of leg presses and walking much longer distances. I still see a physical therapist, but only for guidance and direction. All of the PT related activities I do are driven by me alone. I have experienced the need for PT previously from knee injuries so I already understood how it important it is to have the drive to push forward on my own. Luckily, all of these activities have helped me to recover from a fair amount of the muscle atrophy that took place from being stuck in a hospital bed and a wheelchair early on. But I still have a long way to go.

Riding a Bicycle 

In addition to riding the stationary bike, Janene recently purchased me a 3-wheel bicycle. While it's not the same as riding a road bike or a mountain bike like I used to do, it is very similar and it allows me the freedom of being on a bicycle. Strangely, we had a difficult time finding a shop that was willing to assemble the bike for us. I guess lots of shops aren't familiar with them and each one can be so different that they cannot predict the time it will actually take. Luckily, the Bikesmith in Boulder came through and was happy to do the job.

While riding, I do have a hard time keeping my feet in the proper place on the pedals, so I am thinking about putting some toe clips on there. Also, the seat is not very comfortable on my sit bones due of the muscle atrophy in my butt. I'm also hunting for some other seats to help me tolerate not only sitting for a longer period of time but also the bumps on the streets.

As I mentioned it's not the same as riding my road bike and climbing steep mountain roads like I used to love doing so much, but it's the best thing I can do at this time. I'm so grateful that my wife is encouraging me to do something that I love, even if it isn't exactly the same as it was before.

30 April 2015

Traveling to ApacheCon :: Bruce Snyder's Status

Several weeks ago I traveled to ApacheCon, the annual conference for the Apache Software Foundation, and it was the best experience I have had traveling since my accident almost one year ago.

For the last 10+ years, I've done a lot of business travel. I've been through many cities in the US, Canada, Germany, Poland, The Netherlands, Belgium, Denmark, Sweden, Ireland, UK, Spain, France and Japan. Traveling was always difficult both mentally and physically unless I was with my family or just my wife, and this only served to soften the blow. But compared to what I experience now when I travel, all of that previous business travel seems to have been a lot easier. 

Even almost one year after the accident, it's still difficult for me to sit for a long period of time. When I say long period of time I'm referring to a span of two plus hours. I have taken several flights of 2-2.5 hours and I can achieve these without too much difficulty. But I have not taken a longer flight yet, especially a flight to Europe. I'm hopeful that I will have an opportunity to do this soon.

Dealing with life in a hotel room for several days certainly presents some challenges, but nothing that I was not able to handle. This is still a new experience for me because I have never been presented with such issues for all the years I've been traveling. For example, when I am at home, I still use my wheelchair when I get out of bed to the shower. This is because I am not yet wearing my leg braces (which allow me to stand and walk) at this time in the morning. So I either muscle through this situation by either using just my crutches and going very slow or I use the wheeled office chair in the hotel room. Another example, in the shower I need to use a padded bench. Getting a bench seat in a hotel isn't a problem as long as I plan ahead and make the proper arrangements, but I do not travel with my wheelchair at all anymore.

Making it to ApacheCon was a good experience to get out of my comfort zone, hang out with some old friends and even make some new ones. I was struck by the opening keynotes on the first morning of the conference because they were so overtly driven by vendors. One vendor even stated that it was starting a new software foundation and charging $1000 for other vendors to join. This was quite a surprise given how community driven the Apache Software Foundation has been since the beginning. But I suppose the realities of financing a software conference at a pricey hotel in a large city has driven ApacheCon in this direction.

I'm very happy that I was able to attend ApacheCon this year because it was only three weeks after ApacheCon 2014 when it took place in Denver, CO that I experienced my accident that resulted in a spinal cord injury. So for many people, this was the first time that they have seen me since last year's conference. At any rate, it was great to see friends and prove to myself that I can get along outside of my comfort zone.