Thursday, July 28, 2011

Preparing for a new semester

My strength and fitness are improving daily with my rides to campus. Last monday night, I went to watch my summer league team play. They had 1 sub to begin with but then he had to leave and another player may have broken a bone in his hand, leaving them with only six players. It was so windy as a storm blew through at the beginning of the game, that I thought about trying to play a little. If I could safely huck (which I can't yet), I was thinking that I could walk around the field, and be available to huck the disk and then let my team play a 6-person zone. Fortunately, the wind calmed down and those crazy thoughts passed. I can't waste 7 weeks of work just because I feel a little better.

I got the slightly frustrating news today that I will be in the boot for another week. Really a week and a half since I see the surgeon again on Monday of the following week at exactly 8 weeks after surgery. I was hoping to be ahead of schedule enough to get some boot-free walking in, but the PT is not cleared to make that sort of decision. As I note above, I have to avoid being stupid at this point. I am at 6 weeks and 3 days post surgery and that is just not enough time to get out of the boot...

In between the hectic preparations of a poster for a conference, an accelerated search for a position for this fall, and trying to get a new course proposal ready for submission, I have been thinking about my fall class. It is a senior level undergraduate course in mixed models. Basically it involves statistical methods for correlated data that might come from measuring the same person repeatedly or students in the same classroom or spatially, temporally, or spatio-temporally correlated observations.

I try to let my teaching be influenced by recent experiences, be they research or life experiences. I got a push in sharing my life with my students by Tim Robinson at the University of Wyoming. We team-taught an engineering stats course and he had an almost folksy presentation style (in a good way) with his Virginia accent and stories about his family and his research projects permeating lectures. This made a class 80 students feel like a much smaller class setting. When I took over the class, I wasn't ready to bring that familiarity into my teaching but have slowly gotten more relaxed when I am teaching and more willing to share what I am up to with my students. My classes are heavy on my research projects as examples of hard learned lessons in various areas. But I am also willing to let students see that we all try to balance work, family, and fun - letting them know that sometimes when I am not in my office I am out hiking, biking or skiing. I am in my office enough hours with my door open to also try to set a strong example for how much work is required to do this job. This fall, my achilles tendon rupture and rehab will be a prominent part of my class and discussions.

During my surgery, I discovered the "new" infra-red based technology to get body temperature readings non-invasively. It uses the temperature of the blood vessels in the temple area. I looked around and discovered that you can get them relatively cheaply ($30 for a decently rated one, $10 for one "fresh" from China) and even more cheap is the hardware version of the tool - a laser-based temperature gauge ($10). I am yet to get a reasonable body temperature reading from the laser temperature gauge but it may be possible; the "real" gauge seems to work well although I haven't bothered with the rectal temperature calibration test. Regardless, I am going to try to integrate the real and alternative temperature gauges into my class in the fall. I am hoping to use them and the idea of doing a study of body temperatures to motivate some of the big issues in the class during the first few lectures. I plan to have them design, collect, and analyze a study using the different gauges. I have a few different ideas that would be fun but am trying to remain open to whatever ideas they might come up with in class.

I also starting to find some interesting articles related to achilles tendon problems for my class in the fall. One is here which contains a summary of possibly more interesting studies but with statistical methods that might not be as good a fit with the class. I like this one because it has nice graphics and is a simple repeated measures analysis with a single(sort-of) quantitative explanatory variable. It also illustrates why researchers might be interested in taking repeated measures instead of one measure per "subject" - they are working with cadaver's legs. There are a couple of issues with how things are reported and the model but I'll leave that for my students to sort out on their homeworks...

I was also entertained to find an achilles related data set in R in the repolr package. It is a repeated measures, ordinal response data set with a 3-level response of level of recovery. I have been working in this area and looked at that package last spring, prior to my injury, and didn't think too much of the data set back then. I will definitely be revisiting it later.

I find that I am struggling a bit to write this to whatever audience I have - maybe I should split my posts into different topic areas. I mix my life and work up together, but maybe my posts should have more separation. I am beginning to think that blogging is as much for yourself as it is for other people... it certainly was in my first days post-surgery.

Sunday, July 24, 2011

Transportation Independence...

When I first saw the surgeon, he was happy for me because I hurt my left foot and could drive sooner than if it was my right foot. Unfortunately, we have a manual transmission so I still haven't driven since June 5th. Usually, we bike or walk around town and it has been wearing on me (and Teresa) that we have been driving everywhere. Friday, I got permission from the PT to use my commuter bike while I am wearing my boot.

So I pulled my bike out of the bike trainer stand the second I came home and used it to ride to campus. My commute is almost exactly a mile with a small climb at the edge of campus. I took off not expecting too much even though I had been riding for 10 minutes straight in the bike trainer, which is about how long it usually takes to ride to my office. I discovered that my boot makes it a little cumbersome when starting up and it can get caught on my fender when I turn right, but the biking is pretty natural. I took it a little slower than normal and had more traffic than normal to deal with, but found the ride easy and climb at the end pretty manageable.

The north end of campus at Montana State is a mess with construction. At the corner of 11th and College, we are getting a roundabout. That should be interesting when students come back to campus in the fall. 8th street is also torn up with new water lines being installed. So traffic is getting pushed into 9th and 10th streets from both sides and those are the streets I use to commute to campus. Surprisingly, riding with a boot gets you no sympathy from drivers that have been diverted by construction. At one intersection, I tied with the car coming the opposite direction at a stop sign. I came to a momentary stop and since her turn signal was not on and she saw me, I proceeded forward. She started to turn and gave me a dirty look! Even without a boot, I would have been mad about this. With a boot, wouldn't you be a little more patient with someone on a bike (even though I didn't need it)? I get so tired of people with cell phones stuck to their ears driving around and nearly hitting me, especially when I am on a bike and behaving legally - following the traffic laws.

Next week looks to be much easier for both of us since Teresa no longer needs to take me everywhere. We can return to our old schedule and routines of biking to campus and one of us biking home to let Buster out during lunch. My appointments next week will no longer require complicated logistics to get me there and back home. And I start to regain some of my fitness as part of my daily routine.

I had a replacement physical therapist last week and she was really impressed with my recovery at this point. I am getting close to walking without my boot. I am still nervous about that as I feel like I am still pretty weak, but at some point I have to get back to full weight bearing without protection. One of my PT upgrades to get me back to walking has been balancing on one foot with my eyes closed. Try this sometime. Even with full functioning legs, it is challenging to hold for 30 second to a minute. I do this sort of exercise in the winter to improve my balance and glide on skate skis, but had always kept my eyes open. This is definitely a level higher.

Sunday, July 17, 2011

Returning to normalcy...

I am daily feeling gains in strength in my injured leg, both in terms of balancing in my boot and walking with more strength. The PT is getting more adventurous as I improve as well.

One aspect of that is scar tissue remobilization. I am just at the beginning of that process but for now it involves gentle massage of the incision site. Some spots feel good to have this treatment, but a couple of areas, especially near the top of the incision are less enjoyable. I have heard this gets more intense and less comfortable sometime in the future.

In general, I am progressing quickly and should be starting to do some work outside my boot in the next weeks. I sneaked standing on my injured leg without the boot a couple of times and found it to be strong and comfortable. Not trying to roll forward on it yet but I think that is coming soon. My therapist described the next weeks as a series of levels to reach and then I get to move to the next level. Everyone's timeline is different at this point, but once you can do something, then you can try the next. For example, I have been one-legged biking with a bike trainer I borrowed from a friend the last couple of days. Now that I can balance on my injured leg in the boot I can add the second pedal. I will still be biking in the boot, but can have a more natural biking experience. Once this gets comfortable, I think elliptical training will be next but will wait until later this week to find out about that.

I have tried two different massages in the last two weeks. Somehow our insurance is more in favor of massage than acupuncture so I wanted to see what benefits I could get from massage on top of my other treatments. Last week, I got more of a relaxing massage except for some deep tissue work on my shoulders. It probably was good because it helped me break some defenses down after the surgery but really wasn't terribly therapeutic in any way. This weekend, I went to see Katie Cook Massage and got an entirely different sort of treatment. Her thoughtfulness and methods were completely different from the previous weekend. She seemed to work on fixing function of parts of my body and my posture, and doing this by manipulating soft tissue. I can't say it was enjoyable (it actually was near my upper pain threshold frequently) but I can already feel some changes. My neck and shoulders are moving better. She tried to fix the alignment in my hips that has been messed up by walking in the boot - the difference in heights is somewhat unavoidable. This morning, I noticed that I was walking on my tip-toes on my right foot. Amazingly, my hips wanted to stay at the same height instead of twist to accommodate the differences. I'm sure I will reverse this with more walking in the boot, but it shows what she can do for me once I am out of the boot. It was such an interesting experience, I think I bored Teresa with stories from my treatment by telling so many but I was fascinated by what she did. There are stops that she pressed on that I didn't know could be sore. I think both Teresa and I will be using her services to keep us running smoothly as we escalate our exercise intensities into the future. I would recommend her even if she wasn't our neighbor and friend!

As I mentioned before, Teresa has been starting to run and enjoying it. Once I am free to go into the outdoors again, she will be running loops to get her cardio with me along. I don't mind but we are both preparing mentally for this role reversal. I think she is quite excited about leaving me in her dust...

Wednesday, July 13, 2011

Starting PT

Now the fun really begins! I had my first and second PT sessions last week and started walking with a boot and crutches and now can walk without support. I am using a cane to try to level out the walking a little but am walking enough to make my shin sore while everything else is feeling great.

The main focus of the PT is on strengthening and not on range of motion at this point. I didn't quite understand the therapists explanation of the mechanisms behind this (I was trying to spell the alphabet with my foot and somehow it took all my mental focus to do that) but the main concern is over-stretching the tendon. If that happens, it will be really hard to have strength in the range of motion required to push forward. So for now, building strength is the key. I could start doing some riding of my bike on a borrowed trainer but wasn't strong enough to change the pedals over the weekend. I will try again soon.

Last Wednesday after PT, 4 hours at work, and learning to walk again in the boot, I had an acupuncture treatment. Ever since the surgery, I have been extremely sensitive to the needles - much more than before. Part of this is that she can't "confuse" my nerves in my ankle area by pressing on them prior to inserting the needles because it would hurt too much to press that hard. Part of it is that my system is still a mess and needs some time to get back to normal. And some if it is due to the slight swelling I am still working on below the injured area. She has been focusing on getting things in better alignment, healing, and reducing swelling. I am also continuing to take a suite of chinese herbs to help with the swelling and keep my calves relaxed. As far as I can tell, all this is helping me. My most recent treatment was my most "normal" yet. She thinks that the herbs and treatments have me doing better than I was before the injury (except for my achilles of course). But my pre-surgery status was related mainly to trying to rebuild my body after the stress of the tenure process.

The tenure process is an interesting experience. You put every fiber and thought into getting as much done as possible before you have to send your packet out for review. You barely see family and friends, take on too many projects, and are always looking for one more paper. I really enjoyed the lag between submitting an article to a journal and hearing back because it meant I could focus on another project. I was working at a rate of submitting or re-submitting an article every month for the last year and a half of the process and was right at the upper limit of my productivity during that time. And some projects fell to the wayside and some surprised me to get done quickly. One surprise was a paper just recently accepted to the electronic journal of applied statistics (for statisticians, the acronym EJASA is not a coincidence).

The story behind it is not really all that typical: I was working with some Arctic researchers on other projects and they brought me a side project looking at presence or absence of certain microbes in different layers of ice cores. The data set wasn't conducive to inference, really it just needed a nice description of the patterns observed. I did a standard hierarchical cluster analysis but the reviewers wanted some revisions on the paper. I ran into a different type of clustering more suited to the binary nature of the data set and showed the results to them. They thought it was nice but that the plot was hard to interpret. So I made it better. And that application paper got accepted. And then I used the same method on a data set from the Examining Mathematics Coaching (EMC) project that I am funded on and showed it to those collaborators and they thought it was interesting as well. So I wrote a paper describing the method being used and why the graph I developed was useful, and suggested some different areas of interest for its application. I think it took me a week to write the paper although it was built on my previous work and feedback from great collaborators. The first reviews wanted more of a contrast between methods and I added that to it shortly after the semester ended. I am happily surprised about its subsequent acceptance but it shows that small novel ideas can get you publications without years of work. And sometimes years of work on a project barely gets you a publication. 

The main frustrations of last week have been hearing the recovery timeline re-iterated and some stiffness in my neck. My neck has improved, but I am still faced with the following. The surgeon says 6 months to fully unrestricted activity and the physical therapist said that I will struggle to recover my previous strength for up to around a year. So my week has included the excitement of walking, returning that awful scooter, starting my PT, getting an article accepted... and then thinking about a long time to getting back to where I was a month ago. But I feel like I have a good team around me - PT, acupuncturist, wife, and dog. And I will get to cross-country ski this winter so I can't wait for the snow.

Tuesday, July 5, 2011

4 weeks post injury, 3 weeks post surgery

Happy 4th of July weekend!

Recovery continues to progress well. I had a bit a swelling and discomfort the last few days as I have gotten more active and started trying to move my ankle around but it is enjoyable to get things working again. I expected some pain as I start to break the scar tissue up and form better tissues in the area. Being able to directly ice my ankle has provided some nice relief and kept the swelling down. I took an opportunity to explore some of the literature related to achilles tendon ruptures (ATR). There seems to be studies indicating no evidence of a difference with and without surgery after 6 months. Those studies might have ignored looking at differences in trajectories over time as they all seem to use relatively simple statistical analyses to compare different outcomes at fixed time points. I wonder if they are missing differences in recovery at earlier time points... More on this later when or if I find some studies I want to use in my class in the fall and really dig through the details.

I have been enjoying watching Teresa get into running in the last couple of weeks. It is early days for her doing this, but she seems quite taken with it. Before my injury, we would go for bike rides and I would often ride ahead and then loop back to ride with her for a bit. Whenever I get back to doing fun stuff, I suspect she will be giving me the same treatment. It will be a while before I get to going ahead of her again.

We have been dealing with fireworks "season" here in Bozeman, MT. In 2004, non-flying, non-concussive fireworks were legalized for July 3, 4, and 5th (I guess). This has lead to Bozeman sounding like a war-zone for about a week around the 4th. We tend to hide in our basement a few weeks to try to get some sleep and let our dog keep from overloading in adrenaline. Our personal problems with this vary depending on how much our close neighbors choose to violate the law. This year was one of the worst in recent memory... I like to think people are generally clueless about the actual laws here (Bozeman ordinance), the impacts on pets, babies, wildlife, the environment, and people that actually try to work in the mornings during this time of year. An interesting article about pollution from fireworks and a potential method of reducing it for professional shows is here. I think Bozeman's "real" show had fewer loud concussive fireworks and was much less jarring than previous years. I appreciate that change and wish all of our neighbors would read and obey the regulations. I also wish the city would ban all fireworks because most people seem to have missed (or outright disobey) the nuances in the current law.

I really like Bozeman but I do think the city council has missed the boat in their regulation of fireworks and the police in terms of trying to enforce the laws. I don't really blame the police, because I think they have many difficult laws to enforce at this time of year.

I will stop ranting about fireworks as I am headed out to the doctor to get fitted into my boot. It will be interesting to see how hard it is to walk now. My calf muscles now can contract and I am only lacking a few degrees of flexibility in the injured foot. I will be really happy to be free of crutches and scooters in the near future...