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1 Year 5 Months Update: Water-Bound

irisappenrodtSeptember 4, 2019September 4, 2019Leave a comment

In this Update:

Water-Bound via Sea Kayak
Moving
Water-Bound via Packraft
Getting Ready for Hurricane Dorian

I am going to start by saying that I almost didn’t write an update for this month at all. This year has been emotionally draining, first with Ponce passing, then my dear friend’s daughter passing, while struggling with school and work obligations. I kept thinking how horrible 2019 has been for so many people, and that the year is not over yet…. Little did I know. I am not ready to share the gruesome and scary circumstances that came to light on August 12^th, but we are facing the hardest challenge of our lives right now, and I am mentally and physically in a pretty intense state. And no, it's not related to my back (which is fine).

With that being said, on Ralf's insistence, I will try to focus on the good times we had this month, which was all about water.

Water-Bound via Sea Kayak
During the second week of August, my annual leave officially started, and Ralf and I decided to use this time before the move to our new place to travel to Miami – a four-hour car ride - to renew his German passport. Those pesky Germans make you go in person every 10 years, and this year was his turn. The process has usually been very painful and frustrating but I must say that the consulate actually did a pretty decent job processing the paperwork without adding more gray hair to my head.

Welcome to downtown Miami!

And this is the obligatory photo-op from the women’s bathroom of the German Consulate…

Since we already made it all the way to Miami and had some time off, we decided to spend a couple of nights in Key Largo to do some sea-kayaking. We drove another 1 1/2 hours to what we expected to be this nice, tropical environment but were a tad disappointed. Driving into Key Largo was no different than driving into Cocoa Beach, a little run down, with lots of junk sitting around and adult stores down the street. Not the type of entertainment we were looking for….

But we made the best lemonade our of this lemon when we got a private tour arranged with an outfitter that rents out pretty nice sea kayaks. This was our first-time kayaking adventure, and I was a little concerned how my back would feel after sitting in one position in a tight space while using your feet to move the rudder. But kayaking turned out surprisingly more stable and manageable than I thought. Even getting in and out was not as difficult as I anticipated.

Our awesome guide Andrew took us through mangroves out into the Atlantic Ocean, where we spend 3 hours exploring. The water was clear enough to see the bottom, which is very different to being on a lake with much more murky water.

One special moment that I found very amusing entailed a couple of dolphins rounding up a school of herring. As we tried to paddle closer to the action, I suddenly found myself surrounded by bubbling water – kind of like a Jacuzzi – and something slapped me in in arm. Next, I see this herring jumping out of the water and right into my kayak! As the poor fella flopped around the bottom, all I was able to say was “fish!!!” I tried to catch it with my hands but that was easier said then done, especially while seated in a kayak. I used my paddle to prevent the herring from flopping away into the front while Andrew made his way over to me to snatch and release my distressed passenger. I hope the dolphin didn’t eat it after that, but I think it made it with most scales in place.

Another nice aspect of our stay in Key Largo was the nice restaurant with outside bar right at the water (marina) that was within walking distance, so we both could indulge in some adult beverages.

After a two-night stay, we drove back home – 5 ½ hours through multiple thunderstorms – to start preparing for our impending move to our new place.
When you see what you are driving into…..

... And there is nothing you can go about it! Oh, well... here comes the rain again...

Moving
Because our leases overlapped by over one month, we didn’t have to move within a day or so, which helped a lot. Nevertheless, moving is still pretty stressful, especially if you are moving out of a two-story town home. We both got our exercise in that way for sure. To save some time and money, Ralf and I moved a lot of the boxes, kitchen stuff, etc. over to the new place ourselves. Only the heavy and bulky furniture we left for Two Men and a Truck (there were actually three men, but who’s counting). They did a great job, and the main move went pretty smooth.

We still have to clean up the old place, but we are mostly done and ready to turn in the keys. I really, really like our new place, just the current circumstances prevent me from enjoying it much at the moment.

Anyways, all the activity between the long car ride, sea-kayaking, and then moving didn’t bother my back at all. Sure, I am sore after certain things (including running up and down two stair cases all day long), but nothing pathological or unusual.

Water-Bound via Packraft
Shortly after our main move, Ralf’s packraft finally arrived. Believe it or not, but this raft only weighs four pounds, folds up to small bundle to be carried on the bike, while being able to strap said bike to the front of the inflated raft to cover some distance by water – packrafting it is! Since our new living area is so nice and open, we were able to inflate the raft inside – much to the joy of Ralf!

The next day, we gave it a try at Moss Park on Lake Mary Jane. Since last year’s hurricane, the beach area of this lake has been permanently closed. So we just went on the side of one of the canals and put the raft into the water. Let me just say that paddling in a packraft is very different compared to a sea kayak. It’s more demanding on the biceps, and fighting currents and winds is also more of a challenge. But it was a lot of fun, and Ralf and I took turns until the incoming thunderstorm ended our first packraft outing.

A couple days later, we returned to Moss Park for a more extensive outing. A very funny moment came to pass when the ranger at the entrance eyeballed our half-inflated red raft in the back of our vehicle. She asked us if we were planning on going on the water, and we said yes. She then was quite worried and urged us that under no circumstances are we to launch from the side of the canal or any other unofficial place due to alligators (oops, we kind of already did that a couple days ago… oh, well). We were instructed to use the official boat ramp, located a little further up from where we launched previously. Since we didn’t want to cause any trouble, we parked by the boat dock, inflated the raft, and carried it over. And what do you think we found? The ONLY alligator, sunbathing in the middle of the boat ramp!!!

Ralf had to shoosh him away (I missed to film that adventure), and after the gator swam off into the canal, we were finally ready to get the raft into the water. This time, the weather held up nicely, so both of us were able to take turns and paddle all around the island located within Lake Mary Jane.

PS: the gator never returned….

Getting Ready for Hurricane Dorian (More Water)
Now that September is approaching, so was Dorian. We really, really could have done without a category 5 hurricane, snailing its way toward Florida’s east coast. To be honest, it wasn’t so much the hurricane (ain’t our first rodeo) but the impact on schedules and important appointments. Two years ago, Ralf, Ponce, and I stayed at the hospital because I had to work during the storm but this year, we were hunkering down together in our newly boarded-up home. It’s like living in a cave for five days… Getting these shutters up turned out to be a major project, and the bags of mulch were no joke either. Did I mention that it’s still super-hot and humid in Florida right now?

In addition, we just kind of plopped a lot of our stuff down all over the new garage. Now we needed to make room for two cars to fit. I suppose, the upside of Dorian was the motivation to get the garage organized and shelving assembled…

Garage before…

Garage after!

Today is Wednesday, September 4th, and Dorian came and left. Our friends who live closer to the coast got hammered by a lot of rain and wind gusts, but Orlando was spared for the most part...

I feel for those poor people in the Bahamas, who undeniably got the full wrath of this hurricane.

Since we didn't get to eat any of our hurricane foods, we are all set for the next one...

1 Year 4 Months Update: Slow and Steady DOES win the Race!

irisappenrodtAugust 3, 2019August 3, 2019Leave a comment

In this Update:

Getting Stronger!
Mind your Step
No more Grades!

Getting Stronger!
So, I can proudly announce that I have been working out (mostly) in a very consistent way! Even though my schedule continues to throw me curveballs here and there, I have been going to the gym at least twice a week (with a few exceptions). I have made slow but consistent progress, which I really wasn’t aware of at the time until my latest push-up day on 07/26: I started out with doing incline push-ups in late May using a box because I was too weak to do them lower. I have reduced the height/incline over time but on this day, Angela instructed me to only use one bumper plate. I wasn’t quite sure about that, but as it turns out, I got significantly stronger over the last two months!!!

Here is a short video of me doing push-ups on the box on May 20^th….

… and here is the result of consistent training on July 26^th!

I suppose, this would be already exciting for someone who just want to get in shape but to me, it is a freaking miracle! Before my lumbar artificial disc replacement (ADR) surgery, I would have fallen flat on my face and remained in that position if I attempted this move. But now, it feels great!

Angela also added a new move to my routine to further build up my shoulders and core: Prone Barbell Rows.

... which is an upgrade from the single-armed dumbell row...

Mind your Step
Ralf and I managed to visit a couple of wilderness preserves as well. However, this time we explored by foot rather than by mountain bike. You see, Florida summers are rather water-filled, and over the last few weeks we had so much rain that I was about to suggest to built another arch, just in case.

Our first outing was to the Seminole Ranch Conservation Area (not a place many people tend to go). It was pretty hot and steamy, but the jungle-like vegetation and beautiful wildlife (especially birds) made it all worth it. The trails weren’t very technical but they ended up to be flooded at times, which is nothing new, and this wasn’t the first (or last) time I was wading through ankle-deep puddles.

I am still laughing out loud when I remember the following scene though: As I am walking down my side of the trail, I see something colorful laying right in front of me.

Me: “Oh look, is that snake skin?”
*as snake is lifting its head*
Ralf: “Yeah, with the snake still in it!!!”

Turns out, this was a Pygmy rattlesnake, and they are indeed venomous. As I slowly step around the snake, Ralf steps a tad closer to make a positive ID. What he didn’t realize was that he was now standing in a fire ant hill! Let me tell you, these sneaky little bastards don’t bite one at a time, they all crawl on your ankle and bite at once, so you won’t know it until it is too late. I am still wondering if that was a joint operation between the ants and the snake…

Our second outing was at the Isles of Pines Preserve, which is only 10 minutes from our house. Not many people come here, so the trails were pretty overgrown at times.

This hike turned out to be a real workout: not only were the trails overgrown, but they were significantly torn up by pigs, in addition to the ground being soft and squishy, which is apparently a great way to exercise your ankles and calves…

But at the end of the trail awaits a gorgeous lake (Lake Mary Jane), so that makes it all worth it! However, my ankles were so sore the next day, I had a hard time climbing stairs!

No more Grades
Sooo, I turned in my evidence-based research paper on July 17th (45 pages of glory!), and on July 31st, I had to present my evidence in person in front of my peers at the University of Central Florida! It felt quite strange when I drove onto the College of Nursing campus parking lot, as I had done hundreds of times before, years ago during my BSN program.

I was pretty stressed out, even though it was my own research paper that I should be VERY familiar with, but still, I am (and always have been) a stress muffin!

Now the semester is over, I got my A (hallelujah!), and the next semester will be the LAST! Since it “only” entails my 180-hour internship that I have to complete on my days off, I am done with grades! The internship is Pass/Fail, so my GPA is what it is now! I am not saying this will be an easy semester but it takes the pressure off when grades are not an issue anymore.

Tomorrow, Ralf and I will take a trip down to Miami and the Keys for a few days. After our return, we will tackle a whole different monster: We-Are-Moving! Stay tuned!

1 Year 3 Month Update: Progress!

irisappenrodtJuly 9, 2019July 28, 2019Leave a comment

In this Update:

12-Week Workout Routine
Biking in Florida Summer
Mini-Deployment

12-Week Workout Routine
I made it to 12 weeks of continuous workouts, at least 2-3 times per week! For me, that is huge!!! The demands of graduate school, full-time work, and other obligations really made it extremely challenging to stick to regular workouts – much to my dismay! As a result, I was told that my arms look more toned, and I feel stronger. My low-grade backache is also under control, which I credit to the fact that the worst part of my studies is finally over and I don’t have to be glued to the laptop for endless hours. In fact, I just applied for graduation, FINALLY!!!

Progress is slow but steady at this point, which is totally alright with me. I am not in a hurry. My back feels fine, and I am able to hip-thrust 100 pounds at this point. The key is to do the movements in a slow and controlled manner, adding weight in small increments. I certainly don’t want to be an Olympic weightlifter but adding weights is so important for healthy bones and muscles.

This is my “happy post-workout” face

Biking in Florida Summer
Some would call us crazy to go biking in the wilderness during summer in Florida. Well, I admit, the heat index was about 107 degrees but as long as you take enough water, it can be done!

We went to Hal Scott Preserve, which is not too far from where we live. We were the only ones present in the parking lot though…

Due to our now daily thunderstorms, the trails became rather ... interesting. For Ralf, it was an easy and casual ride – for me, not so much!

Trails went from….

… nice small gravel

… to teeth-shattering large gravel

… to grassy

…to muddy

…to wet

… to “I guess I will carry my bike through the water”

I was pretty much toast after this outing but not in pain. That tells me, though, that my endurance and leg strength still need some work!

Mini-Deployment
Last week, my co-worker and friend Bonnie and I participated in a “mini-deployment” with the Director’s 50 Emergency Response Team. The two of us were sent to a close-by mall’s parking lot to assess, treat, and rescue a home-health nurse who got injured during a tornado and was waiting for us in her damaged car.

I am pretty sure she was very glad that the damage to her car was just simulated and that she had the luxury of air condition while she waited. Here are some snapshots of our mission:

I am happy to announce that no VA nurse or federal property was damaged during this exercise, lol.

1 Year 2 Month Update: Consistency at Last!

irisappenrodtJune 9, 2019June 9, 2019Leave a comment

In this Update:

Sticking to my Workouts
Birthday Surprise
Biking at Charles Bronson (second try)

Sticking to my Workouts

I have mentioned this numerous times during the past year, and the struggle of sticking to a workout routine while working full-time in an ER, coupled with the demands of graduate school, are still an ongoing issue. However, I am finally able to say that I have worked out 2-to-3 times per week over the past seven weeks! Thanks to my personal coach Angela, I was able to follow a progressive workout routine that enables me to get strong and fit in a safe and consistent way. I am slowly increasing weights, moving from the baby-kettle bell (18 lbs) to the heavier version of 26 lbs for my goblet squats, or from the 35 lbs barbell hip-thrusters to 65 lbs. I can even do hand-stands again, lol!

At this point I want to mention that I have had some lower back aching (!) going on that was quite persistent. I blame this on sitting in my chair for hours on end, hunched over my laptop, writing my masters’ thesis on healthcare simulation, whenever I wasn’t working. This is still going to be the case until the end of July, when I will finish my LAST class of graduate school. With that being said, I also think that my training with Angela is the reason that this backache has not taken over, and I am fully convinced that this will go away, especially after those marathons at the computer will have come to an end. That shows you, though, how important it is to KEEP MOVING!

I assembled a view pictures of my workouts to document what I have been doing. In the near future, Angela will add running to the mix, which I am really excited about!

Birthday Surprise

Even though I have been super-extremely stressed, I made sure to be off work on my birthday weekend at the end of May to spend some quality time with Ralf. To my surprise, he booked us a trip to Vero Beach in a 5-Star resort hotel, with a room facing the ocean so we can see the sun rise in the morning! We even had our own cabana at the beach – with beach service! I guess I can say that I turned 44 in style… You did great, sweetie!

And we scored two very nice dinners, one paid for by his mom, and the other paid for by my mom as a birthday gift.

Biking at Charles Bronson (second try)

I can clearly remember when we attempted to bike at this place last year. Epic fail! The trails were so muddy that it was like riding through syrup, and since I still had my old bike with the regular tires, I didn’t even make it past the 2-mile mark.

So, now we returned to do a re-trial: I now have my new mountain bike with plus tires, and due to lack of rain, the trails were mostly dry. HOWEVER, that apparently didn’t mean that riding those trails was any easier! The first part that was so muddy the last time was now all torn up and deeply rutted all over the place, which made it hard at times to see where I should be going.

One cool encounter was with a tortoise we crossed path with at the beginning of our ride. It was sitting right in the middle of the path, so we stopped to not startle it. Normally, tortoises will go the other way or retreat into their shell, but not this one! In fact, as I was deciding if I should just dismount and push my bike slowly past the (pretty big) guy, it started running towards me! And I mean, running! I have never seen a tortoise move so fast, and as it got closer I could actually hear him breathing. All I was thinking was “is he coming for me? I guess he is…”. And sure enough, the tortoise came all the way over and then stopped next to my foot. Maybe he was trying to say “happy birthday”? Well, this will remain a mystery…

Then we entered a segment of trails on a more hard-packed, level surface where we first encountered a free roaming bull (which made me worry about how he liked my bright-orange bike) and then a big flock of wild turkey that crossed the path by cutting us off. I found a gorgeous feather that may have belonged to an eagle. After miles of all this, we decided to explore one more segment of the forest, which ended up being loose sand. Considering that it was close to 100 degrees, this turned out to be major work, and we had to turn around and abort mission at that point. But overall, this time was a lot more fun than being “stuck in the mud”!

1 Year 1 Month Update: A Muddy Adventure 2

irisappenrodtMay 1, 2019May 1, 20192 Comments

In this Update:

A Muddy Adventure
Mass-Casualty Incident (MCI)
School, Work, and Devastation

A Muddy Adventure
A couple weekends ago, Ralf and I drove four hours south to the Everglades to participate in the Fakahatchee Grind – one of those bikepacking events organized by Singletrack Samurai (Karlos) that Ralf has participated in many times in the past. However, this time there was a difference: instead of me dropping Ralf off/picking him up for such events, I actually tagged along! Besides the long car-ride, this event also entailed tent-camping and riding on muddy trails during a downpour while avoiding getting eaten by a gator…

When we arrived at the Fakahatchee Preserve in the late afternoon, we were greeted by a school of vultures that we had to pass on the way to the camping area. A bad omen? Not really, but it was a tad weird…

After setting up the tent and getting the bikes ready for the next day, we sat around a campfire with other participants before turning in for the night. This was the first time I slept on a flimsy mattress in a (barely) two-person tent since I was 16 years old… The good news: it didn’t bother my back at all, not the crawling in and out of the tent, nor the cramped and unusual sleeping-positions I had to assume. I have to admit though that a possible future investment into a small camper sounds like an excellent idea…

The next morning, Ralf and the other riders got ready for the start of the Fakahatchee Grind. Since the shortest route was about 45 miles long, I decided to do my own thing. I am still trying to find a good saddle that I can sit on for long periods of time, and I was afraid that I won’t be able to keep up at this time.

After the group departed, I broke down the tent and packed all our belongings in the car. I then got a paper map of the preserve and looked at my options: Karlos suggested to follow the scenic trail to Gate 7, from which I could get to some of the actual trails. That sounded like an excellent idea – if it wasn’t for the monsoon that started to pour upon me about 45 minutes into my ride.

After riding the scenic trail for about six miles, which was mostly hard-packed gravel, I made it to Gate 7. As I am approaching the gate entrance, I saw an unraveled piece of tire laying smack in the middle. That was until I realized that the tire was indeed the tail of a giant gator. When I was only a few feet away, it decided I wasn’t worth the hassle and lazily made his way into the bushes and adjacent body of water. In my surprise, I wasn't fast enough with my camera though and only got the "tail-end" of things....

Even though the rain was now really starting to pick up, I entered the trail and started my exploration. Well, rain turned into a whole lot of water, which turned the ground into a muddy mess and significantly reduced visibility within a couple of minutes. As I pushed on, bumbling over rocks, cypress knees, and through mud-holes, a I saw headlights approaching me, fast! Mind me not, I am in the middle of the woods, somewhere in the Everglades! As it turned out, a park ranger had to rescue a rider who fell off his bike and seriously hurt his leg just a mile up the trail. He was in a golf cart-sized four-wheeler, so as he came at me, I squeezed myself with my bike as close to the edge of the jungle as possible to let him pass. The ranger inquired if I needed help as well, which I declined. I was going to finish what I started!

When I reached a fork on the trail, I tried to rely on my paper map for orientation. Well, the problem was that it more or less dissolved due to the rain, and when I pulled it out from my waistband, the ink was stuck on my belly like a tattoo and the pages just stuck together. Great, there goes my navigation. I decided to turn to the right in hopes to eventually re-connect to the scenic trail. Unfortunately, as I pushed on, the trail started to fork again, going in three different directions. Since I was by myself, I decided to play it safe and turned around to backtrack where I came from.

Luckily for me, I marked the correct trail with an arrow in the ground so that I wouldn’t get lost in case I had to retreat.

That kind of made me feel even more like an adventurer, and I admit that even though I was covered in mud, completely drenched, and on my own, it was a lot of fun! On my way back down the trail, the rain finally stopped, and I got to explore a few strange structures along the way, such as an abandoned cabin and a rather deserted “picnic area”. Unfortunately, I couldn’t really stand still for long due to biting yellow flies that found me very tasty. I suppose all the rain had washed off the Deet and sunscreen, exposing me to become part of their menu.

I finally made it back to the scenic trail (and thank goodness, the gator did not return). At this point I decided to continue on the trail to its end point (another seven miles), and then turn around to return to camp. I saw a lot more gators, turtles, and birds along the way (it was pretty scenic, lol), and when I reached the end, there was actually a checkpoint set up by the park rangers, with water. As it turned out, I just missed Ralf and his group that came from a different trail, so he had 30 more miles to go, whereas I chose to backtrack the 11 miles on the scenic trail.

Upon my return to camp, I discovered the outside shower that was set up! So I grabbed a change of clothes and a towel and started walking to the shower area. That is when a truck pulled up next to me, and the couple then asked me if I wanted the rest of their baby shampoo. I suppose I looked the part since this was the first time that some strangers offered me shampoo as I was walking on the side of a trail, somewhere in the Everglades…

In any case, this was a very nice adventure, and I am truly amazed about the things I can do again. Ralf and I spend the night in a B&B in Everglades city, which I was so grateful for, and the next day we made our way back home.

Mass-Casualty Incident (MCI)
This month, our community conducted the annual MCI training event, in which all hospitals, first responders, and other ancillary services train together during a mock mass disaster event. This year, the scenario entailed a massive explosion at the convention center, along with four active shooters. There were over 200 “victims” with various degrees of injury, and we got 20 of them at the Orlando VA Hospital. Since I am part of the Emergency Response Team, my role was to “treat and stabilize” in the made-up treatment area and then decide who gets transferred to the ED first. I must say that even though this is all “make-believe”, these events are very intense and chaotic, so I was pretty drained after all was set and done. Emergency Management and Disaster Response have always been a passion of mine, and I hope our team gets now more training opportunities as funding has finally improved this year.

School, Work, and Devastation
April also marked the last month of the spring semester, and between full-time work, helping out with TNCC classes on my days off, and pending assignments and research papers, I never really caught a break besides the outing to the Everglades.

However, all this paled in the face of tragedy, as my dear friend Bergie's beautiful daughter Lourdes suddenly became gravely ill, went into respiratory failure, and ended up on a ventilator and a “rotoprone” bed in the intensive care unit within one week! It was only a few months ago that we celebrated Bergie’s birthday at Hamburger Mary’s! It was Lourdes who made me flowers out of tea bags to include in the beautiful gift basket full of inspirational items the day before I flew to Germany to have spinal surgery – just to give me courage and support!

beLots of prayers and a couple miracles that needed to happen made it possible for Lourdes to go home on high-flow oxygen and pain medication on April 23^rd – that was her ultimate and dearest wish, to go home! I so wish she had more time but this pure and beautiful soul passed away peacefully at 04:45 AM the following morning, leaving her mother Bergie and all her friends in devastation. I am just grateful that I was able to rub her little feet and say good-bye to Lourdes, but I am pretty mad at the universe for taking her away so suddenly and unexpectedly. Of all the people on this planet, Lourdes deserves to be here! And I truly wish I had more time to get to know this incredible human being and shining soul much better. We love you, Lourdes!

One-Year Update: Special Edition! 1

irisappenrodtApril 4, 2019April 4, 20191 Comment

In this Update:

Reflection
Follow-up X-rays
Starting from Scratch
Emergency Management

Reflection
I am 12 months post-op, wow!!! Last year, same time, I was admitted to the SANA Dreifaltigkeits-Hospital in Cologne in hopes to reclaim my life. The feeling of finally boarding the airplane to fly overseas to have a German surgeon I have never met operate on my spine was simply indescribable: I would say it was a mix between anticipation, fear, and hope. Ralf and I arrived on a Saturday, the day before Easter and our 8-year anniversary, and I was admitted the following Tuesday. I met Dr. Desai that Tuesday for the first time, and I do remember that most of my worries melted away, and deep down, I knew I would be alright. And so it came to pass!

I decided to capture my reflection on video, and I hope that maybe it will help someone else, who faces a similar situation, to get through such a life-changing experience. I have also compiled some pictures from that time last year.

Ralf and I spent our 8-year anniversary (which also happened to be Easter Sunday) eating dinner at a Spanish restaurant in Cologne. He has suffered just as much through the last couple of years, so we both were ready to get this surgery done and over with!

This was my spine before: it still blows my mind how one degenerated disc (in my case L5/S1) can cause so much crippling pain and disability!

I remember everything! Dr. Desai actually stayed with me for 15 minutes in pre-op, talking to me until I was "put under" ...

Here I go, walker and all, for a stroll down to radiology to get my 1-day X-rays taken by Dr. Desai! At that time, ALL of the "old, crippling" pain had just vanished!

This was the first time I got to see my new spine, including my beautiful LP-ESP. Even though, the portion the covers the underside of L5 is a tad too long (2mm), the ESP covers my the entire endplate of S1. Fantastic outcome all around!

Here is an "up and personal" look of what's inside of me now (of course I got a new one, not the model, lol): the LP-ESP feels very stiff but that is great for protecting the facet joints while still providing motion in all six degrees, including shock absorption!

Here is my incision at two weeks right after Dr. Desai pulled my stitches versus today. Best scar ever!

And of course I had to wear my custom-made back brace. If it wasn't so stiff, it could have actually passed as a fashion accessory! So, after the six weeks were over, I had to find a purpose for that thing... Nailed it!

And here I am, at my last follow-up visit with Dr. Biren Desai, the person who gave me my life back! I might be biased but to me, he is not just an incredible surgeon but also a kind and humble human being. Thank you for everything, Dr. Desai!

Follow-up X-rays
And here they are: my 1-year follow up X-rays (lateral, flexion, extension, anterior). Dr. Desai said they look perfect, no issues whatsoever!

1-Year Lateral view:

Here is a side-by-side lateral view comparison of my 1-DAY old X-ray (Left) and my 1-YEAR old X-ray (Right):

Flexion (Left) and Extension (Right):

Aaaand anterior:

Starting from scratch
I know I said it a few times in the past, and believe me, it wasn’t for lack of motivation that I didn’t get to stick to regular workouts as planned, but things are starting to fall into place. Since I missed six weeks of workouts due to my overloaded, crazy schedule, Angela had me start from scratch, and this time, I WILL make it happen!!!

Food for thought: During the time that I was still on FMLA (when I was off during the first three months after surgery), I was very active, but as soon as work and school resumed, all bets were off! That is something that others in my line of work/type of schedule may face themselves, but even if you can’t make it three times per week to the gym, recovery from ADR can still go well…

Ralf and I also made to Seminole State Forest for a 2-hour bike ride through those beautiful (and often bumpy or sandy) wooded trails… (yes, it's the end of March here, those are the perks living in Florida)

This picture has actually a very personal meaning to me. Before my pain prevented me from doing anything physical anymore, Ralf and I did a lot of outdoors activities together - always together. That was taken away from us when I couldn't come anymore due to being disabled. But now, we can - together!

Emergency Management
My plan is still in motion: I decided to use my MSN Nurse Educator degree to try to transition to the incredible National SimLEARN center in Orlando (still VA) to reduce my stress level and have a more structured schedule. But even if I leave the bedside to continue my nursing path in a different role, I still have my Disaster Response and Emergency Management teams to provide some "hands-on" emergency nursing. April 2^nd was our pre-preparation meeting to go over detailed plans and check our gear for the upcoming annual Mass Casualty Incident (MCI) drill, an interdisciplinary mock mass casualty event that all emergency services within the city of Orlando will respond to!

11 ½ Months Update: Approaching One Year! 1

irisappenrodtMarch 21, 2019March 21, 20191 Comment

In this Update:

Changing roles
Getting ready for my follow up
Petition
Cirque du Soleil – Luzia

Changing roles
I love emergency nursing. In fact, I joined the Emergency Nurses Association while I was in my senior year of nursing school. But what that last year has also taught me is that I need to decrease my level of constant stress and look out for my health. Granted, my initial disc herniation at L5/S1 was due to a car accident many years ago but I can’t deny that my job certainly didn’t help, especially during the last couple of years when things got from bad to worse. Most importantly, I realized that being under constant stress the way I have been is not how I want to continue my life.
So, I decided a while back to make some changes, but it will most likely take me until the end of the year to make it happen. Good news is that I can still be on the DEMPS disaster relief team and on my local Director’s 50 Emergency Response team – both also passions of mine.

Sooo, we have that impressive National SimLearn Center located right across from where my hospital is at (it’s also VA-related). I am going to finish my Master’s degree as Nurse Educator by the end of this year, and I really would like to transition there. One course that is being taught at the SimLearn Center is the “Trauma Nurse Core Curriculum “course, so I decided to become an instructor. Unfortunately, I work under management that doesn’t really support growth and continued education, and during the last couple of weeks I actually had to use my days off and even vacation time to attend this class where my performance was evaluated. That meant that I had to deal with 16-hour days. After eight hours of class I had to finish up eight hours of work, so I was ‘on’ from 7 o’clock in the morning to almost midnight, and only to do it again the next day. Mind me not, I had to take vacation time for the class hours that overlapped the beginning of my shift... But I did it. Somehow. It’s a blur at this time. So, say “hello” to your new TNCC trauma nurse instructor!

Thank you, LP-ESP, for not letting me down, even though I was either standing for hours, sitting in a class room for hours, or running around at work for hours. Couldn’t have done it without you!

Getting ready for my follow-up
Also quite exciting, at least to me, is the fact that I am approaching the one-year mark post ADR surgery! One year! I just got my orders placed for x-rays and will be getting this done this coming Thursday. Dr. Desai’s office sent me a link to submit my images electronically, and if that works out as planned, this service will be available to all future patients!

I am planning to write a more detailed reflection on the past year in the next edition. I am actually quite anxious to see what the images look like, especially since I didn’t work out for an entire month due to the stress and lack of time from work, graduate school, and other miscellaneous obligations. I did hear some weird clicking sound a couple of times during the past several weeks, but I couldn’t quite place it. I have absolutely no pain, so I am not sure where it came from. It didn’t happen often, and I haven't heard it in a while, so I hope it is benign.

Petition
I received an email request through my website from Backernation.com, asking me to share a petition they started in an effort to overturn Aetna’s stance on denying lumbar ADR coverage for their patients.

Aetna’s policy review of lumbar ADR coverage is coming up in June, so Backernation created this petition as one way of ensuring that our voices are heard: http://chng.it/6Q9mxPvcVS

I have been on their website in the past when I was doing ADR-related research, so I am somewhat familiar with them. Backernation also shared an article that explains why Aenta changed their policy in the past to refuse lumbar ADR coverage now: https://backernation.com/healthcare/insurance/major-health-insurer-refuses-patient-access-to-lumbar-total-disc-replacement

In any case, I thought I share.

Cirque du Soleil – Luzia
Even though I have been so stressed and feel like the days are simply not long enough to accommodate all I need to do, Ralf and I did attend the Cirque du Soleil – Luzia performance last Saturday night. Those tickets were a Christmas present, and we had not just awesome seats but also enjoyed the show tremendously.

Even with that extremely excited older guy that was sitting next to me, yelling “Bravo” and stomping his little feet with the music…. Because the temporary seating was rather crammed, it was a tad annoying (and I deep down wished for a syringe filled with Ativan a couple of times), but you couldn’t really be mad at the guy since he was obviously completely mesmerized… In any case, it was a nice break, even if it was only for a couple of hours.

... Ok, who else is a little disturbed by that guy???

11 Months Update: Keeping Busy – One Day at a Time

irisappenrodtMarch 6, 2019March 6, 2019Leave a comment

In this Update

Picking up the pieces
So much to do!
Spending time with friends

Picking up the pieces

The last couple of weeks have been very difficult, and I can only manage things one day at a time. We got our baby’s ashes back on Valentine’s Day, and it helped a lot to “have him back”. I had to rearrange my schedule because bursting into tears periodically at work wasn’t working out, so we decided to get away for one night to Coral Gables in Miami. I know some people may find that silly, but I couldn’t stand the thought that Poncebear would be home alone, so we took his ashes with us…

Now, I am slowly coming to terms with that our baby is gone, and I am grateful that I am somewhat able to focus on all those tasks at hand again. We made a nice memorial in our living room, and I touch his little paw print all the time. At least he is home…

PS: I didn't realize the variety of lizards south Florida has to offer...

So much to do!

With that being said, my to-do list appears to be a mile long, and between doing some work to connect Dr. Desai’s hospital administration with Blue Cross Blue Shield, graduate study due dates, TNCC Trauma Nursing instructor certification preparation, and heavy-duty stress at work, I barely get to sleep anymore. I admit that I am a tad overwhelmed right now, but at least I am not in physical pain. I can’t even imagine doing all this with a broken back and nauseating pain… So, I AM looking on the “bright side”, even though I didn’t get to go to the gym AT ALL since Ponce passed away. But after I am done with the last part of the trauma certification next week, I should have more time and less stress – I can’t wait!

Spending time with friends

Part of my busy schedule was due to the fact that I needed to “work ahead” to make time to spend with some special friends who visited us from Pittsburgh/DC for a few days. And, boy, did we make the most out of that short time.

We picked up Rachel, Mara, and Ana form the airport around 11 am, went for breakfast, followed by (yet another) airboat ride on the St. John’s river, which had a lot of gators to showcast. After that, we went for a 3-mile hike in the Orlando Wetlands Park (more gators), followed by dinner at our favorite Thai restaurant.

The next day, we all went to visit (and climb) the Ponce Inlet Lighthouse (yes, my baby is everywhere) by New Smyrna Beach. We got so lucky with the weather, especially since the rest of the country has been rather chilly these days… Now, to get to the viewing platform of the lighthouse, we had to take the stairs: 202 of them (of course both ways). That had my calves and thighs burning for sure, so I consider that a mini-workout. After another small hike through the area, we headed over to the Smyrna Dunes beach, located within a nature preserve. We even saw a bunch of dolphins so close to the shore, it was amazing!

Day three entailed a hike through Blue Springs state park, and even though there weren’t any manatees to be seen, we really enjoyed the beautiful scenery. I actually haven’t been there in a very long time (Ralf and I used to freedive there years ago). After Blue Springs, we visited the “spiritual community” of Cassadaga, but instead of having our fortune read, we went yet for another 2-mile hike through typical Florida trails.

So: first a LOT of sitting in front of my computer, coupled with running around at work, followed by lots and lots of hiking, climbing stairs, beach-walking, and sitting in the car to get to places (thanks for driving, Ralf!) were the “activity-highlights” of the last couple of weeks. As I mentioned, I hope to be able to return to the gym toward the end next week, and I am also thinking about some jogging to come. We’ll see how it goes.

Also, it is about that time to make an appointment with Dr. Gayles to get my 1-year follow up X-rays done! With all what my back has been through so far, I am quite anxious to see if anything has changed!

10 ½ Months Update: Victory and Devastation

irisappenrodtFebruary 12, 2019February 12, 2019Leave a comment

This is going to be a short update, but I wanted to share a victory that I consider huge, but I am also experiencing a very devastating loss right now. First of all, my back is still fine, I didn’t get as many workouts in as I wanted over the last couple of weeks, mostly due to a nasty sinus infection. Right now, it’s not my back that is broken but my heart.

Victory
I have fought hard and long to get my ADR surgery approved and covered by my insurance carrier, Blue Cross Blue Shield (BCBS). At the beginning of my journey, I tried to get pre-authorization in the United States, first in Miami with Dr. Garcia, then Dr. Zigler at the Texas Back Institute. Both of these initial attempts, as well as the peer-to-peer reviews were unsuccessful (the procedure was deemed not medically necessary). I was denied appeal rights in Florida (which I still believe was not legal), and the written appeal through Dr. Zigler was again denied. That is when I paid out-of-pocket and went to Germany to have surgery with Dr. Desai, which has turned out to be the best decision of my life.

Upon my return to the US, I filed an international claim with BCBS for reimbursement. At that point I knew of so many others who got reimbursed for the exact same surgery and disc. But of course, I was denied coverage yet again still on the grounds of the procedure not being “medically necessary”. I filed a written appeal, complete with letter of medical necessity and my medical history, but I was denied again, but this time for the ESP disc not being FDA-approved. I had one last shot: filing an external appeal. I made one last effort, making my case and providing all the evidence I had, and submitted that last year in September. In early October, I received a letter from OPM (Office of Personnel Management), confirming that my appeal has been assigned a case number. Then I didn’t hear back until now .

A few days ago, I received the letter from OPM, stating that the reviewing physician ruled that my lumbar Artificial Disc surgery WAS INDEED medically necessary and an appropriate treatment option for me. I got the Explanation of Benefits from BCBC today, and also received a direct-deposit into my account this morning, covering the majority of my medical bill (but of course not all associated costs). So, later today, I will go to my credit union to pay off the loan I had to take out to finance my surgery in Germany.

I consider this not just a victory for myself, but for all others who seek coverage for ADR surgery. Health insurance is not cheap, and the least they should do is pay for our medical needs when we need it!

Devastation
I have posted about my sweet baby Ponce in the past. Due to a congenital heart defect, he developed severe congestive heart failure that became very evident during the summer of last year. We managed his condition with a sophisticated medication schedule as best we could, and he was such a happy puppy! As his condition progressed, we bought a “Ponce-mobile”, a pet stroller to be able to take him places. We would take him to Menchies’ frozen yogurt to have the sample cup of vanilla ice cream. We sometimes would go to that Italian restaurant close to our home, getting a table outside with Ponce sitting in his stroller, waiting for snacks. Even with that bad hand that nature has dealt him, he was so happy and the best puppy anybody could ever ask for.

Since November last year, we started to carry him up the stairs in our townhome, so his big heart didn’t have to work so hard (he had the tendency to race up the stairs, which wasn’t good for his condition). So, in hindsight, I got to hold him in my arms so many times, and I would give him kisses on the head while walking up the stairs. I would give anything to hold him just one more time.

On Saturday, February 9, 2019, I came home late from my midshift at work. As I was about to walk in, Ralf came out with Ponce on the leash because the puppy was restless. Around that time, Ponce went into significant respiratory distress, panting, coughing, not being able to settle down. At 2 am, we took him to an emergency vet to get a shot of Lasix, a diuretic (“waterpill”) to get the fluids out of his lungs. After all, that was what helped Ponce the last time this happened. But not this time. We didn’t want to leave him at the vet all alone, so we took him home. But he was still struggling to breathe. So, we turned around and took him right back, where he was placed on oxygen. The vet informed us that there is no realistic hope that he would recover again from this, so we had to make that horrible but kind decision. We made our baby a promise that we won’t let him suffer.

Our precious, innocent, sweet Poncebear passed away in peace, in the early morning hours on Sunday, nestled between both of our arms while we talked to him, kissing his little head, petting his fur that was supposed to be groomed the very next day on Monday. Then we had to walk out of that room, having to leave behind our baby laying on his angel blanket on that exam room table, then sitting in the car in front of the vet’s office, having to drive away without my baby in the backseat.

Words cannot describe what I feel right now. I am chocking on tears, re-living this moment, feeling guilty, even though I know it was the right thing to do. I hate coming home, where there is no Poncebear greeting me at the stairs. He left such a huge void, and I hate the thought that he is “out there” until we get his ashes back, hopefully on Thursday or Friday. Then our baby will come home forever. We love you so very much, Poncebear!

10 Months Update: Stepping Up my Game in 2019!

irisappenrodtJanuary 23, 2019January 23, 2019Leave a comment

In this Update:

Adding Structured Training - For Real!
First Mountain Bike Outing in a While!

Adding Structured Training
After spending a wonderful time with my family over Christmas and New Year’s, I was hitting the ground running, starting the first week of January. One big benefit of writing this blog is that it makes me reflect on my progress (or lack thereof). I have to say that I haven’t felt all that great: I have been really sore between my shoulder blades and upper back (you could single out individual knots), my lower back has been fine but also tight, and my endurance level is pitiful. I do treasure the absence of the crippling pain every day though!!!

Here is a significant pattern that I am very much aware of: between my stressful job (and long hours), the demands of graduate school, and day-to-day errands, I just don’t find the time to do true workouts! Last summer, I was trying to commit to a structured workout routine every week, no matter what. I have to admit that this didn’t work out at all – I failed miserably! I realized that without guidance and structure, I won’t be able to do what I need to do in terms of exercise. So, I adjusted my strategy: my dear friend Angela Clough is the owner of the Crossfit Lake Nona gym, and she agreed to help me achieve my workout goals in a safe and effective way. Angela has recovered from a serious back injury herself, so she knows my fears (especially of lifting weights) and where I am coming from. She is creating tailored workouts for me, so that I can get strong and fit again without jeopardizing my new back.

Meet Angela, my photo-bombing trainer:

Over the last couple weeks, Angela assessed my abilities, strengths, and weaknesses in order to come up with a progressive workout plan. There were four “assessment days” during which my posterior chain, hamstrings, glutes, shoulders, and core were put to the test… But don’t let the word “assessment” fool you, I was soooore (in a good way, if you know what I mean) like I haven’t been in a long time!

First of all, I want to thank my physical therapist and trainer Bill for doing a fantastic job rehabbing me after surgery. Apparently, my back muscles are a lot stronger than expected, which was evident during the Sorenson test (see picture). I was able to hold the required position for 3 minutes and 10 seconds, which I was told was an excellent result! But now, I am ready to enter the next phase of fitness and wellness.

DAY 1
Starting out with some very basic movements and exercises to gauge my overall strengths and symmetry .

DAY 2

DAY 2
After Day 1, I couldn’t lift my arms over my head for a couple of days, even if my life depended on it during a bank robbery. I haven’t done pull-ups and push-ups like that in ages, and even though the pull-ups were banded, they kicked my butt, lol!

DAY 3
Day 3 was scary and exciting all at once. I know I need to re-introduce weight training into my routine to keep my bones and muscles strong. But I am not going to lie: I have been a tad leery about lifting weights but having such a competent coach has helped me gain the confidence I needed. To be perfectly clear, though, I have absolutely not ambition to become an Olympic Weightlifter or Powerlifter. But I need to be able to train with weights to protect my back and bones!

Here is the answer to the question that most likely crossed your mind at this point: how did/do I feel? AMAZING! Doing a deadlift correctly will tax your hamstrings and glutes but should never strain your back. At no time did I feel any pain or undesired discomfort during or after the move! After all: that’s why I chose the LP-ESP and its buffering properties. Before surgery, I couldn't even pick up my 13-pound senior-puppy!

P.S.: I also realized that I needed flat, non-cushioned shoes to secure a non-wobbly stance while lifting, so I got a pair of Nike Metcons (my first non-Hoka pair in a long time).

Before surgery, I couldn't even pick up my 13-pound senior-puppy!

DAY 4
At this point, I can already feel the effects of a structured workout program. I have more energy, my muscles between my shoulder blades and lower back are significantly less tight, and I feel overall a greater sense of wellness, if that makes any sense. However, Day 4 had a heavy focus on the hamstrings and glutes, so for the next couple days, I dreaded stairs and walked like a duck! But I am all recovered now and ready to begin my actual workouts this week!!!

Biking in Hal Scott Preserve
I haven’t had the chance to ride my new mountain bike much at all, lately. I am also still in the process of finding the right saddle for my butt, but maybe if my glutes get stronger, my tolerance will, too. So, last Saturday we went on a leisurely ride (my legs were still tired from the Day 4 workout) at Hal Scott Preserve. There is an interesting network of trails, going from grassy-overgrown, to hard-packed dirt, to large-gravel trails, to peanut butter mud holes. It was a beautiful Florida day, just before the next cold-front was rolling in. I think I should get properly fitted at JC’s bike shop to get the saddle-issue resolved. After that, I will be unstoppable!!!