Sunday, September 30, 2023

 Sunday, September 30, 2023

   My PT said I have fulfilled my range of motion expectations. Katie had me working on strengthening exercises now. I started on the hand bike for six minutes, three minutes in one direction and three in the other. The PT measured my range of motion on a finger step. With my right arm, I got to level 31; with my left, 26. This is not as far as I will be able to get. PTs have limited objectives. Reaching the full range of motion takes time, effort, and money. My visits to the PT have been reduced from two times a week to once a week. The final goal is up to me.

  I had the same situation when I fell down a flight of stairs when I was 35 and tore my rotator cuff. I iced my shoulder every night and exercised for several years. I achieved a range of motion greater than most people with uninjured arms.  

   I saw an orthopedic physician's assistant right after I saw the PT on Friday. My instructions were to get information on my limitations. She told me there would be no limitations. I asked what about reaching behind my back. She said I would be able to do that. It might be a good idea to wait for six months. The only time she had seen reaching behind be a problem was when someone refused to wear a sling and did that reach behind his back two weeks after the surgery.

  She told me a story of her own experience. She had a shoulder injury that left her arm limp. A doctor told her she would have to live with it. She continued lifting weights and using a TENS machine nightly. She regained her full range of motion. It took time and effort, more than any insurance company is willing to pay. Their acceptable goal is basic functionality. It's up to the patient to achieve anything greater than that. I was good for that at 35 and will do the same now. I understand the position of the insurance companies. However, I resent the position that the patient can't move on independently. Most people would not think to achieve more or be willing to do the work. I enjoy the challenge.

  The orthopedic PA recommended I get a TENS machine. She marked the spots on my forearm and shoulder where to apply the pads. When I got out to the waiting area, I took pictures of the X marks. One I couldn't reach on my own. I asked a woman waiting to take the shot.

  As I left Kaiser after my orthopedic appointment, I stopped by to check if I could get my latest Covid vaccine. Today was the first day Kaiser had the latest vaccine available. The line wasn't bad at that point. I learned the line had been out into the parking lot earlier when they opened at 8:30 a.m. However, It was almost the nurses lunch hour. I decided to get in first thing on Monday morning rather than wait.

    When I arrived at Ula Wini, the supervisor had a list of names of kids who wanted to work with me, four names of kids in first through fifth grade. Two were emergent readers; they couldn't recognize any words. B can decode words, but she can't remember the words they or there from one minute to the next. A reads on a high first-grade level and is responding well. A little girl I hadn't seen before who looked like she could be A's sister, whose name was not on the list, asked for help. She wrote her name. Oh, dear. I wondered about her education. I found out; she had none. She had never gone to school. B and A claimed her as sister. C didn't look a bit like B. Either way, I had to let Josephine know she had one that hadn't been to school yet.

  I couldn't find Josephine. I walked away. I assumed Josephine was in charge and the other employees were ineffective. One of the women pursued me when she heard what I wanted to tell Josephine. I showed her how C wrote her name. The woman walked out with me to find the girl. I told her C was A and B's sister. She knew better. She asked all three girls what house they lived in. If they were all sisters, I was one of their sisters, too. The woman would track down C's story and find out why she wasn't in school. Josephine had uncovered a child who wasn't sent to school for eight years. The parents' explanation was they couldn't fill out the application form. They were probably telling it the way it was. They couldn't read or write and were uncomfortable asking for help.

  L, the ninth-grade student who asked for help, arrived. The older children's bus drops them off an hour later than the younger kids. I promised to help her with comprehension today. I started the WbyW process with material on a third-grade level. 

WbyW resembles sentence diagramming using questions. After I did two sentences with that process, I asked if she had any grade-level material in her backpack. No, she did not. What?!!! I remember lugging books back and forth from school daily. I found a sixth-grade book I had used with another student on my Kindle. It was in a poetic form. Ninth-grade L told me she had problems with vocabulary and comprehension. English was her second language. Of course, she didn't use a sophisticated version of her native language. She just used it for domestic conversation and when speaking to her peers. She didn't know the words peel or apron. As we worked, I encouraged her to use the two new vocabulary words as we talked about what happened in the story. I had lots of fun doing this work. L did, too. Once I get kids to see language as a puzzle, something to figure out rather than something transparent, it frees them to take on the challenge of comprehension.