This week in Qingdao

The following is Joseph's latest update from Qingdao, China:

Monday May 26

After a weekend of rest, Monday was back to work as usual. It seems like Jason (my physical therapist) and his assistants are pushing me harder and harder as time goes by. We've been transitioning from simple upper body exercises that isolate a single muscle group, to exercises that involve multiple muscle groups at the same time. I think this is more effective in actually producing functional movement for me, but it sure does wear me out! We've also been working on rolling over onto my side from a sitting position. Jason assists with my lower body quite a bit, but I am improving my ability to throw my arm across my chest to get my momentum going. Without any kind of lower body or trunk control, rolling over it is a pretty difficult task. But I'm discovering ways to manipulate my shoulders to flip my upper body around. I'm much better rolling onto my right side, which involves throwing my left arm around, then I am in the other direction. It's encouraging to see this kind of improvement.

Many of the new patients coming in do not require physical therapy. These patients are here for vision problems, certain types of traumatic brain injuries etc. This of course frees up the equipment in the gym. Consequently I have been spending extra time on the tilt table instead of going to lunch at our scheduled time. A lot of times while I'm standing vertical I will strap weights to my wrists and work on shoulder shrugs. By rolling my shoulders around in different ways with the weights I can exercise parts of my upper back, as well as my shoulders and neck. Since I've been doing this I seen an improvement in my endurance in these types of exercises.

So far I feel like I've improved in a handful of specific areas, I believe this to be a direct result of the physical therapy I've done since I arrived. We have not discovered yet any kind of new muscle movement, systemic function or otherwise that can be directly related to the stem cells. This is of course is to be expected. As we have known all along, for spinal cord injuries most of the improvement is seen long after we leave the hospital, and over the following six months. I'm learning a valuable lesson in patience during my stay here. :-)

Before my fifth spinal cord injection on Monday, I had a good discussion with the doctors about the possibility of injecting the stem cells directly into my neck as opposed to my lower back. After reviewing the MRIs we took in Qingdao city, the doctors were not entirely sure if it would work. Their main concerns are the soft tissue areas around the injury, and in measuring exactly how far the distances between my skin and the actual spinal fluid. It was too soon to make any major decisions regarding this before my spinal injection that day, but on Tuesday afternoon for a CT scan to further investigate. As of today (Wednesday afternoon) I have not received word yet if there's been a decision made.

The spinal cord injection went smoothly. I did my best to sleep as much as I could to help the time pass during the six hours afterwards that I'm required to stay in bed. As has been done in all the other transplants, I was hooked up to an IV with fluids since the patients are not allowed to eat or drink for an extended period of time. This time I had then use my right hand that is less functional, so I can still do things like scratch my face and move the blanket around without getting the IV tubing all tangled up. Unfortunately finding good veins in my less functional hand can be quite tricky, and the nurse had a hard time doing so. Ultimately the IV "infiltrated" which means that it slipped out of the vein in the fluid was being deposited into the space between my skin and the meat of my hand. From what I understand that this is quite painful, and typically a patient with normal touch sensation in their hand would notice this right away. Of course I do not have any touch sensation in either of my hands, so there is no way of me noticing. By the time I woke up about half the bag of IV fluid had drained into my hand. When the nurses came in to do their normal rounds they noticed that my right hand was quite swollen (see picture). My hand was probably four or five times its normal width. It was really quite funny looking! The nurses quickly remedied the situation, and started a new IV in my other hand that worked just fine. Over the past couple days my right hand is slowly been shrinking back down to normal size. It's been very interesting to watch the process.

Tuesday May 27
Tuesday we found ourselves back into the normal routine. Physical therapy and the tilt table in the morning, acupuncture and electrical stimulation in the afternoon. We have been having the guys here teach Matt how to do acupuncture on me. It's proving more difficult than it looks. The needles are so thin that if you do not hit the skin with the right speed and momentum it just bends away and doesn't even penetrate. On Tuesday Matt had about six different tries and was never quite able to get the needle in, it was really quite funny. He eventually gave up and resolved to try again on Wednesday. I've been having the acupuncturist turn up electricity that goes to the needles by almost double. It still does not get the same reaction out of my muscles that the large electrical stimulation pads yet, but they certainly can single out the small muscle groups (like single fingers or toes, specific wrist motions etc.).

It amazes me how the physical therapists blend together Eastern, Western and ancient medicine all into one general practice. It's like they understand that good can come from all of that, and they simply take what works best for the given situation from each field and combine them into a more all-around approach to general wellness. It certainly makes some of the medical practices done in the United States seem somewhat narrow-minded. I think this encompasses well why I enjoy traveling to other countries so much. Because there is good everywhere, and there are many different ways to accomplish the same task successfully. Just because you've always been accustomed your whole life to doing something one way, doesn't necessarily make it the "correct way" or certainly not the "only way".

Tuesday night we had another little party on the hospital floor for all the patients and staff. Matt and I were in charge again of running to the store to buy the ice cream and goodies. It's fun having these little parties, even though everyone here comes from different parts of the world, we are all here for the same purpose, and we all have the same hope. It amazes me how quickly everyone becomes friends even when it is nearly impossible to communicate effectively. For example, last night after most of the patients had retired to their rooms, a few of us remained out of the common area to continue chatting. There is a thirty-something Romanian gentleman here who suffered a traumatic brain injury not too long ago. He and his father really don't speak a word of English, which makes it very difficult because the staff really only speak Chinese and English, and there are no other patients who speak Romanian who could help translate. Lawrence (the Romanian with the TBI) came in and obviously wanted to participate in the conversation. We all spent about 40 minutes talking with him about Romania, what kind of music you listen to, and what kind of food he liked. It was actually really quite fun. You could obviously tell that he is a great sense of humor despite the language barrier. It wasn't too long before we discovered he was a fan of the Spice Girls, and he was singing and dancing for us. Good fun was had by all!

Wednesday May 28
Wednesday during acupuncture Matt had another go at trying to get a needle into me. The physical therapist was kind of in a hurry today, so he didn't have a whole lot of time to wait for Matt. After a couple of tries he was still having a hard time getting a needle in, the looks like it'll be another day before Matt can call him self and acupuncturist. I guess I'm the perfect patient to learn to be an acupuncturist on, I don't feel a thing.
Anyway, I think that sums up the last few days pretty well. We are having a lot of fun, and keeping really busy.