Towel Theory

A popular way of looking at the effort that someone with a chronic illness must expend to get through the day is Spoon Theory. It came about when the author, who has lupus, was in a restaurant trying to illustrate to her friends how she must ration her efforts to avoid exhaustion. She gathered spoons from nearby tables, gave them to her friend, and asked her to list the activities for a typical day. As her friend recited the activities she would have a spoon taken from her. Once those spoons were used up, any further effort that day would be nearly impossible.

This metaphor for expending limited resources has become very popular in communities for those with such chronic illnesses; some even refer to themselves as “spoonies”. I’ve also heard Spoon Theory applied to introverts, who can be in social situations for a much shorter time than others. I am an introvert, and I guess I could never quite feel that Spoon Theory was an accurate description of what my exhaustion felt like. I’m also a bit too literal at times, so the concept of somehow your spoons getting replenished didn’t seem realistic – is there some spoon delivery service? Spoons also don’t lend themselves to division: how would you spend half a spoon? Yes, I understand that this is all a metaphor, but effective metaphors should have clear connections to the reality they are describing. For it wasn’t just the simple passing of time that recharged me; it was how that time was spent made a huge difference in how quickly I could handle more activity among others.

One day I was hanging up a towel after a shower, and I thought about the cycle of use for a towel. A fresh towel can dry off a person who has just bathed, but there is a limited capacity any towel has for this. Once it has absorbed enough water, it can’t absorb any more. So after drying the person, the towel has to dry itself out. And it isn’t just the passing of time that is needed, but also proper placement of the towel. Leaving the towel balled up on the floor would require a very long time for the towel to fully dry; it would probably get mildewed first! But if you were to hang it up so that air is able to circulate around it, it will be dry much more quickly. And if you hung it on a clothesline outside in the sun on a breezy day, it would be dry in no time at all!

Towels also come in different sizes and materials, both of which affect its capacity to absorb water. The drying task that the towel is used for also affects its usefulness: drying a hand here and there would never saturate it, but being wrapped around someone stepping out of a pool soaking wet would test its limits.

8pc Cotton Bath Towel Set - image 1 of 6

Introverts are like smaller towels that more quickly reach their limit absorbing social interactions. My experience attending tech conferences seems to mirror the cycle of towels. If I’m listening to sessions, with only occasional interactions, I can go all day. If I’m involved in lots of discussion-type sessions, I can’t go nearly as long. If I’m giving a talk, that’s even more draining. And when I’m staffing a booth, where I need to be constantly talking with all sorts of people, I run out of energy much more quickly. For a towel, that would be like being held under a running faucet: it loses its ability to dry very quickly.

How I “hang myself up” also determines how quickly I recover. I can sit in a corner of the conference and work on my laptop, but it’s much better if I can work in my room where there are no other people walking around. And what seems to work best for me is to go outside and walk around: the movement, the fresh air, the different visual scenery – all that helps me feel more energized. The last few years I have made it a practice that, weather permitting, I find a block of time toward the middle of the day, and go outside walking with my camera. Being a photographer, I can often get some good opportunities, no matter where the conference is held. And it seems that focusing my brain on creativity for an hour or so allows me to feel energized and able to immerse myself back into the conference events. It’s like a clothesline in the sun for my towel!

So I hope that Towel Theory does as much to help people understand what the introvert experience is like as Spoon Theory has done to help illustrate the situation of people with chronic illnesses.

Moving On

It’s been a great run, but my days in the OpenStack world are coming to an end. As some of you know already, I have accepted an offer to work for DataRobot. I only know bits and pieces of what I will be working on there, but one thing’s for sure: it won’t be on OpenStack. And that’s OK with me, as I’ve been working on OpenStack in one form or another for 10 years now.

Wait a moment, you say – OpenStack is only 9 years old! Well, before the OpenStack project was started, I worked on Swift briefly when it was an internal, proprietary project at Rackspace. After that I switched to the Cloud Servers team, which was the team that started Nova with NASA. So yeah, it’s been a full decade. That’s a loooonnnnggg time to be on any development project!

So the feelings of burnout combined with the shift away from OpenStack within IBM made moving to DataRobot a very attractive option. And after having done several video interviews with the people there and getting their impression of life at DataRobot, I’m that much more excited to be joining that team. I’m sure that for the first few months it will be like drinking from the proverbial fire hose, and that’s perfectly fine by me. It’s been much too long since I’ve pushed the reset button for my career.

Over these past 10 years I have made many professional contacts, some of whom I consider true friends. I will miss the OpenStack community, and I hope to run into many of you at future tech events – PyCon, anyone?

Withdrawal, Part 2

A few weeks ago I wrote about my first experience attempting to stop taking the painkiller Tramadol that I had been using in my recovery from a total knee replacement. I had been assured by my health professionals that it was not habit forming, but I found that, at least for me and many others, that was not the case.

Before that attempt I was taking 4–50mg tablets a day. I called my surgeon’s office to ask for some advice, and spoke to one of the nurses there. When she heard my question, she replied dismissively along the lines of “oh, don’t worry – you can just stop taking it whenever you don’t need it anymore”. I told her that that was certainly not true, and recounted what I had gone through when I tried to do just that. She was shocked, and said she had never heard of anyone having withdrawal symptoms like that. I mentioned that a quick Google search would show that I was not alone in this regard. But we did discuss a plan to slowly wean myself off of it, and that’s what I began doing. Six-hour intervals between doses became 12 for a few days, then 16 for the next few. After that I started cutting the tablets in half, and taking half a pill every 12 hours, and after a few days increased that to 16 hours. Note that all this time I was continuing to do my physical therapy exercises and walk 30+ minutes a day, without any pain at all. Last Sunday I was out of the house when my next dose was due, and didn’t get back until 4 hours after that. I figured I was at such a low dose that I could now stop taking it without going through as horrible an experience as I had earlier.

Sunday evening I did have some difficulty falling asleep, as my muscles weren’t able to easily relax, but eventually I did get some sleep. Not much, but enough to function on Monday. When I got up I felt fine: no pain, and none of the runny nose, coughing, or sneezing that I had had last time. But by the time night came, I could definitely feel my muscles getting tense, and I knew I would have trouble laying still. It was now about 40 hours since my last dose. I knew that this night would be tough, so I made a plan. I was going to stay up as late as I could, so that I would collapse from exhaustion and fall right asleep! I even took a couple of sleep aid pills to ensure that I would go out like a light!

Well, it was a good plan, but it didn’t work. The sleep aids did their thing, and I got really drowsy. I knew if I tried laying down in our bed that I would end up keeping Linda awake, too, so I laid down in the guest room and tried to rest there. Every time I tried to get in a comfortable position, though, my muscles would get tense and my joints would hurt, and I’d have to move. It felt as though I was twitching uncontrollably. I thought about walking it off, but I felt too drowsy to even sit up! It continued to get worse, tossing and turning repeatedly, never staying in one position for more than 5 seconds or so. At a few points in the night it got so bad that I had to sit up and flail my arms around wildly to get them to feel OK. I would start to doubt the wisdom of continuing – maybe I should take another pill and wean myself even further before stopping. But I figured that I had come this far, and I really wanted to see it through. Besides, I didn’t have any critical meetings or anything at work the next day, so I could take it off to recover.

I would look at the clock every now and then, and remember the time passing midnight, then 1:45am, then 3, then 4:30am, then…

The alarm went off! I had set it for 6am because my wife had to get up early for work. But that meant that I had finally fallen asleep! I got up, went to our bedroom, woke her, gave her a quick summary of the night’s events, and then crawled back into bed. I slept until almost 11am, and though my body felt a whole lot better than it had before, my brain was still pretty fuzzy. I wasn’t able to focus on any task for very long. I’m not sure if it was from sleep deprivation or another symptom of withdrawal. I tried reading Twitter but had to put the phone down after a minute or so. Same thing when I tried to play some games. I started writing this post that afternoon, but after about 2 sentences I gave up. So I watched some TV, laid in bed, walked around our garden, watched some more TV, and generally was a blob all day. When Linda came home that evening, she saw the state I was in, and knew what I needed: a big bowl of homemade ramen, with lots of veggies and hot chilis! It actually seemed to wake my brain up, and I was once again able to focus on things.

Later that evening I was walking to the kitchen, and I noticed that my surgical knee felt… different. It was sore! When I bent it, I could feel the muscles and tendons and everything pressing together painfully in the still-swollen interior of the knee. It had now been 8 weeks since the surgery, and I was told that although the swelling would diminish in the first few weeks, that it wouldn’t be gone for about 6 months! So it appears that the Tramadol was helping to control that low-level pain, even if it wasn’t much help when, say, the physical therapists would force my knee to bend further than it wanted to – that was still extremely painful! But now that this low-level pain is present, I kind of like having it, as it reminds me that I need to keep working on getting it stronger and more flexible.

I’m writing this two days after that difficult night, and the only odd symptoms I’ve had are some strange visual effects. They started later in the evening both days, and it looks like there is a curved band of kaleidoscopic distortion in my right eye. It goes away when I close my eyes, so I’m not sure what it could be. If it keeps happening I’ll get it checked out, but for now, it’s a minor annoyance.

I now have a much greater appreciation of what addicts go through when they try to get clean. My addiction was tiny compared to most, and yet it left me feeling horribly uncomfortable and unable to lay still. It’s a small price to pay for the privilege of having a new knee, but it’s one that I didn’t expect. It’s great to finally be done with the painkillers! I really needed them to make the progress I’ve made, but I didn’t want to be addicted to them any longer than absolutely necessary.

Withdrawal

So this week was the big post-op appointment with my surgeon following my total knee replacement. Six weeks: that was the first big milestone, where my progress would be assessed to make sure that I was recovering well. It was also the point where some of the more annoying things that I had to do would end (assuming I had progressed well): no more compression stocking; no more sleeping only on my back with my foot in a foam block to stretch the knee, and no more walker. Full disclosure: I hadn’t used the walker at all since about 2 weeks after the surgery, but the doctors insisted on it as a safety measure, so… 😉

I wasn’t too concerned about the exam, as I had been doing the physical therapy religiously all this time, and had a gotten a good deal of flexibility and strength back. And that’s exactly how the exam went: I was given a proverbial gold star, moving me ahead to the next phase. Joy!

One thing that has always concerned me was my use of pain medication. After surgery they start you on Hydrocodone, a strong opiod painkiller, and boy, did I need it! But as I healed the severe pain diminished, and I really only needed it when doing some of the more painful PT exercises. So two weeks later they switched me to Tramadol, a non-opiod pain medication. Since it’s not an opiod, it is supposedly not as addictive, nor as difficult to stop using once you no longer need it.

So, given my progress on the healing front, and my missing being able to share a glass of wine with my wife at dinner, I decided to stop taking the medication. Sure, it would be uncomfortable for a day or two, but after that I’ll be clean!

So my last dose was this past Tuesday at 11am. Wednesday morning I awoke with what appeared to be a cold: runny nose, congestion, watery eyes, sneezing, and a dry, hacking cough. Oh, great – now I have to deal with a cold on top of everything else!

Towards the end of the afternoon, I started to feel lethargic. OK, I thought, this is the drug withdrawal, and I have to tough it out. I was also feeling chilled, but I didn’t know if that was the cold or the withdrawal causing that. My wife took good care of me, and made a delicious ramen to warm me up, with lots of chili to clear my sinuses, and lots of kale and other veggies to keep me strong.

I went to bed, trying to relax enough to fall asleep, but I just couldn’t get comfortable. I had taken some Tylenol to help ease any knee pain, but my knee wasn’t really bothering me that much. No matter how I tried to position myself, I could feel the muscles in my legs twitching, making it impossible to lay still. I didn’t want my constant movement to keep my wife awake, so I got up. Maybe walking around a bit would calm my legs down, so I walked around the house for a while. That helped a little, but I still didn’t feel like I could rest, so I sat down at the computer, and figured I’d see if there were any tips I could find on dealing with Tramadol withdrawal.

Well, it wasn’t hard to find that information! And man was there a ton of it! The first page I read was a message board where different people described their experiences, and it was like a slap in my face! They described everything I had been feeling; even my “cold” wasn’t a cold, but just some of the symptoms of withdrawal!

I continued reading a variety of sites, and it reinforced all of the anecdotal reports of the first site I read. What was worse, though, is the timeline they described for these symptoms: they would peak after 72 hours without the medication, and continue for 10 days or so! I was barely 36 hours into my withdrawal, and I wasn’t going to be able to handle this without locking myself in a padded room for the duration. Every single site recommended the only way to stop is to gradually wean yourself by slowly reducing your dosage, so that’s what I decided to do. I felt defeated: I had been kicking ass on this whole knee-replacement thing since the beginning, and now I finally ran into something that kicked mine. So I reluctantly took a Tramadol pill at 11:30pm, and an hour or so later I was feeling better enough to attempt sleeping. I did manage to get a few hours, so this morning I’m a little sore and grouchy. My (revised) plan is to go with taking it at 12 hour intervals for a few days, then increase it to 16 hour intervals for another few days, and adjust that as needed until I’m off it completely. No heroic cold turkey for me anymore!

Let me close with a current photo of how my knee is progressing. The swelling continues to diminish, but it’s still there. The scar is looking fine, thanks to the Vitamin E oil I rub in it daily.

6 week knee photo
6 weeks after surgery

Dry

One month ago today I had Total Knee Replacement surgery for my left knee. Before undergoing the procedure, I did as much research as I possibly could. I knew the risks. I knew the timeline I could expect for recovery. I knew the range of outcomes. I knew that the more work you do in physical therapy, the better the outcome. I knew that the physical therapy would be very painful. I knew that I would need to rely on pain medication in order to be able to do what needed to be done.

And all of that information has been spot-on. But there was one bit of information that I probably should have known, but didn’t make the connection: while I was recovering from this surgery, I couldn’t drink alcohol. Opioids and alcohol do not mix!

It’s now been a month since I’ve had any sort of alcoholic beverage. Before the surgery, my wife and I would split a bottle of wine with dinner, and then later I’d maybe enjoy a bourbon later in the evening as the day wound down. Not anymore! I feel as though I should get my 1 month sober chip from AA (well, except for the minor detail that I’m taking opiods!).

I know this sounds a little crazy; after all, I have a brand-new knee! But it’s just one of those things that you really don’t think about ahead of time.

knee replacement at one month
Left knee, one month post-surgery

Here’s a shot of the knee today: the staples have been removed, and all but one of the little bandage strips have fallen off. Compare it to the photo I took 2 days after surgery in this post! I’ll have a nice Frankenstein-like scar on it, but other than that it’s amazing that I can walk and move around almost normally already. I still lack some flexibility, but I’m working on that!

So while I’m happy that the new knee is healing well, I’m longing for the not-to-distant future when I can be off pain meds and enjoy a nice glass of wine once again!