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The older I get, the more I think I’ve spent almost as much time off my feet as I have on.
Falling down when learning to roller skate, just as falling down when trying to ride my new two-wheel bicycle, was normal.
Falling down when ice skating—and afterwards, missing weeks of fifth grade, from a badly sprained ankle —wasn’t so unusual either. But that was when I first heard what became a frequent refrain: “Joanie has weak ankles.”
“Joanie has high arches,” my foot doctor later told my parents. “Practice your walking, Joanie,” he said. “Roll your foot from your heel to your toe.”
Despite years in ballet classes meant to strengthen my ankles, and hours practicing heel-to-toe walking meant to strengthen my arches, I kept falling down. By my 20's and 30's, I’d topple to the sidewalk and spring back up so quickly, that for years few people seemed to notice. “Oh, it’s nothing. I must have tripped on something,” I’d say whenever anyone did.
In my 40's, things began to change. By then a mother of four young children, I was working as a psychologist in a hospital-based learning disabilities clinic. Outside, when walking, I was still falling down and getting right back up. But I was surrounded by medical colleagues, and they knew something was amiss—only it wasn’t my falling.
“Joan, you’re walking bent over, at a funny angle,” a doctor friend said one day during lunch in the crowded hospital cafeteria. “It’s my back,” I said. “My back feels like it `goes out’ every few months, and it becomes excruciating. Probably from carting around one or more of my children on my hip?” I suggested. The doctor made an office appointment for me. He planned to fit me for a cumbersome back brace. He said the plaster cast would provide instant relief.
Several weeks later, I returned to the doctor’s hospital office. “Am I embarrassed,” he said. “You don’t need a back cast. You need back exercise and a muscle relaxant. Your x-rays show it's scoliosis - a curvature of the spine - that's causing your back trouble. He prescribed a muscle relaxant to use whenever my back started to go out. He also told me to enroll in some back exercise classes in a nearby YWCA.
"I'm a life-long exercise -phobic," I told the doctor, "but I'll try."
"I bet that once you start you'll become an exercise addict," the doctor said.
This was the first such sentiment I've heard from countless doctors since then,who've each provided me with countless other prescriptions for physical therapy for my back - not one of whom has yet been rewarded by seeing me morph into the desired exercise-addict
I did the exercises for a while. And for a while.they, and the muscle relaxants seemed to help. Then miraculously, some years after I stopped the back exercises, my back stopped going out. By then, however, I'd begun to suffer from different - arthritic - pain. This took a toll not only on my back, but also on my knees, hips, hands and just about everywhere. Not surprisingly, it also left me walking even more awkwardly than before. But during these next years spent doing, and not doing, my new physical therapy exercises, I had my usual trouble remaining upright. I'd be walking across the street when OOPS! - I'd trip and SPLAT! - down I'd go again. Only now I could no longer fall down and pick myself up before anyone noticed. Instead, I'd be surrounded by people trying to help me up, and worse, after years of priding myself on never having broken a single bone, I seemed unable to stop.
I'd be picking my way across my 8-year-old grandson's crowded bedroom floor when -CRASH! I tripped on his small metal car, and there I was, down on my hands and knees, nursing what proved to be my first broken finger.
Or, I'd be walking past a Starbucks at the corner of 60th Street and Broadway when - THUD! I tripped on the small protruding leg of a green metal construction barrier and landed on my chin with such force I had to be rushed to the nearest ER to have more than a dozen stitches inside my mouth to staunch the blood that gushed from my lips.
Or, I'd be leaning over a Madison Avenue curb, trying to hail a cab when - BAM! - Instead of sitting inside the cab, I was lying next to it on the street, with blood streaming from what turnout out to be my painful and rapidly swelling broken nose.
I now got used to hearing a different group of questions: "Joan, before you fell, did you get dizzy? Were you nauseous? Did you lose consciousness?"
"No," I'd answer. "No to everything. Not dizzy, not nauseous. not unconscious."
In my mid-60's by then, I had friends who also sometimes fell down. Reading about the subject, thanks to my growing use of the Internet, I learned I was one of millions - one of some 35 to 40% of people age-65 or older, who periodically fall, according to the Merck Manual, the NIH and other institutions that study the elderly. Only these statistics didn't seem to apply to me since I'd been falling down forever.
During these years, my burgeoning medical record, with its repeated series of MRI's, Cat Scans and X-Rays all showed, along with worsening arthritis, the same, albeit worsening, curvature of the spine that had first shown up on my hospital lab tests some forty years ago. During these later falling-down years of broken bones, doctors continued to hand me new prescriptions for physical therapy. By now these therapy exercises were meant to aid in my `core strengthening,' my walking, and `balance improvement.'
By my late 70's, several doctors suggested I use a cane to additionally help with my balance. Despite my fear that a cane would make me look at least fifteen years older - like a sexless little old lady from my grandmother's era- I reluctantly decided I'd better heed their advice.
But I still fell down, and I still broke bones - sometimes I even fell down because while walking I'd tripped over my cane.
I've fallen and re-broken the fourth finger of my right hand so often that its bones have grown so fused together that x-rays can no longer determine whether or not it's broken again. (I alone can tell, by its small amount of extra pain and slight degree of new swelling.)
I've fallen on my head with such force I needed terrifying-sounding surgery to remove (successfully, thank goodness) a `bleed '- a subdural hematoma - from my brain.
During these years I periodically proposed new reasons of my own for my frequent falls: Is my chronic anemia to blame? My sedentary life style? Does my perennially low metabolism make me too weak to remain upright? Do my heavy legs keep me from walking normally? What about my growing number of medications? Could my bifocal glasses make it harder for me to see down to the street in front of me?
I didn't know that the NIH and other institutions that deal with the elderly have speculated that one or more of these possibilities might actually be implicated in falls among the elderly.
My internist - a man a few years my senior - never seemed persuaded. "Be careful, Joan," he'd say, during my office visits, adding: "JUST DON'T FALL!"
I didn't realize that I needed more medical insight than this well-meant exhortation to `BE CAREFUL!' `DON'T FALL!' until last summer. That's when I fell three times, three months in a row. Twice, even when using my cane, I tripped on the street and fell flat on my face, and once when a bus I was on jerked so suddenly to a stop, I fell down hard on my back.
For the first time in my falling-down life, I experienced its consequences. Although everyone assured me I'd gotten off lightly, with no major injury, and I too was aware of it, I spent most of the summer indoors. I didn't want to leave my apartment until make-up could even partly conceal the horrific bruises that covered my face, or until the excruciating pain from a fractured vertebrae began to ease.
It was during my weeks spent recuperating indoors that I thought to inquire if any doctor could tell me why I'd spent my life falling down so often.
I felt sure I'd embarked on an impossible, if not a crazy, quest. I doubted I'd ever find a simple answer. Instead, within weeks, three Manhattan specialists to whom I'd been referred - two spinal surgeons and a movement specialist - gave me an identical answer.
"You're falling, Joan, because of your poor balance from your worsening scoliosis - your curvature of the spine."
The three specialists were unanimous as well in the grim prognosis they gave me. I was too old to consider surgery - which might easily have been an option decades ago. So if I didn't start to use a walker, I'd go on falling, risking ever more dire injuries - from a broken hip to death itself.
I've been in shock since finding an answer which has been obvious for decades. My scoliosis, and the degree to which it's been worsening has been visible on all my lab reports. It's also been easily seen by anyone, for starters just by looking at the slant of my back whenever I stand, not to mention the more than three inches I've lately been losing in height,
But not until I finally thought to probe the reason for my falling-down life - and wouldn't take `DON'T FALL!' as the last word in medical knowledge -not one doctor I'd seen -almost all of them practicing in some of New York City's most prestigious institutions - had ever thought to provide me with this same answer. This seems unimaginable, considering that the answer was hiding in plain sight, right inside my medical folder. Instead, whenever I'd sit face to face with any of my doctors following an office visit, my bulging medical file typically remained unopened on my doctor's desk. Such laziness puts the medical profession in an even worse light than I'd thought.
Had my doctors earlier urged me to seek help from any of Manhattan's many scoliosis experts years ago, might I today be in better shape? It's more than likely. Meanwhile, I'm still brooding over news that one of New York's best known physical therapy centers - one which specializes in treating people like me with scoliosis - is located in the same hospital in which more than one doctor I've gone to for years for treatment for my arthritis also have their offices. But not once did any of these doctors refer me to this center. Although they all wrote prescriptions for physical therapy - and usually gave me lists of reccommended physical therapy locations - not one of these doctors even mentioned this scoliosis center based right in their own hospital.
The same scoliosis center is also located in the hospital in which one of the spine surgeons who evaluated me and told me that my scoliosis was causing me to fall also has his office. But when I recently phoned his office, his receptionist told me the surgeon has never referred any of his patients to this center - including me - because he'd never heard of it.
Because I'm still trying to make sense of my decades of wasted care, I’ve almost accommodated to the shock of needing to use the walker my three medical experts all insisted I use to keep me upright in my remaining years - and alive.
And yes, I do look just like all the other little old ladies I see traveling about the city pushing these sexually neutering contraptions. But presumably, it’s better safe, sexless and right side up, than upside-down, immobilized with a broken hip or worse, and looking every bit as sexless.
