What You Should Know About A Functional Capacity Evaluation

Yesterday I googled, "functional capacity evaluation" and entertained myself with a couple dozen horror stories about this process and the suffering it caused. There needs to be a term for the harm we cause ourselves by opening that Pandora's Box that Google has become. Sometimes it's better not to know. Because for me... it made for a lot of anxiety that I didn't need.

So. I'm going to share my experience for those who love me and want to know how it went... and for those who found me by Google and want to know what they can expect.

I had read that they start evaluating you from the moment you get out of your car. In this moment, that seems utterly ridiculous because how would they know that the chubby girl struggling to drag herself out of that random non-color Nissan is the girl that is here for the FCE? Of course they wouldn't know. And of course, I didn't think about that this morning. I acted like Alec Baldwin facing the paparazzi - defensive and avoiding eye contact with anyone and everyone who might be the FCE Spy - and promptly went in the wrong door and had to walk around the building. Stellar.

Once I found the right entrance and the front desk, the ladies who were working seemed completely discombobulated and it took for-blooming-ever for them to find the right paperwork and find the therapist who was to perform the exam. Because I had read that they evaluate your response while signing in and filling out paperwork, I was careful to mind my P's and Q's, including refusing to sign a paper acknowledging that I had been given a list of preparations for the exam because I hadn't. In fact, if I had not spent time on Google yesterday, I wouldn't have even thought to wear comfortable clothes and tennis shoes. They assured me I'd get complete instructions and so I signed. Ultimately, I didn't get anything but the guy who did the test was so very thorough about what we would do and how he would evaluate me that I feel like I was better informed than I would have been by reading. So there's that.

The first thing he did was have me put on a heart monitor. It was the exercise kind (I think - it definitely wasn't the traditional medical outfit) and I warned him that I have tachycardia and that my heart rate will be higher than average. I demonstrated this by having a flying 126 beats per minute reading while sitting calmly in a chair. Then he took my blood pressure which was borderline high but not really high for me. They are not supposed to start the test unless you have a heart rate of below 100 so we waited until I got a little more zen before we started.

The next step was having me sit in a chair, lift one leg and push against his hand. I could do it with the left leg but couldn't lift the right leg at all. I have more weakness in the left leg normally but it really seemed like I couldn't stabilize myself with my left leg and that was why I couldn't lift the right. I don't know.

Oh, I didn't mention... before we started, he encouraged me to attempt everything. He told me that he would stop me if my heart rate got too high or if he felt like my pain level was too high. He told me that we would evaluate my pain level and "perceived exertion" along with my heart rate during every task. But he also told me that if I got to a point that I was uncomfortable, we could stop.

Next he had me stand facing a bookshelf. I was to squat down, pick up a crate and put it on the shelf. After I did this he checked my heart rate, pain level and perceived exertion. Then he added some weight to the crate and had me do it again. It was a struggle. Then he added a little more weight and had me do it one last time. I had a really hard time lifting the crate - to the extent that my muscles were shaking - so he had me stop at that weight.

After that I had to do 25 squats. I've got pretty muscular legs and I was able to do this about 20 times before it became uncomfortable. He told me to stop. This really helped boost my confidence that he was not going to push me too far.

Then we went to the stairway at the end of the building. The task was for me to go up and then down a flight of stairs eight times. During this he was asking me questions that were conversational - "do you have any kids?" that kind of thing. I suspect this was so that he could determine if I was able to talk while I was doing the stairs. I made it six times before my heart rate was too high and he made me stop.

Typically this test will include things like crawling and going up and down a ladder. He said he could tell that I wouldn't be able to crawl without injuring myself and that I had no business on a ladder. That made me feel like he was gaining perspective about my restrictions.

Next I had to carry a crate with increasing weight for about 25 feet. Again he checked the stats.

Then he had me walk 500 feet and describe my pain at certain intervals. Initially I had trouble with my left leg, this is common but after awhile I had much worse pain in my right hip. I've never had that before. I think what has happened is that I favor the left leg so much that eventually it begins to hurt the right side. Since I normally stop (if possible) when the left leg starts giving me trouble, I've never gotten to the point where the right side hurts that bad.

After each station he would offer me water and even refilled my cup several times. There was pleasant conversation about random things like tipping - why do we tip waitresses at sit down restaurants but not at fast food restaurants - football, things like that.

Next he had me stand for five minutes while working with these pegs. The idea behind the pegs is that with your mind and hands occupied, you are less aware of any discomfort than you would be if you were just standing. I got creative and made a rainbow out of the pegs in the first five minutes and then made a football game complete with cheerleaders, refs and spectators in the second five minutes. Then I had to kneel for a certain amount of time while playing with the pegs - this was much more difficult. And finally, he had me sit and lean forward to work with the pegs.

Then he gave me a basketball and I had to turn my torso to the left and then the right holding the basketball 25 times. By this point I was having pretty bad muscle spasms in my back and told him quite candidly that this activity was much more painful than it would normally be because of all the things I had already done. He said that was the point, they want to evaluate the cumulative effect of the activities.

Then he had me hold this instrument in my hands and try to squeeze it. After each squeeze he would adjust it
to make it harder or further apart. Then I had to squeeze it repetitively and transfer it back and forth between hands.

Then... back to the crate and the squats and the stairs to compare my ability at the end of the evaluation. While I was on the stairs he asked where I lived in Cleveland and I responded with, "have you ever heard of the nudist resort in Cleveland." Yes. He had actually gone out there before as a Home Health provider. He said, "you know... they aren't really the kind of people you'd want to see naked." True story. And although I was out of breath, I had a good laugh over it. With all three of the tasks at the end he stopped me before completing all the reps.

It was tiring, painful and at times difficult BUT it was nowhere near the torture chamber that I had prepared myself to expect. I had a hard time walking to the car afterwards and the drive home was uncomfortable but I've driven in worse conditions. I came home and immediately doped up and it feels like I was hit by a truck but it's not as bad as I expected. (what did I expect? To feel like I was hit by a tank, maybe?)

I sometimes (yesterday) get this attitude about being the last kid picked for kickball. I was convinced that it didn't matter if I went for this test because nothing ever goes my way and there was no way that anyone was going to understand or agree with me about what a struggle life has become. I had prepared myself to get blown out of the water and to come away from this process with even less hope of having my case approved. I can't say for certain until I have the report in my hands but honestly, I felt like he "got it". I truly felt like he got it more than anyone has "gotten it" so far in the past three years. And what's more important, after our conversation during and after the test, I feel like he understands better than anyone (except maybe my lawyer) how important it is to document and substantiate my restrictions. I'm supposed to have the results within 48 hours. I'll let you guys know when I know.

And then I have to decide if I want to go back to the attorney that dropped me or if I want to find a new one. On one hand I'm sorta pissed that they dropped me BUT, as I said before, I'd much rather have an honest review that lets me know where my case is weak now, rather than find out after I go before a judge and end up on the losing end because I wasn't prepared. So I'm prayerfully considering if I want this lawyer back if they want ME back.

So that's about it. I survived. Happy Monday.