Shoulder Surgery – 4 weeks in

Shoulder Dislocation Anatomy - Source: eorthopod.com

Shoulder Dislocation Anatomy - Source: eorthopod.com

As I do every week, I’m following up to last week’s post to document the recovery process as I heal from Open Bankart Shoulder Surgery on my right shoulder. This week has been one of great success and some minor set backs. First the success, by last Friday (11/13/09) I had finally broken through on overcoming my healing plateau. I was finally during my at home PT exercises able to raise my arm during the pendulum forward/back swing above my shoulder (90 degrees) without pain. Later that same day during my PT session my therapist was able to raise my arm in a forward position while laying down to 128 degrees (about what it takes to reach a box of cereal on top of a 6′ tall fridge). I was told this was both significant progress over my prior 120 degree limit and better than normal healing usually allows.

As such, the therapist introduced two new exercises to my at home PT regime: The side to side pendulum swing (5 minutes) and the shoulder shrug (10 reps). This was in addition to my existing 10 forward and  backward shoulder rotations, 5 minute forward and backward pendulum swing, 10 forward and backward elbow circles, 10 bicep curls, and 3 repeated 15 second neck to the shoulder stretches on each shoulder. My total work out time climbed from 15 minutes to about 20 minutes per session and believe me– it sounds like a lot less physical work than it really is. Especially when you consider this routine is done three times per day (that’s an hour long work out when you add it up total per day!). Needless to say, the first few times were a bit tiring. I noticed though day over day my endurance and range of motion continued to build.

Then came Tuesday (11/17). The previous day I felt absolutely great. I did light chores around the house (washed dishes, swept, and cooked). I was able to do light routine tasks with my right arm like wash under my left armpit, brush my teeth, shave, and wipe my rear side all without issue. I was also surprised to find out I could with a shuffling motion drive with two hands (I have an automatic V6 Mustang). I was even able to use the mouse for brief periods. In short, I was about about 40% recovered and around where I was about two weeks before surgery. I felt great!

Inferior Dislocation - Source: eorthopod.com

Inferior Dislocation - Source: eorthopod.com

I was doing my afternoon at home PT work out yesterday and was very hopeful about today’s PT visit where I could potentially accomplish some more movement forward in recovery. I was doing my 5 minute forward pendulum swing and my two year old daughter was running around getting into everything. I was busy watching her and not paying enough attention to the swing’s peak position. That’s when in one forward and upward motion I overreached with my swing limit. I ended up going well beyond 128 (I guess it was somewhere around 140). There was a brief sharp sting through my arm much like the kind you get when you get an electric shock from an outlet. I could continue on with the PT session, but my range of motion was noticeably reduced.

That entire evening I felt very sore, but not in any significant pain. I had no trouble sleeping, but this morning when I woke up I was more stiff on my right body than I had been for the past two plus weeks. I knew since I could raise my arm I hadn’t torn anything. This was discomfort and soreness like too hard a work out at the gym  and waking up the next day to regret it. It was not shoulder dislocation grade pain though. It was clear I had over extended my arm and probably strained my bicep in the course of doing so. I spent the rest of the day icing myself and gave myself some heat before bed. I also lightened the work load on my afternoon and evening at home PT routine by reducing the pendulum swing range.

Open Bankart Surgery - Source: eorthopod.com

Open Bankart Surgery - Source: eorthopod.com

When I got to PT today they started by heating my arm. Then an elongated massage. There was noticeable reduction in swelling around my incision scar and bicep itself since my last PT visit. Clearly the inflammation (though bothersome) was not severe. In fact, but all observations the arm was near normal in size. Regardless, any motion above 90 degrees had to be done gingerly because of the lingering soreness. We did manage to get my right arm to 128 degrees so there was no reduction in range (which is good).

More concerning though was something else I hadn’t noticed until the major surgery swelling/pain was able to heal over the course of the last week. I had a bruised like feeling in my humerus’s frontal lobe (that’s the bone in the upper arm). I’d been noticing a lingering pain in the top part of my arm and had simply been treating it with both ice and heat (which helped it somewhat) thinking it was just part of the overall pain. That pain/bruise/whatever had been there since the major soreness of the surgery subsided some three weeks ago. The problem is that except for my pulled bicep; the rest of my arm was now painless except for that humerus lobe region.

The bigger problem is that is the very part of the bone in your arm that must pass through the collarbone/clavicle when going beyond 130 degrees as you reach forward and upward. There was no way that lobe would pass through the bone without a rubbing sensation that was indeed true pain (somewhere around a 6 plus). Therefore the therapist broke off therapy. It was clear that I needed to have that lobe heal before I could move any further. With that we ended the session with ice and therein my disappointment of:

  1. Pulling my bicep in a random accident that set me back a week easy.
  2. Finding out though the majority of my arm is healing there is still this abnormal inflammation of the humerus head. Leaving a bigger question of when/how can we make that go away?

I’m continuing, per my therapist, my at home PT exercises though in a slightly less strenuous manner during the pendulum swings.  I’m also watching that I don’t go above 120 degrees. I’m continuing to ice the joint as well after each session. This Friday we’ll revisit my range of motion forward/upward from there and hopefully (if my healing pattern holds true) by the following Monday I should be able to get to 130 plus (or at least feel as well as I did yesterday before my accident).

I also had a minor side issue with my insurance provider. For whatever reason they only accepted eight visits to PT instead of the full 16 I need. Eight visits isn’t enough (I’m on visit five as of today’s visit) to let me recover properly. Apparently there is some paperwork the PT can do to show them I need additional treatment. I surely hope so– I cannot afford the non-insurance rates and there’s no way I can stop therapy after next week. I’m not even two weeks in on PT and by all medical professional estimates I’ll need a total of at least six weeks of PT to be able to work out on my own going forward.

Shoulder PT streches - 180 degrees. Source: mattsmithpt.com

Shoulder PT stretches - 180 degrees. Source: mattsmithpt.com

My second major post operation milestone is on Monday (11/23). Before my Monday PT, I visit my orthopedist for post op check up number two (week five). He’s going to review my PT results and decide from there if I can go back to work (12/7 was the six week post op target) full time, as well as, what’s best to move me along to final healing in PT. I’m hoping for good news. My FMLA and disability goes out into the first week of January 2010 (12 weeks total), but I really want to get back to work. Sitting around the house and doing nothing is driving me crazy. The flip side is that if I’m not physically in a place where I can return to work I’ll be of no value to them.

This is all the more frustrating with today our CEO announcing my promotion to Network Operation Manager. I really am itching to get back to work and get the ball rolling on some projects, but here at I am at home– sore as Hell. Label that frustration number three for the record.

I’ll update next week as per usual to let you know how it all goes. Clearly this is where things get tough and patience needs to become a virtue I learn to respect for my own good. In my heart of hearts, I know that if I don’t let my body heal and recover properly I’ll, in the long term, be physically of no value to anyone (my family, my employer, myself, etc…) and that is something I keep in my mind to balance things out.

Week six seemingly cannot come fast enough.

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Shoulder Surgery – 3 Weeks In

Basic Shoulder Therapy Excercises

Basic Shoulder Therapy Excercises

Three weeks removed from my shoulder surgery, not much has changed since my last post. It’s typical during recovery from Open Bankart surgery to plateau. In other words, there are points where you seemingly do not progress and in some instances take a few steps back. This is due to the way your body naturally recovers. Left unattended there are major side effects to shoulder surgery such as muscle atrophy, which is a weakening of the muscles due to lack of use. There is also a danger of tightening of ligaments and tendons leading to paralysis of the shoulder and arm. The root culprit of this is two fold.

First, scar tissue (while stabilizing the overall structure of the wound) creates a hardened almost callas like formation within the arm preventing normal range of motion. The second, is because your arm stays in a protected position (usually close to your body and slightly bent with the shoulder propped forward) similar to when it was in the sling. Because of that positioning the arm muscles literally begins to form and stabilize in that unnatural position. This places a tremendous burden on your neck and back, as well as, leading to a limited range of motion in the shoulder itself. It also causes the now shortened ligament to begin tensing up and shortening themselves. The result is the tendons and ligaments become so tensile it becomes hard to fully open and extend your arm. This effect is particularly noticeable during the morning when you first take your arm out of the sling and alleviates over the first few hours (especially after I do my morning exercise regimen) with normal use. Left unattended for weeks though the ligaments would become near impossible to  move and tighten to a dangerous level of shortening.

The scar tissue is good though. My orthopedist actually purposely created scar tissue during surgery because during the course of letting my shoulder deterioate in the years prior to surgery I actually destroyed the scar tissue that was trying to form in my shoulder. As stated earlier, the scar tissue is necessary to help stabilize/support the joint, which prevents tearing and provides a tough layer of tissue to protect the joint, but this tissue must be strategically broken apart so it does have flexilbity enough to allow normal range of motion.

We’ll get into how they address all these under use dangers later in the post when I discuss PT (physical therapy).

The exact opposite can be said about over use. Over using or extending the joint beyond the shoulder line (such as washing your hair or reaching upward) or applying weight over 5 lbs. during lifting of objects comes with the risk of tearing the scar tissue at the incision point, as well as, causing a shoulder dislocation risk that would effectively undo your surgery. This risk is particularly high during the first six weeks after surgery. Common sense and caution must be used. If something causes pain verses normal discomfort you need to stop doing whatever you’re doing immediately. If that painful feeling does not subside within a few minutes you need to call  your doctor ASAP.

The final big risk is infection and normal daily showering will prevent this along with being sure to change your shirt each day. I know this sounds like common sense, but you must keep yourself clean hygiene wise to avoid infection. I also like during the last part of my shower to turn the shower head on massage and kick up the heat on the water a bit. I run my arm, back, and opposite arm under the warm  jet stream slowly for a total of about 10 minutes. This warms and soothes all the muscles helping to expedite healing. After three weeks, according to my PT, you can begin moving away from ice and towards heat. Ice is for post PT work out, but heat is for sitting around the house and relieving normal aches/pains that may arise. Purchasing a heating pad is thus a great idea.

This brings up the balance that at three weeks you must walk. You should use your arm where ever possible, but you should also not over use the arm. I’ve limited my arm usage to typing, limited body washing in the shower on the torso and abdomen, occasional eating, and light sweeping. These short, brief, and non-intensive tasks test the shoulder without tasking. You should not do any motion that requires upward or outward extension such as reaching above your head. You should around the house when awake not wear the sling at this point. Keep your arm free and let it rest on a pillow verses be in the sling.

As mentioned above, ice is important as well during the first three weeks. You should ice your shoulder with an ice pack for at least 20 minutes three times a day during the third week. As noted before, you’ll then switch to a combo of ice after exercising and heat to relieve aches/pains after three weeks for five minutes after the work out. This keeps swelling down and helps relieve the soreness associated with the in home or at PT therapy regimen. Speaking of the regimen, it is important you do your daily prescribed exercises. These motions have helped soften the plateaus and long term I notice improvement to the overall range of motion in the shoulder by religiously doing them each day.

When not in use I try to prop my shoulder up. The key is to get the shoulder not to slump forward. Putting a pillow under my arm while sitting watching TV helps make this happen (as noted above).

Wrecking Ball Style Shoulder Excercise

Wrecking Ball Style Shoulder Excercise

The most important thing is to not let soreness slow you down to a halt. Yes, you can rest your arm and ice your arm. You should take your pain meds as prescribed. By all means though, unless told otherwise by your medical professionals, do not stop using your arm completely. It is important to work through discomfort and to keep going despite it. There is a noticeable difference between discomfort and pain though. My movements may come with soreness or discomfort, but anything over a three on the pain meter should be noted to your medical professional ASAP. I make sure to tell my PT and orthopedist during my visits any pain no matter minor regardless though as point of habit. It’s better to be told that’s okay then to ignore something that turns out to be important.

This evening I will be taking my last Vicodin. I’m going to try to go on Ibuprofen alone. The pain meds are there to support your capabilities and again– depending on your pain threshold you may need them longer. I’ve been these past few days extending my med time interval to 8 hours to see how manageable the pain was with just the Ibuprofen. Again, this is part of the dialogue between you and your medical professionals.

I’m able to drive one handed short distances (say less than 5 miles) on one off occasions. I do so with my meds well worn off (do not be medicated and drive– it’s as bad as drinking and driving if not worse), but at this point driving with any regular ability would be impossible. I leave the vast majority of driving to my wife.

I’ve still having some trouble sleeping full nights. I don’t wake up tired, but I find that every six or so hours I wake up for whatever reason. After some laying there I manage to fall back asleep on my own. I think it may be a side effect of the Vicodin and I’ll have to see if I fair better tomorrow without being on the narcotic.

Today’s second PT session was about 30 minutes. My PT (physical therapist) spent mos of the session doing a massage on my arm while I lied flat on my back. We then did some reach forward and reach over body stretches. I then laid on my left side while he massaged my arm and then again we did some reach forward stretches. We then did some resistance work where lying on my left side I pushed back on his hand with the shoulder as he pushed against my shoulder blade. The session was minor in pain and no worse than my daily pain. Particularly sore is the back of my arm and my upper shoulder blade. That again– comes from lack of use of the joint and arm.

Deltoid Muscle Structure

Deltoid Muscle Structure

This goes back to where I started. The PT massages do wonders to offset the muscle and tendon breakdown caused by the healing process. I felt at least 50% better after the massage. The PT worked hard to “break apart” the scar tissue and soften the ligaments. My PT explained he would do this again on Friday. He’s also going to consult directly with my orthopedist to develop an individual recovery plan. The light stretching and massaging will slowly over the next few weeks work into actual work outs where I put physical light effort on the shoulder. Again, my PT will coordinate that with my orthopedist to make sure the timing is correct based on the orthopedist’s recovery plan. Even on the day of PT you should do your PT at home sessions. It’s important to stick with it no matter how tired or sore you may be. Again (I must stress this) there is a difference between sore and being in true pain. If you find yourself in real pain you need to call your doctor– even if it’s dismissed better safe than sorry. The PT is a must though. The massages, stretching, and exercising off set any improper healing and keep your body’s recovery on track. Do not skip PT! There is no way I can see any one recovering on their own without it. Having said that, even with insurance it is expensive. I’m looking at about $600 for six weeks of PT in co-pays and I know by no means is that cheap, but it is worth it to heal right.

So in short at weeks three you’ll be:

  • Able to shower with your left arm and wash your hair. May be able to lightly wash upper body with right arm.
  • You’ll still have to brush your teeth and use the toilet with your left.
  • Able to eat briefly with right. Possibly able to cut soft meat or bread with knife. Mostly still eating with left hand.
  • Able to write for short periods with right hand legibly.
  • Short trips with an automatic vehicle (must let meds wear off). No regular trips or commuting.
  • Wash a few dishes.
  • Light sweeping.
  • Able to open jars, but be careful of that twisting motion and don’t over do it.
  • Typing on keyboard. Mouse will be moved by left arm though cause of lateral motions required.
  • Still sleeping with sling on. Laying flat on back propped up with two pillows.
  • Still not able to work or sustain long term activity.
  • Long walks are painful and stress the back because of shoulder “slump”. Sling helps that, but will not totally elevate the effect. Try to keep sustained activity or standing to under an hour.
  • Must wear sling in crowded places such as mall or supermarket due to risk of bumping into another person causing shoulder dislocation.
  • Everything else is done with left arm still (brushing teeth, shaving, pouring drinks, opening doors, etc…).

The hardest thing to learn left handed is (I know this gross, but I’m going to say it) wiping your hind side on the toilet. Second hardest is brushing your teeth. Everything else was pretty easy to do and able to be figured out within a few days of getting into the routine of things.

My youngest daughter (who’s two years old and about 25 lbs.) accidentally fell on my shoulder while I was lying on the bed yesterday. It stung a bit, but didn’t dislocate so it’s obviously harder to pull it out than a simple bump; but again– the risk is there so don’t do anything stupid. Stay at home. You’re still a bit crippled– don’t forget that.

I spend 95% of my day in my house lounging around. You still will most likely need to rest most the day, but you can now do so sitting up most of the day in a chair with arms to support your elbows (and ultimately both shoulders) to avoid back pain. You’ll no longer need to nap as much as you did when you were on heavy pain meds during the first two weeks. Getting 8 hours of sleep is essential so get your rest and make sure to eat right. I also have not drank alcohol for about four weeks. You really shouldn’t drink while on your meds. It also could slow down your body’s healing process.

So there is where I’m at with week three in the bag. We’ll see how things go into week four.

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Search Improvements, Arm Improvements

Red Squirrell Peering OutI spent a great deal of the day toiling away at improving the df.com Search widget in the left hand menu. Please feel free to give it a try. It works great. You’ll also notice that if for whatever you don’t seem to find what you’re looking for with our in in house search you can fallback to our customized Google Search. That Google based search is now conveniently found at the bottom of any in house search results page. I think that makes finding anything you may want on the site all the more accessible and insures that you can double check your search results with ease.

I’ve also added a countdown clock to the left hand menu as we continue moving towards a new digitalflood Pirate Radio episode (coming on 11/28/09). We’re about 18 days away at the time of this posting. Feel free to watch the seconds tick away in real time… or not.

Today I had my first physical therapy session. I had to fill out about 15 minutes worth of paperwork explaining what I was there for and how severe my pain was doing various tasks. The physical therapist then did a range of motion test with my arm and prescribed four more exercises to limber up my right shoulder joint. The first was shoulder shrugs, the second was rotating my upper arm in circles while in a down position, third a bicep curl, and fourth was a neck stretch. I have to do this in both forward and reverse 10 times each (except the stretch– that’s 15 seconds held on each side three times). My therapist told me the first few sessions would be to stretch and loosen the upper arm, neck, tendons, and back muscles. She will then begin slowly increasing stress on the joint with new exercises over succeeding sessions until I regained most of my range of motion. I will then be able to do the exercises on my own for another six weeks to finalize my recovery. I still also have to do the “wrecking ball” 5 minute arm hang as well, which was prescribed by my orthopedist. Each exercise session is about 15 minutes. I have to do three sessions a day everyday. One interesting thing I learned was the majority of my back pain I’ve had for the last few years can be attributed to how my shoulder has been sitting all these years.

The therapist showed me that because of the weakened muscle structure in the front of my arm I had been letting that shoulder shrug forward and compensated by keeping my elbow tucked in to hold the joint together. The result is I have been putting severe strain on my upper and lower back. I’ve also been pulling my other shoulder causing pain there as well. Again, the plan is to remedy all this over time. It was nice to figure out why I’ve had so much back pain the last few years though and that going forward there’s something I can do to remedy it.

The therapist has prescribe three PT sessions a week (about 1.5 hours per session) for the next six weeks. We’ll then take it from there. I was forewarned that the therapy will be grueling and at times painful, but that sticking with it and continuing to move is key to healing correctly.

Finally, as many of you may know my house has been plagued by two red squirrels for about the last two years. I cannot trap them. Cannot poison them. They’re pretty smart little critters. My wife won’t let me get a BB gun to shoot them (probably a good idea). Worse yet, I haven’t been able to figure out how they were getting in.

That was until yesterday morning. I noticed both of the squirrels were running out to a walnut tree by my landlord’s office building. They would then run back and disappear seemingly right under my kitchen window. I could then hear them in the wall of the kitchen. It was at that moment I realized I’d been looking on the wrong side of the house. I immediately went outside and stood back from the house. Sure enough after about 10 minutes of standing perfectly still the squirrel ran right by me and disappeared under a stone on the edge of my back patio. Three minutes later it popped back out from under the stone and ran back out to the tree.

I walked over and lifted the stone (which was on the ground flush with my house). Sure enough there was a trench dug under the stone and right to a huge hole in the back wall of my house (all which was hidden by this one patio stone). I called my landlord’s wife and supposedly he’s going to come by to look at it. In the meantime, I’m thinking of how to best seal the back wall off (my landlord tends to not be the most reliable fix it helper– I’m used to taking matters into my own hands and then billing him for it). It’s an old house and for whatever moronic reason the wall supporting the one side of the rear of the house does not have concrete poured between my back porch wall and the southern wall of the house. Even stranger– the rest of the house does have concrete poured around the foundation. So why they didn’t finish that side is probably either laziness or concerns over the both the sewer, as well as, the water main coming in through that wall about 12″ below top soil. This span is about 15′ in length and what this does is provide an easy way for rodents to dig down below ground level by about 6″ and be able to then burrow up into the field stone foundation revealing access into the rear wall. This is the little trick the squirrels use to get into my house. How they figured it out is a miracle of nature. How I’m going to seal it will be a miracle of old fashioned good old boy engineering.

I still have a one way chicken wire shoot on the hole in the eve of my house. I left it there purposely so once I did find the bottom access point and sealed it, they could then exit through that top hole (which used to be their primary entrance/exit before I sealed that) and be stuck outside. Dead squirrels in walls do not smell good even during winter.

You’ll find a picture of said squirrel in the top part of this post. It was taken back on 8/16/07. He’s peering through said chicken wire shoot, but smart enough not to come out of it.

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Shoulder Surgery – 2 weeks in

Open Bankart SurgeryI received a surprising amount of hits from my recent shoulder surgery updates and also received a bunch of questions from viewers, as well as, those of you who are considering surgery yourself. So I figured now that I’m well enough to type this would be a good time to catch you up on where I stand today two full weeks after my surgery.

Two weeks ago (10/21/09) I underwent Open Bankart Shoulder Surgery (info here) to fix continuous dislocations of my right shoulder. I had a large group of muscles in the front part of my shoulder torn (see older article here on that). I had to undergo an initial X-Ray to confirm the dislocation was occurring and then a closed MRI to confirm what muscle groups were torn. Once that was determined they did a follow up physical and scheduled surgery.

The whole process (from final severe dislocation to surgery) took about a month to go through.

Surgery itself is described as walk in and walk out. That is if all is well and there are no complications. In my case, the muscle damage was far more severe than they thought. The doctor could only determine this once he had me fully opened. My doctor feared there was more damage than the MRI showed and that’s why he went with the open verses  Laparoscopic, which has much smaller incisions then the open. The risk with Laparoscopic is the surgeon may not see the full extent of damage. Laparoscopic and open incision both have the same healing time requirement (12 weeks) though I’ve been told the initial pain from Laparoscopic is much less than open incision as there is less cutting. Open incision has the higher success rate according to my orthopedic surgeon and again– also is the most painful surgery to recover from.

shoulder-joint-ligamentsSurgery preparation was less than an hour. The night before I had to shower completely, dry off completely, and then apply an antiseptic scrub to my entire arm and right torso (scrubbing the body for 10 minutes). The next morning I had to scrub for 10 more minutes and put on a new shirt (button up style so it’s easier to get on/off). I could not eat or drink after midnight of the proceeding night to my surgery. I also could not take my stomach acid medicine. When you get to the hospital you strip down to your underwear and put on a medical gown. I was dropped off by my wife around 10 am and actual prep started at about 11 am. They then have you meet with the post-op nurse, the operation room nurse, the anesthesiologist, and finally the doctor. You fill out allergy paper work, sign over consent to operate to the doctors, and also consent to being sedated. You also confirm what body part you’re having operated on and what type of surgery (they do this some five time orally and two times in written sign off). The doctor marks your arm with a marker. Again, this all takes about an hour.

You are then given an IV so they can administer liquids direct to your circulatory system. I had the IV put in my left hand in the vein on the top of your hand. There’s a severe pinch and it will be sore for at least 24 hours. You have to just deal with it. You lay down for 10 minutes and get comfortable on a cot.

You’re wheeled on a cot into pre-operation where they begin with liquid anesthesia. You are then given (if you agreed to do so during the questioning earlier) a nerve block by the anesthesiologist. This is four needle shots into four different nerve endings in your neck. Each shot you tell the anesthesiologist  what part of your arm is numb. After all four shots you whole arm goes numb within five to ten minutes. Once they are sure your numb (you’re still somewhat awake and can tell them) they roll you into the operating room. You’re covered with blankets and a tube is put under them that blows hot air. The operating room is very cold to keep germs down (as is most of the hospital). Once they are sure you’re both warm and comfortable the surgeon ask you if you’re ready to begin. Once you say yes they give you the final liquid anesthetic. They hook up all the heart and breathing monitoring tabs on your body. Within one minute you’re asleep.

Once you’re asleep they put a tube in your throat via your mouth to administer oxygen. They then being the procedure.

You wake up in recovery, which is near pre-op staging. Your arm is in a sling and entirely numb. You have oxygen being given through your nose. Your throat is sore from the previous throat administered oxygen though the tube is long gone. The sore throat will last about two days and is minor in nature.

I was supposed to be under for two hours tops, but because they found so much damage I was under for almost four hours. You’re still covered by blankets and on the IV. The anesthesiologist checks on you first and asks you to move your fingers. He then tells you to take deep consistent breaths to “blow off” the anesthetic. For whatever reason there was only one nurse in recovery. For reasons still confusing to me she throws a fit that there are two patients in there and says she cannot watch us both. They send for my operating room nurse who then moves me into pre-op. She sits with me for the next twenty minutes while I come to.

The orthopedist then visits with me to tell me about the extent of the damage and that all went well. He tells me my blood pressure is a bit high (170/90) and that when I get fully awake they’ll give me pain killers to take it down. He states it’s from the extended length of sedation. They then wheeled me back into the first room I was in when this all started (the general recovery area). I sit there another twenty minutes and slowly come to. I can feel the heavy amount of pain in my arm despite the nerve block. Because of the nerve block I cannot move my right side. They then called my wife and let her know she could come to see me, as well as, maybe bring me home.

Twenty more minutes go by and it’s nearly 6 pm when my wife arrives. I tried to stand up, but I’m still too weak from being under so long. Because I was still in pain, they give me a percocet pain killer. This makes me instantly nauseous. By 6:30pm I’m able to stand long enough to use the bathroom and urinate. At this point my blood pressure is down to 140/85. Still not normal, I’m still dizzy, still in pain, and still cannot stand. The post-op nurse decides to admit me for over night monitoring.

They wheel me up stairs in a wheel chair and move me into their orthopedic recovery wing, which I’ll later find out is self care. How partially crippled people end up in self care is beyond me, but fortunately the nurses do help out a lot more than they probably are supposed to.

The hospital would rather you did not stay over night for two reasons. First, because keeping me there under 24/7 monitoring is mighty expensive. Second, because the longer I’m there the more risk there is I’ll catch something as the nurses move between the orthopedic recovery wing to the general population recovery area (where the swine flu sufferers hang out amongst others), which shares the same floor as my room and is the next hall over.

They sit me in an upright position in the hospital bed and immediately I feel better. The hospital bed is much wider and had a better mattress than the same day surgery cots. The room is slightly warmer as well. I’m on the same IV bag from downstairs and they hook me up to a blood pressure machine. I’m sharing the room with one other patient and it is the smallest room in the hospital for two of the largest guys they arguably have there. My roommate, Nick, is 49 years old and in for complete right knee replacement. It’s around 7 pm so I missed dinner. They bring me a small cup of chicken broth and crackers. I get another percocet and am told they’ll give me another one in four to six hours.

Nick and I decide to watch ESPN. We each have our own flat screen TV with a limited DirecTV line up, but there is no way in a room barely big enough for our two beds we could have both going at once. Fortunately we’re both into sports and stick with that theme for the night.

Around 10 pm my blood pressure comes down to 130/75 and they take me off the machine. The liquid anesthesia has worn off, but the nerve block will last until around 4 pm the next day. I fall asleep around 11 pm. I’ll be woken up every six hours from there in by a nurse who will take my temperature, my blood pressure, check my IV, and give me pain medicine. This goes on 24/7 whether you’re sleeping or awake. The bath room is shared between two rooms and has no shower. You cannot get up anyway.

The next morning is horrible. As you approach 24 hours from the beginning of surgery the pain starts to come through. They up your pain meds at that point. I can get up with a lot effort and walk. My blood pressure is finally down to 120/70 and my doctor/orthopedist stops in. He checks me over. The anesthesiologist also stops in. I let him know as each finger starts feeling again I get spasms in my arm. He lets me know that’s normal.

By the time my wife is allowed to take me home the nerve block has worn off. They put me on two 5mg Oxycodin with 325mg of Acetaminophen (I’m told this is Vicodin but who knows) every six hours. I’m told to keep my arm in the sling 24/7 and am allowed to only move my hand and lower arm. I’m also told I can sponge bathe, but cannot get the bandages under the sling wet. While bathing I can have the sling off, but must support my arm with my other good arm.

I don’t think about bathing at that point. I basically lay in bed from the time I get home Thursday (10/22) night to Saturday morning (10/24). I get up only to urinate. The first 72 hours are complete Hell pain wise. Every day gets better from there.

I start on 10/24 being able to wash my face and brush my teeth. The next day (Sunday- 10/25) my wife is able to have me stand long enough so she can wash my hair. I then sponge bathe quickly with baby wipes. This is about as far as I move for the first week. Just shy of a week (Tuesday 10/27) I’m finally able to walk around in minor discomfort. My wife is then able to help me through my first sponge bath. I’m also able to finally walk downstairs to eat so I don’t have to sit in bed completely all day. Since coming home I have not worn a shirt. I cannot get it on without being in severe pain. My lounging around shirtless becomes as common as most of the guys you see being chased in “Cops” on TV. I finally am able to pass stool on 10/28. Apparently the Vicodin constipates you for a bit.

On 10/29 my appetite finally comes back. I’d mostly been eating light meals until that point. I’m able to walk around on Halloween (10/31) for trick or treating for about an hour and half. After that I’m exhausted and back in pain again. I also manage to wear a shirt for about three hours while I’m out and at my Mother’s with the family.

On 11/1 (just two weeks shy into recovery) my meds are reduced to one Vicodin every six hours. I can sponge bathe myself at this point except for washing my hair. 11/3 I have my first post-op follow up with my orthopedist. He takes off my bandages and tests my arm. Everything is intact and I have no infection in the wound. They stitched me back up with clear self dissolving stitches so they don’t have to pull anything out of me. They do have to cut each end off of the stitch though that was left for slack and to keep it secure while I healed. The stitches then pull into your skin and will dissolve on their own from there. During the check up I pass out briefly while they test the limits of my range of motion. I’m told this fairly normal. I’m out for no more than 10 seconds. They lay me down, put cold towels on my neck and forehead, and raise my legs. I come to and am back to normal in 10 minutes.

When I get home I’m allowed to take my first full shower. I do so happily. I also only need to wear the sling at night. I’m given an exercise I must do three times a day (you basically use your body to move your arm while it hangs at your side) and am told my only limitation is I cannot raise my bicep any higher than my collar bone line. I’m also given a prescription for physical therapy and told to along with the Vicodin take two tablets of Ibuprofen three times a day.

Since then I’ve been doing my exercises. I’ve also been told to type to spur blood flow in my right arm (a great excuse to make this blog). I can finally also wear a tee shirt. Tomorrow I’m going to call a physical therapist who is nearby. I’m hoping to either line them or another local PT who accepts my insurance provider for payment so I can get my therapy going. I’ll have to go there twice a week for the next twelve weeks.

I hope this answers a lot of your questions and gives you some insight into the recovery process. I’m about 35% back to normal as far as my arm goes. I’m told within six weeks I’ll be at 50% with PT. I’ll be sure to post any milestones as I go through the process so you can see how this whole shebang progresses.

I have not been at work since the day of surgery. It hurts to stand or do any sustained activity for more than an hour or so. That makes work tough, as well as, a lot of other things. Therefore sick time is a must if you plan on getting shoulder surgery and you should clear at least six weeks with your employer from the day of your surgery. I did this by saving up my sick time over the last two years and banking as much time as possible knowing eventually I’d need it for shoulder surgery. If possible, apply for FMLA and short term disability to protect your job. Talk with your HR or local government benefits official to find out more about that. You’ll have to do some preliminary paper work and your doctor will also have to do some. There is a few follow up forms and I’m expected to give NY state monthly medical reports on my recovery. I cannot return to work until I get a note from my orthopedist saying I’m cleared to do so. As such, I’ve setup a six week follow up appointment on 11/23 with the intention to get clearance to return the following week. I should be four weeks into PT at that point if all goes well.

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Double Trouble

This morning I woke up and found my left shoulder mildly dislocated. I’m not sure how it happened, but I been noticing that over the last two weeks my left arm has become more and more sore. From what I can tell, I’ve been favoring my right side. This has begun to stress my left side and in particular my left upper arm. There’s a lot of strange popping/rubbing in my shoulder that I don’t remember. By the end of my work shift my left arm was in more discomfort/pain than my right. That in itself is concerning.  I’ll try to speak with the orthopedist tomorrow, but I’m sure it’s fatigue related and that I may have unfortunately discovered an existing issue I just never knew about.

I spent some of today working with JDiddy during break time bringing up a new Linux LAMP (web page) server. For those of you who know me, this will come as no big surprise. I’m a huge Linux nerd and love bringing up/working on servers. We’re trying to get him a decent platform to launch his new web site on and it’s given me a chance to coach him on setting the system up. It’s been a while since I’ve had a chance to coach any one at any thing in such a regimented manner and honestly it reminded me how much I like teaching others new things especially when they’re excited about what they’re learning. Good stuff. I can’t wait to see what JDiddy does with the new site and I’m pretty excited to pass on the new skills I’ve learned over the last six months building this one.

Fall is definitely here in downstate New York. The morning and nighttime temperature is in the low 40s. I came out to frost on the Stang this evening. I can definitely feel a cold draft drifting through my walls. I had to cave and turn on the heat earlier last week. It’s just too cold this year (some five degrees on average) to not do that. The summer was very mild (some ten degrees on average) than last year so it would make sense that fall/winter will follow suit. If that holds true though we’re definitely in for a very cold wet (read: lots of snow and ice) winter. My hope is my shoulder heals before the major snow falls in December.Pirate mime

Minor issue with my plan to roll out Pirate Radio– my main hard drive is slowly failing. I’m hoping it holds out long enough to kick out a new episode, but if not I do have a spare (though arguably slower and smaller IDE verse the existing SATA) hard drive to fall back on. I rue the thought of reinstalling Windows XP and all my applications, but it is what it is at this point. Quick flashback, over the summer it appears I may have run my PC too hard during 90 degree temperatures and cooked the hard drive platter. Not good, but the HD is some ten year old (bought in 2001) and way beyond the eight year meantime to failure average. Again– it is what it is.

Finally, today’s “Random Picture of the Day” is a pirate mime. I had no clue until my recent search of the WikiCommons that such a beast existed, but here he(?) is in all his wondrous mime glory. He would say “ARRR!” but he’s a mime. Alas, he can say nothing. He can merely glare at you with his buggy eyes and wave his dull short short in anger. It’s sad really and I’m sure Sally Struthers will soon start some sort of charity to help pirate mimes out. For now though– he suffers in silence while we mock him over the Internet. We rock so much indeed.

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