This is a tale of my subacromial decompression and distal clavicle resection. In the months and weeks before my procedure I had done quite a bit of Googling and didn't come across a first hand account so I figured I would record my experience for those who may be pondering the sharp end of the scalpel.
Doctor Number One
Well I made it to 52 without a doctor opening up the aging carcass but the persistent pain in my right shoulder finally sent me to the doctor about three months ago. Having an HMO, I had to go to my primary care physician first. She asked me to move my right arm in certain ways. Funny how she knew which ways I couldn't move it, but I guess that's what all the schooling was for. I quick referral note and I was off to the orthopedic surgeon.
Doctor Number Two
The orthopedic surgeon was a good natured fellow. Took and read a few X-rays and asked me to move my arm in absolutely impossible ways. I really hadn't noticed how much range of motion I had lost until that examination. Looking at the X-rays his diagnosis was an impingement. He pointed it out in the X-rays but me looking at them would be very much like him looking computer code. I could probably tell him it was going to do all sorts of things! He prescribed a month of physical therapy and did I mention THE SHOT?
It was actually two shots, but the pain I was in from the nurse pulling down on my arm to partially separate my shoulder as I was leaning across an exam table out shadowed any needle he used. After the shots, instant relief. I could do just about anything I wanted for about two hours. You see one shot was an anesthetic, similar to the dentist. The Doctor said it was to confirm that the problem was actually in my shoulder as ailments of your neck can masquerade as shoulder pain and the anesthetic rules that out. The second shot was cortisone the is an anti inflammatory to give the area a chance to heal.
Physical Therapy (aka.The Rack)
I had heard all sorts of things about this part of the process. From " It's a waste of time. " all the way to " It eliminated my surgery.". I'd like to say my experience was along the lines of the latter, but it went like this. The first month there was absolutely improvement, so much so the surgeon prescribed another month. He said I should "reach a plateau". I reached it the second month. My therapist measures improvement with a protractor to see if my range of motion had increased. The second month there was NO improvement, so back to Doctor Two.
After what looked like to me like an I told you so sort of look the surgeon talked about the proposed procedure but qualified all that with, " We don't really know till we get in there ". Just what I wanted to hear. He said the next step was an MRI, call his assistant for a date and he wouldn't see me again till surgery.
The Multi - Million Dollar Horizontal Phone Booth
On November 16th, just Sunday before last, I had my first experience with an MRI. Lay absolutely still for forty minutes, in a cylinder barely bigger than your body, with all sorts of really loud noises? No problem, except no one told me I would be required to position my bad arm in a position that was moderately painful for them to get the best image. I believe that was the longest forty minutes of my life. Doctor two had prescribed some pain medication, but who would think you would need pain medication to get your picture taken. If you find yourself in a similar situation use the medication you were prescribed.
PreOp
Like I said, Doctor two is a nice enough guy but his organizational and communication skills leave something to be desired. Just the end of last week a nice lady called me on the phone and said " Mr. Scofield, I'm so and so with such and thus Home Health Care. Did anyone mention to you that you would be going home with an IV in your arm?". This is getting better all the time. Next comes a package in the mail telling me all the details I guess they though I needed to know right now. What I can't figure out is why, when I live in a city with TWO hospitals, am I going to the next city for surgery. Wait a minute, this is an HMO, maybe it's cheaper? Maybe not but no one has said why. So today it was off the neighboring city for a little fancy needlework, chest x rays and an EKG.
Thursday, November 27, 2003
Well here I sit Thanksgiving morning with a vicious head cold. Just four days till the big day and several folks have told me there's no way they'll operate if I'm sick. I guess we'll have to wait and see. I'll sit inside today and hope for the best. The cold came to the fore yesterday about mid-day but come to think of it, my nose has been stuffy for several days. Figure the odds, I haven't had a cold in over a year!
Sunday, November 30, 2003
Well the cold's let up quite a bit, but we'll see tomorrow if I'm well enough. Went to the store this morning and took a look at my watch figuring where I would be in twenty four hours. It was about twelve o'clock so the would put me under and in the thick of it I guess. I really would like to get the cutting part of the process over. I've heard the biggest part of this whole thing is the therapy and recovery and if I don't follow through I'll end up with a frozen shoulder. No joy there! I started drinking eight ounces of water every half hour at noon in preparation for tomorrow morning. My instructions are no food and no water after midnight tonight.
The Big Day
I woke up at my usual five o'clock which meant I had a lot of time to kill till my surgery at twelve forty five. I fiddled around on the computer read a bit of news and looked a bit at Perl which was to be one of my next projects. I was to be at the Outpatient facility at eleven thirty so I really wasn't in a rush. Terry came over about eight thirty so I headed for the shower.
At quarter to nine the phone rang. On the other end a lady said that the doctor's ten o'clock surgery had canceled and could I be there by ten. Slammed into gear and headed the twenty or so miles to arrive at ten minutes to ten. It was the rush took my mind of the two or more cups of coffee I was used to every morning, not only that but I was seen right in to the prep room without a wait.
Next up was the anesthesiologist. I really good natured fellow dressed in a very festive smock and cap. He also confirmed what I was to have done and which shoulder was involved. I asked if I was to be knocked out or if I was to have only a pain blocker. I had read it is done both ways and if you have a choice you should get both. He assured me I would have both. And the blocker wouldn't wear off for at least twelve hours. He then preceded to put an IV in the back of my left hand remarking what nice veins I had.
Before long it was off to the operating room. I was fully awake when they rolled me in and it was then that I realized why the Doc wanted my to drive so far away from home. The room was really nice. As an inspector for the city, I've seen quite a few operating rooms. This one looked more like someone's living room than the inside of a white tile butcher shop. Nice quiet decor and a row of clearstory windows which lit the room with nice natural light instead of the cold glow of fluorescent. I climbed up on the table and the anesthesiologist took over after a chat with my surgeon. I laid down with my head in a U shaped padded head rest. The anesthesiologist came over with a serious looking needle, wiped the right side of my neck with a alcohol swab and said I would feel a burning sensation in my left hand from the IV. It was indeed a burning sensation, so much so I didn't really notice the needle going in my neck. The burning didn't last long as the next thing I knew I woke up in the recovery room actually quite comfortable.
The first thing I recall was a nurse asking me if I would like some ice. She was right on with the ice as I was quite thirsty. I couldn't even raise my head at first but within a few minutes I could sit up and the nurse gave me the whole cup of ice which I made short work of. Next they wheeled me out the prep room I had been in before where I could dress and discuss my experience with Terry. So off we went to fill a pain prescription and home. I was in no pain from whatever pain killers were in the IV and the pain blocker. The pain blocker was so fierce my lower lip on the right side was numb, like after the dentist.
Home at last with my IV in hand, just the needle that is and a spanking new prescription which I started taking one every four hours as directed. I felt good, I mean really good. The phone rang, it was some fellow who said he had a bag of medical supplies and wanted directions. The phone rang again, this time the home nurse wanting directions. The phone rang yet again and the therapist wanted directions.
First to arrive was the fellow with the supplies. A really big bag with all sorts of syringes, needles, bandages, etc. Next the therapist arrived. She manipulated my arm out to the side and in front. She next instructed me on how to do passive exercises. Don't lift you arm on your own I was instructed.
Next came the physical therapist. She took my arm out of the sling and stretched it quite a bit both to the side and forward. She instructed me in some passive exercises and said not to lift my arm on my own. I guess the stretching didn't hurt due to the pain blocker and the oral meds.
The nurse didn't arrive until about eight o'clock that evening. The trick was Terry and I had to perform do it yourself infusion therapy.
This is what my hand looked like and at different intervals we had to infuse either antibiotic or pain killer. The intervals worked out so that we never got more than two hours sleep for the next twenty four hours.
Here is a shot of the syringes laid out for one of the doses. We had to alternately connect then disconnect each of the syringes from the IV rig. The only thing that really bothered me was that the little shut of valve seemed to leak later on in the night so blood would back up into the rig. I figured since the last thing you put in was an anticoagulant it would be al right. I guess so since it never clogged up.
Now I don't want to wine but Terry and I had a real argument at eleven thirty that night when it was time for the first run. Neither of us had ever done anything like this before and she had taken a nap. I was nervous that she seemed groggy and the nurse put the needle on and off the hypo, which mixed one of the drugs with saline in one of the syringes, so quickly that neither of us realized the needle screwed onto the hypo and the guard acted like a sort of wrench. To make a long story shore, it took us over an hour the first time and by the next day we were doing it in under ten minutes. I feel that this was a little much for people to do on their own just to save the insurance company a few bucks but we did it.
Post-Op The Long Road Back
Up pretty much all night I took the chance between the nurse and therapist coming over to nap as much as I could. I found sleeping in my recliner the most comfortable. If I tried to lie down, the weight of my shoulder caused me some discomfort so for now it'll be the chair.
The nurse came to remove the drain I had in my back, remove the IV, and change the dressings. When she removed the dressings this is what we both found...
Looks like quite a bit more than a "couple of small holes you could cover with a Band Aid" to me. The operation was supposed to be arthoscopic but in his defense I did tell him I didn't care about a scar and I wanted him to do what he thought best after he could get a good look at it. Guess I will have to wait till my follow up visit next Tuesday to solve the mystery.
Next came the therapist who said it looked like a good job. She manipulated my arm, stretching it further than yesterday, and remarked how there was no swelling at the incision or my hand. She said it was unusual.
Wednesday, December 3, 2003
I was up pretty much all night except for a couple hours here and there. Terry had to be up all night because of a previously scheduled hospital test where she had to go to sleep during the test. I went along with her to the hospital, and believe me she had no problem sleeping for the test. She had been up for two days. She's been a real trooper through all this.
I'm taking the pain medication every four hours. I'm not in a great deal of discomfort even though I've been weaned off the IV pain medication. The therapist came to the house for the last time. More of the same, stretching even further. So far this has been a walk in the park.
Thursday, December 4, 2003
I spoke too soon. Last night I got about seven hours of sleep in one shot, but when I woke up! The pain medication had time to completely wear off. I wasn't about to wake Terry up as she had the first real night's sleep since this started. Getting out of that chair, over to the sink for TWO pills, and back to the chair is something I doubt I'll ever forget. I will have a glass of water and a pill within reach from now on. No therapy today just relax and watch TV.
Friday, December 5, 2003
Last night was a little better as I set the alarm so I wouldn't go more than four hours without a pill. First visit to my regular therapist, the one I went to before surgery. They remarked how good the incisions looked and how they would have to do all the work at the beginning. They measured my range of motion and were impressed. At the end of the session it was ice pack and a new electrical gadget I had never experienced called e-stim.
The therapist turns the juice up as high as you are comfortable, then the automatic control takes over. The control varied the electrical level to a pair of several electrodes around my shoulder and seemed to rotate the juice at varying levels in waves. My shoulder was also packed in ice while all this was going on. It's the first time I can remember feeling better coming out of therapy than going in.
Monday December 8, 2003
Ran out of my original pain medication this morning. I had been taking one or two 500 mg Tylox capsules every four hours and had been able to take one most of the time. The next medication on the list is 500 mg Vicodin capsules one every four to six hours as needed. Second trip to my regular therapist and the range of motion was forced a little bit further. She also measured the range with a protractor for a mini report I was to take with me to the surgeon on Tuesday.
Tuesday December 9, 2003
First follow up visit to surgeon after surgery. He looked at my shoulder and said I didn't have to wear the sling all the time anymore. He also said I couldn't drive, even back and forth to therapy or to light duty work, at least until after my next visit with him in another month. Best news of all, I can now take a shower since the stitches are out. I had been taking "bird baths" and washing my hair in the sink. When asked why he had to open up my shoulder verses an arthoscopic procedure, he replied the arthoscopic procedure revealed "some arthritis" , so he went in and "cleaned that up a bit". I didn't know you could just go in and grind arthritis off or whatever, but I had told him on a previous visit I didn't care about a scar, just go in there if you need to. Spent the evening, until 2 AM, surfing the net down loading various utilities for my new iBook and doing a lot of reading. I had tried several Usenet readers and finally found one I think I'll like at the Apple software site MT-NewsWatcher.
Saturday December 13, 2003
Had a full week of therapy every day. By the end of the week my external rotation had gone from neutral to twenty degrees. Not so hot when you figure eighty to ninety is where I've got to go, but progress none the less. I do believe I over did it yesterday as I feel it today. After therapy Terry and I went to the Rec Center and went in the pool. I know I was just supposed to just move it around a bit but guess I moved it a bit too much. I had never been in the city's Rec Center and now I don't know why. It's quite beautiful. I've got therapy Monday and will probably go in the pool but I vow not to over do it.
Saturday December 21, 2003
This last week was quite eventful. It started with a visit to my second home here lately, the therapist. I struggled through the exercises which always come first. I was getting along OK until I came to the last part of every therapy session, the stretching. I've never had my shoulder muscles react the way they did. They just launched into spasms as she put on the pressure. We really didn't get anywhere that day. I received explicit instructions, I was to go home, put on the sling, and give my shoulder a rest!
One unexpected thing I believe did as much as any other to aggravate my shoulder was the time I spent on the computer. Two handed typing and most of all using my right arm with the mouse. Today I am two handed typing, however I still will not use my right hand for the mouse.
Wednesday went much better in the stretching department. Only a couple days rest did wonders. I've since been careful no to leave my arm out of the sling all the time.
Thursday brings us to a topic I've been told, is not discussed in polite company. Both the nurse and the surgeon had warned me that the pain killers would "bind you up". I'm going to come right out and say the "C" word. That's with a capital Constipation. It's my fault for not keeping track of my "schedule" so to speak. I had been keeping track but when the emergency occurred I couldn't recall when "the last time" was. Suffice it to say I would suggest you have a Fleet on hand for your recuperation. That's all I'm going to say about that.
Friday brought another visit to the therapist since I'm on three days a week now. I was told to remind her that Friday was "measuring day". Woah, she took me to the limit and I'll be frank I didn't think I could go that far. The torture was worth it as my external rotation had gone from neutral to thirty degrees with eighty to ninety the goal. My extension had gone from ninety to one hundred twenty degrees, one hundred seventy to eighty being the goal if memory serves. That's measurable progress and I'm quite satisfied. The only part I didn't like was her response to my question about what kind of shape I would be in when I went back to the surgeon the second week of January. It was something to the effect "you won't have a properly functioning shoulder".
Next week's goal? To try and reduce the drug intake and show some more improvement.
Tuesday December 23, 2003
Not a bad nights sleep last night but the pain this morning was a surprise. I really would like to cut down on the medication but at this point is seems only a goal. Did fairly well yesterday trying to reduce the doses but I'm off the wagon so to speak this morning. Terry spoke yesterday of going to the Rec Center for a swim but when she got up this morning I told her no way.
Saturday December 27, 2003
Yesterday at therapy was especially interesting. First a bit of background. My therapist is really three therapists that sort of tag team. They each have different styles form nice and easy to medium to not so nice and easy. Friday I drew the not so nice and easy one. When I walked in I was told not so nice and easy would be helping me today, the dread began. The usual drill the last couple of weeks has been, first I do all my appointed exercises then I am "ranged" by the therapist, and finally I get twenty minutes of ice pack and e-stim.
This "ranging" consists of the therapist pulling my arm in directions It doesn't want to go but should go. I asked how she knew how far to go and the response was, it's different with different people. With one it my be the lip curling up or the wrinkled brow or the toes curling. In other words it's until you give pain feedback. I figure the idea in all this is to improve my range of motion so Friday I held out as long as was comfortable and let her go quite a bit further. After the ice and e-stim twenty minutes later, I didn't feel any worse than I felt when I "wimped out" earlier in previous sessions.
On a bright note the therapist said the surgeon would probably let me do some limited driving when I went back to him in January. I drive all day at work and we'll see what he says about that. Since I do a lot of programming on the side at work, maybe I'll at least be able to do some of that at the office so they don't forget who I am.
Saturday January 3, 2003
Another week in the can and little noticeable change. Last Monday I was able to shave with my right hand for the first time without holding it with my left. When I told the therapist later on that day she made quite a big deal about it.
It's a continuing battle with the pain medication and constipation. Last Sunday at the grocery store Terry picked up some bran cereal and that seems to have helped quite a bit. Just like old folks huh?
Next Tuesday it's back to the surgeon for a visit. The therapist thinks he will release me to drive. I sure hope so. I'm making a list of things to talk with him about. One of the things on the list is how long does he think the pain will last. The other is what type of arthritis I have, as I have never been formally diagnosed.
Saturday January 10, 2003
Hot off the press! I was able to get an old scanner working on the Windows 95 workstation so here's a shot of my operation in progress taken with the arthoscope...
On the upper left you can see my collar bone after the surgeon had removed a small portion. In the other photos all the fuzzy looking stuff is arthritis according to the Doc and he "cleaned it out".
I asked all the questions I talked about last week. The Doc wasn't very forthcoming about when I could drive but he said if I have an automatic I could probably manage it but the legal issues were "something else". When I pressed further telling him I had to tell them something at work, he said to give them a range, three to seven weeks! I'm just about to go nuts, so I called work and will try to go in on the days I don't have therapy and ride with our Fire Protection Engineer on a few inspections. When I go back full time I'll be a Fire Inspector and I'd like some time to prepare.
On the subject of my arthritis, it's osteoarthritis. I figured as much, but now it's official. The Doc gave me samples of Vioxx to try and it seems I no longer have to take Vicoden. I did some research on WebMD and Vioxx can be nasty stuff but I feel no dizziness or and of the other side effect mentioned.
Saturday January 17, 2003
This week I went back to work. Well kinda sorta. When I left I was promoted to Fire Inspector which thankfully doesn't involve a lot of climbing and crawling. Besides people know what a Fire Inspector is but when you say you're a Mechanical Inspector you just get a blank stare.
I said kinda sorta because it's just two days a week and I only ride with another inspector who will leave as soon as I am released for work. I think it's a beneficial arrangement as I get some procedural training before I have to hit the ground.
The Doctor didn't say I could go back at all but then again he didn't say I couldn't. My boss, said only to come in if I feel OK and not to over do it. She's been great about this whole thing.
My therapist keeps asking how I'm doing and I always reply, " two steps forward and one step back". This week is the first time since the surgery I actually go for several minutes at a time without thinking of my shoulder. I hope those minutes stretch into hours and finally I'll just think of it as something in the past. Time will tell.
Monday February 2, 2004
It's been awhile since I've updated but really there's not a whole lot to say. Getting along better all the time. I ran out of Vioxx last Thursday and seem to be none the worse for it. I've read Vioxx helps different people to differing degrees but all I've noticed since running out is the heavy duty ringing in my ears has stopped. I've had ringing in my ears for several years but the Vioxx " kicked it up a notch ".
It's been two weeks of working three days a week and it feels good to get back. Since I can't drive according to the Doc, I ride with a Fire Inspector on loan from the Fire Department. It's been a great chance to see how someone else does the job.
Thursday February 5, 2004
Yesterday was my regular therapy day and this morning I could barely get out of bed. You know how I said a while ago there were three therapists and they ranged in levels of zeal with which they approached their jobs? The luck of the draw gave me the most zealous two sessions in a row. I haven't hurt this much in weeks. We're going to have a talk. Needless to say I missed work today. Since I'm not really supposed to be there I guess it's alright.
The real news is I was talking to a fellow therapy victim yesterday and here's the rundown. He's had his lower spine fused and pins inserted, both knees replaced, and as soon as he recovers sufficiently he will have BOTH shoulders done. OUCH, OUCH, DOUBLE OUCH!!! I'll count my blessings.
Wednesday February 11, 2004
Yesterday at work was no treat. I actually stood outside the office near the end of the day and had thoughts of weather I would ever be able to return to full time work or not. A day of nagging low level pain interspersed with the occasional sharp twinge does it. Today it's at home for most of the day then therapy at three thirty. I've been assigned another small Access program to write for work, so that will pass some of the time.
Tuesday February 24, 2004
Finally! I have been released for work without restrictions. I've been driving my own vehicle back and forth to work and therapy for over a week now but tomorrow will be my first full day back. The Doc now finally told me the truth about the recovery time. Ready for this !!!
"You should get about eighty percent back in the first three months, ten percent over the next three months, and the last ten over the last six months". A FLIPPIN' YEAR !!!
Saturday March 6, 2004
My first full week at work and I "graduated" from physical therapy to boot! I learned graduation takes place when your insurance coverage expires. What a coincidence! I have signed up for "post rehab", an exercise program I intend to attend three days a week. The fee was extremely reasonable for this program and you come in when your schedule allows. My therapist felt I would benefit greatly from this. My shoulder feels pretty good but I think the exercise is necessary to strengthen muscles which have had limited use for the last year or so. I hear horror stories about people who fall post surgery and their muscles haven't developed sufficiently to avoid injury.
I did quite well at work except on Thursday I had to begin taking aspirin again. Not for my shoulder this time but for my lower back and feet. I really don't want to go to my doctor unless it becomes much worse. The aspirin seems to get it under control.
Saturday March 20, 2004
Seems like the post rehab therapy sessions are going quite well. You get almost as much help as the full sessions. I've made sure not to interrupt any of the paying customers. The pain in my lower back and feet is now overcoming the shoulder pain most days. I don't know if that's good or bad.
I developed a rippin' head / chest cold kind of thing Friday, so it's in the house this weekend.
Sunday May 2, 2004
I've come to the end of my post rehab sessions and feel they were well worth the time. As a matter of fact I lugged a new Sony 21 inch monitor upstairs to the computer corner an had no trouble doing it.
Thursday May 27,2004
The rebuilt shoulder got the shock test today and came through with flying colors. I really didn't mention on my personal page that my job involves a lot of time on construction jobs. Well today on my way out the door of an apartment building, one of those brown paper shingle wrappers was upside down on top of a sheet of plywood. My right foot slipped out from under me toward the front and I went down hard on my butt. In an automatic reaction I broke my fall by putting my right hand behind me. The right shoulder took all the shock and I didn't end up in the hospital. It must have been a hell of a fall because the Superintendent and all who saw gasped. Tonight it's just a little sorer than usual. Whew!
Wednesday July 28,2004
Bad news! Last Wednesday July 21 Stan Foster, a Battalion Chief with the local Fire Department had "minor" arthroscopic knee surgery, and returned home I guess much the same as I did. Over the weekend HE DIED at 48 years of age! Blood clots from surgery or so I've heard. I guess this bone work can be dangerous indeed!
Monday, November 8,2004
I just realized the other day that there were hours on end when I didn't give my shoulder a thought. There hasn't been a full day like that yet but time will tell.
Saturday, December 31,2005
Another year has come and gone. I use my right arm as much as my left and have to say, I got more than the Doc promised eighty percent.