Had my 5-ish week checkup this morning with the shoulder surgeon (strange person — I’d describe them as “brusquely kind”), and based on my pain levels, the prognosis is good!
Shoulder surgery happened on June 13 (a little over five weeks ago). This whole process has been… fascinating.
The surgical morning itself had that weird fast-slow sensation to it: it felt like the waiting was forever, and then suddenly I was getting wheeled back and drawn on and poked and suddenly I was waking up and couldn’t breathe and coughing and then waiting… again.
In one of the waiting phases, I did an awesomely helpful meditation with PUUC‘s Rev Robin. I went into surgery nice and calm, and everyone was pleased and surprised at my cheery demeanor afterwards. Aside from occasional whining, my mood remains pretty cheerful, despite some miscommunications that have occurred.
During one of the wait periods that morning, a random person came by and dropped off the sling I’d be wearing for at least 6 weeks. Hi, random person. I don’t know you, but you were pretty nice.
I had two nurse-like people give me sets of directions for post-op care. Greg made sure to take notes when he didn’t think the packets had enough detail, which was quite nice of him, as was him agreeing to stay with me for a few days while I got my bearings and understood my limitations.
One of the discharge folks, though, was incredibly frustrating. They were showing Greg how to adjust the immobilizer sling, and no matter how I asked “How do I do this solo? I live alone,” all I got was “You can’t.” I seriously recall asking this about three different ways, including asking, “What do your patients who live alone do?”
Well, lucky for me, my right shoulder remains as creepily flexible and able as ever, because I do live alone, and I have to adjust the sling by my damn self.
Greg also had a really difficult time getting a clear answer from them on something equally important: how the sling was supposed to be positioned. Where is the front edge of the pillow supposed to sit? What angle is the elbow supposed to be at? If I’m feeling pulling in the shoulder, should it be adjusted?
We got how tight the band was supposed to be around my ribs, but pretty much nothing else. We were both pissed when they left, but one thing they successfully instilled is that my job during this healing process was to keep my shoulder relaxed. I’ve been tensing against pain for a long time, and it’s second-nature to “help” when someone is getting me dressed or adjusting a sling, but that tensing is (according to this nurse) setting up for an imbalance.
I went home with an anesthesia catheter taped to my neck, my arm still 95% numb from a nerve block, and prescriptions for oxycodone acetaminophen and an anti-nausea medicine.
The Medical Stuff
Here’s where things get a little explicit in terms of the procedure.
We were prepared for any number of things: a labral tear/SLAP lesion, damage to the rotator cuff, a subacromial decompression (shaving back a bone), and tightening the ligaments in my shoulder. Dr. B couldn’t know what had to be done until they got in there and saw with live cameras.
The awesome news is that the only thing that needed to be done was the ligament tightening. They put in anchors in the front and back of the shoulder socket and sutured the ligament to them to hold it in place. The anchors and sutures are probably dissolved now (supposedly it takes about a month), but in the first few weeks I could definitely feel the yank of pain if I — against nurse’s orders — tensed the shoulder. That yanking feeling is gone now.
(Being an easily startled person in this situation was absolutely BS. Delivery people, the cats getting into stuff, my alarm clock…)
Returning to the ER
By the time I got home around 13:00, I was ready to eat (nom, sushi), take some oxycodone, and doze.
So I did!
And then I woke up having trouble with my throat and breathing. I’d been intubated during the surgery, though, so it was expected that my throat would be a little bruised, and I wasn’t used to the sling around my ribs yet…
Greg called the triage nurse, and she gently encouraged us to go to the ER, since this sounded pre-anaphylaxsis. So we bundled me back up into yoga pants, a huge men’s dress shirt, and flip-flips and headed to the normal hospital associated with the orthopedic hospital I’d been to that morning. I didn’t want to fuck around with records being in two different places.
Emergency rooms… Sigh. Places of pain and discomfort and with surprisingly little “emergency” feel to them.
I told my story to a triage nurse, a… non-triage nurse, and finally to the chipper doctor who needed to take my concerns a bit more seriously. They finally decided on intravenous delivery of benedryl and a steroid.
At that point, it was heading on 20:00, and I was exhausted and in pain–the oxycodone and the nerve block were fading fast. I’d had to be at the hospital around 06:00 that morning, if I recall correctly, and I really just wanted to crawl into the recliner Nathan loaned me and sleep for days.
The benedryl, of course, made me more sleepy. I have a very clear memory of most of that whole day, but the benedryl on top of the oxycodone… the aftermath and the ride home are a blur.
I remember that the vein on the back of my hand had been blown by the IV that morning, so they had to do the IV at my elbow. Then they also decided to take my blood pressure with an automated cuff, and the cuff overlapped with the IV… Ow. I cried. Greg snapped at the nurse. The nurse let the BP cuff continue its cycle unabated.
I didn’t find the ER doctor’s jokes about “Must not have gotten enough of us today, huh?” particularly funny, but I did manage to learn that as long as my elbow is as a 90 degree angle and able to fully rest without pulling, then the sling is positioned correctly.
I went home with a prescription for trusty ol’ hydrocodone, which I’ve taken in the past.
Life After Surgery
Things got so much better after that. The surgery was on a Friday, and Greg took the pain catheter out on Sunday. The dressing came off my shoulder on Monday, but I was too scared to take a shower, so I didn’t until Tuesday.
I cried through that whole first shower. It was incredibly nerve-wracking to have my shoulder be so… unable to perform, and so fragile on top of that. Under no circumstances was my shoulder supposed to hang, so I showered with a towel between my forearm and body, much like where the abduction pillow sits on the sling. But I had pretty much no strength to hold that towel tight, and if I tensed the wrong way, I’d have that yanking pain.
I was terrified of fucking this up. If this went well, if I did my physical therapy properly, then it was expected that I’d have a full, 100% recovery of strength and ability in the shoulder. Like, seriously. Better shoulder health than I’ve had since 2011… if I don’t screw this up.
I didn’t wash my sling until this Friday, five weeks after surgery, because I wanted to minimize the risk of spending too much time out of the sling. That’s after a month of going outside on 15-30 minute walks once or twice a day in the summer. Ultimately, I just couldn’t stand the smell anymore and didn’t want to inflict on the folks at the meetup I was going to that night.
Adapting to life with only one able arm hasn’t been too bad. Many things in my home were already set up for this to a lesser degree, but I did have to sleep in a recliner for a week or so, and get help with emptying litter boxes. I bought a handful of shoulder shirts (so comfy!) and have resigned myself to buying new bras after this is over, since I have to pull clothes on from the floor up and my hips are wider than my ribs.
Oh, and I can’t drive.
There were a few miscommunications that have proven… annoying at best.
- Two weeks without driving. This is what I was told. When I had the stitches removed 11 days after the surgery, I was told that I wouldn’t be able to drive until after the sling came off. See… that whole thing about living alone? Super-inconvenient to not be able to drive. I have great friends and family, and they’ve taken good care of me, but my goodness it’s inconvenient. It does also mean I’ve been working from home for the last five weeks, though, which is… nice. Mostly.
- Physical therapy would begin during the six weeks of sling time. I thought it would begin in the last couple of weeks of sling time, but apparently it’s not until after sling time. I have an appointment on Tuesday which will include more details, but having taken my sling off for a couple of hours on Friday to wash it, they simply cannot just have me go cold turkey out of this sling and then send me to PT.
- Sleep in a recliner for a while. This is a good miscommunication! I was anticipating having to sleep in the recliner for weeks, which is uncomfortable and painful. They cut me loose to sleep in bed as soon as the stitches were out. I had to construct a bit of a pillow fort to support the shoulder, but oh, the bliss of lying down to sleep.
I was both surprised and not at the amount of sexism I encountered in the hospital staff. I hear this a decent amount among nurses and similar staff, but that day had a lot of “men couldn’t handle this kind of pain” and “wow, it’s so nice that your husband is helping you out.”
Like.. what? Greg is a decent fucking human being. Yes, it was very kind of him to stay with me for almost 5 days to help, but they were already assuming we lived together. Apparently, it’s nice for husbands to drive their spouses to the hospital.
And somehow the theoretical ability/biology to give birth makes me more tolerant to pain than men? These people clearly didn’t see me get my first tattoo.
All in All
Life is good. Within a week, my shoulder was in less pain than it had been for a few months before surgery. What pain remains is more manageable than before. Hydrocodone is quite good at its job, and aside from that, most pain is very positional: if I shift or lie differently or get a pillow, the pain generally fades pretty quickly.
My short stint without the sling while I washed it showed me that physical therapy is going to be very, very difficult. All I did was sit and work with my arm supported, and every little muscle around my shoulder that I haven’t used in 5 weeks woke up. Loudly.
Sleeping remains difficult. I often wake up in pain, either in the middle of the night or bright and early in the morning. Any position that would normally rock the shoulder around in the socket is painful, but if I perch the pillows behind me just right, I can even sleep on my side. Mostly I sleep on my back with a pillow behind my shoulder and elbow to keep the shoulder from rocking back too far.
The fact that I can tie my shoes, even very crookedly, is a good thing. Next up, running and dancing!
I got an MRI with contrast last Friday afternoon. That process was quite unpleasant–I’d thought the contrast might be issued intravenously, but, alas, it was not. I had a shot into my shoulder socket.
Friday night was rough, because the contrast caused serious swelling in the socket. It took until Saturday afternoon for me to get the swelling back under control with my measly, widely-spaced ibuprofen doses.
I saw Dr. H for the results Monday morning, and there’s evidence of shoulder impingement from the shape of my acromial bone, plus some fraying (and possible tear) in the anterior area of my labrum. I got referred to Dr. H’s favorite shoulder surgeon, Dr. B.
I met Dr. B yesterday afternoon, and although we talked about the possibility of doing a couple months of rehab to see if that heals things up, he agreed that (given levels of pain, the duration of pain, etc.) surgery was certainly a reasonable option.
Despite the MRI, Dr. B won’t know for sure if the fraying and “irregularity” (the radiologist’s word) in the rear labrum is a full tear until they go in and look. So they’re planning for it to be a tear, just in case.
In addition — and this was unexpected — they recommend that something be done about my loosey-goosey shoulder socket. I knew that all that delicious flexibility was a culprit in some of my issues, but Dr. B wants to go in tighten up the ligaments.
Tighten up. The ligaments. Just let that mental image wash over you.
The short-term recovery is also much worse than my research suggested it would be. Six weeks in a sling. Six weeks. Folks, it’s almost summer. That’s going to be bullshit in the heat. Then (with some overlap) a couple months of rehab, which I don’t mind.
“At least” one week off from work. Two weeks without driving. A few days (maybe a week) of someone staying with me to help out (I’ll be on narcotics, and the arm will be initially pretty immobile). Sleeping in a recliner instead of lying flat. The typical care for incisions (not getting them wet, etc.).
I’m currently on my way to NYC for the weekend, but once I get some scheduling worked out with my boss, I’m going to schedule the surgery. I’m hoping for an appointment as soon as June 10.
Almost three weeks ago, I attended a beginner’s yoga class. I’d attended that one a couple times before, along with some more advanced classes.
As always, I only did a few chatarangas and planks, backing off before shoulder pain set in. I took full wheel, which went smoothly (as usual).
Later that evening, my shoulder was in agony. The agony persisted to the next day. And the next. For almost two weeks.
The standard muscular soreness lasted a couple of days, as I’d expect. It was a workout for my shoulder, so I expected the tightness.
But the rest was weird. My shoulder kept clicking and thunking in the socket, and I couldn’t get it to sit right. (It’s done that at times in the last year or so when I overworked the shoulder, but typically not this painfully.) The familiar daily “pulling” pain was constant and present with a vengeance. By the end of each workday, I’d taken the max recommended 4000 mg of acetaminophen, which left my evenings… rough. It was difficult to keep schlepping up to the northern side of town twice or thrice a week for church board and committee meetings when I really just wanted to lie in bed–the best way to relieve the constant downward pull on my shoulder.
Over the last 3 years of this shoulder pain, I’ve made accommodations and found a new normal: wearing pants/jackets with pockets, keeping small pillows at desks, always using chairs with arms, doing rehab exercises, and daily “spoon” calculations. The pain was still present daily, but I could get through the workday without much issue most days.
Plus, I’ve found my perception of the pain has become… strange. The line between discomfort and pain is a blurry one for me now. There are times when I’m genuinely not sure if I’m just uncomfortable or in active pain; sometimes it’s whether I can’t sit still and I feel feverish (things that are out of my conscious control) that are the deciding factors. The fact that I still have an emotional/anxious reaction to incorrect joint behavior (e.g., feeling the shoulder not rotate smoothly in the socket) also complicates the issue.
But this renewed pain was worrying. So I “caved” and called the sports doctor I’d seen back in 2011. I’ve been pretty judgmental to myself over the years about this pain. I must have done “dumb” or “bad” things to cause the spur to develop. (Plus, I’ve never been particularly kind to my body.) I shouldn’t “whine” about the pain; just suck it up, especially at times like the Iceland trip where surely the awesomeness should totally outweigh the pain. (And it does… but ow.)
So when I went to the doc on Monday, I was surprised to hear them say I shouldn’t still be in so much pain. That the clicking/thunking/instability is likely a sign of a different issue, something that wouldn’t have shown on the normal MRI I had done in 2011.
They’ve scheduled an MRI with contrast and gave me some tramadol to help manage the pain, particularly with the upcoming Russia trip.
That was… a relief. I had assumed that I’d be stuck with that “normal” pain forever, with it only eventually worsening as I aged or did additional damage. I’d assumed that I was being weak by being hampered by this pain.
I’d assumed it was my due.
Now I’m faced with the idea that, if it’s what they think, surgery may be a viable and helpful option. Not that that would be painless, of course, and there’d be more focused rehab afterwards, but the idea that by the end of 2014 I might be pain-free? Pretty shocking.
My MRI is two days after I return from Russia, and my follow-up to go over the results is already scheduled for the Monday I return to work. For now, I’m enjoying the most pain-light/free time I’ve had in years.
Or: What Garbage Will I Eat Now?
I spent 4 weeks eating “clean” in July and August as part of #SexyShred:
- no preservatives
- no pork
- little beef
- few oils
- most cheeses eliminated
- few processed foods
- no white rice or white flour
- organic fruits and veggies
- no added sugars or sweeteners other than honey or molasses
Their version of clean eating is a variation on common styles that might prohibit any added sugars at all, but wouldn’t disallow pork.
I felt pretty amazing. I’ve been working through all sorts of food stuff the last few months, discovering what foods trigger more overeating, what foods negatively affect my mood. #SexyShred came at a good time in that process. (Thanks, Dre!)
Once I eliminated a whole bunch of crap (in line with the list above), a lot of the general “noise” in my mind and body about food quieted. I craved less often, and for less time per craving. Tummy discomfort eased. I didn’t think about food as often.
Some things were friggin’ hard. I took the treasurer position in that month, and that’s a lot of work. Church and other meetings keep me away from home until 20-21:00 three or four nights a week. I ended up eating pretty raw some nights as a result–fresh fruit, nuts, etc.
I’m lucky in that I already know how to cook. I got the impression that some folks in the challenge weren’t very experienced at that. I was able to improvise and adapt, given time. Which I was low on.
The management team was pretty clearly tired of running the challenge, and I wasn’t too surprised when they called a hiatus to #SexyShred, with the intent to return at the beginning of 2014.
But now it’s over.
I traveled the remainder of August, and while I made fairly healthy choices, I didn’t eat rigorously clean.
September was pretty bad. Lots of crappy foods, and while I ran some, I didn’t lift weights, didn’t aim for 10k steps a day, didn’t do yoga or any crosstraining. I gained some weight, lost some fitness, and managed stress poorly. Clearly a too-far swing the other way.
One longer-term solution is to go back to eating normal foods. Ho hum, noisy body, but oh hey, easily-accessible and very tasty foods.
The more obvious solution, perhaps, is to find a much cleaner middle ground. Starting October 1, I’m working from the #SexyShred base and opting in carefully to more normal foods. For instance, sushi is happening. I don’t give a damn about white rice in that context; sushi is on. Rice as a side or a filler (á la Chinese food), I’ll pass. I’ll work on easing my sweet tooth, because hoo, boy, honey is amazing.
It’s a little embarrassing how quickly I go through a jar of honey.
Weightlifting is flowing a little easier. I consider working out to be pretty essential self-care, right up there with journalling and meditative study. I lifted last night, and while it was a little rough (and lo, the aftermath), it felt good even to do my warm-up jump roping.
I don’t know if I’ll do the official #SexyShred in January. I had some internal friction about the way some of the leaders chose to interact with the community. The line between “tough love” and “fear mongering” can be a fuzzy one; my interpretation edged towards “fear mongering” often enough that I might sit out the next one.
#SexyShred was incredibly eye-opening, though. I hadn’t really heard of clean eating, and learned a hell of lot about my body and my various neuroses in that month. Now I just have to move forward with the lessons learned.