PT Update 4 - 14 Weeks Post Op

Wow!! It's been over a month since my last post. I've been really negligent.

While a lot of time has past since my last post and while a lot has changed since my last post, a lot has not. So things are the same...but different. I'm still going to Physical Therapy and I'm still spending about two hours a night there. The difference is that now I'm only going two days a week. This is the first week I've been allowed to have my Saturday mornings back and I'm very excited. I've also been allowed to start running again which is great and I've been getting out on my lunch break at least 3 days a week. Not only is it making me feel better but it's helping me keep my wardrobe.

My routine at PT has been changed a bit and I feel I'm getting stronger every day. Below is my routine as of this week.

Exercise	Weight/Color/Time
Heat	15 minutes
Hand Bike	Level 4, 4 minutes each direction
Pulleys	30 reps
Codman's Exercises	30 reps each direction
Front Raise	4 lb
Shrugs	10 lb
Biceps Curls	6 lb
Scapular Retraction	Black
Internal Rotation	Black
Rear Extension	Blue
Adduction	Green
Body Blade, Lateral, Rotation	2 x 30 Seconds each
Ball Stabilization	30 seconds, 5 times
Front Flexion, Wand	3 x 10 Reps
External Rotation, Wand	3 x 10 Reps
Plank	3 x 30 seconds
Kneeling Stabilization	4 lb
Manipulation/Massage	n/a
Ice/Electric Stim	15 Minutes

PT Update 3 - POD 70

PT on Wednesday went well. Although I've seen and felt progress the whole time I've been going for therapy, this week is the first week I've really begun to feel like myself again. I was able to put some boxes up on a shelf at work and reached over my head like I haven't ben able to do in years. Since I'm also in the process of packing to move I'm doing a lot of physical activity that I haven't done to this point. I'm trying to be careful with what I'm lifting since there is no getting away from this work needing to be done.

David added two more exercises to my routine on Wednesday. The first was the plank. I had to 3 planks for at least 30 seconds each. I think I held them for a little longer since I couldn't see the clock while I was doing them.  This is a great exercise for anyone who is looking to strengthen their core and I felt it in my abs for a few days after PT.

 Plank

The second addition was a stabilization exercise. David had me get on my hands and knees on the table, lock my elbows and he tried to push me from different points on the sides of my body and I had to resist him so I did not move. He then increased both speed and pressure as we progressed so that I had to react more quickly. I have to say, it was kind of fun.

Since the PT routine is ever expanding I'm going to recap the routine in a table below which is current as of POD 70.  Also, a note on therabands: I keep talking about the different colors and ,for those of you who haven't been lucky enough to use them, I wanted to mention that the different colors equate to different levels of resistance. The progression from, least to greatest, is tan, yellow, red, green, blue, black, silver and gold.  All of the exercises listed below are for three sets of 10 unless otherwise noted.

Exercise	Weight/Color/Time
Heat	15 minutes
Hand Bike	Level 4, 4 minutes each direction
Pulleys	30 reps
Codman's Exercises	30 reps each direction
Front Raise	1 lb
Shrugs	4 lb
Biceps Curls	4 lb
Scapular Retraction	Green
Internal Rotation	Green
Rear Extension	Green
Adduction	Red
Wall Climb	n/a
Ball Stabilization	30 seconds, 5 times
Front Flexion, Wand	n/a
External Rotation, Wand	n/a
Plank	3 x 30 seconds
Kneeling Stabilization	n/a
Manipulation/Massage	n/a
Ice/Electric Stim	15 Minutes

It's Always Fun...

...when you can shock your doctor. I went to see Dr. Hershon for my 4th post-op visit on Tuesday (POD 69) and he was amazed by my progress.

He asked me to take off my shirt and move my arm and I mimicked his motion. Then he asked me to lift my arms straight up in front of me to observe my front flexion and when I threw both my hands up in the air, his eyes bugged out of his head!!! Then he tested me further and asked me to put my left hand behind my back to test my internal rotation. Again, he was shocked that I was able to almost get my thumb up to my scapula.  "That's the one most people have trouble with." he said. He told me he was very pleased and that he was not so happy with my progress the last time I was there. I told him that the external rotation was the thing that still needed the most work and he assured me it would get there. He also told me that high end athletes (obviously, not me) have a really hard time with this injury because it takes a long time to get back to full function and most of them are unwilling or unable to wait.

He gave me another prescription to extend my PT, shook my hand, told me to keep up the good work and go back to see him in 6-8 weeks.

PT Update 2 - Post Op Week 5

Well, the PT train is running is running fast and furious. I'm at least one entry behind where I should be but only one exercise was added the last time around so it is not really that bad but things have been moving so quickly that I've kind of lost track of dates so you'll have to forgive my lack of time frames. I'll try to take better notes going forward.

So, the last time I mentioned that they had added the hand bike,front raises, scapular retraction and shrugs to our routine. About a week later David, once again, threw some more exercises at me. The list has gotten so long that I had to put a note on my Blackberry so I could keep track of what I was doing during my sessions.

This time around the following exercises were added: biceps curls, internal rotation, rear extensions, wall climbs and ball stabilization. That's 5 new exercises on top of my already lengthy schedule at the clinic so that has kicked my time there up to almost two hours there!!!!

Biceps curls are a pretty standard exercise that most people have done at some point but most people don't realize that the biceps play a part in the shoulder anatomy. The biceps tendon anchors right near the glenohumeral complex and can become dislodged or damaged by dislocations. According to my surgical report my biceps tendon was healthy and undamaged but I still need to build strength in it to aid in the rehabilitation of my shoulder. That is happening in the form of 4 pound dumbbells and, while I won't be winning Mr. Universe any time soon, it is helping the arm.

The faithful readers will know the difference between internal rotation and external rotation. The internal rotation exercises consists of my taking a red thera-band in my left hand and while holding a rolled up towel under my arm rotate my arm internally away from where the thera-band is tied to a piece of equipment. Like all my exercises the routine is 3 sets of 10 reps.

 

 

 

 

 

 

I also added rear extensions to the fray. That consists of standing with my arm by my side and holding a yellow thera-band in my hand while anchored to a fixed point. I then move my hand backward past the plane of my body from the shoulder joint. This helps to strengthen the anterior deltoid. Again, three sets of 10.

Wall climbs are a pretty standard range of motion exercise for shoulder recovery. It is, quite literally, what it's name implies. In this case, I use a towel to reduce friction against the wall and I slide my hand up the wall in front of me to help front flexion and stretch out those tight tendons.

The last thing that was added this time around was the ball stabilizations. This exercise is getting to be one of my favorites because I really feel it. I hold a small, weighted ball that looks like a dodge ball but is about the size of a cantaloupe against the wall at shoulder level against the wall. I then make small rotations from the shoulder and do that for about 30 seconds. It is supposed to help loosen the shoulder capsule and aid range of motion. I just think it's fun.

Two visits after those 5 exercises were added I had one more thrown at me. This one is shoulder adduction and I use the yellow thera-band for this. I hold the band in my left hand out to my side at shoulder level and then bring it across so my hand is out in front of me with my elbow held straight. I always confuse adduction with abduction but Dana (Physical Therapy Assistant) told me that she remembers it by thinking that adduction comes toward your body like you're adding something to your body. So far, that seems to be helping me remember. The adduction is going to help build strength in the pectorals major muscle, which also has a part in the shoulder function.

One last note...I have a follow up appointment with Dr. Hershon I'm curious to hear what he'll have to say about my progress. The progress notes David gave me indicate that I'm doing "very well." I'll post again after my appointment to fill you in.

PT Update 1

It's been a while since I've written. There are a bunch of reasons/excuses. I came down with a cold shortly after my last post and did not feel like doing anything but eating and sleeping for about a week. There was also the fact that there was not much to say until last Wednesday and I was not going to write for the sake of writing. Then my PT schedule changed, the sessions became longer and it was just wiping me out. But now I'm buckling down again to do some writing.

So my PT routine had remained what I described in my last post until last Wednesday, which also happened to be the 2 month anniversary of my surgery. Last week David, my therapist, added 4 exercises to my routine. David added the hand bike, scapular retraction, shrugs, and front raises to my exercises.

The Hand bike is just what it sounds like. It is a stationary bike but, instead of using your feet to turn the mechanism, you use your hands. The bike was set for 6 minutes on level two and I was told to do three minutes going forward and three minutes back. It felt okay going forward but after about a minute of going back the shoulder started protesting. So I finished tha last 2 minutes forward and moved on. It wasn't terrible, it just didn't feel right.

Scapular retraction is probably the most mysterious sounding thing in the list of new exercises.OOOOOOOOHHHHHHHHH!! Well let me end the wonder. It is similar to a rowing type exercise. While in a standing position I hold a Thera-band in my hands, while my elbows are at 90 degrees and pull back so that I feel the squeeze between my shoulder blades. It is supposed to assist with strengthening the rhomboids and aid good posture. It felt good. I quickly moved up two levels of resistance so that I'm using the green bands for that exercise now.

The dumbbell shrugs are a pretty basic weight lifting exercise. I just stand with 2lb. dumbbells in my hands and I raise my shoulders up as high as I can and repeat for 3 sets of ten. This helps to build the trapezius muscles.

The final exercise was the front raise. Standing with a 1 lb. dumbbell in my left hand and 2 lb in my right I lifted the weights straight out in front of me and kept my elbow straight. Once I reached the 90 degree mark I lowered them and repeated for 3 sets of 10. It wasn't much but it's the most exercise I'd gotten in a quite a while so it wore me out.

In addition to the exercise it is just the time I'm putting in. The addition of these exercises to the routine I was already doing pushed the time I was spending at the PT clinic to 1 1/2 hours. After a full day of work and doing PT exercises and stretches through the day and then putting that kind of time in after work was taking it out of me. On the up side, I've been sleeping really well.

People keep asking if I'm in pain or if the PT hurts. Maybe I have a high tolerance for pain but it has not really been bothering me all that much. Yes, I'm sore and yes, I've winced while Dave is digging his thumbs into my trap but there hasn't been any overwhelming, incapacitating pain during PT. The worse thing is on the days I don't go that I'm really dreading doing the last set of external rotation exercises because I'm just so sore. Overall, I feel better when I leave the clinic and I've noticed a marked improvement in my range of motion and my ability to do every day tasks.

The greatest testament to what I've accomplished so far is the things I do with realizing them. I was driving around over the weekend and I propped my elbow up on the door without realizing I had even done it. This was my normal driving pose before the surgery and I just went back to it without any pain. I was shocked because as little as two weeks ago I could not do it.

The other thing was that I tucked in my pants in the back with my left arm. It's the kind of motion you make every day and don't think twice about. I've been thinking about it a lot lately since every time I went to do it my shoulder let me know it was a bad idea. Then one day last week I just got dressed and didn't even realize I had done it until I had gotten half way to work.

The bottom line is this: I'm putting the time in and I'm seeing results and I'm excited.

PT Update 2 coming soon.

PT Evaluation and first two visits

Now that I've carried on enough about the nonsense I had to go through to get my physical therapy appointments set up, let me tell you about the appointments themselves.

My first appointment was my evaluation which I went to on a Thursday night, POD 43. I waited a few minutes in the waiting room before I was seen. Once I went in the therapist, James sat me down on an exam table and we had a chat and he evaluated my shoulder. He checked my range of motion and asked exactly what I had done. There was some confusion because it seems that Dr. Hershon wrote that I had a posterior repair on my prescription but, as far as I knew, I had a Bankart Repair which is an anterior repair and I always dislocated anteriorly. James wanted to know for sure because it was going to make a difference as to how much they were going to push my shoulder for certain ranges of motion. To be certain, he asked me to call the doctor's office and get the operative report. The report would tell us exactly what had been done. He told me that if I had had a Bankart Repair we would not push the external rotation beyond 75 or 80 degrees because it puts pressure on the front of the labrum, which is exactly what I had repaired. He wanted to know but it was not going to make a difference for this visit. He also told me that, even though we would not recover the full 90 degrees of external rotation, I would not notice it in day to day life.

After we did the evaluation he told me what we were going to do while I was there and what he wanted me to do for the day and what I would be doing for ,at least, the next two visits. They started me off with about 20 minutes worth of heat , then they had me work on the pulleys for 30 reps, which is similar to the assisted front flexion I'd been doing at home, a set of the pendulum (Codman) exercises and they showed me how to do the wand exercise for external rotation.

They had me lay on a table to do the wand exercise. I laid on my back and put the head of a golf club in my left hand and with my elbow at my side and with my forearm bent at 90 degrees. I then took the grip of the club in my right hand and pushed my left arm toward an externally rotated position until I felt resistance and then held it for 5 seconds. I did the three sets of ten was that I was assigned.

After I finished the exercises, James did an ultrasound treatment which he said would help with internal swelling and stiffness and then he stretched me out. He worked on my flexion and external rotation and generally loosening the arm. When he pushed me to my tolerances there was some discomfort but no pain to speak of. The front flexion felt weird. I'm still very guarded but it didn't hurt. After that they sat me down for ice and electrical stimulation. I've had stim many times before and this was the first time I was able to say that it didn't feel like my shoulder was going to come out of the socket when they turned it up high.

Before I left, James told me I should come in three times a week for now since I needed a lot of work on my external rotation and I would need to spend much of my time working on that one motion. He also told me to do my Codman and the front flexion exercises at home twice a day and the wand exercises 4 times a day, 30 reps each. It was a lot of work to do but it was what was needed.

The day after my evaluation I called Dr. Hershon's office and they faxed me the operative report. In spite of what had been written on the prescription, the report indicated that I had a Bankart repair. I brought it to my next appointment and we decided to go with what was written in the report as gospel. I didn't even know such a document would be available to me. If you're planning on going to PT after a surgery you should definitley ask your doctor for this and bring it with you.

My next two appointments were pretty much the same routine as my evaluation. I started with heat, followed by pulleys, Codman, wand exercises then ultrasound, stretching and massage and finally, ice and stim. During my third appointment I was shown how to do the wand exercise to work on my front flexion but that was the only change. The illustration shows the flexion being done standing but I did mine laying down. I think it helps to have gravity on your side. I also found that using the wand seems to help me get over that guarded feeling much more than just using my right hand. Maybe I can sleep with my hands behind my head again soon!

I worked on doing my exercises at home. 4 times a day was a lot to try to do the wand exercises, especially when I was working. After a few days I managed to borrow a yoga mat and a golf club at work which allowed me to spread the sets out through the day. I do have to say that doing the wand exercise for the external rotation as much as I've been doing it has left me sore in my pectoral muscle and I've also felt it in my latissimus dorsi. I also noticed that my shoulder feels better immediately after the PT sessions. I was able to do things without some of the pain and discomfort I had felt before. Little things like turning the wheel on my car was easier, putting dishes on the drain board and I was almost able to get up to the first fret on my guitar this afternoon. Even though I've only been to PT three times I'm noticing improvements.

Men Plan, God Creates Health Insurance & LAUGHS

Those of you who know me know that events rarely pass without me having something to bitch about. Physical Therapy was, apparently, not going to be an exception. I was not only ready but actually excited about my first PT visit. After weeks of being immobilized and not being able to use my left arm I was eagerly anticipating moving forward and side to side, for that matter. I knew it was going to be a lot of work and possibly a lot of pain but it also meant progress toward my goal.

To this point, I've had very little trouble with my health insurance company. Actually, I've had no trouble. All throughout my pre-op, the surgery and my post operative visits I've not heard a peep from the insurance company. Everything has been approved and I just flowed through the process, effortlessly. This was about to change.

I wound up choosing a Physical Therapy clinic in my neighborhood in Brooklyn but it was not my first choice. The list my surgeon's office sent me with the recommended PTs was quite long but I soon found out my choices were going to be limited. Although there were a whole slew of places listed in Manhattan, they were several locations for one practice. What that meant to me was that when I called and one location did not accept my insurance it eliminated a whole group from the list. Also there were one or two places that listed my insurance as being accepted but when you called they said they took "out of network benefits." Translation: they don't take the insurance. The list suddenly became very short.

After weeding out the facilities that were of no use to me I settled on a practice. They accepted my insurance and they had locations through out Brooklyn including one in my neighborhood. I called Wednesday and was not able to get an appointment until the following Thursday because I needed an evening appointment. The receptionist took my insurance information and I just knew I had 8 days to wait. I placed a call to my insurance company to inquire about the number of visits I was allowed per year and to ask if there was anything else I needed to know. I was told 60 and all seemed well.

Thursday came and I was excited as I left work. I was highly motivated and ready to get in there and put my time in. As I boarded the bus at 4:20 pm to make my way home, my cell phone rang and I checked it once I sat down. The call was from the receptionist at the Physical Therapy Clinic.

She felt this was the appropriate time to call and let me know that I would need a referral from my Primary Care Physician or they would not be able to see me. When I asked why she was calling me an hour and a half before my appointment to tell me this when she had my insurance information for 8 days she responded "Well, we're very busy here and I just got to call the insurance company." To add insult to injury, I would not be able to be seen for another week unless I was willing to take time off work, which I was trying to avoid and also why I had waited a week for an appointment in the first place. AHHHHHH!!!!!!

I called the insurance company to verify that I needed the referral. Turns out I did but I could also get it from the surgeon. Still pissed, I called the surgeons office and with it being after 4:30 I was greeted by the answering service. No help there. I called my PCP's office. The good news was they were opened until 5:30 that day, the bad news was that I got voicemail. I left a message explaining my plight and continued ranting to anyone who would listen. Erik wound up getting an earful over IM. Thanks, again, for letting me vent.

Luckily I got a call back from my doctor's office. They heard how worked up I was an called the PT office for me and worked it out. They called me back and told me that I had my referral and it had been faxed to the PT office. I would get to keep my appointment.

I was happy but I was still annoyed that I had to deal with all that aggravation to get there. Two things in particular annoyed and continue to annoy me. The first is that I got the call about the referral so late. I know all these offices call the insurance the same day but a call at noon would have easily resolved the issue instead of my scrambling to find an open office at 4:40 PM. Secondly, when I called the insurance company the rep did not mention anything about a referral. I didn't specifically ask if I needed a referral but I did ask if there was anything else I needed to know and was told "No." If either person would have stepped up and put forth a little more effort I would have been saved some grief.

I went for my appointment and all went well with the evaluation.(I will post another, non ranting, entry with details about my evaluation.) As I was leaving I asked to make an appointment for my next visit and I was told that I now had to get authorization! Does the madness ever end? I asked the receptionist how long that would take and she said it could take 48 hours after it was submitted and she would submit it the next day, Friday. I made appointments for the following Tuesday and Thursday and went home, knowing that I was going to aggressively follow up if I wanted to keep my appointments.

Monday morning came and I called the PT office around 10 AM. I was greeted with confusion and asked if I could be called back. "I have charts everywhere and I can't find yours right now." It didn't exactly inspire confidence, yet again. Much to my surprise, I got a call back within the hour only to be told that my request for authorization had not been submitted because she was out sick on Friday and she would submit it now. Things were not looking good for my keeping my appointment.

I followed up by calling my insurance company on Monday afternoon to be sure they had received the request and they had, so that was a step in the right direction. I then called again on Tuesday morning and afternoon to follow up on the authorization. Finally, I got approval on Tuesday afternoon so I would be able to keep my PT appointment. You would think this would end the frustration, but no.

Someone sitting in an office somewhere had decided that I was authorized for 8 sessions during the next 6 weeks and any further visits would require further authorization. This was in spite of the fact that my surgeon had prescribed 2-3 sessions per week for the next six weeks. So if I decided to attend the bare minimum number of sessions they were undercutting my prescription by 4 visits. When I pointed this out I was told that this is just how it is and I have no choice. I expressed my frustration to the customer service rep at the company and explained the frustration I had experienced already with the PT office being on top of following up on this stuff and that I did not have the greatest faith in their diligence to keep up on the paperwork and that this was impacting my recovery. I also pointed out the insanity of having to jump through so many hoops to get a authorization for PT after surgery that they authorized and paid for. The rep, while compassionate, could do nothing.

I now called the PT office to let them know I would be keeping my appointment and about the authorization had received. I was informed that the fax machine was down and, as a result, they had not gotten the authorization. I told her the situation and she said they could get a verbal authorization if they needed to and I asked her to make a note in my chart. I was also told that it would be easier to get authorized for further visits since it was a part of continuing care. I'm not convinced but I guess I don't have much choice. I'm sure there will be another health insurance related rant down the line.

The lesson learned here is to do your homework. Ask questions when it seems there are no questions to ask and when you're given an answer, ask again. In spite of all the doctor's and medical professionals you may be working with, you are the one responsible for getting what you need.

Milestones - POD 37

It's amazing how much you come to appreciate the little things in life when you can't do them for a while. I had a few moments like that this past weekend. Things that were everyday trivialities, that I would do without thinking suddenly became very big deals.

The first such trivial item was wearing a t-shirt. Yeah, I know it sounds stupid but t-shirts are about the right comfort level for me to hang out in. I'm always warm and wear short sleeves all winter with the exception of the brutally cold days, when I'll wear a sweater or a long sleeve shirt. Even in those cases I usually have a short sleeve shirt under the sweater in case I get too warm. Conversely, wearing tank tops during the coldest weeks of winter was a little too chilly for my liking. I was able to put a tee on over the bad arm but it was no replacement for wearing it the right way. I was thrilled when I decided to try putting on a t-shirt Saturday night and was successful. I put it on in a way that favored my left arm but I was able to do it which was more that I could say a few weeks ago.

Milestone 2 was also clothing related. I've been walking around wearing either slippers or a cheap pair of moccasins I bought to specifically get me through the post op period. They did the job but they were a little rough on my feet once I went back to work and was walking more than a few blocks to the store. It's no fun to come home after work and have your dogs barkin' when you get there. I'd also ordered a pair of boots that arrived a day or two after my surgery and I hadn't even tried them on. I was happy to give them a test walk on Saturday and I'm happy to report they were comfy.

Lastly, I got my Jeep back. I was a little nervous about getting behind the wheel and as long as I don't have to perform any stunt maneuvers I think I'm okay driving. Doing things like u-turns are a little tricky since I instinctively try to turn the wheel with my left hand. Luckily, my body is very quick to remind me that I'm not quite ready for that. The other thing that was interesting and a little amusing was me trying to adjust my mirrors and roll down the window. Since I've very little strength in my left shoulder and am currently without the range of motion that would be needed to reach out and grab my mirror I had to reach across my self and do all of that with my right arm. Right about then I was wishing I had power mirror and windows. I can still push a button.

But Wait!! There's more...

One of my favorite things on TV is the infomercial. They always make me laugh when they show the way you would not be able to do things without the product they are advertising. They just make it look so ridiculous, like you can't survive without whatever piece of crap they are selling. As a rule, I refuse to buy anything that is advertised on TV or even anything that has the "As seen on TV" logo on it. I may have to change my opinion, slightly.

While I was preparing for my surgery Matt and Anne insisted on loaning me their Tablemate II table. I was skeptical but I wasn't about to turn down something that might come in handy. They made the hand off about a week before the surgery and I took it home.

After my surgery I used it continuously. It was by my side, day and night for the first week and then from the time I woke up in the morning until I went to bed at night. It was great because it was able to come to me when I was not able to reach out to be near the table since the design allows it to slide it's legs under the chair or couch you're sitting on.

In spite of how useful it was, I could help chuckling when I looked at it and thinking "But wait! There's more!!"

Zero Degrees

Since I have a lot of time on my hands and couldn't get an appointment until next week I've been continuing to do my exercises to continue to restore the function to my shoulder. I was working on it last night and I realized that I have no external rotation on my left shoulder. I can't even get the shoulder to zero.

For those of you who that means nothing to, I'll explain. If you stand straight up with your arm at your side and bend your arm, at the elbow straight in front of you that would be the zero degrees position. From that point if you rotate your arm in toward your body that is called internal rotation. If you rotate it back to the zero position and then away from your body it is called external rotation. You should be able to rotate your arm approximately 90 degrees in either direction as seen below.

I can my turn arm all the way to the internal rotated position since that is where it was held during the entire time I had to wear the immobilizer. Since I was not allowed to move it during the past 5 weeks I lost all the external rotation. Hell, I can't even get back to zero. At best I'm still 1 or 2 degrees internally rotated. This is one of the things that I'm going to work on during PT and I can tell already that it is going to hurt like hell!!

Post Op Visit 3 - POD 34

I went back to see Dr. Hershon yesterday. It was another short visit but I received some good news. After an hour long bus ride from 23rd St. to 60th St. (I hope I feel comfortable to get on the subway soon!) and an hour long wait in the waiting room of the office I finally got in to see him. I was pretty damn beat at that point but happy to finally get my turn.

When I was put in the exam room I took of the immobilizer and my shirt so I would be ready, unlike my last visit. Dr. Hershon came in, asked me how long it had been and asked me to move my arm. First he asked me to move my arm out in front of me. I was able to get it to about 45 degrees thanks to the shoulder flexion I had been doing for the past week and to the little over 90 with his help. When he asked me to move my arm out to the side it was slightly comical. i could not get my arm more than 2 or 3 degrees away from my side. I just looked at him and he said "Let me help you with that." He lifted my arm a little further, to about 30 degrees, and he looked at my shoulder as he did it. My arm would just not move.

After that he said "Okay, let's get you some PT and get this shoulder moving." I was told to wein myself off the immobilizer and start using my arm. He wrote me a script for PT and advised me to keep the immobilizer on in situations where I might have someone unintentionally grab, bump or hug me. We chatted for a minute or two, I asked about the aches I was experiencing and he reassured me it was perfectly normal. Dr. Hershon asked me to come back and see him in a month and left. That was it.

I had become so attached to and dependant on the immobilizers that I was afraid to give it up. I knew my arm would not just start working after surgery and 5 weeks and I was not sure what it was going to feel like. On the other hand, I was really ready to get the hell out of those things so I was willing to give it a try.

Once I got home I, happily hung the immobilizer up and went about doing what I had been doing for the past few weeks at home. It was nice that I was allowed to now use my arm but I quickly found that it was not much use. I could not quite get my hand up to my face to wash it when I got in the shower and I couldn't exactly get my arm all the way extended to turn on the water but at least i was able to try. I still slept with the immobilizer on last night. I'm still worried that I'm going to roll over in the night and wake up in pain.

Being able to take the immobilizer off at work today was very helpful. While I had to walk my hand up to the keys on my keyboard, I was able to type with two hands. I would have to say it increased my productivity, well, two fold. It also made things like going to the bathroom a lot easier. I kept the immobilizer off while I was at my desk and on my floor and I put it on when I went off my floor or went out side and on the commute home. That was more as a visual reminder to others than for me. I was in a little pain by the time I came home but it is not that surprising.

The thing that is most interesting to me is that I did not experience much pain during the initial recovery from the surgery. It would seem that I am entering the period now where pain is going to be an issue. The way I see it, I have a prescription sitting here for 18 torture sessions.

I also got the list of recommended physical therapists from Dr. Hershon's office. I was pretty excited to have the list and get started with PT but I kinda had my bubble burst. I had chosen a place from the list, that a friend from work had been to and was happy with and was very convenient for me to go to from my office. However, when I called them they would not take my insurance and that was the case with most of the places I called. I finally called One on One Physical Therapy in Brooklyn and they took my insurance. The problem is the only appointment I could get for an evaluation that fit my schedule was next Thursday. So I have to spend the next 8 days with a barely useful arm while waiting for my evaluation. I want to get this started so it's frustrating having to wait.

Two bright notes to end this post. 1. I am now officially caught up so now I can start posting in real time. and 2. I'm wrapping up my first two handed post. Woo Hoo!!!

Weren't You Bored?

The one question I was repeatedly asked when I went back to work was "Were you getting bored?"and I can honestly say "No." Frighteningly I could very easily become a recluse. When I was asked what I did at home for a month I quoted Peter Gibbons from Office Space: "I did nothing. I did absolutely nothing, and it was everything that I thought it could be." While that is not completely the truth I was certainly enjoying not having to do anything.

I had planned on doing some reading while I was home But I found that to be difficult since I could not really use my left hand to hold the book. After a while my right would get tired or it was just hard to hold the book up with one hand.

For those of you wondering what I did during those four weeks I will give you a few ideas. I edited some DVDs, I surfed the web a lot, I chatted with people online, I started this blog ( a lot of typing with one hand takes a bit of time) and I took naps. Naps are nice. I had forgotten that.

I also watched a lot of TV. I had gotten the first three seasons of The X-Files on DVD and I watched some of that, caught up on a few movies, made good use of my Media Center PC and became a Law and Order junkie. I learned that I could watch one Law & Order or another from about 2 in the afternoon until about 6 in the morning. I learned to record the ones in the middle of the night so I could watch them in the morning. It got so bad that if there was not a Law and Order on I felt like there was nothing on. SVU is my favorite.

It was nice while it lasted.

My Return to Work

With Dr. Hershon's blessing, I planned to return to work. Although I wanted to take one more day to mentally prepare myself to go back to work but since I was burning up vacation days I decided to go in on Tuesday. I texted my friend and co worker, Liz and made plans. Liz was nice enough to drive me in to work the rest of that week.

I have to say waking up at 6 AM after not having to get up for a month was a shock to the system. I woke up and got dressed, had breakfast and did my exercises. It was helpful getting the ride from Liz since it gave me enough time to eat and do my exercises and not have to worry about getting to work on time. I'll have to think of something nice to do for Liz to thank her.

My arrival that Tuesday was totally unexpected by the people in the office since I was not able to call the office after I found out I was able to return. Everyone was very happy to see me and, in a way, it was nice to get out of the house.  Work is work and I was little stressed out but all in all it was ok. I took a little longer to do everything since I was the one armed man and I could not lift anything but with a little help I made it  through my first week.

I took the express bus home since I felt like I was really not ready to get on the subway yet. I thought the crowds and all the bouncing around were a bad combination. Liz had to leave early on the days she drove me in and the express bus stop right across from my office. Since I leave work a little earlier than most it was easy enough for me get a seat and have enough room that I didn't  feel like I had to be worried about being bumped.

The only side effect I suffered was a little achiness in my shoulder muscles toward the end of the week. It was nothing that an aleve could not take care of. I think it was just a combination the new motions I was doing because of walking around at work and the exercises the doctor gave me.

I was enjoying the little bit of freedom the exercises were allowing me and I was making progress. By the time the weekend came I was able to make fairly large circles with my arm during the pendulums and I was able to get my arm up to a little over 90 degrees during the flexion. I was looking forward to going back to see Dr. Hershon

My Second Post Op Visit

I had my second post op visit scheduled for February 25th, post-op day (POD) 26. It was a pretty quick visit but went well.

Once we got in the office Dr. Hershon came in & asked how long it had been. I told him it was 26 days. He looked at my immobilizer, said "Take that thing off." and walked out of the office. I took it off and when he came back in he showed me how to do pendulum exercises and standing assistive shoulder flexion, told me to do them both a few times a day an come back to see him in a week. He said that maybe then I could start PT.

         

Pendulum exercise (l.) and shoulder flexion (r.)

When I asked if I could go back to work, he asked what I did and I told him. "Yeah, go back." he grumbled at me. He also said it was ok for me to drive if I could do it with one hand. When I told him I drove a stick shift he just chuckled and shrugged and said "Well, maybe not."

I asked about being the shoulder immobilizer and I was told to still keep it om 24/7. I was hoping to get out of it, at least a little bit, but I still had another week in it.

A Note on Coughing & Sneezing

It hurts!!! A lot. For the first few weeks it really hurt badly. I have allergies and everytime I would sneeze it would wrack my entire body and cause a sharp shooting pain to run down my arm. There was a lot of "Achoo! Ouch!" to be heard in my apartment. That pretty much lasted until about post op day 26.

It was weird. I sneezed, was bracing myself for the coming pain and it didn't come. It was a pleasant surprise but not absolute. While it doesn't hurt just to sneeze or cough anymore, a particularly violent sneeze or coughing fit will still cause a bit of pain.

I happened to get some bread crumbs caught in my throat the other night and after all was said and done I needed to take an Aleve for the pain.

I forgot to mention it in my last post and thought it was important to mention.

Post Op - Week 2-4

I'm combining weeks 2,3 and 4 into one post for a few reasons. First and foremost I would like to catch up to real time so I can post about current events as they happen and stop writing about thing that happened months, weeks and years ago. Secondly, while there were accomplishments and milestones during that time, I did spend a lot of time sitting around, doing nothing.

The first big milestone was being able to shower, not only for myself but for everyone else who had to be in the house with me. I had been trying to keep myself as clean as possible for the first week but no amount cleaning, baby wipes, baby powder or deodorant is going to keep you from being a little ripe after a week.

Showering, at first, was a great luxury and a bit of a challenge. I had not worn a shirt for the first week after the surgery, not properly. After showering for the first time I managed to get a tank top on. Since I was not really allowed to move my left arm, I got the top on by running it up my left arm and then putting it over my head and putting my right arm in. This is how I would put a shirt on for the next three weeks. I spent much of that time showering every other day.

I learned quickly that this was not going to be business as usual. Since I really had only one useful hand it took me at least twice as long for me to do anything. It took about an hour to shower and get dressed. In addition to that it caused me a bit of pain. It was not terrible pain but it did not make it pleasant. The pain-shower association continued for about another week and a half. The first time I was able to shower and not have it be painful was February 10. For those of you keeping track, that's 11 days post op.

I also realized that I was not as prepared as I would have liked to have been. I had only purchased one over-sized sweatshirt and no t-shirts. Unlike my first week, it was great to be able to wear a tank top but if I became cold my choices were very limited. I had about two XL tee shirts and that one sweat shirt I had purchased. I needed the extra room since I was only putting my good arm in and wearing the shirt over my left arm. A few more shirts and another sweatshirt or a larger coat would have served me well.

On the other hand I was fairly well prepared in the pants department. If you do have a surgery like this you should be sure you have plenty of pants that you can put on with one hand. I had an assortment of sweat pants and pajama pants that were comfortable and elastic waisted. I also learned how to put my socks on, one handed. I can become very creative when properly motivated.

I could have also used another shoulder immobilizer. The only one I had was the one I was given at the hospital and, considering that I had to wear it 24/7, it was getting a little gamy. I was also having difficulty with the immobilizer I was given for another reason. It's basically a sling with a waist strap and after days of wearing it was beginning to really hurt my neck. I was hoping that I would get a better immobilizer when I went for my appointment but I was left to my own devices. I turned to Amazon.com and came up with the shoulder immobilizer shown below for around $25.

It held my arm in place with a lot more than the sling style one and it didn't put any strain on my neck. It did have two minor issues.

Firstly, the large foam-like piece that wraps around the body and the cuff that wraps around the arm are great for stability but they do make one very,very warm. For me it was not so much of an issue since my apartment is not overly warm in the winter. It actually helped me to stay warm since I was limited in what I could wear.

Secondly, there is the issue of what has become known as the foot-hand. As you can see in the picture, my hand is enclosed in a swath that supports the forearm rather than using a sling. This is great except that your hand is a very small, enclosed area for most of the day and your hand ends up smelling like feet. I realized how much of a problem this was the day Coral came home and, politely, asked if I was going to shower. I had showered earlier that afternoon, but all she could smell was the foot-hand. The beast was living in the swath.

I solved the problem by removing the swath the next day and taking it into the shower with me. I gave it a good washing and let it dry while I wore the old sling immobilizer for a day or two. Now, whenever I wear the the new immobilizer I put deodorant on my hand and it seems to have kept the foot-hand under control.

All the while, my wounds were healing nicely. I was keeping them clean and putting bacitracin on them once or twice a day to help them heal. I took pictures weekly so I could share them with you and I didn't really do too much other than that. They healed nicely and I expect the scars will fade over time. The rear incision is almost invisible now. The most pronounced of the three is the one closest to the clavicle and even that is not readily noticeable. By the end of post-op week three they were no longer sensitive to the touch.

Before the sutures were removed. To give a sense of scale for the incisions.

POD 8

POD 15

POD 23

** Yes they are all the same shoulder. I just took some of the in the mirror.

The last issue to discuss during this period is food. Since I was alone during the day after post-op day 6, I had to make sure I was able to prepare and eat my meals during the day on my own. Coral was good enough to make sure coffee was made before she went to work so I was able to just nuke a cup of coffee when I woke up. Breakfast was usually a simple meal. I would just have a bowl of cereal or oatmeal, coffee and a piece of toast.

Lunch provided some more options. I had purchased a few frozen meals before I went in for surgery so that was one option. My Aunt Gen was kind enough to send over a bunch of very yummy chicken soup in individual containers and then there were also dinner left overs in the fridge. I was able to eat anything that I was able to microwave and I didn't have to cut up. The biggest thing was just making sure I had that kind of food available.

Poor Coral got to come home every night, after being at work and class all day, and not only cook dinner but also do the dishes I had dirtied all day. She did it all without complaining and made life much easier for a temporarily one armed man.

Post Op - Week 1

The first week really flew by. Coral was able to work from home for the first two days after the surgery so I had constant help for the first 4 days. The routine did not change much during that time. We were icing the shoulder in 20 minute intervals throughout the day. My shoulder block wore off some time between 7 & 8 AM the next morning but I was already well ensconced in Vicodin-land. About 5 hours after I had taken the 2 Percosets in the hospital, I started taking the Vicodin and continued on straight through till the morning.

I was, probably, over-medicated but everyone had stressed to me to not let the pain start before I decided to take the meds and I planned on listening. To that end, I was taking one extra-strength Vicodin every 4-5 hours until the shoulder block wore off, then I started taking two. This was a 24/7 routine for the first 3-4 days. Coral was even setting the alarm for the middle of the night to give me pills.

We would put a snack, a glass of water and the Vicodin next to me before I went to bed. When the alarm went off, Coral would get up, make sure I took my meds, I ate a little something and we would ice the shoulder for 20 minutes before she went back to bed. She should be canonized for doing that, it couldn't have been fun for her.

As I noted earlier, laying down was not an option for a while. I didn't have room for a recliner so I slept in the arm chair with my feet on the ottoman for a few days. When I became tired of being in the chair I moved to the couch and slept with my feet on the ottoman while on the couch. I would cover myself with a blanket while I slept. I did that for 6 nights and I was comfortable enough sleeping that way for the week. I don't know what it was but sleeping sitting up for six nights really didn't bother me. Maybe it was the fact that I was taking 750 mg Vicodin tablets, 2 at a time?

I had a large dressing on my shoulder when I arrived home that looked like I had placed a diaper on my shoulder. I was told I could take the dressing off after 24 hours and I did. Coral helped me remove the dressing when she returned from class on Thursday night and I finally got to see the wounds. There were two incisions on the front of my shoulder and one on the back, none of which required more than 2 or 3 stitches. I placed band-aids over them and changed them daily until I had the stitches removed.

The following Tuesday, post-op day 6, I went back to see the surgeon. It was a brief visit. He took the stitches out, told me I could take my arm out of the sling once or twice a day to stretch my elbow and let my arm hang and keep my elbow from getting too stiff. After I asked, he said I could shower but returning to work was still not on my "To do..." list. Other than that, my job was to keep my immobilizer on 24/7, rest and go back to see him in three weeks.

I had been weining myself off the Vicodin a little at a time during that first week. After the first few days, the pain was manageable and started stretching out the time between doses, then I went down to one pill from two and then I was only taking them once in a while if I felt pain. I took my last pill on post-op day 6 when I woke up with some pain.

That night after I got home, I had a horrible headache. I fell asleep in the chair for a little bit while my sister left on the couch but the chair wasn't cutting it for me anymore. Once Jackie was ready to leave, I had to lay down. For the first time in a week, I laid down and went to sleep.

Surgery Day (SNAFU)

The 29th of January was not a good day for me.I was kinda amped up about the surgery and not dealing with it well. I had been out late the night before working. I was so intent on getting to work on time that I ran for the train when I heard the doors closing and I fell down the last three stairs in the station. The conductor was kind enough to hold the train for me but I went down hard. I fell hard enough that I was able to scrape my knee in two places through my pants and my elbow through my coat. It was not a great start to my day.

The doctor's office called me around noon and told me to be at the hospital at 10 AM for a noon surgery. Then I received a call an hour later telling me to be there at 8 AM for a 10 o'clock surgery. I liked that a lot better especially since I would not be able to eat or drink any thing from midnight on. I passed the word along to everyone who wanted or needed to know, went home, did some last minute shopping, had a nice big dinner late in the evening and went to bed.

We arrived at the hospital at about 7:45. Coral and my Aunt had both had small breakfasts, planning to eat lunch while I was in surgery. The staff at Roosevelt Hospital's Ambulatory Surgery Unit were wonderful. They were friendly, cheerful, helpful and generally warm. They had me fill out some paperwork and  we waited. I was called in once to do a pre-interview. I was asked some questions and the interviewer wrote "yes" in purple marker on my left shoulder and I was sent back to wait some more. Then I was finally called to be interviewed by the intake nurse.

She asked me another bunch of questions, made sure they had written yes on my left shoulder, asked about my fresh scrapes on my elbow and I told her about my little fall. While I was being interviewed, Dr. Hershon's office called asking where I had my MRI done because Dr. Hershon was looking for it. I explained that I hadn't been asked to have one and she said ok. I didn't feel good about it but I moved on. The intake nurse said to not be worried and asked me to change into a gown and got someone to show me to a locker.

Coral and my Aunt Gen were then allowed to come and sit in the waiting area with me. We saw a young woman come out from what appeared to be hand surgery. She was very alert and seemed rather chipper and pain free. I was hoping I would come out in as good a mood as her.  We were sitting there for a short time when Danielle came looking for me. Danielle is one of Dr. Hershon's Physician's Assistants and as soon as she said she wanted to talk to me in a private room, I knew some thing was wrong.

Let me interject an observation in my narrative at this point. Ever wonder why they make you strip completely to the skin underneath your gown for even the simplest of procedures? I mean, I was going to walking in and out of the hospital on my own power and the chances of complications were extremely minimal so there would be really no need to insert a catheter or anything else so why make you get naked? It's a power play. It gives the medical staff the upper hand in all situations. You're not going to argue too much with them while you're sitting there , in a rented gown with your bits hanging out. They could say whatever they want and you are at a disadvantage because you're not even wearing underwear. But I digress...

As it turns out, Danielle was there to deliver the bad news that Dr. Hershon had wanted me to have an MRI and somehow that little fact had never gotten to me. The good news, in her opinion, was that they had secured an appointment for me at a nearby facility and I would still be able to have the surgery today (I thought I might escape!), it was just going to be later in the day. She wrote me my prescription for Vicodin so I could have it filled before the surgery, gave me some post-op instructions, the address and phone number for the MRI place and begged me not to eat or drink anything while on my way to or from the hospital. With my 10 o'clock surgery out the window and an 11:30 MRI appointment, I got dressed and we headed over to the MRI facility.

At that point I wanted a big, fat bacon cheeseburger. I also felt badly for my Aunt and Coral. It was getting close to lunch time and instead of being close to going home I was still hours away from going into an operating room. They were both being sympathetic and would not eat in front if me so they were fasting too. It was not fun for any of us and I was cranky due to hunger and my frustration with the situation. But we moved on.

The people at the MRI facility, which was a short walk from the hospital, were very nice and accommodating. The technician was very pleasant and talked me through the whole procedure. That being said, I was not a fan of the MRI. If I was not convinced before I can tell you for sure afterwards that I never want to be buried alive.  We waited for the films, called Danielle on her cell phone and headed back to the hospital. Apparently, there was no need to rush.

We hurried back to the Ambulatory Surgery unit only to wait. Maybe you remember how I wrote earlier that they changed my surgery time from noon to 10 AM. As we sat there, after returning from the MRI, it became clear why. The case that was originally scheduled to be before mer was more involved than mine was so the switched my case to the earlier time to get me out of there more quickly. Now, due to the MRI SNAFU, we sat there waiting till 2:15 PM when the finally called me again.

I go through the whole routine again. Many of the nurses and the staff greeted me with "You're still here?" and they made me put my underwear back in the locker (power play). My escort meets me as I'm coming out of the changing room, hands me a paper hat I was more inclined to put on my chest than my head and escorts me to the pre-op area. Coral and my Aunt were directed there via another route.

I was given a blanket, wished well and left alone to talk and wait some more. A few other staff members came over to check on me and ask me questions and then around 3:15, Dr. Hershon came over to see me.  To his credit, he apologized, right off the bat, for the mix up. That meant a lot to me.

Those of you who know me may be surprised that I was so forgiving, given that I hadn't eaten or drank anything in 17 hours and normally I wouldn't have been. It meant a lot to me that he came over, apologized personally and immediately and didn't make any excuses. Also, I thought it unwise to argue with a man who was about to take a scalpel to my unconscious body. Plus, I wasn't wearing any underwear!

He left and the anesthesiologist, Dr. Rice, eventually came over to talk to me. He asked me a bunch of questions, filled me in on what he was preparing to do and then his assistant began the catheter for the IV. This was the nice treatment: After an extensive search for a vein, he gave me a local anesthesia shot at the site where he was going to insert the catheter. I never felt a thing. Coral left for class and my aunt went to grab something to eat.

He chatted with me, told me he was going to give me "the good stuff" via the IV and start looking for my nerve in my neck. He was feeling around on my neck and asked if I was nervous.

I said "Yeah. Why? Is my pulse racing?"

"No but you are sweating a bit."

**********************************************************

The next thing I knew I was waking up with a big clock in front of me. I was fighting the anesthesia, trying to wake up and the clock said 7 o'clock. I was very very thirsty and was able to see a nurse in brown scrubs. In my foggy state I was able to weakly call out "Brown Nurse! Brown Nurse!" Hey, it made sense at the time.

The nurse came over, got me some juice and I started to wake up some more. I saw Dr. Hershon at the nurse's station and called him over but my recollection of the encounter was vague since I was still slipping in and out of consciousness. Eventually they brought my aunt around and I started to become more lucid. We had a nice talk with the nurse. I was able to wiggle my ring finger and pinky pretty well and my hand was tingling. Danielle had told me that when my hand started to tingle, it was time to start taking the pain meds. I asked for pills, Brown Nurse gave me 2 Percosets and sent me to recovery.

In recovery my Aunt and I talked for a while, I ate some crackers and drank some more juice. I still felt a bit foggy so I wanted to wait a little while. I didn't feel terrible but I certainly was not as alert as the woman I had seen earlier in the day. A short while later, my aunt helped me to get dressed (thankfully that hospital robe was long enough to spare us both a little embarrassment)  and we headed home.

We walked to the parking garage around the corner to where my aunt's car was. I was a little cold since I just had a sweatshirt on under my coat and it was kind of windy. At that point, I didn't care much. I just wanted to get home.

The ride home was uneventful. Even though the shoulder block was still well in effect, I felt every little bump. I wasn't really in pain. It was more a tingling sensation every time we hit a bump that ran down the length of my whole arm. Around 9:30 PM we finally arrived back at my apartment.

It had been a long day, much longer than if I had gone to work. We got me settled into the chair and worked on ordering some take-out. I settled down with a nice plate of pasta puttanesca and we waited. Coral arrived home around 10:15 PM, my aunt went home and the day was finally over.

Preparation

I had a date, so now what? I decided to do some research to see what other people, people who had had the surgery themselves, had to say about their experiences. It's not that I didn't trust the Doctor, it's just that I know surgeons & physical therapists have  unique points of view.

The surgeon sees you on the day of surgery, before and after, a week later and then a few weeks after that and that's all he sees. In other words, he sees you before surgery, after surgery, while you are still drugged up, a week later, after you've had a chance to recover and then a few weeks later when you've had even more time to heal.

Similarly, the PTs see you on the days you go to see them, which is weeks after surgery. They don't see the day to day living that goes on when you're home. I was hearing that the surgery was no big deal from the surgeon and had heard from physical therapists in the past that the recovery is very painful. I wanted to know more about the day to day life between seeing the surgeon and the PT.

I wanted as much information as possible so I would know what I was in for. After a lot of digging I was only able to find one skiing message board where people were offering anecdotes about what they experienced after shoulder surgery. After reading through a lengthy thread that spanned over two years I came up with the following helpful facts:

1. Slip on shoes. You will not be able to tie your own shoes after surgery so if you plan on going outside for anything you will need something you can put on by yourself.


2. After the surgery, don't wait for the pain to set in. Take your pain meds when you're supposed to. Set your alarm in the middle of the night to get up and take them.


3. Opening child proof pill bottles with one hand is impossible. Put your pain pills in a bowl so you can be sure to get them when you need them.


4. You will spend quite a few nights sleeping while sitting up. If you have a recliner that would be ideal. If not, and you have the room, renting one might be a good idea.


5. If you live alone, try to get someone to stay with you for at least the first 48 hours. You will need the help.

I also spoke to my cousin, Mark, and my friend, Andy. They both gave me their perspectives which were vastly different. But I took what I could from their accounts and added the facts to my mental fact book.

I knew I was going to have a shoulder block while I was sedated as my anesthesia for surgery so I did some research about that. I found out that the block was called an Interscalene Brachial Plexus Block and it works on the same principle as an epidural. It is a regional anesthesia where the anesthesiologist injects the drug right near the brachial nerve and it numbs the whole arm. The effects can last as long as 24 hours but usually wear off in 12-16 hours. That allows you to get home and settled before the pain could kick in. I liked the idea of the block over general anesthesia since I had been sedated many times before but had never had a general before. I knew I tolerated sedation well so that helped put my mind at ease.

I also learned that the procedure would take between 45 & 75 minutes depending on how much work needed to be done and that it would take about that long for the block to be done. Then you throw in an hour or two for recovery and you are looking at about 4 hours total time for the procedure. I made sure I had a ride to and from the hospital.

Since I had just recently dislocated my shoulder I was also doing some things to strengthen the shoulder before surgery. A few nights a week I was using a heating pad on the shoulder and doing some rehab exercises. Hell, I had been in PT enough that I knew the exercises by heart. Also, I figured the stronger I was when I went into surgery, the better off I would be after the surgery.

The surgeon's office told me they would call me the day before the surgery and give me a time to be at the hospital. I was also told I would be given a list of physical therapists recommended by Dr. Hershon when the time came. Until then there was nothing to do but wait.

Consultation

The surgeon I found was Stuart Hershon, Orthopaedic Surgeon, Sports Medicine Specialist and Staff Doctor for the New York Yankees. I was happy to have someone who was not only recommended, but also a sports medicine specialist. I wanted a surgeon that was not only an ortho but also a sports medicine guy; someone who was going to be concerned not only with repairing the shoulder but also with maintaining range of motion.

I procrastinated a little longer and finally got up the nerve to call, only to be thwarted. I called after 4 PM and found that the computers were closed down at 4 even though the office was open until 5 PM. So I called again the following Monday and made an appointment for December 11th.

At my appointment I was asked to take more x-rays when I arrived since Dr. Hershon wanted some pictures that were more comprehensive than the ones I had. Then he and I had a nice chat. I told him my story and he asked me to take off my shirt and to move my left arm to see how my motion was and he gave me the scoop.

He told me, very plainly, that I had a torn labrum and bone spurs and that they could be fixed. When I asked him what I could expect, he told me I would be in and out of the hospital in the same day and that would not be the best day of my life. According Dr. Hershon, I would be home for a little bit, have my arm in a sling for 4-6 weeks and then go through a lot of rehab. A LOT OF REHAB. But the part I really liked was that he told me I did not have to have the surgery.

Now, I went in there with the mindset that I was going to have the surgery but I always disliked surgeons who insist on cutting no matter what you say. Dr. Hershon told me that the surgery was absolutely elective but he would highly recommend it. He said he would not worry about it if I were 64 but since I'm 34 he would get it done before my shoulder came out while I was camping or fishing or biking or running. In short, his stance was "You don't have to have it done but you should." I liked his attitude, his manor and generally got a good feeling from him. I left the office and called a week later to make an appointment for surgery. I was given a date of January 30th

Time to Pay the Piper

I was done. The moment my shoulder came out in the apartment I knew surgery was in my future, my immediate future. I had been dancing around the fact that I needed surgery for almost 18 years and after all that dancing it was time to pay the piper. The truth is that my shoulder came out so easily this time that I knew there was no avoiding it and I finally wanted the surgery. The idea of having surgery was suddenly more appealing to me than having to worry about my arm. Also, I had convinced myself after the last dislocation that I would have surgery if it came out again anytime in the near future.

I started mentally preparing myself and thinking about how I wanted to approach the surgery. Most of my activities are Summer activities and I knew I wanted to be as well as possible for the Summer so I could swim, camp, fish, run and bike. I also knew recovery was going to take about 6 months. Obviously, I did not want to be laid up for the holidays and my sister's birthday is the third week in January so I figured the end of January was about the right time. That would give me 4 months to get at least halfway right.

My next concern was who I was going to have do the surgery. I wanted to have it done by a surgeon that was recommended and not just someone that was picked out of my insurance provider book. I checked with my friend, Andy and my cousin Mark, both of whom had the same shoulder surgery I was looking at. They both had good experiences with their surgeons but neither of their doctors took my insurance. Luckily, my cousin had not only had the surgery but was also Physical Therapist and was able to get a list of names for other surgeons he could recommend. Bingo! I got a hit and was able to move forward.

Video of the repair

I was doing some research today and came across this great video on the Hospital for Special Surgery's website that shows and explains what a Bankart repair is. Take a look if you're curious but be warned: it's not for the faint of heart. Power tools are used. Click on the link that says "Video Presentation"

Arthroscopic Bankart Repair Video

A Word of Thanks

I just want to take a moment to thank all those people who ever sat in an emergency room with me, waiting for my shoulder to be put back in the socket. In no particular order, "Thank You" to : My Aunt Gen who sat in three different hospitals with me, Jackie, Jean, Miranda, all the FIT guys: Andy, Wally, Jim and, lastly Matt. I appreciate all the time you put in. I know it was not fun for any of you. Except for Matt. I think we did a lot laughing at Jacobi.

More History...(The Last Two Straws)

If you've read this far, you're probably wondering why I didn't have surgery after the dislocation on the dock so I would not have to think about it any longer. There were a few reasons, starting with my being a chicken. I had never had any surgery to speak of and am not big on new things I'm not sure of. Secondly, I wasn't confident the surgery was going to stop the dislocations.

At that time I knew several people who were dealing with their shoulders dislocating, many of them had had surgery to correct it and only one person I knew had had any success. I could not see going through a painful surgery and a long difficult rehabilitation only to continue to have to worry about the shoulder continuing to come out. My instability was not chronic so I decided to live with it. I lived with the condition for over 12 years and did not dislocate it once in that time.  All good things come to an end.

This is the one that really gets everyone's attention. January 2004 - I was replacing the range hood in my apartment and realized, after I had turned the power back on, that I never checked to make sure the flue was clear. I proceeded to shove a large metal spatula up past the fan an into the flue. The flue was clear but I also hit the coil from the fan and got quite a shock. One minute I was standing there thinking "I'm being electrocuted. This sucks!",  the next minute I'm on the floor and the spatula is half way across the room. Once I shook off the jolt I had just gotten I realized my shoulder felt weird but was not sure it was dislocated. After a moment I came to the  realization that it was and I got the ball rolling. I called 911 and my family that was on their way to my house and let them know to skip my place and just meet me at the ER.

This time I wound up at St. John's Hospital on Queens Blvd. in Rego Park, NY. I was treated fairly well and was attended to relatively quickly.  There were two problems I had with my treatment here. Firstly, as I've mentioned before, I'm a difficult reduction. The nurse miscalculated the dosage of Propyphol, a.k.a Milk of Amnesia, to give me and I woke up with my shoulder still out of the socket and a nice, young doctor tugging on my arm. After a "discussion" between the doctor and the nurse concluded with them not being able to give me anymore drugs because they had already maxed out my dosage, I was privileged enough to experience that which is the pleasure of having your shoulder reduced while wide awake! I have assume that his frustration led to him digging his thumb into my arm pit while trying to get the ball back into the socket. I was so grateful for the ordeal to be over that I didn't realize what had happened. Between the digging in my arm pit and the pulling on my arm with the sheet I was left horribly bruised and the bruising lasted for months! I was quite a shock when the water hit my body in the shower later that night. The armpit is a very delicate area and does not react well to that kind of manipulation.

 

There I went again. I stayed home from work because there was a lot of ice on the ground and I made an appointment to see the Ortho at St. John's. He was very nice and gave me the standard speech. I was over 30 years old and, therefore, less likely to dislocate again and he was not going to push for the surgery. I explained my concerns about the surgery not working and he explained that the field had narrowed to one procedure, Bankart Repair, and that it was about 85%-95% successful. He wrote me a prescription for PT and advised that I should only consider surgery if I felt the shoulder was really limiting my activity.

I went and ,dutifully, finished my PT but ,truth be told, the shoulder was never really "right" after that. I stopped going to the gym because I could not lift weights the way I used to and I never really regained the strength I should have. I did some research on the procedure and felt better about it but still had concerns about needing a lot of help during recovery and living alone. More importantly, the surgeon had given me an out and I was going to take it. I took up other hobbies to stay fit, I started bike riding and running and just continued to be cautious.

Then came 2007. My friends, Matt & Anne, asked if I would help them move the day after Thanksgiving. I agreed and spent the day helping them move their furniture and boxes. They were only switching apartments with the person downstairs from them so it was a fairly easy move. I knew my limitations and let the other guys handle the stuff that could potentially pull my shoulder out. In spite of my caution, I wound up in the ER anyway.

I guess the strain on the muscles was too much. We were joking around at the end of the day and I jumped up, flailed my arms and as I came down I just heard "CRUNCH". I took a knee and , after I convinced Anne I was serious, got someone to call the ambulance.

The EMTs took mercy on me and let me sit in the center jump seat so I would not feel every bump on the way to the hospital. FDNY transported me to Jacobi Medical Center in the Bronx and it was the best treatment I've ever received in an ER! They had me in and out of there in a little under 3 hours from evaluation to release. I think it was a record for me to get out of an emergency room. It was also the first time I had been given pain meds before I was x-rayed. They gave just enough IV morphine so that I could stand up straight for my x-ray and not be in agony. If you have the means I highly recommend it. Matt said he was going to take a picture of me with my arm out of the socket but never did. Too bad. I could've used it now. I explained to the doctor how I was mutilated 4 years earlier and he promised not to do that to me.

Actually, they got quite creative. When the typical traction/counter traction method failed they tried, after some discussion, something I had never experienced before. They hung some IV bags from my elbow and rolled me on my stomach. The weight and the position created enough traction so that my arm went back in on it's own without being forced or creating more trauma on other parts of my body. Kudos and thanks to them. I got a ride home and knew it was time to pay the piper.

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A Little History...

How does one end up with a torn labrum? In my case it boils down to one word: IMPACT.  It was the Fall of 1990, I was 17 and, as a result of being 17, invincible. I was playing football in a pick up game with a bunch of my friends in the park. Per standard operating procedure we were playing a full tackle game, no equipment on frozen earth. I should not have to tell you it might as well have been concrete...the pavement would have had more give to it.  Anyway,  Nick was running right at me, full speed and I was about to tackle him when I heard my name. I think someone said "Get him, Ang!" Well, I looked up and Nick hit me like a freight train and down I went. He hit me in the front part of my shoulder rather than my digging my clavicle into his gut and I remember a distinct crunching sound as I went down. My left arm got locked into an outside open position with my palm facing up and I couldn't put it down. Another friend of mine came over, massaged the shoulder and it fell back into place. It kinda felt like it wanted to go back and as soon as it had the opportunity it went right back. I stood up and went about my business and all seemed well.

About a week later, I was playing our Friday water polo game in my swimming class in HS and I flat-palm slapped the surface of the water and my shoulder just dislocated. It was an odd sensation in as much is it just felt like it slipped out place and then I just stood there for the next 20 minutes, in the corner till class ended.  Since I was in the water I did not experience any pain. My arm was weightless and it was not really a big deal...until they tried to get me out. Then gravity took hold and so did the pain. In the end it took three people to get me out of the pool.  There was one person holding my left arm and supporting the dislocated shoulder, another person pulling me out by my right arm and the third person standing squarely behind me, one hand on either cheek keeping me from retreating back into the pool. I should remember that poor , unfortunate classmate's name but I only have a vague recollection  of his face.

The ambulance arrived and whisked me off to the Emergency Room at Brooklyn Hospital where the nice people were kind enough to use the traction/counter traction method to reduce my shoulder and sent me home.

I spent the next several weeks living in a shoulder immobilizer and then spent several weeks after that going to physical therapy. I don't specifically recall going to see the orthopedic surgeon but I do remember that surgery was not really even discussed as an option. It was just "Go to PT and everything will be fine." and it was. By the time I was done, my left shoulder, which is my non-dominant side, was actually stronger than my right when it was tested.

My next incident occurred a little over a year later. I was attending college in Florida and some of my friends and I were doing some flips into the pool. We were having a grand time until I attempted to do a flip and didn't rotate enough. Instead of going feet first into the pool, which was my intention, I landed with my shoulder blades flat against the water. I surfaced screaming profanities and I was chided by my friends an told the water was not that cold. After making my way to the shallow end of the pool and a brief, amateur medical evaluation we decided to attempt a reduction on our own. After all, we were college students and had been told there was nothing we couldn't accomplish so why not? I've always been a difficult reduction, even with trained medical assistance and drugs so we were not able to get my shoulder back into the socket. As a matter of fact, I recall thinking that we were most likely going to pull my wrist apart before we got my shoulder back into place.

So, once again, I wound up in an ambulance on my way the ER. The doctor who treated me at Holmes Regional Medical Center tried several time to lift my arm up so it would reduce and the last thing I remember after threatening to punch him if he lifted my arm again was the doctor saying "He's not out, give him more!" I saw a needle go into the catheter in my arm and the next thing I remember was Wally standing at the end of the gurney looking at me. In my estimation, I had been out for about 20 minutes but it had actually been several hours. With my shoulder back in place I felt right as rain. We piled in the car, made a stop at Subway on the way back to the dorm and carried on with business. I was sore for a bit, did some PT but was otherwise unaffected. Flips into the pool were crossed off the "To Do..." list. Otherwise,  I was able to swim, lift weights, move vintage VW Beetles (long story) and just about anything else I wanted.

Until I did it, again. During the summer of 1992, I was working at Kings Plaza Marina in Brooklyn and slipped on the dock. My left leg slid on the some mossy wood on the deck and my foot went in the water. I put my left hand out to keep my face from plowing into a step and heard a subtle pop. There I sat until I saw one of my co-workers, convinced him that I needed help,  was not kidding and got him to call an ambulance. The fine EMTs took me to Kings County Hospital where my Aunt met me.

This was, by far, the worst of my hospital experiences. The ER staff left me sitting in a wheelchair for 5 hours while waited for the orthopaedic surgeon to arrive from wherever he was and was not given anything for the pain. I was just told " The surgeon is on his way down." which gave me the impression he was on another floor. In actuality, he wasn't even in the building. After about 2 1/2 hours my aunt raised enough of a stink that they gave some Tylenol (how nice of them) and 2 1/2 more hours later this clown of a surgeon showed up. Then he wants to discuss my having surgery with him. I finally got him to shut up and put my shoulder back and I went home. After the way I had been treated at that hospital there was no way I was going to let anyone affiliated with it touch me.

This time I decided to skip the PT and the surgeon and I went on with my business.I did the PT exercises on my own and eventually healed. Once again, I was able to return to activity and had very few limitations, in spite of what I had been told

. I knew what I could and could not do and was just cautious. The only thing I really had to give up was diving. Otherwise, I played softball, swam, lifted weights, rode roller coasters and just about anything else you can imagine. If some thing made my shoulder feel weird, unstable or made it pinch, I found a way to work around it and keep up my activity. I was spending a lot of time in the gym and was able to do all the exercises I wanted and able to lift more and more weight so why not? From my point of view, there was no need to consider surgery.

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