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.

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.

Technorati Tags: dislocated shoulder,surgery,bankart repair,bankart lesion,torn labrum,history

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.

Technorati Tags: dislocated shoulder,surgery,bankart repair,bankart lesion,torn labrum,history