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.

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.

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.