My Shoulder

I kind of had this plan to blog my way through my surgery this week. I kind of think that was over-optomistic, considering a) I haven’t been blogging at all most of the last year and b) I haven’t really had much use of my left arm.

I didn’t quite get there; best I managed with posting photos f the inside of my shoulder on facebook, and tweeting about how looped I was on percocet in the middle of the night.

To summarize though, for those who aren’t following me elsewhere – December 23, I had arthroscopic surgery on my left shoulder

I’ve had trouble with my shoulder for years; I sort of ignored it generally. It was on’y a problem when I was lifting weights, because it limited my exercises a bit (range and strength), for anything that used the left bicep of the front of the left shoulder.

Recently though, it’s started to get worse. My last serious gym rat phase (four or five years back), it started to really interfere; I would hurt myself about every other week. It wound up so discouraging I gave it up after a while, just quit working out because I got tired of the shoulder issues.

The thing with the shoulder is that it just doesn’t seem to like being old. You hit a certain age, and it seems to want to fail. The group of muscles and tendons that stabilize the shoulder (the rotator cuff) just isn’t that strong, and when you stop using it – or put it under unusual strain – it gives way. I think when I stopped working it, two things happened. One was that I lost strength, and the other is that I lost flexibility. It went from only hurting when I over worked it, to hurting semi-randomly, stiffening whenever it wasn’t it motion.

The difficulty with having a high tolerance for pain, sometimes, is that it leads one to just put up with things that could be fixed. I just ignored it as it got worse.

I went to my MD a couple of times; he diagnosed tendonitis. That’s usually treated with rest, ice and anti-inflamatories. So we tried that, to little effect (while the NSAIDs helped the pain, it came back as soon as I discontinued use). We moved to cortisone injections, and that helped more, but again, it would come back.

Finally I went to my sports medicine/arthroscopy guy (Dr Grady Jeter in Los Gatos, who’s amazing), who said rotator cuff tear, and ordered an MRI.

MRIs are cool. Pictures of the inside of your body are always cool, but ever better when taken with a giant sci-fi magnet that looks like a transporter from some Doctor Who episode. However, the MRI wasn’t conclusive; it didn’t show a major tear, but it did show a structural problem in the bone that connects the collar bone to the shoulder blade (which, I’m sure, has a name, but I don’t have the patience to look it up just now). The bone dips down more than it should, and causes an impingement of the biceps tendon where it enters the shoulder joint. The tendons where rubbing themselves raw, Doctor Jeter felt, against the bone.

The thing with most joint problems is that the only way to know for sure, is the same way you fix; arthroscopy. Basically, you make two or three tiny incisions, fill the joint with saline, stick a miniature fiber optic camera inside the joint, and have a look-see. If there’s something to fix, they fix it (there’s almost always something to fix; joints wear over time, and wear leaves a mess behind).

It’s pretty amazing what surgeons can do with arthroscopy. The instruments are tiny, and they’re working entirely by camera. These guys must be great video gamers. They can cut, sew, patch, trim, clean, grind, all through holes so small they don’t leave scars. I’ve had this done twice in the past; both my knees have suffered small meniscus tears. But the shoulder is a bit different (far more complicated).

We planned the surgery for fall of ’08, but I wound up having to postpone it. Partly that was because of the work load related to my mother’s estate (she died in November of that year). Partly, though, I psyched myself out after seeing a friend go through the same surgery. Instead I got a cortisone injection. That controlled the pain for a good six months, so I began to think I didn’t really need the surgery after all.

The pain came back last summer though; so I got another injection. That one lasted me for about six weeks, rather than six months, and at that point, I realized the surgery was going to be inevitable, if I ever wanted to be able to work out again; it was at the point where I couldn’t even sleep without nightly doses of strong NSAIDs.

I scheduled the surgery for xmas after we decided we couldn’t swing any holiday travel (I get a week off for xmas every year). And then I had time to stew about it, think far too much about pain and discomfort and recovery.

As it turned out, I had nothing to fret over.

I went in for surgery on Wednesday morning; they traded my clothes for a backless gown (and every nurse in the place then had to come look at my back tattoo). They shot me full of versed and fentanyl (and wow, did I like that; versed is one of my favorite drugs), and then the anesthesiologist game me a never block on my left shoulder.

I remember being rolled into the operating room, and the Anesthesiologist saying ‘we’re going to put a mask on you’. And then I was waking up, feeling sick and thirsty. I found out later the procedure had been only an hour.

My arm, which was wrapped in bandages and an ice therapy pack, and a sling, felt like it wasn’t even attached to me. The nerve block worked pretty damn well.

I went home, went to bed with my ice therapy pump running, and marveled at the lack of pain. My arm was completely paralyzed, down to the fingers. I couldn’t ever move my fingers; it was like a dead man’s arm, completely disconnected.

The anesthesiologist had warned me that nerve blocks are unpredictable; they can last only a few hours, or as long as 24 hours. I was lucky; it lasted for more like 28. I had no pain whatsoever for 24, and when the feeling came back, it came back slowly.

My friend Chris had sever pain after his shoulder surgery; the Anesthesiologist also told me shoulder surgery could be ‘extremely painful’. So my expectations were for the worst. When the pain began to return, I swallowed two percocet and went to bed, fearing the worst.

I think I had an hour or so of pain I’d call significant. That was all. By the time I had a second dose of percocet in me, I was able to get up, have dinner, and watch TV. I had only what I’d call strong discomfort and minor pain. Sleeping was a drag (I sleep on my stomach, I can’t sleep on my back at all; same reason I can’t sleep on airplanes); I didn’t sleep at all that first night and very little the second. But by the day following surgery (xmas eve) I was able to make coffee myself, and was up and around enough to post on facebook, and even able to wrap gifts (clumsily).

Xmas day I had no problem getting up and doing family xmas, and then had the usual big in-law xmas morning brunch. I was able to remove the major bandages that night, and found I could move my arm. It was stiff, and it hurt to move; but I didn’t need much percocet.

Since then it’s gotten better each day. While it’s stiff, and reaching still hurts, my range of movement is close to what it was before surgery. More importantly, the pain that caused me to go in is gone; those movements and positions are painless. Last night (the 30th) I was able to sleep all the way through the night with no pain meds of sleep aids, for the first time since surgery. Two days ago I saw my doctor, and he was startled and pleased at my recovery (I think he used the word ‘wow’ three times). Yesterday I was able to return to driving my car (stick shift and all), and in fact went to a sharks game at the Tank (which was an absolutely great game; all sorts of unexpected delights there).

All in all, this has been best-case-scenario all the way. I was expecting to feel truly lousy for a week, and my unable to drive for two; I figured I wouldn’t be able to ride my motorcycle for a couple of months. But I’m pretty sure I could ride by Monday if I feel like it.

I can’t wait to start lifting weights, though my doctor wants me to wait three more weeks for that (we’ll start physical therapy at that time).

My new year’s eve is a casualty of all this; I’m still fighting a sever sleep deficit (I fall asleep halfway through tv shows). So going out was more than I could face tonight, despite several invitations. Instead, I’m headed for an 11pm bedtime, and Doctor Who (season four) on netflix instant play. I may make midnight, but it’ll be without champagne or kisses or dropping balls. And Im ok with that, because It won’t be with the pain I’ve been fighting every night for two years.

I’ll catch up on the champagne and kisses later though. Rain checks on that, k?

(pictures of the inside of my shoulder are here. And yes, I know how dirty that looks.)