A little glimpse of me.
There are two days that I'm REALLY looking forward to:
1) The day after I sleep through the night without waking up. This honestly hasn't happened since late July.
2) The day that I don't think about my shoulder because it hurts, because it's sore, or because it's not working properly. This also hasn't happened since late July.
I will celebrate both of these days. Heartily.
I had my shoulder surgery four weeks ago today. I've been in this stupid sling for 28 days. I have my next follow-up appointment with the surgeon on the 12th of Never...er...November. That means I'll be in this stupid sling for 26 more days. Yesterday was the halfway point of sling wearage. After that, the pain and torture of physical therapy will begin.
I'm weary of wearing the sling, but I'm wary of not wearing it. It would still be too easy to re-injure my shoulder or mess up the work that the surgeon did in my shoulder joint. It would be MUCH worse if that happened, because I'd be right back at square one again.
Fortunately, the elbow pain from the ulnar nerve is pretty much gone. I think it just got used to being in the sling. Unfortunately, sleeping isn't getting any better or easier. I am probably averaging about 6 hours a night--barely enough to survive and not nearly enough to ever feel rested. I still find myself nodding off at my desk in the afternoon. I really don't think that will get any better until after the sling is off, and probably not even then.
I've been able to do quite a bit one-handed though. I actually made cinnamon rolls--a tradition in my family for General Conference.
Almost every day, my shoulder is a tiny, tiny bit better.
Slowly. VERY slowly, I am recovering.
Did I mention slowly? Good.
Maybe I'll learn some patience from all of this.
I went to my first post-surgical follow-up visit last week. Things are progressing just about as well as the surgeon expected they would. Slowly.
He told me that the three priorities after a SLAP-tear repair are 1) healing, 2) range of motion, and 3) strengthening. We're working on priority 1 right now. Slowly.
Priority 1 is the reason for the shoulder sling. The sling mostly immobilizes my shoulder, especially keeping it from moving in ways that might undo what the surgery corrected. If I'm not careful, the bone anchors can pull out, causing even more pain and making a re-do of the surgery medically necessary. I do NOT want that. So I get to continue wearing my shoulder sling night and day until my next follow-up appointment, which is six weeks from today. Six excruciatingly long weeks. After that, I'll start doing physical therapy to regain range of motion.
I've started sleeping in my bed again. I use a lot of pillows to support my arm and to keep me from rolling over onto my left shoulder. I'm not sued to sleeping on my back, but now that I'm back in my bed again, I think I'm sleeping better. I only woke up once during the night last night. I believe that I actually slept for almost 7 hours.
I get to take my sling off several times a day to do very small exercises that will help out in the long run. It's amazing how small the range of motion in my shoulder is, and how little the surgeon wants me to do with my shoulder.
The worst pain since the initial pain of the surgery diminished has actually been in my elbow, not my shoulder. The ulnar nerve (the one that you hit when you hit your "funny bone") doesn't like being restricted and doesn't like the constant pressure from my shoulder sling, and it has gotten inflamed. The exercises, along with ibuprofen and lots of icing, have calmed that down, and hopefully, I can stay ahead of that inflammation and pain. I seriously couldn't handle six more weeks of wearing the sling if it meant that my elbow, lower bicep, and upper forearm would continue to be in that much pain.
But things are also becoming more and more normal again as the pain recedes and as I get more and more used to doing things one-handed. I'm hoping that live moves into a regular routine again, something that could hopefully make the next six weeks pass more quickly.
From all accounts, I shouldn't be looking forward to the next phase of recovery, because physical therapy on a shoulder is pretty darned painful. You will, of course, be able to read all about that here in a few weeks.
For those of you not squeamish, here are some pictures from surgery: http://misterme.com/shoulder.jpg
The top-left picture shows the cause of the soreness I was having before the accident on the river. That's fraying on my rotator cuff tendon. The surgeon cleaned that up in addition to fixing the torn Labrum.
The middle-right picture is the best view of the tear. That gap about 2/3 of the way from the right shouldn't be there. The bottom-left shows more of the tear, being pushed easily aside with a surgical instrument. The bottom-right picture is the "after" picture showing the sutures holding down my Labrum. The sutures are attached to the bone anchors that are in the process of healing.
Everything apparently went well with my shoulder surgery.
I was given a late-ish time to report to the surgical center--1:45pm, and just a we were about to leave home to go to the surgical center, they called and told me that they were running behind. I finally showed up at 2:45 and got all checked in.
I dressed in their blue paper bloomers and their purple gown and wrote "yes" on my left shoulder. They asked if I wouldn't mind helping out a BYU nursing student who had never done an IV before. Sure. Why not? So she worked on it for somewhat longer than a normal nurse might have done. Another nurse came in to shave my shoulder. Most of what was shaved was my chest. And then I waited.
My brother stopped by and we talked for a while.
And I waited.
I was my surgeon's last "case" for the day.
And I waited some more.
Finally, the anesthesiologist came in and talked with me about doing a "shoulder block" which is basically like an epidural for my shoulder and would block pain for 12-24 hours. Yes please!
They sedated me, administered the shoulder block, and soon it was time to head into the operating room. I was transferred onto the table, they asked me to breathe deeply into the mask, and the next thing I knew, I was in recovery.
The doctor told my wife that they had placed four anchors, meaning that it was a more significant tear than they had anticipated from the MRI. I had to hang around at the surgical center to make sure certain *ahem* biological proceses were in full swing, and then I went home, not arriving at home until 9:30 or so Wednesday evening.
So far, the recovery has gone better than I had anticipated. For the first while, the shoulder block kept the pain at bay. After that, regular Lortab helped. They also gave me a nifty ice cooler that, when plugged in, would circulate ice water over my shoulder. That kept the swelling at bay.
As of today, I'm off of Lortab and I'm not in pain. My left arm is kept immobilized except for when I'm supposed to exercise my elbow 4 times a day. I think I'm ready to head back to work tomorrow. We'll see how it goes. Next comes follow-up with the surgeon on Thursday and physical *ouch* therapy after that.
It's really pretty miraculous what they can do through three small incisions.
My blog is turning into a journal of medical horrors. But that's the only really interesting thing going on right now, so here we go.
Yesterday, I went in for the MR-Arthrogram. It wasn't as bad as I made it sound in my previous post. It was worse.
The first worse part? The cost. My Orthopaedic Surgeon's office estimated that it would cost about $600 or $700. They were wrong. The estimated portion of the procedure not covered by my insurance is just under $1150. *ouch!* Right in the wallet! But what can I do? I need to be able to sleep through the night again. I need to be able to get life back to normal again.
The other worse part? It was surprisingly painful. Again, if you're squeamish, you might not want to read on.
After arriving at the Imaging Center and filling out a bunch of paperwork, they had me change into scrub pants and a gown and I was asked to lay down on a table with a fluoroscope. A fluoroscope is basically a lower-dose x-ray machine that provides live images. The radiologist came in to fill my shoulder joint with contrast medium. The local anesthetic was a piece of cake--a little pinch and a little stinging for a few seconds. No big deal. But the other needle? *ouch*
In order to place the needle in the proper position, the radiologist has to push the needle in until it hits the bone, then pull it back a little bit. When that needle hit the bone, it HURT. Instant tears springing into my eyes, and a big wince. Yeah. It was bad. Then I felt strange pressure/pain as he injected a LOT of fluid into my shoulder joint. That fluid has nowhere to go, so it slightly expands the entire joint, and yes, that is a painful process. Worse than I thought it was going to be. *ouch again* When the contrast medium was in, he quickly pulled the large needle out, which was just as painful as when the needle hit the bone, but because he did it quickly, the pain was over before it really registered, thank goodness. And with that, the hard part of the procedure was done.
The radiologist then proceeded to position my arm in different positions and told the radiology tech to take different pictures (basically screen captures from the fluoroscope) of my shoulder joint. That was kind of fun to see. I watched the bones in my shoulder moving about as the radiologist positioned my shoulder.
The next hour was spent in a "high field open MRI" machine. They took several pictures of my shoulder. The MRI made a lot of loud buzzing and banging sounds as it made high-resolution images of the inside of my shoulder. The time to take each picture ranged from 4 1/2 to 15 minutes.
My shoulder remained VERY sore for the rest of the day, and I ended up taking Lortab last night so I could sleep. Fortunately, I'm feeling a lot better this morning. It feels as if a lot of the fluid in my shoulder has been absorbed and a lot of the pain I was feeling yesterday is gone. Because of the Lortab, I think I slept better last night than I have since July. That was nice too.
The result of all of this?
Labral tear extending from the posterior superior labrum posteriorly just past 3 oclock
Now I have a diagnosis.
This particular tear is called a SLAP tear. This web page explains all about it. The most interesting bit to me was the part about causes:
The cause of a SLAP tear can generally be divided into acute traumatic events or chronic repetitive injuries that lead to failure. An example of an acute traumatic event would be a fall onto an outstretched arm, which may result in SLAP lesion secondary to abnormal contact between the humeral head and the superior labrum/biceps anchor. One of the most chronic repetitive injuries that leads to a SLAP tear is overhead throwing. Overhead athletes, especially baseball pitchers, place huge amounts of stress on the shoulder with every throw. The position of external rotation just before ball release can overstress the attachment of the biceps tendon and can lead to a SLAP tear.
Although my shoulder was sore from playing racquetball left-handed, racquetball is not an overhead motion. However, my natural reaction to being pulled backward off of the raft was to extend my arm to stop myself from falling. My right hand was busy with a paddle. My left hand took the brunt of it, and the result was the tear that I'm dealing with. I am 100% certain that this tear happened that day on the river. I felt the pop. I felt the sickening clicking in my joint immediately after. This diagnosis confirms what I had already thought.
The next step comes tomorrow. I am meeting with my Orthopaedic Surgeon to determine the severity of the tear and to decide on a course of treatment. From everything that I've read, this is going to mean surgical repair followed by a bunch of physical therapy. Wonderful.
The nice thing about this diagnosis, though, is that certainty that my shoulder was injured on the river trip. Because of this, I emailed my bishop yesterday and started the process of filing a claim with the church's supplemental insurance program. Costs not covered by my insurance (which will be significant--I chose the high deductible insurance plan this year, not anticipating a shoulder injury) will hopefully be covered by this supplemental insurance.
The other nice thing is simply that there IS a diagnosis. I don't have to continue wondering what's going on in there. With a diagnosis, the surgeon can recommend a definitive treatment plan and give me a prognosis for future recovery. There can be a light at the end of this tunnel of sleep deprivation, even if that light may be a few more months down the road.
I'm tired. I'm really REALLY tired. Every afternoon I start falling asleep at my desk. I'm having trouble concentrating. The reason that I'm so tired? I haven't had an uninterrupted night's sleep since JULY. Every night I wake up multiple times because of shoulder pain.
I'm tired of being tired.
I'm tired enough that I don't care any more how much this is going to cost. I want to get my shoulder diagnosed and fixed.
Tuesday, I'm going to have a MR-Arthrogram done. It's a two-step procedure. The first involved needles. If you're squeamish about such things, stop reading now.
As I said, the first step involves needles. Big needles. Long needles. They use one needle to inject a local anesthetic into my shoulder. Then they use a fluoroscope (basically, a live-view x-ray) to guide another larger-bore and much longer needle into my shoulder joint. They then fill my shoulder joint with a "contrast medium" and remove the big, long needle.
After I move my shoulder in about every possible direction to make sure that the contrast medium is fully distributed everywhere in my shoulder joint, they will use Magnetic Resonance Imaging (MRI) to get a detailed look at my shoulder so that they can find out exactly what is going on in there.
I'm also tired of not knowing what is going on. MR-Arthrography is used to locate problems with the glenoid labrum (the cartilage ring around the shoulder socket) or tears in the rotator cuff. Either of these might cause the type of pain that I am experiencing.
The anti-inflammatory meds don't seem to have done much, but I'm still going to be taking them--just in case nothing is found.
After the MR-Arthrogram, I get to wait. And wait. And wait until my Orthopaedic Surgeon has an opening. Right now, it doesn't look like I'll get in to see him until the 26th of September or so.
I don't care what happens next if it leads to me being able to sleep through the night again.
My shoulder still hurts.
A lot.
Enough to go see a doctor about it today. They took x-rays, and everything appears to be looking pretty normal. There is a little thickening of the acromion. The acromion/clavicle joint might be a little tiny bit wide. There are some tiny bone spurs, but nothing that should be causing problems.
This means that my shoulder still has swelling inside (which my doctor thought was less likely with the "medical history" that I gave him) or there is soft tissue damage to either the labrum (cartilage that surrounds the "socket" part of the shoulder joint) or the rotator cuff (a system of muscles and tendons that make the shoulder work).
My choices:
I'm starting with the least expensive option first. I'm going to be taking anti-inflammatories for the next month or so. It takes 7-10 days for this particular drug to reach "clinical effective strength" in my system. So after a couple of weeks, if it's not getting any better, then I'll probably jump to the third (and most expensive) option. It would end up costing somewhere in the neighborhood of $600-$700. And since I'm on a high-deductible insurance plan this year, all of that cost (plus the cost of today's doctor visit and the medication) will all be coming out of my pocket. That hurts, but not as much as my shoulder hurts.
I thought about going with an MRI right away, because that's the easiest way for the doctors to see whether or not there is soft tissue damage and I could get a much quicker, more definitive diagnosis. But another part of me thinks that even if there IS soft tissue damage, if I can just hold out until January before needing surgery (and the anti-inflammatory meds might help there), I might end up paying less out of pocket.
And that's the update. I'm sure you wanted to know.
Last week, I was able to spend a few days at Flaming Gorge with both of my sons. It was the only "high adventure" camp that I was able to attend with both of my sons. We had a really good time. We floated a bit of the Green River on rubber rafts. We toured the Flaming Gorge dam. I was able to cook some amazingly awesome dutch oven food for the group. It was generally a really good time.
It was also a learning experience for me. I don't really like what I learned.
Since I had volunteered to help with the food for this campout, I accompanied my son's (only one son is a scout now--the other is an adult) leaders to the grocery store to pick up some food. The Varsity Coach (whom I shall refer to as B.B.) said that the had a confession--that he had not completed the required BSA medical form. The Venturing Advisor (whom I shall refer to as C.B.) said that he hadn't done it either. There was no reason given, but it was made pretty clear by their comments that they didn't feel as if it were important enough. C.B. said that he might be leaving early, and that he wouldn't be on the activity for 72 hours. I reminded him of BSA policy that it doesn't matter how long any individual attendee would be at the activity. If the activity itself is longer than 72 hours, then all participants, youth and adult, would be required to have a completed BSA medical form.
This "do as I say, not as I do" attitude displayed to me by my son's current and future scout leaders upset me a little bit. It made me feel as if, for them, convenience trumped obedience to BSA guidelines designed for the safety and protection of both youth and adults participating in a high adventure camp.
The evening that we arrived at camp, the leaders mentioned some of the activities that we would be doing at this camp. One of the activities mentioned was cliff jumping. I mentioned that I didn't believe that cliff jumping was an approved BSA activity. My comment was completely ignored. After we returned home, I read the following in the Guide to Safe Scouting:
Diving and Elevated Entry: Diving is permitted only into clear, unobstructed water from heights no greater than 40 inches. Water depth must be at least 7 feet. Bottom depth contours below diving boards and elevated surfaces require greater water depths and must conform to state regulations. Persons should not jump into water from heights greater than they are tall, and should jump only into water chest deep or greater with minimal risk from contact with the bottom. No elevated entry is permitted where the person must clear any obstacle, including land.
Scouts were jumping into the water from heights much greater than they are tall. One leader jumped from a cliff estimated to be about 90 feet above the water. This is obviously contrary to the guide to safe scouting. This point is also emphasized in the safe swim training that B.B. said he completed just before we left on this trip.
I don't expect that leaders to completely know every regulation and guideline in the Guide to Safe Scouting. However, I doubt that either B.B. or C.B. has read the Guide to Safe Scouting or they would have questioned the wisdom of cliff jumping. Additionally, the scouting unit is required to file a Tour Plan with the district BSA office before a campout like the one at Flaming Gorge. The Tour Plan application says the following:
We certify that appropriate planning has been conducted using the Sweet 16 of BSA Safety, qualified and trained supervision is in place, permissions are secured, health records have been reviewed, and adult leaders have read and are in possession of a current copy of Guide to Safe Scouting and other appropriate resources.
If these leaders had read the Guide to Safe Scouting and if they had a copy of the Guide to Safe Scouting in their possession (which I am 100% sure they did not), we could have consulted the guide about the wisdom of cliff jumping during this activity. In this case, even with someone (me) questioning the appropriateness of this activity, fun seemed to me to trump safety.
As we floated the Green River, the leaders emphasized the importance of wearing life jackets (thank heavens) during the entire float trip. However, at one point on this float trip, I was sitting on the back of my raft next to another gentleman. C.B. and one of the other adult leaders (J.L.) came up with the idea that it would be funny to have one of the youth jump from their raft, grab the back of the life jackets of the two of us on the back of the raft, and pull us into the river. This is obviously not something anyone would consider safe--think of a horse collar tackle in Football. It's a penalty because of a safety issue of being dragged down from behind. C.B. offered the young man $20 if he would do it, and both C.B. and J.L. continued to egg him on until he did so. It tweaked my left shoulder (which has been hurting for a couple of weeks now) pretty badly, and now when I move it, there's a sickening clicking inside my shoulder that I hope won't require surgery. But the leaders again showed me that fun (or funny) trumps safety.
Incidentally, J.L. apologized profusely when he heard that this had tweaked my shoulder. The young man apologized profusely. The young man's father apologized. C.B., who had egged the young man on--even offering him $20--never said a word. I know it's petty of me to expect something, and I'm still pretty ticked off at C.B. I'm working on learning to forgive right now. I'm not learning that lesson very quickly.
So what did I learn from this? I can't trust my son to go on activities with his scout leaders. Even when I go along, I can't let my sons out of my sight. My older son jumped from a 12-ish foot cliff since I wasn't there at the moment to yet again question the wisdom of cliff jumping. I learned that convenience trumps obedience; that fun trumps safety. I learned that these leaders have a "do as I say, not as I do" attitude about rules or guidelines that seem inconvenient.
Fortunately, my younger son now has enough camping nights to earn his camping merit badge, because I can't send him camping with these leaders ever again, and I certainly don't want to go along on campouts with these leaders any more.
In the end, there really is no excuse. The rules that were broken, regardless of importance, are spelled out in black and white. There is nothing ambiguous about these rules. This is why the scouting leaders in my unit have lost my trust and will no longer have my support (or my son) on outdoor activities.
They have lost my trust and I don't know how or if they can gain it back again.
