The mission assignment has been made and unless something out of the ordinary happens, the call letter will arrive on Wednesday.  We should have even more to be thankful for on Thanksgiving this year.

Everyone told me that after shoulder surgery, physical therapy really sucks.  They were neither kidding nor exaggerating.

It's really bad.

The glenoid labrum, the part of my shoulder that they repaired, is usually pretty flexible and moves a bit when the shoulder moves.  But when the labrum has ben re-attached, it doesn't flex very well.  It becomes stiff and often has a bit of scar tissue in it as well.

The shoulder doesn't have a whole lot of room in it, so unless everything is working together just perfectly, the shoulder doesn't move very well.  That's what causes the diminished range of motion that I am experiencing right now.

So here's a typical physical therapy session right now:

We start out with ultrasound therapy.  Lotion/gel is applied to my shoulder and the PT assistant uses the ultrasound wand to shoot high frequency (above the range of human hearing for sure) sound waves into my shoulder.  This helps reduce any swelling present, helps promote healing through improved blood flow, and it gently massages soft tissues deep inside my shoulder while it softens scar tissue.

Next is e-stym, or electrical stimulation therapy.  The PT assistant puts electrodes on my shoulder and adds a heat pad to my shoulder.  Then I sit while my shoulder is stimulated by electricity.  This helps "exercise" the muscles that aren't being used a lot right now because my shoulder doesn't work right.

Then it's time for me to do my stretches/exercises.  So far, I've learned three stretches using a pulley attached to the ceiling and a rope with two handles.  Then I do four more stretches using a cane to help stretch and extend my shoulder.

These.

Are.

Painful.

But once I'm done with my own painful stretches, the physical therapist goes to work.  I lay on my back and he pushes my shoulder past the point of pain, helping slowly increase the range of motion.  This is the most painful part of physical therapy.  It sucks.  Big time.

After only two sessions, I already am enjoying an increased range of motion.  I have a long way to go.  A LONG way.  Before too long, they'll also teach me more exercises that will be used to strengthen the atrophied muscles in my shoulder.

I'll probably have close to 20 therapy sessions before the end of the year, and up to 20 more next year to get my shoulder back to normal again.

I can't wait until they're over, because there's no nice way of putting it.  It's painful, time consuming, and absolutely no fun at all.

Yesterday, my son's mission call status was updated to "Ready For Assignment."

Once a week, a member of the Quorum of the Twelve Apostles reviews new missionary applications and makes missionary assignments.  This usually happens on Fridays, but it can happen on other days of the week as well.

I often wondered about how this process actually happens.  It seems that it could easily be handled purely by computer--Mission X needs Y missionaries.  Missionary Z is available to serve and qualifies based on information provided in the online application.  All of this is easily programmable.

However, this isn't how it happens.

President Henry B. Eyring, an Apostle and member of the First Presidency helps shed some light on the subject of how mission assignments are made:

“I have had [many] experiences feeling of the Holy Ghost…But I’ve never felt what I have felt as I have…participated in the assigning of missionaries…Because of technology, it is possible for us to have your picture and the information about you displayed. And then quickly, on that same screen, all the missions of the Church with all of their needs are displayed. Within minutes, and sometimes less than a minute, the impression comes so powerfully that it would be, if it were a single instance, something that you would never forget. Can you imagine sitting there for hours at a time, having that happen time after time without interruption? I testify to you that it is real…[The Lord] somehow not only knows you but loves you enough to ensure that your call is where He needs you to go to teach the children of our Heavenly Father.”

Pretty amazing.  Elder Ronald A. Rasband of the First Quorum of the Seventy gave an address in General Conference in April, 2010 entitled "The Divine Call of a Missionary" in which he shared his experience of being part of that weekly meeting in which mission assignments are made.  It is a great insight into how missionaries are called of God.

So the fact that my son's mission call status is now "Ready for Assignment" means that the next time this meeting is held, it is possible that my son's face will appear on the screen and a member of the Quorum of the Twelve Apostles will greet him with "Hello, Elder Smith!"  He could be assigned to a field of labor within a week, and, if everything goes normally, the mission call letter will arrive at our home on the day before Thanksgiving.

But what else does "Ready for Assignment" mean?

For my son, I believe that he really is ready for assignment.  He has been preparing to serve the Lord as a missionary for quite some time now.  He graduated from seminary.  He is taking a missionary preparation course in his Young Single Adult ward.  He has a testimony of the restored Gospel of Jesus Christ.   I believe that he will be a good missionary.  He is the kind of young man that President Ezra Taft Benson spoke of when he said

Give me a young man who has kept himself morally clean and has faithfully attended his church meetings.  Give me a young man who has magnified his priesthood and has earned the Duty to God award and is an Eagle Scout.  Give me a young man who is a Seminary graduate and has a burning testimony of the Book of Mormon.  Give me such a young man and I will give you a young man who can perform miracles for the Lord in the mission field and throughout his life.

Yes, my son truly is "Ready for Assignment."

His mother and I, however, are not ready, despite the fact that this is something that we have been praying for for a long time.  We're not ready for him to move on to the next part of his life, even though we know how much growth he will experience as he puts his life into the service of the Lord for two years.  We aren't ready, but we're not sure if we ever would be ready, because we know that once he leaves, our family will be changed forever.

Yet we understand that it's time to let him go.  There's also a lot of excitement as we speculate about where he might be assigned.  Hopefully, it'll only be about ten more days until that question is answered, as well as the question of when he will start his missionary service.  After that comes the flurry of preparation activities--buying suits and white shirts and ties and luggage, attending the temple as often as possible, and doing what it takes to put one's non-missionary life on hold for two years.

He's "Ready for Assignment" and we're going to be on pins and needles until the assignment arrives.

Now the waiting begins.

My son has finished the process of submitting mission "papers" and now we wait to find out where he will be serving his mission for the next two years.  We will find out when he will be starting his full-time missionary service.  We will find out if he will be learning a language.

I was waiting for a mission call during the summer of 1988, and honestly, I'm feeling those same feelings again that I had as I waited for my own mission call.  It's amazing similar these feelings are.

So... any guesses?  Where do you think he will be called to serve?

Today, I finally received the Explanation of Benefits from my insurance company for the bill that they received from the Surgical Center.

Holy for the love of freaking buckets and stuff!!!

Billed amount:  $13,663.76

Network Discount: $3,921.50

So this basically means that the surgical center got paid $9,742.26 for my shoulder surgery.  I think I'm going to ask for an itemized bill, because I'm really curious now what I got for the $10k.

If I didn't have insurance, so far, this shoulder injury would have cost me nearly $20,000.   This shoulder injury has cost the LDS Church nearly $4000, because I have now hit my out-of-pocket maximum of $4000 for the year and we didn't have many medical expenses before this.  Fortunately, it won't cost any more THIS year, because I have hit the out of pocket maximum, so physical therapy will be "free" for me.  My primary insurance will pay out at 100%.

Hopefully, most of the PT will be before the end of the year because after 1 January, Church Activity Medical Assistance will have to pay for the first $3000 of the physical therapy since we're going to be doing the high deductible insurance plan again next year.

In other news, I quit wearing my sling this week.  It's now been more than six weeks since the surgery.  My shoulder aches a lot more because it doesn't have the support and because I'm doing stretches to help increase range of motion.

I'm sleeping better.  As a matter of fact, this morning, after waking up just before 6am, I went right back to sleep and slept well enough to DREAM.  It's the first dream I remember since surgery.

And today, I felt ALMOST rested!

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.

Today, in the first session of the LDS Church's Semiannual General Conference, President Thomas S. Monson announced that young men can be recommended for Missionary Service at the age of 18.

I don't remember much else from the Saturday Morning session, because everything in my older son's life suddenly changed.

He was going to be eligible to start the application process in early December, but now, he can start the process right away.  Next week, we have an appointment with our bishop to get the process started.

He was planning on attending Utah Valley University for another semester--he's there fulltime this semester--and then he would leave on his mission sometime after the end of Spring semester.  Instead, he will finish this semester, then focus on mission preparation.  He will likely tell the missionary department of the LDS Church that he can leave anytime after 1 January, 2013.

For my son, this isn't a big shift.  He will likely leave only a few months earlier than he otherwise would have left.  Yet for my family, this is a big shift.  It's something that every parent simultaneously anticipates and dreads--when their child leaves home.  The anticipation and excitement is because this is a pretty magical time of life for a person.  It's a time full of decisions and changes.  It's a time that sets a person's direction in life.  It's exciting to me that my son wishes to serve a mission for the LDS Church, because my mission was a time of intense growth for me in so many ways.

Yet the dread comes because once he leaves, the dynamic of our family will change, and likely change forever.  We're going to miss having him here.  We're going to miss his humor and his laughter and the personality that adds so much to the dynamic of this little family of four that will soon be a family of three.

This also accelerates the same process for younger son, who will be eligible to serve as soon as he graduates High School.

And then the nest will be empty.

It can't be happening yet, can it?  Yet, today's small, yet historic change in the LDS Church's missionary program has seemed to make all of these changes almost immediate.  It has taken the "looming" event and made it seem more like it is happening right now.

I'm sad and excited.  I'm nervous and proud.  I'm feeling so many, many emotions all at once.

And yet, under all of this is the underlying feeling of peace that tells me that it's right.  That's what's going to get us through these changes that we've been excitedly dreading for more than 18 years now.  It's just right.

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.