Off-The-Rotator-Cuff
Remarks (chronological order, from a blog by Alan C. Baird)
URL of this page:
http://9TimeZones.com/r.htm
Prequel (Me & My Cannibal)
March 1, 2008: My ___ Is In A Sling.
Last weekend, my employer moved us all into a new building. The office looks nice, and I have a large quasi-executive privacy-free cubicle. The tree-lined parking lot looks nice, too, and many large birds like to hang out in the trees.
On Monday, I found out those huge birds generate huge quantities of sh*t. How did I learn this, you ask? Because my car was covered with huge white splotches at the end of the day. I had to wash the windshield, just to be able to see the road for my evening commute.
On Tuesday, when I walked outside for the morning break, I decided to pick up a small pine cone and teach one of those d*mn windshield-crapping birds a good lesson. As I threw the pine cone, my shoulder gave out with a loud SNAP, and the razor-sharp pain has kept me from sleeping ever since.
Boy, I really taught THAT bird a lesson he'll never forget.
Yesterday, the pain finally started interfering with my ability to do the writing that my job requires. So I broke down and visited an orthopaedic doctor, who said my rotator cuff has been severely damaged. Oh goody. Needles. MRIs. Hemostats. Scalpels. Arthroscopes. Stitches. Lots of physical therapy. Plus, thanks to some incredibly shoddy health insurance, a possible bankruptcy.
But the doc prescribed me some Vicodin, which lets me sleep like a baby. So if my luck runs true, I'll end up with a really nasty narcotic addiction, too. Yaay!
March 12: Magnetic Resonance Imaging.
I got a shoulder MRI this morning, to confirm the injured rotator cuff.
First, the doc injected the joint space in my shoulder with radioactive dye.
My shoulder didn't like this. It started to complain about the pain, by cramping.
Then the MRI tech strapped me down in a supremely uncomfortable position, for insertion into the MRI machine.
After the first 3.5 minute session, I asked if she could reposition my arm. She said: "Not without starting over."
So we negotiated a slightly less uncomfortable position for my elbow and wrist, which refused to fold into the optimum angle. My damaged rotator cuff was obviously asserting its dominance over the situation.
During the next 3.5 minute session, I was chanting mantras, doing breathing exercises (not too much, don't move, Alan) and desperately trying every mental trick I knew, to block out the excruciating pain.
Four sessions to go.
During the next session, I tried letting the pain flow through me. That worked for about 3 seconds.
The rest of the sessions were a blur. I remember whimpering softly, hoping the MRI tech wouldn't hear. I think I passed out for a while.
But not long enough. In my mind, those MRI sessions had stretched into eternity: past, present and future. The pain had always existed, and would continue to exist, now and forever after, world without end, amen.
I don't have any fear of the MRI tunnel (I've been in it a couple of times before), but for this examination, it turned into a real torture chamber.
My shoulder went into an involuntary muscle spasm during the final session, so she had to redo the session. Of course.
Afterwards, when she asked if I wanted a copy of the CD, I said: "F*ck, yes!"
I felt like I had earned it.
April 27: Surgery! Yaay!!
I finally got on the surgery schedule: Tuesday morning, 6am. After two months of agony and not being able to sleep, this is better than friggin' Christmas.
April 29: Surgery went well. Three pix from today's outpatient adventure:
1) Stretched out like a flapjack in the pre-op area. If you look closely, you can probably see that I should have used the nose-hair trimmer last night. Anikó's black jacket is over my shoulders, partly because she thought the A/C was too chilly for me, but mainly because she just likes to play "Mamci" every now and then.
2) Eight photos from the tiny arthroscopic camera they wiggled around inside my RIGHT shoulder (that LEFT shoulder caption is just a typo, thank gawd). I have no idea what any of these images represent, but I've been getting flashbacks from the last time I leaned over the butcher-shop counter to look at the leftover scraps and chunks of entrails on the floor.
3) Then there was a two-hour gap in my memory. Afterwards, the nurses couldn't get my giant Hawaiian shirt to fit over my new sling. BTW, this sucker seems to be the Porsche of slings: the logo says "Slingshot 2." It contains an embedded pillow to hold my arm at the proper angle for healing, plus a cute little attached squeeze-ball to keep my blood circulation from slowing down to the pace of dried mud. Notice that enormous beached-whale belly. When I arrived at 5:55am, the receptionist gave me a wheelchair and offered to rush me into the Maternity ward.
May 6: Popping Percocet per physician's prescription.
One week ago, I had the shoulder surgery. A lot of my friends, relatives and neighbors helpfully related their first- or second-hand experiences with arthroscopic procedures, and they kept telling me the recovery times were short. Miraculously short.
But when I visited the doctor last Friday, to have my stitches removed, he said the arm should remain immobilized for up to six weeks. Damn, I have to wear the Slingshot 2 for a month and a half, just for these three tiny pinholes? I knew the damage was serious, but I expected to be throwing pine cones again, after a week or two.
So... this one-handed typing is getting old. Being unable to drive a car is getting old. Gobbling narcotics to dull the pain is getting old.
And I'm not getting any younger, myself.
May 9: Top 5 righty activities.
With the recent rotator cuff surgery, my right arm is trussed up in a super-sling and I'm limited to using my non-dominant left hand. Working the keyboard is more of a challenge these days, especially when I try to do linx and pix. And I was never even slightly ambidextrous, so the times when I really miss being a righty are during the mundane stuff:
5) Flipping my turtle-on-its-back carcass out of bed (grab the nightstand and pull like a sonofabitch, while simultaneously flailing both legs sideways in a spawning-salmon motion).
4) Trimming these tougher-than-titanium toenails.
3) Shampooing my hair (lather, rinse, f*ck the repeat).
2) Wiping my stinky ol' butt.
1) Spanking the monkey (I now carry a wallet-sized photo of my right hand).
THE GOOD NEWS: according to my recent Percocet usage figures, the pain becomes &*%#^@! unbearable only 3 times a day. A week ago, it was 6. I'm a happy camper.
May 15: Sticker shock.
I just got the itemized bill for my little 2-hour outpatient procedure:
Pharmacy - $1,152.75
IV Solutions - $400.00
Med-Surg Supplies - $82.00
Sterile Supply - $5,007.00
Supply/Implants - $3,448.00
OR Services - $13,709.85
Anesthesia - $3,873.45
Recovery Room - $1,969.20
TOTAL CHARGES - $29,642.25
Man, you could buy a really hot car for that kind o' dough. Keerist. I was starting to feel sick... but then realized I couldn't afford it.
May 28: Masochistic tendencies.
I'm in rehab. My first physical therapy session (for the rotator cuff surgery) took place this morning. I'm gonna need more pain pills.
June 4: There's a Porsche in my shoulder!
Evidently, the bill I received on May 15 was for hospital charges only... yup, I just received another bill, from the surgeon:
Scope Shoulder Bancart - $3,000.00
Shoulder Debridement - $3,000.00
Decompression Shoulder - $3,000.00
Scope w/Rotator Cuff Repair - $3,000.00
Subscapular Nerve Block - $1,000.00
TOTAL SURGEON CHARGES - $13,000.00
If we add this to the previous bill:
TOTAL HOSPITAL CHARGES - $29,642.25
, we end up with a truly appalling figure:
TOTAL HOSPITAL + SURGEON CHARGES - $42,642.25
For that amount of cash, I could buy a Porsche Boxster. Next time, I'm taking the car.
June 11: My S&M Dominatrix From Poland.
I recently began a program of physical rehab for the surgery performed on a particularly nasty shoulder injury. My physical therapist's name is Yolanta. She was born in Poland. She's a formidable woman, with a deceptively sweet smile. She is quite capable of inflicting some of the most intense pain I have ever experienced, while smiling beatifically. It's all part of her determined effort to break up my scar tissue.
It seems that scar tissue is one of the unavoidable--and yet desirable--byproducts of arthroscopic surgery. After you rip your shoulder apart, by doing something stupid, the scar tissue from the surgery knits everything back together.
The problem is, your body has just experienced an extremely invasive procedure, and it wants to protect everything that was touched by the surgeon's tools. So it goes nuts with the scar tissue.
As a result, I have scar tissue in places that should never see scar tissue. And I've spent the last month keeping my arm very, very still, so my body was able to grow all sorts of scar tissue, good AND bad.
But now, I have to rip apart the bad scar tissue, while leaving the good scar tissue intact. This is where my Polish S&M Dominatrix Goddess comes in. She knows the best ways to break up that bad scar tissue, while inflicting the maximum amount of pain. Sometimes, when she is twisting my shoulder into a position that it has not been able to approach for the last three months, I look up through a haze of barely-repressed tears and notice her beatific smile. She's enjoying this.
The thing that worries me is: because she is helping me regain the use of my shoulder, I am also enjoying this.
Physical therapy is kinky as hell.
June 23: Adhesions + scar tissue = bad. Cortisone = good.
I was a serious runner for 25 years (Boston & NY marathons). We used to chant: "Run through the pain."
I was a serious weightlifter for 5 years. We used to chant: "No pain, no gain."
I was a serious Marxist for about 5 minutes. We used to chant: "The only antidote to mental suffering is physical pain." Looking back, it wasn't that catchy.
The point is: I'm no wimp. I eat pain for breakfast.
Especially when the oatmeal's too hot.
But the physical rehab torture regimen for my shoulder surgery was making me suicidal. I went to the doc, and said, "Give me better drugs, dammit." He prescribed an ultrasound--which evidently shows some pretty spectacular adhesions (below)--and then shot me up with cortisone.
Life seems worth living again.
July 2: Haven't got time for the pain. (Re: Carly Simon)
An offhand comment from my primary physical therapist (a/k/a The Dominatrix) the other day led me to a disturbing realization. Yolanta mentioned that one of her shoulder-operation clients finished his physical therapy in a week or so. Her intern and I both looked at each other in astonishment, because I've been banging my head against the wall for five weeks, with several more months of painful rehab projected. Yolanta explained that the other client had a simple rotator cuff surgery, and that my repair was a whole lot more complex.
This was confirmed during my last visit to the doc: he said that my surgery was not your run-of-the-mill rotator cuff repair, which is why I have all this extra pain. He also admitted that he did a "tight" repair, because everything inside my shoulder was so loose before. Which means--you guessed it--even MORE pain!
Several old friends have come out of the woodwork, to share their rotator cuff stories. A couple of them have had both shoulders repaired, and both of them quit the second round of therapy. Each decided that limited mobility and strength was preferable to the continued regimen of pain. And they both had simple rotator-cuff surgeries.
I do have pain pills, but they're not very effective. They also have long-term drawbacks, so I resort to them only when my internal angst starts impinging on other people, like poor Anikó. And the recent cortisone shot helped... but only for a couple of days.
Long story short: I visit my physical therapists twice a week, 7am. They prod me into a killing round of exercises for a couple of hours. Then The Dominatrix devises some fiendishly-personalized torture for my shoulder that lasts several years (approximately twenty minutes in real time), and I drive home in a daze. For the rest of that day, I can barely complete the simplest task, because I can't remember anything for more than ten seconds. My body stays in shock for the next 24 hours, then I gradually come out of it. But when I wake up the next morning, I'm faced with a difficult choice: do I continue to self-administer the unimaginable pain of these (supposedly) three-a-day exercises, or do I put a gun to my head?
The gun is still in the nightstand. So far. ;-)
Update from the peanut gallery: Kevin S. from Colorado Springs writes, "It may be necessary to continue the PT at least until you can lift the gun to your temple."
July 3: Milestones.
Don't get me wrong. The news about my right shoulder is not all bad. I **am** making some gains in mobility, but the progress is so hard-won, and so painful, that we celebrate each tiny victory. Today, there were three reasons to rejoice:
1) I can now comb my hair, and
2) I can now brush my teeth, and
3) I can now wipe my ass.
It was a big day.
August 8: Eight, Eight, Oh Eight. (August 8, 2008.)
About a month ago, a British Zoetrope member heard about my pain whining, and suggested something a little unorthodox, that had helped her: magnets.
At first, I resisted: I'm glad this works for you, but I'm still a little skeptical about shelling out 50 or 60 dollars for a bracelet that will probably fry the magnetic stripes on my credit cards. [I also included this link to a debunking article.]
She countered by saying there was a good article in the British Medical Journal.
I wrote: Maybe there's an element of fear in my reaction, but to me, magnets fall into the category of crystal therapy, pyramid therapy, aromatherapy and voodoo. I know some people believe those things work for them, and they have catalogs of second-hand anecdotes to prove their claims, but if I strapped on a sixty-buck magnet, I'd probably just burst into laughter. After getting stuck to the fridge. [Then I posted a link to a skeptical article in the BMJ.]
But I finally relented, and apologized for pulling her leg.
The pain, of course, was unrelenting. So I finally got desperate enough to buy a 500 Gauss wrist wrap from BIOflex® Medical Magnetics. I've been wearing it for 12 hours.
I'll report on significant developments as they occur. So far, it's just making my wrist sweaty.
August 10: Oh f*ck, it's working.
At my twice-a-week physical rehab sessions, I use a Shoulder Finger Ladder to walk my fingers up a wall. The ladder's steps are numbered, so it provides a benchmark for my progress, while stretching out my shoulder. For the last couple of weeks, I have been stuck at step #30.
I repeat the exercise every night at home, without the ladder. For the last couple of weeks, I have been stuck at a point two inches below the top of my closet door frame. But even when I was making progress, a few weeks ago, the increments could be measured only in fractions of an inch.
Yesterday evening, my fingers climbed to a point one inch ABOVE the top of the door frame: a gain of three inches in one day.
The magnet had been on my wrist for 48 hours.
Coincidence?
August 26: Whine and cheese. [The latest pain report.]
The magnet seems to be helping my shoulder, but not as much as I'd hoped. I can now lift my hand to 112 degrees in the forward direction; the final goal is 180. But at the end of June, it was less than 90, so I guess I should feel grateful.
This excruciating rehab (most of the pain has to be self-induced) will continue for several more months. The exercises have forced me to identify--with dismaying precision--the point at which the pain becomes unbearable. So I have become quite skilled at approaching that point every day, with the least possible delay. Fun!
My physical therapist recently mentioned that some patients need anesthesia for this scar mobilization work. I wonder why... ;-)
November 6: Obamaramalamadingdong.
This morning's shoulder rehab session was a real blinger, not because of the pain--which is as excruciating as ever, thank you--but because some Navy lifer jerk came in and started loudly circulating rumors about Barack Obama:
1) he was born in Nigeria,
2) he's a Muslim,
3) he took the oath of office on a Koran, and
4) he refuses to say the Pledge of Allegiance.
There were 8 or 9 people in the gym-like physical therapy center (4 therapists + patients), and they all seemed to accept these claims as true. I suspected the statements were false, but I didn't really know, so I kept my mouth shut. At that point, the Navy a**hole began telling borderline-racist jokes. Nobody objected; in fact, most people laughed.
I know this is Arizona, and I've come to accept the fact that many of my neighbors are hyper-religious white-supremacist nutjobs, but this was the first time I've ever been scared into silence. So I did some fact-checking at Snopes.com when I got home, and sure enough, all the rumors were false.
FYI: if Obama were a Muslim, and swore an oath on the Koran, it would not really be newsworthy. Keith Ellison (D-Minn.) was the first Muslim elected to the United States Congress, and he took his oath of office in 2007 on the bible of Islam, the Koran. In the National Review (Oh Say, Can You Swear on a Koran?), Eugene Volokh, a professor of Law at UCLA, wrote:
To begin with, the oath is a religious ritual, both in its origins and its use by the devout today. The oath invokes God as a witness to one's promise, as a means of making the promise more weighty on the oathtaker's conscience. [¶] This is why, for instance, the Federal Rules of Evidence, dealing with the related subject of the courtroom oath, state, "Before testifying, every witness shall be required to declare that the witness will testify truthfully, by oath or affirmation administered in a form calculated to awaken the witness' conscience and impress the witness' mind with the duty to do so." If you want the oath to be maximally effective, then it is indeed entirely true that "all that matters is what any individual holds to be his holiest book." That book is the one that will most impress the oathtaker's mind with the duty to comply with the oath.
To which my wife, the Shopping Queen, replied: "If I ever take an oath of office, I plan to get sworn in on my checkbook."
November 19: Whine and cheese(2). [The latest pain report.]
The Polish dominatrix (a/k/a my physical therapist, Yolanta) cranked my shoulder up to 146 degrees this morning, before I had to scream for mercy. So it's been a good day. But maybe that's just the Vicodin talking. ;-)
Then Yolanta wanted to hear the story of my latest script, so I gave her a 3-minute pitch. At the end of it, she pointed to her arm. It had visible goosebumps. I figure that's a good sign.
These twice-a-week PT sessions have become routine. I take it for granted that I will be lying on a massage table, writhing in unspeakable pain, while Yolanta tries to twist off my arm at the socket.
It's really quite medieval. If the Spanish Inquisition had employed techniques like these, they would have gotten a LOT more confessions.
Plastic Orthopedic Goniometer
December 18: Hurts So Good. [The latest pain report.]
Two days ago, I was able to raise my right arm 162 degrees in the forward direction and 145 to the side. Plus, the Polish dominatrix and I have set an end date: December 31... which means I only need to survive five more PT (Physical Therapy, or Pain & Torture) sessions with her. That will bring my grand total to 55 two-hour sessions, spread over the last seven months.
I often wish the surgeon hadn't done such a tight repair on this badly-damaged shoulder.
My range of movement probably won't reach a full 180 degrees by then, but the insurance deductible kicks in again on January 1, and I don't have a few thousand extra bucks lying around. So I'll either have to (1) accept the reduced mobility, or (2) rely on self-torture sessions.
Gawd, I love America's health-care system.
In the middle of Tuesday's workout, I was standing in the corner of the PT gym, doing a shoulder-stretching exercise. While staring at the wall, I listened to the physical therapists working, as evidenced by the half-muffled cries and involuntary whimpers of pain coming from the other patients: "Ooo. Ah. Ohhhhhhhh. Uh-uh-uh."
That's when a flash of inspiration hit me. So I turned around and said: "You know, we should record ourselves, and sell it as the soundtrack for a porno flick."
The line got a big laugh. PT humor is an acquired taste.
***
Hurts So Good
written by John Mellencamp, George M. Green
performed by John Cougar (Mellencamp)
When I was a young boy, said put away those young boy ways.
Now that I'm gettin' older, so much older, I love all those young boy days.
With a girl like you, with a girl like you,
Lord knows there are things we can do, baby, just me and you.
Come on and make it...
[CHORUS] hurt so good. Come on baby, make it hurt so good.
Sometimes love don't feel like it should. You make it hurt so good.
You don't have to be so excitin' - just tryin' to give myself a little bit of fun, yeah.
You always look so invitin' - you ain't as green as you are young.
Hey baby, it's you. Come on girl, now it's you.
Sink your teeth right through my bones, baby, let's see what we can do.
Come on and make it...
CHORUS
I ain't talkin' no big deals; I ain't made no plans myself.
I ain't talkin' no high heels; maybe we could walk around all day long... walk around all day long.
CHORUS
December 31, 2008: PT fini.
Halle-f*cking-lujah! I busted out of Pain Prison (physical therapy) today. Current range of motion: 165 degrees in the forward direction (flexion), 157 to the side (abduction).
180 is Optimal, 150 is Functional.
I am delighted to be Functional.
And my one-and-only New Year's Resolution is to make 2009 a less painful year than 2008.
January 16, 2009: Pain-free for 2 weeks! Hot damn. This hasn't happened for nearly a year. I could really get used to it.