Order out of chaos, at last

Things are coming together and surgery is tomorrow! It seems as if it has been a long time getting here. I have had time for second thoughts and second thoughts about my second thoughts. I've read many, many websites about Reverse Total Shoulder Replacement surgery. I've been convinced that the replacement socket should be cemented in place and that it should not be cemented in place. I've learned I am a pretty good candidate since I am not a professional weight lifter, am not employed in a physically demanding occupation, have not had previous shoulder surgery, am a "woman of a certain age" that shall go unstated here, and am mentally stable enough to comply with post op instructions.

It appears a surgeon's level of experience is important. There is a pretty high rate of complications in the first seven cases a doctor performs, one site reported. I wonder what number I will be? For some reason infection becomes a lifelong concern. An infected toe nail can spread to the prosthetic shoulder and create problems many years out. Dental work is fraught with danger. Scapular notching is common and problematic but I am not sure what that is or if it can be avoided. Mostly, it  seems, the solution is DON'T DO THAT AGAIN."

One thing I have learned for sure is that I cannot begin to know what my surgeon knows, no matter how much I confer with Dr. Google. There is no Spock "mind meld" that gives me the insight and experience he has. The human body and the individual experience offer unlimited variations that the surgeon has to deal with. So I think I will just "let it go, let it go" and go with the flow. My ducks are finally in a row. I think. And the cookies are out of the oven.

But Doctor, I like my old lady arms.

Well, maybe I don't exactly like them but I have gotten used to them. My arms have cradled  beautiful babies, hugged many dear friends,  embraced an uxorious husband, rearranged furniture in the middle of the night, shoveled their share of dirt, painted more than a few walls indoors and out, stirred a few hundred batches of cookies,  all those things I took for granted.

Until an instant of carelessness brings one face to face with a orthopedic surgeon who specializes in upper extremities.

When Dr. Kai casually mentioned the surgery would lengthen the operated arm a little, a centimeter perhaps, I suppressed all vanity and said it would be a small price to pay for less pain and more  function. But I did come home and measure my arm length. Couldn't wait to tell him that arm is already shorter than the other so an extra centimeter might be a good thing.

But on my last visit he suggested "the appearance" of the arm might be - did he say - changed?  I am pretty sure he didn't say grotesque. Maybe he said different. Different like Quasimodo? Reverse doesn't mean you can scratch your back more easily cause it's turned around backwards? OK, I am expecting one humdinger of a scar. But I was embarrassed to ask him to elucidate. Would it make a difference? Would I be tempted to trade function for form?

For now, I am hoping he is one of those doctors who prepare you for the worst case scenario while they really expect a great outcome. In the meantime I have my head buried in the sand. Just hope I don't end up wanting to bury my ugly arm in the sand.

Willet

Actually, it is not easy getting your ducks in a row.

I thought I had everything planned so well. At my last doctor visit I asked for the prescription for post surgery pain medication they would be giving me. No problem. My plan has been to get it filled today, six days before the actual surgery. There would be no last minute anxiety, rushing or waiting for the pharmacy to fill the RX.

So off to the drug store I went this morning.

Yes, they had heard of the drug but they did not have it in stock and, even if ordered today, it would not be available for a full week. Yikes! I hope I don't need a lot of narcotic type drugs but sure want to have them available if I do.

So I let my fingers do the shopping and called several chain pharmacies. The first store did not have the drug. The second pharmacy said yes, they had it in stock. Since the drug store is in an adjacent town that I am really not familiar with I asked for directions. The agent said she was not physically in the store itself but she could connect me to the store. The young woman who answered the phone was very nice but not sure if she was east or west of the Interstate highway. Once we converted to right turn-left turn directionese I knew where to go. I decided to ask to speak to a real person in the pharmacy and she connected me. NO, they did not have the drug! Apparently the centralized stock inventory was wrong. Good thing I asked.

Finally, after two more calls, I found a drug store that had 36 tablets. My prescription was written for 50. Yes, they could order fourteen more but that would turn my one RX for a narcotic into two RXs and would not comply with pharmaceutical rules. If I could wait until the order arrived, then they could dispense the proper number to me legally. 

So my fingers are crossed that the stock order will arrive as planned and I will be able to wrangle at least one duck into position.

Things I wonder about.

If you have watched public television as much as I do you have surely looked up at the screen one day and asked the $64,000 question...Why do the Brits call a GP doctor and a surgeon mister? It does seem like all physicians are specialists any more but isn't the surgeon the pinnacle of the medical doctor hierarchy? Don't they deserve a more exalted honorific than the simple "mister?"

The explanation has its roots in 17th and 18th century England as midwives, herbalists, barbers and apothecaries gave way to formally educated physicians trained in universities who were awarded degrees as "Doctors of Medicine." They became members of the Royal College of Physicians and were entitled to be called Doctor. But the messy work of lancing boils, removing gangrenous appendages and pulling teeth remained the purview of lay people who were trained through apprenticeships and were not allowed to refer to themselves as doctors. Eventually the education and training of these "surgeons" caught up with, rivaled and conjoined with that of the "medical doctors" but in a point (or is that pique) of pride the members of the Royal College of Surgeons insisted they continue to be referred to as Mister.

In spite of this fascinating bit of trivia, I think I will stick with the very American tradition of calling all my health care professionals doctor, including the dentist, podiatrist, psychologist, pharmacist, orthodontist, physical therapist, optometrist, osteopath, oral surgeon, and mental health counselor. Sometimes even a basketball player or a rap star!


Willet

See you later, Alligator.

Yesterday I preregistered for surgery. I am always looking for a "sign,"something that says this is  a good move you are making. Karma or kismet or fate having a hand in my decision, I guess. The thing is it never happens. Do I not have a mystical side? . In fourth grade  I plucked my share of daisy petals,"he loves me, he loves me not." But my crush went unrequited. In junior high school I tried the Magic 8 Ball, "will I be chosen for the Pop Warner Cheerleading  team?" "Decidedly so." Didn't happen. Even the college era Ouiji Board failed to foresee a bad grade in Russian history, something everyone who knew me could have predicted.

                                                               Door #2 or Door #3?

So it was no surprise that my appointment with registration went by the book. It didn't matter which door I chose. Instead of a new car or a French door refrigerator appearing, an officious looking clerk called me back to present my picture ID and insurance cards, once again. But this time, as we finished the usual paperwork, she went out of her way to escort me around to the next stop, the Same Day Surgery Waiting Room, and assured me a surgical nurse would call me back soon.

Before I could finish nervously flipping through last year's fashion magazine (animal print purses are in, really?) CJ called my name. In a private little office she began to review my medical history but instead of procedures and dates, she asked about experiences and outcomes. She walked me through who would be working with me the morning of surgery and suggested a way or two to make that difficult morning go a little smoother. Then, as we walked out, she introduced me to the volunteer clerk who would be staffing the desk that day.

So there was no rainbow arcing across the sky as I walked to my car. A happy little bluebird did not lite on my side rear view window, although I did see one there a few weeks ago so it could have happened. But, as I drove past the retention pond that parallels the parking lot and scanned the surface of the water like I always do,  lazily cruising along the far side of the lake was a five or six foot alligator. He drifted slowly toward a shady spot near the shore to take a nap.

The only "sign"I saw was the one that warned us not to feed or molest the wildlife. But he made me smile and I had to admit my appointment had been a positive experience.

Great Expectations

It is difficult to not look at this upcoming surgery as the solution to all my problems.

If my neck hurts, it is because I cannot sleep lying flat because of my shoulder. When my back aches it is easy to blame the canted way I walk protecting my shoulder. If I am irritable it is obviously because I am not getting enough sleep because my shoulder pain wakes me up. If the waist of my skirt is too tight I can say I do not get enough exercise due to "my shoulder." If the weeds are overtaking my garden, it is certainly because I can not trim and edge and dig as I normally would. How wonderful it will be after surgery.

Perhaps.

Dr. Kai has been prudently conservative in his predictions. He asked me what I wanted from the surgery. I said that I wanted my arm to not hurt all the time and I would like more range of motion or use of my arm. He nodded and said that was likely. The choice of Reverse Total Shoulder Replacement Surgery offers a better possibility of getting those results than the original Total Shoulder Replacement Surgery does, in my situation.

He informed me that the patient might be looking at eight or ten years of a good result before needing some kind of revision or redo. I don't think your arm falls off after nine and a half years but perhaps the plastic components of the artificial joint wear out. Right now I am willing to face that uncertain future to have better function and more comfort now. Like Scarlett, I will think about those bad things tomorrow...or in nine and a half years.

But maybe I should rename this post "Reasonable Expectations."