Selfie PO day 45

Wow, it's hard to believe all this apparatus could be inside one's body and cause so little discomfort, let alone actually relieve the original cause of pain. Yes, those are screws anchoring the hemisphere to the scapula. There is actually a part not seen, the plastic disc between the ball and the top of the shaft which allows the two parts to slide against each other. Plastic does not show up in an X-ray. The humerus is hollowed out to receive the metal shaft and it is either cemented in or malleted in. Because I read my surgeon's operative notes I know mine was snugged into place without the cement.

In a normal shoulder the ball is at the top of the bone, the humerus, and the socket is part of the shoulder. This situation is replicated in a Total Shoulder Replacement. This procedure works well when there is still some function of the rotator cuff and has been being done for forty or more years. But when the rotator cuff is too badly damaged one can no longer rely on the usual ligaments to lift or move the arm. Hence, the Reverse Total Shoulder Replacement, developed in France about twenty years ago and introduced in the US about eight years ago. After surgery the deltoid muscle must learn
to lift and move the arm.

Did you know you can ask for your surgeon's op notes? If you can be at all objective they reveal great insight into what the doctor had to deal with, good or bad. Orthopaedic surgery must be a lot like woodworking or metal shop, or home repair, except with blood. Haven't we all bought some device that required assembly, like a new faucet for the sink? And even though the directions say this is a universal appliance that will connect to all sinks, it doesn't, it won't and nothing works right! And there is always a screw missing!

I can only hope that the manufacturers of these medical prosthetic devices are more careful in counting and labeling the pieces. And that the directions were written by someone whose primary language is English!

Yesterday, today or tomorrow?

When I posted Hair Today, Gone Tomorrow it was today on the east coast. But it was still yesterday on the west coast. Of course, Google time! I'll have to remember that when I count my post op days.

I should have realized it. I've had similar errors with eBay auction times.

Hair today - Gone tomorrow PO Day 42

My hair is really short, REALLY short. It started as an accident when I told the stylist  "let's make this really short." I meant quick, she heard Mia Farrow in Rosemary's Baby. But it's hot, I have been one handed and it was a blessing during my recent hospitalization. I didn't have to comb it, just rub a damp washcloth over my head. I was dealing with it.

But now I am faced with Telogen Effluvium.

For the last few days I've been noticing a few hairs in the sink in the morning. If I run my fingers through my hair there are more than desirable strands of hair in the palms of my hands.  Is it my imagination?

No. Telogen Effluvium is a phenomenon that occurs after pregnancy, surgery, extreme stress or drastic weight loss. Well, I've had two of the four. It starts as early as six weeks after the precipitating events. Nice to know I am right on schedule. The normal life cycle of the hair shaft is shortened so that natural shedding of old hair is speeded up. Apparently there is no cure but also no cause for panic. This too shall pass.

In the meantime not only might I pass for a guy, I might pass for a balding guy! Nice :(

A bill by any other name... PO day 40

The first of the "This is not a bill" statements are showing up in the mail. I have really mixed feelings as I scan the multiple pages. I am grateful to have insurance that will probably cover 100% of the 
fees. I am glad my providers have all committed to accepting the reduced value assigned to the services. But I am shocked that an uninsured person would - could be charged four times (or more!) as much as I, that is my insurance, will have to pay for the same procedure. 

An office visit to my orthopod is approved at almost 100% of his usual fee. But the surgical fee is reduced by a whopping 2/3, so he will only be paid 1/3 of his usual charge for my operation. It's even a greater reduction for the anesthesiologist. His approved fee amount is less than 1/10 of his actual charge. I don't know if the fees are artificially inflated or if budget cuts are unfairly reducing what doctors are being paid by government based health insurance plans.

I do know that I want the smartest young people going in to the medical profession. The price of a medical education is unbelievably high. The cost of setting up a practice is huge. The financial reward has to be commensurate with the time, effort, and expense our medical professionals have expended to get there. I don't want ALL the smart young people to become lawyers!

I'm going to have to bake more cookies!

Many, Mini Steps - PO Day 36

After a month of drama and angst things seem to have settled down. Instead of giant leaps backward I am now taking baby steps forward.

The last of the steri-strips came off today. They were at least fifty percent of the itch factor. I don't think my skin likes tape adhesive. Every itch I scratch turns up a spot of adhesive residue that has not rubbed off in showering or lotioning up.

The hard knots in my forearms, reminders of IV lines, have absorbed finally. There is one lumpy vein that didn't use to be prominent but not sore nor hard.

The tender spot on rib cage under the right arm where the chest tube went in is barely noticeable. I may soon no longer have any excuse for not wearing the proper underclothes.

The little scabs that spotted my belly are gone. I don't think I mentioned it before...each day in the hospital a nurse gives you an injection to prevent blood clots. Where does the shot go? In that nice roll of belly fat right around your belly button. It's kind on nice to know that annoying bulge has a functional use. A good reason to pity those gorgeous flat tummied models.

I have created my online patient account through my hospital network. Now I and all my doctors have access to my medical records, lab results, and medications prescribed. Best thing is I can now see every doctor who took care of me in- hospital. Sometimes it is hard to keep track.

I've baked and distributed my "thank you" cookies. I still subscribe to the old fashioned tradition of taking food to your doctor. Especially in light of how poorly paid they are now due to cuts in Medicare. More on that subject later!

I've collected all the wonderful "thinking of you" and "get well" cards I received in the mail. Do I send a thank you note in the mail or is an email alright? I don't know, there is nothing like a real card in a brightly colored envelope nestled among the bills and junk mail to lift your spirits. Or is my thinking archaic, a sign of a passé generation?

What would Miss Manners say?

Things I wonder about...PO Day 34

What is the difference between physical therapy and occupational therapy?

Years ago a friend who was terribly burdened with two parents afflicted with Alzheimer's disease complained that part of their treatment was occupational therapy. "Occupation" to her meant a job and that was not conceivable. It seems we are all much better educated about medical interventions nowadays but I have still been confused about the difference between occupational therapy and physical therapy. My PT facility is a big room with large tables to lie on, exercise machines, pulleys and stretchy bands, balls and big stuff. The OT department is sequestered behind a small door and a quick peek reveals only a long table and a couple of chairs with shelves of small items. What if my occupation is a brick mason or a truck driver or a circus trapeze artist? Will occupational therapy get me back to work?

Well, not exactly.

I can't verbalized this as well as it is written on several websites so I am copying and pasting the best explanation I found.


Occupational Therapists (OT) help individuals achieve independence and improve one's ability to perform daily activities and self-care. For example, OT's may help a patient learn to dress themselves, brush their teeth or comb their hair after a stroke or illness that has severely weakened their arms.

Physical therapists (PT) focus on the large motor groups that contribute to walking, reaching, standing and physical activities. They work on strength, balance, range of motion and swelling as well as pain to encourage independence.

One might start out with a physical therapist who will work on improving the large motor skills, then move on to an occupational therapist whose job would be to improve the fine motor skills required to manage the minutiae of life.

While I am in physical therapy to get my arm and shoulder moving and back in the game, I can really appreciate how important the little motions we take for granted are. Getting a spoon of soup to my lips with my left hand is full of danger. Maneuvering a sonicare electric toothbrush around my teeth with the wrong hand without splattering the mirror is a challenge. One handed flossing does not work. Thank goodness for the iPad's ability to anticipate the word I want...it saves me many keystrokes in my current two finger touch technique.

My only hope is that by using my left hand I am improving my right brain.

Surgery plus one month

It's a month since my shoulder surgery and it seems like a year. I don't see my surgeon again for two more weeks. Obviously, he is not the kind of cook who opens the oven door to peek at the cake every few minutes! I am anxious to see him because I was such a basket case when I last saw him, ten days post op. I am so much stronger now. I actually spent fifteen or twenty minutes pulling little weeds, left hand only, this morning. I could have worked longer but for the noseeums...a unique subtropical invisible insect that drives even the most hardy indoors. After years of semi drought conditions, we are experiencing daily deluges accompanied by lightning and thunder often. But everything is so green and lush and growing.

This sedentary existence is getting boring. I am still restricted to picking up nothing heavier than a  coffee cup with the op'd arm. Is that with or without coffee in it? Still wearing the sling 24/7 which is hot and cumbersome. Not allowed to drive yet. That's a nuisance as dear husband does not consider shopping as entertainment or sport or even a way to while away an afternoon. I probably don't have the stamina for a mall trip anyway.

Thank goodness Dear Daughter and grandson from California are coming next week. He is the only known witness to the broken arm accident that started this whole debacle. He and I were coming back from the beach, waiting to cross the street. A pick up truck stopped and waved us across. I didn't realize the sand apron was lower than the asphalt and just splayed across the road like a flattened fauna. I could tell there was something amiss from the position of my poor arm. What an inauspicious start to his summer vacation with the " grands." I bet he never forgets it! No firetrucks or ambulances were involved, thank goodness. With a little help we gathered ourselves up and made it home.

So that's my brief careless moment that led to this whole experience. Boy, am I more careful now!

Surgery Day + 28, 29, and 30!

Hooray! I am caught up in the time line.

I am in my second.week of physical therapy. Three times a week. My range of motion, all engineered by the therapist, is increasing by a few degrees each visit. It's hard to not want to support the weight or movement of my arm while she does all the work. A big step today... She added a one pound weight to the routine. I get to do ten gentle curls to strengthen the bicep. Since I have had so little use of my right arm for the last full year I do have some wasting of muscle,  not that I had a lot of muscle to start with.

When the stitches were removed 20 days ago the nurse covered the incision with steri-strips. She said  to leave them alone and let them fall off on their own. That has been hard to do. But they are now beginning to peel up and with very little encouragement from me, they flake off. The incision is a fine line,  hardly apparent. The flesh on either side is slightly numb, as incisions often are, but I am sure the little nerves will reconnect in time. In spite of my dread, my arm just looks like my arm, with a new wrinkle or crease. No quazimodo! Thank goodness. I can't extend the arm to measure its length but I will as soon as I can. I am curious to see if it is longer now.

Progress!

Surgery Day + 26 and 27

Things I wonder about:

Why is it so cold in the operating room?

Everyone always says it is to control germs. But a little Google research shows that it is, in fact, for the benefit of the doctors. They are bundled up in layers, masks and gloves. They are working hard, might be a little nervous and under some pressure. Who wants sweat dripping into the surgical site?

Many years ago as I was wheeled into an operating room I complained that I was cold. The scrub nurse brought me an old white sweater she kept in her locker! Not a lot of sterility there. Now you are covered with sterile blankets from a warming oven. At least until you are totally sedated. Very nice.

My recent hospital room had its own thermostat. That was great. The thin hospital gowns don't provide a lot of warmth. But they are very functional. If there was just some better closure in the back! In spite of not liking them, they were my garment of choice during my recent hospitalization, eschewing the cute pajamas I brought from home. Fortunately I was not up walking around much. When I attended the Joint Replacement  Seminar patients were encouraged to bring clothing from home since knee and hip patients are expected to be up walking the halls right away. A hospital gown flapping open in the back is not a good look.

We shoulder patients just lie on our backs and let our staff take care of us. :)

Surgery Day + 22, 23, 24, 25

It's been a good week. Love my physical therapist. So gentle. Love that it is in the hospital. Just seems more professional than the usual gym- PT place. It helps that it is not far from home. A long drive would chill my enthusiasm for three times a week therapy. Really helps that there is a mcdonalds next door! 7:15 AM therapy is followed by a Micky D breakfast. :)

Still wearing the sling 24/7. Why at night? To keep you from rolling over on your arm in your sleep? Lots of pillows make it more tolerable. Still difficult if you are not a back sleeper.

I am no longer taking any pain meds. Just don't need them. I do ice my shoulder after PT. Still pretty much a one armed paper hanger.

Not doing much cooking from scratch. Have lots in the freezer, ready to nuke. I planned ahead.

Dear husband is being a great help. Dear Son comes to visit and is a ray of sunshine. Life is getting back to normal.

Surgery Day + 21

Physical therapy:

I met my physical therapist today.  So professional. She has consulted with the surgeon, developed a plan, and, best of all, it fits everything I have read on the subject. It must drive health care professionals crazy as anyone with a computer and access to the internet can be an expert, me included. But the therapy for rTSA is very specific and gentle. You want to be sure your therapist is following the proper guidelines. Even non aggressive movements can result in disaster.

For the first six weeks:

0. Phase I Precautions:
   
• Sling is worn for 3-4 weeks postoperatively and only removed for exercise and bathing
  once able. The use of a sling often may be extended for a total of 6 weeks, if the current
  rTSA procedure is a revision surgery.
  
• While lying supine, the distal humerus / elbow should be supported by a pillow or towel
  roll to avoid shoulder extension. Patients should be advised to “always be able to
  visualize their elbow while lying supine.”
  
• No shoulder AROM.
  
• No lifting of objects with operative extremity.
  
• No supporting of body weight with involved extremity.
  
• Keep incision clean and dry (no soaking/wetting for 2 weeks); No whirlpool, Jacuzzi,
  ocean/lake wading for 4 weeks. 
  

• Joint protection: There is a higher risk of shoulder dislocation following rTSA than a conventional TSA. Shoulder Dislocation Precautions:

• No shoulder motion behind back. (NO combined shoulder adduction, internal rotation, and extension.)
  
• No glenohumeral (GH) extension beyond neutral.
  *Precautions should be implemented for 12 weeks postoperatively unless surgeon specifically advises patient or therapist differently. 
  

o

Avoidance of shoulder extension past neutral and the combination of shoulder adduction and internal rotation should be avoided for 12 weeks postoperatively.
Patients with rTSA don’t dislocate with the arm in abduction and external rotation. They typically dislocate with the arm in internal rotation and adduction in conjunction with extension. As such, tucking in a shirt or performing bathroom / persona hygiene with the 
operative arm is an especially dangerous activity particularly in the immediate peri-operative phase.

For the first six weeks:

Surgery day + 17, 18, 19, and 20

Just trying to get life back to normal. It's a holiday weekend, in real time, so everything has waited till Monday, the 20th PO day.

My ortho surgeon gave me a list of possible sites to have physical therapy. I decided to use the facility at the hospital. He seemed pleased with my choice, although he did not try to influence me at all. I liked that. I am late arranging this but the secretary on the phone was very cooperative and gave me an appointment for tomorrow for the initial visit. I am anxious that the therapist has experience and that we have been reading the same guidelines for reverse total shoulder replacement PT. I was told I will be evaluated by the "shoulder" expert. Sounds good.

I have had so much help, in hospital and at home, for almost three weeks that I have become quite dependent. I still need some help dressing. All the food la belle Fille brought is helping tremendously. As mentioned, the shower chair is a must! Thank goodness my hair is so short...it hardly needs combing. Dear Husband has turned into a pretty good kitchen helper and laundry starter. And we have a friend coming in to help with vacuuming, etc every couple weeks. I think the worst is over!

I know this was supposed to be all about shoulder surgery. How did I get so sidetracked? Certainly, the complications I have had are not common. But they are the unexpected vicissitudes of any surgical experience. I am so thankful to have had good medical care. The only thing I should have done differently is that I should have paid more attention to my physical distress immediately after and in the week after surgery. Had I complained more my situation would have been treated sooner. But all is well that ends well and I feel I am on track now.

Let the healing begin!

Surgery day + 16...still catching up

I have quit bubbling and my hemoglobin is up to 8.5! Going home!

Thank goodness. My poor left forearm looks like a gnarly pin cushion. Dr. Marsh removed eight inches of tubing from my chest wall. Coming out was a lot easier than going in! The pressure bandage over the wound feels like a baseball but it is still a lot more comfortable than the tube. Dr. Marco was amazed at the positive effect of the Epogen on my Hemoglobin. Hooray!

My shoulder remains a non-issue. It is healing and comfortable. I have been given some isometric exercises to do until I see the regular physical therapist. I am late getting started on that due to circumstances beyond my control.

Did I complain about the "bum's rush" I got leaving the hospital ten days ago? Be careful what you wish for. About eleven AM the word came down I could leave. It was after 5:00 PM before I was released! Isn't there a happy medium?

First thing I did when I got home? Shower and wash my hair!

Be it ever so humble, there is no place like home.

Why a pneumothorax?

Just saying....

The rate of major complications when interscalene nerve blocks (ISBs) are used in shoulder surgery is well under 1%, according to a recently published literature review. Nevertheless, a survey conducted by the authors showed that about a quarter of experienced shoulder surgeons would not elect an ISB for themselves.

The authors searched PubMed for all prospective and retrospective studies that considered patient complications from use of ISBs, specifically in shoulder surgery, with 50 blocks performed per study. They found 13 eligible studies that, when combined, included 6,243 ISBs, of which 15% included a perineural catheter as well. Altogether, 69% of the blocks were performed in a university hospital or university ambulatory center.

According to the authors, there is no well accepted definition of “complication” with regard to ISBs. They defined a major complication as:

• Death
• Risk to the patient’s life (pneumothorax, myocardial infarction, stroke, seizure, or systemic toxicity)
• Nerve injury that had not resolved by study end

The rate of major complications when interscalene nerve blocks (ISBs) are used in shoulder surgery is well under 1%, according to a recently published literature review. Nevertheless, a survey conducted by the authors showed that about a quarter of experienced shoulder surgeons would not elect an ISB for themselves.



 The interscalene nerve block is typically used for shoulder, clavicle, or upper arm surgeries because it covers higher up on the shoulder. The disadvantage is that patients will experience phrenic nerve blockade resulting in diaphragmatic paralysis. In most patients, this does not significantly compromise lung function. However, patients with underlying lung disease are at higher risk for respiratory compromise and should be monitored closely. The risk of pneumothorax is present, but minimal.

Supraclavicular

Supraclavicular nerve block is ideal for procedures of the upper arm, from the mid‐humeral level down to the hand. The area covered is similar to the interscalene block, but does not cover the upper part of the shoulder as well. It has a rapid onset, with a dense and predictable level of pain control. There is a slightly higher risk of pneumothorax than the interscalene nerve block. Signs and symptoms of a large pneumothorax include sudden cough and shortness of breath. In addition, approximately 50% of patients will have diaphragmatic hemiparesis.

Thanks to l'autre belle Fille for leading me to the right Google search.

Surgery Day + 11, 12, 13, 14 and 15

I feel as if I am in that movie Groundhog Day where every day is just a repeat of the day before and nothing ever changes.

First thing in the morning Dr. Kai stops by and we agree my operated shoulder is doing very well.  Being totally confined to bed makes it easy to follow all the rules about not using your operated arm to lift anything heavier than a cup of coffee. My half reclined, beach chair position to facilitate breathing is ideal for my new shoulder, if not so good for sleeping.

Next, the respiratory therapist drops in, one of four visits a day.  My favorite treatment involves puffing through a device that resembles an Indian peace pipe but I am not able to instigate an uprising among the staff.

Next appears Dr. Marco, the hospitalist assigned to my case. He is charming, multi- lingual, up- beat, and thorough. He is concerned that my hemoglobin has dipped to 7.5 and is beginning to think about a blood transfusion, something everyone has been trying to avoid since surgery. Apparently blood loss during hip or knee replacement surgery is a common problem, less so in shoulder surgery. Only about 20% of patients undergoing shoulder replacement surgery will require a blood transfusion. One option to consider is autologous donation,  meaning you donate for yourself well in advance of your surgery date. You can also arrange for a a Directed Donor, someone you choose with your same blood type. 

 Next appears Dr. Marsh, a thoracic surgeon. Who ever would have thought I would have one of those? He is confident, plain spoken, and calm. He squints at the water receptacle to which I am tethered by the lung tube and sees tiny bubbles that doom me to yet another day, every day. If I would ever quit effervescing I could be disconnected and go home.

Meals appear and disappear regularly. The food is good but I have no appetite. Nurses and aides inquire as to my pain level frequently. The chest tube hurts, more with movement or, heaven forbid, coughing. Trips to the bathroom are choreographed like a Donald o'Conner dance; me, my IV stand and the water receptacle. Instead of a gossamer gown, or even some pajamas from home, I am content in the hospital gown barely tied behind my neck. Visiting grandchildren raise my spirits tremendously. Dear Husband reads to me, TV sustains me and boredom has morphed into ennui.

But my shoulder is getting along fine.

Surgery + 10 days

OMIGOSH!

Today has been a rough day. A very rough day. Postoperatively, my shoulder looks great. Usually the Doctor does not do an X-ray on the first post op visit but he did today. My new hardware looks in good position, there is no swelling and the incision looks very much better than I  expected. What is there to complain about?

An hour after returning home the phone started ringing... A radiologist I had never heard of, my orthopedic surgeon and the surgeon's nurse. All calling to say Go to the Emergency Room immediately.  A closer look at the X-ray showed a collapsed right lung! Well, that explains a lot.

I was prioritized in the ER but it still was a couple hours before meeting Dr. Right. Very nice ER doctor who implied we would be waiting for the thoracic surgeon on call. More terse emails to children; where I was, not to worry, dear husband has gone home to call everyone. Again, no cell service within the hospital buildings.

Getting a thoracic surgeon late on a Friday afternoon proved to be a problem, especially for something as mundane (!) as putting in a chest tube. An executive decision was made that Dr. Right would do it. He assured me he had done it before. :) We agreed that I could say "ow" as much as I wanted or needed to. The approach was a problem because my right arm could not be moved out of the way as one would normally and I was very concerned that no one put any pressure on my right shoulder joint. I only became really worried when I deduced the rather large young man was present, not as an observer, but to restrain the uncooperative patient!

Sparing you the details, there was a lot of oohing and owing and any discomfort I felt in my shoulder was blocked out by the extreme discomfort of having a tube the size of your index finger shoved between your ribs repeatedly into the pleural space that was accidentally filled with air. Suddenly there was a huge gush like a balloon deflating and cold, sweet air filled my right lung. Wow, that was not fun but we had all survived and my shoulder was unscathed. The tube was sewn in place where it would remain until the compromised lung could heal itself. Only thing left to do was get a portable X-ray machine to peek inside my chest to be sure the tube was in the right place. Dr. Right and I were still on good terms.

Thirty minutes later it was déjà vu all over again. It may be hard to believe but I actually felt worse for Dr. Right than for myself when he had to tell me the tube was NOT in the right place and the procedure had to be repeated. "All of it?" I asked. "All of it," he said. The only part missing the second round was the large young man. I guess I had demonstrated physical self-restraint, if not verbal.

So here I am, back on the third floor, connected on the right by a chest tube to a box on the floor of bubbling water and on the left side to an IV stand of indeterminate hemoglobin boosting blood by- products. I am not particularly breathless now but I am weak as a wet noodle and totally spent. The chest tube discomfort outweighs the shoulder surgery residual pain. I guess my brain can only focus on one source of agony at a time. Thank goodness! Dear husband and Dear son are looking appropriately worried at the sides of my bed. And I am learning a whole new list of names from my dry-erase board.

Surgery Day + 6, 7, 8, 9, and 10

How I would like to join this little guy in a bath! Well into and beyond a week sponge baths are not enough! But I am probably too weak to stand up in a shower. L'autre Belle Fille (that's the "other step daughter in French) brought me a shower chair. I didn't think I needed it but I keep being proven wrong about how much help I need. I can sit on it and use the hand shower attachment to rinse carefully not getting my shoulder wet. She knew what she was doing. She also brought ice packs, a thermometer with disposable sleeves and a fresh, smiling face not dulled by hours of my medical complaints. My temperature is low, like 95.8; my BP is low, around 90/50, and my pulse is rapid, 100+. And I am so breathless.

I am hardly aware of my shoulder and cannot complain of any measurable level of pain. Just weak. It is hard for me to let other people take care of me but right now I have no choice.

I see my surgeon for my first post op visit today. I know he will be pleased with his handiwork. I have so much less discomfort now, even just ten days post op, than I did all of the last eleven months!

Surgery Day + 3, 4, and 5

I came home Thursday morning following surgery on Tuesday. I was really ready but not prepared for the fast track out of the hospital! The orthopedic coordinator came in about 11:00AM and asked me if I wanted to go home. Yes! She talked to my surgeon, changed the dressing on my incision (it did not look so long nor so scary), arranged for a pneumonia vaccine (I had never had one before), helped me get dressed and pack up my unused hospital wardrobe, printed out my exit papers and had me sitting in a wheel chair at the front door  waiting for my family, all within thirty minutes! I was breathless!

So good to be home! La Belle Fille ( remember, French for step daughter) has been amazing. She chauffeurs, cooks, does laundry, shops, and raises everyone's spirits. I did not think we would need help but boy, was I wrong. Thank heaven she insisted on coming to stay! I am quite weak and very breathless. The least activity makes me have to sit down and rest. I have discontinued the medication prescribed for post op pain as I wonder if I am having a bad reaction to it. Ibuprofen seems adequate to control my pain but it always does make me unable to sleep.  I called the surgeon's office and got an immediate call back from the office nurse. She is ordering hydrocodone 5/325 which has worked for me in the past. And I am going to start taking an iron supplement as I did lose a lot of blood at surgery and my hemoglobin is quite low.

On the fast track to feeling better.

Surgery Day + 2

Going home From the hospital and getting a  reprieve from the governor for  your prison sentence are about equal in importance .  Dr. Kai says I can go home tomorrow. The usual hospital stay is one to four nights so two nights does not sound so bad, kind of like a cheap cruise package - three days and two nights - only not so cheap. The modern hospital wrist band includes a bar code which is scanned with the administration of each pill, shot, treatment, blood draw, meal delivery, and therapy. There is a definite cha-Ching sound with each wave of the scanner wand.

Dr Kai passed the HIPAA test yesterday. Or was it day before yesterday? Anyway, as Dear Husband and Belle Fille ( that's the lovely French term for step daughter) waited to speak to someone as the surgery was over, they witnessed an older doctor stick his head out the door of the surgical sanctum and deliver a cryptic "your loved one has survived" message broadcast to the anxious family and everyone else in the area. As the family jumped up and rushed forward he was already receding back behind the safety of the "surgery personnel only" door. So it was with something more akin to suspense than anticipation that they awaited Dr. Kai's appearance. When he did appear, a bit wan and with bloodshot eyes, he invited them into the surgical area and patiently and privately revealed the details of the operation. He reassured them everything went well and told them they could join me in my room momentarily. That's how it is supposed to go!

By Day 2 I was ready to eat grilled cheese and tomato soup, my version of comfort food. I could visit the bathroom on my own. Love that! I was alert, awake, pretty comfortable due to the miracle of pharmacology. Why didn't my nerve block work? "Sometimes they don't." No matter, I was doing well, albeit slightly breathless. The respiratory people kept telling me to breathe more deeply. Did my arm hurt? Not really. It burned a bit, the bandage from collar bone to inner elbow was kind of scary, but pain? No more than the miserable eleven months previous and I didn't have the benefit of drugs, staff and hospital flowers to dull the discomfort then.

I was still wearing hospital gowns, had not the energy nor desire to delve into my tote bag of carefully chosen, chic pjs. The gripper bottomed hospital socks were better than my color coordinated socks, especially since I was not wearing anything they coordinated with. A hairbrush and a toothbrush seemed to be all the grooming tools I needed. Why did I bring all that stuff? The only toy I needed was the TV remote control. A second slightly restless night.

Time traveling

The astute blog reader might notice that my dates are a bit off. My only explanation is that, along with the upper parts of my humerus, they also removed some brain cells. I simply could not tackle intellectual pursuits for the couple weeks after my surgery. A light novel I had downloaded to my ipad went unread. Magazines lay unopened. Don't even think about a crossword puzzle! If you are not bored to death by now and if you keep reading, you will see that there was a lot going on and my Little dipper was full. Opening a new blog page was out of the question.

So in order to keep continuity I am labeling my posts as "Surgery Day + " and hope to fill in all the missing details pretty quickly now that I am feeling better. Stand by.......

End of Day 1

By the time I was moved to my room it was 6:00 PM. I was alert but weak and not hungry, even though I was offered all sorts of food, snacks and even grilled cheese sandwiches. I was thirsty and water sounded perfect. A dry erase board across from the foot of the bed was crucial to my knowing who was who. There was a veritable parade of doctors, nurses, therapists, technicians, service people,  food service workers and volunteers. Everyone introduced themselves. Every procedure was explained, every drug was identified. Everyone asked about my pain level and offered pain relief if needed. As abhorrent as a catheter is it was a blessing to not have to get out of bed to tinkle. After family visits I was able to sleep intermittently all night. Day 1 went pretty smoothly.

Day of surgery!

Coordinating who is where at what time for surgery has to be as complicated as planning the invasion of Europe in WWII. Of course the hospital gives you a time to show up for all that pre op stuff but does your family really need to be sitting in the "family waiting area" for hours before, during and after? One thing my hospital does is to assign you a secret code (number) that displays on an electronic board in the waiting area  along with the brief detail of where you are: pre-op, surgery, recovery or patient room. You can also use that number to request info by phone if you, the friend or relative, are not at the hospital. Great idea!

But I was given the number as I checked in and the race was on! I was  whisked into pre-op and asked to disrobe and put on the dreaded hospital gown. I grabbed my cell phone to call the triage system of notification. No signal in the depth of the surgery wing with all its electronics.

Now positioned on the Stryker bed with a friendly nurse putting an ID on one wrist and an IV in the other, I was trying to log my iPad mini in to the hospital network to send family emails. Yes, I agree, yes, I accept, oops here is my surgeon. We quickly agree which shoulder is being operated. Did you know a representative from the company that makes your prosthetic knee, hip or shoulder is present in the operating theater? They are not present to assist in the surgery. That would be illegal, remember the Law And Order episode? But they are in place to consult about the devices and offer suggestions if things don't snap together like Lincoln Logs. As Dr. Kai walked away the anesthesiologist, Dr. Magnifico, rolled up with his portable ultrasound machine. As I frantically typed my patient ID number into the email and zipped it off to all children, Dr. Magnifico explained I would receive both a nerve block and general anesthetic. The nerve block lasts 24 to 36 hours and numbs the shoulder during the immediate possibly painful post op period. The ultra sound helps him position the drug in just the right spot for greatest effectiveness. As the nurse slipped my ipad from my hands I slipped away.

My eyes fluttered open briefly and I had been magically transported to the surgery room. It was cold and brilliantly illuminated and white. Off to one side Dr. Kai and the prosthetic rep were rattling pieces of metal rod, presumably my new arm parts, and nurses moved in slow motion around my bed.

That's the last I remember until I managed to squeak out "HURTS" to a recovery room nurse bending over me. Briefly incredulous, she asked me if I could feel her touch my fingers. I certainly could! I heard someone say the nerve block did not work and someone else said dilaudid and I was instantly pain free and drifting back to sleep.

In spite of the failure of the nerve block, from that moment on the pain was not severe and managed very well with ordinary pain meds administered as often as I requested. It seems to me that the hospitals are very concerned with your pain level and mean to keep you as comfortable as possible.  In spite of the failure of the nerve block I was kept quite comfortable...if you don't count how uncomfortable hospital beds are.

Don't get your knickers in a twist!

Packing for the hospital stay is a challenge. Wear something easy to get out of. Bring something easy to get in to. Wear slip on shoes or shoes with Velcro closures. A big loose button front soft shirt will let you slide your operated arm into the sleeve without too much contortion. But what about the bottom half? Loose stretchy pull-on shorts, loose enough that you can pull them up with one free hand, is a good idea. Those popular "pajama" bottoms that are seen everywhere now are great.

Remember house dresses of the 1950s? Loose fitting and buttoned all the way down the front. Where is a vintage store when you need one?

No one has mentioned unmentionables. What does the zaftig, modest female patient do? The morning after surgery the doctor is going to walk in to the hospital room, smile reassuringly, and want to check out his handiwork. Will you be wearing your Maidenform under your hospital gown? Probably not. I'm still working on this problem. If "bloomers" suggest something loose and large below that is a good idea.. What I don't need right now are Spanx!

What I do need is Anna, the lady's maid from Downton Abby!

What kind of a joint is this?

I forgot to tell you about the TOTAL SHOULDER JOINT REPLACEMENT PATIENT AND FAMILY EDUCATION PROGRAM offered by my hospital. This is really an addition to the long standing HIP And KNEE program which is much more popular. It is run by the Rehabilitation Services Department, presented by an RN and a physical therapist with a power point program. Lots of fluff but also lots of good information. Of the 25+ participants I was the only shoulder patient... made me feel a little anxious. Many of the patients were repeats so even they had good advice to share. We could ask all kinds of personalized questions.

A big deal is made about scrubbing down with Hibiclens the night before surgery and again the morning of. This is to prevent infection, of course. I was diligent Monday night before surgery, practically scrubbed my skin raw! Then, as I stepped out of the shower and grabbed my four day old bacteria-ridden towel to dry off, I realized a vital step had been omitted. USE A FRESHLY LAUNDERED TOWEL if you don't live in a hotel with fresh towels daily!

The blog is back!

Wow is not enough. I've been busy. But I am going to catch up on all the fun I have been having the past twenty or so days. If it is too much detail, forgive me. There is nothing more fun than reliving your medical experiences once they are behind you.