I have left several little things hanging so here is a little list to catch up on what I've overlooked or omitted:
I do still have some pain in my operated arm. I'm going with the opinion that it is secondary to the recent, more vigorous physical therapy. I see the surgeon in about ten days when he will do another X-ray. That will alleviate any doubts I might still have about the source of the recent discomfort.
I continue to massage the scar and cover it with Kinesio tape. The tape protects the scar from sun exposure which is a good thing. Also it disguises the half that is exposed to public view when I wear a sleeveless top. But mostly, I do believe that wearing the tape has had a positive affect on the way my scar looks.
I have increased my "walking for exercise" to two miles and try to do it daily now. I go at 7:00 AM as it is just too hot later.
I am busily converting bras from back hooks to front closure. The clips I ordered from Canada work great. With a little experience, it now takes me about fifteen to twenty minutes to make the switch. It is so worth the cost and time. Being able to dress oneself is crucial to one's independence.
I am recovering from the pneumothorax (collapsed lung) that was secondary to nerve block done at the time of my surgery. I'm not 100% but getting there. I've noticed that I have turned into a bit of a mouth breather, especially with exercise, and I can easily become slightly breathless with activity. But I am much improved. From my checking with Dr. Google and from what friends have told me, it can take a year to fully bounce back. I think I am doing well. I see the pulmunologist again in January.
I'm still taking a big dose of iron supplement daily. This was prescribed due to anemia secondary to blood loss at surgery. Iron creates its own set of problems but I guess the good outweighs the bad. I will have some blood work in October so will learn then if things are back in the normal range and I can stop the supplements. For now I am happy to blame general laziness on "Iron poor blood."
I have packed up my three slings and put them away. I wouldn't dare get rid of them. That would guaranty a new need for a sling! Can't have that.
I still operate under several restrictions. Don't move your arm behind your back (adduction, extension, internal rotation). Don't pick up anything heavier than your purse ( per surgeon last visit). Don't put your weight on that arm, like getting into bed or rising from a soft sofa). Don't pull or push with great force. Don't make hard, forceful motions, like hammering.
I think that pretty much says where I am. Getting better, feeling better, still have a way to go.
Sunday, August 31, 2014
Saturday, August 30, 2014
Are you Thinking of writing a blog?...PO Day 75
A blog is nothing more than a diary that you keep on line instead of locked and hidden under your mattress or in your underwear drawer. A password has replaced the little lock that prevented the considerate mother from reading your secret hopes but in no way deterred the nosy little brother who shared your private thoughts at the dinner table. A diary made a great Christmas present for your best friend, they were inexpensive and every girl wanted one, even if it turned out she never wrote a word in it. Those blank pages held the promise of dreams and dates, dances and personal dramas. For some of us the discipline of the calendar format and lined pages was daunting. It demanded daily attention, a devotion to detailing a young life that we just didn't have yet, maybe never would. A book of blank pages did not assign us a 200 word essay every night, nor did it limit us to one small sheet when we were full of angst. Even words were not necessary, a penciled heart with an arrow through it spoke volumes. The diary held our most private thoughts.
There's nothing private about a blog. It's a diary meant to be shared with relatives, friends, neighbors, and strangers, the more the better. (Actually, you can restrict who gets to see your blog but who would want to do that?). The exponential growth of the readership is exciting and rewarding to the blogger. In some cases, a blogger even can benefit financially by hosting ads and hyperlinks directing readers to businesses tangentially related to the subject of the blog. There are political blogs, cooking blogs, medical blogs, business and financial blogs, blogs for home schoolers and home handymen, speciality blogs by invitation only for violin makers or medical facilities, and on and on. All you have to have is an idea, an opinion, an experience to share. And a host site where you can post your blog. Blogger.com is one that is pretty simple to learn to use. Thank goodness. Used to be only the smart young computer generation had blogs. Now grandmas can do it.
But you can't press a flower in your blog like you could your little diary. The "post" page won't show a blurred ink spot where a tear fell late one night. We can't wear our password on a chain around our necks like we did our little key. (That was the only way to be sure it would not be discovered.) And we can't ceremoniously burn a blog when we want to erase certain young men from our memories.
Well, I guess we could burn it to a CD but that seems counter productive.
Here are some interesting blog facts:
In 1994 Justin Hall created the first computer diary. Between 1994 and 1999 John Barger coined the word weblog and Peter Merholz turned weblog into blog.
In 2002 Heather Armstrong was fired from her job for writing on her blog, dooce, while at work, thus creating the verb to be dooced which means fired for blogging.
And in 2004 Merriam Webster named "blog" the Word of the Year.
There's nothing private about a blog. It's a diary meant to be shared with relatives, friends, neighbors, and strangers, the more the better. (Actually, you can restrict who gets to see your blog but who would want to do that?). The exponential growth of the readership is exciting and rewarding to the blogger. In some cases, a blogger even can benefit financially by hosting ads and hyperlinks directing readers to businesses tangentially related to the subject of the blog. There are political blogs, cooking blogs, medical blogs, business and financial blogs, blogs for home schoolers and home handymen, speciality blogs by invitation only for violin makers or medical facilities, and on and on. All you have to have is an idea, an opinion, an experience to share. And a host site where you can post your blog. Blogger.com is one that is pretty simple to learn to use. Thank goodness. Used to be only the smart young computer generation had blogs. Now grandmas can do it.
But you can't press a flower in your blog like you could your little diary. The "post" page won't show a blurred ink spot where a tear fell late one night. We can't wear our password on a chain around our necks like we did our little key. (That was the only way to be sure it would not be discovered.) And we can't ceremoniously burn a blog when we want to erase certain young men from our memories.
Well, I guess we could burn it to a CD but that seems counter productive.
Here are some interesting blog facts:
In 1994 Justin Hall created the first computer diary. Between 1994 and 1999 John Barger coined the word weblog and Peter Merholz turned weblog into blog.
In 2002 Heather Armstrong was fired from her job for writing on her blog, dooce, while at work, thus creating the verb to be dooced which means fired for blogging.
And in 2004 Merriam Webster named "blog" the Word of the Year.
Friday, August 29, 2014
PT Evaluation...P O Day 74
At physical therapy today I was evaluated or reevaluated, as it may be. As I began therapy, about three weeks post op, I was asked to fill out a questionnaire rating ten different activities by how easy to how difficult they were to do. "I can wash my hair, I can reach an item on an upper kitchen shelf, I can put on a pull-over t-shirt, I can pick up something weighing ten pounds, I can reach behind my back to scratch it," were typical questions. Of course, these apply only to the operated arm/shoulder. The higher the level of difficulty you assign a task (10=not able to do it at all, 1=duck soup) the higher your total score. My initial score was 80, I couldn't do much.
That was the evaluation. Today, after eight weeks of therapy, was the reevaluation. I've made tremendous progress and both I and the therapist are pleased. But that is not to say that there is not still some difficulty in everything I do with the operated arm. Three actions on the list are definite "don't even think about doing this" activities, like scratch your back, lift a ten pound weight, or remove your wallet from your back pocket. Not that I carry my wallet in a back pocket, this is obviously a unisex exam. Today I scored 40, a huge improvement. Good for me.
The good reason for the test is to objectively measure one's progress. The real reason for the test is to decide if insurance, Medicare in my case, will pay for continuing therapy. In some perverse* corporate/government rationalization, if you are not showing improvement, not getting better, if your score is not going down, Medicare will not continue to pay for therapy. Wouldn't it seem like the person who has not improved needs continuing therapy more than someone like me who is well on the road to recovery? Therapy for the unimproved patient now falls into the category of "maintenance" and is not covered.
My test results and the therapist's notes will now go to my surgeon. He will look them over and, most likely, recommend more therapy sessions. And Medicare will, most likely, cover the cost. It just seems backwards to me.
That was the evaluation. Today, after eight weeks of therapy, was the reevaluation. I've made tremendous progress and both I and the therapist are pleased. But that is not to say that there is not still some difficulty in everything I do with the operated arm. Three actions on the list are definite "don't even think about doing this" activities, like scratch your back, lift a ten pound weight, or remove your wallet from your back pocket. Not that I carry my wallet in a back pocket, this is obviously a unisex exam. Today I scored 40, a huge improvement. Good for me.
The good reason for the test is to objectively measure one's progress. The real reason for the test is to decide if insurance, Medicare in my case, will pay for continuing therapy. In some perverse* corporate/government rationalization, if you are not showing improvement, not getting better, if your score is not going down, Medicare will not continue to pay for therapy. Wouldn't it seem like the person who has not improved needs continuing therapy more than someone like me who is well on the road to recovery? Therapy for the unimproved patient now falls into the category of "maintenance" and is not covered.
My test results and the therapist's notes will now go to my surgeon. He will look them over and, most likely, recommend more therapy sessions. And Medicare will, most likely, cover the cost. It just seems backwards to me.
perverse" - contrary to the accepted or expected standard or practice."in two general elections the outcome was quite perverse"
synonyms: illogical, irrational, unreasonable, wrong, wrong-headed
"a verdict that is manifestly perverse"
Thursday, August 28, 2014
Diane Keaton or Me...PO Day 73
Of all the personal and household chores I can now do (even with my newly sore arm) my greatest achievement may be coloring my hair.
The fact is that I have been coloring my hair one armed. It's a messy job with two good arms but, with only one, it's a disaster. Globs of gelatinous hair dye drip on the bathroom sink, the vanity, the bath towel, and the rug. I didn't even pretend I was "parting off sections and applying the product to the roots only." I was lucky to get it somewhere near the crown of my head and then be able to smear it around. My temples and the nape of my neck never quite got covered adequately.
But the other day, with a functioning right arm, I tackled the job again. What a difference! What progress! Physical therapy may just be worth it.
I wouldn't say L'Oreal will be calling to ask me to represent the senior segment of society in an ad campaign. It didn't turn out that good and they already have Diane Keaton. But, like Diane, I look like "I am worth it," again.
Now if I could just pluck my eyebrows...
The fact is that I have been coloring my hair one armed. It's a messy job with two good arms but, with only one, it's a disaster. Globs of gelatinous hair dye drip on the bathroom sink, the vanity, the bath towel, and the rug. I didn't even pretend I was "parting off sections and applying the product to the roots only." I was lucky to get it somewhere near the crown of my head and then be able to smear it around. My temples and the nape of my neck never quite got covered adequately.
But the other day, with a functioning right arm, I tackled the job again. What a difference! What progress! Physical therapy may just be worth it.
I wouldn't say L'Oreal will be calling to ask me to represent the senior segment of society in an ad campaign. It didn't turn out that good and they already have Diane Keaton. But, like Diane, I look like "I am worth it," again.
Now if I could just pluck my eyebrows...
Wednesday, August 27, 2014
Would you like a little whine with this post?...PO Day 72
After two + months of boasting I have had little or no pain my arm has begun to hurt. I can imagine all kinds of things that have gone wrong. The natural humerus has developed a stress fracture from being reamed out. The titanium joint is dislocating. The plate into which the new "ball" is screwed is loose. I have a loose screw! Infection or hematoma would hurt, wouldn't it? To quote Walter Mitty, "coreopsis has set in." Or maybe not.
The discomfort began Saturday night after I did some fairly vigorous arm extensions and by Sunday morning I was certain my arm was going to fall off. I skipped home PT Sunday and talked to my therapist Monday morning. Instead of a strenuous work out she spent most of my session massaging my tricep muscle and reverting to some of the PROM (passive range of motion) stretches. She was so sympathetic.
At home yesterday I chose to concentrate on the wimpy exercises but it still hurt and the niggling worry that I was damaging something was back. So when I presented for therapy at 7:40 this morning I was singing the same song. But my therapist had conferred with my surgeon and the consensus is I am simply feeling the result that strength building exercises have on weak muscles. Interestingly, the usual AROM (active range of motion) exercises actually made my arm less sore this morning.
So, while my arm is still pretty tender, I am under orders to bravely forge on. And not to worry. The forging is easier than the not worrying.
Tuesday, August 26, 2014
Recent Electronic Records experience...PO Day 71
Because of my reverse Total Shoulder Arthroplasty surgery in June 2014 I have been seeing a lot of doctors, some old, some new. Consequently I've had a good bit of exposure to the EMR and to the EHR. Like everything, there are good features and not so good features.
Getting something removed from your Electronic Medical Record is difficult. Five years ago I twisted my ankle and it swelled up. I think to my dying day I will have a "swollen right ankle" according to my EMR. On the positive side, the first time I saw my primary care doctor after shoulder surgery, anemia due to surgical blood loss, and pneumothorax, he already knew all about it and it wasn't from chatting across the lunch table in the doctors' cafeteria. He was receiving daily reports via my EHR. I wonder if this electronic deluge of data must not add tremendously to the primary care doctor's work load.
My emergency room visit when it was discovered I had a post op lung collapse was a bit of a blur and I got Dr. Right's name wrong. Going to my EHR at my hospital's website let me see which radiologist took a second look at my shoulder X-ray and alerted everyone to the pneumothorax and revealed Dr. Write was really Dr. Right. (Not cool to get the name wrong in a thank you note!)
I am able to peruse days and days of lab reports and results. I don't always know what the lab test is
but I can see what normal ranges are. (Always good to be normal :). No one mentioned it at the time but even my cholesterol levels were checked. However, while apparently my physician can see the results of X-rays and CT scans, I cannot, can't even see that they were ordered. I hope that is something that will be added in the future for the patient's benefit.
The whole network is impressive and we know that knowledge is power. But I can't help but wonder how we keep this "power" out of the hands of malicious east European hackers and curious computer savvy kids.
Getting something removed from your Electronic Medical Record is difficult. Five years ago I twisted my ankle and it swelled up. I think to my dying day I will have a "swollen right ankle" according to my EMR. On the positive side, the first time I saw my primary care doctor after shoulder surgery, anemia due to surgical blood loss, and pneumothorax, he already knew all about it and it wasn't from chatting across the lunch table in the doctors' cafeteria. He was receiving daily reports via my EHR. I wonder if this electronic deluge of data must not add tremendously to the primary care doctor's work load.
My emergency room visit when it was discovered I had a post op lung collapse was a bit of a blur and I got Dr. Right's name wrong. Going to my EHR at my hospital's website let me see which radiologist took a second look at my shoulder X-ray and alerted everyone to the pneumothorax and revealed Dr. Write was really Dr. Right. (Not cool to get the name wrong in a thank you note!)
I am able to peruse days and days of lab reports and results. I don't always know what the lab test is
but I can see what normal ranges are. (Always good to be normal :). No one mentioned it at the time but even my cholesterol levels were checked. However, while apparently my physician can see the results of X-rays and CT scans, I cannot, can't even see that they were ordered. I hope that is something that will be added in the future for the patient's benefit.
The whole network is impressive and we know that knowledge is power. But I can't help but wonder how we keep this "power" out of the hands of malicious east European hackers and curious computer savvy kids.
Monday, August 25, 2014
Electronic Health Records...PO Day 70
According to HealthIT.gov:
The physician has access to records from his office, home, hospital, medical seminar, even vacation. Lab reports and scans are available in real time. Documents are legible and complete. Pharmacies are linked so prescribing is simple and immediate.
For the patient, there are fewer forms to complete at each facility, e-prescriptions are convenient and fast, and referrals to specialists are less complicated and time consuming.
The program encourages standardization of data, tests and treatment plans. "Best Practice" procedures and "evidence-based" medicine encourage a uniformity of care. The goal is more convenient, faster and simpler disease control.
There are financial rewards for participating and financial penalties for not. As with any new operating system there is quite a cost in time and money. The "programs" to create and utilize the EHR System are created, sold and maintained by private software vendors. A medical facility must consider software, hardware, maintenance, upgrade costs, option of phased payments, interfaces for labs and pharmacies, cost to connect to health information exchange (HIE), customized quality reports), and more. Privacy, security and back up capabilities are critical issues.
It's complicated. The bottom line is "does this leave room for the think outside of the box doctor?Would TV's House fit in to the new medical paradigm? I kind of doubt it.
Sunday, August 24, 2014
Electronic medical records...PO Day 69
If you have been to a new doctor recently, or even to an old doctor who you have not seen in a while, you most likely have been asked to fill out an information packet as part of the government Affordable Health Care Act. As of January 1, 2014 public and private health care providers are required to use a standard digital record keeping system. The questionnaire is so voluminous that many offices mail the forms to you so you can fill them out prior to coming for your appointment. It's not just a name and address form. You are required to provide a complete medical history, list all previous surgical procedures, detail all drugs, legal or not, you take and why, the medical problems of your ancestors and siblings and when and if they died and of what, list your employer and your spouse's employer, when you retired if you are, identify your emergency contacts including adult children and their contact information, reveal if you smoke or ever did, confess if you drink alcohol and how many ounces a week or day, report what you do for exercise, admit if you do not wear a seatbelt, report your race and ethnicity ( I thought that was not supposed to matter ), provide your address, home phone, cell phone, email address, share your social security number, and hand over your driver's license and insurance cards to be photocopied by the receptionist at the front desk.
Does anyone else worry about identity theft? According to a piece on ABC in May 2014, never share your social security number with anyone, even your physician's office (although how you avoid it if you have Medicare I do not know since the ID number and SS number are one and the same in most cases), do not communicate with your doctor's office via unencrypted email, and do not allow them to store your credit card information. Furthermore, do not allow them to use your DL number as an identifying number on a personal check.
Once created, your Electronic Medical Record should help y our physician track data over time. identify patients due for screenings and preventative visits, monitor how a patient measures up to certain parameters like vaccinations and blood pressure readings, and improve the overall care in a practice. But your EMR is not easily shared outside of a particular practice and most likely would have to be printed out and delivered by snail mail to other specialists. In fact, every time I see my primary care doctor a thick summary packet arrives in the mail a few days later recapping what I said, what he said, what I am to do, and when I am to come back. Do they think I can't remember? It seems a bit redundant and I don't see how this is moving us towards a paperless society. Should I save this medical screed, add it to the stack of "This Is Not A Bill"s and "Explanation of Benefits?" Dare I toss it in the garbage or shouldn't it be shredded? When the need arises will I really be able to find the lab work orders that they included for my check up next August 2015?
Does anyone else worry about identity theft? According to a piece on ABC in May 2014, never share your social security number with anyone, even your physician's office (although how you avoid it if you have Medicare I do not know since the ID number and SS number are one and the same in most cases), do not communicate with your doctor's office via unencrypted email, and do not allow them to store your credit card information. Furthermore, do not allow them to use your DL number as an identifying number on a personal check.
Once created, your Electronic Medical Record should help y our physician track data over time. identify patients due for screenings and preventative visits, monitor how a patient measures up to certain parameters like vaccinations and blood pressure readings, and improve the overall care in a practice. But your EMR is not easily shared outside of a particular practice and most likely would have to be printed out and delivered by snail mail to other specialists. In fact, every time I see my primary care doctor a thick summary packet arrives in the mail a few days later recapping what I said, what he said, what I am to do, and when I am to come back. Do they think I can't remember? It seems a bit redundant and I don't see how this is moving us towards a paperless society. Should I save this medical screed, add it to the stack of "This Is Not A Bill"s and "Explanation of Benefits?" Dare I toss it in the garbage or shouldn't it be shredded? When the need arises will I really be able to find the lab work orders that they included for my check up next August 2015?
Saturday, August 23, 2014
Grocery Shopping...PO Day 68
About all that's left of the pre-surgery frozen cache are desserts. I think there is one spaghetti casserole still buried under the permanent freezer paraphernalia; a ziplock bag of frozen bread crumbs, a package of bait shrimp ( just in case), and a half bag of pre chopped onions and celery soup mix. I need to sort out the banana cake packages, they did not carryover well. The little chocolate cakes and the individual cherry tarts still taste fresh. I feel sure there are a few more small chicken pot pies in there. Just need to excavate a little deeper.
But a restocking trip to the grocery store was in order this morning. Since surgery grocery shopping has been a team sport. Dear Husband pushes the cart while I fill it with fresh fruits and veggies, lunch meat, bread, milk, eggs, ice cream and other food stuffs to supplement the frozen entrees at home. Today I decided to go heavy on the fresh (or pre-frozen, as the market likes to call it) fish. I couldn't resist a few BOGOs (buy one, get one free) and a couple frozen convenience foods for nights I'd rather nuke than cook.
I was on my own. Dear Husband was two doors down returning and buying new shoes. No problem. I am knocking off a mile and a quarter now every morning and physical therapy demands all kinds of lifting, stretching and pulling.
Gathering the goods was no problem but pushing and steering the shopping cart was surprisingly difficult. I couldn't seem to exert the same force on both sides of the handle which caused the cart to veer to the right like a car with an alignment problem. That is except when I wanted to turn right, then what should have been a ninety degree turn became a wide circle careening into oncoming traffic. And it made my shoulder, the one that surprisingly never hurts, HURT! Am I not ready to solo? Is there a PT exercise to facilitate cart pushing? Do I really need a helper?
Or do I just like the company?
But a restocking trip to the grocery store was in order this morning. Since surgery grocery shopping has been a team sport. Dear Husband pushes the cart while I fill it with fresh fruits and veggies, lunch meat, bread, milk, eggs, ice cream and other food stuffs to supplement the frozen entrees at home. Today I decided to go heavy on the fresh (or pre-frozen, as the market likes to call it) fish. I couldn't resist a few BOGOs (buy one, get one free) and a couple frozen convenience foods for nights I'd rather nuke than cook.
I was on my own. Dear Husband was two doors down returning and buying new shoes. No problem. I am knocking off a mile and a quarter now every morning and physical therapy demands all kinds of lifting, stretching and pulling.
Gathering the goods was no problem but pushing and steering the shopping cart was surprisingly difficult. I couldn't seem to exert the same force on both sides of the handle which caused the cart to veer to the right like a car with an alignment problem. That is except when I wanted to turn right, then what should have been a ninety degree turn became a wide circle careening into oncoming traffic. And it made my shoulder, the one that surprisingly never hurts, HURT! Am I not ready to solo? Is there a PT exercise to facilitate cart pushing? Do I really need a helper?
Or do I just like the company?
Friday, August 22, 2014
I thought physical therapy was ending....PO day 67
As I approach ten weeks post surgery with only three more PT appointments scheduled, I thought my formal physical therapy was ending. I've made tremendous progress in the past three weeks, since moving into the AROM (active range of motion) phase. I can raise my arm to comb my hair, hang up measuring cups on the inside of an upper cupboard door, and put up my towel on the upper towel bar in the bathroom. I washed the living room window today just to see if I could...a little streaky but clean! Every PT exercise has a comparable household job. Vertical flexion (what I call wall slides) converts to shower wall cleaning. Unloading the dishwasher is a good substitute for one pound curls. External rotation emulates moving cookies from the baking sheet to the cooling rack. Abduction seems a lot like reaching up to get a cup off of the higher shelf. And the standing bar flexion exercises are very much similar to hanging up clothes in my closet now that I am shorter! Got it!
So, when I started to begin the farewell process today, "only one more week," I said, I was surprised to learn there is more to follow. I am in the middle of PO week 9, which is half way through phase II (weeks 7-12). In the next few weeks I will work on gaining strength by using slightly heavier weights and continue to " demonstrate the ability to isotonically activate all components of the deltoid and periscapular musculature." I hope that correlates to pulling weeds in the garden.
I'm afraid to write that there is a Phase III. But this might be the most painless way of letting Dear Husband know...he reads my blog.
So, when I started to begin the farewell process today, "only one more week," I said, I was surprised to learn there is more to follow. I am in the middle of PO week 9, which is half way through phase II (weeks 7-12). In the next few weeks I will work on gaining strength by using slightly heavier weights and continue to " demonstrate the ability to isotonically activate all components of the deltoid and periscapular musculature." I hope that correlates to pulling weeds in the garden.
I'm afraid to write that there is a Phase III. But this might be the most painless way of letting Dear Husband know...he reads my blog.
Thursday, August 21, 2014
Life changes, kind of...PO Day 66
When I was young I ran into my friends at the beach, Steak and Shake (a drive-in back then), or the Movie theater. If I was trying to avoid a certain teacher it was inevitable they would be coming down the library steps as I was going up. The library was one sure place your parents would let you go after dinner, even if you had stayed home from school sick that day.
As a mom I encountered my friends at the park , dance class/tai Kwan do. or the pick-up line of cars before or after school. If I was trying to avoid the Class Mom who was always looking for volunteers, it was a given that she would get in line behind me at the grocery store. At least I could still buy what I needed for the bake sale before I went home.
Nowadays we rendezvous-vous in different places. The orthopedist 's waiting room is like the campus Student Union. I, as a post- op patient, am just leaving as my friend, a pre-op patient, is coming in. Two wives are comparing notes as one husband is going in one direction for X-rays and the other husband is being seated in an exam room. The doctor and his staff may be constrained by HIPAA rules on confidentiality but we patients are not.
The Physical Therapy room, mine is in the hospital, is large and open. Don't ask your therapist if your dentist's partner doing the same pulley exercise as you has had shoulder replacement surgery too, she can't say. But walk out to the parking lot at the same time, joined by the woman in the cute exercise outfit, and the next thing you know you are sharing post op stories over coffees at Starbucks,
The very physician I've been trying to avoid (I've just been too busy to schedule my annual mammogram) was going in the hospital side door as I was going out the other day. Looking preoccupied, I thought I had made it past her when she turned and called my name. "How are you and aren't I due to see you soon," she asks. "Well, I've been very busy with shoulder surgery and all...." I stammer, feeling very much like a sixteen year old who has skipped school standing on the library steps.
Some things never change.
As a mom I encountered my friends at the park , dance class/tai Kwan do. or the pick-up line of cars before or after school. If I was trying to avoid the Class Mom who was always looking for volunteers, it was a given that she would get in line behind me at the grocery store. At least I could still buy what I needed for the bake sale before I went home.
Nowadays we rendezvous-vous in different places. The orthopedist 's waiting room is like the campus Student Union. I, as a post- op patient, am just leaving as my friend, a pre-op patient, is coming in. Two wives are comparing notes as one husband is going in one direction for X-rays and the other husband is being seated in an exam room. The doctor and his staff may be constrained by HIPAA rules on confidentiality but we patients are not.
The Physical Therapy room, mine is in the hospital, is large and open. Don't ask your therapist if your dentist's partner doing the same pulley exercise as you has had shoulder replacement surgery too, she can't say. But walk out to the parking lot at the same time, joined by the woman in the cute exercise outfit, and the next thing you know you are sharing post op stories over coffees at Starbucks,
The very physician I've been trying to avoid (I've just been too busy to schedule my annual mammogram) was going in the hospital side door as I was going out the other day. Looking preoccupied, I thought I had made it past her when she turned and called my name. "How are you and aren't I due to see you soon," she asks. "Well, I've been very busy with shoulder surgery and all...." I stammer, feeling very much like a sixteen year old who has skipped school standing on the library steps.
Some things never change.
Wednesday, August 20, 2014
Weight gain vs rTSA...PO Day 65
Before shoulder surgery walking aggravated the pain in my arm but not enough to keep me from trying to persevere. But post surgery the combination of breathlessness, weakness and shoulder discomfort coupled with heat and humidity has been the perfect storm to excuse me from hitting the road. Three times a week physical therapy at 7:40 AM seemed a reasonable substitute for less climate controlled ( read "outdoor") activity.
But the recent shocking discovery of losing an inch in height made me realize that a proportionate
decrease in weight would be required to maintain my usual BMI ( body mass index). Sure enough, my BMI increased almost a full point given my new stature.
So, how seriously do I have to take this change? Does being overweight affect joint replacement surgery as negatively as we are told it does everything else about our health?
In a study comparing normal weight, overweight, and obese patients who underwent shoulder replacement surgery pain relief was comparable in all three groups. In fact, obese patients self reported the greatest level of pain relief.
Operative time and intraoperative blood loss were slightly greater in obese patients but it was not significant and did not result in increased number of days in hospital, complications during surgery or the need for blood transfusions.
It is true that patients who weighed less did demonstrate greater function after total shoulder replacement surgery but the operation benefited all three categories of patients. The bottom line is that the surgery benefits patients of all weights in improving function and pain relief and weight does not affect the operating procedure nor the hospital stay.
I think I will have a cookie now.
Tuesday, August 19, 2014
My operation didn't make the news...PO Day 64
This has kind of been my lost summer. Between getting ready for surgery and having surgery, what with complications that put me back in the hospital, and a slow start on physical therapy, I am just finally getting back to a normal life and going out in the world.
If we go out to eat the server asks where we have been. When I go to the post office the postal worker says she has missed me. Now that I have started walking for exercise again I encounter somewhat distant neighbors who inquire if I have been " up north," where most sensible people here go to escape our hot and humid summers.
Too bad my little local paper did not cover my story. It would have saved me a lot of explaining. On the other hand, I might not like the scrutiny and unsolicited advise that comes with a public life. Anyway, I thought it was interesting to read about Justice Breyer and if he checks in to my blog I wish he would let us know how he is getting along. :) I might also suggest he stay off of a bicycle!
If we go out to eat the server asks where we have been. When I go to the post office the postal worker says she has missed me. Now that I have started walking for exercise again I encounter somewhat distant neighbors who inquire if I have been " up north," where most sensible people here go to escape our hot and humid summers.
Too bad my little local paper did not cover my story. It would have saved me a lot of explaining. On the other hand, I might not like the scrutiny and unsolicited advise that comes with a public life. Anyway, I thought it was interesting to read about Justice Breyer and if he checks in to my blog I wish he would let us know how he is getting along. :) I might also suggest he stay off of a bicycle!
"According to Supreme Court spokesperson Kathleen Arberg, Associate Justice Stephen Breyer underwent reverse shoulder replacement surgery for a proximal humerus fracture at MedStar Georgetown University Hospital on the morning of April 27th, 2013.
The fracture was sustained in his right shoulder after a fall from his bicycle on the afternoon of April 26th, where he was taken to the hospital by an ambulance.
This is the third biking mishap for Justice Breyer. Two years ago, he fractured his right clavicle (collarbone) after he fell near his home in Cambridge, Mass. He suffered a collapsed lung and multiple rib fractures in 1993 when he was struck by a car as he was riding his bicycle in Harvard Square."
Monday, August 18, 2014
Snake Oil for scars...PO Day 63
My physical therapist looked at my scar today and announced that it was looking very "good." It made me wonder if she has ever announced that someone's scar looked really bad. Is how an incision turns out due to the surgeon 's talent or the physiology of the patient? Is it true that in a surgical teaching setting the experienced surgeon peels off his gloves and nods to the inexperienced resident, "you can close," as he exits the OR? Or did I just see that on TV?
There are many products on the over the counter market that are purported to improve the look of surgical scars. Onion oil is a key ingredient in one popular and expensive product. Vitamin oils, including E, sound good. I am using the Kinesio tape* on my scar even though I am a doubting Thomas. There does seem to be some credibility to the silicone sheet treatment but that may be as simple as retaining moisture in the site which is a good thing. Would plastic wrap and adhesive tape work just as well? Massage appears to be beneficial and any oil, even Vaseline, is a good vehicle.
The idea of treating scars with oil preparations isn't new. William Haubrich wrote in Medical Meanings (1997) that the Seneca Indians of Pennsylvania and New York used petroleum from oil deposits to treat cuts and wounds. By the 19 th century entrepreneurs of European ancestry (that's white men for the politically incorrect) realized the commercial value of this substance and bottled it for sale as a cure-all. Originally called Seneca oil, the pronunciation evolved into snake oil, in modern parlance, "a product of little real worth that is promoted as a solution to a medical problem."
However I consider my scar, whether I decide to hide it or expose it as a badge of courage and survival, I like what Garrison Keillor said, "It's a shallow life that doesn't give a person a few scars."
There are many products on the over the counter market that are purported to improve the look of surgical scars. Onion oil is a key ingredient in one popular and expensive product. Vitamin oils, including E, sound good. I am using the Kinesio tape* on my scar even though I am a doubting Thomas. There does seem to be some credibility to the silicone sheet treatment but that may be as simple as retaining moisture in the site which is a good thing. Would plastic wrap and adhesive tape work just as well? Massage appears to be beneficial and any oil, even Vaseline, is a good vehicle.
The idea of treating scars with oil preparations isn't new. William Haubrich wrote in Medical Meanings (1997) that the Seneca Indians of Pennsylvania and New York used petroleum from oil deposits to treat cuts and wounds. By the 19 th century entrepreneurs of European ancestry (that's white men for the politically incorrect) realized the commercial value of this substance and bottled it for sale as a cure-all. Originally called Seneca oil, the pronunciation evolved into snake oil, in modern parlance, "a product of little real worth that is promoted as a solution to a medical problem."
However I consider my scar, whether I decide to hide it or expose it as a badge of courage and survival, I like what Garrison Keillor said, "It's a shallow life that doesn't give a person a few scars."
Sunday, August 17, 2014
Hard Back, Paperback or E...PO Day 62
I suppose I could be called a Luddite when it comes to reading for enjoyment and entertainment.
I love a good book. By that I mean a good hardback book. I might not choose a book by its cover but weight can be a deciding factor. A hefty tome two and a half pounds will always win out over a slim lightweight of 14 ounces. Who wants the reading relationship to end just as the story gets going? Give me a saga, an epic, a 463 page chronicle that keeps me awake long into the night. The best book is one with a mysterious past; a prior reader has dog-eared a page or underlined an especially moving passage. Better yet is the gift inscription in the front of an old book, the more mysterious, romantic or sinister the better. A hardback book can be lent to a friend never to be seen again or settle in on your bookshelf to be reread years later when you discover it like an old sweetheart you run into on the street.
Paperback books are strictly a beach accessory, tucked in with the sunscreen and bottle of water. They are convenient and expendable. A half finished paperback accidentally left on the nightstand of your friends' summer cottage will not merit a trip to the post office to return it. In fact, their opinion of your literary acumen will likely suffer even if the title is Middlemarch. They will only notice the curled corners of the cover, the loose leaves including the title page that flutter out, and the addendum at the back recommending a variety of crime novels by the same publisher. (Remember the fitted cloth covers that came along in the seventies to hide the suggestive picture on the front of the summer best selling romance?)
And now we are reading E books. Even I am reading E books. What does this have to do with
recovering from rTSA? In the middle of the night confined to a hospital bed, when every television
channel is an infomercial, you can shop Amazon for the latest best seller. When the IV line will not
reach as far as your purse and you've already buzzed the night nurse three times, you can download
great classics from free e-book websites. Balancing a tablet or iPad on your lap is easier when your right arm is constrained in a sling and your left hand has an IV sticking out of it pinging you every time it is moved. If the light over your bedroom is reminiscent of a B movie interrogation scene, the soft glow of the iPad screen is all you need to read by and even makes a pretty good flash light if turned facing out when you've lost your glasses in the covers.
An E book doesn't smell or feel like a hardback book, it can't be shared or shown off on your coffee table, it doesn't lay on your bed stand inviting you to join it at night. But, like all modern technology, once you have made the leap, there may be no going back.
I love a good book. By that I mean a good hardback book. I might not choose a book by its cover but weight can be a deciding factor. A hefty tome two and a half pounds will always win out over a slim lightweight of 14 ounces. Who wants the reading relationship to end just as the story gets going? Give me a saga, an epic, a 463 page chronicle that keeps me awake long into the night. The best book is one with a mysterious past; a prior reader has dog-eared a page or underlined an especially moving passage. Better yet is the gift inscription in the front of an old book, the more mysterious, romantic or sinister the better. A hardback book can be lent to a friend never to be seen again or settle in on your bookshelf to be reread years later when you discover it like an old sweetheart you run into on the street.
Paperback books are strictly a beach accessory, tucked in with the sunscreen and bottle of water. They are convenient and expendable. A half finished paperback accidentally left on the nightstand of your friends' summer cottage will not merit a trip to the post office to return it. In fact, their opinion of your literary acumen will likely suffer even if the title is Middlemarch. They will only notice the curled corners of the cover, the loose leaves including the title page that flutter out, and the addendum at the back recommending a variety of crime novels by the same publisher. (Remember the fitted cloth covers that came along in the seventies to hide the suggestive picture on the front of the summer best selling romance?)
And now we are reading E books. Even I am reading E books. What does this have to do with
recovering from rTSA? In the middle of the night confined to a hospital bed, when every television
channel is an infomercial, you can shop Amazon for the latest best seller. When the IV line will not
reach as far as your purse and you've already buzzed the night nurse three times, you can download
great classics from free e-book websites. Balancing a tablet or iPad on your lap is easier when your right arm is constrained in a sling and your left hand has an IV sticking out of it pinging you every time it is moved. If the light over your bedroom is reminiscent of a B movie interrogation scene, the soft glow of the iPad screen is all you need to read by and even makes a pretty good flash light if turned facing out when you've lost your glasses in the covers.
An E book doesn't smell or feel like a hardback book, it can't be shared or shown off on your coffee table, it doesn't lay on your bed stand inviting you to join it at night. But, like all modern technology, once you have made the leap, there may be no going back.
Saturday, August 16, 2014
Once You Learn A New Word... PO Day 61
You know how it is, once you learn a new word it pops up everywhere. You wonder how you have been ignoring that word all these previous years. It was there; I guess your brain just didn't see it.
I am that way now with orthopedic problems. RTSA has been a surgical option in the US since 2005 but I had never heard of it until I was facing it. Shoot, I didn't even know about regular shoulder replacement surgery. There are many procedures available in the surgeons armamentarium.
Arthroscopic Debridement is indicated if there is no history of injury but the patient has pain that is not relieved by therapy or medications. Small incisions allow the surgeon to clean up irritated tissue or bone spurs. Recovery is about a month.
Shoulder stabilization surgery is used when the patient has dislocated their shoulder and the lining of the joint has torn away from the bone. This repair, too, is done arthroscopically and recovery is about six weeks.
Rotator Cuff repair seems to be talked about, if not done, a lot. I HAD heard of it. This surgery follows a tear or injury and is also arthroscopic surgery. Recovery is more like six months.
Shoulder replacement surgery comes in three versions: Hemiarthroplasty (in which only the head of the humerus is replaced), Total Shoulder Arthroplasty (the ball of the humerus is replaced with a prosthetic ball and the natural socket is replaced with a prosthetic socket) and reverse Total Shoulder replacement (where the parts to be replaced are reversed). Which is the "bigger" surgery is directly related to which one you are facing.
I'll let you know how long recovery is.
I am that way now with orthopedic problems. RTSA has been a surgical option in the US since 2005 but I had never heard of it until I was facing it. Shoot, I didn't even know about regular shoulder replacement surgery. There are many procedures available in the surgeons armamentarium.
Arthroscopic Debridement is indicated if there is no history of injury but the patient has pain that is not relieved by therapy or medications. Small incisions allow the surgeon to clean up irritated tissue or bone spurs. Recovery is about a month.
Shoulder stabilization surgery is used when the patient has dislocated their shoulder and the lining of the joint has torn away from the bone. This repair, too, is done arthroscopically and recovery is about six weeks.
Rotator Cuff repair seems to be talked about, if not done, a lot. I HAD heard of it. This surgery follows a tear or injury and is also arthroscopic surgery. Recovery is more like six months.
Shoulder replacement surgery comes in three versions: Hemiarthroplasty (in which only the head of the humerus is replaced), Total Shoulder Arthroplasty (the ball of the humerus is replaced with a prosthetic ball and the natural socket is replaced with a prosthetic socket) and reverse Total Shoulder replacement (where the parts to be replaced are reversed). Which is the "bigger" surgery is directly related to which one you are facing.
I'll let you know how long recovery is.
Friday, August 15, 2014
Why A Sling For Six Weeks? PO Day 60
In the case of the reverse Total Shoulder Replacement (abbreviated rTSR) the ball and the socket are not attached to each other. They nest together, the ball screwed to the scapula and the cup at the top of the stainless steel post fitted into the humerus. This arrangement is the reverse of the natural shoulder joint, hence the name. The rTSR procedure is used when there is not enough of the rotator cuff intact to support the artificial device that normally would replace the cup in Total Shoulder Replacement arthroplasty.
This unusual reverse arrangement makes one somewhat more likely to dislocate the artificial joint. We human beings tend to get in some pretty weird positions. An unreachable itch in the middle of your back, a stuck zipper when you're trying to get out of a tight dress, or an angry wasp between your shoulder blades can lead to disaster. As my therapist says, extension, adduction and internal rotation is a dangerous combination. Catchy phrase.
Immobilizing the joint in the immediate weeks post op allows bone and tissue to grow into the prosthetic parts and better stabilize the joint. Conservative doctors, like mine, advise a solid six weeks wearing the sling 24 hours a day, 7 days a week. That's no guarantee that you can't or won't have trouble but it makes for a better start. This also explains the uber conservative approach to physical therapy in the first six weeks. The PROM (passive range of motion) technique administered by an experienced therapist allows the arm to be moved without interfering with the "knitting together" that is going on.
I've copied this photo of two x-rays showing the unfortunate process of a dislocation. The simplest fix involves manipulating the shoulder to get the the ball and joint realigned properly and then immobilizing the arm, either in a sling or even a cast, for up to six weeks. That must be the magic number.
This unusual reverse arrangement makes one somewhat more likely to dislocate the artificial joint. We human beings tend to get in some pretty weird positions. An unreachable itch in the middle of your back, a stuck zipper when you're trying to get out of a tight dress, or an angry wasp between your shoulder blades can lead to disaster. As my therapist says, extension, adduction and internal rotation is a dangerous combination. Catchy phrase.
Immobilizing the joint in the immediate weeks post op allows bone and tissue to grow into the prosthetic parts and better stabilize the joint. Conservative doctors, like mine, advise a solid six weeks wearing the sling 24 hours a day, 7 days a week. That's no guarantee that you can't or won't have trouble but it makes for a better start. This also explains the uber conservative approach to physical therapy in the first six weeks. The PROM (passive range of motion) technique administered by an experienced therapist allows the arm to be moved without interfering with the "knitting together" that is going on.
I've copied this photo of two x-rays showing the unfortunate process of a dislocation. The simplest fix involves manipulating the shoulder to get the the ball and joint realigned properly and then immobilizing the arm, either in a sling or even a cast, for up to six weeks. That must be the magic number.
Thursday, August 14, 2014
Complications or Coincidence? PO Day 59
I thought a pneumothorax was just about the worst complication from shoulder surgery I could experience. Anemia was a less dramatic development but has had to be dealt with. Two months post op I thought I was finally in the clear.
But some mysterious symptoms have begun to arise that I can no longer ignore.
I have no desire to go shopping! Macy's Big Weekend Coupon Sale has no allure for me. I took some things to the neighborhood thrift shop and did not even go inside to look around. I did stop at a garage sale last weekend, more out of habit than desire. I bought Dear Husband a book for 25 cents but nothing for myself. The mark-down shelves at TJMaxx do not entice me to make the seven mile drive to the store. Did the anesthesia convert the need for retail therapy to physical therapy?
In the eternal battle over the thermostat I was always too hot and Dear Husband was always too cold. I don't see how I can claim my surgery has affected his internal thermometer. It has to be me. I now carry a jacket with me everywhere I go and snuggle under a thick terry cloth robe to watch TV. For goodness sake, it's August in the South! That means 90 degrees and 90% humidity, slightly less indoors huddled around the air conditioner. What is going on?
But most alarming, I am shorter! I've been noticing that reaching an oft used bowl on the third kitchen shelf required a little toe lift for the last couple weeks. And I have been avoiding hanging up clothes that go on the upper rack in the closet. A long reach used to be sufficient to hook the hangar over the bar. Now I have to step up onto a little stool. How did that happen? Dr. Kai did warn me that my operated arm might be a little longer after surgery. Did he borrow an inch from my torso?
This is very mysterious. :)
But some mysterious symptoms have begun to arise that I can no longer ignore.
I have no desire to go shopping! Macy's Big Weekend Coupon Sale has no allure for me. I took some things to the neighborhood thrift shop and did not even go inside to look around. I did stop at a garage sale last weekend, more out of habit than desire. I bought Dear Husband a book for 25 cents but nothing for myself. The mark-down shelves at TJMaxx do not entice me to make the seven mile drive to the store. Did the anesthesia convert the need for retail therapy to physical therapy?
In the eternal battle over the thermostat I was always too hot and Dear Husband was always too cold. I don't see how I can claim my surgery has affected his internal thermometer. It has to be me. I now carry a jacket with me everywhere I go and snuggle under a thick terry cloth robe to watch TV. For goodness sake, it's August in the South! That means 90 degrees and 90% humidity, slightly less indoors huddled around the air conditioner. What is going on?
But most alarming, I am shorter! I've been noticing that reaching an oft used bowl on the third kitchen shelf required a little toe lift for the last couple weeks. And I have been avoiding hanging up clothes that go on the upper rack in the closet. A long reach used to be sufficient to hook the hangar over the bar. Now I have to step up onto a little stool. How did that happen? Dr. Kai did warn me that my operated arm might be a little longer after surgery. Did he borrow an inch from my torso?
This is very mysterious. :)
Wednesday, August 13, 2014
Progress Report... PO day 58
Reading yesterday's 8 week post op progress report really brought me up short! While I tried to stress what I now can do, I couldn't help letting what I want to be able to do creep in. Are we never satisfied?
It made me think about the question Dr. Kai asked me on my first visit when we discussed the possibility of surgery. He wanted to know what I hoped to get out of having the operation. I said that mostly I wanted to not have pain almost all the time. And I thought it would be a bonus if I could have some better range of motion with my arm. I was unable to elevate my arm or reach out with it at all and sharp, stabbing pain accompanied almost any useful maneuver.
Well, my surgeon, the procedure and my body have totally delivered on what was most important, pain relief. Even in the first day or two after surgery when one expects postoperative pain, I was more comfortable than I had been in the previous eleven months when I was supposedly healing from a broken shoulder. In a very few days after surgery I was weaned off of narcotic pain medications.
The immobilization of my arm for a good six weeks kept me from knowing for sure if it would again hurt with use. But now, at eight weeks post surgery, I am continually amazed how pain free I am. My arm is stiff and physical therapy is a challenge. The muscles which have gone unused, not just since surgery but for the months before, are sore and tender from being asked to work again. An ice pack and aspirin are in order after PT.
But the chronic, sharp, stabbing pain that accompanied almost every motion is gone. How did I fail to mention that yesterday?
It made me think about the question Dr. Kai asked me on my first visit when we discussed the possibility of surgery. He wanted to know what I hoped to get out of having the operation. I said that mostly I wanted to not have pain almost all the time. And I thought it would be a bonus if I could have some better range of motion with my arm. I was unable to elevate my arm or reach out with it at all and sharp, stabbing pain accompanied almost any useful maneuver.
Well, my surgeon, the procedure and my body have totally delivered on what was most important, pain relief. Even in the first day or two after surgery when one expects postoperative pain, I was more comfortable than I had been in the previous eleven months when I was supposedly healing from a broken shoulder. In a very few days after surgery I was weaned off of narcotic pain medications.
The immobilization of my arm for a good six weeks kept me from knowing for sure if it would again hurt with use. But now, at eight weeks post surgery, I am continually amazed how pain free I am. My arm is stiff and physical therapy is a challenge. The muscles which have gone unused, not just since surgery but for the months before, are sore and tender from being asked to work again. An ice pack and aspirin are in order after PT.
But the chronic, sharp, stabbing pain that accompanied almost every motion is gone. How did I fail to mention that yesterday?
Tuesday, August 12, 2014
Progress Report..PO Day 57
I have started over on this post three times. It seems like my brain wants to go to what I still CANNOT do and not to what I CAN do. How do I have full disclosure and not sound so whiny?
So, in an extreme effort to restrain the natural desire for sympathy, I will try again. I don't think I have ever said my operated shoulder is on the right and I am right handed.
So here goes:
I can drive! I feel like a 16 year old who just got their license.
I can eat with a fork. Getting a spoon of liquid to my lips is still awkward but doable.
I can cook but I let the mixer or food processor do the hard stuff.
I can wash dishes, although pots and pans could use a good scrubbing.
I can do light housework but need help with vacuuming and bed making. Sheets defeat me!
I can wash my face with two hands now and comb the front of my hair, not the top or back yet.
I can push but not pull, things like doors and drawers.
I can reach for a light switch, a toilet handle, the microwave control panel and the cream in the fridge, but not all at once. :)
I can get dressed but sometimes get stuck undressing, especially button up shirts.
I can walk for exercise again. Until recently it made my shoulder ache.
I can file and paint my finger nails but not my toenails yet.
I can apply a little eyeliner and mascara again! Trying with my left hand was disastrous.
I can reposition a small pillow in the middle of the night, a major accomplishment!
I can steady myself with my right hand gently but would not want to wobble much.
I can lift a glass of water to my lips.
I can write, almost legibly.
This begs for that old joke...sounds like Henny Youngman.
"Doctor, will I be able to play the violin after the surgery?" the patient with the broken arm asks.
The doctor, smiling reassuredly, "sure, I don't see why not."
The patient says, "Great because I've never been able to play before."
So, in an extreme effort to restrain the natural desire for sympathy, I will try again. I don't think I have ever said my operated shoulder is on the right and I am right handed.
So here goes:
I can drive! I feel like a 16 year old who just got their license.
I can eat with a fork. Getting a spoon of liquid to my lips is still awkward but doable.
I can cook but I let the mixer or food processor do the hard stuff.
I can wash dishes, although pots and pans could use a good scrubbing.
I can do light housework but need help with vacuuming and bed making. Sheets defeat me!
I can wash my face with two hands now and comb the front of my hair, not the top or back yet.
I can push but not pull, things like doors and drawers.
I can reach for a light switch, a toilet handle, the microwave control panel and the cream in the fridge, but not all at once. :)
I can get dressed but sometimes get stuck undressing, especially button up shirts.
I can walk for exercise again. Until recently it made my shoulder ache.
I can file and paint my finger nails but not my toenails yet.
I can apply a little eyeliner and mascara again! Trying with my left hand was disastrous.
I can reposition a small pillow in the middle of the night, a major accomplishment!
I can steady myself with my right hand gently but would not want to wobble much.
I can lift a glass of water to my lips.
I can write, almost legibly.
This begs for that old joke...sounds like Henny Youngman.
"Doctor, will I be able to play the violin after the surgery?" the patient with the broken arm asks.
The doctor, smiling reassuredly, "sure, I don't see why not."
The patient says, "Great because I've never been able to play before."
Monday, August 11, 2014
Medical Tourism...PO day 56
Used to be that people from all over the world flocked to the US for first rate medical care. Remember all the trouble we got in with the deposed Shah of Iran? And only a few years ago there were boutique hotels in New York City that catered to tourists recovering from surgery performed at prestigious New York hospitals.
The operating tables are turning.
Because of rising medical costs, lack of insurance coverage, or even employer health care plans that encourage it, Americans are traveling to familiar and exotic places around the world seeking modern, inexpensive surgical treatments. There are web based companies that connect the medical bargain shopper with facilities as close as Mexico or as far away as South Korea. The sites list everything from reverse Total Shoulder Arthroplasty to Heart by-pass surgery. A hip replacement surgery that costs $50,000 ( actually, that sounds like quite a bargain but I am quoting a site comparison list) in the US is less than $8,000 in Thailand. The medical menu is prix fixe and usually includes air fare and accommodations before and after.
I like the idea of knowing in advance what something is going to cost. Just try asking your hospital what your total bill will be prior to surgery and hospitalization. And medical beds are like airline seats...everyone is paying a different amount to get to the same place. There is room for improvement here.
But...for now, for me, I want my healthcare local, not global.
The operating tables are turning.
Because of rising medical costs, lack of insurance coverage, or even employer health care plans that encourage it, Americans are traveling to familiar and exotic places around the world seeking modern, inexpensive surgical treatments. There are web based companies that connect the medical bargain shopper with facilities as close as Mexico or as far away as South Korea. The sites list everything from reverse Total Shoulder Arthroplasty to Heart by-pass surgery. A hip replacement surgery that costs $50,000 ( actually, that sounds like quite a bargain but I am quoting a site comparison list) in the US is less than $8,000 in Thailand. The medical menu is prix fixe and usually includes air fare and accommodations before and after.
I like the idea of knowing in advance what something is going to cost. Just try asking your hospital what your total bill will be prior to surgery and hospitalization. And medical beds are like airline seats...everyone is paying a different amount to get to the same place. There is room for improvement here.
But...for now, for me, I want my healthcare local, not global.
Sunday, August 10, 2014
What Could Possibly Go Wrong? PO Day 55
Definitely NOT A Selfie!
I repeat...this is not a picture of MY prosthetic shoulder joint!
You know the expression "You've got a screw loose?" Well, this is the literal example of that. Boy, not what the doctor or the patient wanted to see. I wonder if the screw came loose, broke off, or was never properly affixed at the time of surgery.
Furthermore, the ball and socket do not appear to be in the proper relationship. It looks as if the ball has migrated upward away from the socket, perhaps because it was not properly anchored. Mostly I wonder if it hurts!
This implant is not exactly like mine. In the US there are about five companies who make nearly all hip and knee implants. I assume that is true of shoulder implants also. Over the years the manufacturers have improved old models and patented new versions but tend to stay close to their original design. Orthopedic surgeons develop a loyalty to one manufacturer or another, usually based on what system was used in their individual training program. Each manufacturer's implant demands it's own individualized set of instruments and tools, too. The cost of the prosthesis is often more than half of the hospital cost for the operation.
Not only is this big surgery, it is big business.
This implant is not exactly like mine. In the US there are about five companies who make nearly all hip and knee implants. I assume that is true of shoulder implants also. Over the years the manufacturers have improved old models and patented new versions but tend to stay close to their original design. Orthopedic surgeons develop a loyalty to one manufacturer or another, usually based on what system was used in their individual training program. Each manufacturer's implant demands it's own individualized set of instruments and tools, too. The cost of the prosthesis is often more than half of the hospital cost for the operation.
Not only is this big surgery, it is big business.
Saturday, August 9, 2014
I bet you know the tune...
Blow me a kiss from across the room
Say I look nice when I'm not
Touch my hair as you pass my chair
Little things mean a lot
Give me your arm as we cross the street
Call me at six on the dot
A line a day when you're far away
Little things mean a lot
Don't have to buy me diamonds or pearls
Champagne, sables, and such
I never cared much for diamonds and pearls
'cause honestly, honey, they just cost money
Give me a hand when I've lost the way
Give me your shoulder to cry on
Whether the day is bright or gray
Give me your heart to rely on
Send me the warmth of a secret smile
To show me you haven't forgot
That always and ever, now and forever
Honey, little things mean a lot
Read more: Kallen Kitty - Little Things Mean A Lot Lyrics | MetroLyrics
Say I look nice when I'm not
Touch my hair as you pass my chair
Little things mean a lot
Give me your arm as we cross the street
Call me at six on the dot
A line a day when you're far away
Little things mean a lot
Don't have to buy me diamonds or pearls
Champagne, sables, and such
I never cared much for diamonds and pearls
'cause honestly, honey, they just cost money
Give me a hand when I've lost the way
Give me your shoulder to cry on
Whether the day is bright or gray
Give me your heart to rely on
Send me the warmth of a secret smile
To show me you haven't forgot
That always and ever, now and forever
Honey, little things mean a lot
Read more: Kallen Kitty - Little Things Mean A Lot Lyrics | MetroLyrics
Little Things Mean A Lot...PO Day 54
I don't know why it has taken me so long to learn how important small gestures of kindness are, especially if you've been ill, but really, all the time.
Receiving a Get Well card in the mail brightened many days recently. It meant so much that someone was thinking of me and wishing me well. Fresh magazines to help while away hospital days were a blessing. A phone call from a friend way more seriously ill than I was humbling and helped put things in perspective. Flowers brought tears to my eyes.
Twice my surgeon has remarked that, when he got inside my shoulder, he could really see why I had so much pain. I could hug him! My primary care doctor said he had been worried about me. A friend has twice admired my functional, but really short hair cut. I know it looks awful but it has been all I could deal with.
A neighbor whom I like but hardly ever see brought the best apple tarts and stayed to visit a short time. Food always gets my approval. Another neighbor offered chauffeur service if needed and I know how busy she already is. Several friends wanted to know what they could do to help. It's not that I need the help, but so nice to have the offer. I am banking all those promises.
While all the hospital staff were great, a few stand out as exemplary. The respiratory therapist was always chipper and a ray of sunshine. The food service man who came to take my meal order acted like he was a waiter in a four star restaurant. There were a couple nurses who dressed or undressed me with the tenderness of a mother for her two year old. They were all "just doing their jobs" but with such grace and kindness.
I've tried to thank the most salient of the many but I think I am just going to have to "pay it forward." I hope I can hold on to the emotion of the moment.
Receiving a Get Well card in the mail brightened many days recently. It meant so much that someone was thinking of me and wishing me well. Fresh magazines to help while away hospital days were a blessing. A phone call from a friend way more seriously ill than I was humbling and helped put things in perspective. Flowers brought tears to my eyes.
Twice my surgeon has remarked that, when he got inside my shoulder, he could really see why I had so much pain. I could hug him! My primary care doctor said he had been worried about me. A friend has twice admired my functional, but really short hair cut. I know it looks awful but it has been all I could deal with.
A neighbor whom I like but hardly ever see brought the best apple tarts and stayed to visit a short time. Food always gets my approval. Another neighbor offered chauffeur service if needed and I know how busy she already is. Several friends wanted to know what they could do to help. It's not that I need the help, but so nice to have the offer. I am banking all those promises.
While all the hospital staff were great, a few stand out as exemplary. The respiratory therapist was always chipper and a ray of sunshine. The food service man who came to take my meal order acted like he was a waiter in a four star restaurant. There were a couple nurses who dressed or undressed me with the tenderness of a mother for her two year old. They were all "just doing their jobs" but with such grace and kindness.
I've tried to thank the most salient of the many but I think I am just going to have to "pay it forward." I hope I can hold on to the emotion of the moment.
Friday, August 8, 2014
A good illustration of the scapular plane
I tried to post this illustration a day ago and was not able to get it to "copy and paste." In keeping with the great mystery of how things work on a computer it suddenly popped up here now. But a picture is worth a thousand words even if it is a day late. I am not brave enough to try to paste it onto the proper post.
Looking for a little "closure"...PO Day 53
Or...Bramakerssupply.com Don't you love the web? A Google search turned up this wonderful Canadian company that sells everything to repair, redesign or create your own foundation garments. Instructions, fabric, straps, clips and hooks, underwire, padding, lace, boning, front closures, back closures...you name it, they have it. These clips are exactly like the one on the BALI bra I have. They sell smaller ones and different styles but these were kind of the Cadillac of bra hooks for the outrageous price of $2.00 each!
I ordered three sets to see if they work out. Can't imagine what could go wrong. I hope I am brave enough to cut the front of a good bra in two. At least now I think I can raise my arm up high enough to use the sewing machine. More progress!
I should mention that I did find a couple other sources for these clips but they were wholesale sources out of China and required a minimum order of 2000. Probably more than I need. :)
I should mention that I did find a couple other sources for these clips but they were wholesale sources out of China and required a minimum order of 2000. Probably more than I need. :)
Willet
 | 1 3/8" (35 mm) Tall Clips , CT-9 For any type of front closure bra that uses a clip, this clip will do the job. The slots on each side are intended for a fabric tube to feed through. The size refers to the size of the tape used, not the size of the clip itself. Now you really can have a front closing bra. One clip per package. | |
Thursday, August 7, 2014
Scapular Plane coming in for a landing...PO Day 52
I don't like to use medical terms that are not transparent so I have been trying to find a simple explanation for " scapular plane." Unsuccessfully. So here's how I understand it.
The shoulder blades ( the scapula) aren't totally flat as they curve across your upper back. The distal ends curve forward about 30 degrees which is what gives us a slightly rounded upper shoulder posture. Some people hunch their shoulders forward even more which leads to our moms saying"put your shoulders back and stand up straight."
If you extend your arm fully parallel to the floor and begin to move it backward, a comfortable angle is reached somewhere before your arm is at a 90 degree angle to the front midline of your body. That is probably the 30 degree point that you don't want to challenge with your operated shoulder.
If you force your arm farther back you can displace the ball from the socket. Not a good thing to do. "The simple act of reaching behind to scratch the middle of your back or (for women) undoing a bra-strap can dislocate a reverse shoulder implant. This action places the arm in a position of extension, adduction (arm close to the body), and internal rotation."
Also, when just comfortably seated or lying down, you should keep a small pillow or rolled up towel under or behind your elbow and upper arm so your arm does not drop backward of your torso. That position moves the ball and socket apart which is undesirable.
I don't yet know when we can quit worrying about things like this but it seems like this scapular plane has us booked for a long flight!
The shoulder blades ( the scapula) aren't totally flat as they curve across your upper back. The distal ends curve forward about 30 degrees which is what gives us a slightly rounded upper shoulder posture. Some people hunch their shoulders forward even more which leads to our moms saying"put your shoulders back and stand up straight."
If you extend your arm fully parallel to the floor and begin to move it backward, a comfortable angle is reached somewhere before your arm is at a 90 degree angle to the front midline of your body. That is probably the 30 degree point that you don't want to challenge with your operated shoulder.
If you force your arm farther back you can displace the ball from the socket. Not a good thing to do. "The simple act of reaching behind to scratch the middle of your back or (for women) undoing a bra-strap can dislocate a reverse shoulder implant. This action places the arm in a position of extension, adduction (arm close to the body), and internal rotation."
Also, when just comfortably seated or lying down, you should keep a small pillow or rolled up towel under or behind your elbow and upper arm so your arm does not drop backward of your torso. That position moves the ball and socket apart which is undesirable.
I don't yet know when we can quit worrying about things like this but it seems like this scapular plane has us booked for a long flight!
Wednesday, August 6, 2014
PT after 6 weeks...PO Day 51
I am so glad to now be in the Active phase of physical therapy. In just the last eight or ten days I have made tremendous progress. I think so, at least.
If someone wants to compare notes, here is what I am assigned to do at home:
Simple curls with a 1 lb weight, 3 sets of ten
Shoulder shrugs, 3 sets of ten
Shoulder blade squeezes, 3 sets of ten
Pulley arm lifts for two minutes, seated
Oblique pulley arm lifts for two minutes, seated
Bar raises from thigh to vertical, 3 sets of ten, lying down
Bar raises from chest to vertical, 3 sets of ten, lying down
Slide hand up wall to maximum stretch, ten times
Continue isometric exercises, arm bent at elbow, push and resist forward, back, in and out. 3 sets of ten.
Always keep your elbow forward of your waist, don't let your arm move back of the scapular plane.
If you don't have a 1 lb dumbbell, a can of vegetables (15 1/2 oz) works fine. And I use a vacuum cleaner wand for a bar to lift.
BE SURE TO FOLLOW YOUR OWN THERAPIST'S GUIDELINES. I AM ONLY POSTING THIS TO SAY WHAT I DO.
If someone wants to compare notes, here is what I am assigned to do at home:
Simple curls with a 1 lb weight, 3 sets of ten
Shoulder shrugs, 3 sets of ten
Shoulder blade squeezes, 3 sets of ten
Pulley arm lifts for two minutes, seated
Oblique pulley arm lifts for two minutes, seated
Bar raises from thigh to vertical, 3 sets of ten, lying down
Bar raises from chest to vertical, 3 sets of ten, lying down
Slide hand up wall to maximum stretch, ten times
Continue isometric exercises, arm bent at elbow, push and resist forward, back, in and out. 3 sets of ten.
Always keep your elbow forward of your waist, don't let your arm move back of the scapular plane.
If you don't have a 1 lb dumbbell, a can of vegetables (15 1/2 oz) works fine. And I use a vacuum cleaner wand for a bar to lift.
BE SURE TO FOLLOW YOUR OWN THERAPIST'S GUIDELINES. I AM ONLY POSTING THIS TO SAY WHAT I DO.
Tuesday, August 5, 2014
One More Doctor To Thank...PO Day 50
I've managed to send thanks to all but one of the physicians who took such good care of me during and after my shoulder surgery. I still have the Emergency Room doctor who treated the pneumothorax to contact. I have stopped at the ER twice and called twice. Either he is avoiding me, he has been on vacation, or he moves around between hospital ERs. I think it is the latter.
I called the ER again this morning and asked if Dr. Right was working today. Or tomorrow. Or when again? The nurse told me that they were not allowed to give out that information. That's the first time someone has put it so bluntly. But I kind of understand. As grateful as I am, I suppose there could be patients or family who were unhappy with a staff person. After a long moment of silence I explained that I wanted to bring him some cookies and a thank you card. Those were the magic words and she gave me his schedule.
She doesn't pass muster as a very good security guard but she obviously appreciates the merits of homemade cookies!
I called the ER again this morning and asked if Dr. Right was working today. Or tomorrow. Or when again? The nurse told me that they were not allowed to give out that information. That's the first time someone has put it so bluntly. But I kind of understand. As grateful as I am, I suppose there could be patients or family who were unhappy with a staff person. After a long moment of silence I explained that I wanted to bring him some cookies and a thank you card. Those were the magic words and she gave me his schedule.
She doesn't pass muster as a very good security guard but she obviously appreciates the merits of homemade cookies!
Monday, August 4, 2014
I Don't Like Change! PO day 49
My physical therapy facility, a division of my local hospital, is no longer a division of my local hospital. At least, that's how I understand it. It's in the same place, same equipment, mostly the same people...so far. But, in the manner of modern business, they have been taken over by a private company.
A few therapists have been laid off. Salaries are being restructured so there will likely be some people leave as their pay is reduced. Scheduling is being condensed and hours extended so that fewer therapists can cover the same number of patient encounters. Happy chatter has been replaced with subdued and terse clinical instruction.
Thank goodness my therapist is still on staff. A wise decision by the new hierarchy. I have been so pleased with her. I really did not know the responsibility the therapist has in developing your treatment plan. Unless your physician micromanages your case, your therapist is in charge of your program and has to be knowledgable. Six weeks of PROM exercises seems so conservative but is crucial to allowing the artificial joint to settle in to place. Gradual introduction of AROM exercises in the six to twelve week post op window increases arm use but does not endanger the integrity of the prosthesis. Reverse Total Shoulder arthroplasty is still relatively rare so an uninformed cavalier therapist could easily get it wrong. I even had to explain how it was different to my primary care doctor and my thoracic surgeon! I read everything I could find on the web before I started therapy and I was so relieved to find my therapist and I were on the same page!
Anyway, the chill in the air at PT this morning was not just due to the air conditioning.
(PROM=passive range of motion, AROM= active range of motion)
A few therapists have been laid off. Salaries are being restructured so there will likely be some people leave as their pay is reduced. Scheduling is being condensed and hours extended so that fewer therapists can cover the same number of patient encounters. Happy chatter has been replaced with subdued and terse clinical instruction.
Thank goodness my therapist is still on staff. A wise decision by the new hierarchy. I have been so pleased with her. I really did not know the responsibility the therapist has in developing your treatment plan. Unless your physician micromanages your case, your therapist is in charge of your program and has to be knowledgable. Six weeks of PROM exercises seems so conservative but is crucial to allowing the artificial joint to settle in to place. Gradual introduction of AROM exercises in the six to twelve week post op window increases arm use but does not endanger the integrity of the prosthesis. Reverse Total Shoulder arthroplasty is still relatively rare so an uninformed cavalier therapist could easily get it wrong. I even had to explain how it was different to my primary care doctor and my thoracic surgeon! I read everything I could find on the web before I started therapy and I was so relieved to find my therapist and I were on the same page!
Anyway, the chill in the air at PT this morning was not just due to the air conditioning.
(PROM=passive range of motion, AROM= active range of motion)
Sunday, August 3, 2014
Allowed to drive again! PO day 48.
When I just saw my surgeon at the six weeks post op visit this past week he said I could resume driving IF I was not taking narcotic pain medications, could steer well enough to execute a sudden swerve motion, and could grasp the wheel with hands positioned at 10:00 and 2:00.
I can do all that. But the 10:00 and 2:00 hand position on the steering wheel harkens back to driver's education circa 1965. Cars of that era did not have power steering and placing your hands at 10 and 2 gave you the extra force needed to rotate the steering wheel for tight turns.
Now we are advised to grasp the wheel at 9:00 and 3:00, or better, at 8:00 and 4:00.
The reasons? Because the steering wheel tilts toward the windshield, when hands are at 10 and 2 your arms are pretty straight. In a wreck you are more inclined to lock your elbows as you brace for impact. This transfers the force of the collision to your shoulders, likely causing more injury. If your hands are placed lower on the steering wheel your elbows are bent and won't lock.
Furthermore, if the airbag deploys and your hands are high on the wheel, your forearms will absorb the force of the airbag. It's a bit of dissembling to say an airbag deploys; it is really an explosion resulting in heat and gas, kind of a controlled chemical reaction. Better to have your hands and arms lower and out of the way. Hopefully your seatbelt will restrain your torso and head and keep them far enough back to avoid both the force and the heat of the "deployment."
But if you are intent on driving before you can comfortably use your broken arm, which, by the way, APPEARS to be perfectly legal as long as you can reach all of the controls, you might want to install a "necker knob" on the wheel. Popular before power steering and bucket seats, the knob allowed one–handed steering to free the driver to wrap his other arm around his sweetie. But be careful. When the car has completed its turn and the wheel spins back the knob can whack you on the wrist or elbow. Not so cool.
I can do all that. But the 10:00 and 2:00 hand position on the steering wheel harkens back to driver's education circa 1965. Cars of that era did not have power steering and placing your hands at 10 and 2 gave you the extra force needed to rotate the steering wheel for tight turns.
Now we are advised to grasp the wheel at 9:00 and 3:00, or better, at 8:00 and 4:00.
The reasons? Because the steering wheel tilts toward the windshield, when hands are at 10 and 2 your arms are pretty straight. In a wreck you are more inclined to lock your elbows as you brace for impact. This transfers the force of the collision to your shoulders, likely causing more injury. If your hands are placed lower on the steering wheel your elbows are bent and won't lock.
Furthermore, if the airbag deploys and your hands are high on the wheel, your forearms will absorb the force of the airbag. It's a bit of dissembling to say an airbag deploys; it is really an explosion resulting in heat and gas, kind of a controlled chemical reaction. Better to have your hands and arms lower and out of the way. Hopefully your seatbelt will restrain your torso and head and keep them far enough back to avoid both the force and the heat of the "deployment."
But if you are intent on driving before you can comfortably use your broken arm, which, by the way, APPEARS to be perfectly legal as long as you can reach all of the controls, you might want to install a "necker knob" on the wheel. Popular before power steering and bucket seats, the knob allowed one–handed steering to free the driver to wrap his other arm around his sweetie. But be careful. When the car has completed its turn and the wheel spins back the knob can whack you on the wrist or elbow. Not so cool.
Saturday, August 2, 2014
Hip or Hype? PO Day 47
Have you been seeing athletes with colorful bands of tape here and there? The first time I saw it was on Misty May and Keri Walsh, the great volley ball team. The tape is part of the kinesiology theory of treating various aches, pains and injuries sustained by athletes and even ordinary people. I am a bit of a skeptic as it purports to heal everything from carpal tunnel syndrome to rotator cuff injury. But one of my therapists applied a strip of the tape to my scar the other day and I thought it had a good effect.
The scar had become slightly elevated and was beginning to look kind of like a two lane highway with a divider down the middle. There were a couple puckers, probably from stitches. She first massaged the scar, then applied the tape. She said to leave the tape in place 24 hours, then replace it with a new piece.
I think it made a difference! After two days the scar had flattened out and looked less puckery. So I have ordered some. I opted for the beige, no pink or blue or green. The added benefit is that it covers the scar and protects it from sun exposure. It's not expensive so I thought it was worth a try.
Maybe now I can pass off a klutzy accident as some cool sports injury.
The scar had become slightly elevated and was beginning to look kind of like a two lane highway with a divider down the middle. There were a couple puckers, probably from stitches. She first massaged the scar, then applied the tape. She said to leave the tape in place 24 hours, then replace it with a new piece.
I think it made a difference! After two days the scar had flattened out and looked less puckery. So I have ordered some. I opted for the beige, no pink or blue or green. The added benefit is that it covers the scar and protects it from sun exposure. It's not expensive so I thought it was worth a try.
Maybe now I can pass off a klutzy accident as some cool sports injury.
Friday, August 1, 2014
If everything is so great why.... PO Day 46
I saw my orthopedic surgeon, Dr. Kai, Wednesday. First, they were really glad to see me looking better. Last visit was when my pneumothorax was discovered. (PODay 10). I rolled into their office in a wheelchair and I'm sure there was a little eye rolling behind the scenes, thinking I was a real drama queen. Everyone including me, was all smiles this time.
I am so pain free that I think it even surprises my doctor. I am beginning to have some use of my arm, just in the past few days of AROM therapy. (That's active range of motion) The X-rays show everything exactly where it's supposed to be. There's no swelling. The incision looks good. I no longer have to wear the sling unless I am out in crowds. Thank goodness, I was sure I was going to wake up dead one morning, strangled by the sling strap wound around my neck.
So, if everything is so great, why am I still not allowed to pick up anything heavier than a coffee cup? Why can't I hook my bra behind my back? Why can't I use my right arm to shift around in bed or pull the pillow from behind my back? How much harm could be caused by tucking in a shirt or pulling up a tight pair of bicycle shorts with the right hand. I'd like to scratch my right shoulder blade but that's a no-no. And heaven forbid I might lean back on my right elbow.
BECAUSE... The artificial ball and socket are not connected. They're not glued together. The ball slides loosely, freely against the socket. What keeps them together? Inertia? Gravity? A mass of flesh and tissue and vessels, a little muscle maybe. So until all those living cells reconnect and reform and regrow the new joint is not secure. Move the wrong way, especially extension and adduction, and the ball can pop out of the joint and bounce you right back to the operating room!
I am definitely following the rules!
I am so pain free that I think it even surprises my doctor. I am beginning to have some use of my arm, just in the past few days of AROM therapy. (That's active range of motion) The X-rays show everything exactly where it's supposed to be. There's no swelling. The incision looks good. I no longer have to wear the sling unless I am out in crowds. Thank goodness, I was sure I was going to wake up dead one morning, strangled by the sling strap wound around my neck.
So, if everything is so great, why am I still not allowed to pick up anything heavier than a coffee cup? Why can't I hook my bra behind my back? Why can't I use my right arm to shift around in bed or pull the pillow from behind my back? How much harm could be caused by tucking in a shirt or pulling up a tight pair of bicycle shorts with the right hand. I'd like to scratch my right shoulder blade but that's a no-no. And heaven forbid I might lean back on my right elbow.
BECAUSE... The artificial ball and socket are not connected. They're not glued together. The ball slides loosely, freely against the socket. What keeps them together? Inertia? Gravity? A mass of flesh and tissue and vessels, a little muscle maybe. So until all those living cells reconnect and reform and regrow the new joint is not secure. Move the wrong way, especially extension and adduction, and the ball can pop out of the joint and bounce you right back to the operating room!
I am definitely following the rules!
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