Time flies when you're having fun or even if you're not. It's hard to imagine that I am four and a half months post rTSA. Sometimes it is as if the surgery was yesterday and other times it seems a year ago.
I think I am getting along very well. My range of motion is excellent. It surprises me, even, at how high or far I can reach. I can reach up and take down the hand held shower attachment, I can hang up or take down clothes from a high closet rack, I can put away dishes on the upper cabinet shelves. Turning the car steering wheel, hand over hand, had been a lingering annoyance but going on a recent little trip where I drove a lot seemed to work out most of the kinks. Ordinary housework has become pretty ordinary, I can even put a pillow case on a pillow which had been a problem. I can gently use my right arm to push up from a chair or sofa. That is a big help! In an abundance of caution, I still don't use my right arm to shift around in bed.
Ever since surgery, I have had a sharp pain mid way down the upper arm, in the front and in the back. The doctor says it is where the deltoid muscle is now attached to the humerus. It has been gradual but I think I can say that I no longer have the pain in the front of the arm. It's still there on the back side of my upper arm but I now have hope it will disappear eventually. The weird little twitches and aches I used to experience high up at the top of the humerus are gone. I do not have good strength in my right arm, lifting a two pound weight is hard work, I trust the arm will gradually get stronger with time and exercise.
I do have a sharp discomfort if I try to reach my right arm across my chest close to my body. And I do not even think about putting my right arm behind my back. Other than those motions I am pretty good. I think they involve adduction in physical therapy "speak" which was an early no-no and
apparently still is.
Alas, my hair is still falling out more than I would like. It's thick enough but such a nuisance; stray hairs scatter across the bathroom vanity and fall down onto my iPad screen as I lean over it to type. I haven't found any more in my food lately but it is inevitable.
My stamina is better but not back to normal. I am sure that is the aftermath of the pneumothorax and time will put things right. I recently had blood work and am no longer anemic so I can stop those awful iron supplements. I am still trying to get back to walking my full three mile route. Too many things interfere.
But my enthusiasm for little projects is back. I feel good. Strangely, I still haven't recovered my lust for shopping. Maybe Christmas will cure me. I see my orthopod again in December, I think. I should be doing very well by then. We'll see...
Friday, October 31, 2014
Thursday, October 30, 2014
Notes from the Dark Side...PODay 137
I discussed my apparent insomnia with my doctor recently. In the past when I couldn't sleep I never thought of it as insomnia. I just thought that I wasn't sleepy. Semantics, I know.. I have been frequenting too many doctor's offices lately. Before I looked at sleeplessness as a bonus, some extra time to accomplish some little job I didn't get to in the waking hours. I could balance the checkbook, write a letter or two (before email), bake cookies, or iron the shirts that tended to live in the bottom of the basket. The only "problem" lay in the fact that I had to get up and go to work in the morning. Now, being retired, I can sleep late or take a catnap as needed.
So why does my being awake in the night have to have a name and a cause and a solution?
We each have a "basic sleep need" which is different for everyone. People like Bill Clintom and Martha Stewart claim to need very little sleep, perhaps three or four hours a night. That explains how they can get so much accomplished in a 24 hour day. If we don't get enough sleep we create a "sleep debt," the accumulated loss of sleep that our body wants us to catch up on occasionally. Add to that the natural circadian rhythm, that primeval tendency to get sleepy after lunch and in the "wee, small hours of the morning," and, even if we think we've had adequate rest, we find ourselves nodding off at our desk or, heaven forbid, falling asleep at the wheel.
Sleep experts say sleeping too little, say fewer than seven hours a night, can cause depression, weight gain, even increased morbidity. But they also say sleeping too much, say more than nine hours a night, can cause depression, weight gain, even increased morbidity. What is a person to do?
Recommendations include:
http://youtu.be/3uEPDEJbJu0
So why does my being awake in the night have to have a name and a cause and a solution?
We each have a "basic sleep need" which is different for everyone. People like Bill Clintom and Martha Stewart claim to need very little sleep, perhaps three or four hours a night. That explains how they can get so much accomplished in a 24 hour day. If we don't get enough sleep we create a "sleep debt," the accumulated loss of sleep that our body wants us to catch up on occasionally. Add to that the natural circadian rhythm, that primeval tendency to get sleepy after lunch and in the "wee, small hours of the morning," and, even if we think we've had adequate rest, we find ourselves nodding off at our desk or, heaven forbid, falling asleep at the wheel.
Sleep experts say sleeping too little, say fewer than seven hours a night, can cause depression, weight gain, even increased morbidity. But they also say sleeping too much, say more than nine hours a night, can cause depression, weight gain, even increased morbidity. What is a person to do?
Recommendations include:
- Establish consistent sleep and wake schedules, even on weekends
- Create a regular, relaxing bedtime routine such as soaking in a hot bath or listening to soothing music – begin an hour or more before the time you expect to fall asleep
- Create a sleep-conducive environment that is dark, quiet, comfortable and cool
- Sleep on a comfortable mattress and pillows
- Use your bedroom only for sleep and sex (keep "sleep stealers" out of the bedroom – avoid watching TV, using a computer or reading in bed)
- Finish eating at least 2-3 hours before your regular bedtime
- Exercise regularly.
- Avoid caffeine and alcohol products close to bedtime and give up smoking
Or, get up and catch up on those little jobs you've been avoiding, like writing a post for your blog.
http://youtu.be/3uEPDEJbJu0
Wednesday, October 29, 2014
Computer trouble...PO Day 136
Never think you can solve someone else's computer problem!
I don't know what I was thinking! When did I become the computer maven around here? I had stumbled through installing a new gmail account on my computer and that made me an expert? Dear Husband wanted to install a gmail account that had been inactive for a few years on his computer's mail program and I acted like I knew all about it. "I'll do it for you," I offered. Unfortunately, he trusts me.
So here I sit, watching that little revolving gear spinning for at least the last thirty minutes, waiting to speak to Apple tech support. What went wrong? Well, first, while he had not been using the gmail account for a few years, incoming mail had continued to pile up so that there were more than 20,000 emails downloading to his computer when we got the old/new account installed. It's too long a story but we (I really mean I) kept creating mirror accounts so at one point there were 92,000 emails coming in.
Much later... Apple was very busy today but I finally connected with a great female tech. She was so gracious and made me feel not so much like an idiot. There was a simple software error that was keeping the messages from being deleted at each attempt. Love Apple's ability to take control of your computer and see what you see. Can't believe how knowledgable the techs are. And how nice! The smartest thing Dear Husband did when he bought this computer was to pay for an additional two years technical support. I joke that I am sure there is a black mark that comes up beside our phone number when we call in!
Wouldn't it be terrific if we could pay for "support"for our poor bodies? I would call the 800 number and report that there had been an accident and a peripheral part had been broken. Two days later a package would arrive by Fed Ex containing the modular shoulder components that connect the humerus to the scapula. The directions would be a little difficult to discern, all pictures and no words. It would include a CD to guide you if needed. Trial and error and a few bad words later, the new shoulder would be installed and operational...no operation involved. Just in my imagination.
http://youtu.be/pBOX_YbwT9
I don't know what I was thinking! When did I become the computer maven around here? I had stumbled through installing a new gmail account on my computer and that made me an expert? Dear Husband wanted to install a gmail account that had been inactive for a few years on his computer's mail program and I acted like I knew all about it. "I'll do it for you," I offered. Unfortunately, he trusts me.
So here I sit, watching that little revolving gear spinning for at least the last thirty minutes, waiting to speak to Apple tech support. What went wrong? Well, first, while he had not been using the gmail account for a few years, incoming mail had continued to pile up so that there were more than 20,000 emails downloading to his computer when we got the old/new account installed. It's too long a story but we (I really mean I) kept creating mirror accounts so at one point there were 92,000 emails coming in.
Much later... Apple was very busy today but I finally connected with a great female tech. She was so gracious and made me feel not so much like an idiot. There was a simple software error that was keeping the messages from being deleted at each attempt. Love Apple's ability to take control of your computer and see what you see. Can't believe how knowledgable the techs are. And how nice! The smartest thing Dear Husband did when he bought this computer was to pay for an additional two years technical support. I joke that I am sure there is a black mark that comes up beside our phone number when we call in!
Wouldn't it be terrific if we could pay for "support"for our poor bodies? I would call the 800 number and report that there had been an accident and a peripheral part had been broken. Two days later a package would arrive by Fed Ex containing the modular shoulder components that connect the humerus to the scapula. The directions would be a little difficult to discern, all pictures and no words. It would include a CD to guide you if needed. Trial and error and a few bad words later, the new shoulder would be installed and operational...no operation involved. Just in my imagination.
http://youtu.be/pBOX_YbwT9
Tuesday, October 28, 2014
Do No Harm...PODay 135
Hippocrates, Greek physician circa 400 BC, is often referred to as the father of western medicine. While it is hard to separate fact from fiction about him, he is credited with being the author of the Hippocratic oath which physicians and other medical professionals still swear to today. Hippocrates was one of the first to believe that disease was a natural development, not a condition caused by gods or superstition. In spite of that, the Hippocratic oath calls on a variety of ancient healing gods to support the physician in striving to adhere to ethical standards in the treatment of patients. He is commonly associated with the phrase "do no harm" which is not part of the oath and not a part of his known writings and probably originated much later in the 19th century.
Through history and prehistory, medicine has striven to establish standards of care. One of the earliest records of guidelines for the medical care giver was established as part of Hammurabi's Code. Hammurabi, a Babylonian King in 1772 BC, established the code which consists of prescribed punishments for societal misdeeds from contract law to murder. It is possibly the father of the "eye for an eye, a tooth for a tooth" moral prerogative. Scaled punishments were linked to social status, particularly slave versus free man. Most of the law related to business transactions like wages, fines for doing a poor job, or damages for failure to fulfill a contract.
Of particular interest is the section of the law that deals with the practice of medicine which was regulated by the state. Malpractice was recognized and specific penalties were laid down. "If a surgeon performs a major operation on an 'awelum' (nobleman), with a lancet and caused the death of this man, they shall cut off his hands." Hammurabi also specified fees for life saving operations; ten shekels of silver for treating a nobleman, five shekels for a poor man and two shekels for a slave.
I guess the modern physician does not have it so bad after all. While malpractice insurance can be thought of as brutal, it is not as draconian as Hammurabi's Code.
http://youtu.be/cmjrTcYMqBM
Archive timeline: 2014: May and June - preparing for surgery, July - surgery and post op problems, August - recovery and physical therapy, September - thinking medically, Octobe
Through history and prehistory, medicine has striven to establish standards of care. One of the earliest records of guidelines for the medical care giver was established as part of Hammurabi's Code. Hammurabi, a Babylonian King in 1772 BC, established the code which consists of prescribed punishments for societal misdeeds from contract law to murder. It is possibly the father of the "eye for an eye, a tooth for a tooth" moral prerogative. Scaled punishments were linked to social status, particularly slave versus free man. Most of the law related to business transactions like wages, fines for doing a poor job, or damages for failure to fulfill a contract.
Of particular interest is the section of the law that deals with the practice of medicine which was regulated by the state. Malpractice was recognized and specific penalties were laid down. "If a surgeon performs a major operation on an 'awelum' (nobleman), with a lancet and caused the death of this man, they shall cut off his hands." Hammurabi also specified fees for life saving operations; ten shekels of silver for treating a nobleman, five shekels for a poor man and two shekels for a slave.
I guess the modern physician does not have it so bad after all. While malpractice insurance can be thought of as brutal, it is not as draconian as Hammurabi's Code.
http://youtu.be/cmjrTcYMqBM
Archive timeline: 2014: May and June - preparing for surgery, July - surgery and post op problems, August - recovery and physical therapy, September - thinking medically, Octobe
Monday, October 27, 2014
My Medicare.gov...PO Day 134
I realized today that I have not received a medicare Summary Notice for the time period from my surgery in June till now. Furthermore that summary is usually just medicare Part B. I don't know what I will receive from medicare Part A. I haven't been an inpatient in a long time. So I decided to look it up on line.
Three or four years ago I signed up with my medicare.gov so I decided to go there if I could remember how. It took a while but I finally figured out my user name and password and logged in. It was all there, names, dates and amounts. Part A charges were mixed in with Part B charges. I continue to be amazed at the negotiated amounts medicare pays for procedures. Everything I've read has suggested joint replacement surgery would run in the neighborhood of $50,000.00. Certainly, considering my additional six days in the hospital due to pneumothrorax, my bill would be exorbinate.
Total approved charges came to about a third of what I expected.That included doctor fees, hospital fees, tons of xrays and a handful of cat scans and MRIs. There were outpatient doctor visits, radiologists who read the scans, and a few doctors I never heard of. I am still stunned. I continue to read how doctors and hospitals are under great pressure due to cuts in fees by managed health care. It has to be true.
I have heard, don't know if it is true or not, that in big cities many specialists will not see Medicare patients because of the low reimbursement. I can believe that if there is a patient base of working age clients, patients with private insurance or even those who pay personally, enough to fill a doctor's schedule, that the physician would choose to not accept Medicare patients. I feel fortunate to live where, if a doctor didn't see Medicare aged people, he wouldn't have anyone to see at all.
I just know I need to bake and take more cookies! Or is it kookies?
http://youtu.be/MT9QZBGyXjU
Archive timeline: 2014: May and June - preparing for surgery, July - surgery and post op problems, August - recovery and physical therapy, September - thinking medically, Octobe
Three or four years ago I signed up with my medicare.gov so I decided to go there if I could remember how. It took a while but I finally figured out my user name and password and logged in. It was all there, names, dates and amounts. Part A charges were mixed in with Part B charges. I continue to be amazed at the negotiated amounts medicare pays for procedures. Everything I've read has suggested joint replacement surgery would run in the neighborhood of $50,000.00. Certainly, considering my additional six days in the hospital due to pneumothrorax, my bill would be exorbinate.
Total approved charges came to about a third of what I expected.That included doctor fees, hospital fees, tons of xrays and a handful of cat scans and MRIs. There were outpatient doctor visits, radiologists who read the scans, and a few doctors I never heard of. I am still stunned. I continue to read how doctors and hospitals are under great pressure due to cuts in fees by managed health care. It has to be true.
I have heard, don't know if it is true or not, that in big cities many specialists will not see Medicare patients because of the low reimbursement. I can believe that if there is a patient base of working age clients, patients with private insurance or even those who pay personally, enough to fill a doctor's schedule, that the physician would choose to not accept Medicare patients. I feel fortunate to live where, if a doctor didn't see Medicare aged people, he wouldn't have anyone to see at all.
I just know I need to bake and take more cookies! Or is it kookies?
http://youtu.be/MT9QZBGyXjU
Archive timeline: 2014: May and June - preparing for surgery, July - surgery and post op problems, August - recovery and physical therapy, September - thinking medically, Octobe
Sunday, October 26, 2014
Penalties for readmission.PO Day 133
So I told you about the Hospital Compare site in Post 130. It sounded so benign and like the whole purpose was to be supportive of hospital and patient alike. It turns out the government gives and the government takes away.
Compiling all those statistics about readmissions to the hospital and educating patients and hospital staff to recognize little problems before they turn into big ones to prevent those readmissions has a more punitive outcome. Since 2010 data has been being compiled about readmittance rates for patients who were in hospital for heart attack, heart failure and pneumonia. Hospitals are fined for patients who are readmitted within 30 days of discharge. Now hip and knee replacement surgery patients have been added to the list.
Hospitals can be penalized as much as 3% of their medicare charges. 2610 hospitals across 29 states will be penalized these year. More hospitals are being fined this year because of the addition of the joint replacement surgeries even though they have reduced the readmission rates for other conditions. Hospitals are in a "catch 22" situation as the financial gain of readmission outpaces the fines for too high a rate of readmissison. What to do?
I suppose eventually shoulder replacement surgery will be added to the list of conditions for which hospitals can be fined. I am so glad that has not happened yet or I would be one of those patients who are part of the problem! In some weird way I do feel like a "bad" patient for developing complications that put me back in the hospital. I am just glad that at this stage I don't count.
Compiling all those statistics about readmissions to the hospital and educating patients and hospital staff to recognize little problems before they turn into big ones to prevent those readmissions has a more punitive outcome. Since 2010 data has been being compiled about readmittance rates for patients who were in hospital for heart attack, heart failure and pneumonia. Hospitals are fined for patients who are readmitted within 30 days of discharge. Now hip and knee replacement surgery patients have been added to the list.
Hospitals can be penalized as much as 3% of their medicare charges. 2610 hospitals across 29 states will be penalized these year. More hospitals are being fined this year because of the addition of the joint replacement surgeries even though they have reduced the readmission rates for other conditions. Hospitals are in a "catch 22" situation as the financial gain of readmission outpaces the fines for too high a rate of readmissison. What to do?
I suppose eventually shoulder replacement surgery will be added to the list of conditions for which hospitals can be fined. I am so glad that has not happened yet or I would be one of those patients who are part of the problem! In some weird way I do feel like a "bad" patient for developing complications that put me back in the hospital. I am just glad that at this stage I don't count.
Saturday, October 25, 2014
MY Simple Shoulder Test..PO Day 132
Here is my version of the SST, the Simple Shoulder Test, modified to fit my lifestyle:
Can I ride my bicycle now?
Am I able to use garden two handed loppers to trim an unruly vine?
Am I able to reach under the pull out bottom freezer drawer to clean up all the ice cubes that fall down there?
Can I reach behind my back to hook a bra or zip a dress?
Am I able to put on a necklace with a small hook by myself again?
Can I move the heavy couches in the living room to clean under and behind them?
Have I stopped looking down when I walk, worrying that I will stumble and fall?
Am I able to sleep on my right side again? And sleep the night through?
Can I dip ice cream from a carton from the freezer?
Am I able to lift down that really heavy Staub cast iron pot from the top shelf?
Am I able to use those two new kayaks I bought the week I fell and broke my arm?
Have I run out of things to say or write about reverse Total Shoulder Replacement Surgery?
Now, that seems relevant!
http://youtu.be/AlGvRwalchQ
Archive timeline: 2014: May and June - preparing for surgery, July - surgery and post op problems, August - recovery and physical therapy, September - thinking medically.
Friday, October 24, 2014
Simple Shoulder Test..PO Day 131
In an attempt to standardize a patient's personal appraisal of their situation and their progress, the University of Washington developed the Simple Shoulder Test. The test consists of twelve questions relating to what a person in the 60 to 70 years old category can reasonably expect to be able to do, assuming they have no shoulder problem. The patient is asked to complete the test, answering only "yes" or "no", with no input from the therapist, before treatment and again at the end of treatment.
This test has become very popular and has shown to be a good indicator of how the patient perceives their progress. It is easy to,personalize the test by modifying questions to suit the athletic experience of the patient or allow for regional differences. "The Simple Shoulder Test provides a practical method for determining the pretreatment shoulder function as well as the shoulder function at various intervals after the treatment. Sequential SST's indicate the length of time required to achieve maximum functional benefit after treatment. The difference between the shoulder function before treatment and after the recovery period is the effectiveness of the treatment."
Here are the standard twelve questions of the SST:
Is your shoulder comfortable with your arm at rest by your side?
Does your shoulder allow you to sleep comfortably?
Can you reach the small of your back to tuck in your shirt with your hand?
Can you place your hand behind your head with the elbow straight out to the side?
Can you place a coin on a shelf at the level of your shoulder without bending your elbow?
Can you lift one pound (a full pint container) to the level of your shoulder without bending your elbow?
Can you lift eight pounds (a full gallon container) to the level of the top of your head without bending your elbow?
Can you carry 20 pounds at your side with the affected extremity?
Do you think you can toss a softball underhand 10 yards with the affected extremity?
Do you think you can throw a softball overhand 20 yards with the affected extremity?
Can you wash the back of your opposite shoulder with the affected extremity?
Would your shoulder allow you to work full-time at your usual job?
These are pretty tough for me at this stage. Actually, at any stage. I don't think I could lift a full gallon of milk to the level of my head with my "good" arm without bending my elbow. And throwing a ball 20 yards? Not with any accuracy. I need a test for me!
http://youtu.be/NafbYJOH0Tw
Archive timeline: 2014: May and June - preparing for surgery, July - surgery and post op problems, August - recovery and physical therapy, September - thinking medically, Octobe
Thursday, October 23, 2014
Hospital compare site...P O Day 130
CMS, the government administrative arm of Medicare, has created "the Hospital Compare" data base. This allows the Medicare patient to compare the rate of unplanned readmissions or deaths within 30 days of being in the hospital of their choice with the rate of those unfortunate events at other hospitals locally or nationwide. The purpose is to improve the quality of care with a measurement that is easy for the consumer to understand. The goal for the hospital is to anticipate and prevent problems that lead to readmission or even death following hospitalization for certain conditions.
"Hospital Compare" records and reports instances when the patient is readmitted to the hospital within 30 days of discharge if they were initially treated for 1. heart attack, 2. heart failure, 3. pneumonia, 4. hip/knee replacement surgery, or 5. hospital-wide readmission to include internal medicine, surgery/gynecology, cardiorespiratory, cardiovascular and neurology services.
Also reported is the 30 day death rate from heart attack, heart failure or pneumonia.
They keep track of surgical complications such as: pneumothorax, blood clots, postoperative wound dehiscense, accidental puncture or laceration, pressure sores, venous catheter related infections, postoperative hip fracture due to a fall, and postoperative sepsis.
Ultimately this data serves two purposes: First, the patient can go to the Hospital Compare Home Page and compare the record of three hospitals of their choosing. This rate is also compared to national averages. Second, Hospital Compare is part of the Hospital Quality Initiative whose intent is to help improve hospitals' quality of care by distributing objective, easy to understand data on hospital performance. both for the benefit of the patient and the hospital.
This is a great way to be able to compare your local hospital with other nearby facilities and even nationwide statistics. To go to the Home Page of Hospital Compare by clicking on this link
http://www.medicare.gov/hospitalcompare/search.html:
I briefly mentioned this medicare site on P O Day 83 so if you have already checked it out thoroughly, forgive the repetition.
Archive timeline: 2014: May and June - preparing for surgery, July - surgery and post op problems, August - recovery and physical therapy, September - thinking medically, October--
"Hospital Compare" records and reports instances when the patient is readmitted to the hospital within 30 days of discharge if they were initially treated for 1. heart attack, 2. heart failure, 3. pneumonia, 4. hip/knee replacement surgery, or 5. hospital-wide readmission to include internal medicine, surgery/gynecology, cardiorespiratory, cardiovascular and neurology services.
Also reported is the 30 day death rate from heart attack, heart failure or pneumonia.
They keep track of surgical complications such as: pneumothorax, blood clots, postoperative wound dehiscense, accidental puncture or laceration, pressure sores, venous catheter related infections, postoperative hip fracture due to a fall, and postoperative sepsis.
Ultimately this data serves two purposes: First, the patient can go to the Hospital Compare Home Page and compare the record of three hospitals of their choosing. This rate is also compared to national averages. Second, Hospital Compare is part of the Hospital Quality Initiative whose intent is to help improve hospitals' quality of care by distributing objective, easy to understand data on hospital performance. both for the benefit of the patient and the hospital.
This is a great way to be able to compare your local hospital with other nearby facilities and even nationwide statistics. To go to the Home Page of Hospital Compare by clicking on this link
http://www.medicare.gov/hospitalcompare/search.html:
I briefly mentioned this medicare site on P O Day 83 so if you have already checked it out thoroughly, forgive the repetition.
Archive timeline: 2014: May and June - preparing for surgery, July - surgery and post op problems, August - recovery and physical therapy, September - thinking medically, October--
Wednesday, October 22, 2014
Just Do It...PODay 129
Every time I try a new motion or activity with my operated arm, it is at the least difficult, and often hurts. It's not the bone parts that hurt, it's where the deltoid muscle has been connected up to the bone about half way down my upper arm. Since the rotator cuff was damaged so badly, and that's why a rTSA was necessary, the only way to to be able to lift and use the arm is to put the deltoid muscle to work in a new way. So first of all, my arm has had very little exercise in the past fifteen months so all the muscles are out of shape. Second, the deltoid muscle has a new job to learn. And third, I have no idea how the deltoid muscle is affixed to the humerus but according to the op notes it involves #2 non absorbable heavy duty suture material and some pretty fancy knots. Why wouldn't it hurt?
When the day came that I thought my right arm ought to participate in rotating the steering wheel my right arm had a different opinion. It complained loudly. Well, the loudly came from me saying OW, OW, OW with every hand over hand motion. As uncomfortable as it was, I toughed it out and within a couple days and a few short trips around town, the discomfort was much lessened. After a few weeks, it still hurts a little but the ows are much fewer.
It's still a little uncomfortable to use my right arm to brush my hair, wash my hair, scratch the top of my head, or even put a pierced earring in my left earlobe. But every time I do it, it gets a little easier.
The projet du jour (a bad job just sounds classier in French) was applying two coats of liquid wax to the kitchen floor. Of course it had to be mopped pretty good first. Naturally, the old right arm didn't like it one bit. When a particularly dirty spot demanded a little elbow grease and individual attention, the right arm grudgingly participated but there wasn't a lot of enthusiasm. Even sliding the sponge mop back and forth to apply the wax seemed more than the arm wanted to do and complaints had to be ignored. I got it done and the floor looks much better and my arm is only a little worse for the wear.
I guess what I'm trying to say is I have to persevere in spite of some discomfort. The more I push myself the more progress I make. But I have talked to my surgeon about what I can and cannot do and I keep his advice in mind. I certainly don't want to damage anything and a clean, waxed floor is not worth some imagined post surgical complication.
But it does look nice now. The floor, not my arm.
http://youtu.be/y56SNOsfgq8
Archive timeline: 2014: May and June - preparing for surgery, July - surgery and post op problems, August - recovery and physical therapy, September - thinking medically, October--
When the day came that I thought my right arm ought to participate in rotating the steering wheel my right arm had a different opinion. It complained loudly. Well, the loudly came from me saying OW, OW, OW with every hand over hand motion. As uncomfortable as it was, I toughed it out and within a couple days and a few short trips around town, the discomfort was much lessened. After a few weeks, it still hurts a little but the ows are much fewer.
It's still a little uncomfortable to use my right arm to brush my hair, wash my hair, scratch the top of my head, or even put a pierced earring in my left earlobe. But every time I do it, it gets a little easier.
The projet du jour (a bad job just sounds classier in French) was applying two coats of liquid wax to the kitchen floor. Of course it had to be mopped pretty good first. Naturally, the old right arm didn't like it one bit. When a particularly dirty spot demanded a little elbow grease and individual attention, the right arm grudgingly participated but there wasn't a lot of enthusiasm. Even sliding the sponge mop back and forth to apply the wax seemed more than the arm wanted to do and complaints had to be ignored. I got it done and the floor looks much better and my arm is only a little worse for the wear.
I guess what I'm trying to say is I have to persevere in spite of some discomfort. The more I push myself the more progress I make. But I have talked to my surgeon about what I can and cannot do and I keep his advice in mind. I certainly don't want to damage anything and a clean, waxed floor is not worth some imagined post surgical complication.
But it does look nice now. The floor, not my arm.
http://youtu.be/y56SNOsfgq8
Archive timeline: 2014: May and June - preparing for surgery, July - surgery and post op problems, August - recovery and physical therapy, September - thinking medically, October--
Tuesday, October 21, 2014
PT 18 Weeks PO...P O Day 128
I reported my physical therapy at 6 weeks and again at 12 weeks. So here I am at 18 weeks post op. I am no longer in formal physical therapy but I continue to keep up some of the exercises. My shoulder certainly feels like it would stiffen up if I did not keep after it. Even just sleeping overnight makes it noticeably less limber the next morning so first thing I do when I awaken is stretches.
I am following up with a Home Exercise Program. This is typical for a rTSA patient at sixteen weeks or four months post op. I do my exercises in spurts during the day, not all at once like when I was in formal PT. I have two goals: continue the progress I have made in AROM (active range of motion) that leads to normal function of my operated arm in real life and improve strength in the operated arm. I find the AROM progressing very well. I have a way to go in the increase strength department. But, as I mentioned in an earlier post, ROM improves in the first six months post op, while strength is built up in the second six months post op. (According to my web reading, for what it is worth.)
For ROM, I use simple pulleys. I do 3 minutes of pulleys when I get up in the AM. Three or four times a day I do three sets of ten supine flexion with a wand and three sets of ten standing up flexion with a wand. I try to work in a set or two of abduction with wand and a set or two of external/internal rotation with a wand but for some reason I am not as consistent in doing those. I do the flexion slide up the wall thing in the shower, always.
For strength, I use a two pound weight. You would think it weighed twenty pounds! I do two or three sets of simple curls. That is getting easier. And I do two sets of one arm military presses. That is hard! I'd like to jump up to five pounds but it just isn't happening. I guess I am using what I read as an excuse to focus on ROM for now and will work on strengthening exercises later. I am not doing any stretch band work. Maybe next month. It's just too hard right now.
Finally, I am increasingly active in housework and garden clean up. Surely I get some credit for that! Although it is said you don't burn many calories in ordinary housework. My arm is still pretty tight. But I have very good ROM and hope to maintain it. I constantly remind myself to use my operated arm to reach and lift. It's easy to forget to use it. My arm does still hurt but less and less as time passes. I can't complain.
I am only doing exercises prescribed by my therapist who knows my situation.
I think it is important to follow your own therapist's advice and program.
http://youtu.be/vWz9VN40nCA
I am following up with a Home Exercise Program. This is typical for a rTSA patient at sixteen weeks or four months post op. I do my exercises in spurts during the day, not all at once like when I was in formal PT. I have two goals: continue the progress I have made in AROM (active range of motion) that leads to normal function of my operated arm in real life and improve strength in the operated arm. I find the AROM progressing very well. I have a way to go in the increase strength department. But, as I mentioned in an earlier post, ROM improves in the first six months post op, while strength is built up in the second six months post op. (According to my web reading, for what it is worth.)
For ROM, I use simple pulleys. I do 3 minutes of pulleys when I get up in the AM. Three or four times a day I do three sets of ten supine flexion with a wand and three sets of ten standing up flexion with a wand. I try to work in a set or two of abduction with wand and a set or two of external/internal rotation with a wand but for some reason I am not as consistent in doing those. I do the flexion slide up the wall thing in the shower, always.
For strength, I use a two pound weight. You would think it weighed twenty pounds! I do two or three sets of simple curls. That is getting easier. And I do two sets of one arm military presses. That is hard! I'd like to jump up to five pounds but it just isn't happening. I guess I am using what I read as an excuse to focus on ROM for now and will work on strengthening exercises later. I am not doing any stretch band work. Maybe next month. It's just too hard right now.
Finally, I am increasingly active in housework and garden clean up. Surely I get some credit for that! Although it is said you don't burn many calories in ordinary housework. My arm is still pretty tight. But I have very good ROM and hope to maintain it. I constantly remind myself to use my operated arm to reach and lift. It's easy to forget to use it. My arm does still hurt but less and less as time passes. I can't complain.
I am only doing exercises prescribed by my therapist who knows my situation.
I think it is important to follow your own therapist's advice and program.
http://youtu.be/vWz9VN40nCA
Monday, October 20, 2014
Grade your doctor...PODay 127
I had forgotten about "the survey."
In writing about some of my doctors being employees of the hospital system I forgot to mention that, as a new patient, I receive a survey from the hospital to evaluate my experience. Filling out the latest survey made me realize that so many of my minor complaints about my visits involve independent doctor practices. When no one answers the phone and it all goes to voice mail, when I have had to wait more than an hour, even two, to be seen, when I've had to wait weeks for them to arrange an appointment with a specialist- All those occurred with doctors in private practice.
When I go to the doctors who are part of the hospital system the staff is polite, the wait time is minimal, and the phones are answered by a living person. Is it as simple as we all need someone watching us, someone who will point out the error of our ways? When did "customer service" come to the medical profession?
I am totally surprised. I would have expected the incorporation of small doctor's practices into large hospital industries to result in less user friendly experiences, more like dealing with government service employees. But what I am finding is that the employed physician and the staff are expected to "provide the highest quality healthcare." The survey provides the administration with a way of knowing what is being done right and what (or who) needs improvement.
Certainly, the competition for patients within the medical industry is the explanation. I guess that is true even if my medicare insurance pays so poorly. That's when volume becomes even more important. It seems the Wal-Mart business plan of low profit margin and high sales volume has come to the business of medicine. It seems to be working for me.
http://youtu.be/WLY2BylN6oA
In writing about some of my doctors being employees of the hospital system I forgot to mention that, as a new patient, I receive a survey from the hospital to evaluate my experience. Filling out the latest survey made me realize that so many of my minor complaints about my visits involve independent doctor practices. When no one answers the phone and it all goes to voice mail, when I have had to wait more than an hour, even two, to be seen, when I've had to wait weeks for them to arrange an appointment with a specialist- All those occurred with doctors in private practice.
When I go to the doctors who are part of the hospital system the staff is polite, the wait time is minimal, and the phones are answered by a living person. Is it as simple as we all need someone watching us, someone who will point out the error of our ways? When did "customer service" come to the medical profession?
I am totally surprised. I would have expected the incorporation of small doctor's practices into large hospital industries to result in less user friendly experiences, more like dealing with government service employees. But what I am finding is that the employed physician and the staff are expected to "provide the highest quality healthcare." The survey provides the administration with a way of knowing what is being done right and what (or who) needs improvement.
Certainly, the competition for patients within the medical industry is the explanation. I guess that is true even if my medicare insurance pays so poorly. That's when volume becomes even more important. It seems the Wal-Mart business plan of low profit margin and high sales volume has come to the business of medicine. It seems to be working for me.
http://youtu.be/WLY2BylN6oA
Sunday, October 19, 2014
Doctors as employees...PO Day 126
I know I complained about collecting new doctors like a rock rolling downhill gathers moss. It's true. I already had one primary care doctor and two specialists to answer to prior to my rTSA. I added an orthopod, a pulmonologist, a thoracic surgeon, and two hospitalists to the list as a result of reverse total shoulder replacement surgery and pneumothorax. Fortunately the hospitalists stayed with the hospital and were only my doctors while I was an inpatient. But now, instead of three doctors, I have six looking out for me. Fortunately five of them have joined the increasing trend of becoming employees of the hospital rather than maintain private practices. If I did not have personal experience, I would presume these were less than Grade A+ doctors who were taking the easy way out. So not true!
Everyone of them has great credentials, excellent training at first rate hospitals. Their offices are well run.. organized, staffed with efficient people, responsive and located conveniently right in the hospital complex. Why would smart young doctors be willing to give up autonomy and become employees of a hospital system?
Meeting salaries, rent, operating costs, malpractice insurance, overhead and unexpected disasters are not young Dr. Kildare's responsibility. If the roof leaks, the receptionist quits, or the electric bill doubles someone else will handle it.
Cash compensations for signing up with a hospital can be significant and give a young physician a boost in starting his career. Salaries are often higher than a starting out physician might expect to earn in a private practice.
Benefit packages, like health care, are standardized and predictable. Doctors employed by the hospital usually have the same package as clerical staff. Someone else, someone with a Business degree, will deal with the morass of health care rules and regulations.
Physicians are often backed up by well trained ancillary staff like nurse practitioners who see the more routine patient leaving the doctor time to practice at the top of their skill level. Everyone feels more challenged in their role as health care provider. It's nice to be part of a team.
While specialists are already seeing high compensation for services, government health care programs are beginning to recognize the value of the primary care doctor and fees for service are being increased for doctors in this category.
Employed physicians are taking on greater roles in the administrative operations of the hospital. As doctors become more involved in the operation of the hospital they may see opportunities in administration that would not be there in a private practice.
Finally, wage negotiations may not be all about salaries. Educational packages, student loan pay outs, sabbatical breaks are all fair game. Work hours and vacation can be on the negotiating table.
So far it looks like it is turning into a winning arrangement that lets the doctor focus on the patient. Already 25% of physicians are now working as employees of hospital systems. And I am finding that it is very satisfactory to me, the patient. We'll see where it goes in the next few years.
http://youtu.be/rwv7FYqV2Wo
Archive timeline: 2014: May and June - preparing for surgery, July - surgery and post op problems, August - recovery and physical therapy, September - thinking medically, Octobe
Everyone of them has great credentials, excellent training at first rate hospitals. Their offices are well run.. organized, staffed with efficient people, responsive and located conveniently right in the hospital complex. Why would smart young doctors be willing to give up autonomy and become employees of a hospital system?
Meeting salaries, rent, operating costs, malpractice insurance, overhead and unexpected disasters are not young Dr. Kildare's responsibility. If the roof leaks, the receptionist quits, or the electric bill doubles someone else will handle it.
Cash compensations for signing up with a hospital can be significant and give a young physician a boost in starting his career. Salaries are often higher than a starting out physician might expect to earn in a private practice.
Benefit packages, like health care, are standardized and predictable. Doctors employed by the hospital usually have the same package as clerical staff. Someone else, someone with a Business degree, will deal with the morass of health care rules and regulations.
Physicians are often backed up by well trained ancillary staff like nurse practitioners who see the more routine patient leaving the doctor time to practice at the top of their skill level. Everyone feels more challenged in their role as health care provider. It's nice to be part of a team.
While specialists are already seeing high compensation for services, government health care programs are beginning to recognize the value of the primary care doctor and fees for service are being increased for doctors in this category.
Employed physicians are taking on greater roles in the administrative operations of the hospital. As doctors become more involved in the operation of the hospital they may see opportunities in administration that would not be there in a private practice.
Finally, wage negotiations may not be all about salaries. Educational packages, student loan pay outs, sabbatical breaks are all fair game. Work hours and vacation can be on the negotiating table.
So far it looks like it is turning into a winning arrangement that lets the doctor focus on the patient. Already 25% of physicians are now working as employees of hospital systems. And I am finding that it is very satisfactory to me, the patient. We'll see where it goes in the next few years.
http://youtu.be/rwv7FYqV2Wo
Archive timeline: 2014: May and June - preparing for surgery, July - surgery and post op problems, August - recovery and physical therapy, September - thinking medically, Octobe
Saturday, October 18, 2014
What a diff an inch makes..PODay 125
What a difference an inch makes, 2.54 little centimeters.
I mentioned recently that I had suddenly noticed I was shorter. It's driving me crazy. After an adult lifetime of 67 inches, 66 inches is unexpected. It would be reasonable for you to say that reaching for things was a problem caused by my right arm not being able to elevate and extend. But I've been living with that for over a year. My left arm has managed very well retrieving highly placed articles around the house. I've had to make a lot of adjustments living as a one armed bandit but height was not one of them.
It started with the little bowl I use to scramble up eggs. I have to tip toe now to get it down off of its spot on the shelf. I have a low stool in my closet now so I can hang up clothes on the upper rack. Used to not be a problem. The other day I wanted a black belt to wear but belts are in a hat box on a high shelf. I wore a silver belt that was curled up. I hadn't put it away because the hat box was just barely out of reach. My make up might be a bit garish as the switch for the extra light over the bathroom sink requires more effort to reach than I care to make.
Conversely, my feet seem to have gotten longer. A favorite pair of shoes I haven't worn in a while are suddenly too small. And a nice pair of leather gloves don't seem to have enough room for my long fingers anymore. I could make quite a demonstration in a courtroom with them if necessary. The surgeon suggested my operated arm would be longer post rTSA but that didn't happen. I know, I measured it before and after. Good thing because I already have long arms. Hats still fit. I guess I haven't lost enough hair to make that kind of difference...yet.
The thing is we all must have experienced this access-changing phenomenon, only in the reverse, growing up. I don't remember being surprised as the inches added up and I could reach new heights. Were there just so many readjustments in life that we didn't notice? We have a wall in our house where everyone's height is recorded. The grandchildren add a good three inches a year. Dear Husband and I seem to be going in the opposite direction. Yes, it's happening to him too and he can't blame it on shoulder surgery!
http://youtu.be/ks02alWbpvk
Archive timeline: 2014: May and June - preparing for surgery, July - surgery and post op problems, August - recovery and physical therapy, September - thinking medically, October--
I mentioned recently that I had suddenly noticed I was shorter. It's driving me crazy. After an adult lifetime of 67 inches, 66 inches is unexpected. It would be reasonable for you to say that reaching for things was a problem caused by my right arm not being able to elevate and extend. But I've been living with that for over a year. My left arm has managed very well retrieving highly placed articles around the house. I've had to make a lot of adjustments living as a one armed bandit but height was not one of them.
It started with the little bowl I use to scramble up eggs. I have to tip toe now to get it down off of its spot on the shelf. I have a low stool in my closet now so I can hang up clothes on the upper rack. Used to not be a problem. The other day I wanted a black belt to wear but belts are in a hat box on a high shelf. I wore a silver belt that was curled up. I hadn't put it away because the hat box was just barely out of reach. My make up might be a bit garish as the switch for the extra light over the bathroom sink requires more effort to reach than I care to make.
Conversely, my feet seem to have gotten longer. A favorite pair of shoes I haven't worn in a while are suddenly too small. And a nice pair of leather gloves don't seem to have enough room for my long fingers anymore. I could make quite a demonstration in a courtroom with them if necessary. The surgeon suggested my operated arm would be longer post rTSA but that didn't happen. I know, I measured it before and after. Good thing because I already have long arms. Hats still fit. I guess I haven't lost enough hair to make that kind of difference...yet.
The thing is we all must have experienced this access-changing phenomenon, only in the reverse, growing up. I don't remember being surprised as the inches added up and I could reach new heights. Were there just so many readjustments in life that we didn't notice? We have a wall in our house where everyone's height is recorded. The grandchildren add a good three inches a year. Dear Husband and I seem to be going in the opposite direction. Yes, it's happening to him too and he can't blame it on shoulder surgery!
http://youtu.be/ks02alWbpvk
Archive timeline: 2014: May and June - preparing for surgery, July - surgery and post op problems, August - recovery and physical therapy, September - thinking medically, October--
Friday, October 17, 2014
Routine Blood work...PO Day124
In preparation for an annual check up I had to have blood work done today. Used to be I went to a laboratory facility but to my surprise, my doctor's office now will draw the blood and take specimens. So convenient. I'm a little afraid my "numbers" will be bad as my diet has just been terrible lately. Too many breakfasts at McDonald's and too many sweets! Not enough exercise.
Anyway, here's what they look at:
CBC: comprehensive blood panel - checks red blood cells, white blood cells, looks for anemia.
Renal panel: checks kidney function
Liver panel: checks liver enzymes.
Blood glucose: looks at blood sugar levels.
CMP: comprehensive metabolic panel. Tests chemical balance and metabolism.
Vitamin D test: not done every time but a baseline test is becoming popular. Low levels may cause bone disorders and possibly play a role in heart disease and cancer. This is especially important in relation to breast cancer as low levels of vitamin D are associated with it. Ask your doctor.
Not included here are cholesterol tests; HDL, LDL, and triglycerides.
All this was done during my hospitalization in June and except for anemia, all was good. I will be glad to see my blood levels and hope they are back to normal.
I would just be happy to see life get back to normal. It seems as if all I do is go to doctors these days. Every new doctor I "picked up" due to the complications that occurred during my shoulder surgery wants follow up visits. Add that to the other few specialists I had already been seeing and I feel like a hypochondriac. I used to be a person who never went to the doctor! I feel like a stone rolling downhill gathering more and more moss as it grows bigger and bigger.
http://www.youtube.com/watch?v=0MdFW6dYOJ0&sns=em
Archive timeline: 2014: May and June - preparing for surgery, July - surgery and post op problems, August - recovery and physical therapy, September - thinking medically, Octobe
Anyway, here's what they look at:
CBC: comprehensive blood panel - checks red blood cells, white blood cells, looks for anemia.
Renal panel: checks kidney function
Liver panel: checks liver enzymes.
Blood glucose: looks at blood sugar levels.
CMP: comprehensive metabolic panel. Tests chemical balance and metabolism.
Vitamin D test: not done every time but a baseline test is becoming popular. Low levels may cause bone disorders and possibly play a role in heart disease and cancer. This is especially important in relation to breast cancer as low levels of vitamin D are associated with it. Ask your doctor.
Not included here are cholesterol tests; HDL, LDL, and triglycerides.
All this was done during my hospitalization in June and except for anemia, all was good. I will be glad to see my blood levels and hope they are back to normal.
I would just be happy to see life get back to normal. It seems as if all I do is go to doctors these days. Every new doctor I "picked up" due to the complications that occurred during my shoulder surgery wants follow up visits. Add that to the other few specialists I had already been seeing and I feel like a hypochondriac. I used to be a person who never went to the doctor! I feel like a stone rolling downhill gathering more and more moss as it grows bigger and bigger.
http://www.youtube.com/watch?v=0MdFW6dYOJ0&sns=em
Archive timeline: 2014: May and June - preparing for surgery, July - surgery and post op problems, August - recovery and physical therapy, September - thinking medically, Octobe
Thursday, October 16, 2014
Why I did it now...PO Day 123
I can't believe I was brave enough to go forward with reverse shoulder replacement surgery. Part of it is that there appears to be some self-preservation thing that protects us from remembering pain. I can intellectually recall the discomfort my right arm provided but I can't conjure up the misery that it brought me. More than that, though, was my blissful ignorance of the seriousness of rTSA. Now, when I read some website where a surgeon calls the procedure "a last resort," it scares the beejeebies out of me.
My surgeon, Dr. Kai, to his credit, did stress that there was no deadline for doing the surgery. He explained that my situation was not one that was going to get worse because I chose to wait a week or a month or a year. But neither was it going to get better without surgery. From the day when I committed to being operated until my surgery date was more than five weeks and it seemed like forever. It was long enough for me to see other doctors and get clearance, attend the joint replacement class my hospital sponsors, fill the freezer with food to nuke post op, buy hospital pajamas that I never had a chance to wear, and get very cold feet.
But I think the tipping factor was one of those anonymous politically oriented emails that you don't know whether to believe or not. This one focused on future changes in Medicare coverage under the new affordable healthcare act. The author explained that hip and knee surgery were consuming a huge chunk of the healthcare budget and there would be new guidelines in the upcoming years that would limit the availability of the surgery to patients over some arbitrary age. Since no one really knows what all is in the affordable healthcare act, I didn't know whether to believe it or not. But I was afraid that if I waited, the option might no longer be available to me. It certainly is true that there have been some significant changes in Medicare coverage already and looks like more to come.
As it turns out it was the right thing to do. My shoulder is SO much better, the awful pain is gone, I can use my right arm almost normally again, and I didn't die from a pneumothorax. I'd say a pretty good outcome. But having the surgery is not a decision to be cavalier about. I'm glad I had a surgeon who didn't try to frighten me into being operated. Instead, it was an anonymous, probably bogus political email that did it!
Archive timeline: 2014: May and June - preparing for surgery, July - surgery and post op problems, August - recovery and physical therapy, September - thinking medically, October--
My surgeon, Dr. Kai, to his credit, did stress that there was no deadline for doing the surgery. He explained that my situation was not one that was going to get worse because I chose to wait a week or a month or a year. But neither was it going to get better without surgery. From the day when I committed to being operated until my surgery date was more than five weeks and it seemed like forever. It was long enough for me to see other doctors and get clearance, attend the joint replacement class my hospital sponsors, fill the freezer with food to nuke post op, buy hospital pajamas that I never had a chance to wear, and get very cold feet.
But I think the tipping factor was one of those anonymous politically oriented emails that you don't know whether to believe or not. This one focused on future changes in Medicare coverage under the new affordable healthcare act. The author explained that hip and knee surgery were consuming a huge chunk of the healthcare budget and there would be new guidelines in the upcoming years that would limit the availability of the surgery to patients over some arbitrary age. Since no one really knows what all is in the affordable healthcare act, I didn't know whether to believe it or not. But I was afraid that if I waited, the option might no longer be available to me. It certainly is true that there have been some significant changes in Medicare coverage already and looks like more to come.
As it turns out it was the right thing to do. My shoulder is SO much better, the awful pain is gone, I can use my right arm almost normally again, and I didn't die from a pneumothorax. I'd say a pretty good outcome. But having the surgery is not a decision to be cavalier about. I'm glad I had a surgeon who didn't try to frighten me into being operated. Instead, it was an anonymous, probably bogus political email that did it!
Archive timeline: 2014: May and June - preparing for surgery, July - surgery and post op problems, August - recovery and physical therapy, September - thinking medically, October--
Wednesday, October 15, 2014
Where is PO Day 122?
I have no idea how I skipped a day. It may have something to do with the fact that I post in the middle of the night and my brain may not be fully engaged.
Of course it's possible no one but me would notice. I'm going to have to look at the calendar and count the days since surgery June 17th. So I may or may not have to fix it.
OK, I've counted. Today should be 122 and not 123. Let's see if I can change it without losing everything.
I did it!
Of course it's possible no one but me would notice. I'm going to have to look at the calendar and count the days since surgery June 17th. So I may or may not have to fix it.
OK, I've counted. Today should be 122 and not 123. Let's see if I can change it without losing everything.
I did it!
Shopping cart shoulder...PODay 122
There's tennis elbow and turf toe, housemaid's knees and Raquetball wrist. Now I have one to add to the list, shopping cart shoulder.
Today was our not too frequent trip to the big discount store. It combined groceries plus a list of little household and garden odds and ends. I've never learned the arrangement of the merchandise and there is a lot of wandering aisles aimlessly and backtracking looking for less common items like ceiling fan chain extensions and wax for no wax floors. Weed eater line was a total no-go, the lawn equipment department is now Christmas Central. I am really not ready for that!
Dear Husband was on his own mission so I was in charge of driving my own shopping cart. I can't figure it out but there is something about steering a cart that just kills my shoulder. Yes, I have whined about this before, August PO Day 68. Wouldn't you think things would be better? Or, wouldn't you think I would have learned something? Apparently not.
So I am home now, soothing my discomfort with an ice pack and chocolate cake with ice cream. A perfect prescription for pain. But this is a temporary tonic. The season for marathon shopping is fast upon us. I had a glimpse of the future today when I discovered wreaths and tinsel where weed whackers and top soil used to be. I see two possible solutions here: I can join the tsunami of online shoppers who shop in their pajamas for purchases that magically show up at the door for a punitive shipping and handling cost or I could frequent the chi chi specialty shops with salesgirls who wrap expensive doodads in lilac tissue and carry your packages to the car for you. At least there would be no loaded down shopping cart tweaking my shoulder and ruining my holiday spirits.
But wait! There is another option. A nearby place with a selection guaranteed to please the pickiest person on your list. Books from Amazon, apparel from Macy's, housewares from Bed, Bath and Beyond, candlelight dinners or fast food fare, concert tickets to see Adele, or tools from your favorite home improvement store..it is the Gift Card kiosk at the local grocery store! No shopping cart required.
I have the perfect excuse this year and I'm using it!
http://youtu.be/3k27udNlpGM
Archive timeline: 2014: May and June - preparing for surgery, July - surgery and post op problems, August - recovery and physical therapy, September - thinking medically, October--
Archive timeline: 2014: May and June - preparing for surgery, July - surgery and post op problems, August - recovery and physical therapy, September - thinking medically, October--
Today was our not too frequent trip to the big discount store. It combined groceries plus a list of little household and garden odds and ends. I've never learned the arrangement of the merchandise and there is a lot of wandering aisles aimlessly and backtracking looking for less common items like ceiling fan chain extensions and wax for no wax floors. Weed eater line was a total no-go, the lawn equipment department is now Christmas Central. I am really not ready for that!
Dear Husband was on his own mission so I was in charge of driving my own shopping cart. I can't figure it out but there is something about steering a cart that just kills my shoulder. Yes, I have whined about this before, August PO Day 68. Wouldn't you think things would be better? Or, wouldn't you think I would have learned something? Apparently not.
So I am home now, soothing my discomfort with an ice pack and chocolate cake with ice cream. A perfect prescription for pain. But this is a temporary tonic. The season for marathon shopping is fast upon us. I had a glimpse of the future today when I discovered wreaths and tinsel where weed whackers and top soil used to be. I see two possible solutions here: I can join the tsunami of online shoppers who shop in their pajamas for purchases that magically show up at the door for a punitive shipping and handling cost or I could frequent the chi chi specialty shops with salesgirls who wrap expensive doodads in lilac tissue and carry your packages to the car for you. At least there would be no loaded down shopping cart tweaking my shoulder and ruining my holiday spirits.
But wait! There is another option. A nearby place with a selection guaranteed to please the pickiest person on your list. Books from Amazon, apparel from Macy's, housewares from Bed, Bath and Beyond, candlelight dinners or fast food fare, concert tickets to see Adele, or tools from your favorite home improvement store..it is the Gift Card kiosk at the local grocery store! No shopping cart required.
I have the perfect excuse this year and I'm using it!
http://youtu.be/3k27udNlpGM
Archive timeline: 2014: May and June - preparing for surgery, July - surgery and post op problems, August - recovery and physical therapy, September - thinking medically, October--
Archive timeline: 2014: May and June - preparing for surgery, July - surgery and post op problems, August - recovery and physical therapy, September - thinking medically, October--
Tuesday, October 14, 2014
Judging success...PO Day 121
In an article reprinted by the NIH from the Open Orthopedic Journal in 2010, Canadian authors : Roy, MacDermid, Goel, Faber, Athwal and Drosdowech addressed the subject of what makes for a successful outcome with reverse Total Shoulder Arthroplasty. It seems that there are subjective ways to judge the result and objective ways to look at it and in the end they do not necessarily agree.
Objectively, 51 patients were screened using various exams including the SST (Simple Shoulder Test), ROM, and strength testing. Subjectively, they were individually interviewed as to their overall satisfaction with their shoulder care. Follow up was in the range of two years post surgery.
At the two year interview 93% of the patients were satisfied with their care. Only 7% were unsatisfied. The 7% consisted of only three patients; one had experienced a dislocation, one had a very low SST score (able to perform only2 of 12 standard actions) and the third had no apparent reason for dissatisfaction as he had no complications and scored 100% on the SST exam. Of the 93% (48 individuals) who expressed satisfaction with the surgical results, 32% (14 patients) were objectively characterized as having a poor outcome with substantial complications.
Patient satisfaction exceeded 90% in spite of residual pain, limited range of motion, strength deficit and functional limitations. The data suggested "that patients' satisfaction with their care rating is a poor indicator of shoulder function." Complications appeared to affect the doctor's perspective on surgical success more than they did the patients' opinion.
My conclusion, not necessarily the authors', is that the typical rTSA patient is older and has had a good bit of pain prior to surgery. While the surgeon's expectations might be high, the patient may find even modest functional improvement and modest relief of pain quite satisfactory and tolerates complications better than the surgeon who finds them distressing. Furthermore, the study did suggest that the overall satisfaction of the patient might be influenced by the care and attention received more than by statistical results.
I hope I have presented a reasonably accurate summary of their excellent report. I think it speaks well for the spirit and resilience of the rTSA demographic.
http://youtu.be/b2ff8qXa248
Archive timeline: 2014: May and June - preparing for surgery, July - surgery and post op problems, August - recovery and physical therapy, September - thinking medically, October--
Objectively, 51 patients were screened using various exams including the SST (Simple Shoulder Test), ROM, and strength testing. Subjectively, they were individually interviewed as to their overall satisfaction with their shoulder care. Follow up was in the range of two years post surgery.
At the two year interview 93% of the patients were satisfied with their care. Only 7% were unsatisfied. The 7% consisted of only three patients; one had experienced a dislocation, one had a very low SST score (able to perform only2 of 12 standard actions) and the third had no apparent reason for dissatisfaction as he had no complications and scored 100% on the SST exam. Of the 93% (48 individuals) who expressed satisfaction with the surgical results, 32% (14 patients) were objectively characterized as having a poor outcome with substantial complications.
Patient satisfaction exceeded 90% in spite of residual pain, limited range of motion, strength deficit and functional limitations. The data suggested "that patients' satisfaction with their care rating is a poor indicator of shoulder function." Complications appeared to affect the doctor's perspective on surgical success more than they did the patients' opinion.
My conclusion, not necessarily the authors', is that the typical rTSA patient is older and has had a good bit of pain prior to surgery. While the surgeon's expectations might be high, the patient may find even modest functional improvement and modest relief of pain quite satisfactory and tolerates complications better than the surgeon who finds them distressing. Furthermore, the study did suggest that the overall satisfaction of the patient might be influenced by the care and attention received more than by statistical results.
I hope I have presented a reasonably accurate summary of their excellent report. I think it speaks well for the spirit and resilience of the rTSA demographic.
http://youtu.be/b2ff8qXa248
Archive timeline: 2014: May and June - preparing for surgery, July - surgery and post op problems, August - recovery and physical therapy, September - thinking medically, October--
Monday, October 13, 2014
Paul Grammont 1940-2013
This is not my daily post. I just wanted to share this tribute to the man who is responsible for finding the solution to the reverse arrangement of the shoulder joint. Until his developments with the reverse shoulder prosthetic, patients with fully torn rotator cuffs, malunion of the proximal humerus post fracture, and other less common complications of the shoulder joint did not have a satisfactory surgical solution. His design continues with several of the modern reverse shoulder artificial joint manufacturers.
Written by E. . Baulot
Written by E. . Baulot
Service d’orthopédie-traumatologie, hôpital du Bocage, 14, rue Paul-Gaffarel, BP 77908, 21079 Dijon cedex, France
Paul Grammont
Paul Grammont's achievements were all the more remarkable in that he succeeded in creating a great deal with limited time and resources. Research, indeed, does not come down to resources! In his laboratory, he was able to count on the inexhaustible energy of Pierre Trouilloud and the cooperation of a succession of teams, all of which he esteemed highly. To those who criticized him for not writing enough and concentrating too closely on his own goals, he replied, with a hint of malice, “Usually, inventors do not write a lot and writers do not invent much,” confident as he was that nothing can stand in the way of a good idea. And the results are there to be seen, and are very impressive.
Paul-Marie Grammont died on March 30th, 2013.
He was born on April 12th, 1940 in Salin-les-Bains and was educated successively in Besançon, Alès, Quimper, Lons-le-Saunier, Troyes and finally Lyon, where his father had been nominated head of the prestigious Lycée du Parc high-school, where Paul-Marie took what was at the time known as the “Elementary Math” baccalaureate, in 1957.
He went on to become the first member of the family to qualify in medicine. In Lyon, after a residency in general and osteoarticular surgery, he worked as a university assistant in Michel Latarget's anatomy laboratory from 1968 to 1971, than as senior registrar in Albert Trillat's renowned department until March 1972, when he was titularized as senior registrar, a position which he held until April 1974. He applied for an associate professorship and was admitted on the reserve list in July 1974, the third of four of Trillat's students to become associate professors..He began lecturing in Dijon in September 1974. His career, however, came to a premature end following a severe stroke in June 1997.
It was thus in Dijon that this Chief, with a passion for the “knee and shoulder”, brimful of new ideas and repelled by stagnation, conducted his research and innovations...Innovation was the keyword of P.-M. Grammont: innovation marrying the intuition that is the motor of invention to the solid work of analysis of a given problem, often seen from a new angle, but with a solid basis in mechanics and followed up by the requisite experimental validation.
To carry out all this work, he applied to himself the message he constantly hammered into the rest of us: examine everything, ruthlessly and without exception, think for yourself and by yourself and, finally and above all, never bend to difficulties or criticism!
Paul Grammont's achievements were all the more remarkable in that he succeeded in creating a great deal with limited time and resources. Research, indeed, does not come down to resources! In his laboratory, he was able to count on the inexhaustible energy of Pierre Trouilloud and the cooperation of a succession of teams, all of which he esteemed highly. To those who criticized him for not writing enough and concentrating too closely on his own goals, he replied, with a hint of malice, “Usually, inventors do not write a lot and writers do not invent much,” confident as he was that nothing can stand in the way of a good idea. And the results are there to be seen, and are very impressive.
Automatic distraction osteogenesis over an elongation nail; the so-called “morpho-adapted” made-to-measure hip implant. In knee pathology, tibio-patellar fixation, also known as patellar olecranization; the self-centering patellofemoral prosthesis.
The Shoulder: to begin with, surgery for anterior instability, for which he proposed what he named the “Bristow-Trillat” procedure and explained its biomechanical rationale. But it was above all in degenerative pathology and prosthetic surgery in this, his “favorite” joint, that his ingenious creative spirit would show how much it could achieve, leaving its mark on his contemporaries.
Firstly, scapular spine osteotomy (Translation Rotation Elevation, 1975) for anterosuperior impingement played a central role, which needs to be understood, as it was the harbinger of the basic mechanical principles underlying his future reverse prosthesis
And so, we come to his masterpiece, the reverse shoulder prosthesis, the incarnation of his principle of functional surgery. The reverse design was not in itself original, as it had already been tried and abandoned as being lateralizing, in contrast to the truly original medializing biomechanical concept to which his name is definitively attached and which has spread worldwide: first the Trumpet implant in 1985, then the first-generation Delta, both developed in partnership with the French Medinov laboratory.
This development was a genuine odyssey, a long and difficult gestation, meeting at first with a dubious reception. Paul Grammont, however, understood very well that radical innovation raises apprehension and doubt. That only boosted his motivation, to press on in the face of (almost) universal skepticism, with an unrivalled tenacity that took no prisoners!
Finally, to paraphrase a famous quote, I think that we can say that Paul Grammont did not ask what orthopedics could do for him but rather what he could do for orthopedics – for French orthopedics, the image and quality his was an exceptional It is my well-loved, discerning Chief, a great team leader and above all an inventor of genius, who has left us.
© 2013 Published by Elsevier Masson SAS@@#104157@@
Smarter than me?...PO Day 120
Today was a beautifully day and I spent the morning working in the garden. Our lawn guys mow and trim but they do not "do" flower beds. All the rain that has been falling this summer, combined with the recuperative sabbatical of the regular garden gnome, has resulted in things getting a bit out of control. Looking around, the undergrowth of weedy vegetation was rather daunting. So I asked Dr. Kai if I could use a weed eater. He said it was okay to use an electric model since they are not as heavy as gas powered models and don't require that "pull the cord" action to start them.
Great because I had recently bought a battery powered trimmer anticipating a return to action. It has a lithium battery that charges quickly so you aren't dragging a 50' extension cord around behind you. It's not too heavy and the weight is mostly supported by one's left hand-arm so, in my case, my operated right shoulder is just guiding the tool. Sounds perfect.
Well, it turns out this is one of those household-garden-life appliances that thinks it has to protect me from myself. There is a safety cut off switch which must be depressed at the same time the power switch is being held down. So you grasp the loop handle with your left hand to support the weight of the machine. You hold the upper part of the wand with your right hand to squeeze the power switch and guide movement and you depress the safety cut off switch with...what? Your third hand? Has anyone on the desIgn team heard of ergonomics?
To be fair I have to admit a guy's right hand could probably press both the power switch and the cut off switch at the same time. But mine cannot. Furthermore, guys want power! This is a wimpy weedeater, perfect for the female gardener, small, lightweight and barely adequate to trim spent flowers. And is there some new OSHA rule that requires an extra switch like this? All our other and previous weed whackers did not have this annoying "safety feature."
Choices? I could return the weedeater but then I would be stuck with dragging that electric cord behind me again. AHA, a small piece of wood wedged into the gap in the safety switch defeats its main purpose, to frustrate the would-be user! What did they think I was going to do?
Anyway, at approximately four months post op rTSA life is really getting back to normal. The garden is looking a lot better, I felt good to be doing something productive, and I am still able to outsmart a poorly designed lawn tool.
BTW, I'm not suggesting anyone else live dangerously and bypass the safety features that corporate or government finds essential to protect us from ourselves. If a person needs to be reminded to not use an electric corded trimmer while standing in a water puddle, they probably need that safety switch.
http://youtu.be/ElqZms_SUjg
Archive timeline: 2014: May and June - preparing for surgery, July - surgery and post op problems, August - recovery and physical therapy, September - thinking medically, October--
Great because I had recently bought a battery powered trimmer anticipating a return to action. It has a lithium battery that charges quickly so you aren't dragging a 50' extension cord around behind you. It's not too heavy and the weight is mostly supported by one's left hand-arm so, in my case, my operated right shoulder is just guiding the tool. Sounds perfect.
Well, it turns out this is one of those household-garden-life appliances that thinks it has to protect me from myself. There is a safety cut off switch which must be depressed at the same time the power switch is being held down. So you grasp the loop handle with your left hand to support the weight of the machine. You hold the upper part of the wand with your right hand to squeeze the power switch and guide movement and you depress the safety cut off switch with...what? Your third hand? Has anyone on the desIgn team heard of ergonomics?
To be fair I have to admit a guy's right hand could probably press both the power switch and the cut off switch at the same time. But mine cannot. Furthermore, guys want power! This is a wimpy weedeater, perfect for the female gardener, small, lightweight and barely adequate to trim spent flowers. And is there some new OSHA rule that requires an extra switch like this? All our other and previous weed whackers did not have this annoying "safety feature."
Choices? I could return the weedeater but then I would be stuck with dragging that electric cord behind me again. AHA, a small piece of wood wedged into the gap in the safety switch defeats its main purpose, to frustrate the would-be user! What did they think I was going to do?
Anyway, at approximately four months post op rTSA life is really getting back to normal. The garden is looking a lot better, I felt good to be doing something productive, and I am still able to outsmart a poorly designed lawn tool.
BTW, I'm not suggesting anyone else live dangerously and bypass the safety features that corporate or government finds essential to protect us from ourselves. If a person needs to be reminded to not use an electric corded trimmer while standing in a water puddle, they probably need that safety switch.
http://youtu.be/ElqZms_SUjg
Archive timeline: 2014: May and June - preparing for surgery, July - surgery and post op problems, August - recovery and physical therapy, September - thinking medically, October--
Sunday, October 12, 2014
Go home or go rehab? PO Day 119
It is definitely more common to have a friend who has had knee or hip replacement than total shoulder replacement surgery, reverse or not. We might even have visited the knee or hip patient in the rehabilitation facility where many of them went when they left the hospital. While we all would rather be home in our own surroundings under these circumstances, sometimes a nursing home, Rehabilitation facility, can be the best choice. If we live in a multistory home, if we don't have someone at home to help us immediately post op, or if we have concurrent health issues that make our recovery more complicated...we might be better off taking advantage of our medicare allotment for inpatient nursing care. Even in spite of my hospital orthopedic coordinator's admonition that one's risk of contracting post surgery infection is greater in a nursing facility than at home!
But, we shoulder surgery patients insured by medicare do NOT qualify for this coverage! Unlike the knee or hip patient, we are considered perfectly ambulatory. Our shoulders might hurt, it might be hard to dress, we might be sleeping in a recliner for a while, we might even feel a bit wobbly for the first few days. But we can walk and that makes all the difference. So clear a path from the bed to the bathroom, remove those hazardous items from the stair steps, and pick up that throw rug that everyone trips over.
As a matter of fact, your recovery will be faster and easier the more you walk around. Just be careful.
http://youtu.be/RGQmvPSjrpk
Archive timeline: 2014: May and June - preparing for surgery, July - surgery and post op problems, August - recovery and physical therapy, September - thinking medically, October--
But, we shoulder surgery patients insured by medicare do NOT qualify for this coverage! Unlike the knee or hip patient, we are considered perfectly ambulatory. Our shoulders might hurt, it might be hard to dress, we might be sleeping in a recliner for a while, we might even feel a bit wobbly for the first few days. But we can walk and that makes all the difference. So clear a path from the bed to the bathroom, remove those hazardous items from the stair steps, and pick up that throw rug that everyone trips over.
As a matter of fact, your recovery will be faster and easier the more you walk around. Just be careful.
http://youtu.be/RGQmvPSjrpk
Archive timeline: 2014: May and June - preparing for surgery, July - surgery and post op problems, August - recovery and physical therapy, September - thinking medically, October--
Saturday, October 11, 2014
Scapular notching ...PO Day 118
I finally asked my surgeon to explain scapular notching and tell me how to avoid it. I was pleased to learn the burden falls on the surgeon's shoulders and there is nothing the patient can do about it.
Scapular notching was a bigger problem in the earlier days of rTSA but remains a bugaboo, for surgeons and device manufacturers. As the operated arm moves up and down, the metallic socket (or cup) at the top of the humerus pivots on the glenosphere (the metal ball) separated only by a polypropylene liner, like the one in the photo above. (Except without the damaged area.) A common problem has been that the socket/cup, in some arm positions, extended beyond the circumference of the glenosphere (the ball) and wore away at the exposed scapula to which the glenosphere is attached. This created a groove in the scapula and erosion on the poly liner. Actually the poly liner seemed to have endured the worst of it. See photo above. There is some question about the effect of plastic particulates from liner sluffing off into the blood but so far it has not been identified as a major problem. Gradual notching of the scapula does not appear to cause pain or discomfort. So what is the big concern? As a chronic condition there is some conjecture that it causes a loosening of the glenoid but so far this is unproven.
Surgical technique and evolutionary design changes in the prosthetic devices have improved the situation. Lateralizing it (that's making the glenosphere stick out farther, to you and me) and inferiorizing it (dropping it down a little lower so it is a little off-center) and using as large a glenosphere as possible are techniques used to prevent scapular notching. At least that is the approach used by my surgeon and the company whose product he chooses to use. I can imagine there are as many opinions of what to do as there are manufacturers of the artificial shoulder joints and surgeons to install them.
I am just glad to know there is at least one possible glitch that I can leave for someone else to fret about.
Archive timeline: 2014: May and June - preparing for surgery, July - surgery and post op problems, August - recovery and physical therapy, September - thinking medically, October--
Friday, October 10, 2014
How to communicate? PO Day 117
We have so may ways to communicate in this modern world. We have cell phones, land lines, Voice over IP phones, and smart phones. There are faxes and email and Skype. We can even tweet. But instead of making life easier, it has just become more difficult to connect on a personal level.
When I have just taken the last pill in my bottle of " life and death medicine," I will rush to the phone to call my prescribing physician's office. I know the "call your pharmacy" routine but I am trying to speed thing up. Alas, the familiar recorded voice of the ubiquitous virtual telephone receptionist will answer. "If this is a medical emergency, please hang up and call 911." While I consider this an emergency, I am pretty sure the call screener at 911 would not. "Please listen closely as the menu has changed." The 'menu" never changes! After listening closely to office hours, address and directions to the office and whether or not they close for lunch, I am finally presented with the menu, as if I am going to be offered a filet or salmon. "If this is a doctor's office, please press 1." I admit it, I've tried that and it has gotten me nowhere. "To schedule an appointment, please press 2." Hoping to raise a live person, I press 2, prepared to fib that I misunderstood. "You have reached the appointment desk of Mary Smith. I am away from my desk or helping another caller. Please leave a message and I will return your call as soon as possible." I just love the next part..."Please do not call again. Calling repeatedly will not result in speaking to someone sooner. In fact, it will delay a return call." If they were promptly returning my call I would not be tempted to call every thirty minutes! Moving on in the menu: "If you are calling to refill a prescription, please hang up and call your pharmacy. Thank you and goodbye." I knew that but I needed to speak to someone! There are extenuating circumstances!
I want to say that no one answers their phone anymore but that is not true. The phones at work are not answered. Those same people, in the restaurant or in line at the post office or at their sister's wedding, will move heaven and earth to find their ringing phone in their purse or backpack and loudly acknowledge the caller to one and all. Would that the call to the doctor held the same importance as the call from the sister-in-law wanting to know who's hosting Thanksgiving this year. I wonder what would happen if we were able to acquire the personal numbers for the folks in the office to whom we need to speak. Maybe when we are completing that multi page "electronic medical record" form where it asks for OUR home phone and OUR cell phone and OUR work phone and OUR emergency contact's phone number, we could request THEIR cell phone numbers. What do you think they would say?
Just call me.
http://youtu.be/pchw3L-8ZbE
When I have just taken the last pill in my bottle of " life and death medicine," I will rush to the phone to call my prescribing physician's office. I know the "call your pharmacy" routine but I am trying to speed thing up. Alas, the familiar recorded voice of the ubiquitous virtual telephone receptionist will answer. "If this is a medical emergency, please hang up and call 911." While I consider this an emergency, I am pretty sure the call screener at 911 would not. "Please listen closely as the menu has changed." The 'menu" never changes! After listening closely to office hours, address and directions to the office and whether or not they close for lunch, I am finally presented with the menu, as if I am going to be offered a filet or salmon. "If this is a doctor's office, please press 1." I admit it, I've tried that and it has gotten me nowhere. "To schedule an appointment, please press 2." Hoping to raise a live person, I press 2, prepared to fib that I misunderstood. "You have reached the appointment desk of Mary Smith. I am away from my desk or helping another caller. Please leave a message and I will return your call as soon as possible." I just love the next part..."Please do not call again. Calling repeatedly will not result in speaking to someone sooner. In fact, it will delay a return call." If they were promptly returning my call I would not be tempted to call every thirty minutes! Moving on in the menu: "If you are calling to refill a prescription, please hang up and call your pharmacy. Thank you and goodbye." I knew that but I needed to speak to someone! There are extenuating circumstances!
I want to say that no one answers their phone anymore but that is not true. The phones at work are not answered. Those same people, in the restaurant or in line at the post office or at their sister's wedding, will move heaven and earth to find their ringing phone in their purse or backpack and loudly acknowledge the caller to one and all. Would that the call to the doctor held the same importance as the call from the sister-in-law wanting to know who's hosting Thanksgiving this year. I wonder what would happen if we were able to acquire the personal numbers for the folks in the office to whom we need to speak. Maybe when we are completing that multi page "electronic medical record" form where it asks for OUR home phone and OUR cell phone and OUR work phone and OUR emergency contact's phone number, we could request THEIR cell phone numbers. What do you think they would say?
Just call me.
http://youtu.be/pchw3L-8ZbE
Archive timeline: 2014: May and June - preparing for surgery, July - surgery and post op problems, August - recovery and physical therapy, September - thinking medically, October--
Thursday, October 9, 2014
Info From the Internet...PO Day 116
If you've ever been daring enough to admit to your doctor that your medical knowledge comes from the "internet," you know the look you get. There's a scowl, a head shake and an implied tsk tsk as he leans back to get a better look at this pretender sitting across from him. "Don't do that," he says. "You can't rely on the information being true or current." The problem is that he is mostly right.
For every credentialled article, say something published by the NIH or the FDA, a Google search will turn up a 'paper ' written by a self-proclaimed expert. Sticking to references from legitimate medical or educational sources with domain names that end in .edu or .gov is a good start. Although not everyone trusts the .gov resource in all matters.
If I come upon a web-based article with intriguing but unverified information, I'll shift the focus of my search to see if there's a lot of other people out there espousing similar opinions. If the lone wolf doesn't have supporters, it doesn't mean he's wrong, just not repeatable at this time. The other night I found several web articles about the use of surgical robotics for shoulder replacement surgery. The problems with repeating it, for me, were that all the articles I found referenced one company developing the equipment and I couldn't find anything more recent that 2006 or 2007. I hope someone is working on the idea but I'll have to pass up writing about it for now. Then, there is "computer assisted" shoulder replacement surgery which sounds like more of the same but really has to do with planning the surgery, analyzing the X-rays and cat scans to custom fit the artificial shoulder parts and is in common use already.
I have had my doctor tell me that Internet information is not current, therefore not necessarily true. He's right. There are many negative articles on the web about reverse total shoulder surgery and many of them reflect the opinions prevalent when rTSA came to the U.S.in 2004 or 2005. Reading the same critiques in 2010 or 2011 give a totally different outlook. It's not easy to find dates on many of the articles. Sometimes the only way to guess when it was written is by scanning the bibliography at the end where, in keeping with good term paper etiquette, the date is part of the reference. So you can merely infer the article was written later than the posted reference. The biggest problem is that current data is not usually accessible to the lay researcher. We cannot log into many of the private membership only sites that publish the latest medical research. One needs a medical license and speciality affiliation. Journals are similarly restricted and may require a subscription.
I look at a site like Wikipedia as a bastion of erudition but the fact is Wikipedia is a collaborative project written by many experts and unknown numbers of self professed experts. It is policed by people who, hopefully, know more about the subject than those of us who run to it like we did the Encyclopedia Britanica purchased by our parents from a door to door salesman.
Prevention Magazine has five suggestions for searching the web for medical information:
Narrow down your results. Be specific.
Look for consistency in the articles that you rely on.
Consider the source; the author or the institution.
Check the date of the article.
Stay connected, keep looking. Don't stop with one article that supports your position.
Listen to your doctor but don't give up on the web. Just take it all with a grain of salt and consider the source! Be especially suspicious of writers like me!
http://youtu.be/5IBeYILiUj0
Archive timeline: 2014: May and June - preparing for surgery, July - surgery and post op problems, August - recovery and physical therapy, September - thinking medically.
For every credentialled article, say something published by the NIH or the FDA, a Google search will turn up a 'paper ' written by a self-proclaimed expert. Sticking to references from legitimate medical or educational sources with domain names that end in .edu or .gov is a good start. Although not everyone trusts the .gov resource in all matters.
If I come upon a web-based article with intriguing but unverified information, I'll shift the focus of my search to see if there's a lot of other people out there espousing similar opinions. If the lone wolf doesn't have supporters, it doesn't mean he's wrong, just not repeatable at this time. The other night I found several web articles about the use of surgical robotics for shoulder replacement surgery. The problems with repeating it, for me, were that all the articles I found referenced one company developing the equipment and I couldn't find anything more recent that 2006 or 2007. I hope someone is working on the idea but I'll have to pass up writing about it for now. Then, there is "computer assisted" shoulder replacement surgery which sounds like more of the same but really has to do with planning the surgery, analyzing the X-rays and cat scans to custom fit the artificial shoulder parts and is in common use already.
I have had my doctor tell me that Internet information is not current, therefore not necessarily true. He's right. There are many negative articles on the web about reverse total shoulder surgery and many of them reflect the opinions prevalent when rTSA came to the U.S.in 2004 or 2005. Reading the same critiques in 2010 or 2011 give a totally different outlook. It's not easy to find dates on many of the articles. Sometimes the only way to guess when it was written is by scanning the bibliography at the end where, in keeping with good term paper etiquette, the date is part of the reference. So you can merely infer the article was written later than the posted reference. The biggest problem is that current data is not usually accessible to the lay researcher. We cannot log into many of the private membership only sites that publish the latest medical research. One needs a medical license and speciality affiliation. Journals are similarly restricted and may require a subscription.
I look at a site like Wikipedia as a bastion of erudition but the fact is Wikipedia is a collaborative project written by many experts and unknown numbers of self professed experts. It is policed by people who, hopefully, know more about the subject than those of us who run to it like we did the Encyclopedia Britanica purchased by our parents from a door to door salesman.
Prevention Magazine has five suggestions for searching the web for medical information:
Narrow down your results. Be specific.
Look for consistency in the articles that you rely on.
Consider the source; the author or the institution.
Check the date of the article.
Stay connected, keep looking. Don't stop with one article that supports your position.
Listen to your doctor but don't give up on the web. Just take it all with a grain of salt and consider the source! Be especially suspicious of writers like me!
http://youtu.be/5IBeYILiUj0
Archive timeline: 2014: May and June - preparing for surgery, July - surgery and post op problems, August - recovery and physical therapy, September - thinking medically.
Wednesday, October 8, 2014
Sales reps in the OR..PO Day 115
We've all seen them; smartly dressed young professional types pulling a rolling suitcase, standing aside at the reception desk in our doctor's office. They look like they are waiting for an audience with the Queen. Suddenly the door to the inner sanctum opens and the doctor's assistant nods for them to follow and they disappear.
Generally you have just seen a pharmaceutical representative making a "call" on a physician. Their job is simple and straightforward; they educate the doctor about their products, provide samples, leave coupons to be shared with patients starting on the new drug, share a couple fresh jokes with usually a medical derivation, and occasionally arrange a free lunch for doctor and/or staff, although such monetary compensation is frowned upon these days.
What we, the patients, usually don't see takes place in the operating room. In addition to the surgeon, the OR fills up with ancillary people there to support the surgeon and the patient. You might recognize the anesthesiologist, the scrub nurse who assists the doctor with sterile procedures and instruments, a circulating nurse who is responsible for the non-sterile jobs on the periphery of the scene, a holding room nurse who brought the patient in and the recovery nurse who takes the patient out. Off to one side is a professional looking salesman type, most likely dressed in operating room scrubs but not quite dressed as if to "scrub in." He is a Medical Devices Sales Representative.
He has developed a friendly rapport with the surgeon who has come to respect the agent's knowledge about the artificial devices used in so many surgeries today. Not only is he there to deliver the artificial knee, hip or shoulder that will be used today, he has very likely been in on the decision of what to use, what size is required and what "issues" might show up in this patient. He is now in the operating room to offer support to the nurses in arranging instruments according to when and howthey will be needed and "provide guidance during unexpected events and equipment failures." Wow, he sounds like someone you really want to be there!
The problem is that he is "expensive." He is usually well compensated by the devise manufacturer both in salary and sales commissions. Yes, he is a salesman. He is not there to encourage the surgeon to comparison shop or try the equivalent of Consumer Reports "Best Buy"prosthesis. He is there to promote his product. And in this day when hospitals are having to reduce overhead, he is being looked at as a way to reduce costs. In many joint replacement procedures the device is the most expensive item on the list of charges in the bill. The one big advantage third-world-reduced-cost-surgical-destinations have is that the prosthetic device they utilize will often cost one tenth of the US manufactured joint.
Hospitals are beginning to see the merit in creating a regular staff position, a liaison between the surgeon and the device manufacturers. This person would be responsible for inventorying the equipment needed, assuring its sterility, shopping around to get the best prices, all the while being well versed in the vagaries of the equipment and how to use it. Even knowing hospitals are thinking about it has caused manufacturers to reduce their sales staffs.
I don't know how to think about this potential change. It's kind of like when Allen Shepard realized his space ship was built by the lowest bidders on government contracts. If you remove the profit incentive will you have the same dedication and work ethic? Will the manufacturers have the same desire to educate and inform? Will the surgeon have the same expertise available to him? I hope so.
Archive timeline: 2014: May and June - preparing for surgery, July - surgery and post op problems, August - recovery and physical therapy, September - thinking medically.
Generally you have just seen a pharmaceutical representative making a "call" on a physician. Their job is simple and straightforward; they educate the doctor about their products, provide samples, leave coupons to be shared with patients starting on the new drug, share a couple fresh jokes with usually a medical derivation, and occasionally arrange a free lunch for doctor and/or staff, although such monetary compensation is frowned upon these days.
What we, the patients, usually don't see takes place in the operating room. In addition to the surgeon, the OR fills up with ancillary people there to support the surgeon and the patient. You might recognize the anesthesiologist, the scrub nurse who assists the doctor with sterile procedures and instruments, a circulating nurse who is responsible for the non-sterile jobs on the periphery of the scene, a holding room nurse who brought the patient in and the recovery nurse who takes the patient out. Off to one side is a professional looking salesman type, most likely dressed in operating room scrubs but not quite dressed as if to "scrub in." He is a Medical Devices Sales Representative.
He has developed a friendly rapport with the surgeon who has come to respect the agent's knowledge about the artificial devices used in so many surgeries today. Not only is he there to deliver the artificial knee, hip or shoulder that will be used today, he has very likely been in on the decision of what to use, what size is required and what "issues" might show up in this patient. He is now in the operating room to offer support to the nurses in arranging instruments according to when and howthey will be needed and "provide guidance during unexpected events and equipment failures." Wow, he sounds like someone you really want to be there!
The problem is that he is "expensive." He is usually well compensated by the devise manufacturer both in salary and sales commissions. Yes, he is a salesman. He is not there to encourage the surgeon to comparison shop or try the equivalent of Consumer Reports "Best Buy"prosthesis. He is there to promote his product. And in this day when hospitals are having to reduce overhead, he is being looked at as a way to reduce costs. In many joint replacement procedures the device is the most expensive item on the list of charges in the bill. The one big advantage third-world-reduced-cost-surgical-destinations have is that the prosthetic device they utilize will often cost one tenth of the US manufactured joint.
Hospitals are beginning to see the merit in creating a regular staff position, a liaison between the surgeon and the device manufacturers. This person would be responsible for inventorying the equipment needed, assuring its sterility, shopping around to get the best prices, all the while being well versed in the vagaries of the equipment and how to use it. Even knowing hospitals are thinking about it has caused manufacturers to reduce their sales staffs.
I don't know how to think about this potential change. It's kind of like when Allen Shepard realized his space ship was built by the lowest bidders on government contracts. If you remove the profit incentive will you have the same dedication and work ethic? Will the manufacturers have the same desire to educate and inform? Will the surgeon have the same expertise available to him? I hope so.
Archive timeline: 2014: May and June - preparing for surgery, July - surgery and post op problems, August - recovery and physical therapy, September - thinking medically.
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