Re-gifting...PO Day 199

...and December addendum.

I always end a month with a wrap up of what is going on with my shoulder but I could not resist the natural segue  from gifting to re-gifting. The first public exposure of secret re-gifting was on Seinfeld when the dentist character re-gifted  Elaine's label maker. Of course it has been going on since   Adam gave the resident serpent a Harry and David fruit basket...and you know who ended up with the apple.  It's just no one talked about it. And perhaps the growing affluence and materialism of our society makes for an abundance of "things" we neither want nor need.

So morally, ethically, is it okay to re-gift?  And if it is, why do we deny it? After all, the item gifted to us is ours as surely as if we had gone to the store and bought it. Mainly, I guess, we don't want to hurt the feelings of the original giver. We have to believe they put some effort into choosing something special just for us. And we wouldn't want our recipient to think they did not warrant the same effort of shopping and choosing a present. But sometimes the item is so egregiously wrong for us that we have to wonder, as we are wrapping it to give to someone else, if we are re-gifting a re-gift!

There are some rules to re-gifting. You can't have used the item. If an item of clothing, it has to be in the neighborhood of the right size and appropriate style. If food, it has to be re-gifted before the Sell-by date has expired. If the gift/re-gift is a hobby related item, the new recipient must actually participate in that hobby already. You can't claim you are introducing them to a new activity. And most importantly, you must be certain the item has not been personalized and there is no note or gift card tucked in a hidden spot. Everyone has probably heard the story of the newly weds who re-gifted a wedding present, a crystal vase. Nice re-gift but the new recipient was dismayed to discover the
vase had the wedding couples' initials etched in it. So a thorough inspection is in order before wrapping up that re-gift.

Now, back to the serious stuff...I am just over six months post reverse total shoulder replacement surgery. I have healed well. I have very good range of motion in all fields except behind my back. My surgeon says reach back but don't force it. Yes, it hurts but less and less, the more I do. What hurts is not the joint. It is the muscles where they attach to the bone. Dr. Kai says the muscles are pulled tight in order to be able to lift the arm and it is the tightness that hurts. That is exactly how it feels. He says that should improve with time and use but may always hurt some. It's okay. I am so pleased with the function that I will accept the discomfort as a necessary evil. I am hoping to build up some strength in that arm in the next six months. It is still a good bit weaker than the other arm. So lifting and pouring from a gallon of milk pushes the limit. Tincture of time, as Dear Husband says.

Oh, my hair? Still falling out but maybe the loss has slowed down. Not growing much at all.






Archive timeline: 2014: May and June - preparing for surgery, July - surgery and post op problems, 
August - recovery and physical therapy, September - thinking medically, October - getting back to 
normal. November. -still in recovery, December-6 months and holding.

Gifting...PO Day 198

How do you go about shopping for a gift for someone?

Now that Christmas is past, at least the present presenting part of it, I've been introspecting the way gifts are chosen. Do I buy what I like or what I think the recipient will like? I fear it is the former. But if I like something, really love it, how could the recipient not share my feelings? I like to cook so I don't understand the rule about not buying your wife an electric appliance for Christmas. But many women consider the gift of a kitchen tool a demeaning way of stereotypical branding. On the other hand, men don't turn up their noses at shop tools. The only problem there is that men are so specific about what they want and we females are so clueless when it comes to hardware.

Children are easy, only because they have a list. And they like everything except clothes. Why don't adults have lists? A letter to Santa would work too. It is nice to be surprised but shocked is not a good thing. When did we stop writing to Santa? Did he fail to come through a year or two in a row or did we stop believing?

Giving a book is risky, too personal. It's like taking their intellectual level and gifting based on IQ. Clothing is a minefield; too small is upsetting, too big is insulting. Jewelry is expensive unless you go costume. Would they be okay with that? Food, like baskets, is too corporate. Smelly stuff is good if you know their signature scent but I wouldn't presume to choose for someone else.

I read somewhere to think about what that person always gives you.and follow their lead. Odds are they've been gifting what they like to you so if you stay in that range they're sure to like it. It's true. Dear Sister always likes jewelry and always gifts jewelry. The only risk is that they, too, are trying to buy based on your personality and not their own.

A good combination is a small item to unwrap and an appropriate gift card so they can buy what they want. Consumer Reports doesn't like gift cards. Says it is better to just give the cash. But the gift card kiosk is so colorful and full of promise, so tempting. And a gift card is a gift. It can't be used to pay the electric bill, buy groceries or finance ones bail, no matter how essential those needs might be. Just be a little discerning. Don't buy Aunt Ethel a card to Sports Authority or your vegan grandchild a McDonald's card.

Finally, keep in mind that it's the thought that counts. And if the choice was really off the wall there is always re-gifting! But that's a whole other post.

BTW, I haven't abandoned the subject of this blog, rTSA. Just taking a break from thinking too much and relishing the holiday atmosphere.

Homemade or not..PO Day 197

There was just an incident locally where many people were sickened at an office Christmas party. It wasn't the usual food poisoning as the victims became ill almost immediately after eating and, normally, food poisoning kicks in some few hours after eating. The party was catered and it turned out that the culprit has something to do with the chemical used to heat the chafing dishes. Don't quote me, that's just what I think I heard.

But it started a conversation about holiday food and " stranger danger." I was reminded of a similar incident at an office where Dear Daughter worked several years ago. At an office Christmas party where employees brought dishes, many people who ate the mayonnaise laced food became ill. A new company rule was established...no homemade food at office parties.

Dear DIL reported that one can no longer take homemade goods to the school. No cupcakes for the teachers' lounge, no birthday cake for the little ones celebration, no cake or cookies for a fund raising bake sale! You can only bring pre-packaged commercial food items. And if the packaging has been compromised, torn, broken into, it cannot be served.

So, am I wrong to take homemade baked goods to my doctors? Are they foolish to accept and eat them? At least if they get sick they know what to do. If I bake a cake I often give a slice to the girl across the street who does not cook much. Am I endangering her health? She's a nurse so I might be able to convince her that she caught food poisoning from one of her patients. Oh, you don't think it works that way?

There is no way I will be buying commercially made baked goods for my doctors. It's the homemade way or the highway. Perhaps the hospital, in spite of being in the health care business, has not instituted the new "food police" rules. I know that during this past Christmas season I saw staff people carrying trays and plates of food in and it was not hermetically sealed. We can't protect ourselves from everything!

The Christmas letter...PO Day 196

I have never written an annual Christmas letter to include in my Christmas cards to catch my friends and family up on what was going on in my life. I could claim I was too sophisticated for such foolishness or that my life was too busy to spend a day composing the perfect synopsis or I was too modest to publicly extol my family's accomplishments. The truth is I was just never organized enough to do it.

I might have made a few disparaging remarks about the ones we did receive but the fact is I enjoyed reading them. They were like a slice of Facebook before there was Facebook. No one ever posts about a child's bad grade or a teenager's failed romance on Facebook. Likewise, the traditional Christmas letter presented a perfect world of academic success, marital harmony and fiscal solvency. It was a wonderful world.

Oh, there was the year my cousin sent out a letter detailing the agony of having had her mother in law move in with the family. That letter created more intra family phone calls than the Cuban Missle Crisis. It stands as a prototype of what not to write in a holiday letter, it certainly is the exception to the standard.

But this year there was a noticeable decline in cards received, even in cards sent. I was brutal in crossing names off of my list. A few had passed away, naturally they did not merit a card. A couple had stopped sending to us so I retaliated and did not send to them. And a few more had slipped from friend to acquaintance status, they really never were friends at all, and I heartlessly drew a black line through their names. Obviously that same scene was playing out at other breakfast tables where my name was being deleted from someone's  address book, and not because I was deceased.


I heard a "talking head" on tv discussing the death of the Christmas card this year. She thought it was partially the cost of postage but more the price of time. In our busy modern life we can compose a holiday message, even order up a lovely animated "card," hit "select all," and zip it off to dozens, even hundreds of our closest friends. We can compose a Facebook message that includes photos and background music and reach our family of friends with the tap of one key. It's too efficient to not do it.

So the art of the Christmas card is on the wane. The first warning sign was the pre-printed signature on the inside of the card. Next came the computer generated addressed envelopes. This year it is the disappearance of the Christmas letter tucked inside the card. Next year, I fear, it will be the card itself.


 But only we older baby boomers and great generation folks will notice. The younger generations have already made the emotional break from the card and envelope, stamp and address book. And mostly from the work and time it takes.

Is Christmas over? PO Day 195

For most of us, Christmas is more than one day, it's a season. The world of commerce has taught us that Christmas begins the day after thanksgiving and extends to January 6th. The longer the better so we will have more days to shop. But Christmas is not a creation of the commercial interests, in spite of how they seem to control our thoughts. Christmas is a religious celebration and the dates are founded in tradition.

Most of us think of the day after Thsnksgiving as the start of the Christmas season because of Black Friday. But if you're going to go with that date, you have to recognize the religious season called Advent. Advent lasts forty days leading up to the Epiphany on January 6th. Advent means the coming and loosely means the coming of Christ. The Advent Calendar encourages a small gift every day of the forty and has become very popular.

The Epiphany occurs on January 6th and celebrates the day the three wise men arrived in Bethlehem to welcome the baby Jesus. If you celebrate a shorter Christmas season you might prefer the Twelve days of Christmas which begin on December 24th and end on January 6th.

In many traditions, especially the German culture which brought us the chrustmas tree, the decorations do not appear until Christmas Eve. The children go to bed and the tree in all its glory appears overnight. That must have started back before parents had to stay up half the night assembling bicycles and doll houses. Plus, the tree was lit with candles, a particularly dangerous thing to do with a rapidly drying spruce tree. So the tree was a briefly occurring holiday decoration.

Electric lights and artificial trees have hugely extended the Christmas tree season. I wonder if "live" trees, which are technically "dead" trees, are sprayed with any kind of fire retardant? Perhaps not, as the chemicals might prove toxic in a closed up winter home. Even so, some people suffer allergies from the introduction of the tree into the home. Even the artificial tree can be a problem as it introduces dust and mold from the basement or attic into the living areas of the house. Every year there is at least one story about a squirrel or chipmunk or other small live critter that makes it into someone's house  hidden in the branches of the tree. Exciting!

Well, my mother added the interesting caveat to christmas tree lore...it was unlucky to leave your tree up after January 1st. She never explained why but New Years Day was always spent taking down the decorations. I doubt there was anything more to the story than a desire to get the house back in order. It is true though, as beautiful as the house looks fully decorated, it is a welcome sight to see it stripped bare of decorations.

The final Christmas challenge is incorporating all your wonderful gifts into your environment. Gift cards are easy. They can be tucked into a drawer or even a wallet. Cash fits everyone and the color goes with everything. A new sweater or piece of jewelry  isn't so hard to put away. A panini maker or a griddle grill may require some kitchen cupboard rearranging, it may even set out on the counter for a while. All the better to use it 'cause it's probably not going to get much use once it is moved to the top shelf in the pantry or the bottom shelf under the sink. If your gift is as big as a tv or a piece of furniture let's hope you knew it was coming!

So, whether Christmas is over for you today, the 26th, or you're just getting started celebrating, I hope     it brings you the peace and love we are all seeking this time of year, in deed, all year round.

Christmas Day..PO Day 194

It doesn't seem appropriate to write a post about transparency in hospital billing or the significance of the color of the "scrubs" the different hospital workers wear. It's Christmas and my thoughts should travel a higher road today. Maybe a post about aspiring to live a better life or how to make a difference in the world would be a good topic today. but it's hard to broach those subjects without sounding pious at best, preachy most likely.

I do want to be a better person, not just today but every day. The problem is that life gets in the way.
I'm impatient or too busy. Too busy to be nice? At least too busy to be considerate sometimes. I would like to make a difference in the world. I just can't go to a third world country and volunteer for a year. I have responsibilities here, people who depend on me here. Can't I be heroic here? Don't the little things here count?

Isn't there a humanitarian award for the mom who quietly raises good children? Or for the spouse who stands by the partner undergoing serious medical treatment? Maybe those acts are only valued when they are done selflessly with no expectation of recognition. I do think it's true that if you do a good deed expecting a reward, the good deed turns into a black mark on that cosmic report card.

Bravery and courage aren't just for the good soldier. A friend facing a scary diagnosis who stoically endures the onslaught of medical interventions deserves a battlefield commission. But the most she gets is a new pair of hospital socks with the grippers on the soles.

There is no public adulation, no awards ceremony, no red carpet gala celebrating those little victories over indifference or detachment or self pity. We are at our  best when no one notices but we persevere and do the right thing, hopefully for the right reason. I guess that is most I can hope for.

Christmas...PO Day 193

Merry Christmas, Everyone!

Wearables...PO DAY 192

Get ready for a new word to enter your vocabulary. Well, maybe an old word with a new meaning.

It happened with the word "swipe." It used to mean "to steal," now it's an action of sliding your credit card through a little card reader. "Tweet" was something a birdie did, not people. A "cell" was where a prisoner stayed, not part of a phone system.

In the past if someone said "wearables" your brain would make the leap to clothing that was comfortable, easy to launder, durable, and so versatile you could wear it for any occasion. But you'd be wrong. A wearable is a medical device that monitors a bodily function like heart rhythm, temperature or blood pressure. Some devices communicate directly with the doctor or the hospital, some are just for the wearer's information.

Apple has the iHealth wrist monitor. There's the Jawbone, the Pebble, and the galaxy Gear. Nike has the Fuelband, Adidas has MiCoach. There's the Fitbit and I'm Watch. And those are just the best recommended for the health conscious individual.

According to the Institute for Health Studies, "Wearable Technology - Market Assessment, roughly 50 million wearable units will be sold in 2014, and more than 180 million are predicted to sell in 2018. Wearable devices create new ways for businesses to connect with customers and employees – and wellness, healthcare and medical categories are forecasted as the top applications. Based on these figures it is no surprise that life sciences companies are showing a keen interest."

Just when we thought there was nothing new under the sun...an entirely new industry comes along. 

Nothing to say...PO Day 191

I have nothing witty to say. Not even anything boring or dull. My brain cells are fully occupied with last minute Christmas thoughts. Fortunately family members have taken on the responsibility of negotiating who goes where when. I don't think the White House social secretary could have done a better job of tip toeing the diplomatic minefield of a blended family holiday! Thank goodness for great step daughters and daughter in law.

 I am having such fun making chocolate mice that traditional Christmas cookie baking has been neglected. But everyone thinks the little mice are too cute and it is more fun to give them away than a mundane chocolate chip cookie. Not that my chocolate chip cookie is mundane...I use the New York Times recipe which is great. I don't know who came up with the mouse idea but they deserve some kind of recognition for creating culinary cuteness.

Presents are wrapped but no bows yet. When I took inventory I realized I have one more gift to buy so will make a dash to local stores today.  The guys, who are usually SO hard, are mostly getting gift cards so they are turning out to be SO easy. There is still the suspense of whether or not UPS, FED EX or the USPS will actually get some packages to their destination by the 24th. The new tracking only shows things have been shipped, not where they are en route.

I should be asleep but I guess I am anxious to wrap up things, literally. If I shut down my iPad and turn off the tv will my brain stop spinning? I guess I should try. If I can't go to sleep I'll come back here to hang out.

Goodnight all.

How old are you? PO Day 190

How old are you versus how old do you feel? Not on a bad day, not on your best day. Just in general. In spite of a really bad year and a half I still don't feel my age. Do I dress too young? My voice is young sounding so callers still ask for my mother on the phone. I do sometime wonder who that woman in the mirror is. It couldn't be me! Is there any benefit to having a youthful attitude?

The December 2014 issue of the JAMA, Journal of the American a Medical Association, published a synopsis of a study addressing this question. 6489 individuals with a mean age of 65.8 years were asked "How old do you feel you are?" Self perceived age was then compared to actual age and participants were followed for a little more than 99 months.

Most participants felt younger than their actual age: 69% felt more than three years younger than their real age; 25% felt just about their real age; and 5% felt more than one year older than they actually were.

Even when depression, cognitive function and real physical condition were considered, the mortality rate remained unaffected by those issues. If you felt younger, you lived longer. Interestingly, perceived age wherein you thought of yourself as older had a significant effect on cardiovascular deaths but no association with deaths caused by cancers.

So...think young, dress young. Do young things. It's all about your attitude unless it's all about cancer.

Popular procedure...PO Day 189

Reverse total shoulder Arthroplasty used to be a rare surgical event. But it is becoming much more common and one reason is that it is used to revise previously operated shoulder situations that have gone awry.

In a statistical study using the Nationwide Inpatient Samples for 2009 thru 2011 there were approximately 52,397 primary shoulder arthroplasties (total, hemi, and reverse) in 2009, increasing to 67,284 in 2011.

Reverse TSA accounted for a surprising 42% of all primary replacement surgeries of the shoulder. 8.8% of those were revision procedures, that is, procedures to correct problems that were a result of previous shoulder surgeries, for instance if there was loosening or dislocation.

So what was quite recently considered experimental has become the go-to fix for post operative problem situations along with the primary surgery for extreme situations. The surgery does remain much more common for older women; in the study the highest rate for rTSA was for women 75 to 84 years old.

A revision procedure appears to be technically more difficult than the primary operation so if you are considering it you might think about seeking a second opinion and going to a high volume surgeon who has more experience with the revision surgery.

Busy days...PODay 188

I am not ready for Christmas and the clock is counting down. Please forgive me if my posts are pretty brief. To make things worse, there is a puzzle on the breakfast table that simply devours my time. I cannot walk past it without stopping for a minute that turns into thirty minutes.

Tomorrow is my last chance to go shopping. Me and a few million other slackers.

I've managed to get packages that have to be mailed off. It's still difficult for me to carry much weight so I have a baby stroller that I use for packages. It's one of those frames meant to receive an infant carrier so there is no seat, just the frame and the sling type basket below. Very handy. Some times I even recruit it to roll groceries in from the car. Definitely use it for trips to the post office.

Our primary care doctor filled out the paperwork for a handicapped parking permit based on Dear Husband's foot-ankle problem. It is legitimate, he is really having a problem walking any distance. The permit really benefits me the most as I drive and let him off at the door. Then I have to park and catch up with him. Now I will be able to park close by, maybe even close enough that he can walk the Distance. It's just another little thing that makes life easier for us.

Finally, I colored my hair tonight. Two good hands! I really could apply the dye very well with my operated right arm. I even semi parted off my hair like you are supposed to do. Using my arm, even behind my back to some extent, is really adding to its range of motion. It's time for a haircut but it has grown so little and is so thin that I think I will pass. Besides I need that time for shopping...or hunting  puzzle pieces!

Falling is bad!...PO Day 187

If you watch football or basketball on TV, the players take some horrific falls and bounce up to keep playing. Kids tumble and fall all the time, usually without bad results. Who hasn't tripped and come home with skinned knees and wounded pride, nothing more?  But put us in the geriatric generation and falls become serious problems. A fall certainly brought me to this place and time.

However we came to rTSA, a fall after surgery is even worse. A great deal of the stability of the implant is due to tissue ingrowth. Any event that disrupts the knitting together of living tissue with bionic implant is undesirable but a fall in this early healing phase poses a serious risk for thepatient.

In a small study of 41 surgeries on 37 different patients (28 women, 9 men) the surgical results were generally satisfactory with improved abduction and flexion. However, complications included four falls  that resulted in glenoid  loosening. That does not sound like much but it is a statistical rate of 10%.

This indicates that there is an increased risk of falling for the rTSA patient and such a fall can be a particular problem if the glenoid fixation depends on bone ingrowth. When one falls the natural response is to put out your arm to try to catch yourself. A new glenoid screwed into soft bones will not hold up to such events. But why is this patient susceptible to falls? We tend to be older than the average orthopedic patient. Disabling one of our arms creates a balance problem and leaves the patient a bit off kilter. It may be that medication to help with balance can have the opposite effect. Sometimes the more anxious we are about our gait, the worse we are at walking. 

Whatever...we need to be aware and careful. Falling is never good, right now it's a disaster.

Nostalgic...PO Day 186

Is it nostalgic or elegiac? There's a fine line. But I was just thinking that I miss Christmas sweaters. They were definitely an 80s thing, maybe even 70s. They were adorned with Santas and reindeer, jingle bells and sometimes even working lights. I preferred the ones where the design continued over to the back. I felt cheated if Santa's sleigh stopped at the side seam. I had one long cardigan style that had a real bell near the bottom back that made it kind of hard to sit down. Another favorite of mine and my "grandcat" had little elves with 3-D beards of some white furry stuff. The beards were like catnip to Libby the grandcat.

Living in the South made it difficult to find days cool enough to wear your pullover holiday sweaters.  You really had to wear a shirt under the sweater which doubled the internal temperature. But if you didn't, when the thermometer reached 80 degrees at 2:00 PM, you could not peel it off revealing a shirt damp under the arms and on the back. Corduroy pants in bright colors were the perfect accessory but definitely increased the thermal factor. You are not a real southern girl until you have worn your Christmas sweater with shorts.

Christmas sweaters were kind of like the annual Waterford Christmas ornament, you added one to your collection every year. They were relatively expensive so the smart collector might wait for after Christmas sales and hope the coveted sweater was still on the rack. Of course, then you had to wait eleven months to get to wear it. No one ever wore a Christmas sweater before Thanksgiving or after December 25th.

Now there are office parties whose themes involve "tacky Christmas sweaters." Lucky millenials have moms who could not bear throwing away their Christmas sweaters, unlucky ones search second hand thrift shops. There is even an eBay market for gaudy sweaters of red or green adorned with ribbon and snowmen and decorated trees. The more garish your sweater the more likely you are to win the prize for the worst Christmas sweater.

Well, all I can say is that winning sweater was once loved by someone who wore it and thought they looked terrific in it. And when they "come back" I'll be ready...I have my favorite two or three tucked away on a shelf in my closet just waiting.

Human connection...PO Day 185

I still think it is strange that my surgeon has never looked at my incision. Oh, he must have before it was covered with a big bandage immediately after surgery. But not since. His nurse was the one who removed the bandage and took out the stitches. I thought he would come in the room and take a look but she covered it all up with steristrips and that was it.

At each subsequent visit I get an X-ray first thing. They advise to not wear anything up top with metal or plastic even. So a pull over stretchy cami under a pull over type shirt makes it quick,and easy and you don't have to disrobe at all. The first couple visits I tried to wear something that could be pulled over or up to give access to the scar. But I learned that was not necessary as no one, certainly not the doctor, was going to actually look at the surgical site.

I'm quite sure had I complained of something wrong, like dehiscence or gooey stuff oozing out of  a gaping hole, it would have attracted some attention. At least I hope so. But I cannot complain as the wound has healed well and the incision looks as good as I could hope. On at least two visits, including this last one, I said that the scar had healed flat and cosmetically well and I was very pleased. Not that I will be wearing a strapless evening gown to expose my bare shoulders. But it was an opening for the doctor to say, "Let's take a look at that scar." Nope, no interest.

Everyone likes to share a peek at their surgical site. President Johnson pulled his shirt up and his pants down to let the press corps get a look at his gall bladder scar. I've had perfect strangers show me their surgical scar if a chance encounter led to comparing hospital experiences. The only person to remark on my incision was the nurse coordinator who discharged me. She changed the bandage to a waterproof one so that light showering would be possible and she proclaimed  that the incision looked fine. I wonder what she would have said had it looked not fine.

Anyway, I just can't imagine that Dr. Kai hasn't taken a look at his handiwork. Yes, the X-ray gives him a look inside and that is, of course, what's important. But it just seems strange to me that the wound closure deserves so little attention. Also, I think he is missing the opportunity for that brief but essential moment of the healing human touch.

To quote from a recent piece from the New York Times, internist Danielle Ofri says we need to look past the lack of evidence supporting the physical exam. The benefits of touching the patient, and listening to his heart and lungs, cannot be quantitatively measured:

"Does the physical exam serve any other purpose? The doctor-patient relationship is fundamentally different from, say, the accountant-client relationship. The laying on of hands sets medical practitioners apart from their counterparts in the business world. Despite the inroads of evidence-based medicine, M.R.I.s, angiograms and PET scanners, there is clearly something special, perhaps even healing, about touch. There is a warmth of connection that supersedes anything intellectual, and that connection goes both ways in the doctor-patient relationship."

I just think my doctor is missing an opportunity to bond with the patient in the most simple and basic way. But maybe that is old-fashioned thinking, certainly not taught in the modern clinical setting. Too bad.

Selfie @ 6 months...PO Day 184

I can't explain the animation, if it is still going on as this is posted on my blog. I guess it is switching between the two X-rays . The. good news is that everything is still where it is supposed to be. The longer it stays put,the more tissue grow into the device and the less likelihood that there will be a dislocation.

Of course , we talked about the discomfort I have. Dr. Kai says it is due to the way the muscles have to be pulled tight and afixed to the bone. The tightness facilitates raising and lowering the arm but also causes the pain. He says that with time the muscles should stretch out some and feel less sore. But there may always be some discomfort. I can accept that. He says use the arm, reaching and stretching as much possible. I do, I do!

I was given their version of the SST, Simple Shoulder Test. It included those throwing a ball 65 feet overhand and underhand questions. I don't see how that is a good judge of function for a non-ball playing woman. Ask me if I can stir a stiff cookie batter with that arm, can I hang up clothes on a clothesline, could I clean my oriental rug on knees with a scrub brush. By the way, the rug looks terrific!

Because I was given a copy of the op notes, I learned the manufacturer of my artificial shoulder device. The company is based about 70 miles from here. I asked Dr. Kai if it was alright for me to contact the company and perhaps ask for a tour. He thought it was a great idea and encouraged me to do it. So after Christmas I will get to work on that project. I think it would be very interesting.

I see the doctor again in six months, then convert to a once a year schedule. I think this is going to be a lifelong relationship. But it looks like he is more committed to his patients than to his staff...almost everyone was new. Since he is a hospital affiliated doctor, does he control his staff or does the hospital manage employees? Another doctor I see, my primary care physician, is constantly rotating staff in and out. He, too, is a hospital employed physician. They both have one "right hand man" (in both cases a woman) who does not change but seems everyone else is expendable.

The modern state of employment is challenging. There does not appear to be much, if any, loyalty to the employee. Does not bode well for job security. So glad I am retired, I don't get nearly as much accomplished as when I worked. Everyone agrees that is true for them too.

It's like that old adage, " if you want something done, assign it to a busy person." Not me, for sure!

Nighttime angst...PO DAY 183

Wouldn't you know...I see my orthopedic doctor this morning and my arm/shoulder is more sore than usual. Other than a mega day shopping Saturday which did not cause any trouble yesterday, I can't explain it. What did I do yesterday? I made some toffee, that recipe with butter, brown sugar and saltines. Yum. I packaged up a few pre-Christmas gifts to take to the post office today. I wrote my Christmas cards. My hand writing has improved considerably, thank goodness. Last year my cards were barely legible. Nothing to warrant discomfort.

I can't call it pain, definitely discomfort. I can't describe it as other than muscular. When I discussed it with the doctor before he said it was the deltoid muscle and its new connections. From my reading the deltoid is connected either by drilling into the bone to anchor it or by installing screws into the bone to tie the muscle to. I have to ask him how he did it. I'd just like to understand what and why it hurts.

But even though I'm complaining, I am not unhappy. Before surgery the doctor asked me what I hoped the outcome would be. I said I would be happy if I either had less sharp, stabbing pain or if I had some better functional use of my arm. Well, I definitely have both of those positive results. The grinding bone pain is gone and I can reach and use my arm quite normally. Yes, it is pretty stiff and there are motions than tweak me but all in all it is so much better.

Do I think it is slowly getting better? I do. But the improvement is slow. I want it all and I want it now. I do know that simply taking one ibuprofen almost totally relieves the discomfort. But ibuprofen keeps me awake and nighttime is when I am most uncomfortable. I certainly don't need any narcotic type drug.

I wonder if an ice pack would help. I think I will go get one. I haven't used ice on my shoulder is quite some time but it was very helpful in the month or two post surgery.

Nite all.






Archive timeline: 2014: May and June - preparing for surgery, July - surgery and post op problems, 
August - recovery and physical therapy, September - thinking medically, October - getting back to 
normal. November. - still recovering. December - 6 months PO!

Christmas shopping..PO Day 182

I was one of the hoards of people out Christmas shopping today. About time! I have been a real slacker about doing anything to prepare. Oh, there's a wreath on the front door and my Martha Stewart's design three tiered tree in the living room. I did buy some Christmas cards and Dear Husband has addressed his half. I'll try to do mine today. I have made some cookies but that is nothing unusual.

I had an appointment for a pre-Christmas hair cut  today but along with falling out my hair is just not growing. At all. It is quite short so normally even two weeks time results in out of control curls at the nape of my neck. I often take a pair of scissors to the fringe on my neck and in front of my ears between appointments. But not this month. Weird.

My shopping gene must have been damaged during my rTSA surgery as I have just not been interested. I didn't even have my usual collection of coupons and discount $ off cards  with me today. Did I throw them away thinking I would never shop again? Macy's was great...when I bemoaned to the clerk that I didn't have the requisite $50 purchase to qualify for the 20% off, the coupon for which I didn't have anyway, she instantly offered me $10 off the already great sale price I was getting on a Lenox tablecloth. Steinmarts was so crowded but I managed to find something for a teen grandson, absolutely the hardest person to shop for. TJMaxx  had the longest line to check out I've ever seen there. Unfortunately I only found something for myself, a real danger of aimless Christmas shopping.

One more marathon shopping day should do it.

I have to mention the wreath on the inside of our kitchen door. Dear Son and Daughter in law sent us a live wreath from L.L.Bean last year just after thanksgiving. It was adorned with sand dollars and star fish, appropriate since we live in a little beach village. It was so pretty that I hung it on the inside of the kitchen door so the weather would not destroy it so quickly. Well, time passed and the wreath did not deteriorate. That door gets opened and slammed shut several times a day but no needles fell to the floor. Christmas 2013 turned into Valentines Day and the wreath endured. Soon Independence Day came and went, Labor Day and Halloweeen. The wreath endured. It got to be a challenge to see how long it would last. I looked at it the other day, tugged at a few branches to see if a handful of needles would fall off...they didn't, and decided the only sign of age was a change in color from evergreen to Olive green. So I took it down, expecting it to fall apart in my hands...it didn't, and I sprayed it with an ancient can of fake snow. It is back in its place of honor, now well into its second year.

That's my Christmas miracle story this year. I should tell L.L.Bean.

Activities...PO Day 181

Today was a high activity day for me. It was pre-Christmas cleaning and it involved cleaning the oriental rug in the living room. No rug shampooing machine for it...two scrub brushes, vinegar and water and four arms, including one slightly compromised shoulder. It was a work out. Am I overdoing it?

In a 2012 study that included 78 patients with 81 treated shoulders (rTSA) it appears not. The average age was 73, 49 women, 32 men. Average time since surgery was 3.6 years.

Activities were broken down into three categories: low demand, medium demand and high demand. Low demand consisted of things like cooking, baking and driving. Medium demand  involved gardening, leaf raking and lawn mowing. High demand included snow shoveling, using a wheelbarrow and dirt shoveling.

There was no difference in activity levels from patients who had undergone other types of shoulder arthroplasty. And a significant number of the rTSA group continued to perform medium and high demand activities. Patients did recognize that participating in high demand chores might lead to discomfort afterwards so there was a short term price to pay. But in general, it did not deter them.

The study suggested long term follow up would be useful to see how patients tolerated medium or high demand activities at ten or more years post op.

I'm not sure where I would place rug cleaning on the low-medium-high scale but it was a workout. But the interesting thing is that I usually find greater activity loosens my shoulder up and has a positive  effect. It might seem uncomfortable as I am doing it and it might make sleeping a bit more uncomfortable but it does seem to move my recovery forward in the long term.

Now if I can just convince Dear Husband and the doctor of that!

Celebration...PODay 180!

It is hard to believe it has been 180 days since my rTSA surgery. Six months!  My six months check up is next week so I guess that will make it official. I wonder if after that my next visit will be in six months, then once a year? And for how long? Am I now a perpetual patient, like the anniversary clock my aunt had on her buffet, the one that had to be wound up once a year? It seems so strange to be a regular patient who sees the doctor on a fixed routine. I was always the person who went to the doctor when she was sick. Otherwise, not at all.

I always say that if you go to the doctor they are going to find something wrong with you. It's their job. Obviously I am not a big fan of the well-patient check up.

My favorite doctor is my primary care physician. I've referred to him here as Dr. Kildare. He is caring and thorough but he never makes you feel like there is something wrong, even when there is. He eases you into the shock of something being amiss. I like it that he allows me a short period of denial before I have to cope with the truth. If a lab result is a little high, he says it is nothing to worry about. But he can be firm and when something really is wrong, he cuts to the chase, orders the tests and does what has to be done.

I made more of the Christmas chocolate mice. It wasn't as much fun as doing it with the grandchildren. Boxed some up and delivered them to three of our doctors today. At our ages you can't   drop by a doctor's office without running into a friend...naturally we did today. She lamented that she had not brought something to the doctor, like food. But I am glad she didn't as anything she made would have been spectacular and my little mice would have hung their heads in embarrassment. I want to make one more batch so I'll have some to mail to a grandson in California. I wonder if they'll
survive the trip? Well, it's the thought that counts.

I have to get busy and do something for Christmas. I haven't finished my shopping, very little decorating, just don't have it together. Maybe I should spend less time on line!

Speaking of change...PODay 179

For the past few years it seems as if we have been being weaned off of the emergency room. It is frequently reported that the public tends to use the ER like a primary care doctor but it is much more expensive than a doctor office visit. So, many of us have got message and have turned to "urgent care" facilities when we have a sore throat or a sprained ankle and it's the weekend or we can't get in to see our regular doctor. We thought we were doing the right and recommended thing.

But whoever has been spreading the word to avoid the ER hadn't been talking to the ER Doctors!

In a recent poll by the American College of Emergency Physicians nearly 3000 physicians were asked their opinions about urgent care centers. Eighty-six  percent said there was an urgent care facility within ten miles of the ER where they worked. More than half of the physicians felt that the centers were marketing themselves as an alternative to the ER. Three fourths of the polled doctors said they were concerned that patients with serious.medical conditions might seek help through the Urgent care centers. They felt this delayed patients with serious medical conditions getting proper treatments in an ER.

Young people find the urgent care facility affordable and efficient. But many Emergency Departments and Primary Care doctors are concerned about the rapid growth and competition presented by these clinics. The majority of ER doctors would like to see the states set specific guidelines for staffing and equipping urgent care centers.

But the bottom line is that many of the surveyed doctors feel that these centers are okay to treat minor  sprains and cuts but "don't have the capabilities that emergency departments do for complicated diagnoses and treatments."

But if there is not one near you now, hang on, there is probably one coming soon.

Crystal ball...PO Day 178

Price Waterhouse got out its crystal ball recently to look at the future of healthcare in the U.S. Here are some of the issues they see facing the medical industry in 2015.

Privacy will give way to convenience. With the use of electronic health records accessing the patient's medical information will become faster and easier but restricting its accessibility will become more difficult.

The aging population will force the medical industry to become more creative in delivering care to a variety of patients with different needs and financial resources.

New laws will extend the use of ancillary medical personnel like nurse practitioners. Remote digital patient monitoring will become more prevalent.

The trend will continue to make clinical trial data available, study outcomes will be transparent along with physician-pharmaceutical relationships.

The emphasis on positive outcomes will increase. It won't be enough to just treat the patient, a good result will be considered and expected.

Portable home medical devices will be more common and link information to the medical office.

Do-it-yourself healthcare, that is monitoring your heart rate, exercise and activity, caloric intake, blood pressure and temperature, will be common and convenient with personal computer devices. 

It appears we will be more in charge of our own health. Result oriented health care will replace the current practice of throwing the kitchen sink at a problem. The patient will have access to a variety of medical personnel, not just the medical doctor. Research information will be more available and more transparent. It sounds like a real change is coming. Is it all in response to obama care? Is it due to cuts in reimbursement forcing the medical industry to be more lean and mean? Well, Hopefully not so mean.

It's not easy! PODay 177

Touch the image to enlarge it.

I don't know if anyone remembers my google disaster of a month ago. Suddenly, in the middle if the night, probably because I hit some weird key combination, all the Google instructions on all the Google pages changed from letters to rectangular Os. I did everything to change things back to normal to no avail. This has happened to other people and the support chat areas are full of details. I've tried all the fixes but I now think the only thing I can do is delete my current Google account and start over. The problem is not in my equipment, it is in the Google program. 

Well, I don't want to cancel my blog. When I started this I said I'd stick with it for one year or until I ran out of things to say. So I am stuck with the lack of directions. I can mostly remember what to click on to do the normal things like write a new post or publish it. Sometimes I go to the wrong place because I clicked on OOOO OO instead of OO OOO OO. I can no longer tell how many readers are checking in from which countries and I miss that function. Believe it or not, I had quite a few readers from France. The program still reports the data, I just can't tell who OOO OOOO is from who OO OOOO is.

If a message pops up I don't have a clue what it says. Fortunately what I write appears in normal letter print. And if I open the blog like the reader does, it appears in normal print. So I guess things could be worse.  I consider the inconvenience a challenge for my memory and I am doing pretty well. Maybe this will ward off Alzheimer's. 

Naturally, since blogspot is a free service provided by Google there is no tech support to call for help.  I can't use the Settings function since I can't read any of the directions. Not even the word Settings but I do remember how to open it. Google members have made many suggestions and they either don't work or I can't do them because I can't read anything! I thought I could outsmart the program and tried logging in on a Dear Husband's computer. That's what made me realize the problem is in the Google settings, not my equipment. 

So, I'm sharing my sad tale to excuse all the strange things that might happen here. It's only six more months to go. 

choosing a hospital...PO Day 176

In an article in the Dallas Morning News USC researcher, John Romley, reported an interesting trend. As reimbursement from medicare and other insurances falls, hospitals are adding luxury features in an attempt to attract patients.

It used to be that the choice of hospital was based on where your physician "had privileges." Now it is quite possible that your personal doctor will not see you in hospital, rather you will be seen by a hospitalist, a staff doctor employed by the hospital. So you can go to any hospital you wish and your decision m ay  not be based on the best rationale.

Increasingly, reimbursement for medicare patients is tied to the satisfaction of the patient. Corporate health care thinks they know what we want and it's not better medical care. It's better food, fine art in the lobby and on the walls, and valet parking. Hospitals are spending their money on cosmetic remodeling with fountains, travertine floors and plush furnishings. Patients are making their hospital choices based on amenities since those are things we can understand. Infection rates, survival statistics, and best practice policies are not as visible as luxury patient suites and gourmet dining options.

But aren't they more important? Until the patient asks for information related to successful patient outcomes the hospitals will continue to assume we are more concerned with the five star spa atmosphere than with how well the hospital manages their patient's ultimate outcome.

So while medicare payments to hospitals are falling, the hospitals are spending huge amounts of money on cosmetic improvements to attract more patients for whom they will be paid less.

Sorry, my music link ended up in an odd place below.



Archive timeline: 2014: May and June - preparing for surgery, July - surgery and post op problems, 
August - recovery and physical therapy, September - thinking medically, October - getting back to 
normal. November. - still recovering.
http://youtu.be/gBCdlBrgEmE

Where is Willet?...PO Day 175

It's 3:00 AM on the east coast, midnight on the west coast...where is Willet?

Well, speaking of those grandchildren...they're here and nothing else is as important, not even one's blog. They used to come stay for a day or even a week frequently but since I injured my shoulder in July 2013 we haven't had them for an overnight visit. It wasn't so much cooking or doing for them as the logistics of getting them here was a problem. They live a good hour and half away.

 So yesterday, for the first time in a long time, I drove about 60 miles to rendez-vous with their mother and pick them up. We spent a couple hours Christmas shopping and then headed home. I handled the driving and the walking in the mall, both crowded with lots of holiday shoppers, very well. Of course, I was highly motivated. It's a short visit. We will meet up again this morning and they will go home.

We had to squeeze one Christmas project into the visit so after dinner we made chocolate Christmas mice. Always a little hard to entertain young teen kids but this was a lot of fun. Pretty messy but it had the benefit of working with food items everyone loves (chocolate, cherries, Hershey kisses, Oreo double stuffs) so it turned into crafting and dessert all in one. Dear Husband was a bit dubious when we started but even he thought the finished product was pretty cute and very tasty.

But mostly, it was so normal. After a year and a half of being a "sickie," an invalid kind of, I was back doing fun little things with the grandchildren. Driving, shopping, cooking...not so much to ask for but out of reach for a long time.

What a great Christmas present for me!







Archive timeline: 2014: May and June - preparing for surgery, July - surgery and post op problems, 
August - recovery and physical therapy, September - thinking medically, October - getting back to 
normal. November. - still recovering.

This flu this year...PODay 174

Reported by ABC, CBS and NBC and summarized by the AMA Morning News is the story of this year's flu strain. H3N2 is an unexpected variety of flu and we are poorly prepared for it.

Each year researchers make an educated guess as to which flu strain will afflict the human race the coming winter. A flu vaccine is developed to combat that particular variety and eventually makes it to our local pharmacy or clinic. We do the right thing, get immunized and feel protected from the virus de jour. It didn't work out so well this year. Perhaps the scientists guessed wrong, maybe the virus mutated before the vaccine made it to market...whatever, the vaccine is "not going to work the way a flu vaccine normally works," according to Dr. Richard Besser of ABC News.

While the shot we got may offer some protection, it will not have the effectiveness we expect. Hopefully if we do get the flu, H3N2 this winter, this "wrong" vaccine will have some effect, perhaps 40% protection, as opposed to the 60% we would normally expect. Unfortunately, it appears this H3N2 is turning out to be a severe strain. It has been circulating for the last few years and has tripled hospitalizations of victims, particularly the elderly and young children.

It used to be that there was little physicians could do for viruses. But antivirals are now available and are recommended as soon as the patient recognizes they are sick. Unlike antibiotics which kill off the bad bacteria, the antiviral drug can only slow the growth of the virus it targets. Nonetheless, it is the best weapon in the fight against the flu, after the vaccine of course.

The CDC is still recommending everyone get vaccinated against the flu. Forty percent protection is better than no protection. Wash your hands frequently. Avoid large crowds and sick friends. Be especially suspicious of small, runny nosed children! My experience is that they get over the "bug" in a week and we are sick with it for a month! Gotta love those grandchildren! :)






Archive timeline: 2014: May and June - preparing for surgery, July - surgery and post op problems, 
August - recovery and physical therapy, September - thinking medically, October - getting back to 
normal. November. - still recovering.

Back to work...PODay 173

An interesting survey addressed the question regarding going back to work, when, if ever. Of 365 patients who underwent rotator cuff repair, not rTSA, 305 were able to return to work by 6 months post procedure and 60 were not, or did not.

Two issues arise.

On the surface rotator cuff repair seems a less major surgery than TSA ot rTSA.  But I did read that cuff repair often took longer to recover from than from TSA (total shoulder arthroplasty). And I have a friend who had a cuff repair shortly before my own surgery and she has had at least as rough a recovery as I, if not worse. It's hard to compare your own medical situation to someone else's.

Second, Motivation is a huge part of going back to work and it may have little to do with one's post op situation and more to do with liking your job.

A surgery may be the incentive one needs to take an early retirement. It might be the perfect opportunity to become that full time mom or wife you've been imagining yourself. If your job is too physical, like lifting heavy weight or making repetitive movements, you may see this time as an opportunity to look for a new job.

Could I do my old job at 173 days post rTSA? I think I could. Would I want to have to? Definitely, no. Is that a fair answer?  Would "work" allow me a little lay-me-down in mid afternoon? Could  I take a little longer to  get a job done? Could I set aside more difficult tasks to another day when I felt more like tackling them? That's what I do at home. I say I can do anything if given enough time.

"Work" makes demands on our time and energy that are tolerable because we have gotten used to the inconvenience of it. The discipline of getting up and going to work everyday is learned as teenagers in our first summer job. If we make it to 65 and social security we have earned an honorary PhD in how to make a living and meet the requirements of a job. It's not that we quit working in retirement. Far from it. But we do it on our own terms, what we want to do when we want to do it.

So, if I am honest with myself, would I be back at work now, almost six months post op? If I weren't retirement age already? No. Could I do the job physically? Yes. But I have experienced the freedom of not working and I am spoiled. I don't think it would have taken six months off for me to unlearn the discipline of the forty hour a week job.

Pain medication...PODay 172

My shoulder hurts just enough that I'd like to take an over the counter drug for it. Aspirin causes me to have little hemorrhages so I tend to avoid it. Ibuprofen works very well but it keeps me awake if I take it at night which is when I could use something. It's true that a lot of pain medications have caffeine   added to the active drug ingredient. Caffeine perks us up, delivers the pain relieving element of the pill faster and is, in and of itself, a mild pain reliever.

That's great except for those of us who are sensitive to Caffeine. Oh, I don't mean I'm allergic to it. I used to love the "kick" a real coke gave me. But a little, a very little, caffeine, nervouses me up and keeps me wide awake. I have enough trouble sleeping without adding caffeine to the equation.

So what doesn't have caffeine in it? Dr. Google says aspirin, acetaminophen , and ibuprofen probably do not contain caffiene. However, individual manufacturers could add it so one has to check the label. Tylenol probably does and so does excedrin. The military used to hand out "APCs" which were a combo of  Aspirin, phenacetin, and caffeine (a pill containing all three). Phenacetin was the first nonsteroidal anti-inflammatory drug (NSAID) to be associated with kidney failure. Scary but very effective. Does chocolate contain caffiene? Yes, but not much. When I was a teenager working in the mall my breakfast if choice was a coke and a piece of chocolate cake. That gave me the strength to work twelve hours on Saturday.

But even though I have bought what I think is caffeine free Ibuprofen  it adds to the insomnia problem. I don't believe being free of discomfort keeps me awake. It ought to be the other way around, pain free should equal sound sleep. But in spite of the fact I am not sleeping well at night I am full of energy and don't feel sleep deprived. And, because I get up so early, I get a lot done before 7:00 AM. 

I used to be jealous of early risers. Now I am one!

Decorating...PO Day 171

It's December 2nd and time to start thinking about decorating for Christmas...if you're going to do it. I am always amazed at the german tradition of putting up the Christmas tree on the night of the 24th. If I am decorating I want to get my "money's worth." It's a huge investment in time and energy, too much for just one night.

I "inherited" my mother's collection of Christmas houses. I have had them for years but never displayed them. So last year I decided to put them out. I couldn't find them! These are no little things. As Christmas drew closer I just gave up. Well, looking for something else several months ago I found them stored in a window seat. Who put them there, I wonder. So today was the day to get them out. I set them up in the kitchen to see if the lights worked. A couple had a broken chimney or railing that required gluing. Two are missing the electric cord and little light bulb. I think replacements are sold someplace. The electric cords are more of a snarled mess than what you see behind your computer work station. All of them were dusty and got a light brush off. Finally they were ready to be moved to their temporary home. Houses, cords, and extension cords had to be moved in groups of three or four, up and down the stairs many trips. Electric outlets were not as accessible as they had been in the kitchen so a trip to the hardware store for a surge protector multi outlet unit was required. There was a lot of reaching and stretching, the houses in groups were heavy but I thought five loaded down trips were better than twenty safer trips one at a time. My arm sure had a work out.

Last night was a restless night. I foresee tonight will be the same. It's that over tired thing. My shoulder is still hurting more than in weeks or months past. I wonder if it is because I have upped my activity level?  I was cleaning a silver plate tray last night. It was quite a workout for my arm, a lot of elbow grease and a small amount of tarnish remover. I am just no good as a leftie doing something like that. Tomorrow I might put up some decorations outdoors and that ought to do it. Perhaps my arm will have time to settle down before my doctor appointment in about ten days.

But there are cookies to bake and Christmas cards to address. The good thing is my handwriting has suddenly improved. For a while it was nearly illegible. Chaos has begun to take over so it's  definitely time to tidy up. Maybe even vacuum! Now there's a work out! I'm not planning anything that involves the ladder. Although there are some windows that could use washing. I guess they'll have to wait.








Archive timeline: 2014: May and June - preparing for surgery, July - surgery and post op problems, 
August - recovery and physical therapy, September - thinking medically, October - getting back to 
normal. November. - still recovering.

Bono bike injury...PO Day 170

In a "high energy bicycle accident'" in Central Park in NYC, U2 frontman Bono was seriously injured several  days ago. He suffered three separate fractures of his left shoulder blade and a fracture of the upper part of the humerus. The bone was shattered in six different places and tore out through the skin. He also has a fracture of the left eye socket. Less dramatic is a broken pinkie finger, but perhaps critical for a musician.  He underwent five hours of surgery to repair the left arm where three metal plates and eighteen screws were attached.

He was operated at New York-Presbyterian/Weill Cornell Medical Center and Hospital for Special Surgery by Dr. Dean Lorich.

My "low energy walking accident" did considerable damage to my shoulder but nothing like what Bono has experienced. And his bone tore out through the skin! Terrible, just terrible. The article I read said that prior to surgery he had multiple xrays and CT scans. I don't know how that is tolerated by the patient or the X-ray tech. My injury was so much less than this and it was all I could do to cooperate for simple xrays. Do the doctors ever sedate the person before they go to radiology? 

It is projected that Bono will have extensive therapy as he heals. I hope his relative youth and good health will give him a boost in the healing, back to normal, process. 

It just seems that life is full of risks that cannot be avoided. It's not fate nor karma that we are injured, it's just the price of living a full existence. Bless his heart, I wish him a smooth recovery.

Alcoholism and .TSA PO Day 169

In a statistical analysis of 422,321 patients a study revealed significantly increased poor outcomes for patients identified with some form of alcohol disorder. Patients were identified by diagnosis codes.

Such patients had a greater risk of death, pneumonia, deep vein thrombosis, acute renal failure, transfusion, longer hospitalization, and other complications. The complication rate for this subset of patients was 25% while those without an alcohol history had a complication rate of 10%.

The conclusion the authors of the study came to was that since TSA (Total shoulder arthroplasty)  is almost always an elective procedure patients who are known to have an alcohol problem should receive counseling prior to undergoing surgery. They need to be advised of the particular risks they face and should enter a program to stop drinking to show their commitment to a good result. This is a difficult situation to deal with and orthopedic surgeons are not necessarily prepared to counsel patients with alcoholism. Furthermore, it is a difficult time for the patient who may find the combined stress of shoulder pain and sobriety impossible to deal with.

The unfortunate facts are that patients with alcohol problems are generally less healthy, have poorer immune function, are at greater risk for falls and are less likely to follow a course of rehabilitation. It is a very difficult situation for patient and doctor alike.

At least patients should be fully aware of the increased risks they face.

http://youtu.be/QARzdOL3-0whttp://youtu.be/QARzdOL3-0w

Archive timeline: 2014: May and June - preparing for surgery, July - surgery and post op problems, 
August - recovery and physical therapy, September - thinking medically, October - getting back to 
normal. November. - still recovering.http://youtu.be/QARzdOL3-0w