Focus on the positive...PO Day372

To be fair one always has to balance the good points of aomething by mentioning the negative points. But right now I don't want to be fair. I just want to say positive things about rTSA because I personally have not experienced anything bad. I realize things could happen in the future but right now everything is wonderful.

How could I not love the surgery?  It has given me such tremendous reflief from the constant pain I had post shoulder break. My first orthopod sent me (to his facility) for three months of physical therapy. I did my exercises at home. He said with time it would get better. It got worse.    When I was at my wit's end I found my new orthopod who said it was not going to improve. He didn't push for surgery but did say surgery was the only option for possible pain reflief and better function.

Now to the point:

Reverse Total Shoulder Arthroplasty gives a much more stable shoulder joint that can function pretty nearly nornally when the patient does not have an intact rotator cuff.  This is because the surgery creates a deeper socket that prevents the ball from sliding up and down. The force of motion is pushing the ball and joint together rathen than apart. The deltoid muscle takes over and is used to raise and lower the arm. The result is an arm that functions better, is less painful and can last for years without loosening, as happens with regular shoulder arthroplasty.


 Now the patient has to do their part.  Very little use of the arm during the first six weeks post procedure.  Gentle use until the doctor says you have reached optimum healing and strength.  Avoid ]]]reepeated forceful blows. Do NOT fall! It's natural to put your arm out to catch yourself. Not a good move. 

Here's wishing everyone who is considering this surgery has as good a result as I have had.

New cholesterol drug PODay 371

New drugs don't come along very often. At least not as often as those of us who take them wish. A new drug is full of promise. Think about the new drug for hepatitis C. One course promises to CURE hepatitis C in 93% of the patients. It does cost in the neighborhood of $63,000.00 to $95,000.00 though.

So a new drug to treat high cholesterol seems kind of anticlimactic. But it is expected that the FDA will approve two new cholesterol drugs this summer. Repatha and Praulent are PCSK9 inhibitors. They block a protein that keeps the liver from clearing the blood of LDL, the bad cholesterol. These injectable antibodies (did you catch that...injectable) may turn out to be safer than statins. During trials the new drugs lowered cholesterol levels by more than 60%. It is projected that they may cut a patient's risk of a major cardiovascular event in half. Further testing is needed to confirm that.

Certainly it will be more expensive than the old tried and true. Hopefully it won't cost $63,000.00. But since it is injectable there will be an office visit involved. And starting a new drug will mean returning more frequently to be sure it is working. And most difficult of all, you'll have rto learn a new drug name.

To say I'm sorry..PODay 370

I never did get that line from Love Story....love is never having to say you're sorry. Whatever was meant, the medical industry has certainly practiced the position. If a caregiver, doctor, nurse, or hospital, thinks the patient is seeing a lawyer that's the end of talking.   If you want to know what happened, get a subpoena.

University of Michigan  is trying a new approach, maybe something like the way you would run your life. "The health system has an institutional policy, which calls for open communication with patients and their representatives after a complaint. The hospital reviews the complaint impartially, including peer review. The health system offers to meet with the patient's legal counsel if he or she has representation. If during the review, the hospital determines that medical care was inappropriate, the hospital apologizes to reach a resolution, which may be a settlement. Even if the review determines that care was appropriate, the hospital still offers to meet with the patient to explain what happened."

This policy of being open and honest with the patient has resulted in reduced legal action against the hospital and doctors. "Viewing the courtroom as the last resort, the health system's model has resulted in fewer malpractice claims, from 260 pre-suit claims and pending lawsuits in July 2001 to currently 100. The average legal expenses also fell 50 percent since 1997, and open-to-close time for claims dropped to 10 months from more than 20 months in 2001."

They report that many patients just want to know what happened and drop all action after an explanation and an apology. The fear that an apology would confirm guilt and insure a law suit has kept doctors silent in the face of circumstances that could easily be addressed with a simple I'm sorry.

Looks like Mom was right!

Predictive text...PO Day 369

I have been a little worried about my brain lately. As you know I often write my posts in the night. A couple times I posted the messages right away and went back to sleep. When I looked at the blog the next morning it really did not make good sense. I thought in my sleeepy state that I was ramblintg at best, delusional at worst. Weird words appeared out of context. What was I thinking?

I rushed to correct the typos and fix the unusual insertions, all the while wondering what deep recesses of my brain came up with those words so unrelated to what I was thiinking or what I thought I was thinking.

I learned not to publish the post until I read it when I was not so sleepy. The problem is a somnolent person is not necessarily the best judge of how sleepy they are. Evidenced by the drivers who don't realize how sleepy they are and crash. While that has kept me from the most egregious mumbo-jumbo presentations it has not reassured me that my brain was doing alright.

My typing is always messy but in the night in the dark it is downright chaotiic. Apple, in their wisdom, has created "predictive text" to speed things along. As I begin to type a word the program completes it for me saving me having to type the full word, having learned how much help I need. But the program is too smart. It remembers weird words I have used once and sticks them in where they don't belong. Once I said La Belle Fille rhymes with La Belfry...the word belfry peppered my writing for weeks after that! I have "typoed" shoulder so much the program thinks it is spelled shuolder!


So I have decided the problem is not my brain...it's my fingers! I wish I were a more accurate typist but I'm glad to think my brain is doing okay.

Bad news...PO Day 368

Here I was just bragging about being awake in the night and how useful that "free" time is. And dear husband has to pop my bubble by sending me the following news item...

Digital devices taking a toll on getting a good night’s sleep.

In its “Sleepless in America” special series, NBC Nightly News (6/24, story 9, 2:45, Holt) reported, “The CDC has called lack of sleep a public health epidemic, and most sleep experts say all our digital devices we’re taking into the bedroom are taking a toll on getting a good night’s rest.” NBC News correspondent Hallie Jackson explained, “Experts say it’s no coincidence 95 percent of us look at some kind of screen within an hour of bedtime and 85 percent have trouble falling asleep.” Blue light emitted from “screens send[s] a signal it’s still daylight, triggering a surge of energy and blocking the melatonin that makes us sleepy.” Therefore, it’s “no wonder then that with the device on nearly every nightstand one in three people sleeps less than six hours a day, raising the risk for diabetes, heart disease, obesity and depression.

I've always been a night owl. College was the first time I was able to set my own wake-sleep schedule. I wasn't alone studying for exams at three in the morning. Or just crashing in someone's dorm room to talk. When my children were little I stayed awake long after they were in bed so that I could sew or write letters or just read a book. As a working single mother there were never enough hours in the day so it was not unusual for me to iron or paint the living room or even go grocery shopping at 2:00 AM. Retirement actually brought me the closest to a regular wake - sleep pattern..for the first time in decades there was enough time for sleep!

So when my broken shoulder began to interrupt my sleep it was easy for me to accept being awake in the wee small hours. Doing something, like playing computer, actually helped distract me from the general misery I felt. I caught up on all the great buying opportunities through thirty minute infomercials, learned all about news events around the second and third world, and relished reruns of my favorite tv show, Frasier (2:0O-4:00 AM on the hallmark channel). And, my blog! I could pour out my heart and angst to an anonymous audience who never once said ENOUGH about rTSA. They could turn me off (or I could turn them off) and I would never know. If I chose to not check the stats on my site I could pretend hundreds of devoted followers were hanging on my every written word. And if I did check the stats I could discover that someone in France or China or India was checking in to see what I had to say.

So at the risk of obesity, depression, diabetes and heart disease, I will see you in the middle of the night!

Did anyone notice? PO Day 367

I did miss a couple days and did not count those missed days when adding up the post op days. But we are now at a minimum 367 days since surgery.

I can't say it feels like a year since surgery and yet in a way it feels longer than a year. Maybe it feels  like forever. i've had a great result. I have pretty much normal range of motion and normal function. It hurts some to put my arm behind my back and the doctor says just don't do it. I can livewithout that   motion.

There are frequent little twinges, reminders to be careful, which I heed. I take an occasional asprin for arthritis like pain in the opposite arm. It does make the post op arm feel better, actually everything feels better but don't want to be in the habit of taking anything.

I have not been walking with any regularity since Christmas. Right now it is too hot and will stay like that for several months now. My friend with whom I walk has been out of the loop since Christmas and I have not walked alone.

Running the vacuum cleaber used to be very difficult. I just couldn't do the push pull motion.I am good with vinyl floors etc. A few days ago I used the vacuum cleaner  and had no touble.I can stretch and reach across and behind things pretty well now. I'm quite certain my operated shoulder arm is not as strong as my left arn. But I can pick up and pour from a ten galllon bottle or spray bottle for the windows. Stretching those odd postions to wipe the floor behind the the toilet can be done.  But I can put dishes  away in the cupboards on higher shelves.

Putting on a jacket remains the most difficult action I perform. I just can't figure out the best way to do it. Well, actually I can get it on, it's just difficult and I'd rather not struggle unless i have to. I am hoping that problem resolves  itself during the summer.

Of course you think I do not sleep well but the fact is I  like waking up at 2:30 AM and playing conputer for a while and then going back to sleep. The house is quiet and dark and my thoughts are not interrupted by life's usual little details. Only problem...my typing is littered with errors. I misspell everythng and my words quickly dissolve into gibberish if I am too sleepy.

I have strength and power to do what a want. I have the perfect excuse to not do the things I wish to avoid. For me, having the surgery was defiinitely the right thing to do. I was so handicapped before. The pseudoparalysis (not able to lift or raise the arm) was very limiting. And the constant pain just
defeated me. I was a good candidate due to age. level of activity, and desire to be cooperative. I've had a good support systen from la belle fille (step daughter) who came and stayed post op and dear husband who has had to fill in a lot of gaps in my normal level of activiity. I hope anyone else who is considerding reverse Total Shoulder Arthroplasty will line up help beforehand.

So I am off to sleep again. I hpe there are not too many errors and typos here. It's rumbling and grumbling outside  and raining off and on but not storming. No lightning tonight. Actually, good weather for sleeping. Goodnight.

Makes no sense...PO day 366

There was quite a hullabaloo about a year ago when it was revealed how long veterans were having to wait for medical care at VA clinics and hospitals around the country. I think I recall that there were congressional hearings to get at the root of the problem. It was all over the news but as a normal human being I don't remember the outcome since it did not really impact me personally. I do remember there were pledges and promises to do a better job serving our veterans.

So fast forward to the present. Waitlists for appointments have grown longer, not shorter. The number of veterans on a waitlist longer than one month is up fifty percent from last year. The agency has a $3 billion ($3,000,000,000!) budget shortfall and they are looking for ways to cut costs. The excuse for the increased wait for an appointment  is that by increasing the agency's capacity to treat patients it was overwhelmed by the increased demand by new patients seeking care. So said VA Deputy Secretary Sloan D. Gibson.

The budget shortfall is a major concern and ways to reduce costs are being considered. The VA plans to ask congress to allow them to shift funds between departments to keep operations going. They are considering furloughs, hiring freezes and other ways (not explained) to deal with the funding gap. Most surprising is a plan to outsource medical care for the 180,000 veterans with hepatitis C. The cost of caring for these patients has increased significantly because of effective but expensive new drugs. One proposal suggests rationing new treatments so that patients who have less than a year to live or if they are in a persistent vegetative state or suffer from dementia would be ineligible for treatment. 

To me this is a perfect example of a government run health care program. Expand the coverage to encompass more people and then cut service to the neediest or sickest to save money. Is this the future of Medicare? Will the only way to fund the Affordable Health Care Act be to cut services for the most costly Medicare patients? Already emergency rooms are overwhelmed with people who previously did not have health care insurance. The idea was that they would not have to use the ER as their primary care physician but the opposite has occurred.  So far reductions in the cost of medical care have come at the expense of physicians and hospital reimbursements, not in reduced demand on the most expensive source for routine care, the ER. Will the only way to continue to fund the ACA 
(Obama care) be to limit care to the oldest and sickest patients?

That would seem to be the VA's approach.

The God Complex...PO Day 365

It's kind of a stereotype or maybe I should say cliche, to accuse your surgeon of having a God complex. It's the kind of person who thinks they are always right, can do no wrong, holds your life in their very hands and orders everyone around. Ben Casey had it, Dr. Kildare did not. Marcus Welby certainly did not  but "House" has it in spades. Does my orthopedic surgeon have it? I don't think so.
But it is hard to be objective.

So a orthopedic group with a penchant for research tackled the question.

The Federal Aviation Administration and the Canadian Air Transport Administration have defined 'hazardous attitudes" in pilots. Macho, impulsive, antiauthority, resignation, invulnerble, and confident are traits that make up the personality syndrome. These traits are associated with road traffic incidents in college age drivers and in aviation accidents. Using these quideines the group surveyed 364 orthopedic and trauma surgeons from around the world.

137 of the 364 surgeons had at least one score that would have been considered dangerously high in pilots, including 102 with dangerous levels of macho (28%) and 41 with dangerous levels of self-confidence (11%).  On average, 19% of surgeon responses implied absence of a safety valve.

Just because these personality scores indicate the person poses a risk on the highway or at the control of a 747 doesn't mean he is a risk in the operating room. But it does raise the question. I don't want my surgeon to be so high strung that the least thing causes him to snap. Being abusive to the OR staff is unacceptable. Perhaps the medical society could devise a test and even administer it to new doctors who are in line with questions. The residency year is where you really learn to be a doctor. I don't 
think you have to be all of those macho things to be a very good doctor.

So take it seriously but lighten up. Good luck on the test.

=== 

Aging Changes...P O Day 364

I just read an article from WebMD about normal aging changes. There were all the expected things like getting shorter, needing reading glasses, having some aches and pains. I had always heard that your nose got longer as you aged but that was not mentioned. Maybe that only happens if you fib a little like Pinocchio. They also did not mention your feet getting bigger. Everyone I know says their shoe size has changed on the larger side. Mine certainly has.

Mostly the changes are negative. It seems no one reports the positive side to aging. But, yes, I think there can be,  there is.

As we grow older we don't hear as well. I do notice that I have to occasionally ask someone to repeat themselves. Bummer. But consequently I am learning to pay better attention and focus on the speaker. I'm sure I come across as more interested and people like that.

I am definitely not as strong as I was even just a few years ago. I have to be more creative about moving something heavy like moving furniture. So I have to be smarter. I bought some of those sliders that go under the legs of furniture. Now it takes much less power to push something and it does not scratch the flloor.

Everyone complains of being forgetful. Perfectly normal. I cope by being more organized. We keep a family calendar and link it between devices with the cloud.

You realize you are running out of time to write the great American novel. This has really inpacted my life recently. I am no longer the chronic procrastinator I have always beeen. I am acconplishing so much, it amazes me!

I don't sleep as long or as well. But I value the quiet time in the middle of the night when the house is dark and there are no distractions. I don't just lie there hoping sleep will creep back in. The heck with all that stuff about no computer in the bedroom. Fortunately Dear Husband sleeps soundly so I could run the vacuun cleaner if I wanted to, Well, that's probably a bit of an  exaggeration.

But there is an aging change WebMD reported that I can't seem to rationalize. They say our ears get bigger as we get older. I don't like my nose or my double chin and my eyes are too close together but I always thought I had nice, smallish ears. They didn't stick out and the lobes were just big enough for a tasteful pierced earring. Nthing too big or gaudy. Now they tell me to expect some changes? This is getting to be uaccceptable.

Whose Shoes?,,,PO Day 363

The shoes I was wearing when I fell and broke my shoulder (that started this whole journey) were at least partially to blame for the fall. We had been at the beach and I wore loose slip on rubber slides that had a tendency to catch on the ground. Needless to say I don't wear those shoes anymore. In fact I am very careful about what shoes I do wear.

Having fallen I am very worried about falling again. Rubber soles sounds like a good idea but sometimes they tend to grab the floor and make me stumble. Ditto shoes with thick soles. But slick leather soles can be slippery. Sandals have to fit tightly or they are a hazard. High heels are definitely out.

High heels look so nice on the foot and tighten the calf muscle to make any leg look better. I'm not short but it's easy to understand why short women like high heels. But boy, modern heels are sky high heels. I can't wer them now but probably wouldn't anyway.

A University of Alabama research study found that accidents due to high heels had doubled between 2002 and 2012. There were 123,135 high heel incidents of which 3294 required an ER trip. And that's just what was reported. I bet most injuries of this ilk don't get reported.

Sprained ankles and feet were the most comon injury but 19% broke a bone.  There were also some other injuries like head bumps associated with the falls. Bunions and other toe problems related to feet and shoes are too numerous to count.

But my balance has been off since falling.. Wearing a sling restricted the natural balance of the hurt arm. As long as i wore a sling I did not feel comfortable walking. The natural rhyhm of walking no longer existed. Now as i have healed things are better. But I still walk like a duck, am as nervous as a cat, and pick my steps like a tiger on the prowl. I'm a regular United Nations!

Ten Down...P ODay 362

So, you are probably wondering where I was when I went AWOL. Off to an exotic island for a few days, entertaining foreign dignitaries, ran away with the circus? Nope, none of those. I was obsessed with watercolor painting.

Did I suggest try number 3 was going to be the last? I struggled through ten attempts,

Water color looks so easy. Colors blend together. Lines are not well defined. A detail is suggested, not  explicite. Errors can be "lifted off" and repaired. The brushes are easy to clean. If you get paint on your white pants, it comes right out.  All you need is that paint box you bought at a garage sale last year and a sheet of paper from your copier.

So not true! Well, the brushes are easy to clean. Mostly. Just like any hobby or activity, there are a million little necessities you need when you sit down to play. Yes, you can use the paint box with the eight patties of  color that spring to life when you add a drop of water. Red and blue make purple, yellow and blue are greem. There's never enough white to lighten a dollop of color and a smidge of black is always too much to darken a shade just a little. If it's more intense color you want, there are pigments in tubes, The craft store display of supplies includes pallets with 36 colots, 48 shades, and more.  Printer paper wrinkles when wet, if you get it too wet it tears. But water paitnt paper, it's thick and absorbs the mooisture without crinkling up. A $17.00 bottle of masking fluid allows you to preserve little white spots whlle putting down a "wash." There are tiny brushes with a few hairs and big fat brushe thta apply broad stripes of sky or sea.

But none of this makes me an artist. The little boy in my mind does not show up on the thcik white paper, Some attempts resulted in a nice looking boy, but one I did not know. A couple trys produced a picture of an older boy when I was aiming for a two year old. One painting looked exactly like my nephew. How did that happen?

In the end I settled on apainting reminiscent of the child I remember, The good thing is he does not remmeber what he looked like at two. It is not great but it is the thought that counts, Isn't it?  

Smile! PO Day 361

I did know we Americans smile more than many other cultures. I thought it was just that we have more to smile about. We even pepper our emails with punctuation marks arranged to look like sideways smiles or emojis, which I could do without as the emoji page pops up unwanted all the time.  But I do appreciate the sentiment.

But I did not understand the significance of the lack of a cultural smile. Yes, I learned one does not make eye contact and follow it up with a friendly smile on the Metro in Paris. Good grief, why not?  What harm is there in a smile? If you flash a friendly smile at a four year old in France her mother will pull her closer and whisper something like " Elle est fou." ( she is crazy)

So, yes, I knew it. I just didn't understand it. But Iosef Stemim, a Russian, did a good job explaining the national anti-smile attitude. The way we westerners use a smile, to convey friendliness, to assure the stranger that we are not a threat, to show acceptance...well, Russians call that smile "a dirty smile." It is considered a bad personality trait (!) , it demonstrates dissembling, dishonesty,and deceit, an unwillingness to show your true self. If I smile at a Russian they think I am ridiculing them, perhaps I find amusement in a stain on their shirt or am secretly laughing at them.

For a Russian to smile without reservation there has to be an overt, obvious source of the humor..there is a Russian proverb that says " A laugh without reason is a sign of stupidity." Wow, who knew?

So,you're probably thinking that I don't encounter very many Russians living in north central Florida. Not true! About the time that the old Soviet Union broke up, many Russians fell victim to a local real estate scam and came to this area. In spite of being victimized, many stayed to start new lives. It is not uncommon to run into Russian accented hospital clerks, department store sales people or car service repair technicians. They are polite, efficient, hard workers, but they don't smile a lot.

That's okay. I understand now. But don't expect me to ration my smiles even if it's a one sided transaction. 

Willet was AWOL....PODay 360

I'm trying to catch up here so these are all the things I would have said had I been here...

1. Recently an acquaintance went to fill an RX for a pain killer prescription and the pharmacy refused to fill it. Seems the patient had filled RXs three times in the recent months for pain meds from three different doctors. He had surgery, an injured knee and was seeing a doctor for chronic headaches pain. So there were good reasons for all three prescriptions.  But the pharmacist was suspicious he was "doctor shopping" to get drugs. The following report helps explain why everyone is so concerned about this problem.

        Reuters (6/18, Kearney) reports that across the US, prescription medication and illicit drug overdoses took the lives of 44,000 people in 2013. Fifty-two percent of these fatalities are tied to prescription medications.

        The AP (6/18, Raby, Mattise) reports that West Virginia leads the US in “the highest rate of overdose deaths.” In fact, the state’s “drug overdose death rate was more than double the national average, the report says.” The report, which cited “statistics from the CDC,” found that West Virginia experienced “about 34 drug overdose deaths per 100,000” people, compared to the US “national average” of 13.4 deaths per 100,000 people.

2. For years people have been arguing about butter versus margarine on the dinner table. Growing up my family had both, my dad favored margarine and in a rare instance of rational medical opinion my mom thought butter was better. Turns out she was right!

 The FDA has given the food industry three years to get trans fats out of the food supply..

        According to ABC World News (6/16, story 11, 1:25, Muir, 5.84M), food manufacturers will have “three years to remove trans fat from their products” under the new policy.

        The CBS Evening News (6/16, story 9, 2:05, Pelley, 5.08M) reported that the policy is based on a determination made by the FDA that “no amount is safe for human use.”

        The New York Times (6/17, Tavernise, Subscription Publication) explains that the FDA “ruled...that partially hydrogenated oils, the source of trans fats, were no longer ‘generally recognized as safe,’” meaning that “companies would have to prove that such oils are safe to eat — a high hurdle, given that scientific literature overwhelmingly shows otherwise.” The agency estimates that the policy “could prevent 20,000 heart attacks and 7,000 deaths from heart disease each year.”

        The Los Angeles Times (6/17, Healy) reports that “FDA officials said Tuesday they expect few will have difficulty meeting the three-year deadline,” especially considering that “food manufacturers have steadily reduced their use of hydrogenated oils” since a 2013 announcement by the FDA that it was beginning the process of removing trans fats from the food supply.

        The Washington Post (6/17, Dennis) reports that the FDA estimates “the new regulations could cost the industry $6 billion or more over 20 years, but that savings from reduced medical care and other benefits during the same time could eclipse $130 billion,” according to an FDA economic analysis published Tuesday. Michael Taylor, “the FDA’s top food safety official,” said that “the public health benefits in this action far, far, far outstrip the cost of compliance,” adding that “it’s a very clear case where the benefits far exceed the costs.”

        Congressional Quarterly (6/17, Gustin, Subscription Publication) reports that the FDA said “it does not have plans to proactively monitor compliance, but that it routinely surveys the food industry’s use of ingredients.”

        The Washington Post (6/17, Ferdman) reports in its “Wonkblog” that the FDA’s decision is “probably the single most important change in our food supply, if not in decades then ever,” according to Michael Jacobson, executive director of the Center for Science in the Public Interest.

        According to Inside Health Policy (6/17), the policy “drew immediate praise” from the American Medical Association, which last week “adopted a policy at its 2015 Annual meeting supporting state and federal legislation banning the use of artificial trans fat in the United States.”

        Forbes (6/17, Walton) contributor Alice Walton writes that Dr. Steven J. Stack, MD, president of the AMA, said that “the American Medical Association commends the U.S. Food and Drug Administration for its decision today to remove partially hydrogenated oils, the primary dietary source of artificial trans fat in processed foods, from all U.S. food products,” adding that “we support the FDA’s move to eliminate trans fat as an important component in a multipronged strategy needed to help improve public health.”

Just chatter...PO Day 357

Enough serious talk the last several days. I really am not  obsessed with dire medical news. It must look that way though.What is it about "news" that it has to be bad to be interesting? While I live in a small town our television news comes out of a medium large city 75 miles away. The nightly news is a litany of robbery, car crashes and murder. The choice to watch local news or national news is a choice between your daily dose of violence on a local or global scale. One of the national networks tries to end their nightly broadcast on a positive note. It just doesn't work for me.

Oops, more serious talk!

Changing the subject...I am trying to water paint. I'm on the third attempt at a small portrait of  a family member when he was little. It's not going well. Catching the spark of a person is truly difficult. I'm no artist but I can do a recognizable inage of an inanimate article. But a person? Impossible!   So, what do I do if the painting comes out 'just fair?" Certainly not a Monet, not even a Picasso. Do I give it to the subject? That was my original plan. Do I keep it and hang it in some out of the way spot where no one will see it?

Is it possible that the subject might be so flattered with my effort that he will see only the effort and not the result? I wish.:)  As said, I am on my third attempt which I think is going to be my last. Each try one aspect improves and another gets worse.



And while Iam asking rhetorical questions...what do I do about my Blog? There's not a lot more for me to say about rTSA, although it is always fun to talk about oneself and your medical issues. I was highly motivated to start a new blog when the site was corrupted and there did not seem to be any way to  correct the  serious problesm I had with it. But the miracle of the Lithuanian language glitch ended up serendipitously fixing all my problems with the site. No, I have no idea why it resolved the troubles but I'll take it.  So, naturally, I am less motivated to start over.

I am not narcissictic enough to think I have something really interesting to say. But writing the blog has gotten to be a routine, a ritual so to speak. What else can I do at 3:30 in the morning? It looks like I have about 8 more days to make a decision. What to do?

Never Events...P O Day 356

Major medical-hospital errors are called Never Events. Examples would include operating on the wrong body part, operating on the wrong side of the body, and operaring on the wrong patient! In spite of systems in place to prevent these disasters, errors still occur. Mayo Clinic did an in-house investigation to try to learn why,

The obvious and predictable events contributed.

• Preconditions for action, such as poor hand-offs, distractions, overconfidence, stress, mental fatigue and inadequate communication.
• Unsafe actions, such as bending or breaking rules or failing to understand them. This category of errors includes confirmation bias, in which clinicians convince themselves they are seeing what they think they should be seeing.
• Oversight and supervisory factors, such as inadequate supervision, staffing deficiencies and planning problems.
• Organizational influences, such as problems within the organization'sl culture or operational processes.

 The committee said the staff shoud  develop a protocal like what flight crews do. There should be a time out in the operaitng room just before surgery and a check list that is gone through every time.  Poor communiction tends to be the root of the problem.  The Mayo Clinic estimates a Never Event occurs one in every 22,000 cases but in the general hospital industry the incidence is more like one in 12,000 cases. That sounds rare but nationwide that breaks down to approximately 268 cases a day!

The problem is that human beings are involved and we humans are subject to human error. We make mistakes. That's not to say having computers run things would be better, just different. Computers leave no room for decision making and  judgement but, in humans, judgement opens the door for poor judgement. Perhaps some kind of cross checking could work but I don't think there will ever be no Never Events.

Hospital Dangers... P O Day 355

I am so sleeepy I don't know if I can get through this or not. But going to try. I just hope it does not turn into "middle of the night gibberish."

According to an article in Forbes Magazine just being in the hospital leaves many patients with long term damage from post-hospital syndrone and deliriium. Delirium, affecting up to half of all elderly patients and as much as 85% of intensive care unit patients is a major hazard. Also, according to Robert Pearl, MD, it doubles the risk of death within the year post hospitalization.

The problem begins with disorienting lights, drug treatments, frequent sleep interruptions, and strange environment during the hospital stay. Often the condition is misdiagnosed as dementia.   Sixty-five percent of patients older than 65 will develop weakness in their legs and dizziness while standing as a aresult of hospitalization A third of patients readmitted with this problem will lose the ability to walk alone as a result of  weakness of leg muscle.

It may be difficult to control the total hospital experience for your loved one. Certainly, staying with them until they are well oriented is a good beginning.A daily newspaper helps the patient know what day it is and what is happening in the world. Double checking what drugs they are being given can uncover pharmaceuticals that, while keeping the patient calm, may be contributiing to their confusion. Helping them keep a journal is a good way to remember which doctors are seeing the patient. Arranging to share mealtime may encourage the patient to eat a normal diet and follow a home routine. Encouraging the patient to "wash up" and put on fresh pjs, even hospital gown, can really make a person feel better.Getting the patient up to walk a little. with assistance, helps a lot ut only with assistance.

Ideally hospitals will take steps to improve the hospital experience for elderly patients but until they do, it is up to the family.

Medical errors..PODay 354

According to the Boston Globe medical errors are on the rise  in the state of Massachusetts. There were 753 medical mistakes in 2013 and 821 serioius incidents in 2014, an increase of 9 percent. But the Department of Public Health says that is not such a bad thing, that the increase is due to better reporting, not more errrors.

This follows a rise from 444 in 2012 to 753 in 2013, a 70 percent rise in reported errors.

"The newest data show that there were 290 serious injuries or deaths resulting from a fall in 2014, a slight rise from 282 incidents in 2012, the Globe reports. The number of wrong-site surgeries decreased, from 36 to 24, and the number of wrong surgeries/procedures performed stayed nearly the same--11 and 10, respectively, in 2013 and 2014. There also were 41 foreign objects left behind during surgery in 2014, compared to 33 in 2013."

It seems as if some things are improving but some are worse. Don't we all hope that the Department of Public Health is right, that reporting incidents has improved and not that incidents have increased. BTW, Hospital errors are the third leading cause of death in the United States!

The Fat fight...PO Day 353

If you are awake in the night watching TV or just living in the USA, you have to be aware of how our society is obsessed with weight loss. I guesss it is because such a high percentage of us is overweight.

There are exercise programs and machines, food plans to control your caloric consumption, surgery to alter the digestive system, and drugs to limit appetite or change absorption. It's all iffy.

But now there is something new and more promising, something old actually. A plant used in ancient China to treat a variety of medical problems including inflammation and  fever is looking very promising. The thunder god vine (tripterygium wilfordii) produces an extract that, when tested on mice, resulted in an 80% reduction in food intake after just one week. After three weeks test mice lost 45% of their initial body weight.

The next step is to learn if it is safe and effective for people.

This just reinforces the idea that these old folk medicines have tremendous potential. The classic example is the "old woman of Shropshire" who treated local people with dropsy with leaves from the foxglove plant. "Real" medical doctors, who were not having much success with congestive heart failure (aka dropsy), beat a path to her door. Foxglove turned out to be the source of digitalis, still the pharmaceutical treatment for heart failure.

In error I filed post number 351 twice so to catch up this will be post 353.

Doctors as typists..PO Day 351

Charles Krauthammer, political commentator, author and medical doctor board certified in psychiatry,  writes in the Washington Post that America's doctors are "deeply demoralized" by the current medical  atmosphere. "Incessant interference" from insurers, lawyers and government is destroying any personal autonomy they have had in the practice of medicine.

The biggest complaint is with the EHR (electronic health record) which mandated that medical offices go paperless in January 2015. The result is that your doctor now spends more time per visit looking at and interacting with his computer, "scrolling, tapping and typing" than with you, the patient. One study found that emergency room doctors spend 44% of their time filling out forms, instead of taking care of the sick and injured. 

When we see our primary care doctor now we receive in the mail a summary of our visit a few days later. The interviewing nurse had to make our history fit the program so the details are almost always incorrect. The boxes to be checked do not include every possible complaint, remark or variant so the facts have to be fudged a little to a lot. By the time our chart reaches the doctor our physical complaints are reduced to check marks in boxes. There is no place for a narrative that previously revealed so much about the patient. There is no place for a physician who listens attentively and examines the patient thoroughly.

Dr. Krauthammer opines that the government rationale is that electronization worked for the banking 

industry so it should work for medicine as a business. So far it isn't.

rTSA stats...PODay 351

  A high volume shoulder surgery practice analyzed Medicare stats to see who was getting shoulder surgery, what kind, and why. Over 31,000 procedures were performed. rTSA made up 37%, TSA were 42% and 21% were hemiarthroplastys. Not sure what the latter consists of so now I am only going to talk about rTSA and TSA ( reverse total shsoulder arthroplasty and total shoulder arthroplasty). 91% of TSA and 45% of rTSA were done for osteoarthritis.

in their opinion the increase in rTSA is evident. One possible reason is that it is perceived as cutting edge technology. Apparently post operatively there are fewer problems with instability, cuff failure and glenoid failure. Also they consider the rTSA a more forgiving procedure technically, and in the case of post humeral fracture, rTSA may "offer major advantages over internal fixation or anatomic arthroplasty in the management of proximal humeral fractures."

I have the impression, perhaps not true, that they feel rTSA is being done excessively. Nonetheless, all of their reasons for why it is increasing in popularity , especially the last, reinforce my opinion that it was right for me.

I'm glad i did it and glad it is behind me.

Too Tired to think...PO Day 350

The epiphany created the Christian Work Ethic and I spent the day doing every kind of odd job. I am exhausted. I am too tired to be smart or clever or witty...not that I ever am. But sometimes I make a stab at it.

One of the jobs of the day was to burn some old tax returns and other financial papers. I did that about 1:00. Then about 5:00 I remembered I had found a charming photo of my son tht I had set aside for a special project. I began to hunt for it and could not find it anywhere. After searching and searching I became convinced that I must have accidently burned it. But how could I do that! More serching, more angst. Cupboards, drawers, boxes dug through to no avail. Finally there it was in a manila folder, carefully set apart for safe keeping. A perfect example of  cognitive aging. Not Alzheimers, I hope.

So I don't have the energy to contribute anything intellectual here. Not even enough to correct this italicized print. Maybe tomorrow.

Epiphany,,,P O Day 349

I wish I knew what epiphany befell me that I have been so inspired to get things accomplished. If I could save it so that when I fell back into my usual state of procrastination I could consume it like a drug it would be wonderful. Is it just that I looked around one day and realized I would not live forever? Did I fear someone else would have to sort out my clutter drawer? Why didn't it occur to me before that if I didn't use that lovely bedspreaed it would likely end up in a garage sale some day?

My mother was not a hoarder at all. If she didn't wear an article of clothing over a period of three months it disappeared. She was not sentimental about old stuffed animals, favorite books or bits of lace left over from a project long fogotten. There must be a gene that condemns  you to the saver or tosser category in life. If so, I didn't inherit hers.

One thing that has happened to encourage purging clutter is the opening of a small church sponsered thrift shop in our little town. I always have a bag of donations in the car now. Somehow I can give something away when I find it impossible to thow it away. I just have to follow my rule that I must not come away with more than I donate.


I am not yet to the state to which I aspire. Thimgs here will never have that post modern, glossy magazine look. Remember the English country garden style? Layers of floral prints upon plaids accented by stripes, tables of mini collections protected from dust by antique glass dome. secretary desks spilling over with memorabilia from  foreign travel, one strategically placed leopard fabric pillow on the sofa? No, that is not our home but that is the design school against which I struggle  constantly.

Laura Ashley...it's all her fault!

Cognitive Aging...P O Day 348

Dear Husband gave me a copy of an email article he received about Cognitive Aging. I read it and set it aside to use as the basis of a blog post. Now I can't find it. A sure sign of cognitive aging. But at least I am not worrying about it being a sure sign of Alzheimers' Disease which I might have before I read the  aforementioned article.

So here I sit aging cognitively...which is not necessarily a bad thing. At least as conmpared to the generally accepted alternative. We toss around the diagnosis "Alzheimers" like it was as common as a cold. When we were in our 20's if we lost our car keys it was annoying. Now it is a sign we are doomed to a fearsome future. When we were young and couldn't remember names or dates or phone numners we considered ourselves too busy to try to  remember... Now we depend on our phone or tablet to remember for us and don't even try to keep track of information. Does laziness cause memory loss? Or worse?

The point of the article was that aging results in a normal decline in cognition. Mental speed and agility decline with age. But wisdom and experience increase as we get older. It's easier to misplace an important paper or the car keys but you know exactly what they are , what they are for and why you need them.  Unlike with Alzherimer's, cognitive aging does not progress to a terminal neurological state. It does, however, keep us occupied looking for all the things we have lost.

Who's a candidate...PO Day 347

I thought the statement below, copied from the Web, covered the question of who was a candidate for rRSA surgery vey well. It is most commonly used for patients with serious arthritic problems. And, according to my surgeon, those people do the best. I fall into the last category, patietnts with proximal humeral fractures with massive cuff tear.  

I harbored some resentment toward my first orthopedic doctor who did nothing for a year and did not investigate with CT or MRI. But my current orthopod assured me he, too, would have waited to see what would happen. Having rTSA is a big step and should only be considered when other alternatives have been tried. such as physical therapy.  And tincture of time.

In fact, to be fair, I have to admit that my first orthopod did mention surgery once. Not that he was recommending it. Rather I think he threw it into the discussion to be medically-legally protected in that he had offered me the option to consider it. Maybe he really did think I was going to improve without surgical intervention. All I can say is that I am very glad that I wound up where I did.

"In the reverse total shoulder, the positions of the ball and socket are reversed from the anatomical arrangement. This type of prosthesis is used when the arthritic shoulder demonstrates instability that cannot be managed with an anatomic prosthesis or when the shoulder is ‘pseudoparalytic’, meaning that the shoulder cannot be actively elevated to 90 degrees in spite of a good range of passive motion and intact deltoid function. Reverse total shoulder arthroplasty is used to manage rotator cuff tear arthropathy and anterosuperior escape after a failed attempt at rotator cuff repair. The reverse arthroplasty is also used to manage comminuted proximal humeral fractures in the osteopenic bone of older individuals, massive cuff tears without arthritis and failed anatomic arthroplasty with instability or pseudoparalysis."

I just have to add this bit of updated blog news. As said, it's an ill wind that blows no good to someone. The accidental change to Lithuanian has solved a major headache for me! All those "0"s that had replaced the writtten directions on my blog are gone and regular print has reappeared. Of course I don't read Lithuanian but I can get the program to translate it to English for me. In case you ever need to know, English is Angly in Lithuanian. Things are looking up. :)

Good outcome...PO Day 346

Now I know I have to open a new blog! A few minutes ago I hit something and now the few words that did appear on my site are now in Lithuanian! I can ask to translate it to English but the new default keeps going back to Lithuanian. I'm not kidding. ARGH!

But the good news is That I saw my surgeon and all is well. I had three x-rays and nothing has changed Which is what you want. I took the Simple Shoulder Test again (see previous post 131) and can do most everything on it now. Well, throwing a ball overhand 65 Feet: may be a problem. Obviously written by a man.

My surgeon and I agree I have done great. He said people who have this surgery for arthritis are the ones who have the best results. People like me, a broken shoulder and a torn rotator cuffs, do not usually do as well. But he said I have had as good a result as he has seen. And I agree I am doing well.  He said I was showing good deltoid development, which is what now raises and lowers the arm.

We talked about what I May and May not do. All normal activity is okay. What not to do? Do not lift weights. If it hurts, do not do it. No jerking, yanking motions. I can kayak but do not try to lift the kayak onto the roof of the car. And do not fall down.

I will see him again in one year.

A goof visit, a good report.

May Summary...PODay 345

I try to sum up my shoulder situation on the last day of the month. But tomorrow is my one year post op visit to the doctor where I get to tell him how I am and he gets to tell me how I am. I  hope we are in agreement.

So, without going in to details, I'll just say I am doing well. I think I have had as good a surgical outcome as possible, better than I expected. Better than the doctor predicted.  The anesthesia complication, pneumothorax (collapsed lung), threw a monkey wrench in the healing process but I think I am pretty much over that too.

Tomorrow I will have an xray and I will try to copy it so I can post it here. I trust there will be nothing unusual turn up.   The radiology department of our local hospital is always very nice. They are very happy to provide a CD of your latest scan or whatever. Problem is, I have never been able to open the program on the CD. And anytime I tried to share it with a non branch hospital or have an outside of the system doctor look at it nothing happens. So I have learned it is a waste of time to get a copy.  The x-ray tech let's me see the screeen and I take a photo of it with my ipad. That works.

So, hoprfully good news tomorrow.