Showing posts with label rTSA. Show all posts
Showing posts with label rTSA. Show all posts
Wednesday, November 12, 2014
The New Parts...PO Day 150
If you watch a lot of television, like I do, you probably know one way the detectives identify "the body" is by serial numbers on some body part implant. Well, as far as I can tell, there are no serial numbers on artificial joint implants. It would seem that there would be but I can't find any evidence on the web.
There have been some "recalls" by joint manufacturers. The couple I found were not for the joint parts themselves but rather for one of the very specialized instruments used in fitting or assembling the parts at the time of surgery. It would be very upsetting to have an implanted part of your artificial shoulder recalled if you were doing fine! Could you be required to have surgery to remove it? I wouldn't think so.
There are reasons that a re- operation is necessary but they do involve problems with the existing shoulder. Instability or dislocation are two main reasons a patient may be looking at repeat surgery. While these situations are not common early on, instability due to wearing of the liner of the glenosphere is one reason the surgery is said to "last", depending on who is talking, seven to ten to twenty years. RTSA patients who use their new shoulder in more physically demanding ways, in sports or physical labor, face this problem earlier. Chronic, recalcitrant infection, when it simply will not respond to antibiotic treatment, can necessitate surgery.
Rarer is base plate failure. In fact, it might be a problem that has been resolved with design changes as it is seldom mentioned in current literature. I hope so. But, having just said that, I found an article that says it is the biggest post operative complication. I can't tell when the article was written, this is the problem with web research. Let's hope it has been resolved. Periprosthetic fracture of the humerus and acromiom fractures can occur but do not require surgery as far as I can tell.
I am counting on none of these really bad things happening. I suppose there is no avoiding the relentless march of time and the normal wear and tear of life. I expect ten years and hope for twenty. Dr. Kai is young, I hope he will still be around when I need him.
http://youtu.be/qy1A5KQhq28
Archive timeline: 2014: May and June - preparing for surgery, July - surgery and post op problems, August - recovery and physical therapy, September - thinking medically, October--
Sunday, October 19, 2014
Doctors as employees...PO Day 126
I know I complained about collecting new doctors like a rock rolling downhill gathers moss. It's true. I already had one primary care doctor and two specialists to answer to prior to my rTSA. I added an orthopod, a pulmonologist, a thoracic surgeon, and two hospitalists to the list as a result of reverse total shoulder replacement surgery and pneumothorax. Fortunately the hospitalists stayed with the hospital and were only my doctors while I was an inpatient. But now, instead of three doctors, I have six looking out for me. Fortunately five of them have joined the increasing trend of becoming employees of the hospital rather than maintain private practices. If I did not have personal experience, I would presume these were less than Grade A+ doctors who were taking the easy way out. So not true!
Everyone of them has great credentials, excellent training at first rate hospitals. Their offices are well run.. organized, staffed with efficient people, responsive and located conveniently right in the hospital complex. Why would smart young doctors be willing to give up autonomy and become employees of a hospital system?
Meeting salaries, rent, operating costs, malpractice insurance, overhead and unexpected disasters are not young Dr. Kildare's responsibility. If the roof leaks, the receptionist quits, or the electric bill doubles someone else will handle it.
Cash compensations for signing up with a hospital can be significant and give a young physician a boost in starting his career. Salaries are often higher than a starting out physician might expect to earn in a private practice.
Benefit packages, like health care, are standardized and predictable. Doctors employed by the hospital usually have the same package as clerical staff. Someone else, someone with a Business degree, will deal with the morass of health care rules and regulations.
Physicians are often backed up by well trained ancillary staff like nurse practitioners who see the more routine patient leaving the doctor time to practice at the top of their skill level. Everyone feels more challenged in their role as health care provider. It's nice to be part of a team.
While specialists are already seeing high compensation for services, government health care programs are beginning to recognize the value of the primary care doctor and fees for service are being increased for doctors in this category.
Employed physicians are taking on greater roles in the administrative operations of the hospital. As doctors become more involved in the operation of the hospital they may see opportunities in administration that would not be there in a private practice.
Finally, wage negotiations may not be all about salaries. Educational packages, student loan pay outs, sabbatical breaks are all fair game. Work hours and vacation can be on the negotiating table.
So far it looks like it is turning into a winning arrangement that lets the doctor focus on the patient. Already 25% of physicians are now working as employees of hospital systems. And I am finding that it is very satisfactory to me, the patient. We'll see where it goes in the next few years.
http://youtu.be/rwv7FYqV2Wo
Archive timeline: 2014: May and June - preparing for surgery, July - surgery and post op problems, August - recovery and physical therapy, September - thinking medically, Octobe
Everyone of them has great credentials, excellent training at first rate hospitals. Their offices are well run.. organized, staffed with efficient people, responsive and located conveniently right in the hospital complex. Why would smart young doctors be willing to give up autonomy and become employees of a hospital system?
Meeting salaries, rent, operating costs, malpractice insurance, overhead and unexpected disasters are not young Dr. Kildare's responsibility. If the roof leaks, the receptionist quits, or the electric bill doubles someone else will handle it.
Cash compensations for signing up with a hospital can be significant and give a young physician a boost in starting his career. Salaries are often higher than a starting out physician might expect to earn in a private practice.
Benefit packages, like health care, are standardized and predictable. Doctors employed by the hospital usually have the same package as clerical staff. Someone else, someone with a Business degree, will deal with the morass of health care rules and regulations.
Physicians are often backed up by well trained ancillary staff like nurse practitioners who see the more routine patient leaving the doctor time to practice at the top of their skill level. Everyone feels more challenged in their role as health care provider. It's nice to be part of a team.
While specialists are already seeing high compensation for services, government health care programs are beginning to recognize the value of the primary care doctor and fees for service are being increased for doctors in this category.
Employed physicians are taking on greater roles in the administrative operations of the hospital. As doctors become more involved in the operation of the hospital they may see opportunities in administration that would not be there in a private practice.
Finally, wage negotiations may not be all about salaries. Educational packages, student loan pay outs, sabbatical breaks are all fair game. Work hours and vacation can be on the negotiating table.
So far it looks like it is turning into a winning arrangement that lets the doctor focus on the patient. Already 25% of physicians are now working as employees of hospital systems. And I am finding that it is very satisfactory to me, the patient. We'll see where it goes in the next few years.
http://youtu.be/rwv7FYqV2Wo
Archive timeline: 2014: May and June - preparing for surgery, July - surgery and post op problems, August - recovery and physical therapy, September - thinking medically, Octobe
Saturday, October 11, 2014
Scapular notching ...PO Day 118
I finally asked my surgeon to explain scapular notching and tell me how to avoid it. I was pleased to learn the burden falls on the surgeon's shoulders and there is nothing the patient can do about it.
Scapular notching was a bigger problem in the earlier days of rTSA but remains a bugaboo, for surgeons and device manufacturers. As the operated arm moves up and down, the metallic socket (or cup) at the top of the humerus pivots on the glenosphere (the metal ball) separated only by a polypropylene liner, like the one in the photo above. (Except without the damaged area.) A common problem has been that the socket/cup, in some arm positions, extended beyond the circumference of the glenosphere (the ball) and wore away at the exposed scapula to which the glenosphere is attached. This created a groove in the scapula and erosion on the poly liner. Actually the poly liner seemed to have endured the worst of it. See photo above. There is some question about the effect of plastic particulates from liner sluffing off into the blood but so far it has not been identified as a major problem. Gradual notching of the scapula does not appear to cause pain or discomfort. So what is the big concern? As a chronic condition there is some conjecture that it causes a loosening of the glenoid but so far this is unproven.
Surgical technique and evolutionary design changes in the prosthetic devices have improved the situation. Lateralizing it (that's making the glenosphere stick out farther, to you and me) and inferiorizing it (dropping it down a little lower so it is a little off-center) and using as large a glenosphere as possible are techniques used to prevent scapular notching. At least that is the approach used by my surgeon and the company whose product he chooses to use. I can imagine there are as many opinions of what to do as there are manufacturers of the artificial shoulder joints and surgeons to install them.
I am just glad to know there is at least one possible glitch that I can leave for someone else to fret about.
Archive timeline: 2014: May and June - preparing for surgery, July - surgery and post op problems, August - recovery and physical therapy, September - thinking medically, October--
Thursday, October 9, 2014
Info From the Internet...PO Day 116
If you've ever been daring enough to admit to your doctor that your medical knowledge comes from the "internet," you know the look you get. There's a scowl, a head shake and an implied tsk tsk as he leans back to get a better look at this pretender sitting across from him. "Don't do that," he says. "You can't rely on the information being true or current." The problem is that he is mostly right.
For every credentialled article, say something published by the NIH or the FDA, a Google search will turn up a 'paper ' written by a self-proclaimed expert. Sticking to references from legitimate medical or educational sources with domain names that end in .edu or .gov is a good start. Although not everyone trusts the .gov resource in all matters.
If I come upon a web-based article with intriguing but unverified information, I'll shift the focus of my search to see if there's a lot of other people out there espousing similar opinions. If the lone wolf doesn't have supporters, it doesn't mean he's wrong, just not repeatable at this time. The other night I found several web articles about the use of surgical robotics for shoulder replacement surgery. The problems with repeating it, for me, were that all the articles I found referenced one company developing the equipment and I couldn't find anything more recent that 2006 or 2007. I hope someone is working on the idea but I'll have to pass up writing about it for now. Then, there is "computer assisted" shoulder replacement surgery which sounds like more of the same but really has to do with planning the surgery, analyzing the X-rays and cat scans to custom fit the artificial shoulder parts and is in common use already.
I have had my doctor tell me that Internet information is not current, therefore not necessarily true. He's right. There are many negative articles on the web about reverse total shoulder surgery and many of them reflect the opinions prevalent when rTSA came to the U.S.in 2004 or 2005. Reading the same critiques in 2010 or 2011 give a totally different outlook. It's not easy to find dates on many of the articles. Sometimes the only way to guess when it was written is by scanning the bibliography at the end where, in keeping with good term paper etiquette, the date is part of the reference. So you can merely infer the article was written later than the posted reference. The biggest problem is that current data is not usually accessible to the lay researcher. We cannot log into many of the private membership only sites that publish the latest medical research. One needs a medical license and speciality affiliation. Journals are similarly restricted and may require a subscription.
I look at a site like Wikipedia as a bastion of erudition but the fact is Wikipedia is a collaborative project written by many experts and unknown numbers of self professed experts. It is policed by people who, hopefully, know more about the subject than those of us who run to it like we did the Encyclopedia Britanica purchased by our parents from a door to door salesman.
Prevention Magazine has five suggestions for searching the web for medical information:
Narrow down your results. Be specific.
Look for consistency in the articles that you rely on.
Consider the source; the author or the institution.
Check the date of the article.
Stay connected, keep looking. Don't stop with one article that supports your position.
Listen to your doctor but don't give up on the web. Just take it all with a grain of salt and consider the source! Be especially suspicious of writers like me!
http://youtu.be/5IBeYILiUj0
Archive timeline: 2014: May and June - preparing for surgery, July - surgery and post op problems, August - recovery and physical therapy, September - thinking medically.
For every credentialled article, say something published by the NIH or the FDA, a Google search will turn up a 'paper ' written by a self-proclaimed expert. Sticking to references from legitimate medical or educational sources with domain names that end in .edu or .gov is a good start. Although not everyone trusts the .gov resource in all matters.
If I come upon a web-based article with intriguing but unverified information, I'll shift the focus of my search to see if there's a lot of other people out there espousing similar opinions. If the lone wolf doesn't have supporters, it doesn't mean he's wrong, just not repeatable at this time. The other night I found several web articles about the use of surgical robotics for shoulder replacement surgery. The problems with repeating it, for me, were that all the articles I found referenced one company developing the equipment and I couldn't find anything more recent that 2006 or 2007. I hope someone is working on the idea but I'll have to pass up writing about it for now. Then, there is "computer assisted" shoulder replacement surgery which sounds like more of the same but really has to do with planning the surgery, analyzing the X-rays and cat scans to custom fit the artificial shoulder parts and is in common use already.
I have had my doctor tell me that Internet information is not current, therefore not necessarily true. He's right. There are many negative articles on the web about reverse total shoulder surgery and many of them reflect the opinions prevalent when rTSA came to the U.S.in 2004 or 2005. Reading the same critiques in 2010 or 2011 give a totally different outlook. It's not easy to find dates on many of the articles. Sometimes the only way to guess when it was written is by scanning the bibliography at the end where, in keeping with good term paper etiquette, the date is part of the reference. So you can merely infer the article was written later than the posted reference. The biggest problem is that current data is not usually accessible to the lay researcher. We cannot log into many of the private membership only sites that publish the latest medical research. One needs a medical license and speciality affiliation. Journals are similarly restricted and may require a subscription.
I look at a site like Wikipedia as a bastion of erudition but the fact is Wikipedia is a collaborative project written by many experts and unknown numbers of self professed experts. It is policed by people who, hopefully, know more about the subject than those of us who run to it like we did the Encyclopedia Britanica purchased by our parents from a door to door salesman.
Prevention Magazine has five suggestions for searching the web for medical information:
Narrow down your results. Be specific.
Look for consistency in the articles that you rely on.
Consider the source; the author or the institution.
Check the date of the article.
Stay connected, keep looking. Don't stop with one article that supports your position.
Listen to your doctor but don't give up on the web. Just take it all with a grain of salt and consider the source! Be especially suspicious of writers like me!
http://youtu.be/5IBeYILiUj0
Archive timeline: 2014: May and June - preparing for surgery, July - surgery and post op problems, August - recovery and physical therapy, September - thinking medically.
Tuesday, September 30, 2014
September Addendum...PO Day 107
Instead of rambling today, here is a wrap up of where I am at the end of September 2014, a little more than fourteen months after breaking my right shoulder and three and a half months post reverse total shoulder replacement arthropathy, rTSA.
Dr. Kai, orthopod, has cleared me to do most usual activity within reason. That doesn't mean I can actually do everything, but I can try.
I still need help with some household tasks: making a bed, vacuuming particularly. I'm getting better at ironing but don't do a very good job of it. Cooking is pretty much back to normal. I'm still avoiding really heavy cookware like Le Creuset cast iron pots and going with the lightweight stainless steel.
I continue physical therapy at home but don't have to go for formal PT.
My hair is still falling out. See July PODay 42 "Hair Today Gone Tomorrow" Telogen Effluviam. Good thing I had thick hair to start with! I do still look normal, hair wise, but there is always a hair falling on my ipad as I type or tickling down my bare arm, feeling like a bug is on me. The other day one of my hairs was in my salad! Yuck!
I feel like I am recovered from the pneumothorax (collapsed lung) See July Surgery plus 10 days. I don't even notice myself breathing through my mouth much any more.
I'll have some blood work for a different doctor this month and will find out if I am still anemic. I feel okay and imagine things are back to normal again. Hope so. Ditto: July Surgery plus 10 Days.
I still don't sleep well but that is probably only partially due to my arm. It's not really a problem as it is a great time to work on one's blog!
I'm better at dressing and undressing but it remains the one activity when I am most aware of my arm limitations. It's not harder than, say, driving but it's just that it is usually so automatic to pull up a pair of pants or zip up a dress. I hope it will become more second nature. But I still had to get help pulling my tee shirt off today.😞 (frownie face courrtesy of iOS 8.0 upgrade)
I did some work in the garden today. Weeding and raking. I'm considering the activity my physical therapy for the day. It's the first really physical work I've done in over three months. I must be feeling better!
All in all, I can't complain. Well, I can, I just shouldn't.
http://youtu.be/S9nSgMwtkK0
Archive timeline: 2014: May and June - preparing for surgery, July - surgery and post op problems, August - recovery and physical therapy, September
Dr. Kai, orthopod, has cleared me to do most usual activity within reason. That doesn't mean I can actually do everything, but I can try.
I still need help with some household tasks: making a bed, vacuuming particularly. I'm getting better at ironing but don't do a very good job of it. Cooking is pretty much back to normal. I'm still avoiding really heavy cookware like Le Creuset cast iron pots and going with the lightweight stainless steel.
I continue physical therapy at home but don't have to go for formal PT.
My hair is still falling out. See July PODay 42 "Hair Today Gone Tomorrow" Telogen Effluviam. Good thing I had thick hair to start with! I do still look normal, hair wise, but there is always a hair falling on my ipad as I type or tickling down my bare arm, feeling like a bug is on me. The other day one of my hairs was in my salad! Yuck!
I feel like I am recovered from the pneumothorax (collapsed lung) See July Surgery plus 10 days. I don't even notice myself breathing through my mouth much any more.
I'll have some blood work for a different doctor this month and will find out if I am still anemic. I feel okay and imagine things are back to normal again. Hope so. Ditto: July Surgery plus 10 Days.
I still don't sleep well but that is probably only partially due to my arm. It's not really a problem as it is a great time to work on one's blog!
I'm better at dressing and undressing but it remains the one activity when I am most aware of my arm limitations. It's not harder than, say, driving but it's just that it is usually so automatic to pull up a pair of pants or zip up a dress. I hope it will become more second nature. But I still had to get help pulling my tee shirt off today.😞 (frownie face courrtesy of iOS 8.0 upgrade)
I did some work in the garden today. Weeding and raking. I'm considering the activity my physical therapy for the day. It's the first really physical work I've done in over three months. I must be feeling better!
All in all, I can't complain. Well, I can, I just shouldn't.
http://youtu.be/S9nSgMwtkK0
Archive timeline: 2014: May and June - preparing for surgery, July - surgery and post op problems, August - recovery and physical therapy, September
Sunday, September 21, 2014
A Little Help to Get By....PO Day 112
For three of the last fourteen months I wore a sling. Six weeks when I first broke my arm, then six weeks after reverse total shoulder arthroplasty, rTSA. Even after the first bout with the sling it was obvious by the way I carried my right arm that it wasn't of much use to me. I might as well have been wearing a sign that said "open the door for this woman," or "offer to help her with her packages." Of course, I was rewarded to see that chivalry is not dead and I really appreciate the Publix bag boy (a man ten years older than I) taking my groceries out to the car. It was very thoughtful of Dear Husband to take on little household jobs to relieve me. And Dear Son in Law (I wonder if it is beau fils in French?) hurried around to open the car door and offer a hand. (But in his case he was just raised right and he probably didn't notice I was compromised and is too polite to have mentioned it if he had.)
But at first it took a lot of self restraint not to snappishly say "I can do it myself." Was I just a little defensive? Why is it so hard to let a stranger, even a family member, do something nice for us? I totally get it...I don't think twice about holding the door for a 6'3" construction worker or letting the mom with the cranky child go in front of me in line. So why don't I recognize the generous action of someone else as just that, not some kind of evolutionary analysis of my vulnerability? Do I think they are going to see me as the weak link in the caveman clan and knock me over the head with a club?
So I practiced smiling and saying, "yes, thank you. That would be very helpful." I tried to add an extra 'how nice of you' as they walked away. It felt awkward at first but I began to realize how pleased the people were to help. That it made them feel good and useful and think that if their mom could see them that she would be very proud. And besides, I came to recognize that I really needed the help.
Now I'm doing better. I look healthier and I don't walk like a bird with a broken wing. Well, not so
much anyway. Little acts of kindness have turned in to more of a give and get arrangement. I'm glad I can once again do something nice for a stranger, nothing too big yet. And I really appreciate a helping hand occasionally.
Now if I can just share what I've learned with Dear Husband who is struggling with a brace on his injured right ankle and is determined to "do it himself."
http://youtu.be/SkyqRP8S93Y
Archive timeline: 2014: May and June - preparing for surgery, July - surgery and post op problems, August - recovery and physical therapy, September..Thinking medically, - October -
But at first it took a lot of self restraint not to snappishly say "I can do it myself." Was I just a little defensive? Why is it so hard to let a stranger, even a family member, do something nice for us? I totally get it...I don't think twice about holding the door for a 6'3" construction worker or letting the mom with the cranky child go in front of me in line. So why don't I recognize the generous action of someone else as just that, not some kind of evolutionary analysis of my vulnerability? Do I think they are going to see me as the weak link in the caveman clan and knock me over the head with a club?
So I practiced smiling and saying, "yes, thank you. That would be very helpful." I tried to add an extra 'how nice of you' as they walked away. It felt awkward at first but I began to realize how pleased the people were to help. That it made them feel good and useful and think that if their mom could see them that she would be very proud. And besides, I came to recognize that I really needed the help.
Now I'm doing better. I look healthier and I don't walk like a bird with a broken wing. Well, not so
much anyway. Little acts of kindness have turned in to more of a give and get arrangement. I'm glad I can once again do something nice for a stranger, nothing too big yet. And I really appreciate a helping hand occasionally.
Now if I can just share what I've learned with Dear Husband who is struggling with a brace on his injured right ankle and is determined to "do it himself."
http://youtu.be/SkyqRP8S93Y
Archive timeline: 2014: May and June - preparing for surgery, July - surgery and post op problems, August - recovery and physical therapy, September..Thinking medically, - October -
Subscribe to:
Posts (Atom)