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.