Selfie PO day 45

Wow, it's hard to believe all this apparatus could be inside one's body and cause so little discomfort, let alone actually relieve the original cause of pain. Yes, those are screws anchoring the hemisphere to the scapula. There is actually a part not seen, the plastic disc between the ball and the top of the shaft which allows the two parts to slide against each other. Plastic does not show up in an X-ray. The humerus is hollowed out to receive the metal shaft and it is either cemented in or malleted in. Because I read my surgeon's operative notes I know mine was snugged into place without the cement.

In a normal shoulder the ball is at the top of the bone, the humerus, and the socket is part of the shoulder. This situation is replicated in a Total Shoulder Replacement. This procedure works well when there is still some function of the rotator cuff and has been being done for forty or more years. But when the rotator cuff is too badly damaged one can no longer rely on the usual ligaments to lift or move the arm. Hence, the Reverse Total Shoulder Replacement, developed in France about twenty years ago and introduced in the US about eight years ago. After surgery the deltoid muscle must learn
to lift and move the arm.

Did you know you can ask for your surgeon's op notes? If you can be at all objective they reveal great insight into what the doctor had to deal with, good or bad. Orthopaedic surgery must be a lot like woodworking or metal shop, or home repair, except with blood. Haven't we all bought some device that required assembly, like a new faucet for the sink? And even though the directions say this is a universal appliance that will connect to all sinks, it doesn't, it won't and nothing works right! And there is always a screw missing!

I can only hope that the manufacturers of these medical prosthetic devices are more careful in counting and labeling the pieces. And that the directions were written by someone whose primary language is English!

Yesterday, today or tomorrow?

When I posted Hair Today, Gone Tomorrow it was today on the east coast. But it was still yesterday on the west coast. Of course, Google time! I'll have to remember that when I count my post op days.

I should have realized it. I've had similar errors with eBay auction times.

Hair today - Gone tomorrow PO Day 42

My hair is really short, REALLY short. It started as an accident when I told the stylist  "let's make this really short." I meant quick, she heard Mia Farrow in Rosemary's Baby. But it's hot, I have been one handed and it was a blessing during my recent hospitalization. I didn't have to comb it, just rub a damp washcloth over my head. I was dealing with it.

But now I am faced with Telogen Effluvium.

For the last few days I've been noticing a few hairs in the sink in the morning. If I run my fingers through my hair there are more than desirable strands of hair in the palms of my hands.  Is it my imagination?

No. Telogen Effluvium is a phenomenon that occurs after pregnancy, surgery, extreme stress or drastic weight loss. Well, I've had two of the four. It starts as early as six weeks after the precipitating events. Nice to know I am right on schedule. The normal life cycle of the hair shaft is shortened so that natural shedding of old hair is speeded up. Apparently there is no cure but also no cause for panic. This too shall pass.

In the meantime not only might I pass for a guy, I might pass for a balding guy! Nice :(

A bill by any other name... PO day 40

The first of the "This is not a bill" statements are showing up in the mail. I have really mixed feelings as I scan the multiple pages. I am grateful to have insurance that will probably cover 100% of the 
fees. I am glad my providers have all committed to accepting the reduced value assigned to the services. But I am shocked that an uninsured person would - could be charged four times (or more!) as much as I, that is my insurance, will have to pay for the same procedure. 

An office visit to my orthopod is approved at almost 100% of his usual fee. But the surgical fee is reduced by a whopping 2/3, so he will only be paid 1/3 of his usual charge for my operation. It's even a greater reduction for the anesthesiologist. His approved fee amount is less than 1/10 of his actual charge. I don't know if the fees are artificially inflated or if budget cuts are unfairly reducing what doctors are being paid by government based health insurance plans.

I do know that I want the smartest young people going in to the medical profession. The price of a medical education is unbelievably high. The cost of setting up a practice is huge. The financial reward has to be commensurate with the time, effort, and expense our medical professionals have expended to get there. I don't want ALL the smart young people to become lawyers!

I'm going to have to bake more cookies!

Many, Mini Steps - PO Day 36

After a month of drama and angst things seem to have settled down. Instead of giant leaps backward I am now taking baby steps forward.

The last of the steri-strips came off today. They were at least fifty percent of the itch factor. I don't think my skin likes tape adhesive. Every itch I scratch turns up a spot of adhesive residue that has not rubbed off in showering or lotioning up.

The hard knots in my forearms, reminders of IV lines, have absorbed finally. There is one lumpy vein that didn't use to be prominent but not sore nor hard.

The tender spot on rib cage under the right arm where the chest tube went in is barely noticeable. I may soon no longer have any excuse for not wearing the proper underclothes.

The little scabs that spotted my belly are gone. I don't think I mentioned it before...each day in the hospital a nurse gives you an injection to prevent blood clots. Where does the shot go? In that nice roll of belly fat right around your belly button. It's kind on nice to know that annoying bulge has a functional use. A good reason to pity those gorgeous flat tummied models.

I have created my online patient account through my hospital network. Now I and all my doctors have access to my medical records, lab results, and medications prescribed. Best thing is I can now see every doctor who took care of me in- hospital. Sometimes it is hard to keep track.

I've baked and distributed my "thank you" cookies. I still subscribe to the old fashioned tradition of taking food to your doctor. Especially in light of how poorly paid they are now due to cuts in Medicare. More on that subject later!

I've collected all the wonderful "thinking of you" and "get well" cards I received in the mail. Do I send a thank you note in the mail or is an email alright? I don't know, there is nothing like a real card in a brightly colored envelope nestled among the bills and junk mail to lift your spirits. Or is my thinking archaic, a sign of a passé generation?

What would Miss Manners say?

Things I wonder about...PO Day 34

What is the difference between physical therapy and occupational therapy?

Years ago a friend who was terribly burdened with two parents afflicted with Alzheimer's disease complained that part of their treatment was occupational therapy. "Occupation" to her meant a job and that was not conceivable. It seems we are all much better educated about medical interventions nowadays but I have still been confused about the difference between occupational therapy and physical therapy. My PT facility is a big room with large tables to lie on, exercise machines, pulleys and stretchy bands, balls and big stuff. The OT department is sequestered behind a small door and a quick peek reveals only a long table and a couple of chairs with shelves of small items. What if my occupation is a brick mason or a truck driver or a circus trapeze artist? Will occupational therapy get me back to work?

Well, not exactly.

I can't verbalized this as well as it is written on several websites so I am copying and pasting the best explanation I found.


Occupational Therapists (OT) help individuals achieve independence and improve one's ability to perform daily activities and self-care. For example, OT's may help a patient learn to dress themselves, brush their teeth or comb their hair after a stroke or illness that has severely weakened their arms.

Physical therapists (PT) focus on the large motor groups that contribute to walking, reaching, standing and physical activities. They work on strength, balance, range of motion and swelling as well as pain to encourage independence.

One might start out with a physical therapist who will work on improving the large motor skills, then move on to an occupational therapist whose job would be to improve the fine motor skills required to manage the minutiae of life.

While I am in physical therapy to get my arm and shoulder moving and back in the game, I can really appreciate how important the little motions we take for granted are. Getting a spoon of soup to my lips with my left hand is full of danger. Maneuvering a sonicare electric toothbrush around my teeth with the wrong hand without splattering the mirror is a challenge. One handed flossing does not work. Thank goodness for the iPad's ability to anticipate the word I want...it saves me many keystrokes in my current two finger touch technique.

My only hope is that by using my left hand I am improving my right brain.

Surgery plus one month

It's a month since my shoulder surgery and it seems like a year. I don't see my surgeon again for two more weeks. Obviously, he is not the kind of cook who opens the oven door to peek at the cake every few minutes! I am anxious to see him because I was such a basket case when I last saw him, ten days post op. I am so much stronger now. I actually spent fifteen or twenty minutes pulling little weeds, left hand only, this morning. I could have worked longer but for the noseeums...a unique subtropical invisible insect that drives even the most hardy indoors. After years of semi drought conditions, we are experiencing daily deluges accompanied by lightning and thunder often. But everything is so green and lush and growing.

This sedentary existence is getting boring. I am still restricted to picking up nothing heavier than a  coffee cup with the op'd arm. Is that with or without coffee in it? Still wearing the sling 24/7 which is hot and cumbersome. Not allowed to drive yet. That's a nuisance as dear husband does not consider shopping as entertainment or sport or even a way to while away an afternoon. I probably don't have the stamina for a mall trip anyway.

Thank goodness Dear Daughter and grandson from California are coming next week. He is the only known witness to the broken arm accident that started this whole debacle. He and I were coming back from the beach, waiting to cross the street. A pick up truck stopped and waved us across. I didn't realize the sand apron was lower than the asphalt and just splayed across the road like a flattened fauna. I could tell there was something amiss from the position of my poor arm. What an inauspicious start to his summer vacation with the " grands." I bet he never forgets it! No firetrucks or ambulances were involved, thank goodness. With a little help we gathered ourselves up and made it home.

So that's my brief careless moment that led to this whole experience. Boy, am I more careful now!