Update to shoulder surgery

[JCook]

I got a lot of great thoughts from many of you about having surgery to fix my torn right rotator cuff, so I thought I'd update you all. The surgery took place this past Monday morning (19th) and went well. They fixed a few different problems. I came home Monday afternoon with an ice water pump, and a line in my neck for a pain blocker called ON-Q that dispenses an anesthetic meant to be used with other pain relief medicines. I took off the bandages yesterday and had a shower finally. The ON-Q ran out today and I removed the line in my neck (this is modern medicine - it's half DIY). Now I only have to deal with the sling for another 5 weeks or so and sleeping in a semi-sitting position (which I'm finding to be the worst part of it, aside from not being able to play). For pain I am taking ibuprofen and acetaminophen together, which is reportedly as effective as the opiate pain relievers while not having the risk of addiction. So far so good. The pain isn't bad generally unless I move my arm, and also while sleeping. Every little step is progress. I have a follow-up appointment on April 3, so by then I hope to be much improved. And then looking forward to PT probably in May.

Jack

[MikeZito]

Hi Jack:

Good luck to you - I can commiserate. I had hernia surgery last week after being misdiagnosed for NINE MONTHS! The pain was (and sometimes still is) knee-buckling, but at least we are both on the mend. My only form of comfort (aside from getting time away from work) is that fact that I can play my mandolin, (guitar is still off-limits because it is 'too heavy' to lift).

I am only next door in Connecticut, so you have a 'neighbor' who shares your plight.

Keep up the good attitude and you'll be picking again in no time!

[JCook]

Wow, that actually sounds worse than mine. But you can play. Good luck to you with a speedy recovery!

Jack

[DougC]

...

[George R. Lane]

Jack,
I had the same surgery and I feel you frustrations. Keep up with the PT, it will be painful, but it does help in the long run. Best of luck on your recovery.

[mee]

This forum was very supportive to me when I broke my arm and wrist last year. I have been told I will always have issues with my hand and wrist but I am playing again. Best wishes and prayers for you to have a speedy and full recovery.

[Bill Clements]

Jack, I was just thinking about you yesterday. I'm glad you posted an update.
The ON-Q is a great help the first days immediately following surgery. It's a bit of a hassle hauling around (about the size of a softball), but well worth the trouble. Sounds like you have a fine surgeon.
This is not a bad time of the year to have shoulder surgery; the snow shoveling is over and lawn work hasn't begun yet. The toughest part is not doing what you want, but be careful to follow your doctor's direction (as I'm sure you know) and do the exercises religiously once PT begins. Ice/cold packs will be your friend following your exercises.
Keep us in the loop!

Bill

PS
If you're comfortable doing so, PM me your address and I'll send you the same cold pack I use.

[JCook]

Bill, thanks for the offer. They gave me a device called a Breg Polar Care Cube. It's a bucket with a pump in it which you fill with ice and water and connects via a hose to a sheath that goes around the shoulder and upper arm. The water circulates around through the sheath and chills the whole area. Pretty effective. I'm using frozen bottles of water instead of ice cubes. That way I can re-freeze them and use them again. Three of those in the bucket with water and it does a great job.

Jack

[Br1ck]

My wife is five weeks out from rotator cuff surgery, and still in a world of pain. They found some tendon damage and bone spurs too. She also has the misfortune to being immune to many pain medications. For instance, she is impervious to morphine, and needs twice the dosage of Percocet. It has been a long grind as she holds out taking meds as long as she can. Doctors tell her she is recovering normally and should get over the hump in the next few weeks. Glad you are doing better and can look forward to rehabbing soon. Good luck to you.

[Bill Clements]

Jack, this is the gel pad I was referring to. It’s more convenient than the cooler type system (mine is made by DonJoy) later in recovery after PT and home exercises. And it’s inexpensive.
Brick, sorry to hear of your wife’s discomfort and meds dilemma. Shoulder surgery and recovery is a long painful road. Best of luck to her as well.

[MissingString]

the snow shoveling is over

Is that a promise Bill? We still have a week of March left LOL... We’ve only had 4 snow storms in MA this month...

[Paul Busman]

Good luck with the recovery. I had the right rotator cuff repaired a few years back and my recovery was extremely painful. Sleeping was the worst. There was no good way I could lie in bed. I slept in a recliner for several weeks. The good news is that my shoulder is 100% asymptomatic now. Look PAST the pain to when you're recovered.
If you need a music fix, consider learning the harmonica.Seriously.You can play it with only your left hand and it's a lot of fun.
Above all, be patient.Tendons and ligaments are slow to heal, and if they had to anchor muscle to bone, that takes time too.

[JCook]

Bill, that pad does look like a good alternative, and more convenient for later in the process. Thanks for the link.

[JCook]

Paul, you are absolutely right, sleeping is the worst part. I don't have a recliner, but I've rigged up a system in bed where I can sleep at a semi-sitting angle using a large wedge shaped pillow (made for reading in bed) and other pillows. But there's no way to get comfortable and sleep is difficult. I know it will take time, and they did have to anchor muscle to bone, so I have to be patient and let things heal up. It ain't easy, though!

[JCook]

Brick, my empathy goes out to your wife in her pain (and to you as her caregiver). Being immune to a lot of pain relievers is not a good thing. Can she take Tylenol and ibuprofen? I am taking two of each at the same time, as I've read a study showing that the combination gives as much pain relief as oxycodone but without the opioid risks. Also, the nurses at the hospital recommended that method. It seems to be working well so far, and I haven't resorted to the vicodin they prescribed.

[Bob A]

Please be careful taking tylenol (acetaminophen/paracetamol) as it is quite toxic if taken in excess, and the toxic level is not much higher than the maximum daily dose.

Also once you've overdosed, it's unlikely the toxic effect can be neutralised. It destroys your liver, and death follows in a week or so.

[Sherry Cadenhead]

Please be careful taking tylenol (acetaminophen/paracetamol) as it is quite toxic if taken in excess, and the toxic level is not much higher than the maximum daily dose.

Also once you've overdosed, it's unlikely the toxic effect can be neutralised. It destroys your liver, and death follows in a week or so.

After reading Jack's post, I was going to say be careful with the ibuprofen. My husband fell from a scaffold in 2000 - 30 feet to concrete! It's a miracle he survived it and with only a crushed heel and ankle and a broken wrist. The surgeon suggested he take 4 ibuprofen 4 times a day for the pain. The result was irreversible kidney damage. He now has 50% kidney function and sees a nephrologist regularly.

Best of luck with your recovery.

[Brian B]

Good luck with that shoulder, Jack. I've had three shoulder surgeries on the right arm, so I feel your pain. the first was a muscle transplant in the 70s. Six months with my arm taped to my chest. Second was arthroscopic for tears. The last, in 2015, was a total shoulder replacement, in which they sever the rotator cuff (not as bad as tearing it, as it can be put back together properly more easily), saw and chisel the top of the humerus off and toss it in the can, and hammer a titanium spike into the bone and put some kind of plastic surface on the shoulder blade. Not fun — but worth it.

A. On painkillers: you're right about the acetaminophen/NSAID combo. Naproxen worked better for me than ibuprofen, but that doesn't mean much. There was a time, right in the aftermath of surgery, though, that (and the shoulder replacement surgeon had to yell at me about this to get it through my head; in fact he came from home to my hospital room at midnight to do it), that opiates were necessary because without them the initial rehab — very important — would have been too painful and would have led to more cramping, which would have prevented the exercises from being done at all. And it was murderous, and he was right. So, if they tell you to use something stronger once in a while, or to help you get the sleep you need to recover, don't be too hard on yourself. It's scary, and you're right to be cautious. Dependence does indeed set in very quickly. New research a friend of mine told me about (he's an ER doc who actually got fired for refusing to prescribe painkillers to the dozens of people who came in every night swearing that their back pain was a 10 and only Vicodin could possibly help, and this in the thick of opiate-epidemic country) suggests that dependence can set in after three days. If you do take the occasional opiate, remember to count the quantity of acetaminophen mixed in with the opiate towards your daily max.

B: On physical therapy: This is the most important thing I learned over 30 years of dealing with shoulder stuff. Do what your physical therapists say, but only up to a point. They're going to give you home exercises, but, say, if a weight is too much and it causes any sharp pain — back off that exercise. Getting sore is one thing, but if something hurts (sharp pain being the best indicator), back off and let the therapist know. Don't try to tough out anything. Good therapists have replacement exercises for any that aren't right for you that will accomplish the same things. With the amount of nerves in a shoulder, something can easily be dinged after surgery, and create a little swelling or irritation that can make the recovery longer. In my most recent surgery, one therapist insisted on a particular exercise that was killing me — a 1-pound weight lift — that her boss later said should never be done when it hurts. And make sure not to do the stuff they tell you not to do. For example, my surgeon told me to risk nothing more than tying my shoes for a while, I don't remember how long, and he meant it. Make sure never to exceed the motions you're limited to, especially the external rotation. That's the one that'll get you every time. The docs understand the healing process well, and so they know when something that's been sewn back together will be at what amount of strength, which in turn contributes to the determination of how much rehab that part can take, whether range of motion or weight bearing.

C: Once in a while, while you recover, you're inevitably going to feel like you hurt yourself, with something like a reflexive movement. It is scary as hell. Remember that unless you really re-pranged something, it's probably okay. It's just going to be sensitive for a while and a little thing might feel big. I've never had a surgery of any kind when I didn't have a moment — or, in the case of the shoulder, many of them — like that. None of them ever amounted to any damage, even though once or twice I was sure I was done for.

C: Be patient. The shoulder is a damned complicated, nerve-filled contraption. Take your time and have faith. You will heal, even though at the beginning there might be times when it even seems like it's getting worse. It's not.

Good luck!

[Bill Clements]

Once in a while, while you recover, you're inevitably going to feel like you hurt yourself, with something like a reflexive movement. It is scary as hell. Remember that unless you really re-pranged something, it's probably okay.

This is all really great advice, Brian. More than once I thought I had undone the surgeon’s work.

MissingString, I guess I was thinking in my "Michigan vacuum" when I said no more shoveling!

[JH Murray]

The torture sessions (physio) are very necessary. Also a massage can help ease some of the discomfort at that point. Healing is a slow process, so don't be too impatient with yourself. Good luck!

[Paul Busman]

Please be careful taking tylenol (acetaminophen/paracetamol) as it is quite toxic if taken in excess, and the toxic level is not much higher than the maximum daily dose.

Also once you've overdosed, it's unlikely the toxic effect can be neutralised. It destroys your liver, and death follows in a week or so.

In case you don't know it, many of the opioids given post surgery eg Percocet, contain the opioid plus acetaminophen. You need to take this amount of acetaminophen into account if you're tempted to supplement your opioid meds with Tylenol. Check with your surgeon to see what he/she recommends.
Acetaminophen toxicity is a big problem. For years, Tylenol was touted as "the brand most Doctors recommend" giving the impression that it's a safe,harmless drug. It's not!

[JCook]

After reading Jack's post, I was going to say be careful with the ibuprofen. My husband fell from a scaffold in 2000 - 30 feet to concrete! It's a miracle he survived it and with only a crushed heel and ankle and a broken wrist. The surgeon suggested he take 4 ibuprofen 4 times a day for the pain. The result was irreversible kidney damage. He now has 50% kidney function and sees a nephrologist regularly.

Best of luck with your recovery.

Sherry and Bob A,

Thanks for your concern about acetaminophen and ibuprofen. I'm really not having much pain and I've been taking them no more than once or twice a day. Of course these things also have implications for gastric problems also, so I'm conscious of not wanting to overdo it with them. And wow - 4 ibuprofen 4 times a day! I would definitely question that! It's good to learn through others' mistakes, though, and not repeat them. Thank you.

[JCook]

A lot of great advice there, Brian, thank you. I've already thought about how I would know if I'd done something that might "undo" the surgeon's work. It's something I want to mention at my follow-up appointment on April 3. I know this is going to take more time than I's like to recover from. My wife, who is the gardener, is going to be very disappointed this spring and summer when I can't dig holes for her plants!

[Brian B]

Thanks, Bill. Yes, that feeling is terrible. It makes you stop dead in your tracks and your eyes pop and no matter how much it hurts the first thought that comes to mind is that now you did it. Part of the deal. I think surgeons don't like to tell you that because they do want you to report anything that might really have pranged the thing.

[Brian B]

My wife, who is the gardener, is going to be very disappointed this spring and summer when I can't dig holes for her plants!

Might be a good idea to warn her that hole-digging capabilities have been known not to return for 20-30 years. in some cases, never. And yet, the ability to pick a mando returns after a short time. Go figure.