Tuesday, October 8, 2013

On the wrong side of the knife

Two weeks ago, I underwent surgery for what proved to be an extensive tear of my right rotator cuff. 

I have never had a major operation before. Here is how it went down.

Back in July, I felt a sharp pain in my right shoulder while playing tennis. Of course, I continued to play that day and for two more weeks. When the pain finally prevented me from playing, I saw an orthopedist who agreed with my guess that it might be a rotator cuff injury. An MRI showed a partial tear of one of the tendons. I was given the option to try conservative treatment or have surgery. I chose the former.

I rested for three weeks and took ibuprofen. I started playing again and was feeling only occasional sharp pain until I fell on my outstretched arm. From that moment, I was unable to raise my right arm above my waist. The pain was intense and unrelieved by medication.

After a week, surgery was inevitable.

The procedure was done arthroscopically through five small incisions. Two completely disrupted tendons were repaired. The anesthesia method was a brachial plexus block which took place after I was sedated.

I woke up with the recovery room feeling fine because the block had not worn off. Even after it did, the pain was tolerable. I stopped taking Percocet after three days. At my first follow-up visit, the surgeon was pleased. That's the good news.

The bad news is I will be in a sling for six weeks and under activity restrictions for 4 months in total.

You have no idea how important your right arm is until you can't use it.

Here are just a few previously simple things that have become much more complicated—typing, shaving, brushing teeth, getting dressed, eating, opening a jar, and most of all, sleeping.

Because the sling must be worn at all times, I have to sleep on my back, which I have never done in my entire life. I have discovered that I am apparently resistant to Ambien. Words can't describe how tired I was those first few days. It was like when I was a resident.

I understand that my situation could have been much worse. It's not a fatal disease, and with physical therapy, I should be OK in a few months.

But my postoperative experience up to now is beginning to affect my usually sunny disposition.

My wife, who is a nurse, has had to call upon all of her skills to get me this far.

But the other day, she said to a friend that as part of the postop care after rotator cuff surgery, the insurance company should include coverage for marriage counseling.


Moose said...

Many years ago I had some teeth extracted by an oral surgeon with the most gentle and patient care I've ever seen from a medical professional. Not one thing happened without him explaining what he was doing and how it would feel. For me, someone who despises people poking around inside their mouth, it was not just refreshing but almost relaxing.

He explained that he had found himself in need of oral surgery and when he was the patient, not the doctor, he was horrified at how he was treated. For example, he knew that it wasn't dangerous to swallow the anaesthetic gel that's used to numb gums before injections, and so most oral surgeons never worry about whether that happens. When he had so much slathered on that of course he swallowed some, and he had that same scary throat numbness that happens to many of us, he suddenly understood why people freaked out when it happens. He also discovered that even though you know a shot in the mouth is coming, having a giant needle shoved into your mouth while someone roughly grabs your mouth open is not comforting in the slightest.

While I don't wish ill will on anyone, I often think that experiencing what you do yourself is the number one best way to get real and true empathy for what your patients (or clients, or whatever is appropriate to one's field) go through. It's a different thing when you're the one on the other end.

I hope your shoulder continues to heal well and you are on the mend quickly, and, at the risk of sounding preachy, I hope this experience helps you become an even better doctor.

Henna said...

Ha! As a nurse, I send warmest wishes and a chummy elbow in the ribs to your wife. I hope your recovery continues to go smoothly. What about plain old temazepam at bedtime?

Skeptical Scalpel said...

Moose, thanks for commenting. I appreciate the story and the kind words.

Henna, thanks for being a loyal reader.

artiger said...

Didn't know you played tennis. No wonder I like this blog.

Happy recovery.

Anonymous said...

Wow, your first encounter being a hospital patient. It sounds like you got great care. And with your wife being a nurse, I'm sure you will follow the proper course for your recovery to T. I'm glad you're still able to type, would hate to wait 4 months for a new blog post.

All good thoughts for a quick recovery.


Skeptical Scalpel said...

Art, I'm a passionate tennis player. Not being able to play is killing me.

Anon, thanks. I'm typing left-handed. Honestly, in a way it's no worse than the way I type with both hands.

C said...

I'm sorry you needed surgery, but glad you seem to be healing, albeit slowly. Tennis = running for me. Had some minor surgery last year and was told no running for a week. My poor husband, counseling included, indeed. I got payback though. My husband needed neck surgery a few months ago-keeping him sane through that was rough.

Anonymous said...

Glad to hear that you got good medical care and things are mending. (I hope). Also that your wife gets some flowers for the care. :)

Although when I saw what you wrote about the most important things, you left THE major player out; going to the bathroom. Enough said ...

Get well soon! I am a swimmer so I can give you some good info about doctors and what they think are appropriate times to 'get back in the game". Being a surgeon (and I've had 4 abdominal surgeries to date), I'm sure you can figure it out. LOL.

Good luck!!!

Skeptical Scalpel said...

C, thanks for commenting. Paybacks can be difficult.. Must have been a pain in the neck. (Sorry)

Anon, yes the bathroom is another challenge. Swimming is supposed to be good for recovering from my type of surgery. We'll see.

Anonymous said...

I feel your pain. Ruptured my quad tendon and needed surgury. Out of commission on crutches 3 months brace for 3 more. Not supposed to golf. Missed whole season and I had just purchased new clubs in Apr.

Skeptical Scalpel said...

Wow. That sounds a lot worse than what I'm dealing with. I hope you're back on the course soon.

Karen RN said...

I am happy you've been so healthy that this is your first experience on the wrong side of the knife. I started at age 5 with a laceration on my chin. Refused lidocaine and demanded a mirror so I could watch - difficult child lacking trust! Nothing has changed! My rotator cuff was torn some years ago, and I limped along until I tore the long head of my biceps tendon, which was one tear too many. Surgery November 1. I hope I do as well as you have. BTW, your wife is a saint! Nurses have to stick together.

Skeptical Scalpel said...

Karen, a biceps tendon. Sounds worse than what I had. Yes, my wife is a saint. And I hope you do as well as I did too. It's not as bad as many people told me it would be. Good luck.

Chuck said...

Sir, you mentioned Percocet. I understand Percocet is a hybrid of some kind of opiod that works and, unfortunately, acetaminophen. As you might guess, I am not a fan of acetaminophen. It does not serve as an effective analgesic for me (I know, different strokes for different folks). Is it at all possible after surgery anymore to get a pain reliever that does NOT contain acetaminophen? Years ago when I had a molar surgically removed due to "resorption" and the periodontist gave me something that contained acetaminophen so I just took 600mg ibuprofen instead. Obviously you are much better informed than I am, but aside from the fact that it doesn't seem to work for me (and I like to have wine or beer on occasion) these two reports seem pretty damning: http://www.propublica.org/article/tylenol-mcneil-fda-use-only-as-directed and http://www.propublica.org/article/tylenol-mcneil-fda-kids-dose-of-confusion

Good 'ol aspirin works well for me but, yes, I know it's not advised before/after surgery. Thoughts? (or maybe you've commented on this before and I haven't seen it.)

Thanks chuck

Skeptical Scalpel said...

Chuck, agree. I never was a fan of acetaminophen either. I guess you could take straight codeine. Aspirin is not as big a deal as most people think. Some recent papers show that bleeding is not as bad as once thought in people taking aspirin. That has been my experience too.

Henna said...

My dad, a dentist, would strongly agree about the acetaminophen. His standard recommendation when people phoned at 2330 saying "Doc, my tooth has been hurting all day," was to say, "Take 3 aspirin and see me in the morning." Ibuprofen is excellent for dental pain but it was on prescription during much of his time in practice (until 1995/96?). His thought was always, Why prescribe ibuprofen when OTC aspirin will work just as well for most people?

Skeptical Scalpel said...

Henna, yes, there is nothing wrong with aspirin. I use it myself.

Anonymous said...

My experience exactly 16 months except that I fell 3' off of a step ladder landing on my right elbow - 5 anchors for a 5 cm tear.. It is amazing what one can learn to do with one, non-dominant upper limb, but operating is not one of them. Fortunately, I had transitioned from private practice to an academic VA practice several years ago. I was able to go to clinic in a sling and supervise upper level residents (with backup) with straightforward cases. If I had been on my own it would have been a $200-300,000 injury. Fortunately, I had a great surgeon and excellent physical therapy and my shoulder is better than before my fall. The lesson is that we should take nothing for granted. Life can change in a heartbeat. Had I not landed on my elbow I probably would have had a serious head injury. In spite of my temporary incapacity, I tried to always keep in mind that there are many with problems much worse than mine.

RuggerMD said...

So you rested three weeks after a partial cuff tear and thought that going back and playing tennis in the first place was a good idea?
Probably should have waited just a bit longer and then eased back into it and perhaps you would have never needed surgery.
Just teasing a bit, but it may be true.
I tore my medial meniscus and had good MRI confirmation.
Kept feeling clicking and pain in my knee and occasionally it would catch.
Went to the orthopod and asked about conservative management and if there were any trials versus surgery.
Said in Europe they scoped knees and didn't repair vs scoped knees and repaired (can't imagine doing that here) and about 35 % or so of the non repaired had healing with time.
So since I was at a new job I decided to wait a few months and give it a shot w/o surgery. One day I just realized my knee hadn't been bothering me and here 5 yrs later still no symptoms.
Suppose I just got lucky, but like most surgeons, we don't like being on the other side.

Skeptical Scalpel said...

Rugger, you may be right. My only excuse is that the orthopod said it was ok to play if it didn't hurt. I have convinced myself that I eventually would have needed the surgery anyway and better to have had it now than in the summer.

I've heard stories like yours before. You are lucky. Good for you.

artiger said...

Scalpel, move South, tennis is not confined to the summer down here. January and maybe part of February is the off season.

Skeptical Scalpel said...

Too much family up north. Also, we have a game called platform tennis which we play outdoors all winter.

Anonymous said...

May you heal quickly and perfectly. And may your wife be rewarded with lots of pretty presents this upcoming holiday season - she's probably earned them in spades, no? :)
As a patient on a seemingly endless saga towards trying to obtain help for a rare hereditary muscle disease (I've been on this road for almost 5 years now, and still no meaningful help in sight), I can attest that we need more doctors like you out there to help those of us who have had the shittiest of luck with our own health.

Skeptical Scalpel said...

Thanks for the kind words. I hope you feel better too.

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