Hey, it's called "off topic"...

~10 days ago, I had arthroscopic surgery on my shoulder to repair what we didn't know beforehand to be a torn rotator cuff. Now that I'm good enough to type at 80% of my usual speed again, I thought I'd do a dump on the experience and see if any of you have any useful advice or meaningful thoughts.

At least a year ago, my right shoulder started hurting. By mid-summer, it hurt bad enough that I was pounding naproxyn pills, with the pain sometimes wandering up from my shoulder to my neck and head, leading to some unpleasant migraine headaches. Last fall, I'd had enough. I asked around with friends and got the name of a local surgeon who specializes in shoulders, elbows, and knees and paid him a visit.

Step 1: x-rays and a cortisone shot. The cortisone shot was nigh magical, killing off the headaches and eliminating the need for the naproxyn. The x-rays showed a possibility of "calcific inclusions", i.e., rice-grain sized blobs of toothpaste-consistency yuck, buried in one of the tendons. The doc suggested that they could surgically go in with a tiny needle, suck them out, and I might then experience immediate relief. But we don't start off there. Nope, come back in a month and we'll see how the cortisone worked. Welcome to being over-40! For kids this stuff heals by itself.

Step 2 (one month later): another cortisone shot. The first shot got me from daily pain to my arm only hurting when I did various things above my shoulder. Like, no way could I swim, but squash was still mostly okay, since most of the action happens below the shoulder. Anyway, the second cortisone shot went in and, over the next month... did nothing. Also, they shipped me off for an MRI on my shoulder. The radiologist reported the possibility of a torn tendon, which the surgeon noted tends to have a very high false positive rate (i.e., 90% of the time, when the radiologist indicates this, there's nothing wrong whatsoever with the tendon).

Step 3 (another month later): Surgeon vacillates on giving me another cortisone shot or calling me in for surgery. If you do the shot, you have to wait a month to see what happens, so he doesn't want to have to wait around that long. At this point, we're in December, and I had a ski trip planned, so we decided to postpone surgery. Instead, I scheduled myself for a second opinion with another shoulder specialist in town. (There's a huge medical center next to where I work. Within walking distance, I've probably got 5-10 world-class specialists in arthroscopic surgery. Convenient, eh?)

Step 4 (the second opinion): Surgeon #1 could best be described as what happens when a serious tech nerd becomes a surgeon instead. Encyclopedic knowledge. Digresses easily to answer any and all questions on any and all topics. Surgeon #2 was a totally different character. Fashionable clothes. More reserved in his opinions. Nonetheless, for my usual $40 co-pay, he did all the same outward tests (push this way, push that way, does it hurt when I do this, ...) and he examined my MRI raw data, which I brought him on a CD that I got from doc #1. His conclusion: some possibility of fraying near the bone, but he'd be hesitant to do surgery. Instead, let's throw you at physical therapy for a while and see what happens.

Step 5 (physical therapy): I went to the PT twice a week, January - March. They quickly diagnosed the root cause of my shoulder problems as my bad hacker-boy posture. With my shoulders slouched forward, the end of the bone and its socket weren't properly aligned, leading to pinching of a tendon. Toss in my athletic pursuits, such as they were (swimming, squash) and I might well have been slowly damaging myself. The solution? Lots of exercises intended to strengthen my upper back muscles and get proper alignment of my shoulder. This process truly did help me a lot, but it didn't fix the problem. It just made it hurt less.

Step 6 (back to the surgeon): Now we're in early April and I decide to pay a visit back to surgeon #1. I detailed the history to him, he asked me many questions, and we reached the conclusion that it was indeed time for surgery. At this point, the diagnosis was still the possibility of those calcific inclusions with the additional possibility of a "labral tear" (i.e., a screwed up tendon). We settled on a surgery date and I had various pre-op things to get done knowing that my right arm would be in a sling for as long as two months. For example, I snaked all the crud out of our shower drain. Get that done while I can!

Step 7 (surgery): I walked to the hospital, reporting there at 6am on a Friday. (And I was the second procedure for my surgeon that day. Uggh.). I believe I was sedated and in the O.R. by 7:30am or thereabouts, although my memory is a bit fuzzy. I believe I came to around noon, and I'm told I was joking around with the nurses and whatnot, but I have zero memory of anything until 2pm. My wife was there, by then. I'm lying in the recovery ward, my arm's in a sling, and it hurts like nuts if I move in the wrong way. Also waves of nausea, for which the nurse would inject something into my saline drip/catheter/whatever it's called, which also has the side effect of being a sedative, so I'd probably go back to sleep. We didn't get out of there until 5pm. Even though it's less than a mile from home, they insisted that I ride home in a car, and I now understand why.

Post-surgery, I had an inkling that they'd done a rotator-cuff repair, but no actual information, no photographs, no nothing. That would come later.

Step 8 (immediate recovery): The two days following surgery, I was asleep probably half the time, fighting off nausea and other side-effects from the hydrocodone. They'd also installed an anesthesia drip into my neck, which every 30 seconds or so would inject half a milliliter of stuff directly onto my nerve. Moving my arm in any way was screaming pain, despite all this, but if I was just sitting there, it wasn't particularly bad. The anesthesiologist called me daily to make sure I was doing fine. ("Oh good, you're following my instructions. Otherwise you'd be in screaming agony.") Once the pump ran out, on Sunday night, I took two hydrocodone (just in case) and went to sleep. After that, I realized I wasn't doing all that badly, and dumped the hydrocodone and switched to just Tylenol. The pain aspects from undesired movements were exactly the same as beforehand, but now I developed feeling for all the weird places that the sling was pressing on my arm. The Tylenol only modestly compensated for this. Sleeping, since then, has been much more of a challenge.

Yeah, about the sleeping part. They suggested sleeping in a recliner rather than a bed, because you want your arm hanging properly in the sling. After a few days, when the pain went down, I was able to transition to propped-up pillows.

Oh and about showering: I was allowed to shower, and that was the only time I was meant to remove my sling. My arm was dead at my side while doing this, but it didn't hurt. I had to get my wife's help with some aspects, especially washing my underarm, which had begun itching like crazy.

Step 9 (post-op office visit): I had been planning to go to work on Monday and Tuesday, but my university and my daughter's school district were conveniently closed by virtue of the half a meter of rain that our city took on in less than 24 hours. I moped around the house. The surgeon's nurse called me on Tuesday and arranged for a post-op visit on Wednesday. Okay, no problem. At this point, I'm experiencing serious improvements in my condition. Like, I could walk the mile from home to the doc's office and the bouncing wasn't painful for my arm. He replaced the steristrips, gave me some super-basic PT to do (flexing my biceps, lifting my shoulders), and said "yeah, gonna be hard to sleep, most people turn into zombies, like some Ambien?". He cleared me to type, but with limited motion of my arm. This and my Kinesis ergonomic keyboard actually work together beautifully. The only change to my workspace is flipping my trackpad to the left hand.

The doc also walked me through a bunch of microphotographs of the inside of my arm, which they can take because the arthroscopic instruments have tiny cameras on them. He was modestly hard on himself for having completely missed the rotator cuff tear, which is now all knotted back to where it's meant to be. Oh and the only way to get tendon and bone to fuse properly is to have blood flow, which isn't a thing you normally have there, so they use a tiny little auger to chew up your bone to create blood flow. Lovely! Also of note, they found a small bone spur that didn't show up on either the x-ray or MRI. Fixed.

Now, 10 days post-surgery, everything is working as well as could be expected. I've sorted out how to mostly sleep through the night. I'm not even taking Tylenol any more, just icing my shoulder at the end of the every day. I can fully flex my elbow, meaning I can now button my shirts. (My outfits: aloha shirts and athletic shorts, the only things you can put on and take off one-handed.)

"Hey doc, any chance I'll be able to ride a bike by June?"

"Maybe. We'll see."