A Phantom Limb!
About hemiarthroplasty of my right shoulder
I can type again, so thought I’d tell you about my shoulder surgery and recovery. First, I hope you never have to have a shoulder replacement because it is weird and stays painful for weeks. However, there were a few funny parts to this tale, so hope you find this entertaining. And yes, I know with all the horrors in the world, this is totally self-absorbed on my part. I know I am lucky to have had access to medical wizardry.
Although no one in my family (that I know of) has had severe osteoarthritis, I do. It seems that wear and tear, getting older, and genetics have conspired. Running, swimming, backpacking, canoeing, and playing every kind of sport wrecked both my right shoulder and hip.
My right shoulder had been getting worse for 15 years. I tried all the alternatives from cortisone to turmeric, Tai chi to yoga, glucosamine to fairy dust, and there was no magical cure for bone-on-bone arthritis. X-rays don’t lie. Despite daily PT, stretching, resting, etc, the joint was only getting worse. I could no longer move my right arm to swim the crawl. I couldn’t put my hand behind my back past my hip. It was time for a new shoulder joint.
In the USA, there are around 50,000 shoulder replacements done each year. Satisfaction rates run 90—95%. The killer pain of arthritis is the most common reason to go to “the knife,” and peaks for 60 to 80 year olds. I’m right in the middle of the pack.
Finding a Good Surgeon
I browsed the internet (yum yum, byte) and asked friends and neighbors for suggestions. Dr. Wong, Tallahassee Orthopedic Clinic, got rave reviews, so I scheduled an appointment. He was no longer replacing shoulders, but could do my hip. Rain check.
Luckily, Dr. Wong suggested a colleague, Dr. Mighell (pronounced Miles), who does muscle-sparing shoulder replacements and is considered one of the best shoulder surgeons in the USA. The only catch was that he’s based in Tampa, but no worries, good excuse to camp our way down the west coast of Florida from Tallahassee, get a BnB, and a new shoulder. Let’s do this!
I got in touch with Rita, Dr. Mighell’s nurse, who answers ALL the questions patients have unless he needs to step in. Rita said Dr. M thinks I should have a hemiarthroplasty. She tells me this while we are camping near Homosassa, land of springs and wintering manatees.
Like the word semi, “hemi” implies that only part of the joint is replaced, the ball part. I googled shoulder replacements and found a peer-reviewed meta analysis showing that total shoulder replacements (new ball and socket) had better outcomes than hemis. I freaked out. I told Rita that a total sounded much better than a hemi.
We were watching manatees when Dr. Mighell called. He explained that those studies didn’t include hemis with the pyrocarbon head he would use. This new technology has a 95% success rate, so forget those other stats, he said. OK, he’s the man. Fingers crossed.
Stinky BnB
Fort De Soto was our last camp “home” before moving to the BnB in Tampa. We’d stay there for three nights after the operation, healing a bit and waiting for a followup appointment with Dr. M on March 6.
Check in was 3pm at the BnB. We were met by Cubano host Orelio, a chunky, jovial, middle-aged man, owner of the main house and small attached apartment with kitchen, bathroom, and bedroom. We moved all our stuff in to the apartment, including stocking the fridge.
Suddenly, the place farted. “Do you smell that?” I asked Tony.
“Yeah, smells like sewage”, he replied. Oh crap!….yes. We start sniffing, but couldn’t find the origin of the smell. We nosed the kitchen drain, shower, bathroom sink, toilet, and found nothing.
We called Orelio and fortunately he also detected the poopy smell. My first hypothesis was that the “air fresheners,” around six of them placed here and there in the tiny one-room apartment, were interacting to make a stink. Experiment number one: get rid of all the plug-in and stand alone odor-masking chemical bombs!
Tony asked if there had been any recent guests with babies, thinking diaper residue. The owner said his wife had just cleaned the apartment thoroughly, and there had been no babies. He rounded up all the “lavender boquets” and said he’d call his handyman uncle and a plumber. It was Sunday, so no plumber until tomorrow, the day of the shoulder replacement.
We debated leaving, finding a hotel, but didn’t have the energy to pack up and move. With a fan on, window and door open, and getting used to the odor, the stink abated. However, once we closed the door, the place farted again, and this time we found the source. It was under the kitchen sink. Blah!
We ran hot water down the kitchen drain, thought we’d cured the problem, but no, it belched the sewer smell again under the sink in a cabinet, so we called Orelio. By then, his tio (uncle) had arrived. They opened up the sewage mains to the house and apartment, suspecting a blockage, but everything was tidy with no obvious bad smell.
Then we put it all together, kind of. There was sewer-line repair going on at a house UPHILL of Orelio’s place. Number one law of plumbing is “shit runs down hill.” Probably as sewage passed through the main pipe, vapors were spinning off for a visit to the apartment and somehow building up under the kitchen sink. We said good night, hoping the plumber would solve the problem while we were gone to get me a new shoulder.
Day of Surgery
Tony and I arrived at Carrolwood hospital at noon. I had stopped eating and drinking at midnight, was hungry and thirsty, but mainly just scared. Why me? I have been such a healthy person. Why are my joints failing me? I know, it could be so much worse. I could be a Gazan, a girl in the Congo or Sudan, or have leukemia or bone cancer. I have got this and I have Medicare! Yikes, but I don’t know my deductible.
I forced myself to be upbeat with the pre-op nurses and my surgeon. The nurse from Guatemala, Dr. Mighell, Tony, and I spoke Spanish together as a diversion. This part of Tampa is Hispanic.
The anesthesiologist, a bear of a guy, had a cold and was not wearing a mask (photo below), but after he delivered 2 units of Versed and another unit of something else via an IV, I didn’t care. Oh goodie, he’s injecting nerve block into my brachial plexus and is using ultrasound to hit his marks. Cooooool.
I sat numbly and humbly waiting. Finally, a guy wheeled me off to the OR (operating room). Tony left for lunch. We passed a clock - 3 pm.
The OR was cold, super tidy with surgical tools laid out on blue cloth along the edge of the room and on little rolling tables. I did not see the pyro-carbon part laying around. Monster lights dangled from the ceiling and 4 guys wearing blue-green scrubs and masks moved me from the hospital bed onto a very slender operation gurney. They put a mask over my face. Did some one say good night? I went dark. Anesthetic shutdown (how it works is still not completely understood).
Dr. Mighell replaced the head of my humerus, the ball joint, with a pyrocarbon bearing. Here’s the joke: It was “cutting edge” science in the world of surgery.
Recovery Room
I wake up. Tony is there. I am alive. I can’t feel my arm. Can’t move my fingers. I am so thirsty. A nurse gives me the best water I have ever tasted. She offers other drinks. I drink the best cranberry juice ever. Taste buds are hypersensitive it seems, but I’m not hungry, or ready to move. I am loopy.
Hospital is closing. They want us out by 8 pm. I don’t really want to stay overnight, and it is not an option, but in hindsight it might have been better.
The late-night recovery nurse doesn’t know how to put a T-shirt on a shoulder replacement patient. Really? Fortunately, I had watched a video. Dress the surgical arm first.
Then, I had to pee, so the nurse told me to get in the wheel chair. I can barely stand up much less get in a wheel chair, but do it. She wheels me towards the bathroom hitting a gurney along the way. Next, she parks the chair and expects me to sort out opening the door, getting on the toilet, back up off the toilet and out of the restroom, one armed. I do it.
A male orderly takes over. His job is simple: wheel me to the elevator and out of the hospital before the security guy locks the front doors. As the elevator door opens, the security man is putting up a large folding sign that says something like “closed” or “ do not enter.” I kid you not, the orderly crashed into the sign with the wheel chair as he rushed to the door. The security guy opened the door, and the orderly left me at the curb, alone. Tony had gone to get the car.
First Night was the Weirdest
We got to the apartment and I was starving. Best husband ever cooks up salmon and veggies. Ommmmm. Purrrrr.
We are sleeping in a Queen. My arm is in a sling across my belly. Tony is on the other side of the bed to make sure he can’t bump the “sick” arm in the night.
Sick arm has her own agenda:
I am sticking straight out. No you aren’t, I can feel you resting on my belly.
I am perpendicular! No you aren’t, you are horizontal in a sling lying across my belly.
This goes on all night. I held my senseless blubbery appendage while she does her own dance. Turns out phantom limb is a phenomenon resulting from the nerve block wearing off. Phantom limb was discovered during the Civil War.
We have a couple of days in Tampa before the follow-up with Dr. Mighell. I can walk, but I can’t poop due to the opioids. We get some Milk of Magnesia. Problem solved.
We explore the hood. Lots of Muscovy ducks waddling in yards. We chat with a nice retired nurse lady with an affectionate golden retriever. (Are golden’s ever mean?)
I can’t open the car door or close it. I can’t drive. Tampa traffic is a panic. Tony does everything. We meet Dr. Mighell who is happy with his work and my recovery. I can wiggle my fingers, pump my fist, rotate palm up, palm down, and wave my hand that feels like a flipper. He shows us an X-ray of my hemi and we take a photo with my phone (below).
Next, we drove home, 4.5 hours, and collapsed.
Home Sweet Home Week 2 and Onwards
Time passed slowly like candle wax melting on an icy night. Still in the sling. Talked with best friends. Best husband ever did all cooking, shopping, cleaning up, etc. I slept a lot, and listened to NPR, same stories over and over.
The pain was excruciating. I kept taking hydrocodone and dealing with the side effects. It’s a Becker family thing, an obsession with a good daily colon release, but opioids cork the bottle. I had to stop the opioids, guzzle milk of magnesia, again, and stick with NSAIDS (acetaminophen, ibuprofen).
After the second week I was allowed to take off the sling. My arm was so happy, but she couldn’t do much. Rita had given me a set of PT exercises, including the fist pumping, rotating palm, moving hand up and down, and letting arm hang and go in circles. Those I could do. There was also crawling hand up a wall and lifting a stick perpendicular to my body assisted by my other hand. Those were impossible due to pain.
Three weeks after surgery, I went to see Dr. Wong in Tallahassee, as he had agreed to do my post-op follow ups. He wanted to see what I could do. I proudly demonstrated flipper motions and arm circles. He wasn’t impressed.
“How high can you raise your arm?” he asked.
Response….. nada, none. I confessed to having quit the hydrocodone. He berated me stating that I would risk scarring and joint “freezing” if I didn’t work harder on PT. He was a tough coach and I was not emotionally ready for that. Dude, arm is gonna do what she wants to do, and I have to poop everyday or go insane.
I agreed to taking what Dr. W said was a non-opioid called Tramadol. Looked it up, and it is an opioid. Tried it. Same problems and not much pain relief, so I just pushed harder to lift the stick and crawl the wall and endure.
Although my right hip screams, the NSAIDs do double duty, so I walk the 2.7 mile “block” around the woods and neighborhood. I raise my arm, make swimming motions in the air, do hula moves, and SS-like salutes.
Wrap Up
Today, is the start of week 6. I can raise the stick and crawl the wall. It still hurts but not as bad as in weeks 4 and 5, so I am calling that progress. In two weeks I have another followup with Dr. Wong. I better be able to raise my hand over my head by then!
Wish me luck!
Oh my ….it’s such a difficult journey healing and being patient for us oh so independent women. Keep up the exercises and your optimism. This will pass. Your shoulder will be better, but still never as good as when you were 20 years old. Aging is not for sissies.
I feel your pain. My knee replacement was a year ago this month and I’m still doing healing stuff.
I thought of you this week with the news of the recreation of the Dire Wolf. So many variables have not yet be explored.