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RIP My Insurance Deductible
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Thorzdad
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Jan 17, 2022, 02:14 PM
 
So, I had my right rotator cuff and one tendon repaired this morning. No idea if I’ll ever get my fastball back, though. On the upside, I killed my deductible in one fell swoop and it’s still January
     
subego
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Jan 17, 2022, 02:15 PM
 
Yikes! Glad you sound in good spirits!
     
Thorzdad  (op)
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Jan 17, 2022, 03:14 PM
 
They did a nerve block on the entire arm, so pain isn’t a thing yet. And I haven’t tried to negotiate bed time yet either. I’m sure that’s gonna affect my mood a bit.

I also have this electric portable ice water cooler pump for the shoulder wrap. I have hook that up for 20 minutes every hour. There’s also this big arm sling with a big pad on it. I look like a moon explorer with all this gear on me.
     
subego
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Jan 17, 2022, 03:17 PM
 
We can rebuild you… we have the technology.
     
Thorzdad  (op)
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Jan 17, 2022, 03:18 PM
 
I just hope I can get my fastball back.
     
Chongo
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Jan 17, 2022, 04:51 PM
 
Originally Posted by subego View Post
We can rebuild you… we have the technology.
Maybe not
45/47
     
Thorzdad  (op)
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Jan 17, 2022, 04:55 PM
 
     
OreoCookie
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Jan 17, 2022, 08:05 PM
 
How’d that happen, Thorzdad? Sports injury?
I don't suffer from insanity, I enjoy every minute of it.
     
ghporter
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Jan 17, 2022, 10:58 PM
 
Keep up with the ice machine, stay on track with medication schedules, and go to PT when the surgeon says to.

The ice machine will do two things. It numbs the heck out of everything for improved comfort - that’s obvious. But it also seriously reduces swelling and inflammation. Those are not only uncomfortable (professional terms for “pretty darn painful”), but they hinder healing.

From personal experience (hip replacements are supposedly a little easier than shoulder surgery, but I’m not going to get a shoulder worked on just to check that), staying on track with meds, especially pain meds and associated meds*, WILL help you feel better and recover faster.

Now the hard part, and it’s going to be the “more uncomfortable” part too. As soon as your surgeon says, go to PT for that shoulder. I’d recommend OT as well - both disciplines can and do work on shoulders - but most people, even a lot of orthopedic surgeons, don’t have a clue what occupational therapy is, or what we do.

Depending on the tendon you had to have fixed, you might be able to throw a ball in months rather than “maybe in a few years.” But the ONLY way you’ll get as far as putting a tee shirt** on by yourself any time soon is by doing the therapy.

*One of those meds is “to manage the side effects of strong pain medications.” You probably know which one I mean. Don’t ignore that side effect, because it will set you back pretty badly if you do.

**Putting a tee shirt on by yourself takes a pretty substantial amount of range of motion, but you’ll have to work around the stiffness for a while. One thing OT does is help patients “work around” stuff while they recover, like learning ways to dress without screaming in pain or damaging yourself. That goes as much for having your hip replaced (me, last April) as for having your shoulder repaired.

Glenn -----OTR/L, MOT, Tx
     
Thorzdad  (op)
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Jan 18, 2022, 07:18 AM
 
Originally Posted by OreoCookie View Post
How’d that happen, Thorzdad? Sports injury?
About five or six years ago, I slipped and fell on ice, reflexively bracing the fall with my right arm, and jamming it hard. It hurt like hell right afterward, of course, but it more or less cleared up, leaving a little tenderness that I learned to live with.

Over the last couple of years, though, it began to hurt more and more and I started experiencing limitations in movements. Mousing was especially bad. Eventually, I just had to pull the bullet on doing something about it. Had a CT done, and it showed tears in the muscles of the rotator cuff, and possible thinning of a tendon. So, surgery was needed. I did that all near the end of last year, but put off surgery until this year so as to kill the new 2022 deductible early.

The surgeon had hoped to be able to use a biosynthetic sheet to reinforce the cuff tissue, but found that the tearing was more severe than he thought and had to go with sewing it back together. Similarly, he found that the tendon had completely detached, so he had to sew that back together as well. It was all done arthroscopically.

They used a nerve block on my arm, and it was completely dead the rest of the day and most of the night. The shoulder’s hurting like fuck this morning.

My post-op exam is this Friday and we’ll discuss PT then. Thanks for the call about getting OT, too, Glenn. I’ll definitely include that in the discussion. Doc says I’ll be doing PT for at least four months. That’s pretty demoralizing. I tend to think of myself as pretty useless as it is, but this is going to take that to a whole new low.

Anyway, this morning I couldn’t sleep, so I got up and figured out how to make a pourover and toast one-handed for breakfast. It went surprisingly well.
     
Thorzdad  (op)
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Jan 18, 2022, 07:31 AM
 
Glenn, any thoughts on pain medication. Surprisingly, my surgeon scripted me good ole hydrocodone. I’ve used the stuff in the past, and know the pros and cons. I’m not excited about using the stuff regularly over the next few days, and definitely don’t want to extend its use beyond that.

My well-meaning sister thinks gabapentin would be a better route. But, she also does the whole herbal remedy thing for various ailments, too.
     
andi*pandi
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Jan 18, 2022, 01:37 PM
 
hope it heals well! as usual glenn has the good advice. They found a small tear in my shoulder last year but didn't think it needed surgery, yet. No idea how I did it either...
     
ghporter
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Jan 18, 2022, 02:42 PM
 
Originally Posted by Thorzdad View Post
Glenn, any thoughts on pain medication. Surprisingly, my surgeon scripted me good ole hydrocodone. I’ve used the stuff in the past, and know the pros and cons. I’m not excited about using the stuff regularly over the next few days, and definitely don’t want to extend its use beyond that.

My well-meaning sister thinks gabapentin would be a better route. But, she also does the whole herbal remedy thing for various ailments, too.
Give yourself a hard limit to how much pain you want to deal with. I usually advise a 4/10 at a hard max before my patients ask for pain meds of any kind. When a subjective pain rating goes above 4/10, you’ve stepped over a threshold…it takes substantially more medication to get back below 4/10 from 6/10 than from 5/10, and it takes longer - often MUCH longer - to get relief. So when you start to feel more than just uncomfortable, rate your pain. If it’s “over 4”, the next step is to see if you can have another dose of whatever.

Keep in mind that surgical pain is a very different thing from long-term pain, or chronic aches from “resolved” injury pain. It is a fresh, physical “injury”, and its signals are more “urgent” than other types of pain. It also tends to resolve pretty quickly after surgery, so if you manage it acutely for several days, you should see it fall off pretty quickly.

Hydrocodone works well for orthopedic pain, but is more likely to cause worse constipation than oxycodone, so a stool softener is a must. Really, from personal experience, Dante left out level 8.5 of Hell because he was never badly constipated. If it’s a combination hydrocodone/acetaminophen drug (i.e. Vicodin), it’ll work better at lower doses than straight hydrocodone.

Gabapentin IS useful, but as an adjunct, not a substitute for opioids after surgery. Gabapentin reduces the sensitivity of nerve conduction, which decreases pain signals. It’s important to understand that, on a short term basis, opioids are an extremely effective way to improve recovery. Again, this is from experience - it helps.

If you can keep your pain managed with a less-than-max dose of hydrocodone, ask your doctor if you could transition to something else, like Tramadol. It’s considered a synthetic opioid, and it’s on the same DEA list as hydrocodone, but it is a very good stepping stone in eliminating opioid pain meds.

The kicker is that ANY substantial level of continued pain will slow your recovery. Stay over 4/10 for more than a while, and you buy yourself extra hours/days/weeks of recovery.

It is OK to take less than you are allowed, just as long as you can keep the pain controlled. It’s often very helpful to take a full dose at bedtime, at least at first. Poor, inadequate or insufficient sleep will also set you back. Much of the physical processes of recovering from any surgery occurs during sleep, so don’t let yourself be shortchanged.

Glenn -----OTR/L, MOT, Tx
     
Thorzdad  (op)
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Jan 18, 2022, 05:43 PM
 
So far, the hydrocodone hasn’t seemed to do anything other than make me groggy. I honestly can’t say that it’s done anything for pain. I’ve taken hydrocodone in the past (back surgery in the T-10 area) and know how well it can work, so it’s kind of frustrating that I’m not getting any relief from it. I’m giving straight tylenol a try. What has helped is the cold wrap and pump. That thing is amazing. It took a bit to get it fitting just right, but when I did it was beautiful relief.
     
subego
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Jan 18, 2022, 06:05 PM
 
FWIW, you can take Tylenol and Aleve. The latter is good for swelling. Staggering them is also an option.

This is what they give to opiate addict gunshot victims in the ER.
     
Thorzdad  (op)
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Jan 18, 2022, 06:47 PM
 
Doc says no anti-inflammatories for now. Apparently they can slow down the healing process of surgery. He had me stop them two weeks ago. I was taking voltaren at the time. Really felt it when I stopped.
     
subego
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Jan 18, 2022, 06:57 PM
 
Gotcha! Sorry for the bum suggestion.
     
Thorzdad  (op)
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Jan 18, 2022, 07:29 PM
 
For anything else, I usually do what you suggested. Not a bum idea at all.
     
OreoCookie
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Jan 18, 2022, 09:13 PM
 
@Thorzdad
Sorry to hear, that really sounds like a bummer. I had two shoulder injuries, but nothing as severe. I remember that not being able to dress by myself and the like was not great to put it mildly.

I can only echo Glenn's sentiment: PT and OT is so hugely important, equally important as surgery. When I had my more severe shoulder injury, my PT was preserving my range of motion with seemingly simple exercises — she moved my arms for me. She was my muscle if you wish. That was a godsend. Do not skimp on PT. I know it seems long, but it'll be worth it.
I don't suffer from insanity, I enjoy every minute of it.
     
ghporter
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Jan 21, 2022, 02:06 PM
 
Ice machine AND meds is the ticket. Professionally speaking, you got the ice machine for a reason, so use it religiously. The meds will help more if you keep on the ice machine schedule.

Nonsteroidal Anti Inflammatory Drugs (NSAIDs) have an interesting side effect. They interfere with a crucial step in the clotting cascade (it’s a complex enough system to warrant getting a PhD in), and thus can increase bleeding.

This also affects the constructive part of the inflammatory response, the part that rebuilds stuff after surgery or injury. This is why you were instructed to stop all NSAIDs for weeks before surgery. There is, however, controversy over whether all NSAIDs impact all parts of all surgeries. But it’s your surgeon’s call on this, so I (and you should too) defer to his/her professional judgement.

Glenn -----OTR/L, MOT, Tx
     
Thorzdad  (op)
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Jan 21, 2022, 04:49 PM
 
Had my first post-op with the surgeon’s PA today. It all looks good. They took off the big wad of bandages on my shoulder. All that’s left are a bunch of steristrips. I’m still stuck in the sling for 4 weeks, but I can take showers again, which sounds like heaven.

I’ve been surprisingly pain-free, using just tylenol and the ice vest.
     
reader50
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Jan 21, 2022, 05:28 PM
 
A practical question - how are you doing the typing? Hunt and peck with one hand, or are you trusting voice dictation?

I've tried voice a few times over the years. It's gotten better, but still had too many errors. Or maybe I just never got a good mic.

I should try it again - it's been years since the last test.
     
subego
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Jan 21, 2022, 05:32 PM
 
I umm typed this with voice dictation and it no wait comma shit.
     
ghporter
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Jan 21, 2022, 10:20 PM
 
No dictation for me…. Them software critters like messing things up.

Thorz, use the shower water for comfort as well as getting clean. Generally you don’t want to put “heat” on a recent surgical site, but shower water is different. And it will feel great.

Do you have “don’t move beyond X” instructions, or are you supposed to not move at all? Because if you’re allowed to move “a little,” starting that in the shower will help AND feel great.

One thing about hydrocodone; a paradoxical effect that makes you more uncomfortable as the drug starts to fall off after its peak effectiveness. This isn’t a 100% thing with anyone, but if you’ve used the drug before and gotten good results, you could be feeling worse just because your system knows how “good” a drug peak can feel. This is not at all related to addiction, but rather the chemical cascade of pain signaling that specific types of drugs impact. If Tylenol and ice give you relief, that’s wonderful, and you can wean/stop the hydrocodone.

Glenn -----OTR/L, MOT, Tx
     
Thorzdad  (op)
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Jan 22, 2022, 09:04 AM
 
Originally Posted by reader50 View Post
A practical question - how are you doing the typing? Hunt and peck with one hand, or are you trusting voice dictation?

I've tried voice a few times over the years. It's gotten better, but still had too many errors. Or maybe I just never got a good mic.

I should try it again - it's been years since the last test.
Hunt and peck. I’ve never used dictation, and I doubt it’s a good fit for me. I do too much copy editing on posts. My wife dictates everything, and it weirds me out how she drops in “comma” “period” etc. into her flow and Siri just seems to understand what she means.

I’ve also flipped the button mapping on my magic mouse and started mousing left handed. I’m doing better than I thought I would, but I’m far, far, far from being Pshop or Illustrator proficient to go back to work.
     
Thorzdad  (op)
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Jan 22, 2022, 09:17 AM
 
Originally Posted by ghporter View Post
Do you have “don’t move beyond X” instructions, or are you supposed to not move at all? Because if you’re allowed to move “a little,” starting that in the shower will help AND feel great.
I’m to stay in the big bulky sling (Breg Slingshot 2) 24/7 unless showering. I can either use a cheap sling in the shower or let my arm hang free. I can raise/lower my forearm, but only by using my other hand. Because of the bicep repair, they really want that muscle to not be stressed in any way for now, which lifting my forearm on its own definitely does. I’ll probably use a sling in the shower just to avoid moving wrong.

The PA told me that the bicep was shredded so much at the shoulder connection that the doc had to sew it up and reconnect it at a different spot. She walked me through the pics the doc took inside during surgery. Pretty fascinating stuff once you know what you’re looking at. There were a lot of “See that? It’s not supposed to look like that.” moments.
     
ghporter
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Jan 22, 2022, 10:49 AM
 
Fascinating and scary all at once...yeah, I hear that. My hip X-rays (and later MRI) were like that, and I already understood what I was looking at.

Glenn -----OTR/L, MOT, Tx
     
OreoCookie
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Jan 22, 2022, 07:52 PM
 
@ghporter
Moments like this make me miss my mom. She used to work in an orthopedic hospital, a very, very good one at that. She took the X-rays of most of my injuries (I think with only two exceptions) and make me do a walk of shame. It was fun. She’d tell me what will likely happen to me (she was right every time). They took really good care of me. Lately, my knee has been acting up, though, so I will have to go for a check-up. Makes me miss my mom … 
I don't suffer from insanity, I enjoy every minute of it.
     
Thorzdad  (op)
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Jan 27, 2022, 10:36 AM
 
Just over 1.5 weeks into being stuck in this brace, I have become surprisingly adept at eating soup left-handed.
     
   
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