Page 1 of 7. Bohol Profile. Bohol. Basic Facts. Geographic Location Bohol is nestled securely at the heart of the Centra
A SURVIVOR’S GUIDE TO ROTATOR CUFF SURGERY by Jo Kline Cebuhar, J.D. THE OBLIGATORY DISCLAIMER. This information is based on my experience as a rotator cuff surgery patient, and not as much on my experience as a health care professional because I don’t have any of that. So, please, please do not—I repeat—do not do anything relating to your medical care without first consulting with a health care professional who is familiar with you and your unique situation. THE BACK STORY. I gotta be honest, until my orthopedic surgeon told me I had a “massive” tear in my rotator cuff (his word, not mine), I didn’t even know I had a rotator cuff. I’m now 11 weeks out from my surgery and I’ve learned a few things along the way. As you will discover, every person you tell about your upcoming surgery has either already had it or knows someone who has. Those who say rotator cuff surgery is no big deal should be politely ignored. The same goes for those who say it involves excruciating pain. Although there is no question that each recovery is unique, I know this to be true for everyone: planning goes a long way toward having an optimal experience and allows you to focus your energy on healing, rather than inevitable sources of distress and discomfort. PRE-SURGERY INFORMATION GATHERING. The patient/physician relationship is premised on the concept of informed consent. That means you—the patient—have the right to a full understanding of foreseeable risks, benefits, alternatives and uncertainties before you agree to, refuse to agree to or request the withdrawal of a medical procedure. In non-legalese, you have the right—and obligation—to know what you’re getting into before giving the okay. The “informed” part can only come from asking questions and listening carefully to the answers. ACTION STEP: Once diagnosed (I had a physical exam and an MRI), have a serious talk with your orthopedic surgeon: What is the diagnosis? What are my options for treatment or symptom control? What are potential outcomes for each? What is the best case scenario? What is the worst case scenario? If you don’t understand what you hear, ask again. Consider everything in light of your personal situation and values—it’s the only perspective that counts. MAKING THE DECISION TO GO FOR IT. Once I understood my options, I consented to surgery and start getting mentally psyched and logistically prepared. ACTION STEP: Schedule your surgery, keeping in mind that there will be a few days of intense bed rest. After that, complete healing takes at least four to five months, with increasing use of your arm. If you work, ask your surgeon when you can expect to fully resume the duties of your job. Put surgery on your calendar, notify those on your “need to know” list and verify health insurance coverage. Timing’s everything, especially if you’re on Medicare. I’m just sayin’, watch out for deductibles and co-pays. PHYSICAL THERAPY. I first went to physical therapy for symptom control because I was in complete denial about needing surgery. But even after my reality check, PT still helped prepare the working parts of my arm. As my orthopedist explained, surgery puts the tendons back in position to mend—but that’s just the first step in healing (think: a cast on a broken leg). The rest is doing what you’re told to do, not doing what you’re told to avoid and being a compliant patient. ACTION STEP: Your surgeon will prescribe physical therapy beginning 7-10 days after surgery. Physical therapists are in high demand so start asking health care professionals and friends for recommendations well in advance. Before surgery, schedule your first few post-surgery PT appointments to avoid any unnecessary delays in beginning this all-important step in healing. By the way, I’ve been a star PT pupil and it’s paying off big time. SURGERY AND THE RIDE HOME. Rotator cuff surgery is usually an outpatient procedure and, with all the prep and post kerfuffle, you will be at the surgery center from four to six hours. Someone must drive you home afterwards. No exceptions. In addition to general anesthetic, you may be offered a “nerve block” to numb your arm for 12-16 hours after surgery. I’m pretty sure I was told I would “feel nothing” but there’s a huge difference between not feeling pain and feeling nothing. For 12 hours, my arm felt like it was asleep, which was weird to the point of being disturbing. Once the nerve block wore off, pain was easily controlled with meds and ice, so I would not opt again for the block and its side effects. But that’s just me. Ask around. ACTION STEP: Fully discuss the details of your upcoming procedure with your surgeon, including anesthetic. Line up your trusted care buddy, the person who will drive you to and from surgery and will be with you, around-the-clock, for 24-48 hours once you get home. © 2016 Murphy Publishing, LLC - A SURVIVOR’S GUIDE to Rotator Cuff Surgery
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THINGS TO THINK ABOUT AND DO BEFORE SURGERY. Your arm will be in a stationary sling for four to six weeks after surgery. This will change your life, and not in a good way. If you’re like me, the more you know ahead of time, the lower your anxiety level. The lower your anxiety level, the better for your healing and for nearly everyone within earshot of you. Start by watching this video—a big thanks to its creator, YouTips4U: https://youtu.be/pmDSFfawOyw. A LEFTIE OR A RIGHTIE? No surprise if you’ve injured your dominant arm, the odds favor that. So begin practicing common tasks with your non-dominant hand, e.g., pouring milk, eating, shaving, teeth brushing, blow-drying, opening doors, etc. Practice really does help. Store up helpful gadgets and substitutes such as a jar opener, back scratcher, slip-on shoes, electric toothbrush, long reach grabber, etc. CLOTHING. If the thought of someone dressing you while you’re unconscious weirds you out, then don’t think about it. You’re going to wake up after surgery with the sling thing adorning your bare body (I always forget: is it butt naked or buck naked?). It’s typical to remove the sling and shower 48 hours after surgery, but refer to your own surgeon’s postsurgery instructions. You’ll be wearing front-close tops (an extra-large one for the trip home) until you’re comfortable slipping shirts over your head. FOR LADIES ONLY. If turning the girls loose and going all Woodstock is an option, be my guest. Otherwise, you’ll need to rely on front-hook bras for awhile. Try https://www.barenecessities.com. NO DRIVING for four to six weeks. If public transportation is not an option, line up drivers and master the art of consolidating trips to work, the doctor, PT and errands. Incorporate stops at DQ and SB. When it comes to rewarding chauffeurs, professional or otherwise, I don’t believe in tipping—I believe in overtipping. CAREGIVING. Ah, the vital importance of reliable assistance, most especially if you have any other frailty issues. Definitely have someone with you until you can shower, usually after 48 hours. Removing and getting back into that sling the first time was mind-melting (although after a few days, I could do it in my sleep). Remember, you may be unsteady from pain meds, so sitting with a hand-held shower head is best, if possible. Stand up slowly and walk mindfully. SLEEPING. It’s a scientific fact that sleeping = healing. You can try it in bed, but most folks end up in a recliner for awhile. (If you rent one, control lever on your good side. Duh.) Covering the recliner with a mattress pad and sheet makes it more bed-like and, well, it might be six weeks, so less gross. A travel neck pillow reduces bobblehead. Clear any essential pathways—a fall could be disastrous—and have a basket within reach for essentials: the remote control, phone, tissues, water bottle, etc. Your caregiver will soon tire of playing retriever and, if at all possible, you should avoid getting on your caregiver’s last nerve. EATING AND DRINKING. Do grocery shopping before surgery so you have plenty of gut-friendly foods on hand for the first few days. Fruits, veggies, simple soups, toast, and water, water, water. By no means should you neglect the food group known as “indulgences”—after all, you are suffering and should be treated accordingly. PERSONAL GROOMING. Too vain to adopt a “Who cares how I look?” attitude, I found that a “hot air brush” was/is my one-handed trick for styling (I also got a haircut just prior to surgery). For the guys, if shaving with your non-dominant hand is a high-wire act, consider your options: electric razor, trust your caregiver to shave you or grow that beard you’ve been wanting to try. And be careful in the shower. PAIN RELIEF (AND ITS INEVITABLE SIDE EFFECTS). Bags of frozen peas? Fuggedaboutit. A “cold therapy unit” is an electric ice machine that circulates ice water through a large pad. It’s worth every penny for 24/7 pain relief and it lasts five to six hours between rechargings. Your shoulder and caregiver will thank you. Go online or contact your surgeon’s equipment rep—you’ll need a prescription. Many choices, but I like the Breg: http://www.breg.com/products/cold-therapy. Opioid pain medication is a huge blessing to get solid, pain-free rest as you acclimate to sleeping in the recliner. Caution: it’s not that opioids may cause constipation, it’s that they do cause constipation. Take regular doses of prune juice, stool softeners, etc. It’s another issue that can be easily dealt with and will be a major bummer if it isn’t. AVOID GOING MENTAL. I stocked up on good books and made sure Netflix was activated. Accept help when offered. Allow others to do unto you as you would do unto them. Practice deep breathing. Be kind to yourself. So there you have it. Did I relish taking a few weeks out of my oh-so-busy schedule to deal with this? Of course not, but once I accepted its inevitability and focused on making it as hassle-free as possible, it all went much better than I had expected. Isn’t that always the way? Hope this helps you on your journey. An attorney and former chair of Iowa’s largest hospice, Jo Kline Cebuhar’s writing includes The practical guide to Health Care Advance Directives (an update of her 2006 award-winning book, Last things first just in case), SO GROWS THE TREE - Creating an Ethical Will and her 2014 novel EXIT, set in a small-town hospice. Most recently, Jo has created a unique and comprehensive Health Care Advance Directive form. Media coverage of Jo’s writing includes The New York Times, Reader’s Digest, the Philadelphia Inquirer and the Des Moines Register.
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© 2016 Murphy Publishing, LLC - A SURVIVOR’S GUIDE to Rotator Cuff Surgery
