2012 Shoulder Pop
true tales and updates on a new medical condition from Justin!3 February 2012 Friday night two colleagues from work held a fantastic housewarming party walking distance from the office. They invited everyone we work with in SF and served up delicious grilled meats: brazilian tri-tip, korean short ribs, tasty spiced sausages, basil chicken wings. Yum! I ate a bunch of meat, many, many delicious fleshpieces, and not much else of the delicious fare that these folk so generously shared. Plus I had like four drinks in like two hours.
Ilyse at her house, and being tired and drunk I was soon asleep. 4 February Saturday morning 4am, I woke up to use the bathroom, tripped over Ilyse's bedframe and landed THUNK hard on my left shoulder.
There was a lot of pain in my shoulder and I didn't want to move my left arm much. There was now a prominent lump on my left shoulder, and my arm was hanging somewhat looser at my side. Plus it hurt to move it much at all. Ilyse had broken her shoulder so she had a sling and some oxycodone to share. We walked three blocks to our local California Pacific Medical Center Emergency Room - blessedly convenient and empty save for one or two sad early morning cases.
here's an explanatory link.
My shoulder hurts to move. I was prescribed oxycodone, my arm is in a sling, and I was told to visit an orthopedic surgeon as soon as I can get an appointment.
Until I hear otherwise then I am laying around stoned on painkillers, sleeping, reading, relaxing on my couch and avoiding moving my left shoulder. My medical marijuana prescription just became more poignant. I have added metamucil to my drug cocktail, dietary fiber to counterbalance the opiates, ensuring that I can actually poop on the daily.
Ilyse is feeding me and relieving me from using my hands around the house. I am grateful to her for taking good care of me, however she has severely restricted my access to the Xbox today in order to rest my arm and I am looking for a second opinion on that. She readily helps with documentation - the pictures of me here are from her, and I am quite grateful and amused!!
visiting a doctorMonday 6 February I visited an orthopedic surgeon Jim Kelly for an initial diagnosis. He looked at my x-rays from the hospital, tested my range of motion and felt around my shoulder. He said he felt I have fully torn the ligaments holding my bones in my left shoulder together. He suggested I get surgery as soon as next week to reattach things.
He said it seems like a bad stage 3 or an early stage 5 (stage 4 is inverted, which he suspects I don't have).
Dr. Kelly suggested I can wait until next week to see how much range of motion and pain I have - if I'm comfortable with the way the healing is progressing, I could elect to postpone surgery, possibly indefinitely. But if I get surgery sooner, he suggested, I can possibly have my own ligaments form scar tissue around the hardware bolting my shoulder together, which could yield better results.
My sister Chris drove me to the appointment and took great notes to keep track of the doctor's diagnosis - that was extremely helpful.
So I'm set up at home, mostly on my couch, using a flexible computer setup (thanks again Ilyse for another fun picture):
Textastic that I can use to edit links.net HTML files live on the server. Hurrah from my couch!
doctor 2 & surgery planningWednesday 8 February I visisted an orthopedic surgeon Christina Allen at UCSF for a second opinion. She looked at my X-rays from the hospital and immediately requested additional angles - "I can't decide whether you need surgery without more information." That was nice to hear.
A resident fellow Dr James Chen was looking over my chart when he realized he recognized me from our overlapping time at Swarthmore College in the 1990s. I don't often run into swatties in the wild; in this case Dr. Chen offered to give me additional context over email if I needed it, which has been very helpful.
It's crazy because it's now Thursday, I injured myself on Saturday; I already feel better after 5 days of healing. Maybe I can just heal this thing, and train my muscles to hold up my shoulder and be okay without opening my skin? For example, I found this inspiring account of shoulder separation recovery on steroid.com:
Dude i had a grade 5 (the worst) from a dirtbike crash. i couldnt afford the surgery so i had my brother push down the bone thats sticking up as low as possible and tape it down with athletic tape running all down my body. After a month i took it off. i had a bad rash from the tape but the injury was reattached in a better place. after a few months i started with the weights again to rehab it slowly adding more weightsd and angles to my workouts and in the end it healed up so well that its better than the one that never got broke. if you dont do something to hold it down it will heal still but the end of yer collar bone wil always stick up where it ripped loose at thye acromeoclavicular joint. so theres hope for a good healing without the surgery is what im telling you.Unfortunately my brother wasn't available with tape for this plan. Fortunately I have health insurance so after two doctors, a bunch of web research, talking with my family, and suffering with a painful floppy left arm, I decided to get surgery. Dr. Allen says she plans to drill two small holes in my clavicle, then wind a loop of merceline tape through those holes and around to pull my clavicle together with my scapula.
Friday 10 February 7.50am I show up for outpatient surgery at UCSF Mission Bay. I can see the ngmoco:) China Basin offices from my doctor's office - something comforting about that. I'll be put under with general anesthesia for an estimated 2.5 hours, then 1-2 hours recovery, and I'm home by maybe 3pm.
For the first week I'm on percocet, not really supposed to do much at all, except sleep sitting upright and avoiding pain and movement and discomfort. I mentioned my medical marijuana prescription to Dr. Allen she said to avoid smoking pot because it inhibits bone growth. I told her I eat, drink or vaporize it, so I'm not getting the tar from smoking it, which seemed to put her mind at ease. She did say I could encounter post-op nausea, in which case medical cannabis could be a boon.
Wednesday 15 February I have a followup inspection and stitch-removal, if things are going well. Then the next week I can see about returning to work and I start physical therapy! I'll be sharply limited in what I can lift and move around during that time - basically the best way for me to screw this whole thing up would be to lift or pinch something with my left hand, or to try lifting my arm over my head. So limits!
For six weeks I have a extremely limited range of motion with my left shoulder. I'll be in a super-thorough sling so people can look at me and know "damn that dude's shoulder is fucked" which might help on public transit or situations where someone is debating whether to hug me or not.
The surgery is a big decision, but what it actually means is I am committing to be a good patient during recovery. Fantastic advice from my Uncle Jim: One of the things I have done that has sometimes proved useful is that once a procedure is scheduled, ask the surgeon “what are the 3-4 things I can do to be the best patient you have ever had?” And then do them. Be a good patient.
I imagine that being a good patient means being mindful of how I use my shoulder, how I hold my body, keeping up with exercises, and avoiding situations which could challenge my healing or stretch out the means they're using to affix my clavicle to my scapula. Being a good patient means not doing too much, not signing up to do too much, being happy not doing too much, because I'm taking the view that from mid-February through early April, my primary goal in life is to rebuild my shoulder so I can do more cool stuff at a later date.
surgeryFriday morning 7.50am, showed up for surgery and signed an Advanced Declaration about my lifestyle preferences:
They used an ultrasound to find the nerve for my left arm in my neck. Then they injected a numbing agent just for that nerve, with a giant needle. That's the last thing I remember before I woke up to ask, when is the surgery? It had happened; the Versed they gave me kept me from remembering anything, including passing out, being operated on, and waking up nearby!
Having my armpit shaved. Thanks Ilyse for the pic!
They opened me up, sawed off a little bit of the clavicle to make room, drilled a hole in the clavicle and ran some merseline tape through that hole under my scapula, to loop them together where I tore my ligaments. Then they sewed me back up. As my uncle Jim remarked, orthopedic surgeons are like great carpenters with clean tools.
Using ultrasound to find the nerve in my neck, before that big red-sheathed needle goes in! Thanks Ilyse for the pic!
I had three things I wanted to ask the doctor, and I guess I asked them before I remember but after the surgery. One, I asked to keep the piece of my clavicle they were shaving off - too late it was already medical waste. I asked for a picture of my open wound - score! here's a picture inside my shoulder taken by Dr. Allen during the operation. Wow thats intense.
Waking up from surgery Thanks Ilyse for the pic!
So I was in a new-and-improved sling, I had a bandage on my shoulder and Ilyse helped me home. There, Ilyse and my sister put me into a recliner. There was food in the fridge, a schedule of visitors to help with housework and keep me company, and not a whole lot planned for the next week or so.
Click that picture above for an inside (gory) view of my shoulder - photo by Dr. Christina Allen.
Can't shower from Friday to Wednesday. Based on my experience at Burning Man I use babywipes to wipe my neck, pits and privates once or twice a day. Ilyse suggested I put baby powder in my greasy hair since washing my send water into my sutures. I sprinkled my head and brushed it through and yes! Also, one-handed toothpick teeth-flosser things: highly recommended.
Vapor Room on Haight Street - the classiest medical cannabis dispensary I've yet found in San Francisco. It's a fine place, if you're a viper. In addition to quality dired marijuana plant matter and compressed hashish, the Vapor Room sells THC-infused olive oil, butter, granola, lollipops, brownies, trail mix, and tea bags. For this illness I bought marijuana tinctures, basically liquid pot, and I bought a bunch of marijuana tea bags. I discussed this with all the doctors I saw; the consensus was that cannabis could help fight nausea, pain, stress; but bone growth is inhibited by the tars in smoke. So if I can consume cannabis without needing to irritate my lungs and sinuses with smoke, then that shit is medicinal.
Dr. Allen prescribed Ocycodone 10mg (not Oxycontin), with 325 mg of acetaminafen aka Percocet, an opiate painkiller. Plus I'm on antibiotics to prevent infection. I take metamucil three times per day to combat the contipatory effects of the opiates. I shat once on Friday after surgery and then I didn't shit again until Monday. I felt more full of shit than usual, something nice to worry about in an otherwise low-stimulation dream like staycation. I'm hanging out in my house on drugs, which is nice except I'm never more than 45 minutes away from serious pain. One decision like "let me hold the milk in my left hand while I get the glass with my right hand" could permanently mess up my shoulder for life. I have to take a really long time to do very basic things like get myself a glass of water. Or pull food from the fridge and prepare myself a serving. I have to pretend that I don't have a left hand, because there's basically nothing good I can do with it until it heals, until the doctor says, until I've rebuilt my muscles to support this whole new arrangement.
5 day surgery followupWent back to see Doctor Allen on Wednesday 15 February. Here's some mid-morning waiting room style, thanks Ilyse:
Underneath was some strips Americ tweezed off. I try to remember hospital people's names so I can thank them and feel connected to them during the experience. These people are professional healers.
I can shower, with the wound wrapped in clear plastic wrap and taped up until a week from now when it should be okay to get wet. I start physical therapy at UCSF Mission Bay on Friday, February 24. Damn I feel lucky that I have good health insurance.
My sister Chris pointed out that if I obey my doctor, to promote maximum healing, then for the next six weeks I won't be able to do laundry, dishes, cut up steak, take out the trash, clean much, lift, carry or push anything requiring two hands. Family and friends can pitch in, but those folks are busy with their own business and I may be overwhelmed. I am going to need hands for these kinds of tasks between now and March.
Probably no paintball for a while, now that I think about it. Damn.
With access to my sister and her car, I scurried over to ngmoco:) to pick something up. It was great to see just a few people again; I really miss my colleagues there. Even just the few folks I saw, one or two reached for my shoulder, and one guy was able to give it a nice, friendly, gentle pat. I said, holy shit, if I'm going to go out and be the world and see people with my shoulder like this, I need to construct something that says "please don't touch this quadrant of my body" - maybe spikes. Maybe I need to buy some shoulder spikes on Haight street.
That night, Howard Rheingold came over to feed me dinner, help me organize my home, and he ended up making me a large "NO" badge that I have affixed to my left shoulder. It's fun to wear and I think people can piece together what I mean - please don't pat me or hug me there! It was a craft-blast to have Howard in my home putting that together.
To work, I wore drawstring pants and socks with sandals, because putting on clothes and shoes is hard with one arm, and painful if I twist myself around too much. It felt great to be able to dress myself, leave the house under my own power, and engage my old life some! Made me feel human again, instead of a drugged lump.
A week after surgery I'm still pretty acutely uncomfortable at times - standing up for more than 15 minutes makes my shoulder ache. Sleeping in a recliner is nice, because I can't sleep on my side accidentally, but it's getting old and I look forward to being a regular bed, being able to move around.
A Week After Surgery: Beginning to RecoverSaturday 18 February I took my first shower since surgery, with help from Ilyse, and wow what a fantastic experience. Being clean - babywipes for my body and baby powder in my hair can only do so much. My skin and my hair feel clear. Preparing for the shower, I saw the area around my surgery is quite a deep yellow - there's a ton of bruising around my left shoulder still and I think that's where a lot of my pain comes from. That and the open sores from the bandages. And the surgery opening itself, which is quietly scabbing underneath sutres and steri-strips and gauze and darkness.
San Francisco has asked me to dial in next week, in case I might be summoned for Jury Duty. Ilyse suggested I tell them I'm taking narcotics for a recent surgery and that might disqualify me. Can people on drugs still discharge their civic duty?
At ngmoco:) many people came by to chat with me about my arm. So many of them had stories about surgery or medical procedures in the past, ending with "and in spite of what my doctor told me, I did X thing early and I totally regret it. I feel pain to this day where the injury happened because I thought I could blow off the instructions." Many people - it was stunning, and a great reminder that the most important part of this journey is yet to begin, when I meet the physical therapist and begin learning how to exercise myself and expand my potential without blowing apart my delicate shoulder. Holding my left arm in my right arm, I can feel how diminished my left arm has already become!
Sunday 19 February I responded yes to Ilyse's invitation to climb out of my recliner and take a walk. We walked up to Buena Vista park early in the morning and looked over the city together. We walked to Magnolia on Haight for brunch, followed by grocery shopping at Haight Street Market, and then I popped a painkiller and walked Haight Street searching for velcro or slip-on shoes I liked (definitely can't tie my own shoes yet). Finding nothing to buy, I enjoyed the chance to be out, moving around. Later that day I joined some friends for a book club discussion, which involved another round of walking. It felt revelatory! To move around my neighborhood so much after being a sedentary person.
I moved slowly, I took a few painkillers, I didn't use my left arm - just my legs. Hurrah! And then, by the end of the day, pain shooting up my calves. Good pain - like I'd exercised them. It was astonishing. Before I hurt myself, I walked 3+ miles per day, I used a standing desk. I went from being on my feet most of my waking hours to laying flat in a recliner for two weeks. Now I can begin to march my way back to human motion.
Monday February 20 I was finally able to shower myself! I have a simple fabric sling, loaned by Ilyse, that I wear. It's fantastic to bring basic hygeine back into my life. I'm glad I won't smell too bad for my colleagues at ngmoco:) tomorrow.
March 5 - Halfway point
(As spoken into Dragon Dictation on the iPad:)
March 5 video demonstrating my physical therapy exercises and ending with a close-up of my scar. Filming by Ilyse Magy, published from iMovie on the iPhone (recliner-based production)
I made some important discoveries along the way, for example I learned that Justinshoulder.com belongs to an artist who in habits glittering mythic creatures.
I attended physical therapy for the first time on Monday February something. I was so excited for physical therapy finally a chance to learn how to use my body again. That weekend before my brother came to town and it was so much fun to see him I'm afraid I pushed myself too hard seeing movies, a double feature in two different theaters, the artist and safe house. Eating out and being social it took a toll on me and I was wiped out by the time I reached the physical therapist passed out in the waiting room even.
Turns out my physical therapy is six weeks of focus on range of motion- light exercises that involve no weight-bearing or real muscle used by my left arm rather using surfaces to stretch it out and extended and in sure that as I heal I have a wide range of motion.
Then if all goes well in early April the sling comes off and I begin strength training with the physical therapist for another six weeks
Even having my arm out of the sling and moving around felt really exciting and gave me some hope. But I didn't have very far to move before my shoulder complains. By the end of the day I was very sore and in spite of all my best intentions I decided to forgo my exercises for a day or two to recover.
Today was a new physical therapist named Bevin Daniels. She encouraged me to increase not decrease my exercises. As long as I was supporting my arm, then I was increasing my range of motion and the pain came from straining scar tissue and doing productive things. then she strongly encouraged me to ice afterwards. We we did a bunch of exercises and then she put a bunch of ice in a hand towel around my shoulder- 15 minutes my shoulder felt the best it's felt in like two weeks. I totally forgot to keep icing.
Bevin encouraged me to do three sets of exercises a day followed by ice. So that means putting aside 20 to 30 minutes at work. Which is probably a good way to stay healthy while ramping up on productivity.
A month after surgery, I am happily in less pain. But my stamina is greatly reduced. Also the doctor warned me: the antibiotics I took after the operation have given me weeks of diarrhea. So now that I don't use opiates painkillers very often, I frequent the toilets. Also, I just feel vulnerable in public. I am accustomed to moving very fast through crowds of people, running to reach trains, jaywalking, swiftly walking places. Now to keep warm in San Francisco winter, I wear a large hooded fuzzy blue coat, and I slowly lurch around. I would like to think that I am appreciating my diminished capacity for activity: a chance to focus on a few things, and enjoy a slow life. Times I do. But I miss kicking more ass and being able to engage my community at work, in the city, and online.
For example, the second week of March 2012 is the game developers conference in San Francisco. I have been a regular attendee for more than a decade: it is one of my favorite stimulating community events. A chance to mingle with people who love play. This year, I am capable of doing about jack shit at the GDC. I am just basically skipping the entire thing, even though, it is happening mere blocks away from me. Too tired to work and then go out - eager to merge with my recliner.
June 7 - Four Months OutThe stretching I did increased my range of motion enough that I don't need to worry about it much anymore. Now, and since about April, I've started lifting light weights. Today I'm happy to report I did a number of push-ups, off of a waist-high surface.
I can swing my arm all around, which strikes me as a miracle. Hallelujah - I can use my whole arm! It's a pleasure to swing my arms around, small or large circles, fast or slow.
In late May I hosted a Makeathon, a one day innovation event at ngmoco:). For weeks I worked across the company, and the day itself turned into a good chance for people to enjoy making things together. I was glad to make a contribution again at work after being a wounded zombie for a few weeks.
At the end of the day at my standing desk, I feel exhausted, ready to head home and relax.
August 15 - Six Months OutI saw Dr. Allen yesterday for a six month review. During that interval they switched to online patient records "APeX" Advancing Patient Excellence I believe. So I was able to snap a picture of my record up on the screen. Acromioclavicular Join Separation! I memorized it some so I could say it.
Doctor Allen appraised my strength with a few tests; could I hold my elbows at my sides whilst rotating my fists outwards against her pressing inwards? She tested my arms and pronounced me good! I had prepared a speech about how I hadn't been exercising enough. But I had done regular incline pushups (I used a railing at the tram stop, which was fun in a jacket and tie; a civilized pushup where I didn't have to reach the ground and I could still make the self-improving best of a wait for a train). In addition some heavy lifting of boxes and the like: living as exercise.
I am now allowed to Run, to Bike, to do regular Push Ups. I can go swing dancing!
I still can't do Aikido, swing from my arms, or do pull ups. Two-three more months; basically wait until November (from a February injury).
Maybe six weeks ago my brother and his wife mentioned that they were going to do a race called "Tough Mudder" which involves fire and barbed wire and splashing mid and hanging from monkey bars and being pulled by your arm up a steep sheer incline. The race is scheduled for September 29 - in a fit of excitement, I decided to make that race a target for my recovery! I signed up without thinking too hard about it, and Dr. Allen said no way when I saw her. Just the aggressive running where I might be put in a position of having to suddenly catch my weight, or fall on my shoulder - too much risk of bad news while I'm still rebuilding.
I can dig on that. At least I'll be able to ride a bike at Burning Man. I'll just have to remind myself to climb anything cautiously! or not at all.
27 February 2013 - one year after injuryOne year after injury, I am recovered. I can do pushups, even pullups. I feel a popping sound sometimes when I move my left shoulder in a specific way, but after years of RSI my right shoulder makes popping sounds too (probably soft tissue crepitus, my physical therapist said). So I am grateful to have my limbs back, and a bit wary of activities that might challenge my body-integrity. I resisted a chance to celebrate exactly a year since my injury with some snowboarding, for example. And now feeling healthy, I'm more inclined to Tai Chi rather than Aikido.