Wednesday, July 9, 2014

Rotator cuff repair - a patient's perspective on what to consider before and after surgery

This week I received this note from a patient over one year after the open rotator cuff repair performed without acromioplasty.

“You were in my thoughts today as I was swimming laps. Thank you, so very much, for repairing my shoulder and giving me back the simple pleasure of a good nights' sleep and being able to swim pain free.”

I asked the patient if she’d be willing to send me some of the lessons she learned about cuff surgery from the perspective of the patient. Here’s what she sent verbatim.

Rotator Cuff Surgery – Patients Lessons Learned

Before Surgery:
Don’t ask your doctor to drive because they have to say no if you are on pain drugs. If you ignore the warning and drive under the influence, you might want to have a good attorney lined up before surgery.
Transportation – explore public transit. Request a temporary Paratransit pass if there is no local public transportation. It may take a couple months to obtain the pass or to become knowledgeable with the public transportation system. Its fun to explore the system while you are recovering (be positive – it’s an adventure and better than watching TV).
Training – hit the gym and/or PT to strengthen your upper body and core because you will not have the use of your surgical side. That means the other shoulder will be getting a lot of use. The last thing you need is to damage the good side with over exertion.
Beds – you will want to sleep upright because laying down means your shoulder is touching the bed and it hurts. Some people sleep in chairs while others use a mountain of pillows in bed ….ALONE. This means you need to reassign beds so that you can sleep alone. (see pet care)
If the surgical side is your writing hand, then start figuring out what you need to do to complete the task when you cannot write. This may mean paying forward on bills or setting up online payments and getting written tasks completed early.
Practice being one handed for the month prior to surgery (use the non-surgery side and no cheating). Every time you find yourself needing to use the other hand, stop and figure out how you will do that task after surgery when you cannot use the surgical side.
Shower set up – Can you reach the soap and shampoo? Can you dispense the product with one hand? Pump bottles on the shower floor were easier than on the rack. Long handled shower brushes help in reaching back areas.
Replace large bath sheets with a stack of small hand towels (easier to control one handed).
Longer shower time – particularly if you have long hair – may result in changing your daily schedule. Plan on draining the hot water tank.
Figure out how to deal with long hair. Be sure to teach your partner how to tie a pony tail before surgery. Who would have known that doubling an elastic on a ponytail is like a rubrics cube puzzle to some men?
Pedicures/Manicures – both sexes. Dealing with nail hygiene is best done by someone else until you regain the ability to do it yourself.
Bathroom habits. Awkward to difficult, more so for women. Baby wipes are a good thing. Changing toilet paper rolls provides entertainment.
Dental habits: Awkward at first. Stock up on the dental floss sticks that facilitate one handed flossing.
Medicine bottles cannot be opened one handed, so ask your pharmacist to provide easy open tops instead of child proof tops. If you have young children or animals, keep the meds out of reach (may require re-arranging cabinets).
Cortisone cream – have a tube handy because the pain narcotics can cause itching.
Bandages/Plastic Wrap/Packing Tape – Get lots of big (3x5 or larger) bandages to cover the wound and return any boxes that are not used. Plastic Wrap and Packing Tape is used for post surgical showers for two weeks.
Shoes - Slip on shoes are the “it” thing until the pain subsides. Eventually you will be able to dangle and tie by pulling the laces with the non-surgical side to avoid loading the surgical repair.
Forget bras until the pain subsides. Strapless bras work but be sure to teach your partner how to fasten them (yeah, it’s different than undoing them – it takes much longer and may require the use of glasses). Slip on sports bras are out for months. If you are alone, you can fasten the bra before stepping into it and pulling it up one handed (maybe but not likely if you are petite). Don’t do anything that could cause a fall.
Shirts – nothing tight can be worn because you cannot squirm into it with rotator cuff surgery. And even if you can get it on via dangling and perseverance, you will end up cutting it off. Remember you will not be wearing a bra, so nothing too thin or revealing. By now, women are beginning to realize that guys are getting a much easier deal with rotator cuff surgery. The surgical site is sensitive so find soft clothing. Half zip shirts seemed to work well. Buttons are a nuisance and cause delays.
Forget anything with zippers for the first six weeks. The last thing you need is to be dancing in a toilet cubicle with your legs crossed, carrying a pillow under your surgical arm and fighting with a stuck zipper.
Cool weather and rain demand additional layers. Nothing too bulky will fit into the sling, so plan for something thin while providing warmth and waterproof. Forget umbrellas.
Prepare two months of food for the freezer – soups, casseroles, etc. Individual servings are easiest. Freeze pizza slices. Make hamburger patties and freeze on a sheet before placing into zippered storage bags.
Pop top cans can be managed by placing in a drawer, held shut with a hip to hold the can, and then the good hand can remove the top. Can openers are out, electric can openers are good.
Kitchen equipment – Le Crueset cast iron dutch ovens require two hands (trust me). Suggest purchasing some inexpensive handled pots until you have the use of two hands. Draining food (potatoes, pasta, etc) requires a strainer in the sink. Slicing and dicing requires impossibly sharp knives (some grocery stores do knife sharpening for free – ask at the meat counter). A Cuisinart is very helpful for one handed food preparation. Otherwise, purchase pre-sliced vegetables. A milk pitcher is a necessary luxury unless you can one arm a gallon milk jug. Move dishes to easy access shelves. Straws are useful even to drink hot beverages because they allow for one handed multi-tasking.
Microwave. You no longer have two hands to hold hot items. Be sure to practice one handed use beforehand!
Phones – a phone with speaker is useful because it allows for one handed multitasking.
Flashlights - replacing batteries one handed in the dark is tough. Suggest taking care of it (flashlights, smoke detectors, remote controls, etc) before you have surgery.
Laundry – stock up on detergent with easy pour lids and not too big a bottle since its one handed. Laundry baskets that can withstand being punter kicked through the house (you aren’t to be lifting or bumping that shoulder).
Making beds – nearly impossible but preferably this task will be done by someone else.
Washing floors & Scrubbing Tubs & Vacuuming – can be done while doing your dangling exercise provided you don’t move your dangling arm. Preferably done by someone else (forever). Be careful not to trip, slip or get knocked.
Pet Care –
Take care of planned vet visits before surgery (well checks, dental, shots, etc). Be sure to get a supply of routine medical stuff like ear cleaning solution, pain med, etc to avoid making trips to the vet when you are not able to drive much less manage a sick animal.
Care – how do you plan on exercising your energetic best friend while in pain and one handed? This one takes a bit of planning and time, so start the minute you know that you need surgery. Hunting collars [] are a great tool for leash free walks! Strongly recommend working with a dog trainer on the proper use of hunting collars though because incorrect usage is cruel. Find places to walk that are free of trip hazards and other uncontrolled dogs. The last thing you need is to have a large dog jump on you.
Food – stock up for two months. Pop top cans are best. How will you lift a 30 lb bag of dog food for the next eight months?
Sleeping arrangements – your best friend knows something hurts and will want to provide comfort (particularly when you are awake all night in pain). Trust me on this – having a 50 lb dog leaping into your lap or onto the bed is NOT a good thing according to the neighborhood that was awoken from their sleep. Figure this out before surgery!

After Surgery
Driving – your doctor has told you not to drive for several reasons. It’s illegal if you are taking pain meds. Your shoulder will atrophy before or beginning at surgery. That means the strong muscles are not able to protect your repaired shoulder and it becomes progressively easier to damage the repair and further damage your shoulder because the muscles are not there to protect it. A damaged repair may not be able to be repaired again and who wants to go through the pain, suffering and frustration twice???
Pain – you will have pain but it varies in intensity with every patient. Plan on not sleeping the first few nights and stay on top of your pain meds.
Have some movies and books handy. A single handle basket with phone, books, Kleenex, water bottle, snacks, etc is handy to easily take everything you need as you move about the house.
Sling/Immobilizer – is awkward but necessary to protect your shoulder. Every bump in the road will be felt. Be prepared to have people want to provide well wishes by patting you on the shoulder and giving hugs – shoulder surgery is a full contact sport and its very painful. The sling/immobilizer will become your friend when you are dealing with the public. Turn away from oncoming hugs!
Resuming Sex? – Not early in the healing. No easy answer on this full contact sport. It’s a long time though… a long, lonely time.
Gym – get back to the gym as soon as you are off pain meds to ride the spin bike, and walk on the treadmill. Do the shoulder dangles prescribed by the PT. Work out a training plan with your physician and PT to avoid re-injuring your shoulder while maintaining your mental and physical conditioning.
Gardening – Nothing bigger than one handed light weeding while sitting using small hand tools. No heavy lifting. Do not trip. No falling.
Painting – actually not a bad activity once the pain leaves and there is no chance of falling/bumping or otherwise disturbing the repaired shoulder.
Salads – it’s almost impossible to toss a good salad one handed.
Eating out – if its one handed on your weak side, be prepared for messy eating. My dog is gaining weight by just following me around the house.
Frustration – rotator cuff surgery is 90% mental toughness. Be prepared to have frustration meltdowns because the healing time is so long and painful. Tell your friends, family and physician if you are frustrated or overly emotional – don’t feel the need to tough it out alone. You are grieving the loss of your independence.
You will learn to ask for help from strangers and it’s an opportunity to meet some really nice people that you might have otherwise not met.
Hope – know things will get better and take one day at a time. It takes about a year to feel normal.

Consultation for those who live a distance away from Seattle.

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