On shoulder surgery

I recently had shoulder surgery, and found the experience and its effects quite a bit different than I’d expected.  I’ve therefore decided to share my thoughts about these experiences and provide advice to anyone facing a similar procedure.  Unlike my usual blog postings, which are generally intended (with varying results) to amuse, this posting is intended to be informative, and perhaps even didactic.  I’m going to tell you the things I wish I’d known ahead of time, along with a few things I knew but didn’t really take to heart.  It might not be humorous, but it might be useful.

I must begin with an important list of caveats: there are many reasons to have shoulder surgery; there are many different procedures that your surgeon might choose to perform; and there are many possible outcomes and followup treatments.  I am in no position to offer any medical advice about what might be best for you.  If my advice differs from that of your surgeon, physician, physical therapist, or other medical professional, you should probably take their advice — they’ve probably done this dozens or hundreds of times, and I’m in the middle of doing it for my first time.  Similarly, if your experiences differ from mine, the differences are most likely to be explained by the differences in procedures and ordinary variability in outcomes, and you shouldn’t interpret it to mean that something went wrong with your surgery.  Your mileage may vary, as they say.

If you think there’s anything missing or incorrect about my advice, please let me know!  You can email me at dannyo@public-spectacle.com.  (You can also leave a comment below, but with all the procedures I need to use to keep the spammers from overrunning this site, it’s a bit cumbersome for non-spammers to register and leave comments…)

You can’t do this alone

The most important thing you can do to prepare for shoulder surgery is find someone, or a rotating team of people, to take care of you for at least a few days, if not longer.  You will be quite helpless for a few days after the surgery, and somewhat helpless for perhaps several additional weeks.  You will need someone to help with all sorts of things — things that require using two hands, or flexing your shoulders in certain ways.  The list of such things is much longer than most people will guess.  You don’t require 24/7 attention, but there are simple things that you will not be able to do for yourself, at least not in the usual way.

  • Dressing/undressing yourself.  See notes below about clothing.
  • Cooking/cleaning up after meals.
  • Shaving, bathing (particularly toweling off afterward).
  • Laundry.
  • Driving.

You’ll be surprised, amazed, and dismayed at how many activities you think of as requiring one hand actually require two.  That other hand might be doing something simple — like holding something you’re trying to cut — but essential.

If you live in an area that gets snow, you’re going to have to find someone to shovel the snow for you — hire someone, if necessary.  It would not be wise to attempt any shoveling or attempting to wrestle with a  snowblower any time soon.

Even if you’re a total masochist, and hate to rely on anyone, there’s no way you’re going to get the bandages off by yourself.

Don’t (always) think for yourself

In addition to the errands your helper(s) will going to run for you (picking up prescriptions and groceries, etc), you also might need someone to help you think and remember things.  When you get out of your surgery, the surgeon will probably tell you all sorts of interesting and useful things about how it went and what to expect, not properly taking into account that you’re still dopey from all the anesthetic and won’t remember more than 10% of the conversation in an hour.  Then he or she will schedule a follow-up appointment or two with you, and give you an appointment card, which within two hours you will forget ever existed.  You need someone whose brain is fully functional to make note of any special instructions that the surgeon gives you, and makes sure that followup appointments get on your calendar, etc.  You’re asking for trouble if you expect to have your wits about you until the fog of anesthesia has completely lifted…  and after it does, you might be sleep-deprived for a while, which isn’t much better.  It’s a good idea to have a brain-buddy to keep track of things.  It’s a good idea to have someone go to the follow up appointments with you and take notes.

I’m going to repeat that for good measure — you are going to be sleep-deprived.  You will forget things, and you may make bad decisions.  Another person can help.

Networking

I didn’t tell a lot of people about my surgery ahead of time, and before I had shoulder surgery, I didn’t know many people who had had a similar procedure.  After I had the surgery, and it became impossible to hide that I’d had the surgery done, it seemed like people who had advice about shoulder surgery, either first-hand or from someone close to them, were everywhere.

If you tell people that you’re going to get this surgery done before you have it done, you’ll probably find yourself with lots of good advice that I never got.

Wear loose-fitting clothing

In the day-of-your-surgery instructions, it said to bring a loose-fitting shirt of some kind to wear after the surgery.  This is more important than you might think, and requires some prep.  I think it’s perfectly reasonable to acquire a new shirt for this specific purpose; a shirt that you might never wear again but will be happy to have for the few days you need it.

If you’re anything like me (tall, broad shoulders, and more than a little bit roly-poly) then the idea of a loose-fitting shirt may seem strange, so you might have to order something from big-and-tall shop or an athletic supplier — maybe one of those shirts that football players wear over their pads, perhaps.  For people who are of more ordinary dimensions, a shirt one or two sizes larger than normal is probably adequate, but don’t skimp.

If your procedure is like mine, here’s what’s going to happen to the shirt: after the procedure, they’re going to put an enormous bandage on your shoulder, and your shirt is going to need extra space in the shoulder and arm area to fit over this bandage, and getting the shirt arm is going to take some extra maneuvering room because your arm is going to be completely immobile.  Then you’re going to wear the shirt for the next few days, because it’s too much effort to take it off, and in the meanwhile your arm and shoulder are going to swell up quite a bit.

Long story short, I wore my largest, loosest-fitting shirt, and after two days I was seriously considering cutting it off my arm with scissors because it was uncomfortably tight and I believed it was beginning to cut off the circulation to my forearm.

I recommend a zip-up or quarter-zip hoodsie.  Or maybe a large bathrobe.

More loose-fitting clothing

Sweatpants or other pants with an elastic waist are a good idea for the time when you’re lounging around the house.  The benefit is that you can dress yourself (and use the toilet) without assistance.  Perhaps this is specific to my shoulder injury, but the motions of fastening buttons on my pants (or zipping my fly) and tightening my belt were just impossible.

More on clothing

Although most people I’ve heard from about shoulder surgery have been men, it’s not unheard of for women to get shoulder injuries as well, and women have an additional issue that men do not: bras.  If you normally wear a bra, you’re not going to be able to wear it after a serious shoulder injury and/or surgery, and figuring out how to unhook it when you do wear one might present new challenges — a front clasp might help.  I don’t have any concrete advice about how to deal with this, but if you’re a woman you probably have an idea or two.

A comfy reclining chair

One of the most difficult things for me to do after my surgery was sleep, despite the fact that it’s the thing I wanted to do more than anything else.  It’s difficult to find a comfortable position, and even more difficult to get into that position, because hard to get into bed or move around in bed without using your shoulder.

I do not have a recliner, but what I’ve heard is that they’re the best approach — especially the ones with the electric motors that raise and lower the chair.  You probably want to have pillows and blankets of various sizes to help hold your body in the right position — whatever is comfortable.

If you don’t have a recliner, at least try to sleep on a reasonably stiff mattress.  If you have one of those memory foam things, remove it for a few weeks.  I find that the softer the mattress, the more difficult it is to roll over and to sit up, because I sink in to it.  You’ll have a hard enough time moving around to begin with, and if you’re fighting to get out of a hole you’ve sunk down into, you might find it almost impossible.

Your experiences may vary — they almost certainly will.  The important thing is to find a way to get comfortable, which may require some inventiveness.  I recommend having a lot of pillows of various firmness and sizes available so you can construct whatever sort of support you need.

My physical therapist has told me several times that the first person to figure out the ideal way for people to sleep after shoulder surgery will be richer than the dreams of avarice.  I understand why.

A nightstand

Because getting up is going to be challenging for the first few days, you are going to want to have a few things closer at hand than usual:  tissues, reading glasses, books, e-reader, something to drink, telephone, snacks, medications, etc.

Some of the medications you might be prescribed should not be taken on an empty stomach, so it’s good to have them at hand, even if you wouldn’t ordinarily dream of eating in bed.

Household prep

Put new batteries in the TV remote.  You’re not going to be able to do this one-handed.

Vacuum.  Clean up.  This might be your last chance for a while.

One reader suggests getting a block of foam and cutting out slots for your smartphones, tablets, and other gadgets.  The idea is that this will make it easier to deal with these one-handed: put the gadget into the slot, and then it’s held steady and immobile so you can insert the power cable much more easily.

Pain management

Pain management is one of the things that is most likely to vary from person to person, from what I’ve been told.

The pain wasn’t horrible for me.  Annoying, but not agonizing.  It was enough to keep me from sleeping well, however, and it’s unhealthy when things interfere with your sleep over long periods of time.

I was given a prescription for hydrocodone, which didn’t seem to do anything to dull the pain.  (I suppose I could have tried a higher dosage, but at the recommended levels it didn’t seem to have any effect.)  I’ve heard that this is not unusual.  Pain killers are good for certain kinds of pain, but “bone pain” (if there is such a thing) isn’t one of them.  Fortunately, ordinary over-the-counter ibuprofen seems to help, and even-more-ordinary ice packs help even more.

Don’t get addicted to painkillers.  Those opioids will literally kill you.  Use what you need, but having a prescription for painkillers is not an excuse to get recreational with them.  As you’re reading this, you’re probably thinking to yourself “of course I’m not going to do anything as totally fucking stupid as that” and you’re probably right.  But after two weeks of not being able to sleep for more than a few minutes at a time, you may see things differently.  That is when people start to do totally fucking stupid things.

Ice bags

If your fridge doesn’t have an ice-maker, figure out some other way to stock up on ice.  Consider getting a special-purpose ice pack for your shoulder.  Start icing as soon as you get the big bandage off.

Entertainment

It’s good to have something to pass the time after your surgery.  Books are good, but only if you can do them one-handed.  I find an old-fashioned Kindle to work well (the kind with the button to flip the page, instead of the swiping motion).  Having some sort of or lap-desk thing might help.  (Some people are comfortable holding a book in one hand and turning the pages with a thumb, but if I do this for more than a few hours it provokes tendonitis, and more joint problems are something I just don’t need.)

Save something to binge-watch on Netflix or whatever streaming video service you like.  Something brainless.  Laughter is the best medicine; Archer got me through some tough hours, but again your mileage may vary.

After the surgery

Chances are good that you’ll be intubated during the surgery.  In simple terms, they’re going to snake a tube down your throat to make sure you can breath.  The problem is that in some cases, when they snake the tube down your throat, it requires a little force, leaving small scratches, which feels like a sore throat and can cause you to cough up small amounts of blood.  (This is the sort of thing you should definitely call your surgeon about, if you experience it, but it’s not uncommon and you shouldn’t panic immediately.)

You want to take this into consideration when figuring out what to eat for your first few meals after the surgery.

Don’t be an idiot like me and eat a handful of tortilla chips the minute you get home from the hospital.  You might regret this very much.

Move

Stop using the sling as soon as you can.  You’re not trying to get exercise yet, but you want to start moving the shoulder a little bit.  Don’t let it get frozen.  Keep it loose.

Of course, if your surgeon gives you a shoulder brace or immobilizer, then that’s a different story.  Do whatever your surgeon says; mine said to lose the sling as quickly as possible.

Don’t throw away the sling, however.  Bring it everywhere you go.  It’s very handy when you’re interacting with people who ordinarily want you to hold doors open for them, or shake hands, or pass them something, or otherwise expect you to do something with your shoulder that you’re just not ready to do.  Nobody is going to give you a welcome-back-from-your-surgery hug when you’re wearing a sling, but if you’re not wearing a sling and your arm is just hanging down at your side, then your injury is, for all practical purposes, invisible.  A sling is a convenient way to let people know that you’re not yourself yet.

Body glide

My arm swelled up to the point where the skin in my armpit was rubbed raw, because there was so much pressure on it when I moved my arm.  This just added to my misery.  Blisters on your pectorals from your biceps rubbing against them is even less fun than it sounds.

There is a product called “Body Glide”, which is probably available at your local pharmacy or market, that helps with this.  It’s meant for runners or other athletes who have problems with body parts rubbing together on long runs or whatever; there are probably similar products with other names, but this is the one I used.  It was very handy for a few weeks while the swelling abated.

Do the physical therapy

You’re going to ask yourself questions like “Does it really matter whether I do shoulder rolls six times a day or seven?” or “Why should I swing my arm back and forth every two hours?  It doesn’t seem to do a thing.”

Do them anyway.  Just do them.  It might seem like nothing is happening, but it is.  The progress might be so slow that it doesn’t seem like progress at all, and some days are going to be worse than the day before, but in a month or two you’ll find yourself doing things that seemed impossible just a few weeks earlier — first it will be small things like scratching your own ear, or putting on deodorant, but soon it will be major things.  Before you know it, you will stop thinking about your shoulder all the time and start using your arm and hand without wincing in anticipation.

Recovery is the hardest part.  The surgery is the simple part; you slept through it.  Keeping with the program of exercises and stretches and whatever else your physical therapist specifies is the hard part.  Keep with it.

 

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