Tuesday, October 14, 2014

38 Things to Expect When You’re Expecting Rotator Cuff Surgery

Nine weeks post-rotator cuff surgery, I’ve learned a few tips that I think would be helpful to pass on to those considering embarking on this challenging journey. This is obviously not my typical blog post, but I figure many of us know people facing or recovering from rotator cuff surgery.

Of course, everyone is different, but this post should apply to most. Be advised that I’m not a health care professional, nor do I pretend to be one; you should always defer to your doctor or physical therapist when in doubt. I've organized my advice into five categories: Pain Management, Self-Care, Healing, Practical Tips, Other Advice, and Supplies I Recommend.

PAIN MANAGEMENT

*Expect to feel no pain the first day or two. After that, you may want to have your doctor in your phone contacts list, as you may need to call for pain consultation at least a couple of times. I had to adjust my pain meds (types, doses, etc.) at least four times in the first ten days or so.

 *Expect pain, pain you may not be used to. Remember that it is temporary; you will get through it. You’ll hear this from other people, but it bears repeating: Do not wait until you’re in pain to take pain meds in those first couple of weeks, because pain is not a possibility; it’s a certainty. Stay ahead of the pain, because if you don’t, you’ll be sorry.

*Expect the possibility of nausea when taking narcotics. My doctor prescribed a nausea patch that I wore behind my ear for a few days after surgery (You have to take them off after three days.) I don’t know why, but it didn’t occur to anyone that I might start puking once I took that off. I spent an entire day throwing my guts up until I basically demanded another patch and got one. Newsflash, though: they take “about six hours” to kick in, so plan ahead. Keep a bucket handy, just in case.

*Expect the pain to migrate over the course of your recovery; it seems I never hurt in the same place from one day to the next, and it’s almost never been the surgical sites. You’ll have pain in other areas of your affected limb and the muscles that connect it to your neck and back. I’m not a medical person, so I can’t explain it, but the muscles that went unused for six weeks in the sling ached like crazy, at times. My bicep killed often, my wrist killed at times, and my left pectorals are the latest stressed-out muscles. I seriously thought I might be having a heart attack** yesterday, due to pain in my upper left chest, but my physical therapist assured me that that pain is simply due to my pectorals getting used to being needed again. (She was right.) The most uncomfortable part of my body affected has been my upper back, caused by hunching my shoulders to prevent my arm from hanging, I guess. Even while wearing the sling, I just naturally held my arm up, which caused muscle strain.

*Expect to have trouble sleeping. You may not want to take narcotics, but at least consider taking them at night, because rest is critical to healing. Stock up on pillows; I never slept in a lounge chair, but I did sleep with seven pillows for about a week--one on each side of me, one under my knees, and four to prop me up.

*Expect your bowels to lock up if you're taking narcotics; it's just unavoidable. For me, it didn’t matter how much water I drank or stool softeners I ate, I just couldn’t poop, at a one point. This is the TMI part of this post: I was thirteen when I watched the very-disturbing movie Sybil; the “enema scene” was seared into my mind, giving me a very negative disposition towards enemas. When my husband brought one home from the pharmacy on the fifth day of my colon's protest, I freaked out a little; there was no way I was going to risk schizophrenia! That said, desperate times call for desperate measures, and I’m happy to report that enemas have come a long way, and using a disposable enema is a pretty minor deal, especially compared to the alternative. (Oh, and as far as I know, I am not schizophrenic, so there’s that.)

*Extra-strength Tylenol will be your friend; buy stock. I am still taking it a few times per week, but for a while there, I was taking it round the clock.

*Afraid to take narcotics for fear of developing an addiction or dependence? Well, that's a conversation between you and your doctor. I'm not inclined to become an addict, but I was still nervous about that. I took them as long as I needed to and weaned off of them as soon as I could. Expect to possibly need them again after deciding that you don't; I did have to come back after a day or two of suffering at one point, but it was only a short time later (days) that I could wean off again. Again, everyone is different, and your doctor should know you well enough to advise you on this.

SELF CARE

*Expect to lose some privacy or dignity when it comes to caring for yourself in those early days. If you want to be able to pull up your own pants in the restroom, wear pants that do not need to be fastened or tied.

*Expect to need help in the shower in the first couple of days post-surgery, and if you don’t, feel fortunate. In hindsight, I didn’t really need to use the handheld shower that my husband installed for me; I didn’t find it that difficult to avoid the spray of the water on my shoulder, and I skipped showering for a day or two that first week.

*Expect to not shave your underarms for a while. Nobody will notice or care. I was able to cram my deodorant up there, at least. Hopefully, you will, too.

*Try to line someone up to stay with you for at least a couple of weeks; your healing will go more smoothly if you can rest and be waited on a little.

*Expect to be at the mercy of others, when it comes to your diet, for quite some time. Unless you are independently wealthy (can hire a chef or personal attendant) or willing to gain a lot of weight due to eating pizza delivery for months, I recommend putting some thought and planning into meals before your surgery date. For example, if you can, stock your freezer with plenty of prepared, portioned meals for you and/or your family. I was only able to start cooking again last week (My first salad was AMAZING!).

*You will not be able to push a grocery cart for a long time; I still can't. Plan on getting help for this, paying extra to have groceries delivered, riding in the little carts they have at most stores, or making very small purchases when you do go. Even when I did feel up to going alone (a few of weeks ago), I found it completely exhausting. (Thank goodness for neighbor kids who could come and help me unload and put them away!) Don't forget to stock up on pet food, too, if you don't buy it at your local grocery store.

*If you blow-dry or otherwise style your hair, expect to not be able to do that for a while. I tried that at the end of my seventh week, and although it didn't hurt much (It was just awkward and difficult due to stiffness.), I paid for it the entire rest of the day. (I'm going to try again this week, though, as I've gained a lot of mobility in the past couple of weeks.)

*Expect to need help; be willing to ask for and accept it. Don’t be a hero; it’s not necessary and isn’t good for you; you need to rest!

HEALING

*Expect to drink a lot of water if you hope to heal well; dried up, injured muscles hurt more than hydrated ones, or at least it feels that way to me.

*Expect to take two or three steps forward and one step back, sometimes, when it comes to feeling good.

*Expect that healing your shoulder to be a full-time job, your first priority; eat well, sleep as much as possible, and do what your doctor tells you. Everyone is different, of course, and the shape you were in before surgery will play a part in your healing speed, but if you have another job, expect to be out of work for a while, depending on a number of factors such as your healing rate (of course) but also the type of work you do. I am a teacher, and my doctor initially said I needed to be out for six weeks, but I went back at three weeks on “sedentary duty,” which basically approved me to sit and do nothing. I did a lot more than that, as my first week back was the week before school started, and it was exhausting. Expect to come home from work and crash, maybe even going to bed immediately in those first days. 

*Expect to heal better and faster if you can add therapeutic massage to your healing plans. I've been able to get three massages in the last couple of months, and the benefits each time were terrific. I gained significant mobility after the first massage; it was remarkable. The other two gave me wonderful relief from muscle tension. I highly recommend finding a way to get at least one massage during your recovery time. Look for a school of massage. they usually offer very reasonable prices for massages; look into it.

PRACTICAL TIPS

*Expect the cleanliness of your home to decline while you’re recovering, especially if you live with anyone else.

*Expect to get little accomplished in those first few weeks. If you have a to-do list, you’ll have to forget about it for at least a month or beyond, so get done what you can beforehand.

*Use an app, a notebook, or some other method of keeping track of the medications you take. It will help you dose carefully, especially in the early days. It will also serve as a reference the next time you have surgery (hopefully not for your rotator cuff). Who wants to go through that learning curve again? (not me!)

*Expect to wear a button-up shirt home from the hospital, but I also just wore a tank top; it was simple to put on. I had my surgery during the summer and pretty much lived in tank tops for a week or two, day and night. Here’s a video I made for how to put a real shirt on post-surgery.



*I'd read stuff about how to get your bra on at the hospital, but I was like, “Seriously? Who at a hospital gives a hoot whether you’re wearing a bra or not in the recovery room?” You’re going home wearing a layer or two on top; don’t bother wearing a bra, silly! (especially if you’re a man) [update: I also wore strapless bras and tube tops (for the first time in 30 years) for a while.]

*When you’re feeling well enough, expect to need assistive technology if your job or personal computer habits require typing. There are lots of voice-to-text apps out there. At the very least, I strongly recommend making sure your computer setup is ergonomically friendly. Your back muscles are going to spasm and be in extreme pain if you are wearing that sling and working in front of a computer screen for long periods of time at goofy angles. You will not be able to type much with two hands in the first few weeks, even with a laptop in your lap, because that screen height is simply not neck/back friendly. When I went back to work, I requested an external keyboard and a stand for my laptop so that I could type in my lap but look up and forward at my computer screen, thereby eliminating upper back strain. Those have been extremely beneficial.

*Expect to over-use your “good” arm. I carry a lot of stuff back and forth from work to home every day. The bags I used to carry with two arms still have to be transported, so I borrowed a wheeled bag/briefcase. However, my good arm is still doing double-duty, so I’ve started to develop tennis elbow. I started wearing one of those bands for tennis elbow on my good arm to avoid it being further stressed, and that has helped a lot. [Update 8/25/15 I think I overused my "good" shoulder; I am probably facing surgery on that one next summer :(]

*Expect to only dream about sleeping on your side for a very long time. Your stomach? Fagettabottit! Just last week, I started sleeping on my "good" side (all night) for the first time, with no pain meds--two firsts for me. I still wake up in the middle of the night almost nightly, but I've made a lot of progress. Of course, everyone is different; I’m just saying that if you’re a side sleeper, you’re going to need to set that dream aside for a while.

*Expect to get sick of wearing the sling; follow your doctor’s orders anyway.



*Expect to follow your doctor’s orders, not your friend’s doctor’s orders, and believe me; they are not all the same. For example, mine forbade NSAIDS for six weeks (He believes they impede healing and increase risk of bleeding.). My friend’s doc let her take Aleve right away.

*Expect to have little memory of the hospital post-surgery: Talk about post-op instructions before surgery, not after. It was two or three weeks after surgery before I noticed a little, black, squeeze-ball on our end table and asked my husband what it was. He told me it had come attached to my sling, but I had no clue what I was supposed to do with it. Upon calling my doctor’s office for something else, I learned that one of my post-op instructions was to squeeze that ball ten times per hour every day. (Had I known this, I wonder if I might have avoided the bicep pain that I had.)

*Expect to rely on your instincts when it comes to physical therapy; it’s normal to have pain, but I personally do not think you should be crying through your PT sessions. A friend suffered for six weeks and waited until her surgeon’s follow-up appointment to consult with him. Turns out a his typical (aggressive) therapy regimen was not appropriate for her, and they have backed off. She is feeling much better, and she’s no longer in tears at therapy. That said, rotator cuff surgery is major surgery; physical therapy is critical. Be sure to do your exercises at home, too, if you hope to have the best outcome. Do NOT expect excellent results if you do not follow your PT’s protocol.

*Expect to need transportation support for a minimum of three weeks. After that, you're going to be either a) very limited in mobility (still in a sling) and/or b) still taking pain meds that cause drowsiness, dizziness, and/or blurred vision: Should you really be driving?

OTHER ADVICE
*Expect better surgical outcomes if you go into surgery already strong and healthy.

*Expect to have less favorable recovery success if you waited til your shoulder was basically useless by the time you went in for the surgery.

*Expect to have good days and bad days; both come with the territory and (in my case) were usually related to medication.

*DO NOT DONATE BLOOD before your surgery! I went to my local blood drive the week before mine and casually mentioned the upcoming event during the screening process. The nurse told me that I could donate but that it would result in a lower blood count, even in the following week, and thus slower healing for me. (I declined.)

SUPPLIES I RECOMMEND KEEPING ON-HAND

*Ice--I recommend having at least four or five ice packs. I keep two at work. I use another one to ice my shoulder on the way to work.

*Biofreeze--What a great product! It’s not cheap (I paid $15 for one roll-on bottle.), but it’s worth it, for sure.
*Essential Oils--I like the quality of doTerra’s essential oils. I massaged Lavender into my shoulder and also inhaled it for pain when I wasn’t due for pain meds or was just trying to avoid them. It helped! doTerra also sells Deep Blue, which I’ve heard is like Biofreeze.
*Mederma PM Intensive Overnight Scar Cream--I used this on my scars as soon as the scabs were gone. Eight weeks out, you would be hard pressed to even find two of my four scars, one is almost completely gone, and the other looks great but has a little dent due to the surgeon’s work; no cream would fix that. Still, everyone who sees my shoulder is blown away by how great it looks; I’ll definitely be comfortable wearing sleeveless shirts next summer. Many people say that much-cheaper Vitamin E cream has the same result.
*To alleviate pain/muscle tension, I highly recommend buying
The Original Backnobber which costs about $35 and is worth its weight in gold. I also had a foam roller already, but that did not provide relief to me. I also recommend a tennis ball; I keep one in my car to push my back against when I don’t have my backnobber handy. Here's my amusing video on the Backnobber (with dog commentary), which I made at least a year before my back surgery, so it's great to have any time!


*Extra-Strength Tylenol--Get two bottles, as you will definitely go through at least one in the course of your recovery. Extra-Strength Tylenol does not have anti-inflammatory ingredients and was therefore allowed by my doctor when I wasn't taking Vicodin (which contains Tylenol) Be sure to read labels and follow your pharmacist’s instructions! If you’re lucky, your experience will be even better than mine. In fact, I hope this post helps that happen for you! Although I’ve told you to expect many things, some of them may not be relevant to you in the end. If that’s the case, consider yourself blessed.

Got other advice? Feel free to share it via the comment form below.


Update [11/2/14] Expect to go from feeling amazing to feeling pain when weather patterns shift; one day I was taking my yoga clothes back out of storage, and the next I was worried that I'd re-injured my shoulder! My doc said it's most likely the weather. I sure hope so!!

Update 9/11/15 My shoulder is about 97% back to normal. I am weight training daily and doing yoga and pushups with ease! The only difference I notice is that it's still pretty tight/sore when I try to reach between my shoulder blades, so when I have an itch, I just use a ruler! :) I feel really lucky, but it's also because I worked really hard at therapy. Good luck to you!

**Do not ignore symptoms of a heart attack! Even if you’re feeling paranoid, call your doctor if you’re concerned.

Factors Associated with Successful Recovery Following Rotator Cuff Repair is an article I recommend and used for part of this post.

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