Browsing articles from "June, 2015"

Shoulder Surgery

Earlier this year I was out for my usual Saturday ride with a friend and a group of other riders. I was pushing it hard going into Nicasio, 30 miles outside of our start on the other side of the Golden Gate Bridge. My water bottle pops out. I can feel the loose gravel under my tires. My back tire flats. Then I feel it. I know I’m going down.

It was my fifth bike crash, but the first one that put me in the ER. Lying there, I was sure I just needed a few minutes and I’d be able to get up and back on the road. “I’m fine,” I said. “But how’s my bike?!”

Fast forward past the ambulance, the visit to the ER to fix my dislocated shoulder, weeks of physical therapy, and an MRI, and I’m ready to go in for shoulder surgery. I’ll find out afterwards that I had not just a torn labrum, but a severely torn biceps as well.

Training

To prepare for the race (aka surgery), I did eight weeks of what the PT called Pre-Hab. I treated it just like I did training for my Ironmans.

The two surgeons I saw in mid April both suggested I keep working on shoulder mobility for another four to six weeks before having surgery. At that time I couldn’t raise my arm above chest height without a ton of pain. One of the surgeons (who also happens to be the surgeon for the San Francisco Giants) gave me a cortisone shot. After that I felt like new. I was sleeping pretty well and my shoulder was improving dramatically as a result of the reduced pain and PT.

The night of the cortisone shot I was so tired I cried—I could feel the tension and pain leaving my body and the sheer physical exhaustion. I didn’t realize how much of a drag the shoulder pain was until the day after the cortisone shot. I woke up after a full night of sleep and thought, wow, this is amazing!

How I Got Here

I’ve hit a lot of patches of gravel, I’ve had a flat before, and I’ve been in multiple crashes, one just a few days before Ironman France that nearly took out my right shoulder. I attribute this one to a combination of lack of sleep, an extra stressful week at work, and pushing it too hard too early in the season, such that when I did hit the gravel and flat, I couldn’t hold on the way I have in previous wobbly situations.

I’m just glad there were no cars around or things could have been much worse. This crash reminded me a lot of the crash in France—I was tired, I was on a flat stretch of road, and like this one I lost traction—in France it was sand on the road. It’s that extra half second it takes to respond when tired that takes a crash from bad to really bad.

For several weeks after this crash I was in denial. I figured it was just a matter of time before things healed up. After the France crash it took about a month till I didn’t have to sleep with a water bottle or tennis ball behind my back. But after three weeks of this one, things were only marginally better. I went in to see my usual doc and he took some x-rays. He sent me to PT.

On the first visit, the PT, Don, told me it felt like I had torn labrum. If ever there was a candidate for an MRI he said, it was me. A few weeks later the doc ordered the MRI and it showed a ton of damage—some scraping of the bone and a tear. They didn’t find out about the biceps tear till I was in for the surgery.

Preparing My Transition (aka Post Surgery Recovery) Area

I prepared my post-surgery area like I would a triathlon transition. To put my mind at ease, I referred to it as transition. I laid out towels, food, water, pain killers and everything else I thought I would need. Although I had friends coming over to help me, I wanted to be fully prepped and as self-sufficient as possible. Just as with any race, I wanted to control the things I could control so I could focus my post-surgery effort on the unexpected.

 

There are a few items I bought ahead of time that I was especially glad I had:

* Squeeze jelly. The first week or two after the surgery opening a jar with a twist top is impossible. With Squeeze jelly you can flip open the top with one hand.

* Spreadable peanut butter. Unlike the usual peanut butter jars that again require two hands to open, this container opens with one hand. You can pop the top off. With these two items and a loaf of bread, frozen pancakes, or crackers, you can make a darn good full or half sandwich.

* Crackers

* Chicken soup. There is something about warm chicken soup that tastes great-and not just when you have a cold.

* Fig newtons. These are an easy way to get in some calories and something resembling fruit.

I also unscrewed all the tops on the pain killer bottles, since you need two hands to do that. (I bought an ice machine, but the hospital ended up sending me home with a different one. Glad I had it to practice with though.)

In addition to the recommended pain killers, I got some ibuprofin PM. I found during the previous few months that that helped when the shoulder pain was really bad. I dislike taking pain killers, and especially PM, but I found that it was better to get some sleep (even with the resulting hangover effect) than no sleep.

The Race (aka Surgery)

I scheduled my surgery for the Friday before Memorial Day weekend. I figured that would give me some time to recover. Some people at work joked that that was a classic entrepreneur move—to schedule a surgery so that I wouldn’t miss work!

Fortunately my surgery was scheduled for 7:30 in the morning. If you have a choice, I would definitely recommend an early surgery time.

It means that you wake up, go straight to the hospital, and you’re under before you know it. There’s no waiting around, no agonizing—and you don’t have to worry too much about hunger and thirst—you just need to get to the hospital, get checked in and be ready to go. Having your surgery first thing also means that in case things take longer than expected (as they did for me), you have the full day to work with. Plus, there are no shift changes in the middle of your surgery. At 7:30am everyone is coming in fresh, and they have seven or eight hours before the next shift change. If you have surgery late morning or in the afternoon, you may go to sleep with one crew and wake up with another.

I ate and drank right up until the midnight cutoff.

As promised, my friend Nagisa showed up promptly at 5:30am. I had the breakfast she’d requested laid out for her—croissants and orange juice. She was sleepy but happy. There is nothing like an on-time friend arrival on the day of a surgery.

The surgery itself is arthroscopic surgery. They make a few small incisions, stick a camera in your shoulder and go to work. It’s pretty amazing. You can see some photos from the operation below.

Apparel

For my race apparel, I wore Champion sweatpants that I had freshly ordered and a plain t-shirt. I brought my post-race surgery t-shirt with me. This is a shirt with velcro straps. You can pull it on from the bottom up and then velcro the sleeves and shoulders. It’s pretty handy for after surgery, and beats a pull over sweatshirt. The other option would be to cut open the side of a t-shirt, but I’m glad I ordered the surgery shirt, it worked great. As long as you get dressed sitting down, using one hand is something you can get used to fairly quickly. I feel exceptionally fortunate that my dislocated/torn shoulder was my non-dominant one. Had it been my dominant one, things would have been even more difficult.

Recovery

When I woke up from the anesthesia, I was already back in my recovery room. The sling was on and the ice machine pad was already attached to my shoulder, which was awesome. I don’t think I came out of the sling or the ice for at least 48 hours. So when they say wear a loose fitting shirt, they mean, really loose fitting. Also, sweats on the bottom are ideal. You really are one-handed, and just as with other apparel transitions like wetsuits and jerseys, you want them to be easy!

The biceps apparently took an extra hour or hour and a half or so to repair, so by the time I fully came to, it was around one in the afternoon. It took me about an hour to wake up and get dressed after that.

On the way home from the hospital Nagisa fortunately realized that we had forgotten the ice machine. We turned the Uber around and headed back to the hospital. She went up and got the ice machine and we were back on our way. Getting in the car was fairly easy—but every bump in the road was rough. Even though I was still on the nerve block and some pain killers from the surgery, the bumps really hurt.

I’ve read that other people’s nerve blocks caused them not to feel their arms at all after surgery. That was not the case with mine. I could feel my arm and wiggle my fingers. It took about 24 hours for the anesthesia and nerve block to fully wear off though. The entire left side of my body, from the side of my face down to my hand was numb until then.

When we arrived home, it was time for a shift change. Nagisa had been up for 12 hours and was exhausted. Surgery day was definitely more stressful and tiring for my friends than it was for me. I was out for most of it!

After that it was one friend and then another. I was finally able to get to sleep around 2 or 3am. I woke up the next morning around 8am feeling good but tired. It was around 2 or 3 in the afternoon that things took a turn for the worse. The anesthesia fully wore off then and despite taking the recommended pain killers, it was pretty rough going for the next 40 hours. A lot of that was because the pain killers made me feel really out of it.

Sunday was tough, basically just sitting on the couch, keeping up with the pain meds. By Monday morning, though, I was feeling good. Monday afternoon I managed to get dressed and make it over to Supercuts. I had them wash my hair before and after the haircut—and boy did that feel good. Between that and a clean shave I was feeling downright refreshed.

The ice machine worked wonders. I kept the ice flow going the entire weekend, with only a couple hours here and there when all the ice had dissolved.

I was back at work Tuesday morning. I ran out of energy around 3 or 4 in the afternoon. The next day was easier and by Thursday I was feeling good enough to work a full day.

The pre-hab really helped as well. I felt strong going into the surgery. I’m now coming up on five weeks post surgery and feeling strong.

Joining The Torn Shoulder Club

Throughout the pre-surgery and post-surgery process, people have been amazing. Friends have helped me with ice, taken me to the hospital and kept the jokes coming. I also felt like I’ve joined a club–the torn rotator cuff/labrum/biceps club. Walking around with the sling I’ve gotten tons of cool comments I never would have gotten had I not been in this bike crash.

“Dude, your labrum’s gonna heal,” a guy said as I was walking toward downtown San Francisco.
“Rotator cuff surgery?” asked a woman wearing a sling near the Farmer’s Market.

People tell me about their injuries, crashes, their kids and parents who have been through the same thing. It’s incredible.

Recommendations

To those of you having labrum or biceps surgery, here are a few things I learned / would recommend:

* Schedule your surgery early in the day if possible

* Setup your transition (post surgery recovery) area as much as possible before the surgery

* Try moving around your home with only your good arm free to see what you might want to put out for easy use. In my case, I put all the dishes and utensils I thought I would need on the kitchen counter. I took out a lot of rolls of toilet paper and paper towel for easy access.

* Get a shampoo and haircut afterwards. It’s an easy thing to do and it’s pretty hard to do anything the first three days after surgery. A little self-care like this goes a long way.

* Easy-open (non twist) peanut butter, squeezable jelly, crackers, and soup are all good things to have. I also bought a bunch of frozen meals and an electric can opener but didn’t end up using much of either.

* Definitely have a friend or family member who can help with the ice machine setup for the first couple weeks. I credit my fast recovery so far to a great surgeon and PT, but also to regular use of the ice machine. It really helps take away the pain and reduces the swelling, which in turn makes it easier to sleep.

* Instead of tying your shoes after you put them on, tie them beforehand and then just slip your feet into them. Or wear flip flops!

Equipment Comparisons

Ice Machines:

This is the ice machine I originally bought, the arctic ice system. The connectors aren’t as solid, the pad is smaller and it has a much lighter feel to it. I’d recommend the Kodiak. The Kodiak ice machine is the one the hospital sent me home with — industrial size pad and a solid feel to it.

  

Recliner:
I bought a Lafuma recliner to sleep in post surgery but found that sleeping on the couch with a foot stool worked great. After the first few days I was able to sleep in bed as long as I had a folded up towel under my arm to support it.

Slings:
The hospital sent me home with a Donjoy UltraSling II. Unlike the hard cast used for a broken bone, the sling is made of soft, flexible material. My friends joked that I should attach an iPhone to it and sell ads or at least let people tweet messages to appear on my sling.

I later ordered a Donjoy UltraSling III. This one is lighter and has better airflow, but is not as thick and protective as the UltraSling II.

Jun 21, 2015