The Arm: Two Years On

December 10, 2012 was the morning I took a hard fall onto a harder sidewalk at work, badly breaking the upper arm bone and messing up a lot of the shoulder, and ending up with an artificial joint and lasting after-effects. I've written about the accident and the recovery (such as it's been) over a series of posts.

So how I'm doing, two years later?

I had an exam and evaluation by an independent (i.e., picked by Workman's Comp) orthopedic surgeon several months ago, and got the results about a month ago. I've been put into a "stable without full recovery" status, which lets WC put my case into an Inactive category, and the doctor rated my right arm as 40% disabled.

That sounds about right. The range of motion, the strength, and the stamina of that arm are all compromised significantly, and look to be for the rest of my life. The good news is that the pain, so long as I remember to take my aspirin/tylenol tablets regularly, is (most of the time) down to a mild ache.

Besides the actual physical limitations of that arm, I find myself continually annoyed by a sense of trepidation in using it. If I want to do something that requires use at the outside of the arm's new parameters, I find myself hesitating and asking myself: Will I be able to do this? Will I need to ask for help? Will it hurt? How much will it hurt? How long will it hurt afterwards?

Annoyance and frustration on an every-damned-day basis. The possibility's been raised of doing a revision of the joint replacement, replacing the standard-model arthroscopy with a "reverse-shoulder arthroscopy". But there's no guarantee of improvement, and a possibility the new joint would be less useful and more painful.  I can continue to live with the current status quo, even if I'm not pleased about it.

I'm fortunate in that I'm still able to perform my current job's work tasks within those new limitations. If I was still working my old job as a letter carrier, involving reaching and stretching and lifting that arm thousands of times per day, I would be completely screwed; for that job, the disability would be 100%.

So that's where I'm at, and where I'll probably be for the foreseeable future.

(Hmmph, this sure is a grumpy post to make a few days before Christmas.)

Anniversary (Informal)

Hilde and I have both our wedding anniversary later this year and a more informal anniversary we celebrate on May 21st.

On this day in 1976, I was driving Hilde to the local SF club's meeting, and in the course of conversation on that drive... it came out that both of us had been thinking "What if?" about the other for the previous few months.

Welp, that sure changed the course of my life.  For the better. Definitely for the better.  I never expected to have joy in my life, and I've had thirty-eight years with someone who can give me that joy.  Not continuously, -- there have been uncomfortable moments in those years, but they never lasted -- but joy was something I never expected to have at all.

(I was talking to Hilde earlier today, and said, "I probably would have done okay if I'd ended up as a solitary unmarried bachelor. Except for the being lonely and miserable all the time part.") 

So thank you, Hilde, for all the past years and the ones to come.  You are the love of my life.

Remembering Al's

(This originally appeared as a comment on a Jo Walton post at tor.com.)


Back in my teens, when I was first really getting into science fiction, the go-to used bookstore in Phoenix, AZ, was Al's Used Books. Al's was in a shabby building in a bad part of town with bad parking. But it was a big storefront; where the average used-book bookstore held maybe 10,000 or so books, Al's held 300,000. The space inside, except for narrow aisles, was completely filled with bookcases, tables, and floor-to-high-ceiling shelves on the walls. There were scattered fluorescent lights on the ceiling, but most illumination came from the big windows at the front of the store. The floors were bare concrete, no tile or carpet. If you'd asked for a cup of coffee there, they would have called the police to report the lunatic that had wandered into the store.

If you were looking for a specific title, Al's wasn't where you wanted to go. The proprietors sorted books by genre and that was it; books to be shelved were shoved into the closest available space in that genre section. When you went book-hunting at Al's, you hunted.

But for someone still fairly new to SF, looking thru those shelves and shelves and shelves of science-fiction paperbacks (hardcovers were a fairly small minority of the available selection) was kind of wonderful. Because you could go into Al's with two or three titles in mind to look for, and by the time you staggered up to the cash register several hours later you'd have made a couple of dozen serendipitous discoveries you hadn't known you wanted.

(This was in the late 60's/early 70's, long enough ago that you could eventually see almost every paperback since the start of paperback publishing a few decades earlier pass thru Al's. If not on one trip, then possibly on the next few trips there.)

I eventually got out of the (inconvenient) habit of going to Al's, shifting to newer and newer books as I got older. But I still held fond memories of the many books I'd discovered there. So it was still a shock when, sometime in the 80's, I happened to be back in that bad neighborhood on other business... and saw the storefront where Al's had been was now selling used appliances instead of used books. (Part of that shock was because I wasn't the only local SF fan who'd been a regular customer of Al's, and I would kind of have expected to hear of Al's closing a lot earlier.)

Not Al's, but this looks a lot like
the shopping-at-Al's experience.

My Year In 2013

And why not add my own gobbet of spit to the year's-end tsunami of "Best of" lists and retrospectives for 2013?

2013, the Good, the Bad, and the Ugly:

Start with the Bad:  The biggie for the year was recovering, such as it was, from the bad arm break and shoulder injury from December 2012.  I wrote a series of posts throughout the year (see all the "The Arm" posts here) detailing the various ups and downs on that front.  At year's end, I still have trouble and pain from that shoulder; if I don't remember to take a couple of hefty aspirin/Tylenol tablets several times a day, I notice.  Oh, how I notice.  (A small pillbox is now an obligatory part of my pants-pocket inventory, along with wallet and car keys.) 

Range of motion and strength for the arm are still significantly compromised.   I figure I can still do about 80% of what I used to without more than mild discomfort, then about another 10% involving stronger reaching and grabbing and lifting that I can do but have to work thru discomfort/pain to do so.  And then the last 10% beyond that, which the arm just plain Don't Do Dat Shit No More.

It is what it is.  I deal with it.  But sometimes I deal with it by feeling broken and fragile and old.

Which leads into the Ugly:  In 2013 I got yet another year older.   This happens every damn year.  What is up with that shit?  In a sensible universe, you'd be able to skip that whole aging schtick once in a while.  Somewhere, there's got to be a button you can click for a drop-down menu that includes "Stop Aging" or even "Get Younger" options.  I'm getting a little tired of looking in the mirror to see some grumpy-looking old guy with a receding hairline and advancing wrinklage looking back.

But, hey, let's end this post with something a little more upbeat, the Good:  2013 was the year when I started writing and marketing fiction again on a moderately regular basis, after falling out of the practice back around 2006.  Ironically, it was in large part because of the broken arm and subsequently being off work for months that I started up again.  I've found myself enjoying the process again, enough that I've tried to continue writing even since going back to work at the end of July.

Concurrent with starting to write fiction again, I seemed to enjoy reading more this last year.  I've delved into the explosion of self/indie-published books that have come out the past few years.  That experience has been mixed.  I've found a few gems, some pretty decent books, but also a large proportion of books that should have been worked over and rewritten more before publishing, and *sigh* a few that just made me cringe.

(The self-published work I enjoyed most this past year was THE DIRTY PARTS OF THE BIBLE by Sam Torode, a picaresque bildungsroman set in 1930's Hobo America with a slight supernatural element.  My own review here.)

Among works from traditional publishers, I found myself reading ebook versions, or listening to audiobooks, more than printed hardcovers or paperbacks.  Primarily this is because I have my smartphone within easy reach on my belt almost every waking moment; with several reading apps installed on the phone, I have access to a choice of books -- there are about 50-60 books downloaded to the phone at the moment, plus I can borrow library ebooks and audiobooks via the Overdrive app --  without having to carry around an additional bulkier object to read during free moments.  Convenience trumps physicality.

My favorite traditionally-published books this year was an older one from 2001, Pat Murphy's ADVENTURES IN TIME AND SPACE WITH MAX MERRIWELL.  It was fun to read.  This 2010 review by Tansy Rayner Roberts says pretty much everything I'd say in a review of my own.

And so ends 2013.

 

 

(I've mentioned it before, but Tatsuya Ishida's SINFEST
is one of my favorite webcomics, including the traditional year's-end sequence
\when Death goes on the hunt for Father Time.
Big archive, large cast of characters, long backstories,
and multiple plotlines, but worth the effort to get into.)

Grumpy Man

Interesting what you can do with your lower face when you leave your dentures out, no?

I had to shave off my beard again (my awesone, awesome, beard! *sob*) when I went back to work, but I decided to try leaving the moustache on.

Besides the obvious current resemblance to an Internet meme, when the moustache was still a bit thin, looking at myself in the mirror kept leaving me with an urge to tell people not to squeeze the Charmin:

 

And when it gets a bit fuller yet, there'll probably be a resemblance to yet another moustachioed gentleman:

 

 

 



 

 

The Arm: Back To Work, Finally

At the end of our last thrilling installment, the arm pain had improved remarkably for no discernible reason, enough so that the second shoulder surgery set for the end of June was cancelled, and I was referred to a physiatrist (musculature specialist) at Mayo for further evaluation and probable return to physical therapy for a while.

Between various scheduling, authorization and paperwork complications, I didn't see the physiatrist until July 19th.  The arm pain had continued at the reduced level, staying mostly in the lower half of that 1-to-10 pain scale doctors like to use, and with the use of aspirin and Tylenol several times a day, mostly in the lower half of that lower half.  And those lower levels keep me out of the Stupid Zone, where you can't ignore the pain and you can't think.

At those lower levels, I felt it was possible to finally return to work.  The upper arm and shoulder still feel stiff and sore a good amount of the time, but it's probably never going to be completely pain-free again for the rest of my life.  The doctor had a job-description sheet from my workplace, and we went over the list of tasks I need to perform at work, none of which I felt were un-doable.  (Some of them, involving high reaches or other extensive arm movements, need to be done with the left arm rather than the right, but they can be done.)  So he gave me a release to return to work as of July 22nd, within the right arm's limitations.  He also wrote orders for me to resume physical therapy for the next month, and scheduled an appointment for re-evaluating my progress in late August.

Then I had to contact the HR rep at work to see about actually resuming work.  Monday the 22nd I met with her and the assistant Security head, then went around the property with him to demonstrate that I was physically able to do the work required.  I didn't have much problem with any of the tests, so I got a call Tuesday morning to say I was back on the work schedule starting Thursday night.

Completed my first work-week back at work Sunday night.  No major problems.  The shoulder got stiff and sore a few times, but that was expected and I carried a small pillbox with extra aspirin/Tylenol tablets for those occasions.  So it looks like I'm a working stiff (heh) again.

The Arm saga isn't over quite yet.  My job isn't strenuous; it doesn't require lifting or moving any heavy objects, at least not any I can't handle left-handed.  But there's still a lot of stuff at home I'm not capable of without over-stressing the arm.  That's one of the reasons for going back to physical therapy, to try and get back some of the strength and stamina the right arm has lost over the months.  (The right arm is visibly thinner than the left, due to muscle loss from lack of use.)

So there'll probably still be occasional post about "The Arm" from time to time.   But, at least as of now, they should be farther apart in time and hopefully less dramatic than some of the posts have been.

Not The Arm: More Medical Fun & Adventure

So, spent about four hours at the Mayo Hospital Emergency Room Sunday.

When I woke up Sunday morning, I sat up... and fell over.   I always thought "The room is spinning" was just a figure of speech.  No, it actually felt like the room was spinning.  And like I was being pulled strongly to the right while the world spun.

Over the years, I've had occasional instances of being light-headed, dizzy, or unsteady on my feet.  This was worse than any of those times.  At least an order of magnitude worse.

I fell back on the bed.  After a moment or two the dizziness and vertigo stabilized.  I tried sitting up again, more slowly... and the second wave of vertigo was even stronger than the first.  This time I had rising nausea to go with it.  Fortunately there was a plastic tub next to the bed that I was able to grab and dump the contents from to use as a catch basin; what I was having were not quite dry heaves.

The retching woke up Hilde, who asked me what was going on.  "I am having severe dizziness and nausea.  I think I need to go to the Emerency Room.  I am scared."   No joke about that last.  It was frightening to be that helpless.  If I'd been someone living alone, I would have had to crawl to the phone to get help.

Hilde called for Tabbi.  We used Hilde's wheelchair to get me out to the car, then Tabbi went back in and brought Hilde out.

What I was diagnosed with was "Benign Paroxysmal Positional Vertigo".  That will not be the name of my next rock band.

What it is, is that small granules in the inner ear, otoconia. break loose from their usual location and travel into part of the inner ear where they're not supposed to be, totally throwing off your perception of position and balance.  The main treatment is a series of physical head-turning exercises that are intended to let the loose particles fall back into their normal area, where they can slowly dissolve.

from dizziness-and-balance.com

 

The head exercises I was put through at the ER triggered more vertigo and nausea, but which calmed down after several moments focusing on a fixed object.  Once I'd gone through them, there was a lot of subsequent relief.   (The exercises are effective in about 80-90% of cases.)  I was given several prescriptions for nausea and dizziness, and told I should not only continue the exercises at home if I continue to have problems, but make an appointment with the PT/Rehab department for further practive with the exercises.

I feel better.  Tired, and still a bit light-headed, but at least I can walk and move around (a little carefully, to be sure).  Probably shouldn't drive until I've recovered more.

One of the possible causes for BPPV is head trauma.  I didn't get a hit on the head, but Saturday was spent clearing out the room I'd used for my (rarely-used) office and making it able to move our son Chris, who's moving back in with us for a while after several years living in Las Vegas, into that room.  That raised a lot of dust and dander, and I spent the day wheezing and dripping and sneezing.  When I sneeze, I tend to sneeze hard, and I wonder if forty or fifty hard sneezes, along with at least a hundred noseblows -- I went thru three handkerchiefs -- might have added up to the same effect a smack up the side of the head might have had.

Just another fun day at Chez' Arthurs.  I could do with a little less fun of this sort.

- - - - -

Saturday night, among the other stuff cleaned out of the office was a box of papers and corespondence that had belonged to Edna, Hilde's mother, before Edna's death about ten years ago.  We went thru it to see what should be kept, what trashed, and what sent to Edna's granddaughters.  I was struck that the commonest theme in letters from family and old friends, most of whom were around Edna's age, was to talk about the latest medical problems they or others were having.

It led me to wonder if I spend too much time on this blog talking about our own medical issues.  Let me know if I'm straying into TMI teritory, OK?

The Arm: The Weasel Gets Weird -- Unexpected Changes

In my last update to the seemingly neverending saga of coping with the breaking the hell out of my right arm last December, I reported that I'd decided to go ahead and have the revision surgery, replacing the standard replacement humerus head implanted in December (and which had seemed to be failing, resulting in quite a lot of pain) with a Reverse Shoulder Arthroscopy, a different type of replacement shoulder joint, hopefully (but not guaranteed) to reduce the amount and intensity of pain I was having.  That surgery was scheduled for June 28th.

And then, beginning last weekend, an unexpected thing started happening.

The arm started hurting less.

Quite a lot less.  I've gone from six extra-strength Tylenol and two Aleve (or, occasionally, one Aleve and a Celebrex) per day (about the maximum dose you're supposed to take per day, or start worrying about liver and kidney damage), all the way down to one or two Tylenol and one Aleve.

I don't know why it's hurting less.  No apparent rhyme, no apparent reason.  I don't know if it's going to last, or if the pain will rack back up at some unknown future date.  But you'd think I'd be relieved and grateful for the change.

In actuality, I experienced an anxiety attack that came close to panic.

For the first several months after the acccident, I seemed to be making slow but steady progress in recovery.   So I thought I'd probably be able to go back to work sometime in late spring.  Then the arm started getting worse again in late March, and planning on the future went into a cocked hat.

When I finally decided, about two weeks ago, to go ahead with the second surgery, it meant that I'd know what my life would be like for at least rest of the summer and most of fall:  Surgery at the end of June, the arm in a sling and immobilized 24/7 for at least six weeks, followed by at least several months of physical therapy.  After that, things would be uncertain again until it became clear if the second surgery had made any improvement.  But at least I knew what would be happening for the next four months.

But when the arm suddenly started hurting less, I had to start wondering if the second surgery was absolutely necessary.   The arm still aches, but the aching is a lot less intense, and I've had very few of the sharp stabbing pains I was having before.  Two weeks ago I was at the point where I was sure I needed the new surgery.   And now... I'm not sure.

Which makes the future very uncertain again.  Which is very upsetting and anxiety-inducing.

So.  After nearly a week of the lower pain levels, a few decisions have been made.  The revision surgery has been cancelled.  I'll be referred to a physiatrist, a specialist in Physical Medicine and Rehabilitation.  We'll try and work with the arm to get its strength and stamina back, or at least better.

I'm still, whatever happens, going to end up with pretty significant limits on how high I can reach with the arm, and how much I can carry.  But the pain has been the most compelling problem these last months.

I also had an out-of-pocket consultation with the doctor who does Hilde's pain-management for her own significant problems.  I got a fairly long list of non-surgical, non-narcotic treatments and medications that might be useful in dealing with the remaining pain.  (One of the suggestion was for adhesive Lidocaine patches.  Hilde used those for pre-surgical pain before one of her joint replacements some years ago, and we still had a partial box way at the back of a closet shelf.  So I tried one today for the aching, and it helped significantly.  This makes me hopeful that I can continue to keep the pain at tolerable levels.)

(Hilde and I get most of our medical care from Mayo, who I mostly think of as wonderful.  But surprisingly the only pain-management service Mayo has is part of the Neurology department, and it only treats back pain.)

There are still a lot of  "If's" and "Maybe's" and "Possibly's" floating around in the forthcoming months.  But for the moment, things are better than they have been.

In the last update, I said the pain was like having a bad-tempered weasel strapped to my arm.  It growled a lot, and sometimes started clawing and biting at the arm.  Well, at least for the time being, it's being a lot nicer, growling less, and even sleeping some of the time.

A well-behaved weasel.

The Arm: Latest Update, or, Wearing the Weasel

At last report, in early May, I was waiting to see a different orthopedic surgeon for a second opinion before committing to the Reverse Shoulder Arthroscopy surgery  recommended by my doctor at Mayo.  The second surgery will "probably" reduce my current pain levels, but even if fully successful I'll still have reduced strength and range of motion in my right arm for the rest of my life.

I saw the second doctor on May 8th, then waited for him to send his recommendations to the Workmens Comp office and to my Mayo doctor.  Then waited until the Mayo doctor got back from an out-of-town trip to have a phone consult with him.  Then waited until my Workmens Comp caseworker got back from her out-of-town trip.  Then found out she needed a second recommendation for the surgery from my Mayo doctor, to reflect that he'd received and considered the second doctor's findings.  So had another consult with the Mayo doctor a couple of days ago, rather more in-depth than we'd done over the phone.

The second doctor also recommended surgery, but the RSA surgery was one of several possible paths he suggested.  Another was to re-do the standard joint replacement surgery I'd had in December, with hopefully better results. And of course the option of learning to live with chronic pain was also brought up.

That last one's not really an option, however.  At this point, pain relief is my top priority.  Rebuilding strength and stamina in the arm come second.  Range of motion actually comes in third.  It doesn't really matter how much range the arm has, when it hurts too much to actually do  much of anything with it.

The degradation in usability and increase in pain that started in late March seems to have not only continued, but even worsened somewhat in the last few weeks.  I still usually manage to get through the days by taking lots of Tylenol and Aleve, but there've been a couple of recent days where the pain was sharp enough and persistent enough that I took half a T-4 (Tylenol with codeine) to get some relief.

Besides taking a lot of analgesics, I try to avoid activities that might cause the persistent ache to turn into sharp stabbing pain.  When I move the arm, I try to move it slowly and carefully.  I try to not lift or carry anything weighing more than a few pounds, or for a long period.  In short, the most effective pain-avoidance strategy has been: Don't do jack with that arm.

An extra hassle to all this has been not just the pain, but the fear of pain, the apprehension that trying to do anything with the arm will set it off.  I'm in a near-constant state of hyper-alertness, constantly asking myself: "How far will I need to reach out with that arm?  Can I do it using my other arm?  Will I have to lift, or squeeze, or twist anything?  Will that hurt?  How badly will it hurt?  How long will it take to recover?  Is this worth doing at all?"  This, above and beyond the physical pain, gets tiring.

I do do stuff with the arm, but nothing heavy, and nothing for an extended period of time.  Even very light work like sorting papers will increase the pain after a while.  When the aching gets intense, I've found I can reduce the recovery time by putting the arm back into its post-surgical sling and letting it rest for several hours.  And one of the few things I've found that I can do for a reasonable length of tie is sit at the computer and keyboard; by resting my right arm on the arm of the chair and bringing the keyboard and/or mouse closer, I can even type or browse the Internet for a reasonable stretch.  (One of the main reasons why you're seeing more postings here than prior to the accident.)



Yeah, something like this.

It's sort of like having a bad-tempered weasel strapped to your arm.  Most of the time the little bastard just lays there and growls; but sometimes he'll have a sudden psychotic break and start clawing and biting.
"Don't do jack" is not a viable long-term strategy, however.  Recovery isn't just a matter of being able to return to work; it's being able to do the things that need to be done in my personal life.  That includes being a caregiver to Hilde, and being able to do the household chores and tasks that need doing.  If I wasn't having the chronic pain, I'd be able to cope with a lot more of that even with a partially-disabled arm.

When I talked to my doctor at Mayo on Friday, he went on at some length to impress on me that there are no guarantees that I'll come away from the RSA surgery with any significant improvement.  I will definitely still have an impaired range of motion, and I won't have as much strength and stamina in that arm as before the injury.  There will "probably" be less pain, but there may still be some pain in the arm afterwards, and there's the possibility of no improvement in that area either.

From the medical articles I've read, shoulder surgery in general is a tricky job.  It's even trickier for a traumatic shoulder injury like mine, and trickier still for a revision procedure to a previous surgery like the RSA would be. I came across a discussion forum for shoulder-surgery patients, and one of the participants whose problems also started with a traumatic injury -- thrown from a horse and trampled -- has had six surgeries and still has chronic pain and little use of her arm.

I don't want more surgery.  I don't want more months of an immobilized arm followed by months of physical therapy.  But if the alternative is to try and live with the current status...

Well, even the hope of improvement is something.

In short, I'm scheduled for the RSA surgery on June 28th.

If the results of the surgery are good, I'll probably be able to return to work sometime in the fall.  If the results are less than good, I may have to start thinking in terms of Long Term Disability (and all the paperwork and complications that would entail).

Tribal Gathering

Last Sunday, Hilde and I spent the afternoon at the Phoenix Tribal Gathering, a rather small event mixing Pagan, New Age and Celtic enthusiasms, held at the Irish Cultural Center near downtown Phoenix. 

Hance Park
lightpost

The ICC is part of  Margaret Hance Park; when the section of I-10 that runs through the actual city of Phoenix was finally completed, the section between 7th Avenue and 7th Street was made a sunken area with the freeway going thru a half-mile-long tunnel.  The topside of those tunnels couldn't support the weight of full multi-story buildings like surrounding areas, so the major chunk of it was landscaped and turned into Hance Park; besides the general park area, it also includes the Japanese Gardens and the Irish Cultural Center.

The ICC is a nice looking building, even if it's not an authentic stone building; the stone facing (which is probably fauxstone) is a passable imitiation.  It would probably look more authentic in overcast weather with a light drizzle.  Get some ivy growing up the walls, even better.

Burton Barr Library

There's quite a contrast between the ICC and the ultra-modern Burton Barr Library (the central Phoenix branch) across the street.

(I guess the reward for spending one's life as a political hack is to have a park or public building named after you.  Meh.)

We have quite a few contacts in Pagan, etc., circles, so we caught up with some friends, browsed the crafts contest entries, listened to a little music, and browsed the various vender booths.  One booth was not only offering massages, they had a new puppy with them.  Massage therapy and pet therapy in one!  (I took advantage, since my shoulder was starting to ache by that point in the day.)

I also had a Tarot reading done.  I'm a pretty thorough skeptic, but Hilde's more open to that sort of thing and urged me to have the reading done.  Very interesting results.  I don't believe in Tarot as prediction or prescription, but I think they can help trigger lines of thought that may help reach decisions that had been treading water before.  So the results seem to have helped firm up some decisions I'd already been considering, about how to deal with the consequences of breaking my arm last December.  It's a pretty distant possibility that I'll go back to the status quo I had before the accident, so I need to figure out in what direction I want to go and try to take steps toward those goals.   I'll probably say more about that in another post.

But it was good to get out of the house for a little while and not have it just be for a doctor's appointment.

Hilde and Tabbi

Hilde and Tabbi

posted from Bloggeroid

The Arm: Pain Issues, and A Probable Re-Do

My most recent post about breaking my arm and the subsequent recovery process, "Two Steps Back", reported that I'd started experiencing a recurrence of pain at a level similar to a month or so after the surgery in December.

Up to that point, about mid-March, recovery had been slow but forward.  My range of motion and ability to use the right arm fell into three categories:

• The Functional Zone, essentially pain-free, mostly involving use of the hand, wrist and forearm, plus about 40 to 45 degrees of forward-lifting motion (less for sideways motion) for the arm as a whole. 
• Then there was the Uncomfortable Zone, up to about 90 degrees forward, where I could feel some strain and aching while I was using the arm, but the strain and ache would recede quickly when I dropped back into the Functional Zone. 
• Then there was the Forbidden Zone, trying to go up past that 90-degree point (only a few degrees unassisted, a bit further with assistance or exercise pulleys), where the aching slid into the point of actual sharp pain, and where it would still ache and throb for a fair while after dropping back into the more usable Zones. 
• Also, the overall strength of the arm was much better than when I first started therapy for the arm, but still a lot weaker than before the accident.

A lot of that progress has been lost.  When the pain started getting worse again, it was accompanied by intermittent scraping and grating sensations from within the shoulder.  (Not all the time, but any scraping sensations is cause for worry.)  Currently, even when the arm is just hanging at my side, there's a slight but noticeable aching; using the arm beyond that, even the light use I hadn't had much trouble with, makes the aching stronger, eventually going into actual sharp pain.  I've gone back to wearing my arm sling again when it gets bad; having the arm supported gives some relief, but it still takes longer, sometimes a lot longer, for the pain and aching to recede. 

The Functional Zone has shrunk, the Uncomfortable Zone has increased, the Forbidden Zone is still forbidden, and pain has become more chronic again.  This is not good.

I had a fresh set of x-rays done after the grating sensations started, and I was able to move up my next appointment with my orthopedic doctor at Mayo.  I saw him yesterday.

I was hoping what he'd tell me was "Your problem's simple.  I can do a laproscopic procedure, minimally invasive, in and out the same day, and you'll be back on track to recovery quickly."

No such luck.  The major source of problems appears to be that the tuberosity where the rotator cuff attaches to the humerus head replacement is displaced by a significant margin.  This is equivalent to having a major rotator cuff tear.  (And probably explains why I was able to get my arm up to 90 degrees with therapy, but increases beyond that have been minimal and painful.)

My doctor at Mayo isn't the surgeon who replaced the joint in December.  Immediately after the accident, I was taken to the closest hospital with a trauma unit, and the surgery was done there, not at Mayo, where I receive most of my usual medical care.  While it's a nearly unbreakable rule for doctors to badmouth other doctors, I felt a clear vibe of "If it had been me doing the replacement, you wouldn't have this problem."

A couple of additional factors may also be contributing:  Besides the actual break in the arm bone, the shoulder bones were badly compressed and squeezed in the accident.  There may still be lingering trauma after-effects from that.  And there was also a small shadow in the new x-ray that the doctor thought might be a loose bone fragment floating free.

The doctor offered several possible ways to proceed from this point:

• Continue as before, with exercise and physical therapy, and hope that the pain and other problems get better.
• Accept living a life with chronic pain.
• Or go back into surgery for a reverse shoulder arthroplasty, replacing the first artificial joint with a different type.

The reverse shoulder prosthesis works backwards from the standard replacement prosthesis: Instead of putting a new ball-head on the arm bone, the ball head is screwed into the shoulder joint and a "cup" for it to fit into the arm bone.  Also, with the reverse prosthesis, arm and shoulder movement comes primarily from the deltoid muscle, rather than the rotator cuff.

The different joint won't give me a better range of motion.  Best results will still probably fall into the 75% to 85% range.  So even in a best-case scenario, my right arm is going to have limitations for the rest of my life.  OK, I can accept that.  I can live with that. I can do work-arounds for that.  (As if I had a choice.)

The chronic pain issue is a lot more intimidating.  A lot scarier.  Because this: Pain makes you stupid.

When you're in pain, even when you're not actually sweating or whimpering,  even when it's "normal pain" and not "sharp pain" or "intense pain", it's there, in your head, making itself known, insisting you recognize it.  It takes up brainspace that would normally be available for the ubiquitous "stuff" our lives are filled with.  Pain makes you lose focus, lose attention, lose thought.  Pain makes you stupid.

I'm not the most focused or organized person, to say the least.  (I suspect I'd probably score fairly high on an attention-deficit-disorder checklist.) I can't afford -- emotionally or pragmatically -- to be any dumber than I already am.  Living life with chronic pain like I've had the past several weeks is not an option.

My orthopedic doctor is having me do a shoulder aspiration on Monday.  This is where they draw some fluid from the shoulder area and send it for a battery of tests to check for any signs of infection.  It's also a requirement for surgery.  (Because you really, really, don't want a bone infection.)  So, unless there's significant improvement in the shoulder and attendant pain in the next few weeks (it takes about two weeks to get full test results back), I most likely will be having a new round of shoulder surgery sometime after that.

(Scheduling will partly depend on how much objection Workmens' Comp raises to the idea of a complete re-do of surgery.  I've actually been astonished by how cooperative and quick Travellers Insurance --who provide Workmens Comp insurance coverage for my employer -- has been in covering all the expenses.  On the other hand, they've already laid out over $100,000 on my case, and might want to send me for, at the least, a second opinion before agreeing to a new operation.)

I'm not at all happy about the idea of a second surgery, one that will put my progress back to the point immediately after the last surgery, with still more months of recovery and therapy following.  This seems an appropriate visual reference:

Five Hundred

 

 

This is the 500th post to UNDULANT FEVER since I began on June 30th, 2004.  A bit over one post per week, on average.

I didn't start keeping track of statistics for the blog until 2008.  Judging from those stats, the best way to increase pageviews for your blog is to write about teapots.  "Two-Fer Teapots" , from 2010, has the second-most pageviews (273).  Other posts about teapot-based ceramic competitions also have high pageviews.

I could probably increase pageviews more by adding keywords to posts, and just by talking it up more out in the real world.  A few posts, like my "Shots In The Dark" and "Lunatics, Imbeciles, and Saboteurs" have been linked to a few times by other blogs.  Most posts get ten or twenty page views, then taper off.  I find myself and my opinions fascinating, but not so much by most people, apparently.

But I've been writing things like this blog long before blogs existed.  I started publishing fanzines and personalzines back in the 1970's, on that old-fashioned "paper" stuff.  (The title UNDULANT FEVER was originally used for a paper personalzine.)  It's a place to leave a record of my life and thoughts.  So it's not a habit I'm likely to break anytime soon.

The Arm: Two Steps Back

Over the months since my accident and breaking the heck out of my right arm and bunging up the shoulder, I've been slowly improving following surgery, recuperation and physical therapy.  Slow, but continuous improvement.

The last several days, however, I've been feeling intermittent scraping and grating sensations in that shoulder, accompanied by renewed pain.  Not as bad as the intial injury, or right after the surgery, but definitely a major step back from where I'd gotten to in recovery.

I'm babying the arm, and even thinking about putting the sling back on, to see if it'll recover by itself.  But I have a tendency to catastrophize the future, and my true worry is that the prosthetic joint may have started to break loose or that the shoulder bones (which got compressed together pretty badly in the accident) have moved into a position where they're rubbing together.  I've tried to move up my next appointment with the orthopedic doctor at Mayo, in mid-April, but his schedule is booked solid; his secretary said she'll try and move me into any opening that becomes available.

Worst-case scenario: I end up having surgery again, possibly a complete re-do of the joint-replacement procedure, putting me back to where I was right after the first surgery.  But I won't know for sure until I get new x-rays and an evaluation.  I'll keep nudging the doctor to try and squeeze me in sooner.  (Because, y'know, the uncertainty is just one more bit of worry on top of worry.)

 

A Simple Breakfast, and A Useful App

Diced fruit (strawberries & mangos), a shotglass (1 oz.) of half-&-half, a bit of sugar.  About 200 calories.

I've been trying to eat a little healthier.  One of the annoying side effects of breaking the arm is that I get a lot less exercise when I stay at home.  (My job usually called for about 3 to 5 miles worth of walking per shift.)  So I gained about eight pounds in the first month after the accident.  Since extra pounds had already been slowly creeping up on me even before the accident, that meant I got back up into the 190's.  Ideally, I'd like to be about 165 pounds.

Those height-&-weight charts say my ideal weight should be about 155, but on the rare occasion when I've gotten down to that weight, I look gaunt, I don't feel great, and I'm hungry all the time.  (True story: The last time I got down to 155, I was still working as a letter carrier, and several of my customers expressed concern that I had cancer.)

Getting down to 165 is do-able (I've done it before), I look good and feel good, and with a bit of time management and planning I can usually stay within a few pounds of that goal for a considerable time.  I've managed, even with the arm restricting my exercise, to drop back down to 187 since the end of February, about a 5 pound loss.

The main tool I've been using to monitor my eating habits and activity is an Android app called Noom.  No, I don't know what "Noom" is supposed to mean, other than being "moon" spelled backwards.

I've used earlier versions of Noom before with some success, tempered by problems with the application.  An earlier version kept freezing up in mid-action, and a later version presented itself in ways that annoyed me.  One example was that they used sports-similes to judge food amounts: "golf ball size", "tennis ball size", etc.  Hey, there are people who have so little interest in sports that they have only the vaguest idea how big a baseball or softball is.  (I'm the only person I know of who flunked grade school P.E.  Yes, I really did.  I was the original "does not play well with others" kid.)

The newest update, which I downloaded onto my smartphone last month, seems to have fixed most of those problems.  Operates smoothly, and you can now choose between measuring by simile or by actual measurements.

One of the things I like about Noom, compared to other diet or fitness planners, is that they use an estimation system for food calories and value.  Other planners I tried had huge databases of specific foods and brands, and it was easy to get lost and spend lots of time finding and entering  those specific choices. 

Noom's first-level food choices divides food into three major categories, "Green" for healthy foods, "Yellow" for okay foods, and "Red" for foods that should be avoided or minimalized.  Each of those wide categories has two to three dozen subcategories, broken down into more specific but not too-specific choices (egg whites are "Green", whole eggs are "Yellow", bacon is "Red").  Clicking on one of those subcategories gives you various amounts to choose from for what your meal contained and calorie counts ranging from 25 for a tiny "Green" portion to 600 calories for a large "Red" portion.  I find this system a lot easier and quicker to use than other planners' more detailed breakdowns.

But it can get even quicker and easier.  When you've familiarized yourself with a bunch of portion sizes and calorie counts for various foods, you can go straight to a "Dial A Menu" feature that lets you enter the general category, portion size and calorie count in a single click.

Noom also has features to track exercise and weight, and provides daily tasks and advice to help keep you on track and motivated.

I use the free version, which I find sufficient.  The paid version ($9.99 per month, yikes!) features extra individualized coaching and guidance.  Android-only, though they're supposed to be working on an iPhone version.

 

The Arm: Latest Update

Saw my orthopedic doctor at Mayo again yesterday.  Got permission to start the next phase of physical therapy, with resistance training and stronger therapist-assisted stretching.  Also got a limited work release, allowing me to work up to two hours at a stretch, twice a day for the time being; the other limitations are not to use that arm for more than 20 pounds, and to avoid repetitive hammering motions.

That's good news, but it's not likely I'll be called back to work within those limitations; they really need me able to work an 8-hour stretch (or 12-hour shifts on weekends) to get me back onto the schedule.  So I'll probably remain off work until those limitations are removed.  Next appointment is in mid-April, when they'll evaluate again.

This is assuming I get back to that job at all.  I spoke to the head of the Security department, my boss, a few weeks ago.  He was of the opinion that if I wasn't able to recover 100% of my arm's strength and range of motion, he couldn't see authorizing my return to work.

I'm not in agreement with that.  Right now, every individual task that I routinely did at work before is something I feel I could do now (although some things, like locking and unlocking deadbolts located high up on doors, I'd have to do left-handed).  It's more an issue of stamina and pain levels.

On an aural-simile pain-scale, my default level of discomfort is currently like having a mosquito whining around your head; bothersome but ignorable.  If I use the arm much for a few hours, you get past discomfort into actual pain; then it's like fingernails scraping across a chalkboard.  (That's where that 2-hour limitation comes in.)  If I try and push myself further, you get into some pretty harsh pain territory, like working next to a woodchipper without earplugs.  At that point, you cannot think straight; that pain is a wet blanket over your brain, and you're not much use in either a domestic or workplace setting.  And the further I push myself, the longer it takes to recover.

THE ARTHURS AURAL-SIMILE PAIN SCALE

mosquito whine

fingernails on chalkboard

woodchipper

But I am improving, getting able to use the arm more and for longer periods.  (The process is just a lot slower than I wanted, or expected.)  So I feel that even if I don't recover the full range of motion for my right arm (and it looks like 85% is about the best I can hope for, barring having the surgery re-done), I'll still be able to perform everything I need to do at work.  I'm hoping my boss' attitude will turn out to have a flexible range of motion itself.  My intention has always been to stay in that job until I'm eligible for my full Social Security in about another six years. 


Photo credits:
mosquito: US Department oif Agriculture (via Wikimedia Commons)
fingernails on chalkboard: from tvtropes.org
woodchipper: from the movie Tucker & Dale Vs. Evil

Richard E. Geis, 1927-2013

cover to SFR #39; I think the artist is Alicia Austin

Over on Trufen, Andrew Porter reported Richard E. Geis' had died last month, on February 4th.  Geis was an important figure in science fiction fanzine fandom, especially in the 1960's and 1970's.  He was also an important figure in my own life, even if we never met.

I cut my fannish eyeteeth on Dick Geis' artificial vagina.  (Now there's a sentence you won't see written very often!)

Geis' SCIENCE FICTION REVIEW (aka, at times, as THE ALIEN CRITIC), in 1968, was the first "real" fanzine I'd seen.  (I'd seen a few samples of comics fanzines prior, mostly ad-based.)  It was an eye-opener.  Not just for the discussion and *ahem* vigorous dialogues about science fiction, but because he was the first person I'd encountered in my entire life who was willing to write openly and un-self-censored about sexual matters like masturbation (including with the aforementioned artificial vagina) and writing porn for a living.

(No, literally, at age 16, he was the first person I'd seen do that, and he did it in a public forum.  Get back on my lawn, kids, and I'll tell you how desperate teenagers were in the 1950's and 60's for ANY kind of sexual facts or information, and how unavailable it was.  But you won't believe me.)

That openness has been a big influence on my own life and writings.  I'm nowhere near as open and uninhibited at the typewriter as Geis was, but I'm open enough to occasionally make people uncomfortable.  Overall, I think that's a good thing.

I'll quote part of  Porter's Trufen post regarding Geis.:

"Richard E. Geis was one of the finest fan writers and fanzine
publishers SF fandom ever produced. His own writings, primarily in
his schizophrenic "Alter-Ego" editorial role in his numerous
fanzines, which were notoriously wont to change their names in mid-
publication, are famous in the field. They gained him numerous Hugo
Award nominations and many wins. His fanzines, which became focal
point fanzines attracting numerous contributions from the finest
writers, professional and fannish, and artists, also gained him
numerous Hugo nominations and wins.

"Geis was a Fan Writer Hugo nominee in 1970 and 1971, and every year
from 1973 to 1986, winning Best Fan Writer Hugos in 1982 and 1983.
His fanzines were Hugo nominees from 1968 to 1971, and 1974 to 1983.
His "Science Fiction Review" won the Fanzine Hugo in 1969, 1970, 1977
and 1979. "The Alien Critic" won the Fanzine Hugo in 1974 (tied with
Andrew Porter's "Algol"), and in 1975. Altogether, he received 30
nominations for the Hugo award, winning eight times."

The Wikipedia entry for Richard Geis is here.