Tuesday, March 27, 2012

The elbow surgery chronicles

4:30 a.m. That's when we left the house. It made for an easy drive into Philly. Any semblance of "rush hour" was a good hour or two away. And when you arrive for surgery at 5:20, the check-in process is shockingly quick, slowed only by a woman shrieking over a mouse in the foyer of Methodist Hospital.

I have told you before about the woes of my right elbow. X-rays and a CT scan showed that it was blocked by bone spurs in two directions. So both extension and flexion were severely compromised. And that has led to tendonitis in my right wrist, which is compensating (read: taking the brunt of the punishment) at the gym during overhead lifts, pullups, pushups and anything else that requires a straight, locked-out arm. Likewise, the absence of full flexion means that I can do a power clean, but my squat clean is non-existent, and my front squat, if heavy, has to be done with either straps or folded arms (a.k.a. the "I dream of Jeannie" pose). Likewise, it has gotten to the point where more than 30 minutes of drumming starts to hurt deep down inside the elbow, and my volleyball team has had to suffer through some ridiculously erratic games from me: fine one minute and unable to serve overhand the next.

So it was time to get it fixed. I had been given the choice of dealing with it or surgery, and for someone like me who likes drumming, CrossFit and volleyball, and has been feeling seriously compromised at all three of late, there didn't seem to be much choice. The prospect of reduced pain and increased mobility was pretty alluring. Unfortunately, to get there, surgery means a recovery full of increased pain and decreased mobility, for a while.

I had been told to prepare for an overnight hospital stay, but my hopes of making it to my fiftieth (!) birthday this summer having never spent a night in the hospital were buoyed when I learned that I was the first surgery of the day. The decision on releasing me that day was going to be made solely on the basis of pain control, and there was a better shot at having that In order if I were the first on the operating table.

So the anesthesiologist and I shot the proverbial shit. Nice guy. Guitar player, wannabe drummer. He totally dug the fact that my gnarled arm was the product of rock and roll. Then we talked about nerve blocks. Apparently my surgeon didn't use a nerve block during the procedure. Instead, he used general anesthesia and then the patient has an option of a post-op nerve block or some cocktail of narcotics. The nerve block has a minor risk of damage, but the bonus of no pain while it lasts, whereas the druggy combo just dulls what is described as some hefty pain.

I was a little torn. The notion of a totally dead arm in a sling for 8-12 hours didn't sound too appealing. But they had me at: "It'll greatly increase your chances of going home if you do the nerve block because pain won't be an issue." I voted for the block.

In retrospect, it was the right call, but once I had my wits about me post-op -- this took a little while including an embarrassingly long harangue from a nurse who was pissed that my still-stoned self apparently kept trying to roll over onto the surgery arm as I came to -- the 13 hours that that arm was dead were some of the most annoying times of my life. Yeah, I was released from the hospital at about 2 p.m., but when they said the arm will be "dead," they were not kidding. It was like a hunk of cement, in a sling, attached to my neck. Bend at the waist at all, and the cement arm swung like a weathervane. And the last four hours or so were the weirdest of all because no matter how many times the anesthesiologist told me that the block would last "up to 15 hours," what I remembered better was both he and the surgeon saying something like: "But often it is more like only eight hours." So when the eight-hour mark hit and I still couldn't even twitch my fingers, it was a little freaky. Enter a little hypochondria (what did they say the nerve-damage rate was for these nerve blocks? One in 2500? That's a lot!), and it was amazing that I drifted off to sleep. Percocet helped that.

I had been advised by a number of people to "stay ahead of the pain" by not waiting until the nerve block ran out before hitting the Percocet. That strategy began with one pill before we left the hospital, another at 6 p.m., and another at 10 p.m. I konked.

90 minutes later, I awoke to my fingers twitching. The block was wearing off. I drifted back to sleep and woke up at 1:30 a.m. with the feeling that a freight train was repeatedly running er my elbow. Wowzers. I cheated by half an hour and gobbled another Percocet, but it had minimal effect. I was up every 30 minutes the rest of the night.

By 5:30 a.m., I was sleep-deprived and let's face it, a little crazed. After pissing and moaning about the nerve block for most of the evening, I had mercifully spared my wife my post-bedtime restlessness by setting up shop in the spare bedroom. I *knew* it was likely to be a rough night, but when the pain hit, it was more intense than I had expected.

Then I remembered the Indomethacin. As I left the hospital, the doc had given me two prescriptions -- one for Percocet ("for pain") and one for Indomethacin, which he said was an NSAID that I should start the next day. It would control inflammation and slow healing just enough to prevent significant scar tissue. What he didn't tell me was that its once-a-day dose would take a *huge* bite out of the pain. Wow. I took it at 5:30 a.m. along with a Percocet and pow! I was sound asleep for 2.5 hours. I woke up at 8 a.m. and have had only minor pain the rest of the day.

It is amazing what reduced pain will do to brighten your day.

So that is my not-very-exciting tale of surgery. I am left with an arm that needs some hardcore physical therapy. That starts with a physical-therapist visit on Thursday, and I already have been doing exercises that the surgeon gave me. Let's face it.... the arm is unlikely to be truly straight, but he told me that when I left surgery I had 20 extra degrees of flexion and 5-10 additional degrees of extension. Now that all that crap is out of there, it's up to me to take this thing the extra mile. That is going to require a little care -- one part of the surgery was moving the ulnar nerve -- but mostly it's just going to be work. Let's go.

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  1. Congratulations on the successful surgery. I hope you recover quickly. I know how it feels to be prevented from doing something you like to do for a while.

  2. It's good to hear that the surgery was a success. Best wishes and good luck on your recovery. Just remember to be patient and not overdo things too quickly.

  3. Congrats for successful surgery and most important that now do proper care of your arm and take proper precaution as advised by doctor and you will get fine soon