Saturday, September 18, 2010

bicep tenodesis vs. subacromial decompression surgery - my story

Who am I: I am a 35 year old somewhat athletic, woman. I am healthy. Except for my chronic pain.... here is my story of the surgery on both of my shoulders. Enjoy, comment as you see fit, ask questions, etc. Thanks!!

5 weeks ago I had surgery on my left arm. I declined to have a block, although the anesthesiologist said that about 90% of the patients do request a block. The OS went in planning on doing a subacromial decompression (SAD) and a distal clavicle excision (DCE or DCR). She said there was a 70% chance that she would do a bicep tenodesis, depending on what she found. She ended up doing the bicep tenodesis - I got about 3 inches of my longhead bicep tendon removed, and two screws to re-attach my bicep to my bone. That was the major part of the surgery, otherwise it would be minor.

Prior to this, I had been doing physical therapy. I was doing everything according to instruction. My left shoulder was NOT getting any better. I got a cortisone shot back in March, for both shoulders. It helped, but not fully. It helped almost completely on my right shoulder, but only maybe about 65% on my left. I found out that most likely is because of my bicep tendon... the cortisone shot is shot into your subacromial bursa, and it isn't able to affect the longhead bicep tendon.

So, I woke up from surgery VERY out of it. I was so groggy. my SO Steve took me home, and started feeding me my narcotics according to schedule. It hurt. I started doing pendulum exercises right away, and saw my physical therapist  6 days post op. He got me going on some other stuff, and off I went. The pain started lessening after the first week. But I have to say the first week was the hardest. The pain wouldn't go away, and I had to go to work. Since I wasn't allowed to take any anti-inflammatories, basically my only options were to take tylenol, or the narcotics. Well tylenol does nothing for me. And I can't take narcotics and go to work. So I suffered.

But I was healing fast. I did take ginger capsules, and used some arnica homeopathic stuff on my arm directly on the shoulder. I also took arnica 200c 2x a day for the first few days. At my post op appt 19 days after my surgery, the OS said that I looked as if I was 6 weeks out, vs. only 3 weeks out. YAY!! I was so proud of myself. I was so scared that I was going to pull the screws out of my bone, the first month that is something you have to be super careful about. So I kept my arm in the sling except to shower and dress and do my physical therapy. I did have a few episodes where I twinged or tweaked a muscle somehow and the pain was excruciating, but I was better in a day or so.

We had my right shoulder surgery scheduled just 4 weeks after this first one (we didn't know at the time whether it would be just a subacromial decompression on the left shoulder, which would have been fine... but since I had a bicep tenodesis with a 3-6 month recovery time, 4 weeks is just too soon). So we decided to wait an extra week. Why didn't we wait longer? Well, I  met my deductible this plan year, and everything was covered 100%, but it starts again Oct 1st, just a mere 2 weeks after my shoulder on my right side... This is the good part of high deductible health plans. It is great for people like me -- most of the time I rarely need to go to the doctor, and I don't take any prescription drugs that I have to have filled every month... I do a checkup, and that is about it. Well, On the flip side, if I do end up needing my insurance, I REALLY use it. This plan year I had 8 months of physical therapy (at least once a week) and 3 surgeries (the first one was a diagnostic laparoscopy for endometriosis... thankfully that wasn't the case, but they did find staples in my insides, even one embedded in my ovary, so hopefully the removal of those will help my cramps!). So I really used my insurance this year.

Now, at 5 weeks post op from the left shoulder, I have been doing the wand exercises (AAROM) and the isometric ones. I also have been given what I think are called isotonic exercises, to start strengthening the 2 back muscles of the rotator cuff. I was amazed at how hard those were, I was shaking and barely could get them finished. But now I can do them and I am doing them with 4 oz of weight. And, I have been out of the sling for a week. I can ALMOST sleep on that side at night. That is my chosen sleep side (I prefer sleeping on my left side) but I am not doing it fully just yet...

So this is where I was to date, going into my shoulder for the right side. We were pretty sure we didn't need to do a bicep tenodesis, according to the MRIs, and the pain on my right shoulder went almost completely away after the cortisone shot, and came back after a month or two. I was told by my surgeon that if the cortisone shot works in the beginning, at least, then after the SAD (subacromial decompression) the pain will be gone just like the cortisone shot, except permanently. I am very excited about that. I have read on forums or message boards of people getting cortisone shots for their shoulder pain, and it didn't work so then they had a SAD. And that didn't work, either. So I am guessing that the cortisone shot is a good thing to try before you have surgery. And if it doesn't work for you, don't have an SAD...

I also had a very good surgeon. She specializes in shoulders. She explained all the different options to me. Surgery was really my last resort. I had to wait months to get in to see her, but I have to say now that it was worth it. I saw a horrible OS last year, for my shoulders and he was very rude. It only took me 2 days to get an appointment with him. So I suspect that the good surgeons, well, you have to wait months to get in to see them, but I also agree that it is worth it TOTALLY. I have pictures of my shoulders, that the scope took, and can see how horribly swollen and inflamed and red everything was. Well, that other surgeon took MRIs and told me NOTHING WAS WRONG! He had the gall to suggest I see a psychiatrist. HAHAHAH!!! It isn't in my head, Mr. It is in my shoulders!

So here I am, Thursday morning comes along (2 days ago) and I head in to the hospital. I am very nervous, because I remember all the pain from 5 weeks prior, and also waking up from anesthesia, it was really bad. That is the worst of it in my recollection...

But I am a trooper, so I stick it out. They had me in the pre-op room, asking me all the millions of questions they do, taking my blood pressure, putting in the IV, etc. Then I talk with the anesthesiologist, he remembers me from last time, and guesses that I don't want a block. Everything moves pretty quickly, I say goodbye to Steve (my SO) and I actually WALK into the operating room and sit on the bed. I tell the nurses there that this is the first time in my life I ever stepped on the floor in the OR before. I lay down on the bed and next thing I know I wake up in the phase I recovery area. They tell me I just got out of surgery 5 minutes before (my surgery 5 weeks before I don't recall being in this area AT ALL). Then, I start asking them questions... like how did it go, how long did it take, etc. And I feel great actually. I didn't feel like throwing up. I didn't feel drowsy, just relaxed. They quickly moved me to Phase II recovery, so that I can see Steve and get ready to go home. I walked to the restroom right away... I was totally fine with that. I think they were impressed, as well.

I think within 30 minutes I was able to go home. We were just waiting on my prescriptions. This time they gave me Vicodin and Vistaril. Since this was minor compared to the bicep tenodesis, where they gave me oxycontin, percocet and vistaril, I didn't really need anything stronger.

So, I went home and took a nap. Then, before bed that night I took 1 vicodin and 1 vistaril and 1 benadryl. Narcotics really make me itchy, so the benadryl helps with that. The next morning, Friday, I took 1 more dose, and just relaxed all day. I did my pendulum exercises, but then took my sling off, and realized I really didn't have much pain. I tried some of the wand exercises, with both arms, and was able to move with a pretty decent range of motion on both arms.

Today, 2 days post op, I have now been off narcotics for a day and a half, and only took Aleve 2x. I went to a huge fundraiser for my animal rescue group today, and then came home and relaxed. Sure, I am tired and worn out. But ecstatic that I can move around... I was able to do all the exercises for my left shoulder (my right arm can lead for the wand exercises).

All in all, I am doing fantastic. I am icing almost all day long for my right shoulder, and I am icing 2x a day still on my left shoulder.

My main fear for my right shoulder was that it would be as sore as my left one. But thankfully that isn't the case. It already seems to have surpassed what my left shoulder can do... just two days post op.

I also have broken up all the scar tissue from my left shoulder. There were two spots (two of the 4 incisions) that were lumpy with scar tissue. I didn't use vitamin E which they suggested. Instead, I used castor oil. I rubbed it in, deeply, morning and night. Within a week, the scar tissue went "pop" and my skin is now smooth, no lumps. You can still see the tiny incisions but they continue to become less visible. Except the one on my arm where they removed the bicep tendon. That was over an inch long, near my armpit, and may take some time to go away, and might never go away permanently.

I wore my hospital gown for 2 days until I showered. And this time around, I showered on my own, without the plastic over my wounds. I just dried the wounds, and re-bandaged them after putting hydrogen peroxide on them. After my first surgery, Steve had to help me wash my hair, dry my hair, and dress. At least for the first few days. This time, he was out taking the dogs for a walk as I was getting ready...

I think that my decision to have these surgeries was the best decision I have ever made. In summary: 5 weeks ago I had a SAD/DCE (subacromial decompression and distal clavicle excision) along with a bicep tenodesis (removal of the long head bicep tendon) on my left shoulder. 2 days ago I had just the SAD/DCE on my right shoulder. And today I would say both of them feel the same in terms of soreness. I know the recovery for the bicep tenodesis is 3-6 months, and I have a long way to go, but I am religiously doing my physical therapy and stretching and strengthening.

I am thankful that this really might be the light at the end of the tunnel, and that my pain will be gone. I will never brush off anyone who says they have chronic pain, ever again. It is serious... I lived with it for so many years. Now I am ready to REALLY START LIVING MY LIFE PAIN FREE!!! Hallelujah!!!