Shoulder Surgery – Recovery

Last week was three months since my shoulder surgery. I started 15 physical therapy sessions after a month, and also went back to work. I saw the doctor again two months after surgery and he felt I didn’t need any more physical therapy.

In the last month my mobility and general pain level have improved. But I have some areas which still hurt quite a bit. I have exercise bands I’m using at home, doing exercises the therapist gave me. But some of them hurt and I’m leaning toward asking the doctor for more physical therapy, both to help with the sore places and to make sure I’m doing the most helpful exercises.

A week after surgery my sister came for a two-week visit.  She did all the kitchen things I couldn’t do, and generally helped me with daily life. We went up the Teleférico and discovered we’re not very good at taking selfies. We visited the botanical gardens, and took a day trip to Otavalo (a large native outdoor market). But mostly we sat and talked; it was the longest time we’d spent together since we were kids, and much more pleasant than back then (when we fought all the time).

Jeanne-Jody Teleférico

High above the city. (It’s hard to take a selfie when you can’t see the screen in the bright sunlight.)


Jeanne-Jody botanical gardens

At the botanical gardens

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Shoulder Surgery: Home Again

I came home yesterday afternoon. I’m sore but it’s not as bad as I was expecting. I’m tired but not dizzy or weak, so we felt pretty comfortable with Scott going in to the office today. (He’s still swamped and his vpn wasn’t working.)

The surgeon said my ruptured supraspinatus tendon was not as bad as the MRI showed–a pleasant surprise.  He was able to repair it with sutures only; he was planning to use an anchor in the humerus. He removed a big bone spur from under the acromion, which will help my range of motion. And he moved the long head of the bicep tendon out of the glenohumeral joint and reattached it to my humerus on the armpit side. If I am diligent in my physical therapy he’s very optimistic for very good results.

I was surrounded by prayer: co-workers, family, Facebook friends. I started crying during the operating room prep and they stopped and prayed for me. And I can remember at least six times visitors to my hospital room prayed for me.

I’m wearing a sling but it is not to immobilize the arm but just to support it and to keep me from using it. Dr. Febres said to move my fingers and wrist often and also gently straighten my elbow and move my arm laterally. I just can’t raise my arm. I see him April 18 to have the stitches taken out.

My care was very good in the hospital.  The nurses and aides were professional and attentive.  I didn’t understand everything but I don’t think I missed anything important.

Our total bill for everything was around $2600, much lower than the $4200 estimate. I would recommend our hospital to anyone, although this would have been very challenging if I didn’t know some Spanish.

I’m thankful for the day of recovery in the hospital. Tuesday was pretty rough and it was really nice to have the IV pain meds when the pain was intense. I was coughing a lot to clear my lungs from the aftereffects of the anesthesia and everything hurt when I coughed. I’m still coughing but that extreme pain is gone. In the US I think this would have been outpatient surgery, a decision that I suspect is driven more by financial reasons than by medical reasons.

I’m very grateful all went well.  Thank you for your prayers.

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Shoulder Surgery: Anxiety

(This didn’t get posted before the surgery, so it’s a bit late.. God gave me a great peace before the surgery, and this scripture is what I was saying to myself as the surgery started.)

“Have I not commanded you? Be strong and courageous. Do not be afraid; do not be discouraged, for the Lord your God will be with you wherever you go.” (Joshua 1:9)

“Ya te lo he ordenado: ¡Sé fuerte y valiente! ¡No tengas miedo ni te desanimes! Porque el Señor tu Dios te acompañará dondequiera que vayas.” (Josué 1:9)

One last post before the surgery: when I am anxious it is a great help to know that God will be with me wherever I go. In fact, since He knows the future, I believe He goes before me. Nothing that happens will be a surprise to Him.

Un último post antes de la cirugía: cuando estoy ansiosa es una gran ayuda saber que Dios estará conmigo dondequiera que vaya. De hecho, ya que Él conoce el futuro, creo que Él va delante de mí. Nada de lo que suceda será sorpresa para Él.

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Shoulder Surgery – Preadmission

When my doctor gave me an admission slip and said to be sure to bring it when I checked in to the hospital for my surgery, I stuck it in a safe place. I also happened to mention it to a friend who just had surgery, and she said, “He didn’t tell you to go do the admission paperwork beforehand?” Nope, didn’t say anything about that, and he was speaking in English.

So Wednesday a missionary co-worker (fluent in Spanish) went with me for the pre-admission process. The helpful hospital worker took my “admission slip” from the doctor, confirmed the surgery with someone on the phone, asked a bunch of questions, sent me to the caja to pay my deposit, and then gave me what I hope is my real admission paper.

I probably could have managed on my own, but it was definitely reassuring to have my friend with me the few times I couldn’t understand a question.

In other news, our health insurance only took four business days to approve my surgery, including correcting the form so that I was the patient and not Scott. I wonder if they even looked at my test results?  I don’t know why my other friend’s approval took two weeks; maybe there’s a different protocol for her surgery than mine. But what a relief to have the approval and not have to reschedule the surgery.

So, as far as I know, I’m ready for the surgery Tuesday morning. I’m to check in at 3 p.m. Monday. I’ll have a bunch of screening tests (blood tests, chest x-ray, EKG, etc.) and appointments with a family physician and an anesthesiologist, all to make sure I’m healthy enough for surgery. An IV will be started to hydrate me, since I won’t be able to eat or drink for 12 hours before the surgery. I’ll spend the night in the hospital and have surgery in the morning.

At least that’s what I think is going to happen. We’ll see if there’s anything else 1) someone didn’t mention because they assumed I already knew it or 2) I didn’t understand.

It’s an adventure, right?

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Shoulder Surgery – A Little Anatomy

Six months ago when I started thinking about shoulder surgery, I realized I didn’t know a whole lot about how shoulders work. Since then I have learned:

  • It’s one of the most complicated joints in my body, a ball-and-socket joint that lets my arm move in a bunch of different directions.
  • It’s a very unstable joint, as the ball (the humerus) is much bigger than the socket (the glenoid cavity). This instability is great for range of motion but makes it prone to injury.
  • (In case you don’t know, ligaments attach bones to bones, while tendons attach muscles to bones.)
  •  There are four rotator cuff muscles (supraspinatus, infraspinatus, teres minor, subscapularis) and their tendons join together to form the rotator cuff.  This cuff, along with the ligaments in the glenoid cavity, stabilize the humerus to keep it in the shallow glenoid socket.

WebMd has two short articles with nice drawings of the shoulder bones, muscles, & tendons:

I have watched a bunch of YouTube videos about the rotator cuff and the shoulder. Here are the ones I liked best:

Here are the results of my MRI, first in the original Spanish and then translated by Google:

  • El estudio demostró ruptura a nivel de la inserción del tendón supraespinoso
  • Cambios en la intensidad de señal a nivel del tendon del subescapular mas presencia de lesiones de tipo osteocondral
  • Cambios inflamatorios sobre el ligamiento gleno-humeral y proceso de artrosis a nivel de la articulación acromioclavicular.  Mismo tendón muestra cambios intrasustancia
  • Relación articular estable en el espacio gleno-humeral
  • The study showed rupture at the insertion level of the supraspinatus tendon
  • Changes in signal intensity at subscapular tendon level plus presence of osteochondral-type lesions
  • Inflammatory changes on the glenohumeral ligament and process of osteoarthritis at the level of the acromioclavicular joint. Same tendon shows intrasubstance changes
  • Stable articular relationship in the glenohumeral space

So, I have a rupture or tear in the supraspinatus tendon where it attaches to the humerus.  This tear will be repaired and the tendon reattached to the humerus.

I have problems with my subscapular tendon, including lesions (I think they are like cysts) which I think leaked from a tear in the bursa.These cysts will be cleaned out and any tears repaired. I’m  not sure how la intensidad de señal (signal intensity) should have been translated. It might be “scar” or “amount scarring.”

I have inflammation in one of the glenohumeral ligaments; the glenohumeral joint is what the doctors call the shoulder ball and socket. .If this involves the long head of the biceps (which attaches in this area), my doctor may move this bicep tendon to a better location. I’m not sure what else he might do in this area.

And I may have bone spurs on the bottom of the acromion bone (“process of osteoarthritis at the level of the acromioclavicular joint”). If so, these will be smoothed off to provide more space between the acromion and the humerus and prevent the bone spurs from causing pain and damage.

(If one of you medical types spots an error in the translation or my statements, please let me know. Thanks!)

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Shoulder Surgery – Appointments

Reach Beyond’s hospital, Hospital VozAndes, is like a medical center as doctors see patients there. I asked Jenny, Reach Beyond’s Ecuadorean secretary, to call and make me an appointment with Dr. Febres, an orthopedic surgeon.

You have to pay for your appointment ahead of time at one of the hospital’s cajas. I usually allow 30 minutes.  After you pay, you’re given stickers with your patient information.  If the doctor orders an x-ray or physical therapy or even surgery, he’ll use these stickers at the top of the form.

Each medical speciality has its own consultorios (examination rooms).  The orthopedists are in Traumatología (Traumatology). You give your stickers to the nurse and she takes them in to the doctor.  Then you wait.  You never know long it will be until the doctor calls your name.

In Ecuador doctor appointments are a social occasion. Everyone seems to come with at least one other person.  In a waiting room with 15 people, maybe only four or five are patients; the rest are providing moral support. When the patient is called, everyone goes in.

My pre-surgical appointment was stressful because almost everything is in Spanish and things didn’t go as expected. Not having command of the language is hard in ordinary situations, but in a medical situation it is much worse. I waited in line for 15 minutes at the normal caja but they couldn’t find my appointment. So I went to Traumatology and the nurse asked Dr. Febres if he could fit me in. He graciously said yes, so it was back to the caja for another 15 minute wait. They said I needed to go to the Emergency Room caja. They asked for a bunch of information that they should have already had in their system, and I paid for my appointment.

I realized later that they had assigned me a new Clinical History number, a number the hospital uses to track each patient’s unique medical history. The confusion probably arose because my previous Clinical History number was connected to my passport number.  In November I got my resident visa and a cédula, a national identification card. When I got to the caja I gave them my name and cédula number,  but presumed they would search for my appointment under my name.

In the meantime Scott had come to meet me for my appointment. He couldn’t find me in Traumatology, at the normal caja, at the second floor caja, or at rayos equis (x-ray). So he went back to his office for his phone (the Reach Beyond offices are across the street from the hospital). I heard his phone call but couldn’t answer in time, so I called him back. Scott found me in Traumatology and stayed for about half an hour.  When patients who had come after me were being seen before me, we realized that the wait could be a long one and I sent him back to work.

Humorous note:  that evening we couldn’t understand why the $10 of minutes Scott had just put on my phone was gone. Scott spent over an hour trying to get on-line access to my account with Claro, our cell phone provider.  He finally succeeded and discovered that I had had a 56 minute call that morning with him.  Neither one of us had hung up after our ten second call and the line stayed open until my phone ran out of minutes!

Thankfully Dr. Febres speaks good English and the appointment went fine. He filled out my admission slip and scheduled my surgery.  I took another form to the information desk to get a cost estimate.  Two different people asked me if I had seguro privado, which I thought meant private insurance (Ecuador has socialized medicine and the government provides healthcare to qualified individuals). I showed them my insurance card but they just asked again if I had seguro privado. I found out later that seguro privado means insurance purchased personally as opposed to insurance provided by an employer.  Now I know.

The next day I submitted the pre-approval forms to our insurance, getting an email response that I should hear their decision in three to five business days.  Soon after, a friend mentioned that it took her two weeks to receive pre-approval for her surgery. Yikes! I don’t have two weeks before the surgery.

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Shoulder Surgery – The Decision

I (Jody) have had pain in my right shoulder for more than four years. Generally the pain was just with certain movements or if I slept on my right side, the kind of pain you can live with.

When we moved to Quito 2-1/2 years ago, though, my life changed quite a bit. We didn’t have a car and I found myself doing more carrying of grocery bags longer distances or carrying a heavy backpack. I also did more baking by hand rather than using a mixer, especially making bread. To do laundry involved carrying the basket up to the roof where the laundry is.

I think my attitude was, “I’m strong, I feel young, I can do things by hand, I don’t need a car or a KitchenAid mixer.”

After about 1-1/2 years, though, my minor shoulder pain became major, waking me up at night. Initial doctor appointments were followed by an ultrasound, then an MRI, appointments with an orthopedic surgeon, and 15 physical therapy sessions. I bought exercise bands in the U.S. and have used them for four months six days a week.

But the pain is still there (although better) and last Wednesday I scheduled surgery for this coming Tuesday. (That’s assuming my insurance pre-approval arrives by then.)  I’ll have it at our hospital here, Hospital VozAndes (“the voice of the Andes”). I’ll have at least two nights in the hospital, two to four weeks with my arm and shoulder immobilized, and one to four months of physical therapy.

My surgery will involve reattaching a ruptured supraespinatus tendon to the top of the humerus, cleaning cysts out of the sub-scapular area, and moving my bicep muscle (or maybe tendon?) higher on the humerus (I think).  The surgery will involve an open incision rather than arthroscopic surgery.

Dr. Febres, my surgeon, speaks English, which is wonderful. Almost no one else in the hospital will speak English, though, and this is one of my major apprehensions.  Scott can’t be with me all the time, and I fear not understanding a question or not being able to communicate a need.  This is the trade off for having the surgery 1) where I live and have people to  care for me and 2) where it will cost much less. (The estimate for my  hospital stay, surgery, and the surgeon’s fee is just over $4,000.)

This is the first of (I hope) several blog posts about the surgery.

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