Thursday, 19 November 2015

My Broken Wing.......

It’s a strange feeling coming round from surgery…like waking from a very deep hungover sleep, wondering where the hell you are, and why part of your body feels a bit strange….so it was as I awoke last Thursday after a couple of hours of anaesthesia whilst my shoulder was being put back together. The last thing I remember after walking to the theatre room and lying down on the bed was an achy feeling spreading through my hand and up my arm and then a funny taste in my mouth, then next thing I know I was waking up feeling groggy, slowly realising I was in a hospital bed and as I tried to move, my shoulder felt restricted. I could see it was covered in dressings, held in a sling, and also looked massively swollen.  Ah yes, the memory became clear…I’d just had surgery! The good thing was at least they’d operated on the correct one!

To be honest that first day is a bit of a blur…. after the anaesthetic drug induced light-headedness, I remember having an incredibly dry mouth, a completely unquenchable thirst, drier than the Sahara in a dust-storm, and drinking endless glasses of water. I can remember the pain setting in and asking for painkillers, being given paracetemol and thinking hmmm…don’t think this is going to help much! The struggle to get dressed with a heavy, painful and unusable arm…and how  awkward it felt to move without causing intense discomfort. And most of all, the dawning realisation of what life is going to be like for a while…..I could feel my mood descending lower despite my best efforts to be positive.

My Surgeon came in and reported all had gone well, although there had been significantly more damage than was evident on my scan. Not only had I had the planned bankart repair to my anterior labrum (anterior stabilisation), he’d also found a reverse bankart tear, as well as a SLAP tear and that as a result of these the whole capsule had shifted to the wrong position. These were all repaired during the surgery, so at least I got my money’s worth! And also at least it was all found and fixed early rather than have years of problems and pain and damaging the joint further. I know that’s a good thing, and that undiscovered, these injuries would have prevented my shoulder from ever functioning normally again….so I should be glad. It’s just quite hard to feel like that currently. The news that the surgery had been a lot bigger than planned only added to how down I was already feeling.

It still baffles me how I sustained so much damage from such a small crash, but hey ho, it is what it is. The ex-physio in me has a need to know what’s been done to my body, so I can understand why it hurts so much and where, and how I can do everything as well as possible to ensure I heal as well as I can. Unfortunately this also means I understand what a massive invasion on a sensitive and important part of my body this is….i can’t help but worry about how much it’ll impact my shoulder in the future...
Here’s a bit of anatomy so you can see what has broken, and been repaired, inside my poor little shoulder…

Anatomy of the shoulder socket []

The damage is to the fibrous cartilage ring called the Labrum, which encircles the shallow socket of the shoulder, providing a lot of the stability in a joint which is inherently unstable. 

Unfortunately when you dislocate a joint, stuff gets damaged…you wouldn’t be able to dislocate it if it didn’t. Whilst broken bones heal, cartilage doesn’t, and so if the damage is substantial, surgery is required to repair it. You can choose not to have this, but without an intact labrum, there is 50% less stability in the joint, and if your job or lifestyle involves overhead movement, weight bearing, or manual work, then the risk of redislocation, pain on movement, and the joint never regaining full strength is high. 

Add to this the fact that continued dislocations, and the joint not working biomechanically as it should for many years will lead to arthritis, and it’s a no-brainer for me to have had surgery….despite the pain it currently is causing me!

If you imagine the shoulder socket, the glenoid cavity, as a clock face, my labrum was torn off from 4 o clock to 12 o clock…ie 270 degrees.

When a tear is to the 3-6 o clock position, at the front of the joint (anterior), it is called a Bankart tear. If the labrum pulls off the edge of the bone with it as mine did, it's called an ALPSA lesion (Anterior labral periosteal sleeve avulsion)

When the tear involves the 11-1 o clock position, and the point where the Biceps tendon attaches to the labrum, it is called a SLAP tear (superior labrum, from anterior to posterior)

When the tear is in the 6-9 o clock position it’s known as a reverse Bankart tear.

All images above
My tear was a combination of a bankart, reverse bankart, and SLAP, a bit like the one shown here.
When you see what has actually been done inside your joint, it explains the pain and swelling….3 incisions made for the arthroscope and surgical tools, 6 anchors that are a little bit like miniature expansion bolts drilled into the bone of the shoulder socket, sutures wrapped around the torn labrum (ring of cartilage) and used to tie it back in place, as well as a few extra stitches/overlaps to pull the capsule into the correct place….yes, all that is as painful as it sounds. It certainly feels like someone has screwed nails into the bone on the inside of my joint….in a way that’s exactly what they’ve done!

The picture below shows a labral repair being done in a similar way to mine, except I have 6 anchors spread out pretty much all the way round the glenoid.
I don’t think I’d prepared myself for how much it was going to hurt post-op, but then I didn’t expect to be having so much drilling, tying, fixing, and poking around done in there either! As the local anaesthetic that had been injected in the joint wore off and the pain from having my poor shoulder thoroughly messed around with kicked in, it was stupidly painful. The paracetomol and codeine I was given did absolutely nothing, and for the rest of the day and all of the night, I suffered with intense pain and a complete inability to get comfortable. I spent hours pacing around, lying, then sitting, then reading, then watching a film, then repeating, all night.

Swollen painful arm one day post-op
The next day I hit a thoroughly low point…as the fatigue from lack of sleep, recovery of my body from the anaesthetic, intense, unrelenting pain, and realisation of how long the recovery is going to take all got to me….I'm a positive person by nature, but I lost it all that day. 

I cried, a lot….from pain, frustration, and anxiety that my shoulder will never be as strong or as good as it was before. I realise it won’t ever be the same, but will I still be able to climb, swim, ride, do yoga, throw a ball, pick my bike up, carry on with all the things I love, without it feeling like I can’t move it in the way I need to do these things? I hope so…At the moment it feels like I will never have the full use or function of it again….

 After the first day and 24 hours of almost unbearable pain, I took the drugs I’d saved from post-op in Canada a few years ago….I hadn’t really needed them there but boy did I need them now. They aren’t licensed in the UK but I’m so glad I had them…along with ice every 2 hours, the pain started to recede a little and I at least got a bit of sleep.

I’ve had lots of injuries and broken bones before, and some surgery, but an injury to your shoulder, and on your dominant side as well, I’m learning is much worse….it’s such a fundamental part of your body, in everything you do, that you don’t realise it until its totally unusable.

Scrambling down from the Squamish Chief a couple of days after hand surgery in 2011....this experience has been very different!
My right shoulder and I have had an awesome relationship the last 34 years….I’m only now appreciating how amazing she is, and how well we’ve got on. From relying on her to pull me effortlessly through water in hours of swimming training and racing, power up and through overhanging walls of rock, carry bikes, perform handstands, back flips, climb trees, build things,, drive cars, to the things I’ve taken even more for granted….brushing my hair, eating, dressing, hugging friends, picking up a cup of tea, writing, rolling over in bed. I realise now there is not a single task I don’t rely on her for throughout each and every day, or where she is not somehow involved. Even things like walking, she’s moving a little bit to balance, or standing still, I constantly adjust her or use her for expressions without realising…..Until now. 
I know I've got another shoulder, but we don’t have the same relationship…..its not her I automatically turn to for every single thing each day. I’ve also never had an injury that took me out of sport for longer than 5 or 6 weeks…it’s already 6 weeks since I dislocated my shoulder, and recovery from this surgery is at least another 12….realistically I’m bracing myself for being told it’ll be longer…..I hope my mental strength can hold out that long.

In my lowest moments since the op, I've missed Gareth more than ever. His giant hugs and the way he made everything feel like it'd be ok in the end I could really have done with at many times in the last week. He was there through all the other injuries I’ve ever had, and I feel like it’s a much harder challenge facing this alone than any of those felt. The day of my op was 4 years to the day since Gareth's accident, and whilst I didn't have chance to dwell much on that this year due to being in surgery or recovering from it, I'm know how low I've felt in the week since is partly down to thinking of those traumatic 10 days following his accident.

Bored, in pain, and feeling pretty rubbish!
By day 3 I'd imagined the pain was going to have settled, especially with the Canadian drugs I'd taken....It hadn't. Another night of little sleep and day of intense pain that didn't seem to be easing at all. I kept telling myself it was bound to be painful after what had been done to it, and I just needed to man up and get on with things....but I was sliding further into depression. I'm used to pushing my body through physical pain, carrying on when everything is telling you to stop, it comes with the territory in many of the sports I've done over the years. I managed to ride a whole season last year with 3 breaks in a bone in my was painful, but tolerable. But the pain from my shoulder has been on another level. It was relentless, doing anything I felt miserable, and everyday tasks were taking forever. Reading, watching films, wandering round in a drugged haze from room to room for a change of scenery, never able to find a comfortable spot but trying all the same. My days were governed by the times I could take the next drugs, even though they gave little relief, or by the next time I could put my magic “cryo-cuff” ice bag on my shoulder for some more temporary relief. I felt like an old person, shuffling round, trying to move as little as possible. In bed I slept, or at least tried to, with 4 pillows propping me up into a sitting position,with another pillow behind the right arm to stop the weight of the rested arm tugging or resting on the places where the drilling and stitching has been done.
I was exhausted, weepy, nauseous, achy, and felt like I was wandering around in a slightly detached world from the rest of reality. 
It was impossible not to get down about things…the road to full function and recovery stretched a seemingly endless distance ahead, and the thought of how far away doing any of the things I love and that keep me happy are, was scary. I felt myself becoming anxious that something was wrong, an infection, one of the bone screws pulled loose...the thought of having to face even more pain was too hard to think about….

By day 4 I'd reached breaking point. I couldn't stop bursting into tears, I felt so low, it’s a long time since I’ve felt like I can’t see an exit from feeling so down, but at that point, that's exactly how I felt.

After breaking down in tears of pain for the hundredth time since the op, my mum and a couple of other friends suggested I should ring Mr Walton’s surgical team to check whether this amount of intense pain was normal for this long post op, and showing no signs of easing. The nurse on the phone was fantastic, even though she probably struggled to understand me blubbing away. She agreed I shouldn’t be in so much pain, and whilst it may just be a case of not being given strong enough painkillers to deal with the pain of the first few days, which has never been brought under control, it could be an infection in the arthroscopy sites or some other damage….certainly worth a check with Mr Walton. 
An hour later I was seen and checked over. The op sites are healing fine, the arm is moving as it should, everything is going to plan, and it's bound to be painful after what's been done…I just needed stronger painkillers to take the edge off it.....if only I'd been given them from the start!! 

Massively reassured  by my lovely surgeon, and armed with some tramadol, I left feeling less worried, and within 10 minutes of taking the drugs, in blissfully less pain for the first time since the operation. Suddenly life didn’t feel so bad, I felt more acceptance of my current situation, and able to deal with the long road ahead, now I wasn’t in agony every minute of the day. 

It’s amazing how much pain impacts on you and your mental state. Now the pain is at a more tolerable much lower level, I feel so much better in myself, I don’t feel like bursting into tears every other minute, and I am calm and relaxed about having to rest and be patient….

Drugs....a concoction of which are coursing through my body each day!
It is like a switch has been flicked and life is ok again!
I had been putting up with such high levels of pain thinking I was just being a wuss, and I had to man up and deal with it….when actually if I’d just asked for stronger drugs at the start the pain would not have spiralled out of control and got myself into the state of chronic pain and depression I was in…oh well, lesson learned. Hopefully from here I am back on track.

It's now a week post-op, I've been able to walk for an hour or so each day, and start a routine of core work sitting on the gym ball, and a few lower limb stretches, gradually introducing my body back to exercise and moving in the way it’s used to! It felt good, I can’t describe how much my mental state has improved since getting the pain under control! 

This last week is one I'll be glad to put behind me, but like any experience, good or bad, there are things to learn from it. I’m so active normally that I expected to bounce back straight after surgery, but I’m learning that whilst the scars from keyhole surgery will eventually be small, what has been done to my body and how much it has to try and heal itself internally is massive. The effect of a general anaesthetic I’m realising is significant too…2 hours of anaesthetic gases will take up to 2 weeks for my body to fully recover from I’m told, and the strong drugs, whilst now keeping the pain under control, are leaving me feeling like a bit of a space-cadet! I did not think this would be the way I felt…with plans for walking the day after the op, the bike set up on the turbo trainer ready…..maybe things would have been a little less tough if I'd got the pain under control from the start, but even so, I completely underestimated the effect of the surgery on my usually bouncy self. I know my body will tell me when it's ready to get back to doing more, but at the moment it’s telling me it can't do much except rest, relax and heal....and (maybe thanks to the drugs?!)....I'm ok with that for now.....

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