I Need a New Shoulder, Part II

Last month, I shared news of my scheduled reverse shoulder replacement surgery. The damage in my right (dominant) shoulder joint had driven me to multiple courses of physical therapy, corticosteroid injections, and an experimental procedure. I coped with daily pain, but my limitations overwhelmed me. My physicians and physical therapists referred me to an orthopedic surgeon with experience repairing complicated shoulders. That consultation, supported by Xrays and MRI, affirmed the need for a new joint.

My orthopedic team explained each step of the procedure, and I went through their preoperative program which involved additional Xrays, blood work, and alterations to my medications. The hospital was two hours from home, so the night before, my husband and I checked into a hotel nearby to be close for my early morning arrival time.

Nervous and Anxious

My nerves were a-flutter, of course. Alcohol is prohibited for several days before surgery, so a relaxing martini was out. In addition, the recommendation to eat a light supper did not encourage stuffing myself full of soothing carbs. I listened to a yoga nidra meditation but the prospect of undergoing major surgery kept me awake much of the night before the procedure. This common reaction is one I had to get through hour by hour.

Everyone Had a Job to Do

I arrived to my preoperative suite early in the morning where I changed into the hospital issued garb with treaded socks. You are not allowed to wear any of your own street clothes, underwear included, into the operating room. There are paper alternatives if you prefer not to “go commando.”

A medical assistant weighed me, started my intravenous line, and scrubbed my shoulder with an antibacterial solution. Nurses interviewed me again and again, asking the same question, “What are you here for?” Having worked in an operating room as nurse, I understand the need for multiple confirmations. There are many documented cases throughout history of patients receiving treatment on the wrong limb or even the wrong surgery all together. All of these checkpoints are what are called “time-outs.” Everyone present understands what part of the body is being operated on, including the patient.

Surgeon Arrives

In the preoperative area, a variety of personnel visited, not leaving me alone for more than a minute or two at a time. My orthopedic surgeon arrived with a big smile. He asked me what I was there for. He outlined the procedure again, and I signed the consent. He wrote his initials on my shoulder, and his confident demeanor relaxed me.

Anesthesiologist Arrives

One of my biggest fears is undergoing anesthesia. Small moments of eye contact and true smiles often warm a patient as much as medication, and I found both in the anesthesiologist. He asked about my nerves, and we discussed what drugs would allay them. I expressed my request for a nerve block, and he paid close attention to me. Not every patient enters the OR with specific knowledge so knowing I was a nurse made our conversation flow.

If you don’t have experience with operating rooms, it is worthwhile to do research ahead of time. A good surgical team will listen and address each question you have. For me, having agency in what is done to my body is an important part of any procedure.

Time to Go!

The OR team descended on me, made introductions all around, and asked what I was there for. I kissed my husband a poignant goodbye. The team whisked me through the hallway, expertly navigating the corners, and I arrived into an OR full of people and tables laden with stainless steel equipment. I have observed many types of surgical procedures from a nursing perspective, but this room had the most equipment I’d ever encountered.

Orthopedic surgery involves power tools and aggressive gear to protect the surgeons and assistants. My surgery was performed with me in a sitting position, offering an observation point before I was anesthetized. Around me stood three or four assistants, as if guarding me from leaping off my gurney. The anesthesiologist told me when he injected the relaxation medication prior to intubation. I thanked him.

Recovery Room

My next memory was waking in the post-anesthesia care unit, or recovery room. I was swaddled in warm blankets, a blood pressure cuff on my nonsurgical arm, and my sling with its attached pillow in place against my torso with a rubbery arm that I could move but could not feel. The rest is fuzzy, but I eventually moved from that location to my hospital room.

Recovery Begins

I stayed overnight in the hospital. The nerve block wore off within 24 hours, and I had full sensation of my arm plus freedom to move my fingers. Narcotics were offered and taken the first two days. Once I was discharged, however, I did not need them anymore. A single Tylenol took care of any discomfort, and I found it remarkable that I did not feel pain in my shoulder.

No Pain Medication?

The PA explained to me that they had cut all the pain away when they removed the damaged bone and inflamed joint. Soft tissue repairs from massive tears had been done and tendons reconnected, but aside from being aware of the arm, I honestly felt great. My physical therapy assistant had told me that she knew of many people who had a similar positive experience.

Occupational Therapy and Physical Therapy

I was given a couple of mild exercises to get my arm moving the first afternoon in the hospital. After my two-week checkup, I started outpatient physical therapy which will last three or four months. The program my doctor prescribed is gentle and progressive. He warned not to lift more than two pounds with my affected arm until three months have passed to allow the soft tissues to fully heal. Updated Xrays showed everything to be functioning normally. In addition, I have a few exercises to do twice a day. The sling stays on most of the time more as a reminder not to use the limb than actual need for restraint. I am able to move my arm in all sorts of ways and would do so if it were left untethered. Especially important is to wear the sling at night for stability.

What to Bring to the Hospital?

I purchased a few accessible tops that use snaps or velcro for closure at the shoulder. They were less than $20 each and easy to find online. I wore one home from the hospital but stuck with institutional jonnies while there. Aside from personal toiletries, there is not much else needed during the immediate postoperative period. I brought a book and my phone but spent most of my time dozing or watching mindless television. My husband bought me throat lozenges because my throat was sore from the intubation. The hospital had hand sanitizer, room spray, and wet wipes for me.

What Did I Need at Home?

I had a recliner moved to my bedroom with a few pillows. Days spent in the recliner alternated with sleeping on a large wedge pillow, partially upright, in the bed itself. Some people sleep in the recliner for night time in the initial postoperative period. I chose the bed, switching sides with my husband (after over 45 years!), using my left arm for leverage to get up.

It’s important to choose a safe sleeping area because the restrained arm is not going to break a fall. We left the bathroom light dimmed, and I used my phone’s flashlight if I needed to take medication or replenish my water. Another positive factor was not taking narcotics that could cloud my mind.

I wore the ice machine shoulder attachment for several hours at a stretch intermittently throughout the day for the first week. The hospital sent me home with portable ice packs and I switched to them because of the ease of use and their effectiveness. A month later, as I write this update, I continue to use ice packs after PT and at night. I take an occasional Tylenol for general discomfort.

I wore either a dress that I could ease over my head or elastic waisted slacks or sweatpants and a loose top during the first few weeks of recovery. If you wear a bra, either learn to put it on backwards and spin it or pull it up over your hips. That said, I went bra-free most of the time at home and still do when I go for an Xray, so I don’t have to deal with the extra work of taking it off.

I used my incentive spirometer religiously for the first two weeks several times a day knowing how easily people who are not active after a surgical procedure with intubation develop pneumonia. I walked purposefully to keep my limbs going and avoid blood clots. It was oppressively hot for the initial two weeks of recovery so going outside was not an option for me. Instead, I traipsed back and forth in my air conditioned hallway, setting goals for 10 or 20 passes at a stretch, measuring progress on my Apple watch.

Complications

One month passed and I noticed a reddened area near my scar. Antibiotics were ordered and almost immediately, the spot faded. It’s vital to report any reddened area, discharge, swelling, or increase in pain as a joint implant can act as a conduit to infection. The damaged tissue and bone that is removed during surgery is no longer there to fight off bacteria. A prosthetic joint, though wonderful in most ways, fails at this specific job. An infection can occur months, even years after the joint implant so vigilance is needed.

Showering, hair washing, and dressing are activities that tired me. Remember, your body has gone through a major incursion and is working hard to rebuild the surgical area. Fatigue will occur so allow yourself tons of rest time.

Summon Your Troops!

It’s helpful, perhaps vital, to have a friend or relative to assist you, especially in the initial period. Personal care is not easy to do with one hand. I was not allowed to shower for three days and the wet wipes that came from the hospital were a great help. Once I got in the shower, I couldn’t wash my hair or reach all my parts despite having a long-armed sponge. If you don’t have someone who can be with you, look into what services might be available in your community for volunteers or a home health aide. The time after major surgery is not when you should grin and bear it by yourself.

If You Need the Surgery, Get It

I am not a proponent of elective surgery in general. In this case, after having experienced the before and after of a damaged shoulder, I heartily recommend a consultation to see if surgery is an option. At this point in my healing, there is no doubt that I did the right thing for myself. My body feels the heaviness of having gone through a major operation, and I require downtime to keep up with the metabolic activity of healing that’s happening in my joint. Physical therapy, though undemanding at one month out, will increase in scope as it progresses.

The prediction is I will be able to do all my daily activities and exercises with very little restriction once everything has healed. Patients return to play tennis, pickleball, and golf after shoulder replacement, even in their 60s, 70s and up. Living without pain has made the surgery a desired alternative after dealing with my shoulder issues off and on for years.

Let’s Have a Conversation:

Are you debating whether to go through a joint replacement? What questions have you had, and have you been able to get an answer? I’m happy to answer any questions from a patient perspective. Please note that my essays do not constitute medical advice, only my personal experience.