Was it worth it?

You may have noticed Monday’s incomplete post about waiting.

At the time, I was in the waiting room at my physiatrist’s office.  On tap was my treatment for a frozen shoulder, namely a corticosteroid injection into the shoulder capsule (to reduce inflammation) and manual manipulations to break up the scar tissue that’s been keeping my shoulder from working, along with injections of a local anesthetic and a couple of nerve blocks so that the manipulations occur with the least amount of pain possible.

I’m happy to say that my post about waiting was interrupted by the prompt service at the office (it’s just too bad that I accidentally hit “publish” on my unfinished post in my smartphone instead of cancel… smart phone, dumb fingers).

After getting changed into a gown, I was taken in for a couple of x-rays of my shoulder and c-spine.  These were nice and quick, and the radiology staff were great.

Next I was put onto a gurney and wheeled into a procedure room.  The ritual washing with foul-smelling iodine-ish solution followed, and soon my physiatrist was there getting ready to do the injections.

Luckily, this guy is awesome at injections.  I get this feeling that he does 40 in a day.  He’s quick and sets expectations appropriately (“This is going to pinch…” “now you’re going to feel pressure…” “now we’re injecting medicine and it’s going to burn a bit…” etc.).

Injections are generally performed under fluoroscopy guidance (that’s real-time x-ray) so that the doc can be sure that the needles and substances are all going to the right places.  As I’ve noted previously, I have a professional curiosity about such things, as well as just generally enjoying being able to see what’s going on when I’m getting things like this done.  I was happy that my position on the gurney allowed me to see the monitor that was showing the images of my shoulder as the doc worked.  Damn that stuff is cool.

Next I was left to relax for a bit with a magazine while the nerve blocks took effect.

Here’s where things started to get crazy.

I had been under the impression that my arm would be numb during this procedure.  Apparently not.  I had FULL FEELING in my arm, with the exception of a very localized spot in my shoulder… basically the joint itself.  As this was not what I was expecting, I was a bit worried, but decided to roll with it.  Surely they would know what to numb to make this comfortable.

Meanwhile, one of the nurses came in and we chatted.  He said “So, he’s going to turn you into a pretzel now, eh?”  He said it jokingly, and definitely with a positive vibe.  Still, I started to get a little more apprehensive.

The doc came back and proceeded to put me in interesting positions (very much pretzel-like, more so than I was expecting) to break up the scar tissue.

And I’m not kidding about “breaking.”  It is literally what happens.  One puts the shoulder at the edge of where it can move, and then FORCES it until it breaks.  There is an audible pop and grinding when it actually lets loose.  And of course, this has to be done multiple times, in all sorts of directions, and it doesn’t all go at once.  It’s a tiny bit-by-bit kind of thing.

Sound painful?

IT WAS.

I actually pride myself on having fairly high pain tolerance.  I’m generally good at breathing through pain, relaxing muscles so that I’m not fighting whatever is going on, especially when I know it’s coming.

But in this case I really didn’t know what was coming.  I wasn’t prepared.  And wow, it really REALLY hurt.  It hurt to the point that I was crying before I even realized it.

He would go in one position, things popping and grinding, until my body couldn’t take it any more and would go into full spasm.  We’d take a 5 second break as he’d reposition me and we’d give it another go in a different position until that one, too, made me writhe on the table.  At least the popping and grinding made it seem as if what we were doing was productive.  It was actually worse when he’d give a position a go and we didn’t get a good crack.

I was shocked.  But I was being a good trooper.  I was breathing, I was trying so hard to relax and not fight.  I wasn’t asking him to stop.  I would smile during the breaks and suck it up for the next round.  But as we went on my body just couldn’t help itself and my muscles started to fight.

Our bodies are designed to protect us from pain.  They are designed with unconscious reflexes that move us away from harm.  And that’s what my body started doing.

The doc had to concede that even though he didn’t get as much of the tissue broken as he wanted, we needed to stop — it was as far as we were going to get.

He said “I know you hate me now, but you will love me later, I promise.”  The funny thing was, I didn’t hate him at all.  At least, not for the work he was doing.  In fact, right then, I believe I was in shock.  I was shaking from adrenaline, and the nurse, when he game to get me to wheel me back to the recovery room, took one look at me and said, “Oh, I’ve seen that face before, ripped your arm off, did he?”  Ha. Ha.  I smiled ruefully and said, “I can’t even CONCEIVE of what that would have felt like without the nerve blocks.”

I was somewhat out of my head, but things seemed OK.  The nurse went and got huge bags of ice and encased my shoulder in them.  I was given some orange juice to help my system recover a bit.  Things were going well.  The procedure was nightmare-ish, but it was done.  Anything can be borne in short increments.

And then the pain came.  And along with it, the panic.

See, no-one told me that the pain DURING the procedure would be nothing compared to AFTER the procedure.

And no-one told me that I wouldn’t be able to move my arm.  When I tried, the poor muscles in my arm which had been fighting so hard to protect me simply gave up.  The pain was excruciating.  My shoulder was golden, but the REST of my arm was on fire.

I seriously thought something had gone wrong.   A muscle had been damaged, surely?  Otherwise someone would have told me to expect this?  I kept telling nurses that something was wrong.  I sat on my gurney inside my curtained area, holding the ice to my arm like a life-preserver, and I couldn’t keep back some more from-the-gut sobs.

The staff called M to let him know I was in recovery and he could come get me now.  I was back to waiting, waiting for him to get to me because I really needed him.  And he came quickly, even though it seemed like forever.  And when I saw him I couldn’t help it, I just bawled as he came over to the gurney and held me, as best he could in the awkward position.  Around him, at least, I don’t have to pretend to be strong, I can let it go.

I got the crying out of my system (mostly) and kept telling the nurses that something had to be wrong.  They spoke with the doc who decided to do another round of x-rays to make sure none of the bones were fractured in the process.  I thought this was silly… I wasn’t worried about my bones, the pain I was feeling was clearly all muscle.

At this point, M had to go get G from the nanny who couldn’t stay any longer.  He would drop off my prescription for Lortab on the way to get G, and then once he’d brought G to me and we could all go home, we’d stop and pick it up.

The x-rays showed that my bones were fine, really no surprise there.  And not even relief because I hadn’t been concerned about it in the first place.  If anything I was annoyed by being needlessly irradiated.

They basically told me at that point I could get dressed and go home.  That was it.  No-one was addressing the issue about me not having a mobile arm.

I went into the changing room and realized I couldn’t get my bra on.  I had brought a shirt that zipped all the way apart in front because I’d been expecting a numb or sore arm that would be somewhat difficult to move – at least I’d thought ahead that much.  But in my current state, the bra eluded me.  I put on my shirt, slowly and painfully sans bra.  It’s amazing that vanity can be so strong.  I looked at myself and couldn’t fathom actually being seen in public without a bra like that.  It made me look deformed (see my post about my breasts here for an explanation).  And so, in tears again in frustration, pain, and embarrassment, I kept sticking my head out of the dressing room waiting for a nurse to walk by so I could ask for help.

While I was waiting, the doc came to see me.  He apologized that I was in so much pain, he reassured me that it would get better, that it was just a flare up.  He again made the “I know you hate me right now,” speech.  And I flat out told him, “I don’t hate you.  I don’t think the work you did was bad.  I think you did a piss-poor job of setting expectations.  I was led to believe that I would be numb, that I would be sore later, but that I would have use of my arm.  I have a dinner party tonight.  At this point I can’t even imagine how I’m going to pick up my baby to feed him!”

Here’s the one place where I’m unhappy with the doc.  Instead of saying, “Yes, I’m sorry, we should have done a better job,” he said, “Most people don’t react like this.  It’s not your fault — your muscles were really fighting me.  But that only happens to 1 in 10 people.”

“Then I should have been told about that possibility, even if it was remote!” I snapped back.

He looked appropriately chastened.  I wanted to be sure he understood.  “Look,” I said, “I get that this kind of procedure is going to involve discomfort, I’m really not at all upset about the procedure itself.  I am grateful, and I know that later it will feel better.  But I’m worried about my muscles, they are very bad off.”

He told me to call his office the next day, let him know how I was doing, and he apologized again.  I could tell he was, indeed, genuinely upset by the fact that I was in so much pain, even if he hadn’t given me the verbal response I wanted.

A nurse came by and helped me with my bra after that, and I went and sat in the waiting room with my huge bag of ice.  At least two nurses came out to see me while I was waiting for M and G to pick me up.  They were just checking to make sure I was comfortable, and were genuinely apologizing.  I appreciated their care and told them so.

M and G made it to me, and we packed up in the car and picked up the narcotics on the way home.  I took one in the car — waiting was not an option.  As I’ve mentioned, I’m bad at waiting.

I may have also mentioned that we were having a dinner party that night for 10.  M was recently elected President of the Board of Directors of a local social organization.  The newly-elected President always hosts the rest of the Board at his home around this time of year.  The party had been planned weeks in advance, and it was just bad luck that my procedure got booked on the same day.  But given the expectations that had been set by my doc’s staff, we figured it would still be OK.  We made crock-pot pulled pork ahead of time, along with cole slaw and green beans.

Now, however, it was a different ball-game.  Luckily another board member offered to come early and help out with the remaining set up so that M could help me with G.

Also luckily, the Lortab kicked in and I was happy to find that I could use my arm again, although with less added movement than I thought I would have post-procedure.  That aside, the party ended up going really well, and I am so grateful for the help provided by the other board member who even stayed after to help clean up, which was great, because by that time the Lortab was wearing off, and my body was pretty much shutting down.

I got about 4 hours of sleep that night.  I took yesterday off of work.  Firstly, I don’t think that working while on narcotics is a good idea… who knows what I might say to customers in a haze of opiate optimism?  Also, my arm was so weak that typing was close to impossible.  The muscles just shook and didn’t want to cooperate.

I’m back at it today.  I’m happy to say that I haven’t needed a Lortab so far (Yay!  I hate narcotics.).  The muscles are weak, but cooperating.  My arm hurts, but not nearly as much as it did, and icing and ibuprofen are keeping the worst at bay.  The shoulder itself feels grand even if I still can’t move it very far… clearly the steroid is working.

The most annoying thing at this point is the “come down” from the Lortab.  I’ve got some shakes and feel like I can’t concentrate on anything.  Typos spring from my keyboard more so than they have since I first started typing when I was five years old.

I start physical therapy again Friday or Monday.  We have to keep my shoulder moving so that the scar tissue doesn’t just build itself right back up again.

I have noticeable improvement in a single direction.  However, in all other directions it feels like there’s been no improvement at all.

I have to ask myself, was it even worth it?  Will I need to do this again?  Is there a way to do it differently so that it’s more effective (E.G. under general anesthesia, different and/or more nerve blocks)?

What if I never get my shoulder back?