Post-Surgery Status Update

Surgery went very smoothly.  It was a quick and relatively painless procedure [post pending].  I did not feel loopy or drowsy afterward, and had a perfectly normal afternoon following surgery.

Now that I have learned the benefits of frequent icing post-surgery, I use significantly fewer painkillers.  Don’t get me wrong – you should definitely use them if you need them!  I took painkillers at the minimum allowed interval for many days after my SLAP repair – that recovery was brutal.

But I have found frequent icing, elevation, and Tylenol to be sufficient for my last two surgeries.  However, it must be said that I have always had a high pain tolerance, which has increased even more after nearly two decades of migraines.

Manage your pain responsibly, and in the way that is optimal for you, in consultation with your doctor.

So now I’m in a soft cast for two weeks, and sleeping in a sling at night to protect my wrist – never comfortable or convenient, but a necessary evil.

I have to say I am incredibly grateful for arthroscopic surgery – it makes the procedure so much less invasive and the recovery so much easier.

I realized as I was in-processing for surgery that it has been four years since the initial injury.  I strongly hope that this will be the last corrective procedure, and I can finally put that incident behind me!  Beware slip and fall injuries!

WARNING: If your prescribed painkiller includes Tylenol (acetaminophen), do not take additional over the counter Tylenol (acetaminophen).  Pay close attention to daily dose limits.  Exceeding the daily maximums can cause liver damage.

I take Tylenol instead of prescription painkillers, NOT in addition to them.

 

I Have a Screw Loose

Headed to surgery tomorrow to have my loose screw removed. Betcha never knew that was an option. 😉

I will have several posts to share about the experience once I’m able to blog again.

Doctor is predicting a simple procedure and a speedy recovery if all goes well.

I want to know if there’s a surgical equivalent of frequent flyer miles…

Planning for Military Retirement

I recently came across this article, which adds some great points I have not already discussed on this blog:

https://www.linkedin.com/pulse/navigating-military-retirement-thoughts-lessons-kirk-windmueller/?trackingId=Q0UHdDCVjQzxru2zUE%2BvTw%3D%3D 

It’s written for officers, but many of the recommendations would be useful to enlisted as well.

Be prepared!

One Sick Vet Second Blogiversary: The Origin Story

 

Whelp, One Sick Vet is two years old, so it seemed like a good time to explain how One Sick Vet came to be.

Backstory: 

It all started with a giant metal chicken.

A friend posted this link on Facebook and I was hooked.  I’ve been reading The Bloggess’s blog ever since.  It was the first blog I read and followed.  The “gateway” blog, so to speak.

That lead to other blogs…

First, The Bloggess’s friends, like Chookooloonks.  Then I found Hyperbole and a Half and Cake Wrecks.  I was entertained, and also learning from others’ experiences of dealing with significant health issues, including mental health issues.

And then Mister Money Mustache (MMM) burst on the scene.  His blog lead me to other personal finance blogs.  Among my favorites are J. L. Collins’s blog (you may recall I reviewed his book, The Simple Path to Wealth); J. D. Roth’s various blogs (he recently bought back his very successful blog, get rich slowly); The Military Guide (started by Doug Nordman, and focusing on  financial independence for military personnel); Frugalwoods (about frugality, financial independence, and figuring out what you want out of life); the Mad FIentist; and The Military Wallet .

I also read Simplicity/Minimalism blogs, travel blogs, and health blogs.

After years of reading other people’s blogs, I eventually decided to start my own blog.  Although there are various health blogs, I hadn’t found any blogs that talked about the specialized health issues of military personnel and veterans, like dealing with the military healthcare system, Tricare, and the Veterans Health Administration.  So I launched this blog, and published my first post on 25 January 2016.

In honor of this blogiversary, and the blogs that inspired me, I recently made a pilgrimage to Mister Money Mustache’s World Headquarters.  Here’s a picture of One Sick Vet (sporting a trademark bandana) wearing a Rory the Raccoon t-shirt in honor of @TheBloggess and standing in front of a MMM t-shirt in the window of his World HQ (@MrMoneyMustache).

How meta. One Sick Vet paying homage to The Bloggess and Mister Money Mustache.

I’d like to give a special shout-out to MMM for his super helpful post on How to Start a Blog, since I used that post to get started.  [The post is now 5 years old, so some of the information is dated, but it is still helpful.]

I’d also like to thank the small but faithful band of contributors, readers, and supporters One Sick Vet has accumulated, especially guest blogger Dave Banko for all of his informative posts and shipmate/Wingman Doug Nordman for all of his advice and support.  And, of course, Spousal Unit for putting up with all of this blog nonsense.

And now, what would you like to see *more* of on One Sick Vet?  What would you like to see *less* of?  What health topics would you like to learn more about?

Feeling like Ross Geller Again

Remember when I said my 2017 New Year’s Resolution was “No surgeries in 2017” – and then I had to have surgery?

Well, I was wiser this year.  I did *not* make a resolution of no surgeries in 2018, which is good, ’cause here I go again.

I met with my orthopedic surgeon yesterday and told him that my wrist is hurting again.  He took x-rays and informed me that the stainless steel screw in my wrist appears to have shifted a little bit, and also appears to be loose and moving around a little bit.

You can imagine the fun Spousal Unit is having with my diagnosis of a “loose screw.”

The surgeon wants to go back in and remove the screw, now that the wrist is stable and the tendons have had time to repair.  He wanted to do the surgery a few weeks from now, but I negotiated for a couple additional weeks – not because I like the discomfort, but because I’m still trying to finish grad school.  And also because I will need time for the authorization from Tricare to come through, which is apparently a hassle right now due to the contract changeover to a new contractor.

So why did I say I feel like Ross Geller?  Well, that’s Spousal Unit’s fault.  When I made the resolution to have no surgeries in 2017, and then needed surgery, Spousal Unit reminded me of the Friends episode in which Ross resolves “No divorces in ’99!” (See below):

So here I am.  Headed for surgery again.  Wondering if I should tempt fate by saying “Just the one surgery in 2018.”

Shoulder Surgery: The Good, The Bad, and The Ugly

To repair some of the damage done when I wiped out on that wet tile floor, I’ve had two shoulder surgeries – performed by two different surgeons.

The first surgery was to repair my severed labrum.  This injury is more commonly known as a SLAP tear.  SLAP is an acronym for Superior Labrum Anterior and Posterior.  The labrum is a ring of cartilage that surrounds the socket of the shoulder joint.  It helps to deepen the shoulder socket and to stabilize the shoulder, and is the attachment point for many of the shoulder’s ligaments and one of the biceps tendons.

Torn labrums are ridiculously painful.  Before I was successful in convincing  my PCM that I needed a shoulder MRI, I was taking strong drugs and begging for a referral to pain management.

My first shoulder surgery was also my first ever surgery – if you don’t count having my wisdom teeth out years ago.  It was pretty straightforward.  My labrum was severed; the surgeon went in and reattached it.  He used a couple of plastic anchor bolts and some sutures to reattach the labrum.  He cut away a little dead tissue, and made sure there was no other damage that had not been detected by the MRI/arthrogram.

Prior to the surgery, I had been in a ridiculous amount of pain.  I was able to sleep in one position on the couch – lying on my non-injured side, with my back against the back of the couch, and surrounded by 5-6 pillows that held my shoulder in the one position in which the pain mostly subsided and I could fall asleep.  Of course, anytime I moved in my sleep and the shoulder shifted, the pain woke me up.

Post-surgery was worse.  I didn’t get the memo that the best way to recover from shoulder surgery is to sleep in a recliner.  We did not *have* a recliner.  Had I known, I would have begged, borrowed, or bought a recliner.

Seriously, if you’re going to have shoulder surgery, make sure you can convalesce in a recliner – or an adjustable bed.

I came home from out-patient shoulder surgery narc’d to the gills (technical term) ;-).  Typically, for shoulder surgeries the anesthesiologist will do a nerve block, which blocks the nerve signals for up to 24 hours.  I was also placed under general anesthesia for the surgery.  And the nurses often will give you a narcotic before you leave post-op, to make sure you “stay ahead” of the pain.

So Spousal Unit got me back into the house and ensconced on the couch.  I got “comfortable” sitting sideways on the couch, with my newly repaired shoulder in a sling that was resting on multiple pillows and leaning against the back of the couch.  I dosed most of the rest of the day, and slept sitting up for the first few nights.  (Not comfortable.  Do not recommend.  You need to be exhausted to do it.]

I had a long and painful recovery.  My labrum hurt significantly LESS after surgery, but it still hurt like hell.  You have to keep your shoulder immobile for a long time to allow the labrum to heal, and that creates other problems, as your shoulder and elbow can get painfully stiff.

Flash forward two years, to shoulder surgery #2:

The shoulder felt “good as new” for about a year and a half.  And then it didn’t.  First the motion felt “off.”  The shoulder started to catch and clunk.  Then the pain started to return.

By this time, we had moved to another state, and I had a different orthopedic surgeon, who had already operated on my wrist and elbow.  After the manual examination and the MRI/arthrogram, he told me he would operate, but he wasn’t going to repair my re-torn labrum.

In fact, he told me that if he had performed my first shoulder surgery, he wouldn’t have repaired my severed labrum.

“Okay, doc, you HAVE my attention.  Please explain to me why you would not have repaired something that was totally severed and causing excruciating pain, because that sounds totally counterintuitive to me.”

We then proceeded to have a long conversation about labral tears.  And age.  In a nutshell, my ortho explained that labral injuries do not heal well in patients over 40.  Based on his experience and knowledge of the literature, he thought it was a waste of time to repair the labrum again.  Instead, he wanted to severe my (perfectly functional and not damaged in any way) biceps tendon from the labrum and reattach it to my humerus in a procedure called a “biceps tenodesis.”

The reason for this is that the biceps tendon is connected to the labrum, and the tension it exerts on the labrum can prevent the tear from healing and can actually make the tear worse.  By removing this tension, you create the possibility that the labrum might heal itself.  But even if it doesn’t heal, because you removed the stress on the labrum, hopefully the tear won’t continue to get larger.

My surgeon recommended I read a couple medical journal articles on the subject (because he knows I always thoroughly research my medical issues and the procedures doctors recommend to treat them), and then we would meet again to discuss the surgical options.

Here are some of the articles I read to inform my decision about revision [repeat] shoulder surgery:

“Controversy persists about whether to repair SLAP tears in patients over 40 years with associated rotator cuff tears (RTC).”

Torn rotator cuff with SLAP tear

The efficacy of biceps tenodesis in the treatment of failed superior labral anterior posterior repairs

“The cumulative evidence supports labral debridement or biceps tenotomy over labral repair when an associated rotator cuff injury is present.”

Subpectoral biceps tenodesis for the treatment of type II and IV superior labral anterior and posterior lesions.

Glenohumeral ligaments

Superior labrum anterior posterior (SLAP) tears

Rotator cuff injury

There’s a good quick-and-dirty summary of the research here, which answers the question: “Why would you fix my biceps if my labrum is torn?” It also provides a good explanation of the procedure and has an illustration.

The research supported what my ortho had said.  In fact, in recent studies labral tears were shown not to heal well in patients older than 26.  26!  In addition to the SLAP tear, the arthrogram had shown a small rotator cuff injury, and the research on that injury recommended repairing the rotator cuff, doing a biceps tenodesis, and leaving the torn labrum alone.

Had this been my first experience with this surgeon, my decision might have been more difficult.  But, based on the research, and based on my previous (all excellent) experiences with this surgeon , I decided to trust him to fix my SLAP tear by ignoring the labrum and jiggering with my biceps tendon.

I felt really uncomfortable letting him cut something that wasn’t broken to begin with.  In the end, you do your research, make the best decision you can, and trust your surgeon (whom you have carefully researched and selected) to do a good job.

Fortunately, when he got inside my shoulder, he found no evidence of rotator cuff damage, so he inspected it thoroughly and left it alone.  Had I needed rotator cuff repair, my recovery would have been much longer.

I was a lot smarter the second time around.  I had a recliner AND an adjustable bed.  Never even needed the recliner – the adjustable bed worked just great!  I was able to raise the head to get enough support for the shoulder, but still be able to sleep.  I still propped up the arm on several pillows, but got much better quality of sleep than the first time around.

But here was the absolute game-changer: a chiller (aka cold therapy).  Now, faithful readers of this blog will know that I seldom endorse any product.  But a post-surgery chiller is something I HIGHLY recommend.

I don’t know how I didn’t know about them before, but these devices circulate ice water over the site of your injury/surgery.  This helps prevent inflammation, and also brings pain relief.  Chillers are particularly useful for joint surgeries (shoulders, knees, ankles, etc.)

I was offered the use of a chiller by some folks at church, because Tricare would not provide one.  [Possibly because my surgery was through a civilian provider.  I have recently seen military facilities loan them to patients post-surgery.]  They come in various sizes.  I was loaned a pretty basic one (see image), but it worked just great.

I understand that the folks I borrowed it from keep an eye open at thrift stores, yard sales, etc., and pick them up pretty cheaply.  Then they have one when they need it, and one or two to loan out.  It certainly made my recovery quicker and much less painful, and I am grateful.

[For the curious: Yes, it’s basically a small ice chest, but it has a pump and hoses that circulate ice water around the injury.  At the end of the hose is a plastic pad (see image) that you wrap around the injured site.  You can secure it with an included velcro flex strap (like an ace bandage).  All you have to do is add ice and water and plug it in.  BE CAREFUL TO AVOID COLD INJURIES.  Don’t ice for more than 20 minutes at a time, remove if it’s uncomfortable, and always place something between the pad and your skin (a hand towel, washcloth, pillow case, etc.).  ]

Why I am in love with cold therapy: After my first shoulder surgery, I was prescribed narcotics – “Take 1-2 pills every 4-6 hours, as needed.”  They wore off after TWO hours, and the pain was overwhelming.  I was living from dose to dose, just trying to hang on.  After my *second* shoulder surgery, I was given the same prescription, but I also used cold therapy.  I took 3 pills TOTAL.  And the second and third were only because the staff had given me multiple warnings about staying ahead of the pain, and I knew from previous experience that I did NOT want the pain to get ahead of ME.  I didn’t think I needed the narcotics, but was afraid to rely on the machine for pain control.  But as I increased the interval between pills, taking them only one at a time, and found that I was able to control the pain with cold therapy, I stopped taking them.  (The other great thing about that is, if you’re not taking narcotics, you don’t get opioid-induced constipation.)

Was the first surgeon wrong?  He repaired the damage, did a pretty good job, and it worked great for about 18 months.  He did no further damage, scarring was almost non-existent, there were no complications, and he didn’t overlook or fail to repair anything else.  My biggest complaints would be that 1) he did a repair that the research clearly shows to have a high failure rate in patients my age.  So I question how current he is in his knowledge of the literature in his field.  And 2) I did not have to suffer as much as I did post-surgery.  I really wish he’d told me about the chiller and the benefits of recovering in a recliner.

Had I seen my second orthopedic surgeon first, I probably would not have needed the second shoulder surgery.

Bottom line: The first orthopedic surgeon was adequate, but probably not as knowledgeable as he should have been.  There is a world of difference between surgeons, even between an *average* surgeon and an *excellent* one.

The Good: Cold Therapy/Chiller.  Adjustable bed/recliner.  An expert surgeon.

The Bad:  Needing revision (repeat) surgery.

The Ugly: The excruciating pain after my first shoulder surgery.  Sleeping sitting up on the couch.  Trying to take a shower after surgery (once cleared by the surgeon).

I did a lot of research before my first shoulder surgery.  I avoided a truly horrible surgeon, and selected one based on research and recommendations.  There was still a lot I didn’t know I didn’t know.  

Stay tuned for blog posts on how to select a specialist, such as a surgeon.  Knowledge is power.

 

Guest Post: Weight Loss One Year Later…

It’s been over a year since my first post sharing my experience of losing over 140 lbs and 40% of my body weight in 18 months, so Crew Dog and I felt it was time for an update.

Dave’s “before” photo

In the middle of my weight loss, I remember calling my family excited to share how much weight I had lost that week, only to get the response, “Let’s see if you keep it off.”  Ouch!  But I’ve been on many “diets” over the years and seen moderate success, only to have something happen, and the weight would come right back on plus more!

So what’s the tale of the scale?  Last Summer, I reached a low of 217 lbs.  This week I was on the scale… 217 lbs!  Easy peasy, right?!  Wrong!

While it generally takes 3-6 weeks to establish new habits, our bodies have what’s known as a set point for body chemistry. This set point is how our body regulates our body composition and prompts us for what we need.  When your weight and body composition remains at one place for an extended period of time, your set point resets.  You don’t have to think about what to eat, or how much, and your weight holds steady.  When your water and energy levels are low after exercise, your body sends signals that you are thirsty and need to drink fluids and your energy reserves are depleted so you get cravings for foods to quickly restore the set point.

After losing significant amounts of weight, studies have shown it can take upwards of a year for the set point to change.  This means a year after losing the weight, we need to stay focused until the new lifestyle becomes the norm.

So what happened to me over the past year? I reached the low point of 217 lbs just before leaving for our Summer vacation in 2016.  While I continued to follow the principles in general, I allowed myself to enjoy myself on holiday and was pleasantly surprised when I returned home that I only gained a few lbs (224 lbs).  Unfortunately, my more relaxed Summer vacation approach continued after vacation, and I had trouble getting back to the eating habits I was practicing before, but I only gained a few more lbs (230 lbs).

Then my wife and I went to Italy to celebrate our 25th Wedding Anniversary, and the relaxed habits continued and strengthened in la dolce vita, but I only gained a few lbs (235 lbs).  Now we are into Autumn, followed by Thanksgiving, Christmas and New Years.  By January 3rd, I was up to 245 lbs! (Although I might have intentionally skipped weighing myself a few days in there.)

Physically I was noticing the difference too, as my energy level was dropping and the sleep apnea was starting to come back.  I had stopped using a CPAP to sleep as I no longer needed it, but as my weight approached 250 lbs, I could feel the tightness in my throat and more difficulty breathing at night.

Enough is enough!  My body was trying to return to the original set point, and I had gotten out of the good habits which helped me lose weight the first time.  I knew what worked and just needed to apply it again.

I re-started, but changing my habits was more challenging than expected.  It was still too easy to add an extra serving on the plate or a late night treat while watching television.

I had also gotten so used to taking long walks that if I didn’t have time for a long walk, I wouldn’t go; so instead of walking 5-6 times a week, I was only walking once or twice.  When I started in 2015, I’d go even if only for 30-45 minutes.  After my annual physical, my doctor reminded me it’s more important to get out for short intervals on a regular basis than a long walk occasionally.

Back to basics for me!

I started doing again what I did in the beginning: focusing on my diet, getting regular exercise, and setting weekly goals.  I’ve now got myself back into the good habits, and the weight is coming off regularly en route to my goal of my old military weight of 210 lbs.

While I plan to enjoy the holidays and parties and will accept the occasional blip on the scale as a result, what I don’t want to see happen is the gradual increase week upon week.  “Only a few lbs,” is no longer acceptable!  I want to reach my goal and keep it there, and eventually be able to do so without really thinking about it.

I will keep you posted!

As always, if you have any questions or comments, feel free to email me at daveb.uk@hotmail.com. Good luck!

Dave after losing over 150 pounds

Follow up note – Since drafting this article in October, I have continued to lose weight and have since reached my goal of 210 lbs, reaching my military weight from 1994!  Now I’m into my weight maintenance mode, as I don’t intend to let it drift again like I did last year.

Crew Dog: Thanks, Dave, for reminding us that a healthy lifestyle is a lifelong commitment, and the path has ups and downs.  

Wishing everyone a Happy and Healthy New Year!

 

 

 

 

 

2018 New Year’s Resolutions

I’m not making any this year.  I’m not tempting fate.

I’d love to resolve not to have any surgeries this year, but we all know how *that* went last year.

So, if you’re planning on making New Year’s resolutions this year, I recommend this post by J. D. Roth about goal setting that leads to greater chances of success.

Wishing you a healthy 2018!

Eliminate BS: Holiday Card Edition

As a military family, we love Christmas cards [and Hanukkah cards, and Kwanzaa cards, and Festivus – whatever you want to send us!]  We have friends and family slung all over the globe, and it’s a great way to keep in touch.  We get pictures and letters and cards updating us on the events of our tribe’s lives.  [Even got a spreadsheet last year!]

Plus, once a year you have a great incentive to make sure you have the correct address for your nomadic acquaintances.

But, you know, what with all the *other* holiday activities, sometimes our cards didn’t get sent until the next summer – if at all.  When my health declined, the cards did not get sent for several years.  [Which means, if you’re not diligent, you start to lose touch with people who have moved, possibly several times, in the interim.]

So last year (2016), we were inspired by Mrs. Frugalwood’s example to send Christmas postcards.  Great idea!  Less time, less money, less effort.  We ordered and sent personalized postcards, with a custom photo, in December, and kept in touch with everyone.  Huzzah!

However.  This year (2017) things did not go as smoothly.

  • Write and design personalized Christmas postcards?  Check.
  • Upload custom photo for postcards?  Check.
  • Use Cyber Monday discount to get a good price?  Check.
  • Buy postcard stamps?  Check.
  • Receive postcards promptly?  Check
  • Review postcards to ensure no errors?  Check.
  • Sit down to address the cards and have allergic reaction to the ink that prevented completing the task?  Check.

Wait.  Say again?

Yup, you heard me correctly.  This year I had an allergic reaction to the postcards.  Same company as last year.  Don’t know why, except that I have become increasingly more sensitive to odors and fragrances ever since that “unfortunate incident” at the VA.  All I know is when I took the postcards back out of the package to address them, the smell was overwhelming.  I sat near one of our air purifiers and tried to get them done, but by the time I’d addressed 20 postcards I had a raging headache, couldn’t stop coughing and clearing my throat, had itchy, watery eyes, and was starting to itch on all of my exposed skin.  Time to abort this mission.

Spousal Unit will probably finish addressing the cards (most likely using computer printed address labels, thus limiting exposure to the cards), although they will definitely be late this year.

And then it looks like we’ll transition to e-mailed holidays greetings next year.  Even less expensive, although taking the same amount of time to write the message.  Better for the planet too.

A bit less fun than cards that can sit on the mantel (or wherever you display them) or pictures you can put on your fridge or bulletin board.

But a better option than being taken out of action for a day (or two, or three).

Bottom Line: Are the holidays stressing you out?  Costing too much?  Making you ill?  Eliminate the B.S.!  

Find ways to reduce stress, expenses, and, especially, expectations.  That might be sending postcards instead of traditional greeting cards.  It might be emailing photos and greetings instead of mailing them.  Or you might decide to call or video message or Skype/Facetime/etc. a few close friends and family instead.

Don’t lose sight of the big picture: celebrating your family’s holy days (if applicable), maintaining and sustaining relationships, and living a healthy, sustainable (in every sense of the word) lifestyle.

Most of the over-the-top Pinterest-y type stuff you see on the internet is just another way for the advertisers to part you from more of your money.  You don’t have to be a Grinch, but don’t be a chump either.

Decide, along with your significant other, what makes you happy at the holidays.  (Maybe give the kids a vote, maybe not.)  Examine why you do all the things you do: Tradition?  “We’ve always done it that way?”  The neighbors are doing it, so we have to compete/keep up?  Figure out what is essential to your health and happiness, and do only that.  As for the rest?

Take a deep breath, relax, and eliminate. 😉

Happy Holidays from Crew Dog & the gang at One Sick Vet.