And the Physiotherapist said …

Today I woke early, after a little bit of a restless night. As soon as my eyes were unglued and my neck was unkinked, and my brain was firing on at least three cylinders, I was aware of a tiny tadlet of apprehension.

You see, today was the day for the first physiotherapist appointment following my rotator cuff repair.

For those of you who have never gone through rehab following surgery, I can tell you that it bloody hurts. To illustrate this, here’s an excerpt from a post I did three months after my last rotator cuff repair:

“So far, the exercises have been aimed at gently mobilising the shoulder joint and easing the stiffened muscles and tendons.  I had gentle circles to make, pointing towards the floor.  I had passive lifts (which did indeed hurt OH almost as much as they hurt me), and I had tentative self-powered lifts – raising my arm up to the front and the side, shoulder hitches, elbow rotations – and yes, they were painful too, but at least the instruction was to stop as soon as it hurt and not push it.

Now this sadist health professional has me sliding pieces of paper up the wall which is not only agony on the shoulder, but the elbow too, for some reason.  He showed me how to do it, then watched solemnly as I had a go.

‘Is that as far as you can reach?’ he said, with the vaguest hint of disappointment. ‘No, no, that’s fine.  Really.  You’re doing well!’

Sure.  Sure it is.

Sure I am.

‘Oh well,’ I thought. ‘If that’s the worst, I guess I can manage that.’

But then he led me into the gym.  He hooked me up to a pulley, so that I could use my left hand to pull my right hand upwards.  A sort of self-assisted passive lift, if there is such a thing.

‘Aaaaaaaaaaagghhh!’  I said, with great restraint.

‘Good!’ he said, beaming.”

And that’s what they’re like – they cheerfully ask you to do things which are extremely painful, and then they grin at you when you yell1.

So you’ll no doubt be relieved to hear that today’s physio session went really rather well! I was fetched from the waiting area by a diminutive young lady with dimples whose name was “M”. She looked about seventeen, and told us that while her origins were Italian, she herself was Portugese2. She took me to her little room, dimpled at me, and filled in her questionnaire. She had a look at my healing wounds and pronounced that they looked very nice3, and asked me to take my arm out of its sling.

Then she picked up a metal crutch and advanced upon me, whereupon the torture scenes from various movies flashed before my startled eyes.

In fact, all she wanted to do was to get me to hold it horizontally in front of me using both hands, to test my range of motion. To say I was apprehensive was an understatement, because for the entire fortnight since the op I’d been forbidden to remove the sling night or day except for washing, dressing, etc, and I’ve been firmly admonished to make sure it was supported either by the sling or by my other hand at all times. It felt very odd to allow my arm to hang loose from the shoulder for the first time.

But here’s the exciting thing: using my right hand to actually move the crutch (my left arm being a mere passenger at the other end) I was able to raise my arm up in front of me, out to the side, and even behind me to about a thirty degree angle – and it wasn’t agonising! This was quite startling, because I distinctly remember, back in 2009, turning the air blue when A was assisting me with some very gentle exercises in the early days of my recovery, and tears leaking from my eyes with the pain.

The difference – apart from the nine intervening years4 – is perhaps that the repair on my other arm was open (resulting in a two and a half inch scar across the top of my shoulder) and this one was done arthroscopically. Last time, my upper arm was black and blue (and green and yellow), and this time, it was not.

And this time, I’d already done six months of physiotherapy before I had the surgery, working on strenghtening my deltoids.

Whatever the reason, it came as a big relief to learn that I’m already in a better place after only two weeks than I could ever have imagined.

Still a long way to go, of course, but I’m going in the right direction, and this time, I seem to have picked up a faster ride!

1 They really like it when you yell. I can only assume they think it means that you’re really trying.

2 For some reason, many of the physiotherapists here are very large and gung-ho Australians, so she came as a little bit of a relief. Although it somehow didn’t feel right to be at the mercy of a dainty young thing like M from Portugal.

3 A matter of opinion.

4 The surgery was at the end of 2008 so it’s nine years, and of course, surgical techniques may well have improved during that time.

Well, Poot!

Sky-RaspberryLime-AtMorguefile

‘Poot’ being a polite way of saying what I screamed to the unfeeling skies late on Thursday afternoon when I tripped up a little step in the garden, fell awkwardly, and dislocated my shoulder.

There was the inevitable moment of flight, the sudden intervention of gravity, and then I was aware that my outstretched hand had somehow hit the ground wrong and it was taking my rigid left arm forward at an angle which boded No Good At All1. I am no svelte young thing, so when my torso weighed in at the moment of impact, there was an ominous crunching and tearing sound which reminded me of 500 giant cows all ripping up a section of lush meadow grass at the same time. I knew then that Something Bad had happened.

Instinctively, I rolled onto my back, and was informed by my entire nervous system that the Something Bad was extraordinarily painful, and, having managed to completely immobilise my arm, was settling in for the long haul. There was no way I could bring my arm close enough to my body to attempt to get up. I tried grabbing it with my right hand and gently easing it over (Oh fuuuuuuuu …. cckkkk, that hurts!), and I tried inching my body around to meet it (“GAAAAAHHHH! No-no-no, that’s worse!) and in this I was hampered by the presence of a narrow flowerbed bordering my garage wall. I was on my back with my arm stretched out sideways at 90 degrees and I could not move. It was a dead weight – albeit a painful one.

I don’t know if any of you have ever dislocated a shoulder. I am told that it’s one of the most painful of dislocations because an awful lot of very large muscles keep your shoulder in place and when it is out of place, they go into spasm to let you know that Something is Wrong and needs fixing, and it needs fixing now. But they don’t do it all at once – oh no. Over time, they gradually increase their grip and so, just as you are getting to grips with one level of pain, they ramp it up and make you cry again2. I don’t like opiates, but after two hours lying there waiting for an ambulance and in screaming agony, I was thinking extremely friendly thoughts indeed about them.

By the time the paramedic got to me, I’d been laying on rapidly chilling concrete for two and a half hours. My pain level had passed my previous worst a long time ago, and seemed to me to be hovering around a 12 on the 1-10 Chart of Degrees of Pain. This may, to be fair, have something to do with the fact that I have fibromyalgia, which helpfully amplifies any pain signals going around and adds a few extras of its own, but as I said, shoulder dislocations have quite the reputation.

Obviously, people at risk of dying from cardiac arrest, bleeding, poisoning, burns, or any other critical condition are going to take precedence, also small children and the frail elderly – and damn right, so they should. After all, I was only suffering extreme pain and some non-life-threatening damage. But I wonder if those idiots who call 999 for a non-urgent problem think – really think – about the consequences? You see, what happens is that when a true emergency call comes in, there literally may not be an ambulance at the station to send out to it. They have to wait for one to come back in, complete any paperwork (I assume? There’s always paperwork …) and then send it out to the next on the list.

Should I complain about the delay. I am undecided. I fell at around 4.30pm, the first paramedic came at about 7pm, was brilliant and very quickly gave me that blessed morphine. He had then to wait for the grown-up ambulance and a second guy to actually get me off the ground after air-splinting my arm, which they did so gently and efficiently and with the help of Entonox (wonderful stuff), and I was transorted to A&E where I had another wait for x-rays before the dislocation was finally reduced at somwhere around 11pm. That’s seven hours3.

But.

There was apparently ‘high demand’ for the ambulance service that evening. There were a lot of other people in A&E that night, all needing treatment, some of them critical, some of them merely in worse case than me, and all hoping that they would be next in for treatment. The nurses were brilliant, the radiographer and the doctor efficient and kind, everyone endlessly patient. They were all doing their best. On the one hand, I am extremely grateful that we have a freely available and free-to-use NHS. I won’t be getting any bills, there won’t be an insurance claim (unless I bent my sunglasses) and I certainly won’t have to remortgage the house. On the other hand, it is a hell of a long time for an over-60-year-old to lie on the ground in pain, getting freezing cold and both busting for a pee and desperate for a drink. And the sling they gave me to keep my shoulder still is complete crap and flat out does not work.

But hopefully, those on the critical list who also rode to hospital in an ambulance on Thursday will have been treated much more promptly, and with a bit of luck and the skill of those wonderful healthcare professionals are now doing OK.

1 – Yes, I know I’m supposed to fold and roll, but I failed, OK?

2 – And scream and swear and roundly curse all of those stupid, selfish people who have ever called an ambulance for a bruised knee, because they’ve been sick for a week and now the doctor’s is shut, because they think they might have been bitten by a spider, or simple to save the taxi fare or to make a point.

3 – What was the first thing I was taught about dislocations when I did my veterinary nurse’s training? The sooner a joint is put back into place, the more likely it is to be successful. Ah, well.

Anatomy for Shoppers

AnatomyMorguefile

Today we went shopping for a few things in town. We visited the new Waitrose, a huge superstore-type supermarket in all its pristine glory. The following conversation took place on the way home:

OH: ‘Trouble with Waitrose is that they don’t make a granary loaf.1

Me: ‘Are you sure? Have you asked them at the bakery? They may call it something else .. ‘

OH: ‘No, they don’t do one. They do artisan bread, though.’

*Pause*

OH: ‘The French bowel is good.’

Me (a tad startled by the change of subject): ‘The French bowel??’

OH: ‘Yes, you know, it’s sort of round and flat.’

Me: ‘What?’

OH: ‘It’s all soft and spongy when it’s fresh, but the next day it begins to go a little more solid and it really lasts well. You might like it.’

Me: ‘Uh … I might?’

OH: ‘Yes – I think it’s long fermentation. You know, it’s like a big crusty roll, sort of thing.’

BreadMorguefile copy

Me: ‘Oh, the French boule! Cos, you know, bowels are sort of round and … uh … long, not round and flat.’

OH: ‘I wouldn’t know.’

Me: ‘You don’t know what shape a bowel is?’

OH: ‘No, and I have no wish to know!’

*Pause*

OH: ‘Anyway, I thought you pronounced it ‘boolay‘.’

Me: ‘No, only if there’s an accent on the end. Otherwise it’s ‘bool‘.’

*Pause*

OH: ‘I knew really, you know. I’m just making fun of the pronunciation.’

*Pause*

OH: ‘Their rustic pains are really good, too.’

Me: ‘That’s rustic ‘pan‘ with a kind of soft ‘n’, not … ‘

I caught sight of a suspicion of a smirk at the corner of his mouth.

Me: ‘Oh, never mind!’

And as usual, laughter ensued, which is good for all that ails you. Bowels or not3.

1 The thing about OH and I is that we have totally different tastes in bread. He likes horrible, squishy, doughy stuff made in the Chorleywood manner, and my digestion won’t cope with it and prefers long-fermentation bread made with a lot less yeast. I also can’t deal with malted flour, which makes me itchy. Granary loaves are full of malted flour so I don’t eat them. OH really likes them .. but not the sort which are like wholemeal bread with a few seeds stuck to the outside. Those aren’t ‘real’ granary bread.

2 What supermarkets call ‘long fermentation’ isn’t really very long at all. Anything over one hour is ‘long fermentation’ to them, but true long fermentation is somewhere around 12 hours and can be even longer. This improves digestibility, and raises the bread’s glycaemic index. All good, huh?

3 OK, I concede that in some specialised cases, laughter might not, in fact, be good for the bowels.