Category Archives: shoulder surgery

2nd Day Post Op — Shoulder Surgery

Here we are still in the now familiar role of trying to find an appropriate combination of drugs to fight pain for an appropriate amount of time. Oxymorphone, Lyrica, Ativan, Percocet, Tylenol, Morphine… the list goes on… how much, how often… still no answers. The Anesthesia Pain team, Aida and company, have been working hard to get things under control but just like a trial and error experiment, medicine is given, there is a delay until it takes effect and then it is monitored to see its efficacy and its duration. With long-acting and shorter-acting drugs in her already, it is difficult to separate out the performance of each drug independently yet this is one of the determinants as to whether or not we go home tomorrow (Friday Oct 10th).

Dr. John Healey stopped in to see us before he begins a trip tomorrow to attend a conference in Chicago. He prescribed a series of exercises to keep Debbi’s left elbow in good working order and to make sure it does not stiffen by staying stationary in the sling day after day. Dr. Healey had to detach the deltoid muscle from the collarbone in order to repair the space between the base of the coracoid process and the glenoid following which he reattached the deltoid. Therefore Dr. Healey cautioned Debbi to use her arm for certain exercises but to be careful to avoid all actions for which the deltoid would be called upon to counteract gravity. One exercise involves leaning over and letting her left arm trace out circles as it dangles by her side. Not allowed would be raising her left elbow in front of her until her upper arm is parallel to the floor. To help her visualize the various permitted and restricted activities, an occupational therapist came by with a helpful set of exercises and illustrations.

Despite the frustrations, Debbi is making progress. She gets in and out of bed with fluid motions… “runs” laps around the floor… everything goes well until the pain breaks through. Then …. WATCH OUT!!. One thing better about being home is that when Debbi wants a pill she can take it right away. Here she has to wait for the nurse (who very well might be attending to the needs of other patients), the nurse has to check the computer to make sure that Debbi is due for whatever medication, request the drugs from the pharmacy, collect the drugs, and bring them to Debbi. Now, knowing Debbi, is it any surprise that she has her entire pharmacy from home with her here in the hospital. Yet, any even slight hint that she might reach into her purse and take one of her own pills (self-medication) draws the nastiest gnarls from whomever happens to hear her remark. And with good measure. Debbi can be doing something (like eating or drinking) and then pass out for a 20 minute nap. Imagine if she took her own Oxycondone and then awoke to a nurse’s request for her to take a second one. Anyway, I think Debbi is just using the back-up drugs as a threat such as the following: “If they don’t get here in 30 minutes with my meds, I am just going to take my own!” The nurses have always arrived in time. Whether or not the drugs actually work is another matter.

Throughout the chemo, Debbi lost a very small amount of hair. During this hospital stay it has become apparent, basically due to the linoleum floor, that she seems to be losing small clumps of say 10-15 hairs at a time. She still has a very respectable pony tail and a quite full head of hair but it seems that after some two months post-chemo… some hair is starting to fall out.

Our thoughts are now centered on reviewing the steps to be discharged tomorrow. Dr. Healey enumerated 4 key items as the determining factors. (1) Be able to be weaned from the IV pain medication. (2) No fever in 24 hours. (3) Removal of the surgical drain from the incision. (4) Pain treated by oral medication.

Debbi has not been receiving pain meds via the IV for over 12 hours so #1 is satisfied. 7pm-8pm has been the witching hour since the chemo began. Like the Bermuda Triangle, in this hour anything can happen. Most trips to Urgent Care began in this time slot. Yesterday, Debbi’s temperature in the witching hour was 100.1 which qualifies here as fever. Today however, her temperature was 98.6 so if all stays stable we may have satisfied #2. This morning, one of Dr. Healey’s fellows came by and adjusted her drain saying he would be back Friday morning to remove it so we should be good on #3 as well. That leaves #4 which as I have described, in probably monotonous detail, is the $64 question. Will the pain be under management such that Debbi can be sent home with a suitable plan to control her discomfort?

Stay tuned for another episode of Debbi’s Journey to find out.

1st Day Post Op Shoulder Surgery

Although she says she is in considerable pain, Debbi does admit that she is feeling better. Partially this is due to having to battle only the pain caused by the surgery unlike the kidney surgery from which she had to recover and battle the then extant pain in her shoulder. Dr. Healey stopped by this morning and the Pain Team is supposed to be revising her medication from Fentanyl to the oxycondone/percocet/ativan that she has been taking all along.

So, the process over the next few days will probably advance slowly but we have every confidence that it will be moving forward. Hopefully Debbi will be able to blog a little later in the day.

Shoulder Surgery — Update #2

It is now 4pm. Debbi has been in the recovery room for about an hour. I was able to visit her once thus far and while she mentioned that she was in pain, I could tell that she was very happy when I reiterated the conversation I had had with Dr. Healey a few minutes earlier. Dr. Healey said that all went very well. He observed, in actuality, only what the scans and x-rays indicated. His surgery lasted about 3 hours (not including time spent by the anesthesiologist prior to Dr. Healey’s initial incision.)

Dr. Healey’s summary of the operation was exactly as he had described it to Debbi and I over the course of our earlier visits to his office. Move a muscle or two. Grind out the cancer from the juncture of the coracoid process and the glenoid. Freeze out any remaining cancer along the margins using liquid nitrogen. Use a pin or two along with some bone cement to put the shoulder back together while always being careful to preserve nerves and operational functionality. Then just close everything up leaving a drain for good measure. So simple… even a caveman could do it. OOPS… that is what they say in the GEICO ads.

“What happens from here?” was the next question I posed to Dr. Healey. He said the following:

Remember Jan, you have a team of top people on Debbi’s side. Let’s let her recover from the operation and then Drs. Zelefsky, Bajorin, Russo, and I will confer and probably Dr. Bajorin will then take the lead on a round of scans to evaluate where we stand at this point. I truly think all went very well and I am hoping and praying to G-d that she is now indeed cancer free.

In my book, you can’t get much better than that.

I am hanging out in the waiting room because I want Debbi to rest for a few hours and to receive the instant attention that only the recovery room staff can provide.

People here at MSKCC always amaze me. A nurse named Josefa Walten, who assisted us prior to the KIDNEY surgery two weeks ago, just came to find me in the waiting room to ask how Debbi was doing. She had seen Debbi’s name on the surgery schedule and wanted to make sure I would let Debbi know that she was thinking of her and wanted to send a special hug and kiss along with her love to my dear wife.

Also, as I was proceeding to the recovery room to see Debbi, I was in the elevator with a nurse practicioner named Aida Milcetic. Aida is a key member of the Pain Team and played an special role in figuring out that Debbi was not getting the proper dosage of Fentanyl during our previous stay. I introduced myself to Aida and expressed gratitude for her assistance during our last visit. Not being timid, I asked Aida to accompany me to see Debbi and asked to have Debbi’s name added to the list for which the Pain Team makes special rounds. Aida informed me that she will be working daytime hours for the rest of the week and will make sure to monitor the pain situation and stop in on Debbi each day.

It sure is helpful to get to know the individuals that are most responsible for the superior care here at Sloan Kettering. One never knows when their help will be useful and appreciated in the future and addressing these stellar individuals by name seems to go quite a long way.

Shoulder Surgery — October 7th, 2008

Hello sports fans… this has been a season of lasts… last Yankee game at the House that Ruth built, last Mets game at Shea, and we are hoping that this will be Debbi’s last operation at MSKCC.

We arrived at 7:45am and were ushered into the pre-surgical suite for gowning, another check of vital signs, and a review of medical history. We were visited by Dr John (who would not tell us his last name) during our stay for the nephrectomy. This time, we twisted his arm and he told us that if we say “papa nice to see you” we would be very close to the pronunciation of Papanisstociu. Dr John brought his unique sense of humor and wide smile to cheer up Debbi and give her encouragement for the operation. He carefully marked her left shoulder so that there would not be any mixups in the OR. Shortly thereafter, a nurse came to escort Debbi to the surgical suites. Hugs and Kisses and she was off.

I expect the operation to take about 3 hours so I hope to update everyone around 1pm.

Stay tuned.