Shoulder Op

So the other day they went ahead and cut some holes in my shoulder and shaved a little bone out in order to give it more space to move. (Arthroscopic subacromial decompression & ACJ excision arthoplasty -if you are interested)
So now I am ambling round in a painkiller haze and trying to force my poor body to do the physio – it is not co-operating.

Firstly, the wounds are still slightly oozy – apparently they inject extra fluid to make things easier to see (and I think anti-coagulants) which means that my dressings require careful attention. Also it turns out that instead of making my shoulder not hurt, codeine makes me sleepy, cranky, weepy and yet oddly emotionally detached from the pain.
The problem with the fact that I am still in pain is that every one of the 5 different exercises that I am supposed to do 4 times a day is a mental battle where every instinct tells me not to force my body that high up the pain scale and I am drained from the effort.

I have other things to do at the moment godsdammit!

That shoulder thing

My left shoulder started causing me trouble quite a while ago now… about three years ago I guess… and intermittently I try to do something about it.

About Aug/Sept last year I got myself another referral to physio (my 3rd I think) and a promise of some more attention. The local policy appears to be approximately 6 sessions of physiotherapy before they need something new.

This time we were able to make some progress on the underlying issues – above and beyond any basic hypermobility (which was not discussed) the possibility of impingement was raised for the first time (not sure why it wasn’t considered before).
Although I did have a course of acupuncture again, I found that the deep tissue massage and heat treatment were more effective for pain relief and for the first time the suggested strengthening exercises seemed to make a difference – although it was only at the end of the course of physio that they suggested a resistance band to work with.
I was pleased then that I was taking less painkillers and feeling less stiff but determined that this time I would not simply wait another year for another course of physio to prescribed when inevitably all my coping mechanisms broke down and delighted that the physiotherapist was in a position to refer me to a shoulder consultant.
Yup after 3 years I actually went to see someone who specialises in shoulders!

The clinic was clearly quite full of people; some having the rehabilitation after breakages examined, some with sports injuries and a few who probably had arthritis but all cranky and bemused by the self-assessment forms we had to fill in and all sat waiting in the over-hot, loud seating by a hospital cafe.
They sent me (and I think everyone) for an x-ray before letting us see the consultant. The only other time I have had an x-ray that hurt was when I broke my collarbone aged 12 & everything hurt – but putting my arm in that position hurts that is one of the reasons I was there! Then after a series of mobility and strength tests they also did an ultrasound and I was offered something approaching diagnosis.
I was rather troubled by the mobility tests – my range of motion is quite good (its not like the knee that just wouldn’t straighten) but a) that is largely down to extensive physiotherapy and regular exercise and b) it hurts.
I understand that they need to check whether there appears to be some kind of blockage etc but I wonder at what point I am supposed to say ‘please the more of these we do the worse it gets’, I didn’t get the impression that he heard me when I said yes I can get my arm into this position but in my daily life I would avoid it wholeheartedly because it really hurts. And yes, I know it was excruciatingly hot in there, but some of that sweat was from tension and pain.

Still, there was something visible in the ultrasound – I liked the ultrasound; the gel was cooling, the process was not painful and the machine looked pretty nifty. I would really have like to have seen the pictures though.
But, what the consultants could see were lesions from an impingement (which sounds like they are infectious – they aren’t) and what it means is that the bones are essentially rubbing together – hence physio is supposed to strengthen the muscles which hold them apart. They sent me a letter with the technical details which in theory tell a Dr which bits are causing the trouble but didn’t entirely help me work out quite what my shoulder was doing to itself even with the wonders of Google.

So after several hours of waiting and prodding and poking I was offered some ways forward. The plan went as follows: a steroid injection, more physio, a check-up a couple of months down the line, and then possibly another steroid injection and possibly surgery or both…

Steroid injections hurt!

Actually I might stress that some more they really really hurt! According to my letter, there was anaesthetic in the mix as well as the steroids which might explain why I was able to walk home but were definitely not noticeable enough.  [Warning: do not read this next paragraph if you are squeamish about needles]
Part of the problem is that when you stick a needle into a joint you can feel it go in and then you can feel it move around. It honestly felt like it was grinding. I am not a wimp, I am ok with giving blood and getting injections generally, I am used to being in pain but this pain was enough to make me think I was going to pass out. The nurse brought me water and I sat with my head down for ten minutes or so – waiting I guess for the anaesthetic to kick in – at which point the consultant checked I could move my arm (and yes moving it over my shoulder was at that point easier) and sent me home.
Gradually, the stiffness set in. I definitely had a steroid flare up and co-codamol was not touching it. By the following morning I couldn’t raise my arm at all, I could only dress myself in small stages to recover from the intense pain, I couldn’t carry anything, I couldn’t even sit quietly without pain. I was a mess.
Still this too passed and two days later the pain had subsided enough for me to feel normal again. I’d like to think that the following two weeks were noticeably better in terms of ease of pain-free movement but I’m not convinced. To be brutally honest they are going to have to offer me some better improvement than that to make the injection worth going through again… As I type the shoulder is aching and complaining and I am still waiting for the referral for more physio to be acted on.
Sigh.

 

Beer Festival 2013

Another year another CAMRA beer festival
A somewhat rearranged and controversial affair this year, it was at least blessed with some sunshine.

For me though it was mostly a reminder that I am older and more broken than I once was.
It seems rather frighteningly that I have been volunteering at this festival for almost ten years. I have done my time at the bar, sat behind membership and at products (kind of a CAMRA gift stall that also does soft drinks); I have run backwards and forwards on traditional pub games, shouting and hustling for all I was worth; I have hefted scaffolding, built bars and lugged firkins; I have worked for a number of years on the cellar team and for plenty of that time I have also worked at the pub.
Double shifts are exhausting.
Somehow every year I forget just how exhausting.

The last couple of years have really taken their toll on me. The new type of breakdown and subsequent anti-depressants reduced the amount of exercise I was taking and helped me pile on the weight [In the c. 4 months I took Mirtazapine I put on over a stone & the same in the 6 months I took prozac before that]. Worse, the last 2 and a half (plus) years of shoulder pain and 9 months of knee issues have left me constantly exhausted and unable to do a fair number of my normal activities.

Some days I notice how much movement, strength and energy I have lost.
It hurts.
Physically and Mentally.

 

 

 

On a related but very different note – I think I get more pissed off every year at the self-righteousness of CAMRA members and volunteers about how much better They could run the festival.

 

Pain is not good for Concentration

These last few days (4 or 5) I’ve been feeling somewhat under the weather.
Headaches, nausea, dizziness and basic malaise – not enough to send me to bed or the Dr. just enough to make me into a whiny sod. I have footled about on the thesis, moped and cried a bit and generally not been very productive.

But once or twice it slipped over into real pain and utter failure to work. I Hurt. Wrist, knee, hips.. My shoulder has been doing a burning, stabbing agony type thing. Not so that I can’t move my hand or type, just enough that it hurts all the time and I can’t move my head without wincing. Although, ironically, it seems to be better in the pub and hasn’t yet stopped me hefting firkins or pulling pints but tends instead to sieze up when I sit down to write or try and sleep.
B tells me it is because I haven’t been using my proper chair and laptop stand… (Don’t tell him but there may be some truth in that) I however am firmly of the opinion that I am suffering an acute psychosomatic stress reaction.
I feel like shit because I am worried about my thesis and I have an excuse for not doing much on my thesis because I feel like shit – sounds like a perfectly plausible self-fulfilling prophecy and one step up from laziness. Fact remains though it is really difficult to concentrate when you hurt

But my bed is really comfortable..

After the house and the wedding rings the bed (incl. mattress) is the most expensive thing my wife and I own – it cost more than the pretty much all the rest of the furniture put together – it is a comfortable bed. So why the hell can’t I find a way to lie that doesn’t hurt?

When my shoulder is hurting during the day I can rest it or stretch it or even distract myself and basically ignore it- its only pain after all.
But at night when what I want is to sleep..have I mentioned I like sleeping? hell that I need to sleep quite a lot or else my psychological grip on myself vanishes… when I want to sleep the pain becomes almost unbearable.

I like to sleep on my side, curled semi-foetal safe, or alternatively to lie half on my fron with my arms under my pillow supporting my head, stretched out recovery-position style – but both are impossible for more than a few minutes. I love to lie spooning with my darling wife, arm draped over her body protectively or vice-versa – forget it.
Lying flat on my back is the only option. And woe betide if the pillows aren’t even because that way a crick in the neck shooting down arm and spine follows. Trouble is I find it uncomfortable in my head, it seems somehow wrong to lie flat like a corpse; plus if I put my hands on my belly they go numb and before the night is out my knees will start to hurt..

So first I toss and turn, determined tonight will be different and I will find a new position or perhaps that old favourites will have somehow ceased to be a problem. Eventually I settle on my back and begin the mindfulness exercises that help me breathe through the pain and accept it. I drift off. For a couple of hours, maybe a full 4 hour cycle, before bam! awake in pain and now stiff from lying still. I get up, go for a pee, stretch, lie down and try the same process as before. Usually I drift off faster and wake up faster this time before repeating (although usually without another pee) so that I barely notice that I have slept and it feels like one long stretch of not quite dozing. Around this time I start to think about whether fetching painkillers is a good idea but I don’t want to be codeine dependent and I usually reject the plan. Finally my wife’s alarm goes off and for half an hour nothing matters more than feeling her body next to mine as we doze. Then she gets up, we chat for quarter to half an hour (depending on how grumpy I feel) and she leaves the house. If I am not also due to head to work I contemplate the options..
If it has been a good night 2 uninterrupted hours at this point should be enough to face the day; I probably don’t fetch painkillers but might pee again and move around to stretch. If on the other hand I have woken not twice but 3 or 4 or 5 times it might be four hours before I can face getting out of bed and pain-relief is a must.

So what helps?
The most important is warmth. It sems daft to me, I’m usually pretty toasty in bed I even get night sweats when I have PMT but the shoulder is one of those regions that is often exposed outside the comfort of both duvet and basic core body temp regulation which means if you keep the room cool (as I and all anti-insomnia recommendations suggest) it can get cold and stiff fast.
Second for me is anti-inflammatory gel which is safe for use at night, non-addictive and not (to the best of my knowledge and GPs comments) contraindicated with my meds.
Finally not pressuring myself, especially to either stay in bed or to get up at a set time and therefore fretting if I can’t face it, but also really working on the mind stilling and meditative practices that stop the whirring thoughts.

I really like sleeping but..

Glad to be Post-Grad

Or perhaps more specifically happy that I’m not an undergraduate any more.

Three days of lectures has absolutely ruined by shoulders and back. I’m sure that the train journeys haven’t helped but what I’ve noticed is the fact that my body just can’t cope with sitting writing notes in a lecture theatre for long periods of time any more. By the time we had finished 2 twenty minute papers plus questions I was desperate to move around and squirmed all through the 3rd. By the end of each day I was stiff and aching from neck to hip, hot showers are good but there is a limit to how much co-codamol it is safe to take!

So anyway I’m glad that I make my own schedule for studying and that I go to conferences out of genuine interest and not day after day all term – just a week would be enough to reduce me to tears. Also the idea of sitting in an exam hall for three hours – well it wouldn’t matter if it was the easiest paper in the world if I had to be there the whole time I would fail simply because the pain would burn through me, distract me, and eventually make it impossible to keep writing. I have nothing but respect for people fighting those internal battles to get their degrees or keep their jobs. Good Luck all

Shoulder

I would love to be able to say that I injured it, or had something specific to blame for the way it feels but sometimes we just have to acknowledge our body has let us down.

The official verdict is a loose joint (hypermobility). Like my wrists (which I have also had my share of pain and trouble from) apparently I have more ability to stretch my shoulder than is strictly normal. When I was younger and fitter the muscles in my back and around my shoulder supported it more firmly but apparently stopping my regular cellar activities etc meant that it became unstable. Now it cracks and slips for the fun of it.

Some days its not so bad, some days I don’t even notice – mostly though its just a dull nagging ache where certain movements make me wince. Some days though I feel the burn across my back and a clunk in my shoulder each time I move. Some days the painkillers don’t touch the pain and I just grit my teeth hour after hour.

Too often, even on the good days, when I lie down to sleep all I can feel is the pain. One side or another compresses or allows the shoulder to slump in a difficult way; on my front either the tilt of my neck is wrong or my arm above my head aches and on my back I can feel the stiffness setting in. Worse than this is sitting on the sofa or in front of my laptop  Рsitting upright with no support is agonising РI can longer work for more than 20 mins before the pain is too distracting. Sigh.

I hate that my body hurts but until I can get the discipline to do the exercises to strengthen the muscles everyday and go swimming once a week I can’t complain. Its also worth noting that I don’t always take as much as of the painkillers as I could out of fear of addiction and dependence. I have to decide whether 2 lots of naproxen per day plus co-codamol is what I want…