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Posts Tagged ‘physical therapy’

It’s been six weeks since right shoulder surgery was performed in order to resect the acronomim and clavicle joint (AC joint) and remove rotator cuff tissue that was damaged by bone spurs. At a follow-up with the surgeon today, he indicated that patients tend to talk about still having pain but of a different quality. This is true for me in that the joint pain is much diminished but dull aches remain. He said this is primarily from healing bone and surrounding soft tissues. He cleared me for stepping physical therapy up from gentle stretches to strengthening exercises. Given my battle with RA, he said that recovery is likely to be longer than normal.

We then turned attention to my left shoulder as it’s been bothersome for quite some time as well. The surgeon gave a steroid injection into it about 8 weeks ago but there was only about a week of relief. He got an x-ray during the visit and discovered that there was acronomim bone rubbing on clavicle bone with no joint space visible. He attributed this to inflammatory arthritis (RA) and said that the cartilage between the bones was damaged but there were no large bone spurs visible. Like with the right shoulder, surgery would be needed to repair this joint and he suggested waiting at least three months after the other surgery. This would be good timing as my insurance out of pocket costs are met and will be until the end of June. We will schedule surgery at another follow-up appointment in six weeks.

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It’s been a little over six weeks since I had anterior cervical discectomy and fusion (ACDF) surgery. Two herniated discs between vertebrae C5-C7 were removed, bone spurs removed, artificial cages seeded with my own bone tissue inserted in the disc space, and the three vertebrae held together with screws and plates.

The good news is that the numbness and tingling in my fingers are almost completely gone. In addition, the shooting pain down my arms is also a thing of the past. This demonstrates that the pinched nerves were released. The symptoms from the compression of my spinal cord (stenosis), including hand clumsiness, are also gone. Muscle pain and stiffness in the neck and shoulders is much reduced but is still present – that will take some time to get better. I still take some muscle relaxants but have been able to reduce the dose over time and hope to stop taking those soon.

Due to the stress of the surgery put onto the esophagus, it was difficult to swallow food. But that has improved to the point of hardly being an issue. The vocal chords were also impacted and I easily lost my voice for the first few weeks but my voice is back to normal now.

photo (1)A six week follow-up with the neurosurgeon was today. It began with an x-ray of my neck – the first image I’ve seen of the handiwork since the procedure (see pic). It was very interesting to see the screws going into the bone and wondering if those things were actually inside my neck! The good news was that there is early evidence that the bone is fusing and hardware remains in place where it should be.

 

photoThe scar still looks rather gruesome and garners comments on a regular basis. But I can see a slow reduction in swelling and the original incision shows up as a thin, dark line (see pic). Like with other surgeries, the scar tissue is sensitive to the touch and based on advice from previous surgeon, I try to gently desensitize it by touching it on a regular basis.

I was cleared to for physical therapy and will begin that tomorrow. The purpose of the PT will be to strengthen the neck and arm muscles which have atrophied from the pinched nerves and lack of use over time. I was also cleared to engage in regular activities and lift objects within tolerance. The next follow-up appointment won’t be for six months at which time a CT scan will be done to check the bone fusion.

It’s been a difficult recovery given the nature of the procedure. The surgery set off a flare of rheumatoid arthritis symptoms which are starting to subside. It’s been a wild ride but just this past week I could finally say that I was glad for having the surgery.

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The last four days have been a grand time of celebrating our oldest son’s college graduation. It’s been a whirlwind of events including his senior engineering project presentation, three formal ceremonies of various sizes and durations, dinners, and a large party hosted at our house. This meant much physical activity around the yard and house the principal of which was 10 hours of smoking five large pork shoulders for 50 people (it was tasty and you should check out the website http://www.amazingribs.com/).

Tired_brown_bear_050701_01Going into this set of events, a nagging thought persisted…”I’m going to pay for this later.” Sure enough, by Sunday evening I could barely walk, my fingers were swollen and throbbing in pain, and sheer exhaustion washed over my body causing me to collapse. I knew that going to work Monday morning would not be possible.

Many argue that movement and exercise is critical medicine for arthritic joints stating that it relieves pain and stiffness (see these websites – Mayo Clinic, NCHPAD). In addition to potential positive impact on joints and muscles, exercise is obviously important for other reasons include cardiovascular and mental health. But my experience over the years has been that exercise and movement causes rebound pain and stiffness. Yet, I know that I’m missing out on the benefits of exercise.

It’s interesting to read some of the recommendations from medical websites. From WedMD…“Regular exercise can actually reduce overall pain from rheumatoid arthritis.” In my experience with RA, exercise always causes more pain. There are many times when I’ve had to stop movement because the pain got worse. WebMD also makes this statement, “Regular exercise improves functional ability and lets you do more for yourself.” This may be true for some but the functional ability of my ankles and Achilles tendons actually got worse after exercising. The tendons tore at a quicker rate and my orthopedic surgeon and physical therapist both recommended that I avoid any activity that puts stress on the tendons.

Can exercise actually be contraindicated for RA? Kelly Young at RA Warrior has an excellent series of posts about this topic. She concludes, “If you can, you should; if you can’t, you shouldn’t.” At the Health Central RA website, Dr. Borogini wrote a balanced article about the topic and makes an excellent suggestion which is in alignment with Kelly Young’s statement, Rest More When RA Is Active, Exercise More When It Is Not. The Johns Hopkins Arthritis Center website makes a great observation about movement and RA.

Acutely, resting of involved joints can assist with pain management and decrease the inflammation of the involved joint. However, the potential side effects of inactivity include decrease range of motion, loss of strength, altered joint-loading response, and decrease aerobic capacity.

This leaves those with active disease in a real quandary.

The conclusion that must be drawn from the recent set of weekend experiences is that my RA is not under control and I should probably avoid strenuous physical activity. But of course, I already knew that going into the weekend. The difficulty lies in the fact that life must go on and I was not about to miss this once-in-a-lifetime celebration. I just have to be ready to pay the consequences afterwards.

Creative Commons Photo Credit: http://commons.wikimedia.org/wiki/File:Tired_brown_bear_050701_01.JPG

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